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1、GlobalHealthcareRepOrtIStIberkadia2023Ageingdemographicsandtheneedforlongtermcarepresentthemselvesaskeyfactorsintheinterestforhealthcareglobally.Introduction4AsiaPacific25Overview26Singapore28Howartificialintelligenceis7Australia29transforminghealthcareIndia30Europe9MiddleEast31Overview10Overview32B
2、ruceWalkerQ&A11KeydeManddrivers34UK12France13BelgiuM14Africa35GerMany15Overview36Ireland16MedicaltOuriSMinAfrica38Spain17Netherlands18Keytakeaways40Summary41NorthAmerica19Howwecanhelpyou?42Overview20Ourpeople44Debt&Financing21Ourglobalnetwork46MarketTrends21SalesTrends22Hospitals&MedicalOfficeBuildi
3、ngS23IntroductionGlobalflowsintocarerelatedrealestateinthe12monthstoJune23amountedtocirca$38bn.Thecaresectorencompassesalloperationalcare-relatedassetsspanningelderlycare,adultcare,primarycare(GPsanddentalsurgeries)andchildcare/specialeducationalneeds,essentiallyanyperson-centredoperationalbusiness.
4、Thesesubsectorscanthenbefurthersplitbasedonacuitytoincludemorespecialistsettingssuchasdementiacarehomes.Thegraphicbelowpresentsavisualrepresentationofthemarket,sbroadness,includinganyrelevantoverlapsrespectivetoacuitylevels.INVESTMENTCASEBroadinitscoverage,thecaseforinvestmentremainsconsistentnotonl
5、yacrossthevarioussub-sectorsbutalsoacrossgeographicborders.Firstly,theemergenceofaglobalpandemichighlightednotonlytheAsprivateequity,REITSandinstitutionalinvestorscontinuetochasetheStrong,longincOMegenerated,thereisgrowinginterestinhealthcare,ScapabilitiestoaidESGinvestingStrategies.”ELDERLYCAREADUL
6、TCAREHEALTHCARESERVICESJCHILDCARENursingcarehomeAdultcarehomesAcutecare(hospitals)Specialisteducation(SENschools)DEMENTIACAREMENTALHEALTHFaqutiesEARLYONSETDEMENTIACAREABIREHABUKPRIVATEHOSPITALS1.ONDON&INTERNATIONALMARKETCHILDRENSRESIDENCESPrimary care (GP clinics)PharmaciesDentistsChiIdrenvS nurseri
7、esPersonalcarehomeSeniorlivingandassistedlivingSupportedlivingaccommodationrobustnessofhealthcareasanassetclassbutalsoitsgenuinesignificanceasasector.Asprivateequity,REITSandinstitutionalinvestorscontinuetochasethestrong,longincomegenerated,thereisgrowinginterestinhealthcare,scapabilitiestoaidESGinv
8、estingstrategies.Globally,acrosstheboard,thefundamentalsthatcreatethecaseforinvestmentflowsintohealthcareareevident.ThegraphicThecaseforhealthcareasaninvestmentDemographicshiftAnageingpopulationmeansincreasingdemandforresidentialcare,primarycareandacutehospitalservices.SecureincomeOperatorrevenueisr
9、einforcedbyahealthymixofself-fundedcareandpublicly-fundedcare.Incomeissupportedbyhighoccupancyandpatientdemandacrossthehealthcarearena.belowhighlightssevenfactorsthatcontinuetocontributetowardsthecaseforhealthcare.Fig.1highlightssomeofthemanyformsthatcapitalisbeingallocatedtohealthcarerealestateglob
10、ally.Whilsttherearedifferencesindeploymentstyle,withsomeinvestorsoptingforanindirectandthereforemorepassivestrategy,itisclear,thatthereisaglobalappetiteforthesector.InvestmentperformanceReturnsarehistoricallystable,offeringinvestorsprotectionanddiversification.夕DemandforsafehavensHealthcareslongterm
11、andoftengovernment-supportedincomeoffersfurtherdefence.StructuralchangeinrealestateRealestateinvestorsalreadyderiskingfromtraditionalsectorssuchasretailintoalternativeslikehealthcare.Fig1:GlobalperspectiveAustraliaaveragedealsize$1-3mWhatthislookslikeApharmacyoroptometrypractice,orasmallmedicalcentr
