longer, healthier, happier lives

128 Pages·2013·7.15 MB·English

ANNUAL REPoRT 2012
LONGER,
HEALTHIER,
HAPPIER LIVES
BUPA ANNUAL REPoRT 2012
2012 HIGHLIGHTS
GROuP REVENuES (uP 4%)
£8.4bn
GROuP uNdERLyING PROFIT BEFORE TAx (uP 8%)
£604.0m
Underlying proft is defned in the Financial review on page 19
REVENuES By MARkET uNIT PROFIT/(LOSS) By MARkET uNIT
43% 43% 48% 48%
30% 30% 19% 19%
14% 14% 19% 19%
3% 3% (2%) (2%)
10% 10% 16% 16%
A ustralia and New Zealand
U nited Kingdom
S pain and Latin America Domestic
I nternational Development Markets
I nternational PMI
See the full segmental results on page 69
TOTAL CuSTOMER NuMBERS (uP 9%)
2012 (11.8m)
2011 (10.8m)
PROGRESS TOWARdS OuR WELL WORLd GOALS
Keeping people well
By 2015, we will have enabled 60 million people to make positive changes
to be healthier and happier and to help protect the environment.
18 million
Supporting a healthy planet
By 2015, we will have reduced our absolute carbon footprint by 20%.
4.8%
Cover image: Jon Sinclair and family walking in Albert
Read more about Bupa’s Well World at bupa.com/wellworld Park, Melbourne, where they took part in the 2012 Memory
Walk organised by Bupa in partnership with Alzheimer’s
Australia. Jon is a resident of Bupa’s Windsor Care Home
in Melbourne.
Bupa annual report 2012 1
tS rate GCI report
Introduction 1
Bupa at a glance 2
Our business model 3
Chairman’s statement 4
Chief Executive Ofcer’s
statement 7
Longer, healthier, happier lives:
Geof’s story 12
Gita’s story 14
Sue’s story 16
Financial review 18
Market Unit reports:
Our purpose – longer, healthier, Australia and New Zealand 22
United Kingdom 24
happier lives – drives everything we
S pain and Latin 26
do. Our new strategic vision defnes America Domestic
I nternational 28
how we will bring that purpose to Development Markets
beneft more people around the world. International PMI 03
Our people 23
During 2012, we developed a new vision Our Well World goals – to have enabled Risks and uncertainties 34
for Bupa in 2020 that will enable us to 60m people be healthier and to reduce
reach millions more people. our carbon footprint by 20%, both by
G oeV rnaneC report
2015 – are integral to our business, which
In it, we have set out our focus on being
is why our Well World data is integrated Chairman’s introduction 38
a healthcare partner to millions more to Governance
throughout this report.
people around the world, on delivering
The Board of Directors 04
extraordinary business performance, Our Annual Report and Accounts are
and on being an organisation where also available online, where you can Governance leadership 24
people love to work. access even more information on Bupa. Efectiveness 4
Find out more on page 8 Go to annualreport.bupa.com Engagement 54
Audit Committee report 64
To deliver our vision and bring us closer
Risk Committee report 48
to our customers, we reorganised
our business in 2012. Now operating Nomination & Governance 94
as Market Units, we are better Committee report
positioned to serve our customers Stuart Fletcher Medical Advisory Panel 05
as their healthcare partner. Chief Executive Ofcer Remuneration Committee report 25
Find out more on page 9 Remuneration report 54
Report of the Board of Directors 95
Statement of Directors’ 06
responsibilities
F In anaIC l S tateM entS
Independent auditors’ report 26
Financial statements 36
Five year fnancial summary 123
International Financial 124
Reporting Standards
relevant to Bupa
View our Annual Report and Accounts online
For video and other additional information, go to
annualreport.bupa.com
STrATEGIC rEPorT GovErNANCE rEPorT FINANCIAL STATEMENTS
2 Bupa annuaL report 2012
STRATEGIC REPORT
BUPA AT A GLANCE INTErNATIoNAL PMI
° Bupa International
° Bupa Latin America
Our 11.8 million customers live in over 190 countries.
Total customers: 0.7m
Our services include health insurance and other
funding products, hospitals and primary care centres, Total employees: 1,600
chronic disease management, home healthcare,
dental centres, prevention and workplace health,
and care services, including residential and nursing
homes and retirement villages. Our business is
managed in fve Market Units.
