Fresenius Medical Care AG (FMS) 2023 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by. My name is Emma, your Chorus Call operator. Welcome, and thank you for joining the Fresenius Medical Care report on the second quarter 2023 Earnings Results. (Operator Instructions) I would now like to turn the conference over to Dominik, Head of Investor Relations. Please go ahead, sir.

女士們先生們，謝謝你們的支持。我叫艾瑪，是你們的合唱呼叫接線員。歡迎並感謝您關注費森尤斯醫療保健 2023 年第二季獲利結果報告。 （操作員指示）我現在想將會議轉交給投資者關係主管 Dominik。請繼續，先生。

Thank you, Emma. As mentioned by Emma, we would like to welcome you to our earnings call for the second quarter 2023 from a cold and rainy Bad Homburg. We appreciate you joining us today to discuss the performance for the second quarter. I will, as always, start out the call by mentioning our cautionary language that is in our safe harbor statement as well as in our presentation and in all the materials that we have distributed earlier today. For further details concerning risks and uncertainties, please refer to these documents as well as to our SEC filings.

謝謝你，艾瑪。正如艾瑪所提到的，我們歡迎您在寒冷多雨的巴特洪堡參加我們 2023 年第二季的財報電話會議。我們感謝您今天加入我們討論第二季的業績。一如既往，我將在電話會議開始時提及安全港聲明、簡報以及今天早些時候分發的所有資料中的警示性語言。有關風險和不確定性的更多詳細信息，請參閱這些文件以及我們向 SEC 提交的文件。

We will try to keep the presentation short and leave time for questions. As always, we would like to limit the number of questions again to two in order to give everyone the chance to ask questions. Should there be further questions and time left, we can go a second round. It would be great if you could make this work again. Unfortunately, we are limited to 60 minutes for the call.

我們將盡量保持演講簡短並留出提問時間。像往常一樣，我們希望再次將問題數量限制為兩個，以便讓每個人都有機會提問。如果還有其他問題並且還有時間，我們可以進行第二輪。如果您能讓這項工作再次發揮作用，那就太好了。不幸的是，我們的通話時間僅限 60 分鐘。

With us today is Helen Giza, our CEO and Chair of the Management Board and until the 1st of October, also our acting CFO. With that, Helen, the floor is yours.

今天與我們在一起的有海倫·吉薩 (Helen Giza)，她是我們的首席執行官兼管理委員會主席，也是我們的代理首席財務官 (直到 10 月 1 日)。好了，海倫，地板就是你的了。

Thank you, Dominik. Welcome, everyone. Thank you for joining our presentation today and for your continued interest in Fresenius Medical Care. I'll begin my prepared remarks on Slide 4.

謝謝你，多米尼克。歡迎大家。感謝您今天參加我們的演講並感謝您對 Fresenius Medical Care 的持續關注。我將從幻燈片 4 開始我準備好的演講。

Earlier this year, we laid out our strategic plan to unlock value as the leading kidney care company. We are actively executing against this plan and today, I am very pleased to be able to highlight several meaningful proof points that demonstrate tangible progress to date.

今年早些時候，我們制定了戰略計劃，以釋放作為領先腎臟護理公司的價值。我們正在積極執行該計劃，今天，我很高興能夠強調幾個有意義的證據點，這些證據點展示了迄今為止的實際進展。

At the beginning of the year, our new operating model was implemented. And last quarter, we rolled out the corresponding new financial reporting. This leaves the simplification of our governance structure as the one outstanding structural element and our extraordinary general meeting in July was an important step towards completing this aspect of the plan.

今年年初，我們實施了新的營運模式。上季度，我們推出了相應的新財務報告。這使得我們治理結構的簡化成為一個突出的結構要素，而我們 7 月的特別股東大會是朝著完成該計劃這一方面邁出的重要一步。

Following the 99.88% approval by voting shareholders in support of our change in legal form, all necessary administrative, compliance and regulatory steps are moving forward, and the entire process is still expected to be completed by the end of the year. At the same time, we continue to advance our operational efficiency and turnaround plans.

在獲得99.88%投票股東支持我們的法律形式變更後，所有必要的行政、合規和監管步驟正在推進，整個過程預計將在今年年底完成。同時，我們持續提高營運效率和周轉計劃。

Our FME25 transformation program is well on track to deliver EUR 250 million to EUR 300 million in sustainable savings by the end of the year. And in the second quarter, we realized an additional EUR 75 million in sustained savings. This is positively impacted by the 53 net clinic closures in the U.S. that we have completed in the last 3 quarters, and we plan to close up to 100 clinics as part of this program.

我們的 FME25 轉型計畫進展順利，預計到年底可持續節省 2.5 億至 3 億歐元。在第二季度，我們額外實現了 7,500 萬歐元的持續節省。這受到過去 3 個季度我們在美國淨關閉 53 家診所的積極影響，作為該計劃的一部分，我們計劃關閉多達 100 家診所。

It's very encouraging to see the execution against our strategic turnaround plans has resulted in visible productivity improvements, most notably in Care Delivery. This contributed to achieving a second quarter margin of 10.4%, which is promising as it is already at the bottom end of our 2025 target margin band for the segment.

看到我們的策略週轉計劃的執行帶來了明顯的生產力提高，尤其是在護理服務方面，這是非常令人鼓舞的。這有助於實現第二季 10.4% 的利潤率，這是有希望的，因為它已經處於我們 2025 年該細分市場目標利潤率範圍的底部。

Our strategic plan also includes a careful reassessment of our portfolio assets and R&D efforts as we focus on sustainable profitable growth assets. and seek to divest noncore assets and dilutive assets. In the previous quarter, we decided to discontinue the development program for a PD cycler, and more recently, we announced the strategic divestments of clinics in Sub-Saharan Africa and Hungary. These exits demonstrate progress against our portfolio optimization strategy. It is also important to us that we have found reputable and well-established partners to ensure the continuity of care to the patients who had entrusted us with their care.

我們的策略計劃還包括對我們的投資組合資產和研發工作進行仔細的重新評估，因為我們專注於可持續獲利成長資產。並尋求剝離非核心資產和稀釋資產。在上一季度，我們決定停止 PD 循環儀的開發計劃，最近，我們宣布策略性撤資撒哈拉以南非洲和匈牙利的診所。這些退出表明我們的投資組合優化策略取得了進展。對我們來說同樣重要的是，我們找到了信譽良好且信譽良好的合作夥伴，以確保對委託我們護理的患者提供連續性的護理。

As a reminder, portfolio optimization effects are excluded from our 2025 target margin band since the timing of the execution is dependent to a large degree on various external factors. This played out difference to our expectations, for example, in the second quarter. Since our Capital Markets Day, we have received many requests to size the impact of our divestitures. Therefore, I would like to give you at least of an idea of how it could impact our revenues, should we execute on everything under review through the end of 2025. In this case, we could see a negative impact from the overall portfolio optimization on 2025 revenues of up to EUR 1.5 billion. Under the same assumptions, we expect a positive impact on margins.

提醒一下，我們的 2025 年目標保證金範圍不包括投資組合最佳化效應，因為執行時間在很大程度上取決於各種外部因素。這與我們的預期有差異，例如在第二季。自資本市場日以來，我們收到了許多要求評估我們資產剝離的影響的請求。因此，我想至少讓您了解，如果我們在2025 年底之前執行所有正在審查的事項，這將如何影響我們的收入。負面影響。在相同的假設下，我們預計會對利潤率產生正面影響。

As you heard me say before, the resulting cash proceeds will be used towards deleveraging in line with our disciplined financial policy. I am also proud of the fact that as we execute against our strategic plan, we are simultaneously driving a winning culture focused on accountability, along with an ongoing commitment to sustainability. We remain a mission-focused company with our patients front and center in everything we do. Turning to Slide 5.

正如您之前聽我說過的，由此產生的現金收益將根據我們嚴格的金融政策用於去槓桿化。我還感到自豪的是，當我們執行我們的策略計劃時，我們同時推動了一種注重問責制的製勝文化，以及對永續發展的持續承諾。我們仍然是一家以使命為中心的公司，我們所做的一切都以患者為中心。轉到投影片 5。

To that extent, we are continuously monitoring our clinical performance to enhance care. An important KPI in this regard is our Global Quality Index. The quality index considers dialysis effectiveness, vascular access and anemia management. Through the second quarter, we continue to see sequential stability at a high level. I will move to Slide 7 to review our second quarter business performance.

從這個意義上說，我們不斷監測我們的臨床表現以加強護理。這方面一個重要的關鍵績效指標是我們的全球品質指數。品質指數考慮了透析有效性、血管通路和貧血管理。在第二季度，我們繼續看到較高水平的連續穩定性。我將轉到投影片 7 來回顧我們第二季的業務表現。

In the second quarter, we saw an acceleration in organic revenue growth driven by both operating segments. This includes sequentially stable treatment volumes in Care Delivery U.S. I'm encouraged to see proof of strong underlying trends beginning to translate into improved financial performance. The execution progress I have mentioned in the beginning is also clearly visible when looking at the second quarter.

