Alzheimers

Alzheimer’s: China’s Looming Health Challenges — The Diplomat

 

 

 

 

Trans-Pacific View author Mercy Kuo regularly engages subject-matter experts, policy practitioners and strategic thinkers across the globe for their diverse insights into the U.S. Asia policy. This conversation with Peter Fuhrman Chairman, Founder and Chief Executive Officer of China First Capital, Ltd.is the 109th in “The Trans-Pacific View Insight Series.”  

With 9.5 million diagnosed Alzheimer’s sufferers in China, why is Alzheimer’s the country’s biggest future health problem?

I would broaden it to say that the treatment of chronic diseases, with Alzheimer’s at the forefront, is the largest future challenge to China’s national healthcare system. From a country that in living memory only offered a very rudimentary system of barefoot doctors, who were often nothing more than well-meaning but untrained quacks, China in 20 short years has expanded genuine healthcare coverage to all corners of the country, providing acute care and medications to the vast majority of its citizens. That’s an enormous achievement; one that’s done more good for more people than probably any other government initiative anywhere at any time. Chronic diseases, on the other hand, were never a focus, indeed never much of a problem. But, Chinese life expectancy has lengthened dramatically, thanks in part of the improvement in the delivery of acute health services. Chinese are now living as long as people in Europe and the United States. The result: China is already feeling the strain of millions of older ill folks with no real treatment options in place. The demographic die is already cast. Within 25 years, China will become a more geriatric society, where at least 25 percent of the population is over 65. Chronic disease will become commonplace, more prevalent than in any other country.

What cultural challenges hinder or help Chinese society in managing Alzheimer’s?    

The generation of people now growing old in China had limited expectations, as they mainly grew up in dire poverty. As they aged, they accepted more stoically that society couldn’t provide much assistance except for immediate medical emergencies. Their children and grandchildren, however, are constituted differently. They often have education and expectations similar to people in the West, including that there should be quality treatment options in China for every medical issue, as there are in the U.S., Europe, Japan, and elsewhere. They increasingly want better treatment for their sick parents, and will certainly expect even more for themselves when they grow older and are diagnosed with chronic diseases like dementia and Parkinson’s, or need extended care and rehabilitation after a stroke or heart attack, both quite common in China. There is still so little care available in China to fulfill this growing need.

What can China learn from the United States and Europe?

Probably the key lesson is to not to expect, as too many in the U.S. and Europe did, a big breakthrough in Alzheimer’s care, the development of drugs to arrest the progress or undo the damage of the disease. The sad reality is despite huge sums spent on research, we’re as far away from such a medical miracle as we were 20 years and at least $20 billion ago. Instead, China needs to foster the development of thousands of quality treatment centers for Alzheimer’s patients, to care for them according to the best global standards, to lengthen and enrich their lives. This requires along with lots of new buildings a huge number of trained doctors, geriatricians, specialist nurses, and aides.

Describe differences between Chinese rural and urban treatment of Alzheimer’s.

Quality healthcare in China is still available mainly in large national hospitals located in major cities. Though the number of rural Chinese with Alzheimer’s is large and growing fast, there is virtually no professional care available for them locally. The government is seeking to change this, not only for chronic diseases, to raise the standards of healthcare in small cities and rural townships, to relieve the huge disproportionate burden on the big urban hospitals.

Identify opportunities for the international healthcare industry in addressing China’s looming Alzheimer’s challenge?  

Over the next 40 years in China, there is no single area offering better investment fundamentals than chronic care, including the care of Alzheimer’s. Sober forecasts are, by 2045, there will be over 40 million Chinese with Alzheimer’s, four times the number presently. By then, it’s likely half the total number of Alzheimer’s cases worldwide will be here in China. As of today, there are fewer than 500 beds in China for patients needing specialist Alzheimer’s treatment. A French company, Orpea, has a first mover advantage, having already opened a world-class facility in Nanjing. In financial terms, quality Alzheimer’s and chronic care provides very solid returns. As or more important, though, is that the benefits will be captured also by Chinese society as a whole. This will certainly be one of those areas where investors will do quite well by doing good, by contributing to a China where the diseases of old age will be competently managed and families kept happy and intact for longer.

