0HCAWhat Does Not Kill HCA Makes It STRONGER2023 10 17|S0120521080001 1 Medicare+Medicare Advantage Medicare Grand Review Research 2030 2.55 20232030 CAGR 7.7%HCA/HCA Galen/AI HCA 20232025 640+6%675+5%713.6+6%EBITDA 126+4%133.3+6%141.4+6%IT/XVCXyRnQoNmNsMnOmRqPqRaQaO6MpNmMmOtQfQoPpPjMoPxPbRnMpMvPsPsOuOoPqR2 CONTENTS010203040506 070809103 01-CONTENTS4 2022 1.4 Grand Review Research 2022 1.4 20232030 CAGR 7.7%2030 2.55 1/2+CDC 10 6 inpatient outpatient/AI Grand Review Research 5 Hospital Corp America/HCA Healthcare 182 2000 5 25 3700 Nashville 53 4 HCA 2020 Galen/PARALLON HCA HCA HCA 2022 HCA 6/Thomas Frist Jr.Sr Jack Massey KFC T.F.Jr.KFC 3$HCA HCA 7 1994 HCA Columbia 193 311 103 1997 1996 319 2002 173 2011 185 2011 108 2022 126 HCA Columbia 20082009 HCA Definitivehc 1828 Hospital ICU Ambulatory Surgery Center ASC ASC 2014 CMS ASC Freestanding Surgery Centers FSSC ASC Urgent Care Facilities UCF ER ER UCF ER UCF PC ER ER Freestanding Emergency Care Facilities Walk-in Clinics Diagnostic&Imaging Centers Radiation&Oncology Therapy Centers Comprehensive Rehabilitation&Physical Therapy Centers Physician Practices Home Health Hospiceoutpatient Beckersasc,Adventisthealth ASC UC ER 9 02-CONTENTS10 55 3 IPO HCA 1968 3 IPO/HCA HCA+Columbia 19801990 Columbia Scott 20 300 180 1968 1969 NYSE IPO1970 John A.Hill CEO Thomas Frist VC+CMO1972 1975 1977/1978 3 CEO 1980 NYSE 10 10 1981 HAI 1/5 Health Care Corporation FTC 1982 American Hospital Supply Corporation Baxter1983 HCC HCA Psyciatric Company1986 1987 Health-Trust 104 1988 51 leveraged management buyout 1989 Columbia Hospital Corporation 4 833 1990 CHC 5 Sutter MCAD JV 1992 CHC 24 1993 CHC Galen Health Care 74 1994 HCA CHC Columbia/HCA1996 Columbia/HCA 170 1997 Value Health 1998/33 40 2000 1997 civil claims 7.5 2001 CEO Scott Frist CEO 2002 20 2003 2005 Bill Frist 2006 2007 2000 2005 2009 CEO Braken 2010 HCA IPO 40-60 2011HCA IPO 1.262 30 37.9 2012 Galichia Heart Hospital 82 2013 3 Tampa Bay 700 2014 Grandview Medical Center 70 CareNow 24 2015 Urgent Care Extra 14 2017 CHS 400 Tenet 3 1000 2018 15 Mission Health 1000 2019 24 MedSpring 160 2020 Galen College of Nursing 9.4 2021 4 Georgia Brookdale Health Care Services 3 250 Steward Health Care 5 2022Galen College of Nursing MD Now 59 McKesson Corporation 2023 FastMed 41 ZIPPIA HCA HCA 11201118+2011 IPO ACA HCA 2016 2011/3：公司重新上市，是最大的上市连锁医疗集团公司2011/7：上市后首次业绩公告，低于预期，股价破发，阴影笼罩整个医疗服务行业；2011/8：美债上限上调至$16.4万亿，股市大跌，对于医疗服务机构最大的担忧是Medicare 支付缩减 the“Budget Control Act of 2011”2012/6：最高法支持并认可ACA扩容2012/11/9：市场对Mitt Romney 取消ACA 的担忧有所缓解2013/4：Medicare 建议对医院的医保支付比例提升0.8%2014/1：超过210万人加入Obamacare-mandated health insurance，2014/1/1 正式启动2014/4：公司收购澳洲医疗服务公司Healthscope2014/7：公司上调全年业绩指引，受益于ACA 扩容2016/11：特朗普当选总统，市场解读为对医疗服务行业的利空（或推翻ACA）2017/3：GOP 试图替换ACA2017/7：GOP 试图推翻ACA的计划以失败告终2017/10：特朗普计划终止向医疗保险公司支付ACA 津贴2018/11：2018Q2 业绩及各项指标再次（连续4 个季度）超预期2015/12：美联储加息0.25%（每年至2017），反应美国经济已经从08 年金融危机中复苏 Wind HCA 20112018 HCA+940%12201923+2019/8：2019Q2业绩低于预期2020/3：Bernie Sanders 在内华达州党团会议上胜出，他曾公开表态建议由政府保险替代商保，支持全民医保2020/3：新冠疫情恐慌带来的大盘整体下跌2020/6：新冠疫情导致手术量持续下滑2020/7：业绩虽下滑，但一定程度上受益于政府刺激金补贴CARES ACT 以及better payer mix，因此业绩优于预期2020/11：2020年美国总统大选，拜登获胜，利好医疗产业2021/2：2020Q4业绩反弹并超预期,COVID 平均收费较高，抵消入院量下滑的负面影响2021/4：Q1 业绩超预期，上调业绩指引2021/7：Q2 业绩继续超预期，再次上调全年指引2020/4：新冠疫情缓和导致医院就诊量下降，同时通胀、人力成本提升等因素导致利润不及预期，且公司下调全年业绩指引，且暂停分红2022/7：Q3 业绩超预期，合同护士比例下降，控费管理效果明显，利润率反转优化2022/10：CPI 