在第二季度，我們看到兩個營運部門推動的有機收入成長加速。這包括美國護理服務的治療量持續穩定。我在開頭提到的執行進度在第二季也清晰可見。

First, the execution against our strategic turnaround plans has resulted in visible productivity improvements in Care Delivery. Secondly, our performance in the second quarter was also supported by savings resulting from our FME25 transformation program. Thirdly, we continue to execute on our portfolio optimization strategy with the announced divestments of two international markets and are actively working on divestments of other dilutive and noncore assets.

首先，我們的策略週轉計畫的執行使護理服務的生產力得到了明顯的提升。其次，我們第二季的業績也得益於 FME25 轉型計畫帶來的節省。第三，我們繼續執行我們的投資組合優化策略，宣布撤資兩個國際市場，並積極致力於其他稀釋性和非核心資產的撤資。

Given our stronger than planned earnings development through the first 6 months, we are narrowing our full year 2023 operating income guidance range, which I will speak to later on. Turning to Slide 8.

鑑於我們前 6 個月的盈利發展強於計劃，我們正在縮小 2023 年全年營業收入指導範圍，我將在稍後討論。轉到投影片 8。

In the second quarter, we delivered revenue growth of 6% at constant currency and we continue to deliver accelerated organic growth with positive contributions from both segments. This development is driven by favorable pricing in both segments by positive volume development and Care Enablement and growth in the value-based care business within Care Delivery. During the second quarter, operating income on a guided basis improved by 44%. This results in a group margin of 8.3%. Earnings development in the second quarter was bolstered by reduced personnel expense resulting from improved productivity as well as from improved business performance supported by FME25 savings.

第二季度，以固定匯率計算，我們的收入成長了 6%，並且在這兩個部門的積極貢獻下，我們繼續實現加速的有機成長。這項發展是由兩個細分市場的有利定價、積極的銷售發展和護理支援以及護理交付中基於價值的護理業務的成長所推動的。第二季度，指導營業收入成長了 44%。集團利潤率為 8.3%。第二季的獲利成長得益於生產力提升以及 FME25 節省支援的業務績效改善所帶來的人員費用減少。

Although we have seen a degree of stabilization, our business still faces the expected inflationary pressures. That particularly impacts our Care Enablement segment. Next, on Slide 9.

儘管我們已經看到一定程度的穩定，但我們的業務仍然面臨預期的通膨壓力。這尤其影響我們的護理支援部門。接下來，在投影片 9 上。

This slide shows the contributions to the operating income development by operating segments compared to the prior year second quarter. Starting from the left, you can see how we get to the starting point of our guidance basis. From the contributions of the two operating segments, Care Delivery represents 88% and Care Enablement 12%. The EUR 44 million special items in the quarter relates to EUR 25 million in FME25 costs and the remaining EUR 19 million relates to charges associated with our legacy portfolio optimization, the Humacyte investment remeasurements and costs associated with the conversion of legal form. Turning to Slide 10.

這張投影片顯示了與去年第二季相比，各營運部門對營業收入發展的貢獻。從左側開始，您可以看到我們如何到達指導基礎的起點。從兩個營運部門的貢獻來看，護理交付佔 88%，護理支援佔 12%。本季 4,400 萬歐元的特殊項目涉及 2,500 萬歐元的 FME25 成本，其餘 1,900 萬歐元涉及與我們的遺留投資組合優化、Humacyte 投資重新計量以及與法律形式轉換相關的費用。轉到投影片 10。

Revenue growth for Care Delivery was driven by organic growth, which was supported by a positive impact from our value-based care book of business in the U.S., reimbursement rate increases in both the U.S. and international markets and a favorable payer mix in the U.S. In Care Delivery U.S., same-store treatment growth was virtually stable on a sequential basis and at the midpoint of our volume assumption of minus 1 to plus 1 for the year. This reflects mortality trends effectively at pre-pandemic levels and still muted new starts as we move through the annualization of COVID-19-related excess mortality in the late-stage CKD and ESRD populations.

護理服務的收入增長是由有機增長推動的，這得益於我們在美國基於價值的護理業務、美國和國際市場報銷率的提高以及美國有利的付款人組合的積極影響。成長季比基本穩定，且處於我們今年銷售假設（負1 至正1）的中點。這有效地反映了大流行前水平的死亡率趨勢，隨著我們對晚期 CKD 和 ESRD 人群中與 COVID-19 相關的超額死亡率進行年化分析，新的開始仍然較少。

Earnings were positively impacted by lower personnel expenses resulting from improved productivity with a meaningful contribution coming from the continued optimization of our clinic network. Also savings from FME25 and business growth contributed in a meaningful way. In Care Delivery International, organic growth was supported by the effect of hyperinflation in various markets. As I highlighted earlier, we also executed on our portfolio optimization strategy with international market exits in Sub-Saharan Africa and Hungary and continue to progress further divestment decisions. Next, on Slide 11.

生產力的提高帶來了人員費用的降低，而診所網路的持續優化也做出了有意義的貢獻，這對獲利產生了積極的影響。 FME25 的節省和業務成長也做出了有意義的貢獻。在 Care Delivery International 中，有機成長受到各市場惡性通貨膨脹影響的支持。正如我之前強調的那樣，我們還執行了投資組合優化策略，退出了撒哈拉以南非洲和匈牙利的國際市場，並繼續推動進一步的撤資決策。接下來，在投影片 11 上。

On this slide, we show how these trends have translated into financial performance. Care delivery revenue increased by 6% on a constant currency basis, driven by a 6% organic development for the reasons I just outlined on the previous slide. In addition to positive business growth and FME25 savings development, Care Delivery also experienced a net positive labor and inflation development in the quarter. The tailwind is mainly driven by a low prior year comparable in the second quarter and by improved productivity.

在這張投影片上，我們展示了這些趨勢如何轉化為財務表現。在 6% 的有機發展的推動下，護理服務收入按固定匯率計算增長了 6%，原因我剛剛在上一張幻燈片中概述了。除了積極的業務成長和 FME25 儲蓄成長之外，護理服務在本季度還經歷了積極的勞動力和通貨膨脹淨增長。推動這一勢頭的主要因素是第二季度的可比水平較低以及生產率的提高。

While we experienced a labor tailwind in the first half of the year, we will face a different prior year comparable in the second half. Overall, while the market is stabilizing, we are still monitoring and managing key hotspot markets and implementing measures as needed. Therefore, for the full year, we still expect a labor cost headwind in line with our guidance assumptions. Turning to Slide 12.

雖然我們在上半年經歷了勞動力順風，但下半年我們將面臨與去年不同的情況。整體而言，在市場穩定的同時，我們仍在對重點熱點市場進行監測和管理，並根據需要採取措施。因此，就全年而言，我們仍然預期勞動成本將面臨與我們的指導假設相符的阻力。轉到投影片 12。

Care Enablement revenue was supported by higher sales of machines for chronic treatment, critical care products and home hemodialysis products as well as increased average sales prices driven by the first impact of our targeted pricing measures. On the earnings side, second quarter business growth is muted by the negative currency transaction effects. The inflationary pressures are developing as expected. In the second quarter, Care Enablement saw a positive benefit from FME25 savings driven by organizational as well as manufacturing and supply chain initiatives. Next, on Slide 13.

慢性治療、重症護理產品和家庭血液透析產品的機器銷售增加，以及我們的目標定價措施的首次影響推動的平均銷售價格上漲，支撐了護理支持收入。在獲利方面，第二季的業務成長因貨幣交易的負面影響而減弱。通膨壓力如預期般發展。在第二季度，Care Enablement 看到了由組織以及製造和供應鏈計畫推動的 FME25 節省所帶來的正面效益。接下來，在投影片 13 上。

Here, we look again at how these trends have translated into financial performance in this operating segment. Care Enablement revenue increased by 6% on a constant currency and organic basis. This was driven by the reasons I outlined on our previous slide. On a guided basis, operating income for Care Enablement increased to EUR 19 million. The improved operating income was driven by FME25 savings as well as positive business growth, which already includes the negative currency transaction effects, I mentioned earlier.

在這裡，我們再次審視這些趨勢如何轉化為該營運部門的財務表現。以固定匯率和有機基礎計算，護理支援收入增加了 6%。這是由我在上一張投影片中概述的原因所驅動的。在指導基礎上，Care Enablement 的營業收入增加至 1,900 萬歐元。營業收入的改善是由 FME25 儲蓄以及積極的業務成長所推動的，其中已經包括我之前提到的貨幣交易的負面影響。

Operating income was partially offset by inflation, which, as assumed in our guidance continues to be the biggest headwind for this business. Year-over-year, the margin has improved as planned. As laid out at our Capital Markets Day, the measures we are taking in Care Enablement to get into the 2025 target margin band will take time. Turning to Slide 14.

營業收入部分被通貨膨脹所抵消，正如我們在指導中所假設的那樣，通貨膨脹仍然是該業務的最大阻力。與去年同期相比，利潤率按計劃有所改善。正如我們在資本市場日所闡述的那樣，我們在「護理支援」中為達到 2025 年目標利潤率範圍而採取的措施需要時間。轉到投影片 14。

In the second quarter, we experienced a strong cash flow development compared to the prior year period. The increase in net cash provided by operating activities was driven by seasonality in invoicing and improved cash collection as well as a weaker prior year comparable due to CMS' recruitment of advanced payments previously received under the Medicare accelerated and advanced payment program in 2020 in the second quarter of 2022.