12、eUKaveragedealsize$2.5-17mWhatthislookslike40-100bedsSpainaveragedealsize$2-2OmWhatthislookslike100bedsforelderlycaresettingsorclinicsinmulti-ownerassetsi Singapore1.ong-termincomeWeightedaverageunepirdleaseterms(WAULT)average2530yearsintheresidentialcareandhospitalsectors.1.easesaremmolyindexed-lin
13、kedtoinflation.SocialimpactTheinfluenceofimpactorESGinvestinginrealestateisgrowingatafasterpacethanever.Arangeofinvestorsarenowfocusingonsocialinfrastructureinvestments,andhealthcareispartofthis.UsuallyinvestedindirectlySource:KnightFrankResearchSECTORUPDATEGloballycapitaldeployedintocarerelatedreal
14、estateequatedtocirca.$38bnforthefourrollingquarterstoJune23asperFig.2,whichaccountedforapproximately4.3%ofallglobalrealestateflows.NorthAmericancapitalwasthebiggestcontribute1,tothesector,accountingforalmost68%offundsdeployedlastyearwhilstFranceandBelgiumreceivedthemostcross-borderinflows.Privatecap
15、italwasoverallthemostactiveamongstthevariousbuyertypes.However,onanetbuyerbasiscross-border,institutionalandREITSemergedasnetbuyers.KeycontributxrstothemarketincludethelikesofHealthcareRealtyTrust,WelltowerandAedifica.Thetop10canbeseeninTable1.Fig2:Globaltransactionvolume$ROLLING4-QUARTERVOLUMEQUART
16、ERLYVOLUME20132014201520162017201820192020202120222023Source:RealCapitalAnalyticsFig 3: Global buyer composition18.2%15.0%32.3%30.8%CROSS-BORDER INSTITUTIONAL REITLSTED PRIVATE USEWOTHER12.6%19.4%17.0%12.4%23.1%18.9%39.1%41.2%25.3%32.7%19.7%11.7%20.3%29.4%7.7%25.0%27.3%22.4%14.4%41.9%47.7%56.7%28.9%
17、31.4%33.6%36.5%41.1%283%3.8今2013201420152016201720182019202020212022 2023 YTDSource： Real Capital AnalyticsI RANKINVESTORGEOGRAPHY1Healthcare Realty Trust Inc (fmr HTA)USA2WelltowefUSA3Remedy Medical PropertiesUSA4Primonial REIMFRANCE5NREPSWEDEN6Kayne AndersonUSA7Pierval Sante #SCPIFRANCE8EQTABSWEDE
18、N9Montecito MedicaLUSA10AedificaBELGIUMTable 1: Top Buyers (by acquisition value in 2022)Source: Real Capital AnalyticsHowartificialintelligenceistransforminghealthcareROBERTALLMAN,SVPEMEA1TTECDIGITALToday,youcantreadthenewswithoutseeingaheadlineaboutartificialintelligence(Al).Aliscreatingabuzz,butt
19、hetruthisthatAlitselfisn,treallynew.Generativeartificialintelligenceenteredourcollectiveconsciousnessin2022whenChatGPTwasintroduced,butotherformsofAlandmachinelearning(ML)havebeenaroundforalongtime,makingapositiveimpactinmanyareas-especiallyinhealthcare.Therearemultiplecomplexitiesintroducedbyageing
20、populations,changingworkforcedemandsandincreasinglydiversepatientrequirementsthatplacepressuresonthehealthcaresector.Thesocio-economicenvironmentforpersonalised,proactive,propensity-andpredictive-basedgainsinpatientcareandorganisationalproductivitywillbeaddressedprofoundlybyAl.ThefoundationalAluseca
21、sesarealreadyouttheretomakediagnosesmoreaccurate,caremoreaccessible,andmedicationsmoreeffective.Inthisarticle,we,llsharefourwayshospitalsandclinicscanimprovetheircareandpatientoutcomesthroughAladoption.1. Al-enabledConditionDiagnosisandEarlyDetectionFrombreastcancertokidneyinjuries,Alishelpinghealth
22、careprovidersidentifyat-riskgroups,andbothtrackandtreattheirhealthovertime.Forexample,mammogramsoftenrunariskofproducingfalsepositives,whichcanleadtounnecessarybiopsies.ByusingAltoassessdatarelatedtohormones,genetics,andbreastdensity,doctorscanreachaverdictfasterandwithgreateraccuracyInsightEngageme
23、ntreducingtheneedforavoidablebiopsies.Beyondbreastcancer,Al-enabledscreeningsolutionscanparsepatientdatatofindpatientswhoareatgreaterriskformanyconditions.2. PromotingExpedientCarewithAlInemergencymedicalsituations,Alishelpingdoctorspredictandprepareforunchartedterritory.Atsomehospitals,predictiveAl
