Tadawul-listed pharma and healthcare players posted strong 3Q 2023 earnings, reversing a weaker-than-expected performance the previous quarter and suggesting the 2Q drop was more seasonal than a sign of structural problems in the industry.

Strong healthcare earnings in 3Q: Average earnings across companies covered by EFG Hermes rose 41% y-o-y in 3Q 2023, 13% higher than the bank’s estimates for the quarter, according a fresh research report by EFG Hermes’ Ahmed Moataz and Hatem Alaa. The reports covers six healthcare providers and three pharma players. August and September were particularly good for business, with average earnings growth of 12%.

Pharma earnings rose 13% y-o-y in 3Q driven by higher ins. market penetration, government programs, and favorable pricing policies, after posting 8% growth in the previous quarter.

But the sector is in for a challenging year due to a decline in consumer purchasing power along with fierce price competition from online and new global players in the local market. The pressure is likely to persist through August 2024, EFG Hermes said, citing Nahdi Chief Executive Officer Yasser Joharji.

An unfavorable base effect was behind the drop in 2Q: Two Eid holidays and Ramadan negatively impacted earnings of 2Q 2023, while the comparable period featured one Eid only. The sector posted an average earnings growth of only 18% y-o-y in 2Q 2023 — 8% below EFG estimates.

Four providers have investment-grade ratings: EFG Hermes has maintained its rating for National Medical Care (Care) and Middle East Healthcare Company (MEAHCO) with “buy” recommendations. The kingdom’s largest healthcare provider, MEAHCO ranked first in terms of earnings growth with a 380% y-o-y increase in 3Q, thanks to a positive base-year effect. Care grew 72% y-o-y in 3Q with positive prospects for growth supported by a plan to acquire a 150-bed long-term care facility in Jeddah before the end of the year. Pharma players Al Dawaa and Spimaco (the latter is in the midst of a turnaround bid, which we’ve previously covered) also have positive prospects, leading EFG Hermes to put a “buy” on their stocks.

EFG Hermes isn’t sold on… The investment bank has downgraded Al Hammadi to “neutral” and has maintained “neutral” ratings for Nahdi, Dallah and Mouwasat. It move Sulaiman Al Habib Medical Group (HMG) to a sell.

Foreign investors like Mouwasat the most: Foreign ownership has increased in all of the companies covered in the report, except for Dallah, Al Hammadi and Nahdi, on a YTD basis as of 29 November. Mouwasat had the highest foreign ownership of 13% YTD, followed by Care (11.6%), while Nahdi and MEAHCO shared the third spot at 9.7%.

The new health ins. (NIH) program is going to have a big impact ont he industry. The program was announced on 30 November by Health Minister Fahad Al Jalajel.

NIH in a nutshell: The program is scheduled for launch by 2026 and is set to provide all citizens with full, lifetime coverage where approvals and annual renewals will no longer be required — and without a ceiling.

Doubling the private sector’s market share by 2030: The market share of private healthcare providers is expected to double to SAR 145 bn, giving them nearly half of what EFG Hermes sees as an SAR 318 bn market by 2030. The government is keen not to crowd out the private sector and is expecting private health ins. to expand by 5x in the coming years on several factors including population growth, more jobs and tourists, amongst others. Private players are also expected to benefit from the government’s privatization program, where 19 healthcare projects are scheduled for PPPs and privatization schemes.

The downside risks for the private companies: The government’s push to revamp public hospitals and widen their range of offerings could possibly mean less business for private operators. Private companies could also experience a drop in business activity from cash patients since the new program aims to cover all citizens. Still, premium operators including HMG and Dallah are less prone to this risk since their VIP clients are less price-sensitive and would still opt in for premium paid services.

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