Investing in Central and Eastern Europe

- Hi, everybody. Thank you for taking a seat. If you're interested in Eastern Europe, I'm, I'm very pleased to have the chance to have a, a great panel with me to talk a bit about the, the, the, the region and how, you know, investors and and provider think about its, its attractiveness or how to operate. We as a firm had the chance to work extensively with, with leaders from the, the Baltics to, you know, to to, to the Balkans.

And, and whereas there are a number of similarities between the, the West and Eastern Europe as, as markets, there are also, I think, distinct features and specificity of some of the models of, of providers who participate in, in the region that are, are very interesting and Will, will come to, to this in, in, in a bit. To, to introduce my panel, I'm gonna start on the, oh, I can see we're not sitting right way, but let's start with Anna Maria, who is from regional Maria. She has, she's m and a director at, at regional Maria, and she's worked in in private healthcare for about 12 years. And,

and before Regina, she was a hospital director of Paneras, which was a hospital bought by by Regina Maria. And she got such great deal added that the, the company put put her in charge of, of, of m and a. And she's done 43 acquisitions for, for the business since in, in that, in that position. And she's partly looking into Romania, of course, but the business now is also in, in, in Serbia.

So that's the provider perspective, if you like. And then we're also joined by, by Paval partner at Mi Ropa, who's a leading private equity, a fund based in the region, does a lot of healthcare, if not exclusively. And over his seven years at MEP has been involved in, in regional Maria, but also at, AT Diagnostic, was recently successfully iPod and Altegra. And he is now co-head of healthcare for, you know, for, for for MMEP.

Anything you guys want to add about your descriptions, Anna, your panel? You wanna say a few words - About May? Maybe just for those who are not familiar with mid, but just in few words. We are a mid cap private equity investor focused on central Europe, originated from the region.

So area of expertise, anything from the Baltic states down to the Balkans. Normally we do tickets of 50 to 200 million Euro equity per one platform. As Giam said, we, we do have quite a lot of healthcare investments apart from that we also do consumer and business services, but healthcare is one of the main verticals where we invest in and, and have been lucky to have some success stories behind that.

- Thank you. Apologies. I finally understood how the clicker works. So we, we really want to touch on two, you know, ma main topic.

One is how attractive the, the region is appreciates. There are multiple countries in the region. There'll be, you know, national differences, but a few salient facts that, that create commonality and some distinction with Western Europe. I'll, I'll set a few, few points of context and then, you know, zoom in more on a, a type of provision model, which is not necessarily completely unique to Eastern Europe, but we see much more in this context or this region.

We, I think we have some Nordic people in the room that recognize aspects of, of, of, of these models. So I'll just set the scene and then you'll hear more from the more interesting people here in, in the room. So how does the region compare? Very high level and stylized with just comparing three countries from western Europe and three countries from, you know, from, from eastern Europe.

Aging is definitely a common, you know, topic population is a bit older in the west, but fairly old as well. In, in, in the east. It's not a major, you know, difference. The underlying demographic and populations are however different.

There is faster underlying population growth in, in Western Europe compared to to, to eastern Europe, which is maybe one of the main reason why, where from a fundamental attractiveness point of view, the west is a bit better in that sense. There is, you know, higher spend in Western Europe compared to eastern Europe. We express tea as a share of, of GDP. We read this as, as at at LEK as a, you know, big catch up, you know, potential.

And as a share of GDP, you know, spend is increasing faster in, in Eastern Europe. There is, and that's in a context where there is, and that's one of the most interesting aspects of the region. A very high degree of private pay to use healthcare services. So we'll talk more about a a this, but if you think in the west, you know, the population is disillusioned about public sector.

Well go to Eastern Europe and people have been in that situation for a very long time, is a long tradition to, to pay, pay private, whether out of pocket or we'll talk more about employer sponsored subscriptions as well. So there, there is a broad acceptance of the private sector and there is, you know, clearly a need for investments here. It's expressed that perspective on, on, on on quality. But certainly the region has a need for more capacity to be invested.

People recognize the need to improve quality. They associate the private sector with more quality than than the public sector. And that, you know, for us gives good, good underlying rationale for, for, for, you know, why we, we do like the, the, the region. So some some points of context scenes.