與去年同期相比，第二季我們的現金流成長強勁。經營活動提供的淨現金增加的原因是發票的季節性和現金收款的改善，以及由於CMS 在第二季度吸收了之前在2020 年醫療保險加速和預付款計劃下收到的預付款，導致上年同期較弱。

Supported by our disciplined capital allocation policy, the quarter delivered strong free cash flow conversion. Our leverage ratio was 3.4x remained in our target corridor of 3 to 3.5x. As it is still at the upper end of this self-imposed range, deleveraging remains our top capital allocation priority, with any proceeds from divestments to be used for deleveraging. I'd like to finish with our update to the outlook on Slide 16.

在我們嚴格的資本配置政策的支持下，本季實現了強勁的自由現金流轉換。我們的槓桿率為 3.4 倍，仍處於 3 至 3.5 倍的目標範圍內。由於仍處於這自我設定區間的上限，去槓桿仍然是我們資本配置的首要任務，撤資的任何收益將用於去槓桿。我想以投影片 16 上的展望更新作為結束語。

For 2023, we continue to expect revenue to grow at low to mid-single percentage rates. For our earnings outlook, we initially guided for a flat to high single-digit operating income decline for 2023. Based on our stronger than assumed earnings development in the first quarter and again in the second quarter, we are confident to narrow our operating income guidance range from a flat to high single-digit decline by around 600 basis points. We now expect operating income to remain flat or decline by up to a low single-digit percentage range. It's important to me that we provide a realistic but careful guidance that we have a clear path to achieve.

2023 年，我們繼續預期收入將以低至中單百分比成長。對於我們的獲利前景，我們最初預計 2023 年營業收入將出現持平或高個位數下降。持平到高個位數下降約600 個基點。我們現在預計營業收入將維持不變或下降至低個位數百分比範圍。對我來說重要的是，我們提供了現實而謹慎的指導，我們有一個明確的實現路徑。

Operating income improved sequentially and year-over-year, due to stronger-than-expected operational performance. But we carefully need to take into consideration the many moving pieces, like labor headwinds, continued impact from inflation and potential currency transaction impacts in the second half of the year as well as a higher comparable in the prior year.

由於經營業績強於預期，營業收入較上季及年比有所改善。但我們需要仔細考慮許多變化因素，例如勞動力逆風、通膨的持續影響、下半年潛在的貨幣交易影響以及上一年的較高可比性。

Even after considering all these moving parts, I feel confident with our new considerably narrowed operating income guidance range. And of course, we are fully confident in our path to unlock value as the leading kidney care company and to achieve an improved operating profit margin of 10% to 14% in 2025. That concludes my prepared remarks. I'll now hand it back to Dominik.

即使在考慮了所有這些變化因素之後，我對我們大幅縮小的新營業收入指導範圍仍然充滿信心。當然，我們對作為領先的腎臟護理公司釋放價值並在 2025 年實現營業利潤率提高 10% 至 14% 的道路充滿信心。我現在把它還給多米尼克。

Thank you, Helen, for your presentation and the insights. Before I hand over for the Q&A, I would like to remind everyone to limit your questions to two, please, so that everyone has a chance to ask questions. And with that, I'll hand it back to Emma to open the Q&A, please.

謝謝海倫的演講和見解。在進行問答之前，我想提醒大家，請將問題限制在兩個以內，以便大家都有機會提問。接下來，我會將其交回給艾瑪，請她開始問答。

(Operator Instructions) First question is from the line of Victoria Lambert with Berenberg.

（操作員說明）第一個問題來自維多利亞·蘭伯特（Victoria Lambert）和貝倫貝格（Berenberg）的線路。

First one is just on geographies as medical care now want to stand. So you guys are out of Hungary, you're out of Sub-Saharan Africa. What would you consider your core geographies (inaudible) the U.S., obviously? And then my second question is just on the outlook for the business, how we can expect margins to develop in H2, given the margin performance between Q1 and Q2 was pretty volatile. I would just like to get a steer on how we should think about that.

第一個是關於地理位置，因為醫療保健現在想要站立。於是你們離開了匈牙利，離開了撒哈拉以南非洲。顯然，您認為美國的核心地理位置（聽不清楚）是什麼？然後我的第二個問題是關於業務前景，考慮到第一季和第二季之間的利潤率表現相當不穩定，我們如何預期下半年的利潤率會發展。我只是想知道我們應該如何思考這個問題。

Victoria, thank you for your questions. On your first one regarding geography, rather than getting into specific countries and geographies for obvious reasons, I think I would just come back to how we are thinking about the countries in CDI, and as I've outlined previously, I would put those into 3 buckets. There's kind of the core markets that we feel are reimbursement friendly, are profitable and that we feel that we can continue to grow those markets. Then there's a middle bucket of markets where they are profitable, we feel that we can improve the performance with a bit more focused efforts and maybe run those out over time with a tail as needed if we don't see a way to kind of improve the profitability over time. And then there's a third bucket, which are either unprofitable, they're smaller in scale, we don't feel that we can do anything with them, and there is likely a better owner than us for those markets.

維多利亞，謝謝你的提問。關於你的第一個關於地理的問題，我想我不會出於明顯的原因進入特定的國家和地區，我想我會回到我們如何思考CDI 中的國家，正如我之前概述的那樣，我會將這些放入3 桶。我們認為有些核心市場是報銷友善的、有利可圖的，我們認為我們可以繼續發展這些市場。然後是中間的市場，它們是有利可圖的，我們認為我們可以透過更集中的努力來提高效能，如果我們看不到改進的方法，也許可以根據需要隨著時間的推移將這些結果用完。隨著時間的推移的獲利能力。然後還有第三個桶，它們要么無利可圖，要么規模較小，我們覺得我們無法對它們做任何事情，而且這些市場可能有比我們更好的所有者。

So clearly, you can see with Africa and Hungary, they were kind of falling into that third bucket, and we will continue to move those forward at pace. As you probably all appreciate, we can only communicate once we have definitive signed agreements, so the timing of these is difficult to project. We know what we have in flight, and I think that's why we're trying to size it. But at the same time, kind of be very clear in the focus there.

很明顯，您可以看到非洲和匈牙利，他們有點落入第三個階段，我們將繼續加快步伐。正如你們可能都意識到的那樣，我們只有在簽署了明確的協議後才能進行溝通，因此很難預測這些協議的時間。我們知道我們在飛行中擁有什麼，我認為這就是我們嘗試確定其規模的原因。但同時，重點要非常明確。

Look, on your second question about the outlook for H2. I'm not going to give you margin guidance by CE and CD. We've obviously guided for the total company. There are swings in that margin, obviously, as you've got the year-over-year comps on the respective quarters. But obviously, we have a full year guidance out there. As we, I think, advised at the Capital Markets Day, with CE, obviously, that is a longer climb, but we do expect to be above our 2022 number, which was 1.9%.

關於你的第二個問題，關於 H2 的前景。我不會透過 CE 和 CD 向您提供保證金指導。顯然我們已經為整個公司提供了指導。顯然，這個利潤率存在波動，因為你已經獲得了各個季度的年比比較。但顯然，我們有全年指導。我認為，正如我們在資本市場日所建議的，CE 顯然是一個較長的攀升，但我們確實預計會高於 2022 年的數字，即 1.9%。

Next question is from the line of Veronika Dubajova with Citi.

下一個問題來自花旗銀行的 Veronika Dubajova。

I will keep it to two, please. First, I want to just go back to the guidance for the full year, and Helen, appreciate your comments about conservatism, but just maybe to push you a little bit. I think historically, the seasonality in your business is the second half EBIT was always higher than the first half. Are there any reasons whatsoever for that not to be the case this year because obviously, the guidance seems to imply that. I'm just trying to understand why that would happen.

請我把它保留在兩個。首先，我想回到全年的指導，海倫，感謝你對保守主義的評論，但也許只是給你一點推動。我認為從歷史上看，你們業務的季節性是下半年息稅前利潤總是高於上半年。是否有任何原因導致今年的情況並非如此，因為顯然，指導似乎暗示了這一點。我只是想理解為什麼會發生這種情況。

And then my second question is just to drill down a little bit, in particular, on the North America Care Delivery growth rate. Clearly, some very notable benefit from revenue per treatment. Just if you can quantify to what extent that's mix versus underlying rate increases? And how durable you think that is into the back half of the year?

我的第二個問題只是深入研究一下，特別是北美護理服務的成長率。顯然，每次治療的收入帶來了一些非常顯著的好處。只是如果您可以量化混合與基本利率上漲的程度？您認為這種情況能持續到今年下半年嗎？

Veronika, thank you for your questions. Look, on your first question on guidance, there's a lot to unpack there. What I would say, yes, clearly, you've heard my language. I want to make sure that we are delivering this quarter by quarter here, which we have done sequentially now for the last 3 quarters.

