Fresenius Medical Care AG (FMS) 2026 Q1 法說會逐字稿

Thank you, Valentina. I would like to welcome everyone to our earnings call for the first quarter of 2026. As always, I'll 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 and to our SEC filings.

謝謝你，Valentina。我想歡迎各位參加我們 2026 年第一季的財報電話會議。和往常一樣，我會先提及我們在安全港聲明以及簡報中所載的警示性語言，以及我們今天稍早已分發的所有資料。關於風險與不確定性的進一步細節，請參閱這些文件以及我們向 SEC 提交的申報資料。

We will have a little bit under an hour for the call. In order to give everyone the chance to ask questions, we would limit the number of questions to two. Thank you for making this work as always. Let me now welcome Helen Giza, CEO and Chair of the Management Board; and Martin Fischer, our Chief Financial Officer. Helen, the floor is yours.

本次電話會議將進行不到一小時。為了讓每位與會者都有機會提問，我們將把提問數量限制為兩個。感謝大家一如既往地配合。現在讓我歡迎 Helen Giza，我們的執行長暨管理委員會主席；以及 Martin Fischer，我們的財務長。Helen，交給你。

Thank you, Dominik. I'd like to extend a warm welcome to everyone on the call. Thank you for your continued invest in Fresenius Medical Care. I will begin my prepared remarks on slide 4. I am pleased to report that we began 2026 with continued operational and financial progress.

謝謝你，Dominik。我也想向線上各位致上熱烈歡迎。感謝各位持續投資 Fresenius Medical Care。我將從第 4 頁投影片開始我的準備發言。我很高興報告，我們在 2026 年開局即持續展現營運與財務上的進展。

We realized the solid organic revenue growth of 4%, reflecting positive contributions from all segments. We achieved strong operating income growth of 10%, in line with our planned phasing for the year and leading to further margin expansion. This was supported by continued execution of our FME 25+ saving program, which delivered EUR50 million in sustainable savings in the quarter.

我們實現了 4% 的穩健有機營收成長，反映所有事業部門皆有正向貢獻。我們達成 10% 的強勁營業利益成長，符合我們對全年分期推進的規劃，並帶動利潤率進一步擴張。這得益於我們持續推動 FME 25+ 節省計畫的執行，該計畫在本季帶來 5,000 萬歐元的可持續節省。

On 30 of April, we successfully completed our initial share buyback program of EUR1 billion in a significantly accelerated way. It was done in less than one year instead of within two years as originally announced. We bought back 24.8 million shares or 8.5% of share capital. At the same time, our net leverage ratio of 2.6 times remains around the lower end of our target corridor.

4 月 30 日，我們以顯著加速的方式成功完成了 10 億歐元的首輪庫藏股回購計畫。實際完成時間不到一年，而非原先公告的兩年內完成。我們回購了 2,480 萬股，約占股本的 8.5%。同時，我們 2.6 倍的淨槓桿比率仍維持在目標區間的較低端。

Let me now turn to key first quarter highlights across our operating segments on slide 5. Beginning with Care Delivery in the US, same market treatment growth declined by 37 basis points as volumes were impacted by miss treatments. We had flagged during the quarter that we experienced severe US weather events in January and February.

接下來請看第 5 頁投影片，說明第一季各營運事業部門的重點摘要。先從美國的照護服務（Care Delivery）開始，同市場治療量成長下滑 37 個基點，因治療量受到缺席治療（missed treatments）的影響。我們在本季期間已提示，1 月與 2 月美國遭遇嚴重天候事件。

As we focus on core operational improvements with clinic closures and insurance verification, this likely had a small impact on patient inflows at the start of the year. This was further complicated by the unclear situation for many patients with their insurance coverage due to the expiry of the extended tax subsidies for ACA.

由於我們聚焦於核心營運改善，包括診所關閉與保險資格驗證，這可能在年初對病患流入造成些微影響。此外，因 ACA 延長稅務補貼到期，許多病患的保險涵蓋狀況不明，讓情況更為複雜。

Volumes also continue to face pressure from mortality remaining above prepandemic levels. We are maintaining our assumption of flat US same market treatment growth in 2026, which includes the expectation for improving volumes over the course of the year. Our Care Delivery international markets delivered 1.3% same market treatment growth. Whilst TDAPA provided a benefit to our care delivery performance, Martin will address that in his remarks. What really stands out to me is the successful execution of our FME reignite strategy and the actions we are taking to strengthen our core care delivery business while driving profitable growth.