But I wanted to basically put the question I was just asking, you know, directly to, to, to pave who's, who's been investing, you know, in the region for, for for very long. So we, we, we have a few points on, on the page, but, but parallel please, let's hear it from, from you directly.

- Yes, thank you Guam. I think first of all, as you said, the, the overall macro trends are very similar for c as as for Western Europe with aging society and, and growing, growing needs for healthcare services. What is quite unique, I would say is the higher level of acceptance of the private pay model, which, which is clearly visible in ce. And it goes back to, to the fact that publicly funded healthcare was underserved for many years and therefore the society was forced to, to accept this private pay model both in the subscription part and also fee for service.

And we have some quite sizable success stories behind that. This is the trend that have built Regina Maria, but also the agnostic and and top tegra as as, as companies. And this trend overall, I would say for us as Ropa, we see investment thesis behind businesses in CE as convergence of average per capita spend towards Western European averages. And this applies both to consumer retail but also to healthcare.

And with healthcare provisioning also in the private part, this is not only the discretionary portion, but also the medically necessary procedures which are more resilient, which create additional attractiveness. You had a very nice slide before on the GDP share of healthcare as a spend. You can see for example, Poland here at 6%. I can tell you that just few years back, three, four years ago, it was more of a four to 5% and now the target is actually until 2027 to reach 7%.

So there is a very steep growth of healthcare spend and, and this catch up that we do towards western Europe, but still quite some room to go to, to the levels of Germany or the uk. So we see this as a attractive market giving very positive dynamics, but also quite resilient. And in this dual model, which actually for us for years have been the, the underlying driver for growth of our businesses being the private pay part of the business. Now we see that actually increasingly we can go into more of the public pay procedures, which have been unlocking due to the higher budgets for the, from the public payer.

So this creates a totally new field for us to explore and have more diversification, not only in the private pay, but also in the public part, which we are actually engaging in in all of our businesses.

- Yeah, and and I, and that's a slightly more recent feature of, of these markets and probably Poland first Romania just, you know, 24 months behind, but the, the increase in in public funding to deliver services has been very significant since Covid. But the public sector is still very constrained in terms of investing in capacity. So there's a lot of that public pay funding that's actually accessible to private providers. And whilst I'm generalizing a little bit about the region, generally speaking level of discrimination between public and private providers is, is is low.

It is almost non-existent between, in in secondary care and diagnostic imaging. Tertiary care depends a bit country by country. It's difficult in Lithuania for instance, but the rest of the region pretty well. Primary care, you, you can't consolidate everywhere or not, not not easily, but through the bulk of the, of the market, there is very limited discrimination between public and private providers.

And the tariffs are, you know, the, the, the same.

- I agree. And I would say that on top of that, it's the inc increased public spend. It's not balancing the, the public, the, the private part. So they coexist, they address different verticals.

So still we have big private pay component, which is there for, for the other part of the market than the public pay is now exploring and opening up. So for example, you get oncology treatments, cardiology and even some of the specialized verticals like ophthalmology, which are seeing increased budgets, but they're not jeopardizing the, the budgets that were spent and are still stable in the pri private pay part of the market.

- Yeah. Do you want to come in on Romania in particular with some of the aspects you really like? We - Read this, yes, we read this slide with similar optimism, let's say not, not only because of the catch up potential, but also this dissatisfaction with the public system creates an opportunity for us from two perspectives. There's a 2 billion euro market, 20 billion euro marketing Romania, 30% of it is out of pocket.

So this is where we come in with the private services people are used to pay for healthcare services. Second, we focused on quality. So we get all the international accreditation, we focus on quality and patient safety, and we actually compete with the public system. So this was our opportunity and in a market that has been growing 15% every year, we outpace it by at least five to 7% every year.

So yeah, we read it as a, - Yeah, as - As a very feature, as an opportunity. And - Actually one, one thing you could spend maybe a touch more on time on is to describe a little bit the subscription model, which is again, quite unique to, to eastern Europe, which is, is has similarities but is not an insurance a, a a product. It's, and that's sold by providers. Yeah, - Sure.