 

As published by The Diplomat

 

 

 

Fresh Ideas For Making Money in China Private Equity and Venture Capital

money-tree2

2016 is looking like it may be another year to forget for PE and VC in China.  The problem, as always, is with exits. For years, IPOs in China for PE-backed deals have been too few and far between.  There was initially a lot of  hope for improvement this year. But, prospects unexpectedly turned bleak when the Chinese securities regulator, the CSRC, suddenly reversed course. Not only did they put on hold previously-announced plans to liberalize IPOs by opening a new “strategic board” in Shanghai and to shift to a registration-based IPO system, they also began clamping down hard on the two main exit alternatives, backdoor shell listings and trade sales to Chinese listed companies.

IPO multiples remain sky-high in China. The IPO queue sits at 830 companies, with at least another 700 now lined up to get provincial approval to join the main waiting list. The CSRC did finally announce one liberalization of the IPO regime in China, but it will likely be of little help to the hundreds of PE and VC firms with thousands of unexited deals. Companies based in China’s poorest, most backward areas, the CSRC announced earlier this month, will now get to jump to the head of the queue.

Not for the first time, it looks like PE and VC portfolios may be mismatched with IPO regulatory policy in China. PE and VC firms have of late invested overwhelmingly in two areas. First is healthcare. The industry in China is growing and reforming. But, entry valuations have been bid up to astronomical levels.

In terms of number of deals closed, Chinese tech startups are getting the lion’s share of the attention. China’s online and smartphone population as well as e-commerce industry, after all, are the world’s largest. What’s missing at most of the funded startups are profits or a high-probability path to making money one day soon. Many are using PE money as part of a “last man standing” strategy to win customers by subsidizing purchases. Loss-making companies are still barred from having an IPO in China.

The main building blocks of China’s corporate sector, manufacturing companies and bricks-and-mortar businesses, are both highly out of favor with PE firms.

Amid so much misfortune, where should the PE and VC industry look next to invest profitably in China? What seems most clear is that any strategy linked to short-term IPO exit-chasing, or seeking to intuit the next flux in CSRC policy, has proved fundamentally risky. Some fresh approaches may be in order.

One priority should be on backing companies that can deliver sustainably high margins and positive cash flow over time to support regular dividend payments. Invest more for yield and less for capital gains.

There are such investment opportunities in China. I want to share six here. There are certainly many others. Looking outside the current China PE investment mainstream has other pluses. A troubling term has entered the Chinese financial vocabulary in the last two years, called “2VC”. It means a Chinese company started and run primarily for the purpose of attracting PE and VC money and less about making money from customers. 2VC deserves a detailed analysis of its own, how much it may be warping the investment landscape in China.

GPs and LPs looking for durable margins, scaleability, and a dearth of competition in China could start their search here:

