Release date: 2016-02-19
Recently, a number of listed companies have a keen sense of smell invest heavily, layout medical rehabilitation. In the United States, the market size of the rehabilitation medical industry is as high as 200 billion US dollars, and in China, this blue ocean market has yet to be developed.
Why has rehabilitation medicine developed slowly in China in the past? And what kind of consideration does the listed company choose to intervene in this field at this point in time? This article is a research by Gao Xinjia, managing partner of Gao Tejia, in this field, and deeply analyzes the characteristics of this market and investment opportunities.
Rehabilitation medicine is an important part of medical services. It is based on diseases, physical and structural disorders caused by diseases, individual activities and patients with limited participation to improve the quality of life and reintegration of injured, sick and disabled people. For professional features.
first part
Blue Ocean Market: The US market of 200 billion US dollars is only 20 billion
The status quo of rehabilitation medical treatment: the gap between supply and demand is outstanding, and the development potential is large
â– The supply is obviously insufficient
The level of development of rehabilitation medicine in China is still at a low level, the supply is obviously insufficient, and the development potential is large, which is manifested in three aspects:
(1) The per capita size of the rehabilitation market is small. The size of the US rehabilitation medical market (including long-term care) has exceeded 200 billion US dollars (about 800 US dollars per capita); while the scale of China's rehabilitation medical market is only 20 billion yuan (only about 15 yuan per capita).
(2) The number of rehabilitation hospitals is small. In 2011, the Ministry of Health issued the “Guidelines for the Construction and Management of Rehabilitation Medicine in General Hospitalsâ€, requiring all general hospitals above the second level to build rehabilitation medicine. By the end of 2012, there were 3288 general hospitals with rehabilitation departments, and China’s second-level The above hospitals have 8,973 (2002 for tertiary hospitals and 6,971 for secondary hospitals). Compared with the requirements, less than half of the hospitals with secondary and higher levels have established rehabilitation departments.
In 2012, there were 3,288 rehabilitation departments in domestic general hospitals and 338 rehabilitation hospitals (excluding nursing homes and community rehabilitation medical treatment), including 206 cities, 116 rural areas, more than 600 cities across the country, and more than half of them have not established independent rehabilitation hospitals. .
(3) The rehabilitation doctor has a large supply gap. According to the statistics of the International Federation of Physical Medicine and Rehabilitation, the number of rehabilitation therapists in developed countries such as Europe, America and Japan is generally 30 to 70 people per 100,000 population. The proportion of rehabilitation physicians in China is about 0.4:100,000.
The reason for the above phenomenon is that the target of rehabilitation medical treatment is in a relatively stable period of disease, the surgical treatment is less dependent on medical technology, and the cost of medicine consumables is relatively small (the average medicine in rehabilitation hospitals accounts for about 20%, far less than comprehensive). Hospitals account for about 40% of medicines. For a long time, rehabilitation medicine has long been ignored under the existing medical system.
â– Demand stocks have great potential, and new demand growth is significant
With the aging of the population and the increase of chronic population, the demand for rehabilitation services continues to grow. The policy of the three-level system of rehabilitation medical services is expected to accelerate the construction of rehabilitation medical care.
Stock demand: there is room for further mining
The potential needs related to rehabilitation have not been fully released. For a long time, the lack of rehabilitation medical education, most patients are still in a state of lack of understanding or attention to rehabilitation. With the relevant supporting policies in place, there is potential for further exploration. .
Incremental demand: aging and slow patient population drive demand for rehabilitation care
Aging. China has entered an accelerated phase of aging. At the end of 2014, the number of elderly people over the age of 60 has reached 212 million, and the number of elderly people over 60 years old is increased by 10 million. 60-70% of them need rehabilitation services; the disease spectrum changes brought about by the aging of the population have created a need for rehabilitation, and chronically ill patients and sub-healthy people need rehabilitation treatment.
the second part
Which listed companies have entered rehabilitation care? What is the mode?