治療量也持續承受壓力，因死亡率仍高於疫情前水準。我們維持 2026 年美國同市場治療量成長持平的假設，其中包含預期治療量將在全年逐步改善。我們的國際照護服務市場同市場治療量成長為 1.3%。雖然 TDAPA 對我們的照護服務表現有所助益，Martin 會在他的發言中說明。對我而言最突出的，是我們成功執行 FME reignite 策略，以及我們為強化核心照護服務業務並推動獲利成長所採取的行動。

We understand the sense of urgency as well as the pace and momentum needed to deliver growth in our underlying business, and there are several proof points demonstrating progress already. While mortality levels are still above prepandemic level, we have seen a reduction in capital related bloodstream infections, with now around 90% of all eligible patients using an antimicrobial catheter lock solution. This is part of our FME reignite strategic priority to increase patient quality and safety.

我們理解在推動基礎業務成長時所需的急迫感，以及所需的速度與動能，且已有多項進展證據。雖然死亡率仍高於疫情前水準，但我們已看到導管相關血流感染下降；目前約 90% 的所有符合條件病患使用抗菌導管封鎖液（antimicrobial catheter lock solution）。這是我們 FME reignite 策略優先事項之一，旨在提升病患品質與安全。

We expect the progress we have made on increased usage of catheter lock solutions to begin to have a positive impact on miss treatments and mortality in the near future. The 5,008X rollout and introduction of high-volume HDF therapy represents the biggest operational and clinical change in our company's history.

我們預期，導管封鎖液使用率提升所帶來的進展，將在不久的將來對缺席治療與死亡率產生正面影響。5008X 的推廣以及高流量 HDF 治療的導入，代表公司史上最大的營運與臨床變革。

With the start of the large-scale launch in January, we have achieved a clear step-up change in rollout speed and are well on track. We surpassed 100,000 treatments on the 5008x in the first week of April and around 100 clinics have been converted to the new care system with more conversions underway as we speak. In February, as part of FME 25 plus, we announced the biggest US clinical restructuring in recent history with plans to close up to 100 clinics. Here, we are also moving at speed with 64 clinics already exited in the first quarter and the remainder expected within Q2. And finally, we have realized improvements in revenue cycle management, providing further evidence of our strategic execution.

隨著 1 月開始的大規模上市，我們在推廣速度上已明顯加速，並且進度良好。4 月第一週，我們在 5008x 上的治療次數已突破 100,000 次，約有 100 家診所已轉換至新的照護系統，且更多轉換正在進行中。2 月，作為 FME 25 plus 的一部分，我們宣布近年來最大規模的美國臨床重整，計畫關閉最多 100 家診所。在此方面我們也快速推進，第一季已退出 64 家診所，其餘預計於第二季完成。最後，我們在營收循環管理方面也實現改善，進一步證明我們的策略執行力。

Turning to value-based care. We delivered positive operating income driven by favorable savings rate, and we realized an increase in member months from future contracting growth. Leveraging data and analytics to improve quality and coordination of care is a central component of our FME reignite strategy. We have expanded adoption of AI-driven interventions for imminent hospital admissions of ESRD patients.

接著談價值導向照護（value-based care）。在有利的節省率帶動下，我們實現正向的營業利益，並因未來合約成長而使會員月數（member months）增加。運用資料與分析以提升照護品質與協調，是我們 FME reignite 策略的核心組成。我們已擴大採用 AI 驅動的介入措施，用於預測 ESRD 病患即將發生的住院。

Where employed these programs have shown a reduction in hospitalizations by as much as 15% and missed dialysis treatments per member per month by up to 26% for the highest risk patients. We will continue to scale this across our VBC population. I'm also proud to report that we continue to be recognized for quality leadership in the United States. Government CKCC program for multiple consecutive years. We delivered over $270 million in shared savings and achieved an 88% average quality score over the first three years of the program.

在已導入的地區，這些方案顯示住院率最多可降低 15%，而對最高風險病患而言，每位會員每月的透析缺席治療次數最多可降低 26%。我們將持續在 VBC 人群中擴大推行。我也很自豪地報告，我們在美國持續因品質領導而獲得肯定，並在政府 CKCC 計畫中連續多年獲得認可。我們在該計畫前三年累計創造超過 2.7 億美元的共享節省（shared savings），並達成 88% 的平均品質分數。

In the most recent publicly available data, we earned over 40% of the program's high performer pool driven by our industry-leading quality. Care Enablement realized favorable business growth as sales of the, sorry, 5008x in the US ramp up. This is a tremendous opportunity to bring new innovation to the US market and we are on track with production to supply both machines and consumables according to our targets for the year.