維羅妮卡，謝謝你的提問。聽著，關於你關於指導的第一個問題，有很多東西要解開。我想說的是，是的，很明顯，你已經聽到我的語言了。我想確保我們在這裡一個季度一個季度地交付，我們在過去三個季度中已經按順序完成了這項任務。

If you take our 2023 half 1 guidance and then you look at the kind of the implied guidance, you're doing the math correctly, it would on the surface, assume that we have a lower H2 in 2023 than we did in 2022. What I can say is we are expecting a half 2 on an EBIT level to be higher than half 1, but there are some moving parts in that.

如果您採用我們的 2023 年上半年 1 指導，然後查看隱含指導的類型，您的數學計算是正確的，從表面上看，假設我們 2023 年的 H2 低於 2022 年。我們預計EBIT 水準的half 2 將高於half 1，但其中存在一些變化。

In 2022, half 2, we did have some, I'm not going to call them one-timers, but -- or special items, but we did have some operational improvements, maybe operational one-timer then we call it that, rather than special items. We had some NCP deconsolidation gains, and we did get an additional consent payment in half 1 -- sorry, half 2 2022. As we look at half 2 2023, we also have to take in the increase from the stock price on stock incentive compensation. So we are taking that into account for our half 2 outlook. In addition to that, as you can see, we do have kind of a nice beat in half 1, but we're also -- and we don't expect some of that not to continue. But we are watching, in particular, I would say, the transaction effects that we are seeing in some of these maybe more volatile countries.

在2022 年2 月半，我們確實有一些，我不會稱它們為一次性的，但是——或者特殊的項目，但我們確實有一些操作上的改進，也許操作上的一次性，然後我們稱之為，而不是比特殊物品。我們獲得了一些 NCP 合併收益，而且我們確實在 1 半（抱歉，2022 年 2 半）獲得了額外的同意付款。因此，我們在製定下半年展望時考慮到了這一點。除此之外，正如你所看到的，我們在上半場確實有一個不錯的節奏，但我們也——而且我們不希望其中的一些不會繼續下去。但我想說的是，我們特別關注在一些可能更加動盪的國家中看到的交易影響。

So underlying operational performance, I'm very confident about when you start to see the comparable half 2 over half 2, '22 to '23, there are some nuances in there. But I feel really confident in our ability to continue to drive half 2 growth over half 1. So hopefully, that helps unpack some of that. Once you strip those out, the underlying is indeed quite favorable.

因此，當您開始看到可比較的 half 2 與 half 2、'22 到 '23 的基本營運績效時，我非常有信心，其中存在一些細微差別。但我對我們繼續推動一半 2 成長超過一半 1 的能力充滿信心。一旦你剔除這些因素，底層確實相當有利。

In terms of your second question on North America CD growth. Really excited with that growth, and it's actually both rate and mix improvement. Obviously, the reimbursement rate is coming through. And then on mix, mainly driven by Medicare Advantage which is now sitting at around 40% -- right at 40%, actually. So nice to see all of these metrics going in the right direction.

關於北美 CD 成長的第二個問題。對這種增長感到非常興奮，它實際上是速率和組合的改進。顯然，報銷率已經實現。然後是混合，主要是由 Medicare Advantage 推動的，目前比例約為 40%——實際上是 40%。很高興看到所有這些指標都朝著正確的方向發展。

The next question is from the line of Richard Felton with Goldman Sachs.

下一個問題來自高盛的理查費爾頓。

Just a follow-up on what you're seeing in terms of labor costs in the U.S. market. In particular, I'd be interested to hear an update on your reliance on sort of contract labor and general levels of wage inflation in that market? I mean it looks like from your numbers that H1 was pretty good, but your comments into H2 sound a little bit more cautious. So an update on what you're seeing would be very helpful.

這只是您所看到的美國市場勞動成本的後續情況。特別是，我有興趣了解您對合約工的依賴程度以及該市場的薪資通膨總體水平的最新情況？我的意思是，從你的數字來看，H1 相當不錯，但你對 H2 的評論聽起來有點謹慎。因此，更新您所看到的內容將會非常有幫助。

And then my second question, just a follow-up on Veronika's question on the payer mix in U.S. Care Delivery. Is there any reason why that sort of tailwind or mix that you saw this quarter, is this sort of a one quarter anomaly? Or are some of those shifts kind of a little bit more durable and maybe duration more than just one quarter?

然後是我的第二個問題，只是維羅妮卡關於美國醫療服務付款人組合問題的後續。您本季看到的這種順風或混合現像是否有任何原因，是四分之一的異常現象？或者其中一些轉變是否更持久一些，並且持續時間可能超過四分之一？

Yes. Thanks, Richard. Look, labor has continued to be a lot of moving pieces. I feel the assumptions that we called at the start of the year are holding. We do talk about labor stabilizing and the availability of labor, obviously improving. The reduced volume of temporary labor and the rates like really dropping kind of back to normal levels. What we saw in Q1, we saw continued in Q2 and very de minimis now compared to what it was last year. I think the bigger driver on labor, I mean not just the fact that costs and wages are in line with expectations is the terrific job the U.S. operations team are doing on driving productivity. So that obviously helps and that's what we're seeing, the beat on that we saw some in Q1 and even more so in Q2. So I feel we've got our arms around labor.

是的。謝謝，理查。看，勞動力仍然是很多令人感動的事情。我認為我們在年初提出的假設是成立的。我們確實談論了勞動力穩定和勞動力供應，明顯改善。臨時勞動力數量的減少和利率確實下降到正常水準。我們在第一季看到的情況，我們在第二季度繼續看到，與去年相比，現在的情況非常微不足道。我認為勞動力的更大推動力，我的意思不僅僅是成本和工資符合預期這一事實，而是美國營運團隊在提高生產力方面所做的出色工作。因此，這顯然有幫助，這就是我們所看到的，我們在第一季看到的一些節拍，在第二季度甚至更是如此。所以我覺得我們已經全力支持勞工。

When you say -- when I talk about the caution going into half 2, I don't need to remind any of us at the hot mess we were in last July when we did our profit warning and the kind of the labor cost spiraling out of control or availability of labor and impacting our operations. The reality is that we see a lot of that labor cost showing up in half 2 of 2022. So we have, obviously, an unfavorable comp for '23. So the full year that we are calling, we feel okay about. I am -- maybe we feel good about. I think the watch out that we have is the high -- what we're calling hotspots. So for the majority of the country, we've got this well under control. But as you can appreciate, in some states, some metro areas and hotspots, we are seeing some of those areas still a little bit more difficult to sell. And while we are seeing this labor improvement and labor productivity, we are expecting to have to invest a little bit in these hotspot areas. Nothing outside our guidance range. And if we -- we don't want to be foolish and not invest to kind of continue to drive the growth in future periods. So that's just a bit of the moving part, and that caution is just that we are very, very carefully managing kind of every clinic, every location accordingly. This isn't a throw the kitchen sink at it, like maybe we had done historically, but very, very targeted view on these areas.

當你說——當我談到進入第二季度的謹慎時，我不需要提醒我們任何人去年七月我們發出利潤預警時所陷入的混亂局面以及勞動力成本的螺旋式上升勞動力的控製或可用性並影響我們的營運。現實情況是，我們看到大量勞動成本會在 2022 年下半年出現。所以我們打電話的這一整年，我們覺得還不錯。我是——也許我們感覺很好。我認為我們要警惕的是高點——我們所說的熱點。因此，對於全國大部分地區來說，我們已經很好地控制了這種情況。但正如你所意識到的，在一些州、一些大都市地區和熱點地區，我們發現其中一些地區的銷售仍然有點困難。雖然我們看到勞動力和勞動生產力的提高，但我們預計必須在這些熱點領域進行一些投資。沒有任何事情超出我們的指導範圍。如果我們——我們不想犯傻，不想投資來繼續推動未來時期的成長。所以這只是一個變化的部分，需要注意的是，我們非常非常仔細地管理每個診所、每個地點。這並不是像我們歷史上所做的那樣，把廚房水槽扔到它上面，而是對這些領域非常非常有針對性的看法。

We're seeing wage inflation still around that 4%. The -- we do go into the holiday period here, so we do use a little bit more temporary labor just to cover regular normal seasonality. That will be a little bit of a tick up in open position as we go through that seasonality. But overall, I think we've got our arms around it quite well, and the team has done an incredible job here. On your second question on payer mix in the U.S., no anomaly there. I mean we -- I think we've got our arms around the mix and rates, and we're seeing that kind of pull through. So we are confident for that to continue in half 2 as it did in half 1.

我們看到薪資通膨率仍在 4% 左右。我們確實進入了這裡的假期，所以我們確實使用了更多的臨時勞動力來滿足正常的季節性需求。當我們經歷季節性時，未平倉部位將會略有上升。但總的來說，我認為我們已經很好地解決了這個問題，並且團隊在這裡做得非常出色。關於你關於美國付款人結構的第二個問題，沒有異常情況。我的意思是，我認為我們已經掌握了組合和費率，並且我們正在看到這種情況的實現。因此，我們有信心在第二半場繼續這種情況，就像在第一半一樣。

Next question is from the line of Hassan Al-Wakeel with Barclays.