â– Tasly Holding Group, the layout of rehabilitation medical field
In 2013, Xiangya Hospital of Central South University, Tasly Holding Group and Hunan Boai Medical Industry Co., Ltd. jointly built Hunan Xiangya Boai Rehabilitation Hospital. Xiangya Boai Rehabilitation Hospital is the largest private rehabilitation hospital in China, focusing on medical rehabilitation, rehabilitation of work-related injuries, and rehabilitation of disabled people.
“Xiangya Mode†has unique advantages. Xiangya Boai Hospital has solved the problem of establishing initial source of disease by docking Xiangya Hospital and undertaking government purchases. Through the hosting of Xiangya Hospital, it solves the scarcity of doctor resources and adopts the light asset model of rented property to quickly recover investment capital. At present, Xiangya Hospital only charges Changsha Boai Hospital a fixed amount of brand fees and custodian fees each year, and referral patients receive referral fees. Changsha Boai now has fewer rehabilitation patients from Xiangya than patients undergoing neurosurgery, orthopedics and spine surgery. 1/5, well defined and Xiangya interest mechanism, will be able to expand the referral volume.
At the end of 2014, Vice Premier Liu Yandong inspected Xiangya Boai Rehabilitation Hospital, fully affirmed its three-level grading diagnosis and treatment model, and named the “Xiangya Model†for promotion to the whole country.
â– Hunan Development Indirect Shareholding Xiangya Boai Rehabilitation Hospital
According to the Hunan Development Announcement, the company and the senior management team have jointly invested RMB 124 million to establish Hunan Development Medical Industry Investment Co., Ltd. together with natural person Zhou Jianglin. The acquisition of equity, indirectly holding a 49% stake in Xiangya Boai Rehabilitation Hospital, to build a rehabilitation medical industry platform.
Hunan Development plans to build a flagship store-style rehabilitation hospital in Changsha to replicate the Xiangya model. The company plans to set up a comprehensive rehabilitation hospital in the inland city of Hunan Province within 3-5 years. The resources of the rehabilitation industry of Zhou Jianglin, the endorsement of the brand of Xiangya Hospital and the background resources of the state-owned holdings constitute the unique resources of the “Xiangya Modelâ€, which is “Xiangyaâ€. "Mode" is a powerful guarantee for the promotion of success in Hunan Province. Xiangxi and Changde Boai Rehabilitation Hospital are expected to open during the year.
â– Hejia shares to build a flagship store for high-end rehabilitation hospitals
On April 17, 2015, the Zhengzhou People's Hospital Medical Management Co., Ltd. jointly established and managed the for-profit rehabilitation hospital “Hejia Rehabilitation Hospitalâ€. On April 29, 2015, the company signed a comprehensive cooperation agreement on the cooperation framework with the University of Utah Medical Group.
â– Winbond Health intends to acquire Rheinland Hospital Co., Ltd. to expand the field of rehabilitation
On July 13, 2015, the company issued an intention to announce the acquisition: it plans to acquire 100% of the shares of Rheintal Klinik GmbH & Co. Porten KG (Rhein Hospital Co., Ltd.) for no more than 8 million euros. Rheinland Hospital is a professional medical institution with a long history and specializing in medical rehabilitation and nursing (including hospitalization).
â– Wanfang Development Acquired Beijing Harmony Rehabilitation Hospital
On the evening of July 19, 2015, it announced that it intends to acquire more than 51% of the equity of Beijing Harmony Rehabilitation Hospital (hereinafter referred to as “Harmony Rehabilitation Hospitalâ€). Beijing Harmony Rehabilitation Hospital is characterized by minimally invasive cerebral palsy and micro-surgical rehabilitation. The project involves many medical fields such as cerebral palsy, hemiplegia, paraplegia, orthopedics and postoperative rehabilitation.
the third part
Investment Analysis of Rehabilitation Medicine: Why are listed companies optimistic about rehabilitation? Listed companies favor rehabilitation medicine, although it is related to the enthusiasm of medical service policy, but more importantly, it is characterized by rehabilitation medical itself.
