Group structure and services provided

Our primary operations are in South Africa with additional activities in Botswana. These two countries are collectively referred to as our southern Africa business and represent 76.4% of the Group’s revenue (2016: 92.8%).

Southern Africa business activities are organised into two divisions – the hospital division and healthcare services division. International operations are located in western Europe (Alliance Medical) and Poland (Scanmed) as well as India (Max Healthcare, a joint venture).

1 Earnings before interest, taxation, depreciation and amortisation.

Southern Africa1

Hospital division

The hospital division provides healthcare services primarily to the private medically insured market. It is composed of the acute hospital business and complementary services.

  Facilities Beds/stations
Business 2017 2016 2017 2016
 
Acute hospitals 50 50 8 152 beds 8 067 beds
Complementary services        
Acute rehabilitation 7 7 319 beds 319 beds
Mental health 8 7 512 beds 437 beds
Renal dialysis 24 22 303 stations 281 stations
Oncology 4 2 n/a n/a
1 An outline of Life Healthcare’s southern Africa facilities can be viewed at www.lifehealthcare.co.za

quick facts

In South Africa:

  • We have market share of approximately 21% of private hospital beds.
  • Life Healthcare owns 50 of the 63 hospital properties that we operate from.

Acute hospitals

Life Healthcare’s various acute hospitals are largely located in metropolitan areas in seven of South Africa’s nine provinces, and Botswana. These general hospital facilities include intensive care units (ICUs), high care units, operating theatres, emergency units, maternity units, cardiac units and paediatric units.

Facility types include:

  • high-technology, multi-disciplinary hospitals offering highly specialised medical disciplines;
  • community hospitals;
  • same-day surgical centres; and
  • dedicated niche facilities.

Approximately 2 934 (2016: 2 850) doctors and specialists, as well as various other healthcare professionals, support the delivery of effective and empathetic care through these state-of-the-art facilities.

Complementary services

Complementary services are specialised healthcare facilities that provide inpatient and outpatient services in the areas of acute rehabilitation, mental healthcare, renal dialysis and oncology. Our specialised care models promote continuity of care and uniquely position Life Healthcare to provide comprehensive therapeutic interventions for chronically ill patients.

Acute rehabilitation

Life Rehabilitation provides acute physical and cognitive rehabilitation for patients disabled by brain or spinal trauma, stroke or other disabling injuries or conditions. Life Rehabilitation uses the Functional Assessment Measure (FAM) for cognitive, behavioural, communication and community functioning, which are of importance concerning patients with brain injuries. Each patient’s clinical outcomes and overall progress are measured objectively to benchmark the performance of rehabilitation units and demonstrate clear patient outcomes to patients, their families and medical healthcare funders.

Life Rehabilitation is the only ISO 9001:2008 certified rehabilitation network and the only official licence holder for the Functional Independence MeasureTM (FIMTM) in South Africa.

Mental health

Life Mental Health provides multi-disciplinary mental healthcare services to adult and adolescent patients. It caters to liaison psychiatry, general psychiatric conditions and substance dependence. Our facilities are designed for transitionary care, and they support voluntary, assisted and involuntary patients. We further operate theatres with full anaesthetic capability for electroconvulsive therapy. In addition to our general psychiatric services, we have a suite of specialised care services for geriatric patients and persons with adjustment disorders brought on by, i.e. post-partum, work stress and divorce. Life Healthcare has dedicated mental health facilities in the Western Cape, Eastern Cape, KwaZulu-Natal and Gauteng.

Renal dialysis

Life Renal Dialysis has specialised units for treating patients with renal dysfunction that require acute and chronic renal dialysis. The renal offering includes peritoneal dialysis, inpatient nocturnal dialysis and mobile renal dialysis services.

Oncology

Life Healthcare offers technologically advanced diagnostic and interventional oncology services supporting comprehensive cancer management. Our holistic care model focuses on extensive patient counselling and support including chemotherapy, surgery and radiotherapy (comprising brachytherapy and stereotactic radiotherapy). Our investment in linear accelerators and treatment planning software provides targeted, accurate and effective treatment for a variety of cancers.

Healthcare services division

Healthcare services relate to specialised care and occupational health services by Life Esidimeni and Life Employee Health Solutions respectively.

  Facilities Beds
Business 2017 2016 2017 2016
 
Life Esidimeni (public sector contracts) 11 9 3 080 2 424
  Clinics Employees cared for
Business 2017 2016 2017 2016
 
Life Employee Health Solutions 366 371 471 699 419 659
Life Occupational Health 288 297 222 895 159 685
Careways 78 74 248 804 259 974
       

Life Esidimeni

Life Esidimeni operates a network of care centres through public-private partnership (PPP) contracts with the South African provincial health and social development departments. Life Esidimeni provides long-term chronic mental healthcare, frail care rehabilitation, step-down care, correctional services, primary healthcare and substance abuse recovery programmes to patients from the public sector.