下一個問題來自巴克萊銀行的 Hassan Al-Wakeel。

I have two, please. Firstly, on rate, what is your take on the preliminary ESRD PPS for 2024, which looked to be more modest, an increase than many expected. Do you expect the final rule to land here? And could this present a challenge at all to your 2025 margin targets, and do you still think the 2025 PPS rate should accelerate meaningfully from here? And then secondly, could you update us on the portfolio side and your progress on divestitures? You highlighted the EUR 1.5 billion of revenues that are addressable if you do all you set out to, which is helpful, but could you help quantify the rough margin differential or indeed tailwind, all else being equal.

我有兩個，拜託。首先，關於利率，您對 2024 年 ESRD PPS 的初步看法如何，該數字看起來更為溫和，增幅超出了許多人的預期。您預計最終規則會落到這裡嗎？這是否會對您的 2025 年利潤目標構成挑戰？其次，您能否向我們介紹一下投資組合的最新情況以及您在資產剝離方面的進展？您強調瞭如果您竭盡全力的話，可以實現 15 億歐元的收入，這很有幫助，但您能否幫助量化粗略的利潤差異或實際上的順風，其他條件相同。

Thanks, Hassan. Clearly, we're disappointed with the 1.6% proposed rate, we obviously don't know what that is going to look like in the final rate. I don't have that crystal ball, unfortunately. Obviously, we continue to put our case forward for an improved rate, but we'll see where the final rate comes in.

謝謝，哈桑。顯然，我們對 1.6% 的提議利率感到失望，我們顯然不知道最終利率會是什麼樣子。不幸的是，我沒有那個水晶球。顯然，我們將繼續提出提高費率的理由，但我們將看看最終費率的結果。

As I've said previously, we have forecast and guided for moderate rate increases. And I think that is consistent with how we have thought through the 2025 targets but obviously, we will continue to advocate for a higher rate for the cost increases that we've experienced. We have no reason to believe that the reimbursement model shouldn't hold true. But clearly, we've seen a disappointing reaction to the current inflationary environment in that rate. And clearly, it's not just an issue for us, it's for all service providers.

正如我之前所說，我們預測並指導適度升息。我認為這與我們對 2025 年目標的思考是一致的，但顯然，我們將繼續主張對我們所經歷的成本成長採取更高的比率。我們沒有理由相信報銷模式不該成立。但顯然，我們看到了對當前通膨環境的令人失望的反應。顯然，這不僅是我們的問題，也是所有服務提供者的問題。

Look, on the portfolio, and -- we do listen, we do take note of the many questions we got about that. So we thought it was helpful to try and size it. Obviously, we're not trying to get an unpacked 2025 detailed guidance because we're trying to be moderate with how we roll that out, and that's why we're kind of focusing on the margin bands. But as I said, if we execute everything, it could be up to EUR 1.5 billion of lower revenue.

看，在投資組合上，我們確實傾聽，我們確實記錄了我們收到的許多有關此問題的問題。所以我們認為嘗試確定它的大小是有幫助的。顯然，我們並不是試圖獲得一份完整的 2025 年詳細指導，因為我們試圖以溫和的方式推出它，這就是為什麼我們關注邊緣帶。但正如我所說，如果我們執行所有操作，收入可能會減少多達 15 億歐元。

Clearly, we are, and if you go back to my Capital Markets Day slide, that was quite deliberate. If you go back to there, and you can kind of look at the things that or either lower growth or lower strategic value, you can assume that they're all in scope. And what we are seeing, if we execute on everything and there are some that we would lose absolute EBIT, but there are others that are loss making. Our current assumption is that it would be margin accretive, and it wouldn't take us out of the margin band.

顯然，我們是，如果你回到我的資本市場日幻燈片，你會發現這是經過深思熟慮的。如果你回到那裡，你可以看看那些成長較低或策略價值較低的事情，你可以假設它們都在範圍內。我們所看到的是，如果我們執行所有事情，有些我們會損失絕對息稅前利潤，但也有一些會虧損。我們目前的假設是，這將增加利潤，並且不會使我們脫離利潤範圍。

Next question is from the line of Oliver Metzger with ODDO BHF.

下一個問題來自 Oliver Metzger 和 ODDO BHF。

The first one is you specified value-based care contribution as a positive driver of Care Delivery. Is there any chance that you can quantify the positive contribution to a certain extent at least? And also whether we should expect the same magnitude for the next quarters? Second question is, sorry for, over your -- again, on your guidance, and I've understood all your words. So I appreciate the narrowed guidance band. And on the moving parts, I still have some misunderstanding, to be honest, and that's particularly on labor cost.

第一個是您指定基於價值的護理貢獻作為護理服務的積極驅動力。您是否有機會至少在一定程度上量化正面貢獻？我們是否應該預期接下來的幾季也會出現同樣的規模？第二個問題是，抱歉，再次感謝您的指導，我已經理解您所有的話。所以我很欣賞縮小的指導範圍。老實說，在移動部件上，我仍然存在一些誤解，尤其是在勞動成本方面。

So initially, you had your labor cost in your assumptions of EUR 140 million to EUR 180 million. In the first half, now you have a positive EUR 49 million. You still stick to the guidance and I understand also the phasing argument. But if I look for the whole guidance and understand that the lower end is not realistic anymore. Therefore, you increase -- you narrowed it. So -- but you stick to one the most -- or basically the most important point of your input cost, the labor cost and you say, okay, that will not change. So could you help me to understand what are the other moving parts, which, at the end, drove your guidance update?

因此，最初，您假設勞動成本為 1.4 億歐元到 1.8 億歐元。上半年，您的收入為 4,900 萬歐元。你仍然堅持指導，我也理解分階段的論點。但如果我尋找整個指導並了解低端不再現實。因此，你增加了——你縮小了它。所以，但你堅持最重要的一點，或者基本上是投入成本中最重要的一點，即勞動成本，你會說，好吧，這不會改變。那麼您能否幫助我了解哪些其他活動部分最終推動了您的指南更新？

Thank you, Oliver, for your questions. We're not going to disclose the relative contribution for the VBC part of the business. Obviously, we don't go into the subsegments here. What we are working through, and Dominik and I have been chatting about this is how can we give more metrics and more KPIs into this business as it continues to grow, both across our ESRD population and CKD population. You know kind of projections on the medical costs under management and you know that margin. We do have now 125,000 lives covered with the biggest number of patients from CKD, but let us -- we're taking that as a follow-up to try and work through how we can disclose some supplemental KPIs on that, and we'll come back in Q3.

謝謝奧利佛提出的問題。我們不會透露 VBC 業務部分的相對貢獻。顯然，我們在這裡不討論子部分。我們正在解決的問題，以及多明尼克和我一直在討論的問題是，隨著這項業務的持續增長，我們如何為該業務提供更多的指標和 KPI，無論是 ESRD 人群還是 CKD 人群。您知道所管理的醫療費用的預測，也知道利潤率。我們現在確實有 125,000 人的生命受到最多數量的 CKD 患者的覆蓋，但是讓我們——我們將其作為後續行動，嘗試並研究如何披露一些關於此的補充 KPI，我們將第三季度回來。

On the guidance question, yes, you're right. Our labor cost assumption is still EUR 140 million to EUR 180 million of a headwind, and we are favorable through half 1. We obviously have some additional productivity, but we also know that we've got this additional phasing in the back half of the year and our merit increases kick in, in July. So that's also in half 2. Obviously, as you can appreciate, we're working through kind of the overall guidance with a lot of moving parts, positive and negative. And I am encouraged by the positive that we've seen in half 1, but also trying to be kind of cautious about half 2 and obviously, as I mentioned in my answer to Veronika, we obviously have some other things to navigate in the guidance that we didn't see when we gave guidance. I mean, I think the incentive stock comp is a piece of that as well as watching this exchange rate.

關於指導問題，是的，你是對的。我們的勞動成本假設仍然是 1.4 億歐元到 1.8 億歐元的逆風，而且我們在上半年是有利的。薪水從七月開始。所以這也在第二部分。我對我們在第1 部分中看到的積極因素感到鼓舞，但也試圖對第2 部分保持謹慎，顯然，正如我在對維羅妮卡的回答中提到的那樣，我們顯然在指南中還有其他一些事情需要指導我們在提供指導時沒有看到這一點。我的意思是，我認為激勵股票補償是其中的一部分，同時也要關注匯率。

Even with those negative impacts, I hope you are encouraged as I am that we are still able to improve our guidance and we'll see how some of this plays out in Q3. But I feel confident with what we're doing today, but obviously, watching some of these moving parts and how they play out.

即使存在這些負面影響，我希望您像我一樣受到鼓勵，因為我們仍然能夠改進我們的指導，我們將在第三季度看到其中的一些效果。但我對我們今天所做的事情充滿信心，但顯然，正在觀察其中一些活動部分以及它們如何發揮作用。

Okay. One quick follow-up on value-based care. Is it -- the payment of the money you have got, is it more a one-time characteristic or should we expect, let's say, homogeneous cash inflow over the next quarters, basically in line with the overall assumption?