It's not an insurance product, it's a prevention product. So we actually, we released these subscriptions 25 years ago in Romania, and we have over 50% market share at this point. So Romania is a market of subscriptions and not private insurance. Out of the 5 billion market in private healthcare services subscriptions fund around 300 million euros, they are actually paid by companies, by employers for their employees to have access to private healthcare for outpatient services and prevention services.

This was our opportunity to actually offer an alternative to the public insurance, which in Romania covers mostly inpatient services. So the money follow the patient and the patient actually benefits from the public insurance insurance when he needs inpatient services. The alternative is a, is the private subscription.

- Yeah. And so I, I think that's one of the key and and obviously there are a number of people from the region who know all of this, you know, very, very well I can see in the room. But from a context of looking into Eastern Europe, from from western Europe, you, you, you know, we talk about private sector as an alternative, as substituting, you know, the, the public sector, that's not exactly the typical narrative. We talk about private sector in, in, in, in, in the west that's certainly more, more, more pronounced and whether it's from subscription or nowadays that public pay tariffs are, you know, more attractive in, in, in Eastern Europe, you know, a clear opportunity that, that you at regional area are leveraging.

And, and more broadly is, is thinking about cross sell and upsell between public and private space. Because as a private provider, you can deliver care for publicly funded and privately funded patients. And people are increasingly thinking about, I can start, you know, offering services on a private pay, but maybe it becomes, you know, cancer care or heavy cardiology intervention. So I can try to switch my patient on a public pay basis and still capture it, capture that patient in network or vice versa.

As we are starting to see more in, in Poland from smaller moms and pop shop, but even the likes of lock at medic cover offering a public pay capitation model to, to residents in, in the country with the clear, you know, view of, of benefiting from that revenue stream, which is at least attractive enough nowadays, but also with, you know, private pay upsell. So it becomes compared to, to my experience, at least in Western Europe, the, the range of revenue streams and how you think about patient value is, is, you know, more, more, more, more profound. I'll, I'll probably get us to next page are clearly differences country by, you know, by country.

Maybe I'll just mention one point about Poland that I particularly like is for public pay tariff, there's basically a mechanism where it's gonna be very unlikely to face staff costs going faster than tariff increase. I think that's a key feature of the, the, the polish market. It's been very attractive in recent years for private providers. Won't be quite as much in the future, but still, you know, very positive.

We like a lot the ability to top up copay in Czech Republic in, in in particular, which, which is quite distinct, which means for a lot of procedure the public sectors cover x and a private provider can charge y on top for, for that procedure. That's for instance not the case in Poland, in in Poland or either fully private or fully public pay. I'm simplifying just, just just a, a, a a a little bit and reia we, we particularly like, because you can also consolidate, you know, primary care and integrate primary care secondary and diagnostic into a comprehensive o offering. So you can see for some of the patients starts to feel like, well, do I need the public sector?

Well, you know, pro probably if you need a very high end a procedure, but for very large chunks of your needs, maybe not. So we, we have a lot of, you know, successful providers in, in, in the region, including models that everybody's quite familiar with. So you have some, you know, hospital specific provider or those who have a, most of their activity in, in in hospital and you have some primary care and you have some, you know, typical, not necessarily single vertical, but but quite focused diagnostic imaging lab, et cetera. And then you have this category in the middle, which is not entirely unique to eastern Europe, but more prevalent with what we've labeled here as integrated healthcare providers.

And that's why we wanna spend a little bit more, more time on in a second and I will talk a bit more about the original Maria model. I won't dwell on this, but, and I I have to redact on bunch of numbers on, on the left here. So you can't necessarily see the maturity of everybody who's, who's listed on this page. You know, these businesses are sizable and they generate, you know, a, a money and they are growing and they offer a wide range of, of services.

They all have a digital enabled, a a component digital enable is a lot about patient engagement. It's, it's less about doing online consultation or a synchronous chat consultation in Eastern Europe. But engagement to, to book rebook, see your benefits Ariat tells you how much you saved if you use Regina Maria than not, for instance, there's a high degree of, of, of digitalization. Anna is gonna do a better job talking about Regina Maria than, than than myself.