UNITEd KINGdoM INTErNATIoNAL
° B upa Health and Wellbeing dEvELoPMENT MArKETS
° B upa Care Services UK ° Bupa Arabia
° B upa Home Healthcare ° Max Bupa, India
° Bupa Cromwell Hospital ° Bupa Hong Kong
° Bupa China
Total customers: 2.8m ° Bupa Thailand
° Health Dialog, USA
Total employees: 31,700 ° N ew Market Development
Total customers: 2.2m
Total employees: 800
ToTAL CUSToMErS SPAIN ANd LATIN AUSTrALIA ANd NEw ZEALANd
AMErICA doMESTIC ° Bupa Australia
11.8m ° Sanitas Seguros ° Bupa Care Services Australia
° Sanitas Hospitales and New Services ° Bupa Care Services New Zealand
ToTAL EMPLoyEES ° Sanitas Dental
° Sanitas Residencial Total customers: 3.5m
54,000 ° Latin America Domestic Development
Total employees: 10,400
ToTAL CoUNTrIES Total customers: 2.6m
190 Total employees: 8,400
M arket Unit customers or employees
T otal customers or employees
Bupa annuaL report 2012 3
STRATEGIC REPORT
ProvIdING hEALThCArE
oUr BUSINESS ModEL We deliver healthcare to customers
in our own hospitals, clinics, dental
centres and primary care centres, and
Bupa is a global healthcare company. We fund and in a range of other settings. Our chronic
disease management services help
provide quality healthcare around the world in a range individuals make and sustain lifestyle
of settings, including clinics, dental centres, hospitals changes to manage their condition and
and care homes. Our services span complex acute improve their health. We also provide
treatment to patients at home, which
care to preventative wellbeing and we engage millions can improve patient experience while
of people in their health, providing them with trusted also reducing costs.
information and advice. Bupa is a leader in care services,
providing nursing and residential care
to over 30,000 residents in the UK,
Spain, Australia and New Zealand.
our business model is shaped by FUNdING hEALThCArE
Our dementia expertise is world-leading.
our commitment to serve customers Through insurance, subscriptions
We are setting best practice in person-
as their healthcare partner. and other funding solutions, we fund
centred care, including through our
healthcare on behalf of our 11.8m
We are focused on creating person- dementia care nursing training.
customers across the globe.
centred health systems that deliver the
ENGAGING PEoPLE ANd
right intervention in the right place at the We have a network of 7,500 hospitals
SUPPorTING BEhAvIoUr ChANGE
right time. We are committed to meeting and clinics and more than 200,000
Our services also include preventative
customers’ needs across life stages. medical providers worldwide.
healthcare, including identifying high
As an expert in funding and in providing We partner with healthcare professionals risk groups and providing support
healthcare, we are able to deliver high to help us deliver the right treatment to and advice to improve their health.
quality patient care while managing patients and to design patient-centred
We reach out beyond our customers to
costs, essential to keeping high quality care pathways.
provide health information, advice and
care accessible.
support to people across the world.
This includes our online resources which
were accessed by 12m people in 2012.
In 2012, our Global Challenge helped
oUr BUSINESS ModEL 97,000 people to get walking, a simple
way to improve health. Under our Well
World goals, we will have enabled 60
million people to make positive changes
to be healthier and happier by 2015.
We will also reduce our carbon footprint
by 20% by 2015.
We fund Foundations in Australia,
ENGAGE Spain and the UK which provide grants
PEOPLE AND for healthcare research. Our total
SUPPORT charitable donations in 2012, including
BEHAVIOUR to our Foundations, was £4.1m.
CHANGE
AN INTEGrATEd ModEL
While we adapt our business model
to refect individual markets’ needs
and opportunities, we believe that
an integrated approach – combining
healthcare funding and provision – ofers
FUND PROVIDE signifcant advantages to customers.
HIGH QUALITY, HIGH QUALITY, It brings better oversight of the patient
AFFORDABLE AFFORDABLE journey and this helps us to make
HEALTHCARE HEALTHCARE better healthcare more accessible and
afordable. This has been demonstrated
in our work in Valencia, Spain on behalf
of the Valencian regional government.
