Hospital investment increases, PE abandons the big and pursues the small and prefers private special hospital

2014-03-19 source: domestic PE in securities times generally avoids public hospitals and comprehensive private hospitals that are hard to improve by burning money, preferring private specialized hospitals The investment in the pharmaceutical industry is in full swing, while the investment in the hospital system is in two directions It is very difficult for PE with non-state background to enter the public medical system However, the investment in comprehensive private hospitals is too long and the funds cannot be consumed At present, specialized and small private specialized hospitals have become the pet of PE Institutions Investment hospitals are very hot, but the public hospitals with the most prominent contradiction between supply and demand are rarely visited by PE Institutions "On the one hand, it's difficult for social capital to control high-quality public medical resources Previously, a prefecture level city in the North wanted to sell part of the equity of a local top three hospital for a price of 4 billion yuan, but it's difficult for non-state-owned funds to participate in the investment of such high-quality medical resources On the other hand, it is very difficult for public hospitals to reform and make profits " A PE director with a non-state background admitted that most PE institutions would not choose to invest in public hospitals Liu Yimin, vice president of another non-state-owned PE colleague Chuangwei, has deep experience "The non-profit nature of public hospitals means that they can't pay dividends, and the general social capital can't be consumed." Liu Yimin said: "the investment threshold of public hospitals, especially the top three hospitals, is high, which is often billions, with a long investment cycle, generally more than ten years Most importantly, the exit path and profit model of investing in public hospitals are not clear at present So at present, PE institutions generally choose to invest in private specialized hospitals " As for private general hospitals, the aforementioned PE director also said that compared with public general hospitals, such hospitals have fewer resources, longer investment cycle and less PE capital For this reason, the reporter of the securities times paid attention to the relevant investment cases of PE Institutions on hospitals in recent years As the above insiders said, unlike the full flowering of capital in the pharmaceutical industry, PE Most of the investment cases of the institutions are concentrated in some private specialized hospitals and high-end medical institutions, while the public hospitals and private comprehensive hospitals with similar scale are obviously avoided Dual concerns affect capital into 2014, and the hot of hospital system M & A is further heating up According to incomplete statistics, at the beginning of 2014, investment transactions in the field of medical services were rare and frequent: in January, angel, a high-end maternity hospital, announced to obtain round B investment from Sequoia Capital; in February, Hengkang medical announced to acquire 100% equity of Qionglai Welfare Hospital, and Fosun Pharmaceutical's subsidiaries planned to join hands with TPG for no more than 193 million US dollars and 315.71 billion US dollars In March, Founder Group announced that it would invest 3 billion yuan in two top three hospitals in Guiyang However, behind the frequent M & A, there are many concerns about the investment of PE or other funds in large comprehensive hospitals First, it is difficult to invest, manage and exit Xu Zhipeng, senior analyst of Qingke Research Center, believes that public hospitals belong to an institution under the current national policy The distribution of benefits in hospitals is complex, and the leakage is very serious Hospitals are not unable to earn money, but under the current system, hospital operators do not want to make money, as long as they can be equal every year Xu Zhipeng said frankly that if you invest in such an institution, if you don't hold a controlling stake and don't participate in the operation, the money you invest in is equal to the money you lose If you want to hold shares, the capital is often billions, which is too high for most investment institutions Moreover, the non-profit nature of public hospitals determines that there are difficulties in making profits, so VC and PE institutions are more difficult to withdraw funds "Whether we can hold a stake is another difficulty Even if it can hold shares and reorganize its operation, the investment return period will be five years or even more than ten years, which is also hard for market-oriented investment institutions to afford " In addition, when investing in or acquiring public hospitals, local people will think that the government is "selling hospitals", which has potential social resistance, Xu said The above-mentioned non-state-owned PE director who did not want to be named said that high-quality public hospital resources are difficult to be taken down by general social capital, and are generally obtained by large-scale state-owned group companies or hospital management groups with very strong strength "At present, it is also such institutions that can make some achievements in investing in public hospitals, such as Founder group, China Resources medical, Phoenix medical, etc these institutions have strong capital strength The purpose of investing in hospitals is mainly to integrate industrial chain resources, and to produce effective benefits through the agglomeration effect of resources, so the hospital's own profits will not be put in the first place." He said On the issue that social capital is difficult to enter the public hospital system, Xu Zhipeng is more direct He believes that the pressure from local governments, health, social security and other departments makes it difficult for PE Institutions to control high-quality public medical resources; secondly, the pressure from the management and doctors of public hospitals, private capital holding is more than one supervisor for the management of hospitals, and for medical students, it is a matter of staffing, welfare and other issues Second, a large-scale comprehensive private hospital is a deep pit where money is hard to improve In a sense, it is also a good choice for social capital to invest in new private general hospitals of similar scale to public hospitals, but PE is ordered The dilemma is that the medical system is not fully market-oriented, and there is a big gap between private hospitals and public hospitals in access to medical resources, which makes it extremely difficult for social capital to support a private hospital to grow up and compete with public hospitals Wang Qiwen, partner of cornerstone investment management, said that at present, the status of private hospitals and public