I'll let you thank you. Take, take, take over and, and, and talk about your, your model. Thank you.

- So Regina Maria is a healthcare services network with revenues of around half a billion euros. Just have a filling, I think the key word here is integration. So it's not actually a collection of healthcare facilities. You see here we have 60 clinics, six hospitals, 30 imaging centers, around 200 labs and blood collection points.

We have all the services from IVF to oncology, but that's not the key element. The key element is that they are all integrated. So there is one brand, one system, and one digital patient pathway. We focus on digitalization, we focus on quality and patient safe safety.

Three of our hospitals have JCI accreditation and also we look at the market very fragmented. So there are 42 counties in Romania, but we only make money in five of them. So we know exactly what's the strategic region, where we're supposed to go, where the market is. We also map it, map it against human capital, we know where the doctors are.

We also have our own academy of nurses and our own surgical training center for, we grow our own nurses and doctors to be sure that in the long term we have enough human capital to, to support the growth. And we have become, we, we are present in the market for 30 years. We have become an actual alternative to the public system.

- Next page.

- Yeah, a little bit about the market. So what I mean about integration is out of the half a billion euro in revenues, more than a hundred million are actually the 40 targets we acquired in the past eight years. But the important thing is you don't know which is which. So out of the hundreds of facilities that we have across the country, you can't tell the difference between the ones that we bought and the ones that we actually built as a greenfield project.

So for patients and for doctors, they look exactly the same. They have the same brand. So our strategies, we fully integrate everything we acquire. That gives me a headache, as you can, can imagine, because I first need to pitch integration to any target that I might have.

And only then after he or she agrees with the integration, then proceed with the actual process and also, or have been so much easier for me to just acquire 51% and consolidate the numbers. Yeah, just, you know, buy the cake and leave them have the recipe or something like this. But yeah, no, we actually fully integrate and integration creates value. What we do is we go through the process and then we have a very strict integration plan.

We deal with the mess from the very beginning. We change the system, we change the brand, we change everything. There's a headache for everyone for the first three to six months, but then everything is fully integrated again. That creates value for doctors, that creates value for patient.

And we have a unique digital patient pathway in the network. And in, in order for us to be able to do that, we have a platform that is very stable and very mature and it's a perfect for add-ons right now because our organic growth is, is very robust. So we are, we grow organically with more than 10% a year. We only do m and a for strategic add-ons.

As you can see, our funnel is very general, so the market is very fragmented still. Even though the larger largest player, we have barely 10% of market share. So in a market of 5 billion, our, actually our playground, our funnel is around 1 billion euro with more than 200 players, we only acquire five to 10 players a year. So we have a lot of work to do to consolidate the market for the next five to 10 years.

- And, and before you move a little bit to the broader region, one thing that's I think worth, there's many things, but one thing I found particularly striking with your model is, is the level of operational and clinical KPI and at the degree of detail, you, you, you, you, you track it. So I you'll you'll do a better job of describing that a a a little bit, but I think of it quasi real time clinician by clinician tracking that's productivity, but that's also onward referrals, other referrals in network. Are there good reasons for not referring in, in network and, and quality in indicators, but the, the list is, is how many KPIs do you, do you I mean it's, - Yes.

So we're, we're, yes, we're so focused on quality for so many years now that we're very confident on our patient outcomes. So we actually display them. We're very transparent and we display our patient outcomes on the website. All the platforms we actually communicate them.

We have, I have to say, so US and Mayo Clinic, I think we look up to them and whenever they add a new patient outcome, we actually follow their leads and we measure that as well. It's important to say that our app contains around almost 2 million patient portal accounts, 1.75 at this point. Patient portal accounts.

So we have a big community of patients and doctors with whom we communicate very transparently, everything that is related to quality and patient safety and outcomes.

- And, and that, you know, for all of these patients, you have their medical records and they visit you, not exclusively, not necessarily purely area, but a large part of their needs will be addressed, you know, by you. So you have very strong visibility on what, what you know, patients use, what, what they need. And effectively you have a massive CRM database that, you know, is helpful to think about what other services we can, you know, we we we can offer. And of course from a data commercialization perspective that also offers, you know, very significant opportunities.