  1. Robotics gearbox. China’s robot industry is hot. By now, about everyone has read the stories suggesting China’s robotics market, already the largest in the world, will boom for decades to come. For now, the investment money in China has gone overwhelmingly into companies that are making simple robots, rather than the robot industry supply chain. This overlooks perhaps the best opportunity of all. Robots rely on sophisticated gearboxes to make parts move. Making and selling gearboxes, rather than the final robot, is where the big margins and demand are. The technology has been around for a while, but the industry is dominated by two big foreign manufacturers, ABB of Switzerland and Rexnord of the US. They make a ton doing it. A Chinese robotics gearbox maker, assuming they get the product right, could immediately roll up sales in the hundreds of millions of dollars, both to Chinese robot makers as well as US, European and Japanese ones. From conversations I’ve had with C Level execs at both ABB and Rexnord, this is the Chinese competition they fear most, but which to their surprise has yet to materialize.  —————————————————————————–
  2. Hospice and specialized late stage care. PE investment in healthcare, especially into biosimilar pharma companies, hospitals and clinics for plastic surgery and dental care has been abundant, averaging well over a billion dollars a year in China. Competition is rampant in all these areas. Late stage critical care, however, has largely gone unfunded. The unmet need in China is almost unfathomably large. There are basically no hospices in China, though some 10 million Chinese die every year, including a surging number from cancers and long-term chronic diseases. There are also 30 million Chinese with Alzheimers and virtually no places offering specialized care. The number of Alzheimers sufferers is rising fast as Chinese longevity surges. Make no mistake, it’s harder to provide this kind of medical care than to do Botox injections. But, anywhere money is easily made in China, it’s getting harder to make any money at all. The biggest provider of specialized high-end late stage care in China is the French company, Orpea. They are doing a great job. I’ve had a close look at their business in China. They too are awed by the scale of the untapped market in China. A big plus: pricing freedom. The business doesn’t rely, as most conventional hospitals and drug companies in China do, on state reimbursement. —————————————————————————————————————————
  3. Dog food and other pet items. When I first came to China in 1981, it was basically illegal to keep a dog or cat as a pet. There was barely enough food to feed the human population and food was rationed. To say the growth in pet ownership since then has been explosive would risk understating things. China is now the third largest dog-owning market globally, with 27.4 million dogs (behind the US with 55.3 million dogs and Brazil with 35.7 million), and the second largest cat-owning country with 58.1 million cats, behind only the US with 80.6 million. China’s pet market will soon blow past that of the US. Everywhere this is presenting great opportunities in pet care, pet food, pet hotels. The US pet food giant Mars has a large chunk of the dog food market here. But, there are still many opportunities to carve out a niche in pet food, both via sales at veterinary clinics and online. The other vast uncharted market: pet insurance.   ——————————————————————————————–
  4. Server storage. Chinese law mandates that the country now has and will continue to have the largest ongoing demand for high-end servers, as well as the software that powers them. The reason: all the major sources of online traffic — Alibaba, Tencent, JD.com, Baidu — must permanently store virtually everything that runs across their network. In the case of Tencent’s Wechat business, that means keeping billions of text, audio, video and photo messages generated every day by its 600 million users. Tencent’s ongoing investment in servers is almost certainly larger than any other company in the world, with the other big Chinese internet companies following closely behind. The growth rate is dizzying. This has created a wonderful profit-center for otherwise troubled chip giant Intel. Its Xeon chips power virtually all high-end servers. No single domestic company has yet emerged to build a sizeable business in storage software, maintenance and integration tailored to the regulatory needs in China. In parallel, there’s also a large market for similar made-at-home software solutions to sell to the Chinese government. They are the reason all this server storage demand exists.   ————————————————————————————————————————————————
  5. Mall-based attractions. Shopping malls in China are in a fight for survival. Clothing retailers, which just two to three years ago took at least half the floor space in Chinese malls, are disappearing. They can’t compete with online merchants offering the same products for one-third to one-half less. The going has proved especially hard for Chinese domestic retail brands, quite a few got PE money back when this sector was hot. Chinese malls need to change, and fast. Their main strategy so far is increasing the floor space allocated to restaurants and movie theaters. Another area with huge potential, but so far little concrete activity, is “edu-tainment” attractions. A prime example is a mall-based aquarium. I was recently shown around one-such mall aquarium in a major Chinese city by its owners, a large Chinese real estate developer. Though they initially knew nothing about aquariums, their design and selection of fish are mediocre, the owner is coining money with over 45% margins. Tickets sell days in advance, not just on weekends, for average of $15 for adults and less for kids. It’s been open and thriving for three years. Every mall they are building now will have a similar attraction. A better operator should be able to push margins higher and roll out nationwide. On average, 55 million Chinese go to the mall each week. —————————————————————————–
  6. Indoor LED vegetable growing.  China has a big appetite for vegetables, about 100 kilos per person per year, or seventy billion tons. Many Chinese, especially the 55% living in cities, have concerns about where and how the vegetables are grown and how they get to market. The worry rises in lock step with per capita income.  Catering to worried Chinese consumers could keep a company in profit for decades. One good idea that’s not yet in China but should be: growing vegetables indoors, using LED lights.The cost of LED lighting has fallen by over 90% since 2010 and will continue to decline, thanks in large part to over-investment in this sector in China. LED efficiency has also nearly doubled over that time. It now costs about the same to grow vegetables indoors with LEDs as it does in well-irrigated farmland. Supplying vegetables to urban China this way has a lot of other advantages, including the ability to provide a secure chain of custody, from the place where the food is picked all the way to the customer’s hands. Lots of models would work in China — large growing areas inside abandoned urban factories to supply better Chinese supermarket chains like Walmart, Carrefour and China Resources, or smaller-scale packages home-delivered or sold through vending machines placed inside high-end residential complexes in China. Organic or non-organic, catering to Chinese picky consumers could keep a company in profit for decades.

Since PE first took off in China in 2005,  China’s economy has grown by almost four-fold. Few GPs in China have done as well in DPI terms. It’s likely not going to get any easier to make or raise money, nor to rack up IPO exits. More than ever, PE firms need to back or incubate ideas to catch and hold some of the new wealth that’s getting created every day in China.

As published by SuperReturn