数据预示通胀或有放缓趋势，市场预期美联储加息幅度或将缩小 1 2 3 2023 Wind HCA 20192023/10Delta SurgeOmicron Surge2022/4：劳动力缺口问题扩大，导致公司业绩低于预期2023/4：Q1 业绩再次超预期，非新冠业务反弹明显，护士缺口问题进一步缓解2023/7：因HCA 业绩指引仅仅只是符合预期，一众医疗服务公司纷纷下跌 HCA+940%13 03 CONTENTS14 Healthcare Readers HCA 10 5 Ascension Health SeekingAlpha PE 16.5X EV/EBITDA 11.1X P/CF 10.6X HCA 2021$(9/27)1 HCA Healthcare 1968 NYSE 185 28 6762 Ascension Health 1999-150 15-3Community Health Systems(CHS)1985 NYSE 85 6.5 3.84Universal Health Services(UHS)1979 NYSE 400*9 875 Tenet Healthcare 1969 NYSE 65 11 676 Ramsay Health Care 1964 ASX 230 7.7 777 IHH Healthcare 1974 BURSA 80 6.5 1118 Apollo Hospitals 1983 NSE 70 4 879 Mediclinic International 1983 LSE 80 3.7 5010 NMC Health 1975 LSE-2 0.12P/E TTMP/E FWDPEG TTMPEG FWDPSEV/SalesEV/EBITDAPB P/CFHCA 12.51 13.78 NM 1.43 1.15 1.81 9.08 NM 7.05UHS 13.29 12.54 NM 1.17 0.66 1.02 8.10 1.46 7.59THC 14.95 11.94 NM 1.83 0.36 1.23 6.72 5.23 3.94EHC 21.00 20.23 0.56 1.71 1.52 2.28 10.95 4.76 10.37ACHC 23.98 20.71 NM 2.09 2.30 2.89 13.47 2.21 17.97ENSG 22.30 19.81 1.27 1.32 1.53 1.98 18.18 3.78 16.88 18.00 16.50 0.92 1.59 1.25 1.87 11.08 3.49 10.63 2023/9/25 TOP10 SeekingAlpha Healthcare Readers HCA 15 04 CONTENTS16 2022 602 3%EBITDA 121 5%44.2 17%10 CAGR 6.2%6.3%9.6%EBITDA adjusted EBITDA NON-GAAP 2010 EBITDA 19.5%2010 3.9%2023H1 8%2023H1 315 6%EBITDA 62 4%26 2%Wind HCA HCA 255 269 284 301 307 297 330 342 369 397 415 436 467 513 515 588 602 315 0%2%4%6%8%10%12%14%16%0100200300400500600700营 业总收 入（亿 美元）增长-60%-40%-20%0%20%40%60%80%100%0102030405060扣 非后归 属母公 司股东 的净利 润（亿 美元）172023H1 2023H1 315 6%EBITDA 62 4%26 2%Same Facility H1 3.3%Q2 2.2%H1 2.7%Q2 1.8%H1 4.2%Q2 3.3%H1 6.9%Q2 3.7%+2.7%+6.9%+4.2%+3.3%HCA HCA Statista 18 05 CONTENTS19 2022 54%46%22%18%2020 46.3%2023H1 2022 4%HCA 2022 Patient Care Cost HCA HealthAffairs VisualCapitalist World economic forum 20 TIPs-1 1 2 3 HRSA BHW 2025 7.9 2030 6.4 2035 HCA contract 1.Texas Florida 2.2020 Galen College of Nursing HCA+Nurseslabs cbsnews 2018 TOP10/21 06 CONTENTS22 MA 2022 Medicare Medicaid 22%70%78%Managed Care 30%53%Managed Care 1 2010 ACA Medicare 2 2014 ACA 3 2020 Managed Medicaid+Managed Medicare Managed Medicare/Medicaid Medicare Medicare KFF Definitivehc HCA 23-Managed Medicare Medicare Part C All in One Plan/Medicare Advantage MA 1997 Balanced Budget Act of 1997 MA Medicare Medicare MA 2 1 Medicare(A/B)MA(D)Medicare Medicare 2010 ACA MA 20092017 80%2023 3000 MA 51%MA Original 2032 MA 62%9430 MA Original MedPAC MA 4%Medicaretalk KFF Medicare MA MA MA 24 07 CONTENTS25AI HCA AI HCA ITG patient interface/(EHR)2023 7 HCA 2014 PatientKeeper APP 2019 AI 8000 2020 Valify 2020 Google Cloud SADA 2020 EVERFI 2021 Google Cloud 2022 Google Cloud Generative AI JAMA(2022;3(12):e224873)ransomware 2021 90 2016 AI HCA 20162021 HCA JAMA Trends in Ransomware Attacks on US Hospitals,Clinics,and Other Health Care Delivery Organizations,2016-2021 Hannah T.Neprash et al.cbsnews HCA AUGMEDIX APP 26 08 CONTENTS272023()20102023 TOP10+HCA Texas Florida 20102023 TOP10 TX FL 2023 2 3 FL TX 10 TX FL HCA()HCA HCA worldpopulationreview HCA Govisafree 28 09 CONTENTS29 2023Q2 632.5647.5 6%EBITDA 123128 4%MarketScreener 2024 2025 EBITDA 675+5%713.6+6%133.3+6%141.4+6%MS 20232025 2023 MarketScreener HCA 30 10 CONTENTS31 IT/AI/32 2019 2018 2017 2016 2015 1.6 6()20%5%20%-5%+5%5%2.A 500 10%-10%10%10%33 34 600 N1 9+86 21 68761616+86 21 68767880400-8888-128