好的。對基於價值的護理的快速跟進。是——你所收到的錢的支付，這更像是一種一次性特徵，還是我們應該預期，比方說，未來幾個季度的同質現金流入，基本上符合總體假設？

Yes, I am -- I'm sure some of my team are listening to the call and they're smiling as you asked that question. I think this is one of the hardest things to forecast in terms of the phasing of the revenue and even internally, we refer to it as the lumpiness of the VBC revenue. I mean I think some of this depends on kind of when the contract is signed, the terms of the contract, then when we get the profit sharing or the risk sharing coming out of these contracts. So while we're doing our best to forecast what we expect on a revenue line from VBC, it is playing out quite lumpy even against our own forecast. So we have to find a way to -- we're doing our best to forecast it the best we can, of course, but I think we then just need to come back with some explanations around that. But yes, it's absolutely not a straight line, unfortunately.

是的，我確信我的團隊中的一些人正在聽電話，當你問這個問題時他們微笑著。我認為，就收入階段而言，這是最難預測的事情之一，甚至在內部，我們稱之為 VBC 收入的波動性。我的意思是，我認為這在一定程度上取決於合約簽署的時間、合約的條款，以及我們何時從這些合約中獲得利潤分享或風險分擔。因此，雖然我們盡最大努力預測 VBC 收入線的預期，但即使與我們自己的預測相比，它的表現也相當不穩定。所以我們必須找到一種方法——當然，我們正在盡最大努力做出最好的預測，但我認為我們只需要對此做出一些解釋。但不幸的是，這絕對不是一條直線。

Next question is from the line of James Vane-Tempest with Jefferies International Limited.

下一個問題來自 Jefferies International Limited 的 James Vane-Tempest。

Two, if I can, please. Firstly, just to follow up on the divestments of up to EUR 1.5 billion. Just wondering, Helen, you've given some scope in terms of the different buckets and where they could possibly get to. But I'm sort of wondering, looking at those in aggregate, it's possibly around 7%, I think, of 2025 revenues. But if this is just the International Care Delivery sort of ex U.S. is potentially up to 40% of that business. So I was just wondering, is that focusing on the right area where those divestments could be? Or are there in other areas?

兩個，如果可以的話，請。首先，只是為了跟進高達 15 億歐元的撤資。只是想知道，海倫，您已經給出了不同桶以及它們可能到達的位置的一些範圍。但我有點想知道，從總體來看，我認為這可能佔 2025 年收入的 7% 左右。但如果這只是美國以外的國際醫療服務，可能佔該業務的 40%。所以我只是想知道，這些撤資是否集中在正確的領域？或是其他地區也有嗎？

And I think related to that, I guess there's a question on the potential margin impact, but these are below group margin, I'm not asking for a point estimate, but just in terms of how to think about it potentially, those are essentially breakeven, and that would add around 70 basis points to a margin roughly or around 5% margin, it could be around 30 bps. So I was just wondering whether that's a good quantum to think about where those could be and what the impact could be to 2025 targets, which exclude those.

我認為與此相關的是，我想存在一個關於潛在利潤影響的問題，但這些都低於集團利潤，我不是要求進行點估計，但只是就如何潛在地考慮它而言，這些本質上是盈虧平衡，這將使利潤率增加約70 個基點，利潤率約為5% 左右，可能約為30 個基點。所以我只是想知道這是否是一個很好的時間來考慮這些可能在哪裡以及對 2025 年目標（排除這些目標）可能產生的影響。

And then my second question is, I'm just curious what it would take for you to raise the upper end of the EBIT guidance range to above 0? And what is the impact to EBIT growth from divestments closed or that could happen this year?

然後我的第二個問題是，我只是好奇你需要什麼才能將息稅前利潤指導範圍的上限提高到 0 以上？今年完成或可能發生的撤資對息稅前利潤成長有何影響？

Yes. Thanks, James. I think I spent a little bit of time laying out the CDI buckets for Victoria because she asked specifically about geographies. Obviously, there are other assets in play and in scope. So you should look broader than just CDI. And again, I would maybe have you go back to the Capital Markets Day chart where you can kind of maybe see some of those assets and where they sit on the chart.

是的。謝謝，詹姆斯。我想我花了一點時間為 Victoria 佈置 CDI 桶，因為她特別詢問了地理位置。顯然，還有其他資產在發揮作用並在範圍內。所以你應該把目光放得更廣泛，而不僅僅是 CDI。再說一次，我也許會讓你回到資本市場日圖表，在那裡你可能會看到其中一些資產以及它們在圖表上的位置。

In terms of the margin impact, I mean, basically, what we're seeing with everything overall, it's why I can kind of say it'd be margin accretive. The net of all of it washes out pretty flat to a small kind of EBIT number. So -- and maybe that's the best way to think about it because we will be focused on some noncore assets that do deliver EBIT, but also on other assets that are negative in EBIT. So when you take it all into account, it's probably a very low single-digit EBIT percentage impact. Maybe that's the best way I can size it right now. It's hard to do that because I haven't given you the guidance budget through '24 and '25. And I know, I know that. But I think that's the best way to think about it.

就利潤率影響而言，我的意思是，基本上，我們在整體上看到的一切，這就是為什麼我可以說它會增加利潤率。所有這些的淨值都相當平淡，只有很小的息稅前利潤。因此，也許這是考慮這個問題的最佳方式，因為我們將重點放在一些確實提供息稅前利潤的非核心資產，但也會關注息稅前利潤為負的其他資產。因此，當您將所有因素考慮在內時，息稅前利潤的影響可能非常低，只有個位數。也許這是我現在調整大小的最佳方法。這很難做到，因為我還沒有給你們 24 年和 25 年的指導預算。我知道，我知道。但我認為這是最好的思考方式。

No, that's very helpful. That gives a lot more color.

不，這非常有幫助。這給了更多的色彩。

Okay. And then your third question actually was about -- question 2 after 1b. Raising the -- what would it take to raise the upper part of the guidance?

好的。然後你的第三個問題其實是關於 1b 之後的問題 2。提升－怎樣才能提高指導的上半部？

Look, I think the -- I'm very encouraged by what we're seeing with the labor productivity. I think how labor will develop in these hotspot markets and what we might need to invest if those don't need as much investment, I think that could play a positive role. And if we continue to get productivity here at an accelerated rate, I think that's something we'd like to see and the team are managing it well.

看，我認為——我對我們所看到的勞動生產力感到非常鼓舞。我認為這些熱點市場的勞動力將如何發展，如果這些市場不需要那麼多投資，我們可能需要投資什麼，我認為這可能會發揮積極作用。如果我們繼續以更快的速度提高生產力，我認為這是我們希望看到的，而且團隊管理得很好。

I think the biggest unknown for me as I look at all the assumptions going into half 2. And I think we have a really, really robust view on H2 is really this foreign exchange transaction and this volatility in exchange rates. And obviously, we look at what we can hedge and what we can't, but this difference in kind of invoice currency versus local currency. We've got China, we've got the ruble, we've got these hyperinflation countries. So if that stabilizes and it's not as bad as maybe we are looking at right now, I think that could also drive an improvement kind of in the guidance.

我認為，當我查看第二部分的所有假設時，對我來說最大的未知數。顯然，我們會考慮什麼可以對沖，什麼不能對沖，但發票貨幣與當地貨幣之間存在差異。我們有中國，我們有盧布，我們有這些惡性通貨膨脹國家。因此，如果這種情況穩定下來並且沒有我們現在看到的那麼糟糕，我認為這也可能會推動指導意見的改進。

And I think overall, everything is on track. It's going really well. Our spend levels are under control, FME25 is delivering quite nicely. So look, I think we're just, and maybe that's the caution. You all know me by now, just delivering this quarter by quarter. And of course, if we see the signs that we have the confidence to change it, we will. I mean also I don't need to remind everybody that we're coming off a very volatile prior year. And I just really trying to take this a quarter at a time which I think you said this morning in your report.

我認為整體而言，一切都步入正軌。一切進展順利。我們的支出水準得到控制，FME25 的表現相當不錯。所以看，我認為我們是公正的，也許這就是謹慎。你們現在都認識我了，我只是一個季度一個季度地交付。當然，如果我們看到有跡象表明我們有信心改變它，我們就會這麼做。我的意思是，我也不需要提醒大家，我們正經歷著非常不穩定的前一年。我真的很想一次一個季度地討論這一點，我想你今天早上在報告中也說過。

Next question is from the line of Lisa Clive with AB Bernstein.

下一個問題來自 Lisa Clive 和 AB Bernstein。

Just two questions. One on reimbursement increases ex U.S. Could you just kind of give us a sense of what proportion of those are sort of tied to inflation CPI, et cetera? And what proportion of those are kind of a bit sort of at the discretion of health ministry to just sort of raise at a certain point in time.

只有兩個問題。一個關於美國以外的報銷增加的問題，您能否讓我們了解一下，其中有多少比例與通貨膨脹 CPI 等相關？其中有多少比例是由衛生部自行決定在某個時間點增加的。

And then second question is just around the Care Enablement margins over the long term. For med tech sector, especially where you're positioned 40-plus percent market share. Compared to other med tech sectors, you would think that you'd have a high teens, maybe, margin even in the 20s. If we think really long term, is there any reason why this is sort of structurally not possible in dialysis? Is it around the reimbursement model? And what would really need to happen in terms of transforming how that business operates? Is it a more active product cycle? Is it better price discipline? Just sort of high-level thoughts on that.