I think you wanted to say a few words beyond Romania and you know, some of your colleagues from Serbia were also in, in the room.

- Just a few words of a success story that we actually accomplished in the past years outside Romania. So Serbia is part of the family and actually the business in Serbia mirrors the one that we built in Romania. So they're an integrated healthcare network. They offer all the services as we do.

And because Serbia was not a subscriptions market, we actually introduced subscriptions with Regina, Maria knowhow and do sales strategy. So we're doing pretty good and we're writing a new success story in Serbia. I will not comment on this at this point on other regions in Europe, but of course we're mapping the market and we know where market resembles Romania, for example. Poland is very similar to Romania, twice in size in population and market, but very similar as as the healthcare services market.

And there are other examples where the public and the private system collaborate quite, quite in the same manner as we do in Romania. So yeah, we keep an eye open on the region and we each other again, HBI with on the topic - As well News. Yes. Thank you.

So we, we what might come back a little bit to in inter or how, how to think about international expansion in, in, in a minute. So I, I wanted to flash these themes. We discuss some of this point also with, with with you of course Ana and, and parallel to outline a little bit more some of the, you know, gross levers that are accessible to these integrated providers that are a little bit, I think at least more numerous than, than than existing in in most of western market. I'm, I'm, I'm familiar with and of course we're very interested in perspective from, you know, from from from the audience.

I've, I've already mentioned the, you know, the ability to straddle public and, and, and private pay that's quite different from country to country. 'cause in some you can top up in some you can't. But fundamentally speaking, for a lot of providers nowadays, it's not about am I just gonna be private pay or public pay focus. It's, it's a lot about how to combine, you know, both and maybe at different, you know, stages of of care.

You can be very public pay highend procedure for your inpatient activity, but try to have the outpatient a, a network attached to it, which should be much more, you know, balanced public and, and, and, and private pay maybe a slightly more hospital led a a a model familiar with in, in, in Poland I also very much like the, the, the effort that providers make to, to really work around helping clinicians to refer in in network. So, so this aspect of, you know, capturing the demand wi within my a network because I'm offering the right amount of services and that the clinicians are, you know, confident to, to refer I think is is also very important.

Pavel, I'm sure there are other elements you, you, you also, you know, find Yes, yes.

- Thank you, thank you. I think, you know what, what Anna said about the community that you're able to build around the brand is, is hugely important for the further success and the higher leverage you have, the more integrated you are. Yeah, so here we are as an investor, we are also a big believer of the integrated models. We are trying to avoid a loose federation of companies just put together for, for the sake of building a larger group.

We believe that actually the synergies that that you're able to extract are coming from the community that you build the trust to the brand and the additional verticals that you can add. So Regina is also benefiting from that, that you can then further consolidate not only organically, that's also one of the ways to move forward with a slightly longer horizon with the green fields that you can establish in, in different verticals, but also the m and a model and buy and build strategy if properly executed with, with a good follow up and integration - And control - And control over the pathway of the patient then gives you the ability to actually convert all the base of your patients, of your loyal, of your loyal customers, especially in the private pay model that you can convert them into other verticals and ultimately increase the share of wallet, let's say Yeah.

Of the, of the individual patient - And, and think in terms of, you know, lifetime value that they are few businesses in, I mean also few in Eastern Europe, we think in terms of lifetime value, but this is a, you know, this is concept that's actually being used much, much more in, in Eastern Europe than, than than in, in, in, in the west, say, say a few exceptions. And the, I think o overall it's back to this point of the, the, the public sector is so much more absent that provides so much more room for private providers to exercise a, a, a bigger role and, and he more space for brands and integrated offering that, that span the care continuum.

We, we are done with the, the slides and content in terms of some of the key themes we wanted to communicate, but I was, you know, very, very keen to hopefully have a bit of a debate with the audience and partly, you know, have, give, give the chance to ask direct questions to the the, to, to Anna and and and pa. I have a few handful of questions to get us going, but I I I'd be very keen to for the audience to, to, to to, to engage and, and hopefully they have interest, they, they find the topic interesting enough topics to ask. One thing I think we can get reasonably quickly over the line is what about staffing, how staffing, finding the right staff, you know, it's a worry for every provider everywhere.