Find out more on page 6
STrATEGIC rEPorT
Lg, ali,
happi
li
4 Bupa annuaL report 2012
STRATEGIC REPORT
I am more convinced than ever that
ChAIrMAN’S our status – without shareholders and
therefore free to reinvest profts into
STATEMENT more and better healthcare – is critical
to the relationship we have with our
customers and business partners.
2012 was a year of considerable change for Having no shareholders, we are held
Bupa, and at the same time we also reafrmed to account by independent Association
Members, who receive no fnancial
our enduring purpose. In the year, pressure beneft from Bupa. They are committed
on healthcare spending – and on provision to seeing us discharge our purpose
efectively.
models – remained intense. We also saw
Our status is of particular value when
trends in health further converge across
trust in other organisations has been
developed and developing economies. questioned and eroded. People are
looking for new models and changed
cultures for value creation in society as
well as a diferent kind of accountability.
BoArd hIGhLIGhTS FroM 2012
° Stuart Fletcher and Evelyn Bourke
joined the Board as CEO and CFO
respectively. New to Bupa, they
bring with them rich experience
and expertise. They underwent
a detailed induction programme,
including one-to-one meetings,
site visits and detailed briefngs on
Bupa’s performance and history.
As a Board, we welcomed Stuart
Fletcher as he took the role of Chief ° To strengthen our governance and
Executive ofcer. Along with his oversight, we split our Audit, Risk
Executive Team, he undertook extensive & Compliance Committee in two.
work in developing a vision for Bupa’s The Audit Committee now focuses
future. we now have a clear defnition of on fnancial statements, and the
how we will pursue our purpose – longer, efectiveness of internal controls
healthier, happier lives – to beneft many systems and of auditors; the
more people across the world. Risk Committee focuses on risk
appetite, risk management
To position us better to deliver our vision,
and compliance.
we reorganised the business around
Market Units, bringing us closer to our ° Succession planning was a key
customers. We also welcomed a new theme for 2012, with three Board
Chief Financial Ofcer, Evelyn Bourke, members nearing the end of their
to the Board. term. Retirement dates have been
phased to ensure an orderly
Lord Leitch On governance, the Board made a series
Chairman of changes to strengthen our oversight succession.
of the business. Following a review, we ° The Remuneration Committee
separated our Audit, Risk & Compliance undertook a review with external
Committee in two. We implemented support to benchmark its activities
an enhanced Corporate Governance and developed an action plan.
Statement, which includes more
disclosures. The Remuneration ° We adopted a new Corporate
Governance Statement with the
Committee also undertook a review
aim of increasing the disclosure
with support from external advisors.
of our governance arrangements
Combined, these and other actions and the workings of each of the
further strengthen Bupa’s governance Board’s Committees.
and transparency, both of which are
essential to safeguarding trust in read more in Governance on page 38
our organisation.
Bupa annuaL report 2012 5
STRATEGIC REPORT
These are areas where I believe Bupa’s Globally, the number of individuals
model has a lot to ofer. with diabetes is projected to rise to ProjECTEd rISES IN
552m by 2030, or 10% of the world’s NoNCoMMUNICABLE dISEASES
Bupa is at an infection point in terms of
adult population, 80% of which will be Diabetes2
the healthcare services that people need 2
in developing countries. Latin America, 371m
and in Bupa’s development in meeting
the Middle East and sub-Saharan Africa
those needs. The Board is excited about 552m
are predicted to see a near tripling of
the impact the new vision – Bupa 2020 –
ischemic heart disease and stroke
will have, and the step change in delivery 3 Dementia7
mortality over the next two decades.
it signifes.
In 2008, cancer accounted for the 35.6m
oUr MArKETPLACE deaths of 7.6m people – 13% of all 65.7m
Bupa serves customers living in almost deaths worldwide. More than 30%
every country around the world. Across of these could be prevented, mainly
markets, we are seeing a number by reducing tobacco usage, but also
GLoBAL dEAThS CAUSEd
of key trends that drive individuals’ through a healthy diet and lifestyle and
4
4 cancer
healthcare needs. They are shaping moderating the consumption of alcohol.
our marketplace today and will see 7.6m
Growing global middle class
it radically transform over time.