第二個問題是關於長期照護支持利潤的問題。對於醫療技術領域，尤其是您佔據 40% 以上市場份額的領域。與其他醫療科技產業相比，您可能會認為即使在 20 多歲，您的利潤率也可能高達十幾歲。如果我們從長遠來看，是否有任何原因可以解釋為什麼這在結構上在透析中是不可能的？是圍繞著報銷模式嗎？就改變業務運作方式而言，真正需要發生什麼？這是一個更活躍的產品週期嗎？是不是更好的價格紀律？只是對此的一些高層想法。

Lisa, I will try and pull it here as I'm talking, but the reimbursement ex U.S. is very much a mixed bag. What we have been seeing, where we've got reimbursement increases in Europe, for example, we are seeing that, that is tied to wage inflation. And obviously, we'll get the reimbursement increase, but then we are kind of having to invest that back in the labor in the clinics. I don't have a number to hand. I'll have Dominik follow back up on that one. But it's nothing -- we're getting our fair share of the reimbursement rate increases, but they don't fall through straight to the bottom line. I think the message here is, it is, for the most part, needing to be reinvested in labor and wage inflation because of the countries we're operating in. But there's nothing else that's remarkable, I would say, ex U.S. on reimbursement.

麗莎，我會試著把它拉到這裡，因為我正在說話，但美國以外的報銷非常複雜。例如，我們所看到的，例如歐洲的報銷增加，我們發現這與薪資通膨有關。顯然，我們將獲得報銷增加，但隨後我們不得不將其投資回診所的勞動力中。我手邊沒有號碼。我會讓多米尼克跟進此事。但這沒什麼——我們得到了報銷率增長的公平份額，但它們並沒有直接落入底線。我認為這裡傳達的訊息是，在很大程度上，由於我們所在的國家/地區，需要對勞動力和工資通膨進行再投資。地方。

Obviously, hopefully, you picked up my comments on CE that we are -- one of our critical initiatives is pricing, and we are starting to see the first benefits of those price increases across our products portfolio kick in, in Q2 as we thought. Which maybe then leads into your second question, Lisa, on the long-term view.

顯然，希望您聽到了我對 CE 的評論，我們的關鍵舉措之一是定價，我們開始看到我們的產品組合價格上漲的第一個好處在第二季度開始顯現，正如我們所想的那樣。麗莎，從長遠來看，這可能會引出你的第二個問題。

Obviously, sitting here with a 2% margin, we've got a long way to go to get into our margin band but confident that we can get there by 2025 with the initiatives and projects that we have in place. But clearly, we are still battling headwinds there. So we have to work much harder. I don't think there's anything that would say we shouldn't be kind of at a med tech margin. As Katarzyna spoke to at our Capital Markets Day, we have a mixed bag within that portfolio, and there are some markets that are hugely profitable and are above that average margin. So I think our focus is really kind of teasing out those that aren't there and then deciding what we need to do with that. Obviously, as we're working through FME25, always taking a look at our structural overhead and seeing if there's anything more dramatic that we can do and do it faster.

顯然，以 2% 的利潤率來看，我們還有很長的路要走，但我們有信心透過現有的舉措和專案在 2025 年實現這一目標。但顯然，我們仍在與逆風作鬥爭。所以我們必須更加努力地工作。我不認為有什麼可以說我們不應該處於醫療技術邊緣。正如卡塔齊娜在我們的資本市場日上所說，我們的投資組合中有一個混合包，並且有一些市場利潤豐厚並且高於平均利潤率。所以我認為我們的重點其實是梳理出那些不存在的東西，然後決定我們需要用它們做什麼。顯然，當我們正在研究 FME25 時，總是會檢查我們的結構開銷，看看是否有任何更戲劇性的事情我們可以做並且做得更快。

But I think the message here is we need to deliver on what we've got in hand, and I'm confident the team will, and then continue to look at the individual components in the portfolio. And then if we have to make different decisions on those, we will in time.

但我認為這裡的資訊是我們需要交付我們手頭上的東西，我相信團隊會這樣做，然後繼續研究產品組合中的各個組件。然後，如果我們必須就這些問題做出不同的決定，我們會及時做出決定。

Next question is from the line of David Adlington with JPMorgan.

下一個問題來自摩根大通的 David Adlington。

First one, I was quite interested to hear about you talking about muted new starts still. I just wondered what -- if you could give us some further color there on [what do those] mean when we might see you start to accelerate again, why that was being muted? And then second, just on the labor side, again, the EUR 45 million tailwind, I think, in the second quarter you pulled out. I just wondered how much of that was because your agency costs have fallen. If you could quantify that at all? And as we look into the second half, do you have a similar sort of comp in terms of agency? And then are we rebased back to normal agency levels in terms of a comp for next year?

第一個，我很感興趣聽到你談論仍然沉默的新開始。我只是想知道，如果你能給我們一些進一步的解釋，當我們可能看到你再次開始加速時，[這些]意味著什麼，為什麼會被靜音？其次，就勞動力方面而言，我認為，第二季度你退出了 4500 萬歐元的順風車。我只是想知道其中有多少是因為你們的代理成本下降了。如果你能量化這一點嗎？當我們展望下半年時，你們在代理方面有類似的補償嗎？然後，我們是否會在明年的薪資方面重新調整至正常的機構水準？

Thanks, David. It was a little hard to hear you, but I think I got your questions. One around muted new starts and the second around the labor tailwind.

謝謝，大衛。聽你說話有點困難，但我想我明白你的問題了。一是圍繞著新的開工乏力，二是圍繞勞動力順風。

No, look, there's nothing -- the muted new starts, that's something that we've just been seeing, right? There's nothing new or unusual there. I think just this annualization of COVID, as we had discussed really still working its way through the end stage of CKD population. So nothing new or alarming, just the timing of this being worked through. We are encouraged by the fact that the overall mortality is on a pre-pandemic level now. So I think it's just the color we've been saying. We know we will return to growth, just the trajectory of that, and we're sitting literally right at 0 right now. So -- which overall is encouraging.

不，看，什麼都沒有——無聲的新開始，這就是我們剛剛看到的，對吧？那裡沒有什麼新的或不尋常的東西。我認為，正如我們所討論的那樣，新冠病毒的年度化確實仍在 CKD 人口的末期發揮作用。因此，沒有什麼新的或令人擔憂的事情，只是解決這個問題的時機。目前總死亡率處於疫情大流行前的水平，這一事實令我們感到鼓舞。所以我認為這就是我們一直在說的顏色。我們知道我們將恢復成長，只是成長的軌跡，而我們現在確實處於 0 水平。因此，總體而言，這是令人鼓舞的。

On your second question on labor, yes, look, there is a -- when we put our guidance out there, we obviously had a forecast for what we thought that the temporary labor would be. We obviously have kind of really reduced our contract labor in 2023. And obviously, there would have been contract labor in the challenging Q2 from last year. We -- and then on top of that, we've got the productivity, which is reducing that headwind. So, look, I think for me, the Q3 labor number is going to be the key on, okay, is it where we thought it was going to be? Or is it continuing to drive improvement, and of course, we've got this weird annualization quarter-over-quarter with all that was happening on labor and the merit increase that kicks in, in Q3. So hopefully, that helps explain. We haven't been talking about labor productivity for a while. So it's really, really nice to be talking about that.

關於你關於勞動力的第二個問題，是的，當我們發布指導意見時，我們顯然對臨時勞動力的情況進行了預測。顯然，我們在 2023 年確實減少了合約工。我們——然後最重要的是，我們提高了生產力，這正在減少這種阻力。所以，看，我認為對我來說，第三季的勞動力數據將是關鍵，好吧，它是我們想像的那樣嗎？還是它繼續推動改進，當然，我們在第三季的勞動力和績效成長方面發生了奇怪的季度環比年化。希望這有助於解釋。我們已經有一段時間沒有談論勞動生產力了。所以很高興談論這個。

Next question is from the line of Christoph Gretler with Credit Suisse.

下一個問題來自瑞士信貸銀行的 Christoph Gretler。

Just actually 1 question left. And I think you mentioned that transactional effect on the product business could be an element that holds you back on the margin -- on the guidance upgrade. Could you actually discuss how meaningful that is, especially since assets moved so much? And I think your manufacturing footprint is pretty kind of in higher wage and higher cost countries like Germany, the U.S. And we have a lot of no inflation in this -- sorry, a lot of devaluation in these emerging market currencies.