First, the four business characteristics of rehabilitation
(1) Low dependence on medical technicians, low bottleneck of talent demand
Rehabilitation medicine has a relatively low dependence on doctors and high requirements for professional services and care. The requirements for medical technicians in rehabilitation hospitals are much lower than those in general hospitals. The most important demand is rehabilitation therapists. This type of talented college graduate can be qualified after a few months of training, and the bottleneck of talent demand is lower than that of a comprehensive hospital.
(2) Low dependence on large-scale equipment, small single-unit hospital investment, light asset model
There is less demand for capital investment in rehabilitation hospitals in different places. The rehabilitation of rehabilitation hospitals can adopt the light asset model, and the average single bed investment amount is only about 300,000-500,000, which is far lower than the comprehensive hospital investment quota.
(3) Small medical risks and high standardization of treatment options
Rehabilitation medicine is mainly for patients after acute phase. The condition of these patients is relatively stable, and it is easier to form standardized treatment methods. At the same time, rehabilitation medical care is already in a relatively stable period of disease, and the risk of medical malpractice is small, and the compensation pressure is relatively small.
(4) Rehabilitation medical treatment has a short profit cycle and strong replication expansion
Although the average daily treatment cost of rehabilitation medical treatment is lower than that of general hospitals, the cost is relatively low. The net profit rate of rehabilitation medical care can reach 15%-20%, the profitability is outstanding, and the scale of business expansion Economic effects, profit margins can be further explored.
This is the key to achieving a breakeven balance faster than a comprehensive hospital. The newly-opened rehabilitation hospital is able to obtain a relatively stable source of disease at the beginning of its establishment, which is also conducive to achieving a significantly shorter profit cycle for rehabilitation medical services: comprehensive synthesis Sexual hospitals generally require more than five years of incubation from start-up to break-even, while rehabilitation hospitals are less than three years (for example, Xiangya Boai Rehabilitation Hospital, which started operations in the second half of 2012 and achieved break-even in 14 years).
Second, rehabilitation medical care is at the discretion of policy, and the speed of landing has obviously accelerated.
Rehabilitation projects will continue to be included in the scope of medical insurance coverage, which will release the need for rehabilitation; breaking the medical treatment and practicing more practice will show the value of rehabilitation and increase the mobility of doctors' resources, alleviate the lack of rehabilitation talents, and greatly ease the supply side. Difficulties; medical insurance control fees, graded diagnosis and treatment will improve the rehabilitation of the ecological environment; specifically:
â– Policy incentives for rehabilitation hospital construction, private capital has intervention opportunities
After the Wenchuan earthquake in 2008, the state paid special attention to the rehabilitation hospitals. The Ministry of Health specifically mentioned two key points in the guidance of the construction of the rehabilitation medical service system: one is the construction of rehabilitation hospitals, and the other is the construction of the hierarchical management system. Secondary hospitals or enterprise hospital transformation rehabilitation hospitals also encourage private capital to enter rehabilitation hospitals.
In 2009, the central medical reform program document "Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical and Health System" (Zhongfa [2009] No. 6) clearly stated that China's medical system should pay attention to "the combination of prevention, treatment and rehabilitation";
â– Medical insurance policy supports the rehabilitation medical field
In September 2010, the Ministry of Health document “Notice on including part of the medical rehabilitation program into the scope of basic medical insurance†clearly included the nine major treatment items of rehabilitation medical care into the scope of medical insurance payment:
In order to improve the basic medical security level for the disabled, the Ministry of Health, the Ministry of Human Resources and Social Security, the Ministry of Civil Affairs, the Ministry of Finance, and the China Disabled Persons' Federation have jointly issued notices to include nine types of medical rehabilitation programs in the scope of basic medical insurance.