24、techniquesarehelpingtoimprovetheefficiencyofpatientoperationalflow.Bycalculatingpeaktimesofdayandpeaktimesthroughouttheyear,aswellascloselymonitoringpatientadmittanceandlengthofstay,medicalteamsarebetterpredictingwhenbedswillopenupandadjustingstaffinglevelstomeetpatientneeds.Alisalsoshiftingsomeofth
25、eintakeburdenfromclinicalteams.Virtualassistantscantakeonsomeoftheinitialhospitaldocumentation,triage,andnotetakingfreeingnurses,medicalassistants,andotherclinicalstafftofocusonhigh-touchpatientcare.Automation3. Al,sImpactonHealthProgramAdherenceOncediagnosedwithadisease,manypatientsroutinelystruggl
26、etokeepupwiththeirnewchroniccaremanagementplans.Acrossthehealthcarelandscape,lapsesinprogramadherenceresultinover125,000deathsayearaspatientconditionsworsen.Alisonewaydoctorscankeeppatientsengagedwiththeircareplans.Throughpersonalizedappsandgamification,patientscancompletetheircareregimeandtickeachb
27、oxontheirhealthcareto-dolist.HospitalsandclinicscanalsouseAltohelpat-riskpatientsre-engagewiththehealthcaresystemafternotedlapsesintheircareplan.Forexample,patientswithhypertensionorType2Diabeteswhomeetspecificsegmentationparameterscanbenotifiedtoscheduleanewappointmentorsentaremindertorefillanoutst
28、andingprescription.4. HealthcareDigitalTwins(HDT)Digitaltwinsaremakingtheirwayintothepatientexperience.Healthcaredigitaltwins(HDT)isaquicklyemergingtechnologyforbetterunderstandingpatients,healthcareassetsandbehaviours,providinghealthcareorganizationswithreal-timereportingfordata-drivendecisions.Ali
29、senablingtwotypesofhealthcaredigitaltwins,whichcanproducethefollowingbenefits: DigitalTwinofapatient:Ensuringthedynamicapplicationofnewresearch,policyprocedureandcarestandardstoapatientscondition. DigitalTwinofacommunity:Adigitaltwinofacommunityhelpshealthcareorganizationscreatebetterdatamodelstopre
30、dictdemandsandrequirementsfordefinedpopulationsorgroupingsproactively.NextStepsforAlIntegrationinHealthcareAshealthcareleadersthinkaboutwaystoimproveoperationsandpatientoutcomeswithAl,it,simportanttounderstandAscurrentrisks,weaknessesandstrengths,aswellasorganizationalreadinesstoimplementthistechnol
31、ogy.TolearnmoreabouthowTTECDigitalcanhelpyougetstartedwithyourAljourney,visitourwebsite:artificial-intelligence.76%Callsansweredbyat-homeagents24%CallsdeflectedbyusingAlOverviewEurozoneGDPgrowthslowedto3.5%in2022from5.3%growthinthepreviousyear,duetorecordhighinflationandrisingborrowingcosts.Therewas
32、,however,significantdivergenceacrosstheregion.Ofthelargesteconomies,Spain(5.5%)andItaly(3.7%)outperformedtheEurozoneGDPaverage,supportedbyastrongtourismseason,whileFrance(2.6%)andGermany(1.8%)expandedmoremoderately.TheeconomicoutlookforEuropeandgloballyisrelativelysoftdrivenbystickycoreinflation,wea
33、keningdemandandtighterfinancialconditions.Tosupporteconomicgrowth,Europeangovernmentsmayincreaseexpendituredrivingupfiscaldeficitsthroughincreasedborrowing,puttingpressureonalreadystretchedbudgetsinmanycountries.TheEurozoneeconomycreatedalmost3.7millionjobsin2022andunemploymentisatthelowestrateonrec
34、ord.Thehealthcaresectorisseeingparticularlyacutestaffshortageswhichhavebeenexacerbatedbythepandemic.Europehasalsoseenanincreasingnumberofstrikesamonghealthcareworkersduetochallengingworkingconditions,lowpay,andinsufficientresources.AssomeEuropeancountriesarefindingitincreasinglydifficulttoattractand
35、retainyoungpeopleinthehealthcareprofessions,nationalhealthcaresystemsarestrugglingtokeepupwiththerisingdemandforhealthcare.Overthenextdecade,EUemploymentinhealthandsocialworkispredictedtogrowbylessthan3%,downfromdouble-digitgrowthintheprevioustwodecades.Atthesametime,thepopulationintheEUaged75andove