But as if you had to qualify a little bit how you see this in, in, in the region, are you worried about clinicians going to the west? Is the private sector much more attractive than than public? Can they work across both? That that'd be a, a topic I'm sure a number of people are interested in.

I will - Surprise you with the answer. So it's not at all such a big challenge as it is in the rest of the region. So we're just a little bit below the European Union average in number of doctors and number of nurses per 1000 population. And as I said, we map the country, so out of 42 counties more than 15 are actually above the average.

So we adapt our strategy, our greenfield and our m and a strategy on the counties that have enough human capital. And as I said, we have our own nurses faculty. We actually train our own nurses. It's a three year program that we support for the nurses and they, they stay to and work with us.

So we actually fund their school. And then we have a training center, a surgical training center that has also a da Vinci robot for example. So for advanced surgery, any kind of surgery that you see right now anywhere in the world, we have it in our training center and we train our own surgeons. So yeah, we've been doing pretty, a pretty good job.

And it's not, so there are of course part of the countries, part of the country that has a lack of human resources where we have adapted.

- Yes. And, and maybe you can add a sentence or two on liberal practitioners versus, you know, employees.

- It's a very good system. So public and private system in Romania are, are in a competition but in a healthy one. We're not actually, we don't have any law that says that a doctor needs to choose between the public system or the private one. So they can actually work in the public system and in the private our model is more for the doctors, it's more our hospital is your home.

So we, we try very hard, more than 90% of our doctors are actually full-time in Regina Maria. So we have this ambition that for the hospitals at least they're full-time. But again, there is no restriction in Romania that they cannot work in public and private. So if we're complimentary, we're complimentary in the funding in subscriptions and the, and the public insurance.

So we also have a copay, for example, so for hospitals there's a legal copay for the patient to be able to actually benefit from public insurance and pay an extra charge to the private hospital in order to have better access to treatment or maybe let's say lower waiting time and so on. So the system works quite well. Actually - From my side, I can comment that indeed we have seen a brain drain over the years of, of people living to, to western Europe looking for, for engagements in healthcare currently, I would say. And we are also fortunate enough to work with market leaders who are having fantastic corporate corporate culture, so are able to attract more talent.

But I would say on the adjusted basis for purchasing power, also the region became back more attractive to retain talent locally but also to even have the trend reverting so with people. So it is, it is definitely, you know, it is a topic that that needs to be addressed and handled properly. But in the, in the recent years, we see definitely more positives than 10, 15 years ago - And presumably quite quite a marked change since Covid with that's, you know, with public tariffs increase in medical wages, you know, substantially increase. I I think, you know, litre has committed for another 8% increase for 2026 that's speaking to, to to, to help pay more wages as as, as I said in Poland, the public tariff is anchored around how much you're gonna increase public sector of salaries.

So, so that dynamic is, is much less worrying, you know, since covid than, than than before. And nowadays you have some people coming back have seen, you know, models elsewhere and want to, you know, develop the region. Yep. And turning to the, oh, here we go.

Perfect. I think my microphone is, is is coming so we can all hear you.

- Hello? Oh, there you go. There's been some quite obvious inability politically in Romania over the last six months or so. Very interested in each of your views on Romania and Poland respectively, in terms of political risk both today and over the next, well, the coming years, I suppose, - Let's just say it's not different than most countries in the region.

And on a serious note, so our position, our strategic position for NATO and our border with Ukraine actually makes us a strategic point for Europe defense and for the region defense. So we are optimistic that we are, we have the right alliances to not have any kind of - More incursion attempts. Yeah, - More incursion attempts. Yes, yes.

You really, - Yeah.

- Government regime. So internally, yes, we had elections, we have a new government, we for the first time in our history, but not the first time in other European countries history, we canceled the election after the first tour and we have elections again in May. The list of candidates looks very good right now. So we don't believe we have any other threat as the one that we we had last year that led to canceling the elections.