Life Employee Health Solutions

Life Employee Health Solutions is delivered by Life Occupational Health and Careways. Life Occupational Health is a provider of contracted on-site occupational and primary healthcare services to large employer groups in the commercial, industrial, mining and parastatal sectors. Use of Life Occupational Health’s clinics is largely driven by the requirements of the Occupational Health and Safety Act, 85 of 1993 (OHSA), and the needs of corporate customers. Life Occupational Health has ISO 9001:2008 and BS OHSAS 18001:2007 certifications and operates on-site, off-site and mobile clinics throughout the country.

Careways encourages and supports healthy and balanced living in employees, improving their well-being and promoting maximum productivity for employers. Careways’ employee wellness services are provided to 226 companies and institutions across the public and private sectors. The Group acquired the EOH Workplace Health and Wellness business with effect from 1 October 2017.

International operations

Alliance Medical Group Limited

Alliance Medical is a leading diagnostic imaging services provider in western Europe. The business is uniquely positioned through a vertically integrated model that provides services across the imaging value chain. The business offers a number of diagnostic imaging services with a focus on magnetic resonance imaging (MRI), computerised tomography (CT) and molecular imaging via positron emission tomography-computerised tomography (PET-CT) services. These services are predominantly supplied to public funders, such as the National Health Service (NHS) in the UK and Azienda Sanitaria Locale (ASL) in Italy, and various public and private funders across Europe. The business also performs radiopharmacy activities. This entails the manufacture of radiopharma-ceuticals for PET-CT scanning operations and clinical trials. Refer to Performance review: Alliance Medical for detail on each service offering.

Alliance Medical’s primary operations are in the UK, with significant operations in Italy and Ireland. Additional activities take place in Spain and in the business’s northern Europe geographic segment (principally in the Netherlands, Germany, Finland, Bulgaria, Austria, France, Norway and Poland).

quick facts

The Group’s total investment in international businesses:

Alliance Medical (western Europe)

R13.9 billion (acquisition effective 21 November 2016). We have a 93.78% shareholding in Alliance Medical Group Limited.

Scanmed (Poland)

R2.2 billion (2016: R2.2 billion). We have 100% shareholding in Scanmed S.A.

Max Healthcare (India)

R2.9 billion (2016: R2.5 billion). We have a 49.7% (2016: 45.95%) shareholding in Max Healthcare Institute Limited.

The business primarily provides MRI, CT and PET-CT scans in the UK, principally through PPPs with the NHS. This is facilitated by 73 diagnostic imaging scanners at 49 diagnostic imaging sites, and 41 mobile scanners.

The business’s embedded partnership with the NHS was secured under a 10-year fixed price contract until 2025. The contract secures the provision of all PET-CT scans in England across 31 cancer centres that operate under a national governance framework. Clinical leadership for this framework is provided by our partner and the largest cancer centre in Europe – the Christie NHS Foundation Trust, also known as “the Christie”.

In Italy, Alliance Medical has the largest network of community-based diagnostic imaging clinics. These provide MRI, CT and PET-CT services in addition to other, more basic diagnostic services. These clinics provide health solutions to local communities.

The business’s geographic operations are set out below.

Scanmed S.A.

Business 2017 2016
     
Facilities 40 40
Cardiac units 12 12
Beds 624 624

Scanmed is a private healthcare and medical services provider in Poland, operating in 40 locations across 23 cities. The cardiology business contributes 40% (2016: 43%) of revenue, and government-related contracts make up 75% of total revenue. Scanmed provides coordinated healthcare for private and institutional patients using public and private sources of financing. This includes inpatient hospitalisation, primary healthcare, medical consultations, diagnostics, analytical tests, medical transportation and home visits.

Max Healthcare Institute Limited

Business 2017 2016
     
Facilities 12 12
Beds 2 375 2 384

Max Healthcare is a leading hospital chain in India. The business operates state-of-the-art hospitals in Delhi-NCR, Punjab and Uttarakhand.

Max Healthcare provides a broad range of specialties including advanced cardiac care, orthopaedics, oncology, renal sciences, neurosciences, metabolic and bariatric surgery, obstetrics and gynaecology, paediatrics, nephrology, general surgery, diagnostic services and emergency services.

Life Healthcare does not manage the day-to-day operational and management activities of Max Healthcare, but rather plays an active shareholder role in the operation of the business.