其實只剩下 1 個問題了。我認為您提到過，對產品業務的交易影響可能是阻礙您提高利潤率的因素——在指導升級方面。您能否真正討論一下這有多有意義，尤其是在資產變動如此之大的情況下？我認為你們的製造業足跡在德國、美國等工資較高、成本較高的國家相當多，而且我們這裡沒有通貨膨脹——抱歉，這些新興市場貨幣大幅貶值。

Yes. Chris, happy to do so. Look, to give you a sense of size and maybe I haven't done this in any of the questions yet or in my voice over. But to put it into perspective, the exchange impact was about half of our margin in CE in the quarter. And it is these countries with hyperinflation, whether that be Argentina and Turkey, but then seeing the kind of the ruble, India, China. So it's the main -- those are the main currencies that drove us in the -- countries and currencies, I guess, in the quarter. And obviously, we're taking a hard look at that on what we can get under and both in contractual currency and hedging. So I think that's also -- I mean, we do hedge, of course, but the volatility here has had a more sizable impact than we were expecting. So I think when I talk about the guidance, we're expecting some of that to continue whether it stabilizes or improves, I think will be kind of the key driver. And again, we'll know more about that as we go through Q3.

是的。克里斯，很高興這樣做。聽著，為了給你一個大小感，也許我在任何問題或畫外音中都沒有這樣做過。但從長遠來看，匯率影響大約是我們本季CE利潤率的一半。正是這些惡性通貨膨脹的國家，無論是阿根廷和土耳其，然後看到盧布的種類，印度，中國。因此，我想，這是本季推動我們進入這些國家和貨幣的主要貨幣。顯然，我們正在認真研究我們可以在合約貨幣和對沖方面獲得什麼。所以我認為這也是——我的意思是，我們當然會進行對沖，但這裡的波動性產生的影響比我們預期的要大。因此，我認為，當我談論指導時，我們預計其中的一些指導會繼續下去，無論是穩定還是改善，我認為這將是關鍵的驅動因素。再說一遍，當我們進入第三季時，我們會對此有更多了解。

And this manufacturing footprint optimization that you have now part of the plan FME25, does this not take into consideration in any respect if a challenge, which, I guess, is an ongoing challenge that will be [long term]?

您現在已經將這種製造足跡優化作為 FME25 計劃的一部分，這是否在任何方面都沒有考慮到挑戰，我想，這是一個[長期]持續的挑戰？

Yes, of course. So we are looking at the manufacturing footprint, but you have to remember that there is -- we do have 44 manufacturing plants and there is a reason that we have some of those manufacturing plants local. But obviously, as we think through that footprint and where we can consolidate, obviously, wherein the cost does get taken into account, and then obviously, looking at the currencies we contract in as well.

是的當然。因此，我們正在關注製造足跡，但你必須記住，我們確實擁有 44 家製造工廠，而且我們在當地擁有一些製造工廠是有原因的。但顯然，當我們仔細考慮足跡以及我們可以整合的地方時，顯然，其中的成本確實被考慮在內，然後顯然，還要考慮我們簽訂合約的貨幣。

Next question is from the line of Falko Friedrichs with Deutsche Bank.

下一個問題來自德意志銀行的 Falko Friedrichs。

Two questions, please. The first one, going back to the same market treatment growth, and, Helen, what's your best guess when this could inflect and turn positive? Could this be in H2 this year? Or is this rather something you would expect to next year? And then my second question, can you just very briefly update us on your home dialysis efforts and whether there's anything new to report on?

請教兩個問題。第一個，回到相同的市場治療成長，海倫，你最好的猜測是什麼時候這可能會改變並轉為正面？今年下半年會出現這種情況嗎？或者這是您明年所期望的？然後是我的第二個問題，您能否簡單地向我們介紹一下您的居家透析工作以及是否有任何新的情況需要通報？

Look, my best guess -- I wish I had some crystal balls here. Look, we're as flat to 0 as we can be, right, at 0 -- minus 0.1. My hope would be if we start to see this continued trend, it could go positive in Q3, of course. But that -- my guess is as good as yours. I mean I think the trend is going the right way. Let's hope that it does. And that's why we've guided minus 1 to plus 1. But you take the midpoint 0, obviously, if you backed out the acute contract cancellations that we spoke about last quarter. We have the same impact this quarter that would have a slightly positive. So it's going the right way.

看，我最好的猜測——我希望這裡有一些水晶球。看，我們盡可能地趨向 0，對，就是 0 - 負 0.1。我的希望是，如果我們開始看到這種持續的趨勢，當然，它可能會在第三季變得積極。但我的猜測和你的一樣好。我的意思是我認為趨勢正在朝著正確的方向發展。我們希望它能實現。這就是為什麼我們將負 1 調整為正 1。本季我們也產生了同樣的影響，這會帶來一些正面的影響。所以一切都在朝著正確的方向發展。

On home, obviously, that's a key strategic initiative for us for a whole host of reasons. We continue to stay focused on that. We are still hovering around the 16% mark in Q2. I think we were, if I get numbers right, 15.7% in Q1 and 15.9% in Q2, so a slight improvement. But obviously, some of the labor stabilization and everything else is helping that so we can drive trainings again. So I think we're seeing our training volume up, which will, in turn, obviously translate into a higher home percentage. But we know that we've really got to kind of turn the corner on this to get to our 25% goal.

顯然，在國內，出於多種原因，這對我們來說是一項關鍵的策略舉措。我們將繼續關注這一點。第二季我們仍徘徊在 16% 左右。我認為，如果我的數字正確的話，第一季為 15.7%，第二季為 15.9%，所以略有改善。但顯然，勞動力穩定和其他一切都有助於這一點，因此我們可以再次推動培訓。所以我認為我們的訓練量正在增加，這反過來顯然會轉化為更高的主場百分比。但我們知道，要實現 25% 的目標，我們確實必須扭轉局面。

Next question is from the line of Hugo Solvet with BNP Paribas Exane.

下一個問題來自法國巴黎銀行 Exane 的 Hugo Solvet。

I have one on FME25. You're at about like EUR 60 million, EUR 61 million benefit in Q2, you were at about the same level in Q1. So just wondering as we think about timing and phasing for Q3 and Q4 to reach that EUR 250 million, EUR 300 million by year-end. That would be my first question. And Second on China, I remember you said it was an anomaly of strong growth in Q1. Just wondering what you saw in the country in Q2.

我在 FME25 上有一個。第二季的收益約為 6,000 萬歐元、6,100 萬歐元，與第一季的水準大致相同。因此，當我們考慮第三季和第四季達到 2.5 億歐元、年底達到 3 億歐元的時間和階段時，我們只是想知道。這是我的第一個問題。其次關於中國，我記得您說過第一季的強勁成長是不正常的。只是想知道您在第二季度在該國看到了什麼。

Yes. Thanks, Hugo. Yes, look, we're very, very encouraged with what we're seeing on FME25. We've had a good half 1, we're on track, I mean, obviously, we're still sticking to the guidance that we have out there for 2023 full year. So no reason to change that at this point. We had EUR 136 million in the first half, EUR 75 million in Q2. So that's fully on track.

是的。謝謝，雨果。是的，看，我們對 FME25 上看到的情況感到非常非常鼓舞。我們已經取得了良好的進展，我們正在步入正軌，我的意思是，顯然，我們仍然堅持 2023 年全年的指導方針。所以目前沒有理由改變這一點。上半年我們的營收為 1.36 億歐元，第二季為 7,500 萬歐元。所以這完全步入正軌。

In terms of China, we had a really strong Q1, as you recall, stronger than we were expecting. We do see continued good growth there in China. I think what we have to kind of -- we expected Q1 to be a pull forward from what we would normally see as Q4. So I think that's obviously what we're expecting. The Q1 was strong, we still had a strong April, it's obviously dipped off now as we kind of go into these next quarters. And with that pull forward, and obviously, that's now reflected in our outlook for half 2. But of course, we're really excited about that higher acute sales that does come with a higher margin compared to some of the other products.

就中國而言，正如您所記得的那樣，我們的第一季非常強勁，比我們預期的要強。我們確實看到中國持續良好的成長。我認為我們必須做的是——我們預計第一季將比我們通常認為的第四季度有所提前。所以我認為這顯然是我們所期待的。第一季很強勁，我們四月份的表現仍然強勁，但隨著我們進入下幾個季度，它現在顯然有所下降。隨著這一拉動，顯然，這現在已經反映在我們對下半年的展望中。 。

In the interest of time, this concludes the Q&A session. And I would like to hand back to Dominik.

由於時間關係，問答環節到此結束。我想把問題交還給多明尼克。

So thank you very much for your interest. We appreciate you joining after a long day with many reporting companies. Thank you for hanging in there with us and for your questions. And while we are drowning in rain here, we'll wish you all a great summer. Hope to hear, see, meet you after the summer break. Thank you.

非常感謝您的關注。我們感謝您在與許多報告公司度過漫長的一天後加入。感謝您與我們在一起並提出問題。雖然我們在這裡被大雨淹沒，但我們祝大家度過一個愉快的夏天。希望暑假後能聽到、看到、見到你。謝謝。

Thank you, everybody. Have a good summer. Take care.

謝謝大家。祝你夏天愉快。小心。

Ladies and gentlemen, the conference has now concluded, and you may disconnect your telephone. Thank you very much for joining, and have a pleasant day. Goodbye.

女士們、先生們，會議現已結束，你們可以掛斷電話了。非常感謝您的加入，祝您有個愉快的一天。再見。