These 9 medical rehabilitation programs that are included in the basic medical insurance coverage of urban and rural areas include: exercise therapy, comprehensive training of hemiplegic limbs, comprehensive training of cerebral palsy, comprehensive training of paraplegic limbs, occupational therapy, cognitive dysfunction training, speech training, swallowing dysfunction Training, assessment of daily living ability.
According to the requirements, the nine medical rehabilitation projects will be paid by the urban workers' basic medical insurance, the urban residents' basic medical insurance and the new rural cooperative medical fund respectively according to the prescribed ratio from January 1, 2011. At the same time, other medical rehabilitation projects in which the provinces (autonomous regions and municipalities) have been included in the corresponding basic medical insurance payment scope should continue to be retained. The eligible regions can be appropriately included in the scope of basic medical insurance according to the fund's ability to withstand and in accordance with the principle of ensuring basic needs. Medical rehabilitation projects; with the development of the economy and society, all provinces (autonomous regions and municipalities) should actively promote the rehabilitation of disabled persons and gradually increase the number of medical rehabilitation projects that are included in the scope of basic medical insurance.
Under the demonstration of active support from national policies, health departments across the country have also given priority support to rehabilitation. Take Changsha City, Hunan Province, where Xiangya Boai Rehabilitation Hospital is located, for example, in 2013-2014, two consecutive publications (2014 document: “On the development of five types of rehabilitation, hospitalization, hospitalization, medical expenses, single disease, dry settlement The notice of the pilot work) included the hospitalization expenses for rehabilitation of five major diseases such as stroke (cerebral hemorrhage, cerebral infarction), craniocerebral injury, postoperative brain tumor, spinal (spinal cord) injury and artificial hip/knee joint replacement. The trial of fixed-line settlement of disease types is as high as 85%-95%.
â– Graded diagnosis and treatment system is expected to accelerate the development of rehabilitation
In 2011, the Ministry of Health document “Notice on Carrying out the Pilot Work of Establishing and Improving the Rehabilitation Medical Service System†started the construction of the rehabilitation medical service system, and clearly proposed to establish a three-level rehabilitation medical treatment system, which divided the national rehabilitation medical treatment into three levels: In the first aid period, the rehabilitation is in the general hospital; the second is the stable period, the rehabilitation hospital or the secondary general hospital with rehabilitation as the main; the third is the recovery period, which is to introduce rehabilitation into the community.
In March 2012, the Ministry of Health held a special meeting on the development of rehabilitation medical care. The meeting proposed: 1) Various types of rehabilitation institutions at all levels are important “exports†for patients in general hospitals to pass the acute phase. Without rehabilitation institutions, it is difficult to truly Establish a hierarchical and phased rehabilitation hospital service system; 2) Comprehensive hospitals should sink patients in stable and recovery periods in time to make room for the development of rehabilitation institutions and long-term care institutions. 3) The focus of the rehabilitation medical service system construction is rehabilitation hospitals. The number of rehabilitation hospitals is insufficient and the capacity needs to be improved. The policy encourages the conditional secondary general hospitals (especially enterprises and business hospitals) to be transformed into rehabilitation hospitals or rehabilitation-oriented general hospitals, and social capital is also encouraged to enter the rehabilitation medical field.
Since 2014, the Health Planning Commission has issued a document to control the size of the general hospital, reduce unreasonable expenses, and reduce the average hospitalization time. The development of general hospitals should consider other development ideas and models, and promptly transfer patients to rehabilitation hospitals. Private rehabilitation hospitals make room;
In September 2015, the General Office of the State Council issued guidance on promoting the construction of a graded diagnosis and treatment system and proposed:
- Two-way referral. Adhere to scientific medical treatment, facilitate the masses, improve efficiency, improve the two-way referral procedure, establish a sound referral guidance catalogue, focus on smoothing the channels for patients in the chronic phase and recovery period, and gradually realize the existence of different levels and different types of medical institutions. Referral referral.