36、risexpectedtogrowby26%.WithEuropeseeingarapidlyageingpopulation,complexcareneedsareincreasingasdiseasessuchasdementiabecomemoreprevalent(Fig.4).Long-termcareexpenditurevariessignificantlyacrossEurope,whiletherearealsoregulatoryandcultural3.7mTheEurozoneeconomycreatedalmost3.7millionjobsin2022andunem
37、ploymentisatthelowestrateonrecorddifferenceswhichmeaninvestors,developersandoperatorsofhealthcarerealestatewillneedtohaveacountry-specificapproach.Persistenthighinflationisputtingfurtherdemandsonoperatingcostsofcarehomes,intheformofhigherutilitybillsandupwardwagepressure,leadingtohighercostsforresid
38、ents.Therelaxationofstatecontrolandgrowingcostpressureatbothcentralandlocalgovernmentlevelwilllikelyleadtomoreprivatisationintheelderlycaresector,offeringopportunitiesforinvestorsinthesector.Sources：WHO.OxfordEconomics.TradingEconomics,KnightFrankResearchFig4:Percentageofpopulationover7520402023Ital
39、yGermanySpainFranceEUNetheriandsBelgiumPolandUnited KingdomIrelandUBruceWalkerUKCountryManager-AedificaQ:InyouropinionwhichcountriescurrentlypresentthegreatestopportunityorchallengeforhealthcareinEurope?TheUKisstillfundamentallyanattractivemarketforhealthcarerealestateduetotheunderprovisionofcarebed
40、sandtheneedtoupgradethequalityofbedsprovided.GermanyhassomeheadwindsatpresentduetoincreasedcostswithoutthefeeinflationseenintheUKbutthisshouldpassandreturntostability.Finlandcontinuestobeagoodmarketasitiswellfunded.Q:Haveincreasedbuildcostsimpactedthedevelopmentaspectofyourstrategy?Yes,itismorediffi
41、culttomakenewbuildopportunitiesworkwithincreasedbuildcosts.Uncertaintyoverbuildcostshasalsobeenanissue,howevertherearesomeindicationsthatbuildcostsmaybestabilising.Q:Whatareyourthoughtsonthesectorspost-pandemicrecovery?TheUKcareoperatorshavebouncedbackwellwithoccupancybacktopre-pandemiclevels.Costsh
42、avebeendifficulttomanageformany-especiallystaffandenergy-butduetostrongfeeincreasesfrombothprivateandlocalauthoritysources,marginshavebeenprotected.Investmentinstaffrecruitment,trainingandretentionisbearingfruitforsomeoperatorswithstaffcostsbeingmoremanageable.Q:Howareyoucurrentlymanagingtheissueofr
43、isingdebtcosts?Andhasthiscausedtheliquidityrequirementsofyourstrategytochange?Thecostofcapitalhaschangedforeveryoneandthisflowsthroughthewholemarket,evenawell-capitalisedbusinesssuchasours.Thekeyissueisthatinterestrateswillneedtostabiliseandthevolatilityindebtcoststoabatebeforeinvestorsfeelconfident
44、tomakemornewcommitments.Q:Whatisyourcurrentstrategicfocusandhasthischangedsignificantlyfromthistimelastyear?Orevenpre-pandemic?StrategicfocusremainsgenerallyoneOfconstantimprovementoftheportfolio,whichisconsistentbutthehowtodeliveritdoeschangewiththecircumstances.Q:Whatwouldyousuggestarethekeyconsid
45、erationsforextractingorcreatingvalueinthecurrentclimate?Sameaseverinthissector-therightpropertyintherightplacewiththeserviceprovidedbytherightcareprovider.Q:Howwouldyousuggestyourcapitalstructure-e.g.equityvsdebt,supportsyourstrategyduringthecurrentclimate?Wearefortunatetobeaverywell-fundedlistedREI
46、Twithastrongbalancesheetanda125%dividendcover.Wecanbepatient.Q:Whatareasofhealthcaredoyoufeelpresentthegreatestopportunityforinvestors?Andwhatsub-sectorsareofmostinteresttoyourcurrentstrategy?ValueisincreasinglybeingrecognisedincareOpCos,whethertheyarefreeholdorleasehold.Carehomeswiththeabilitytodeliverhighqualitycareforhigheracuitycontinuetobeinteresting.Q:Whatwouldyousayposesthebiggestchallengesforcareoperato