hospitals in access to medical resources is not the same, such as land allocation, medical insurance and social security, promotion of doctors' titles, etc., which are too far behind Therefore, the risk of investment in private comprehensive hospitals is too high to compete with public hospitals Liu Yimin also expressed the same view He said that investing in such a large-scale hospital, just like building a university, requires long-term investment The more resources and time are available, the more precipitation can be achieved, and then fame and brand can be made However, in the early stage of private hospitals, it is difficult to gather these medical resources, and the amount of comprehensive medical investment is very high, generally hundreds of millions of yuan, so the revenue of hospitals is very difficult to balance with the expenditure, so the liabilities of such hospitals are very high, the capital pressure is very big, and few of them are successful Some insiders pointed out that at present, there are few successful cases of more comprehensive private hospitals, such as Huizhou Union Hospital, Nanchang Zhonghuan hospital and Shenzhen Longzhu hospital The investment amount is very large, but the effect is not good, because the resources of the government and doctors are very difficult to reach the target Of course, there are a few more successful examples "For example, united family has always been positioned in the high-end medical market There are also some hospitals invested by international giants in some cities in China, which are of a charitable nature The purpose of investment is mainly to improve the image of the enterprise Because such hospitals are generally all self owned funds, the pressure on funds is not strong and they can be consumed in the long run." Liu Yimin said Liu Yimin said that although the threshold for social capital to enter the medical system has been clearly opened last year, the actual implementation of policies in different regions is not the same, and many details are difficult to be implemented, such as doctors' multi-point practice, and ordinary PE Institutions dare not touch it Although there are many difficulties in institutional "curve" layout, there are also non-state-owned PE trying to invest in general hospitals Its model is similar to Industrial Fund - Layout in the industrial chain in advance Liu Yimin, vice president of Tongchuang Weiye, told reporters: "we have invested in Shanghai Renji Hospital Management Co., Ltd (not directly invested in Renji Hospital), which takes Renji Hospital Affiliated to Shanghai Jiaotong University School of medicine as the core unit and hosts a number of hospitals, including public and private hospitals, sharing internal brands and medical resources." It is understood that Renji Medical Management Co., Ltd is the operation subject and management center of Shanghai Renji Medical Group Since its establishment, Shanghai Renji Medical Group has successively hosted more than 10 secondary hospitals, pharmaceutical equipment companies, tumor centers, etc to carry out comprehensive operation for the members of the group "The investment in this project is more optimistic about the opportunity of hospital restructuring and layout ahead of time At present, the most confusing thing for our investment institutions is that there is no clear profit model for investment in such medical management institutions, because the entrusted public hospitals are non-profit and cannot pay dividends Whether such medical management institutions can be listed in the future is unknown." Liu Yimin said Liu Yimin revealed that the company they invested in Shanghai Renji Hospital Management Co., Ltd adopts the management mode of collecting custody fees, but this profit mode is still in an exploratory state "Of course, if we don't do this, it will be very difficult for our social capital to enter." Liu Yimin said In the long run, the policy support attitude to social capital investment in medical service institutions is increasingly clear In this year's two sessions, Premier Li Keqiang proposed the following requirements for medical reform in the government work report: to expand the pilot of comprehensive reform of urban public hospitals We will eliminate the need to supplement medicine with medicine, rationalize the price of medicine, and innovate the mechanism of running medicine with social capital The pilot comprehensive reform of county-level public hospitals was expanded to 1000 counties, covering 500 million people in rural areas Industry insiders believe that this year, Premier Li Keqiang proposed 1000 pilot reforms of county-level public hospitals, on the premise of relatively specific numerical indicators, social capital is likely to achieve a certain range of breakthroughs Xu Zhipeng believes that in addition to high-end medical care and part of medical insurance, the potential opportunities for social capital are in the primary medical service market PE prefers "small and specialized" at present, it is difficult for comprehensive hospitals to have opportunities, and private specialized hospitals have become the hot spots It is understood that at present, there are three types of enterprises that are more interested in investing in medical care: first, medical enterprises or pharmaceutical enterprises; second, real estate developers; third, pure investment institutions The data shows that in the choice of investment targets, PE Institutions prefer to focus most of their efforts on some private specialized hospitals and high-end medical institutions; real estate developers prefer leisure tourism and vacation projects of pension real estate concept with high-end medical service projects; medical enterprises or pharmaceutical enterprises prefer projects related to their own industrial chain Liu Yimin said: "at present, the focus of the industry is on specialized hospitals with higher return rate After all, PE / VC is not a medical enterprise or a pharmaceutical enterprise They buy hospitals with a lot of money, more for the strategic purpose of industrial chain integration To some extent, profit is not their first purpose, but we are different." In terms of the core return income, according to the feedback of the insiders: regardless of the cost of capital, the return rate of the chain specialized hospitals is about 20%, which is a good situation The return rate of the general hospital is more than 10%, which is good In the interview, most PE institutions think that PE institutions are more suitable to invest in private specialized hospitals and high-end medical institutions A number of PE Institutions told reporters that they have invested in or are investigating some specialized projects, mainly in specialized hospitals such as dental, ophthalmology, tumor hospital, hospital beauty, kidney dialysis center and other types "Private specialized hospitals have a centralized and profitable mode