As well as this convergence in health 13.1m
Converging global health risks risks, we are seeing a growth in middle
8
Health risks are converging across the classes in developing economies and an Heart disease
world and across economies, underpinned associated trend of urbanisation, which 17.3m
by common risk factors, principally an itself can be a driver for behaviours
23.3m
unhealthy diet and physical inactivity. which negatively impact health. More
Changes to lifestyles and diets as people than ever now live in cities and by
 Current  2030
societies industrialise have signifcant 2050, around two thirds of the world’s
5
implications on populations’ health. population is expected to be urban.
The impact is immense. By 2030, it is Middle class consumers have increased
estimated that chronic diseases will expectations of the services they want,
cost US$47trn and will represent a including from healthcare, as they
developmental as well as health challenge.1 become more aware of their needs
and their ability to aford choice.
Ageing and ageless societies
“C hronic diseases
The global population is ageing sharply.
The percentage of those aged above 60 represent a
years at the turn of the millennium was
developmental,
around 10% – this is projected to rise to
20% by 2050.6 This phenomenon is not as well as health,
confned to developed economies, with
challenge.”
many developing economies being only
a few decades behind as birth rates
decrease and life expectancy increases.
This demographic shift represents
both the success of, and a challenge
to, healthcare systems. The critical
challenge it presents is the increase
in the number of people living with
dementia. By 2050, more than 115m
UrBANISATIoN ANd hEALTh
people across the world are projected
The number of people living in cities is
to have the condition, raising massive
set to rise to 5bn worldwide by 2030. 7
challenges in care, treatment and cost.
This growth will largely be unplanned.
A key trend that we are seeing 1 ‘ The Global Burden of Noncommunicable Diseases’,
People who move to cities increase World Economic Forum, 2011.
associated with the ageing population 2 ‘ Atlas 5th Edition’, International Diabetes
their chance of developing chronic
is that people are thinking more about Federation, 2012 Update. 2012 data.
conditions, such as diabetes, through 3 ‘ The Global Burden of Chronic Diseases:
the kind of old age they want. In reality, Overcoming impediments to prevention
greater exposure to risk factors including
they want to be ageless – they want to and control’, Derek Yach, 2011.
greater use of motor transport, too 4 ‘ Cancer Factsheet’, World Health Organization,
keep well and they want to preserve 2013. 2008 data.
little physical activity and unhealthy
the independence and lifestyle they 5 ‘ World Urbanization Prospectus: The 2011 Revision’,
diets, as well as increased exposure United Nations, 2011.
enjoyed while younger. There is a 6 ‘ World Population Ageing 1950-2050’, United
to greenhouse gas emissions.
growing need for care solutions that Nations, 2002.
7 ‘ Dementia: A public health priority’, World Health
preserve individuals’ independence. Organization, 2012. 2010 data.
read more in Bupa’s win-win report on 8
‘ Cardiovascular Conditions Factsheet’, World
bupa.com/wellworld
Health Organization, 2012. 2008 data.
STrATEGIC rEPorT
6 Bupa annuaL report 2012
STRATEGIC REPORT
Changing family structures Implications for Bupa
ChAIrMAN’S
The impact of ageing populations, The challenge to deliver better health
STATEMENT
combined with increased expectations to more people has never been greater.
CoNTINUEd around lifestyle and independence, In each of these areas, we see huge
is exacerbated by changes in family potential for our business – to deliver
structures. At a time when growing the services that individuals need in a
numbers need support, family support way that they want at a price they can
is declining. This is not just for the elderly aford, be that directly, through their
but also for those with chronic conditions employer or via government.
or disabilities. These factors are creating
The great risk, which is not confned
a need for alternative care solutions.
to Bupa but extends across healthcare,
Price sensitivity is that a broad spectrum of quality
Increasingly, consumers only want to pay care ultimately becomes unafordable.
for services that are relevant to them. This
We are addressing this challenge head
desire for more personalised services
on, as can be seen in the strategic vision
is linked to a focus on seeing value for
Stuart sets out for the business. I believe
money. New technologies contribute to
that our potential to make a signifcant
this growing expectation as individuals
diference to millions of people’s lives
have ever greater power to access the
across the world has never been greater
information and services they want.
and our focus never sharper.