- My, my perspective Anna, but I, I think the audience wants to have a sense of when the government change, is there a change in healthcare policies and do you need to worry about, you know, everything at every, every turn? No, my my, my answer is, is mostly no, but I'll let you, - It's actually, no, we have, we have a very stable regulatory environment for the healthcare and we have no information. I, no, on the contrary, we have definite information that things will not change for the next five years.

- And I can give a reference, reference point from the Polish market. And we have been through a few cycles of change in the governments and actually the, the entire attitude of the left right wing, and there were quite significant concerns about law injustice, previous government implementing some unfavorable changes, especially for the private, private operators within the public sphere of the, of the healthcare. But actually what we have observed is that this part of the, of the market and, and healthcare provisioning is such an important socially topic that some changes that were implemented were actually surprisingly positive as for the overall attitude towards the, the private providers.

Yeah. So the system was more clear, more transparent with promoting of the providers that provide complex services, which enhances their tariffs and their profitability if they do not cherry pick. So actually the, the entire environment is consistently switching in irrespective of the actual government and the policy that is running the country towards more transparent, more visible and also better funded public healthcare.

- So I, I think you have things like IVF that, that, that is a topic I'd be quite careful, for instance. And, and here that's, you know, the one big change that came in Poland with the coalition, but you know, we, we, we took calls at EK and we like, oh, you know, new government coalition, Poland is gonna be way more attractive. We're like, no, no, no, Poland's already attractive. The change of government is not gonna make a big difference.

And, and you know, it hasn't IVF you know, that, that's obviously a topic that's a, a a little bit different.

- IIVF is a, is a specific one and indeed the current changes are very favorable. But previously starting from oncology through cardiology, even ophthalmology, where we are present in with, with altegra changes were only positives limits have been lifted. Imaging, diagnostics also one of the verticals where one of our portfolio companies diagnostic I entered into a few years ago, these are the re where limits have been lifted. Tys have been increased to make it more, more accessible for the patients to, to address this, this important - Verticals.

And you know, fundamentally speaking, it's an environment. There is not enough public sector capacity and there's no investment in public sector capacity of, of any greater scale. And so, you know, this is not something your ministry of finance is, is gonna tell you, but directly, but they're very happy with, you know, private pay and public pay, privately delivered because it's more, more efficient. The ministry of health, depending on its constituency doesn't necessarily have quite, quite the same perspective.

But the, generally speaking, I would qualify policy makers as as pragmatic. And of course the private sector needs to deliver, you know, value, operate efficiently, efficiently and deliver quality. But it's, it's, it's a permissive environment. The questions we're short on time, but I'm, I'm, I'm sure we can fit one or two more questions.

Klaus, I'm sure you're gonna ask - Digital - Questions.

- Yes, I'm gonna ask digital. I was gonna say, given, you know, already at Reina Maria, you're doing a lot of great digital things, as I hear from my, my colleague Guillaume. I was just wondering, do you see further or any digital m and a on the horizon as well in terms of maybe digital therapeutics, telemedicine, any of those kind - Of efforts? Vertical integr integrations?

You mean efforts for sure. So what we've seen, what we've seen in the past year, the changes that were brought by digitalization and ai, I'm very sure that we will have this in our strategy for, for m and a as well. Yes, - Thank you.

- With maybe one minute left. I, I, I think fa we, we talk a lot about healthcare services, but you might want to say a few words of what, what other sectors, you know, in the regions you, you think are, you know, attractive.

- Sure, happy to indeed. Healthcare services was a big chunk of our portfolio historically, and we, we, we feel quite comfortable in, in the healthcare services space currently. The other verticals where we look into are, let's say more, more pan-European or global opportunities with categories like MedTech or pharma with some opportunities still under review with one of our recent investments in the CDMO space with pharma production. These are businesses where the local aspect is, is less relevant.

It's a hub for, for actually providing products or services more on the pan-European or global scale, which also expand your addressable market quite, quite extensively. So these are the, let's say the, the other two verticals where are currently focusing our attention in healthcare.

- Thank you Anna. Thank you Pave. Thank you all for having join us. We are at time and thank you again.

Thanks.