- Rapid division and treatment. To clarify and implement the functions of acute and chronic disease diagnosis and treatment services at various levels of medical institutions, and to improve the treatment-rehabilitation-long-term care service chain to provide patients with scientific, appropriate and continuous diagnosis and treatment services. Critically ill patients can go directly to the hospital at the second level or above.
Experience at home and abroad has proven that rehabilitation institutions are one of the important channels for diverting patients from large hospitals. In the United States, after the acute phase of treatment, patients will be transferred to subacute treatment hospitals, rehabilitation institutions or long-term care institutions according to the situation. In this process, the rehabilitation of patients' physical function assessment of patients with acute phase diversion It provides an important basis, and the existence of rehabilitation medical institutions also provides a diversion channel for some rehabilitation patients.
The higher average hospital stay in public hospitals in China provides a broad space for rehabilitation medical rehabilitation. At present, the average length of hospital stay in public hospitals in China (about 10-11 days) is significantly higher than other countries and regions in the world (Hong Kong: 7 days; Japan: 5 days). Rehabilitation hospitals mainly undertake patients after the acute phase, and their development will help the public comprehensive hospitals to improve their bed turnover and income levels.
â– The policy landing has obviously accelerated, facing the investment opportunity period
In October 2014, the Beijing Municipal Government issued the “Implementation Opinions on Promoting the Development of Health Service Industryâ€, proposing that Beijing will speed up the establishment of a comprehensive rehabilitation system for comprehensive hospitals, rehabilitation nursing specialist hospitals, grassroots medical institutions, and orderly connection.
In June 2015, Beijing has established a rehabilitation medical service system in 14 hospitals. After the acute phase of treatment in 12 comprehensive hospitals such as Friendship Hospital, Tongren Hospital and Chaoyang Hospital, as long as certain conditions are met and the patient’s consent is obtained, Direct transfer to Xiaotangshan Rehabilitation Hospital and Beijing Geriatric Hospital, continue to receive professional rehabilitation.
In August 2015, the pilot reform of the medical complex of Shanghai Ruijin Hospital took a key step. The southeast hospital of the second-level comprehensive hospital in the medical association was officially transformed into a rehabilitation specialist hospital, and the “Ruijin Rehabilitation Hospital†was listed and the patient was transferred from Ruijin Hospital. The first bed is 200.
Key investigative factors for rehabilitation medical investment
Referral and disease development as a focus of medical services, licensing, technology, medical insurance qualifications are indispensable.
The core concern is the referral and connection of the public hospitals. The source of the disease is the primary bottleneck restricting the development of rehabilitation hospitals. Some hospitals have good construction conditions, but they are always lacking patients, and even have a occupancy rate of 30-40%.
The lack of patients' sources is mainly: 1) the people's awareness of rehabilitation is not strong; 2) the clinical staff's rehabilitation is not professional enough; 3) at this stage, the two-way referral system of stratified medical and phased rehabilitation has not really operated.
Rehabilitation medicine mainly undertakes patients after acute period, so the key to its operation lies in establishing a cooperative network with general hospitals and establishing a reasonable referral mechanism.
Under the premise of establishing a reasonable referral mechanism, there is not only a competitive relationship with the existing public general hospitals, but it may become a partner. The development of rehabilitation medical care can realize itself, general hospitals (transfers), medical insurance, and patients. Multi-win is beneficial to the latter to improve bed turnover and income; rehabilitation medical development is also conducive to reducing the burden of medical insurance (the average daily treatment cost of rehabilitation hospitals is lower than that of general hospitals), and can provide better rehabilitation services for patients.
After designing the benefit sharing mechanism, the company's existing hospital customer resources will be introduced into the rehabilitation business. It is expected that the company's rehabilitation business will achieve profitability with high-end services, in order to provide basic services for medical insurance patients to increase traffic.
Source: Gao Tejia Investment
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