Environmentalism and sustainability
Board news
Finally, consumers want to make
I want to take this opportunity to thank
sustainable choices. There is a much
the Board for the past twelve months –
greater understanding that lifestyle
particularly for their energy and passion
impacts the environment and that this,
in a year of huge change. Particular
in turn, impacts health and wellbeing
thanks go to Baroness Bottomley, whose
– from water use to food scarcity to
six year tenure on our Board concludes in
air pollution. Consumers increasingly
April 2013. She has been a great source
want to know that the products and
of wisdom and her contribution to this
services they use are economically
business has been invaluable.
and environmentally sustainable and
ShIFTING ThE vALUE FroM CUrE do not adversely impact on health. Finally, I want to thank our people. There
To PrEvENTIoN IN vALENCIA, SPAIN is a shared value of care – for customers,
A shift in value for healthcare
In Spain, Bupa’s Manises hospital covers their families and each other – and I
One consequence of these trends
14 towns and a population of 195,000 regularly see our people going well
is a shift from treatment to prevention.
people in Valencia, on behalf of the beyond what is expected and required.
We are beginning to see health systems
region’s government. We also manage This commitment is what makes Bupa
assessing healthcare risk and aligning
20 primary health centres and two extraordinary. I’m very proud of what
incentives to produce the best outcomes
speciality centres. we have achieved together and excited
at an afordable price. In Spain, for
about what is ahead.
As well as providing world class, example, we have seen the efective
innovative hospital care, Sanitas operation of an innovative Public-Private
works with the local population to Partnership (PPP) in Valencia which
keep them well and diagnose and has moved health management from
treat conditions early. the public to the private sector. The
Lord Leitch
Valencian government has reformed
This can reduce the likelihood of health
Chairman
the funding and provision of care – and
issues becoming critical and improve
Bupa is at the heart of this partnership.
health outcomes. For example, we have
improved our performance in controlling With the increased prevalence of chronic
the risk factors for cardiovascular diseases, managing health risk involves
conditions, compared to 2011. helping individuals to take steps to
reduce their risk indicators – namely
to be healthier. While breakthroughs in
areas like robotic surgery get headlines,
in many countries 70% of healthcare
costs are driven by chronic disease and
the most important levers to improve
outcomes and reduce costs are not
necessarily clinically sophisticated.9 They
can, however, be challenging to deliver
as they require individuals to make and 9
‘ The almanac of chronic disease’, Partnership to
sustain signifcant lifestyle changes. Fight Chronic Disease, 2009.
Bupa annuaL report 2012 7
STRATEGIC REPORT
We also announced our intention to
ChIEF EXECUTIvE acquire Innovative Care’s care homes.
Now completed, the deal added more
oFFICEr’S STATEMENT than 1,100 beds and made us Australia’s
largest private care services provider.
Organic growth in our development
We launched a new strategic vision, Bupa markets continued apace, with Bupa
2020, accelerating our pace of growth and Mexico, one of our health insurance
operations, driving good growth in
delivery. In the year, we delivered strong customer numbers as a result of
growth, with revenues up 4% and underlying opening six new sales ofces and
launching new products.
proft up 8%, maintaining our record of
We also accelerated our plans to make
year-on-year growth since the start of quality healthcare more afordable and
the global downturn. accessible, and ensure health insurance
delivers tangible value for money.
In the UK, we provided detailed evidence
to the Competition Commission to
call for remedies that deliver greater
competition, efciency and transparency
in the private healthcare provision
market. There are no easy solutions,
but a lack of competition between
hospitals and information on quality
of care is pushing up the cost of
insurance premiums, which continue
to rise at unsustainable levels.
Also in the UK, we made changes to
address excessive claims infation driven
both by private hospital and consultant
fees and practices. The changes, while
Bupa’s performance in 2012 was
not always popular, are necessary to
particularly strong given the economic
ensure more UK customers are able to
conditions in a number of our markets,
access afordable, high quality private
especially in Europe.
healthcare. There is still much to do but
We created new, innovative, lower we have created a foundation to turn
cost products for corporate customers, this market around.
for the self-employed and for individuals.
We grew our business in ways that, we
Our international private medical
believe, allow us to deliver quality health
insurance business developed products
outcomes. In Spain, our integrated
that are more fexible and tailored
to the needs of the individual. health funding and provision model
continued to provide diferentiation in
In Australia we supported families and the market, enabling growth. This model,
niche groups with specialist services based on quality of health outcomes, is,
and advice. we believe, a good model for the future
We expanded dental provision in of sustainable quality healthcare.
Stuart Fletcher Spain and the UK and are currently We acquired the remaining 40% share
Chief Executive Ofcer in negotiations with the shareholders in our Public-Private Partnership (PPP)
of Dental Corporation, Australia and in Valencia and purchased a 50% stake
New Zealand’s largest dental business, in Torrejón Hospital in Madrid, our
to purchase the business’s 190 clinics. second PPP. The business performed
The transaction is subject to the majority very well despite a challenging
of shareholders voting in favour of a economic environment.
scheme of arrangement. In December 2012, we announced our
Also in Australia and New Zealand, intention to acquire LUX MED, Poland’s
we extended our retail ofering with largest private healthcare company.
two new dental centres providing eye Subject to regulatory approval,
care, health screenings and nutrition LUX MED will make Bupa the largest
and wellbeing advice. New care homes company in Poland’s private healthcare
were opened or acquired across the funding and provision markets, adding
two countries adding 640 beds. 1m new customers.
STrATEGIC rEPorT
8 Bupa annuaL report 2012
STRATEGIC REPORT
ChIEF ageing populations, rising levels of
chronic disease, and new treatments
EXECUTIvE will continue to fuel demand for
oFFICEr’S healthcare and drive our growth.
STATEMENT Around the world, our combination
of healthcare funding and provision
CoNTINUEd expertise, our integrated model, and
our international operations will
continue to diferentiate us.
A NEw vISIoN For BUPA
In 2012, the newly created Bupa
Executive Team focused on creating an
ambitious vision for what Bupa will look
like in 2020. The development of Bupa
2020 was a major area of work. This new
strategic vision sets our direction and
In health funding, LUX MED is Poland’s focus for the next decade. As an executive team, in asking ourselves
market leader in medical subscriptions. how Bupa will better fulfl its purpose,
In provision, it has a national network Bupa is a great company with a rich we challenged ourselves to identify
of outpatient clinics and diagnostic heritage. As CEO, I see my role as how to accelerate our growth to reach
centres, as well as a day hospital and a providing the leadership that will enable us millions more people in more places
large nursing and residential care home. to realise Bupa’s full potential; in essence, to more efect.
Its model aligns with Bupa’s ambition to fulfl our distinctive and inspiring
to see greater integration between purpose – longer, healthier, happier lives. We also asked how we will make our
purpose count in the eyes of customers,
healthcare funding and provision. An important enabler of our delivery
healthcare systems and the communities
We are in a good position to grow our of that potential is our status, which within which we operate, and with our
business in 2013 through a combination was a great attraction for me when own people, the ingredient which truly
of organic growth, acquisition and deciding to join Bupa. It maximises makes Bupa special.
partnership. Difcult economic the degree to which we can pursue
conditions will continue in Europe but growth opportunities for the beneft We believe that the conclusions we
increasing consumer expectations, of customers and society more broadly. reached are exciting and motivating for
all our stakeholders around the world.
The key elements of Bupa 2020 are
BUPA 2020 summarised here:
C we will deliver our purpose through
T
HI V bmeoinreg pae hoepallet hacroaruen pda trhten ewro trol dm. illions
We intend millions more customers will
enjoy better health because of Bupa.
To achieve this goal, trust is essential,
and we intend our customers to trust
us and recommend us unreservedly.
We will also engage tens of millions
more people around the world in their
health and wellbeing. Under our Well
World sustainability agenda, we have
Lg, committed to helping 60m people
make positive changes to be healthier
ali , and happier by 2015.
we will reach millions more people
happi li
as we deliver extraordinary business
performance.
We will build on our success to deliver
O strong and sustainable revenue and
S proft growth, which will ultimately
O I
provide the means for us to reach more
R people and better fulfl our purpose. To
support our eforts, we will be fnancially
disciplined and ensure we invest to
create long-term economic value.
As we can have a big impact on the
world’s health, we are also committed
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