在最近一期公開可得的資料中，憑藉我們業界領先的品質表現，我們獲得了該計畫高績效者獎勵池（high performer pool）超過 40% 的份額。照護賦能（Care Enablement）實現有利的業務成長，因為在美國，呃，5008x 的銷售正在加速放量。這是將新創新帶入美國市場的重大機會，我們的產能供應也按計畫推進，可依照年度目標供應設備與耗材。

In the first quarter, we achieved positive pricing and volume development in our markets outside of China. We faced continued pressure in China, especially from volume-based procurement and stricter tender requirements.

第一季，我們在中國以外市場實現正向的價格與銷量發展。在中國，我們仍面臨持續壓力，尤其來自帶量採購以及更嚴格的招標要求。

We continue to closely monitor developments in China and assess the implications on our product portfolio and strategy as part of FME reignite. We also continue to strengthen our core care enablement business with further FME 25+ progress in streamlining our manufacturing and supply chain.

我們將持續密切關注中國的發展，並在 FME reignite 架構下評估其對我們產品組合與策略的影響。我們也持續強化核心照護賦能業務，並透過進一步推進 FME 25+，精簡製造與供應鏈。

I will now hand over to Martin to walk you through the first quarter financials in more detail.

接下來我把時間交給 Martin，請他更詳細地帶各位了解第一季財務表現。

Thank you, Helen, and welcome to everyone on the call also from my side. I will pick up on slide 7. In the first quarter, we achieved solid organic revenue growth of 4%, supported by growth in all three operating segments. At constant currency, revenue increased by 3%. Care Enablement revenue development continued to face headwinds from regulatory pressure in China. Divestitures negatively impacted revenue development by 50 basis points.

謝謝你，Helen，我也向線上各位致意。請看第 7 頁投影片。第一季，我們達成 4% 的穩健有機營收成長，並由三大營運事業部門全面成長所支撐。以固定匯率計算，營收成長 3%。照護賦能的營收發展仍受到中國監管壓力的逆風影響。資產剝離（divestitures）對營收發展造成 50 個基點的負面影響。

We delivered strong operating income growth of 10% at constant currency. This increase was supported by contributions from all operating segments, that is in line with our expected phasing for our '26 outlook. Special items in the first quarter amounted to a net negative EUR181 million, mainly reflecting costs associated with FME 25+ as we accelerated our US clinic closures. In line with expectations, FME 25+ costs are planned to come down over the course of the year as costs related to US clinic closures are first half loaded.

以固定匯率計算，我們實現 10% 的強勁營業利益成長。此增幅來自所有營運事業部門的貢獻，並符合我們對 2026 年展望的預期分期推進。第一季特殊項目（special items）淨額為負 1.81 億歐元，主要反映我們加速美國診所關閉所產生、與 FME 25+ 相關的成本。符合預期，FME 25+ 成本規劃將在全年逐步下降，因與美國診所關閉相關的成本主要集中在上半年。

Turning to slide 8. This chart illustrates the year-over-year improvement of the group operating income margin, highlighting a further increase of 70 basis points. With 10.1%, this is a solid start toward achieving our projected group operating income margin of 10.5% to 12% for the full year. Care Delivery was the main driver of improved profitability with a small contribution from value-based care. The higher intersegment elimination reflects the 5008X Care system sales in the United States.

接著看第 8 頁投影片。此圖表說明集團營業利益率的年對年改善，並突顯再提升 70 個基點。以 10.1% 而言，這是朝向全年集團營業利益率 10.5% 至 12% 目標的穩健開局。照護服務（Care Delivery）是獲利能力改善的主要驅動因素，價值導向照護亦有小幅貢獻。較高的部門間抵銷（intersegment elimination）反映了 5008X 照護系統在美國的銷售。

Corporate costs increased by EUR37 million. This was mainly driven by the planned cost of strategic IT platform investments, including preparation for the transition to [SAP S/4HANA]. FX translation effects were unfavorable this quarter and stood at negative EUR34 million. The average US dollar exchange rate in the first quarter was $1.17 compared to $1.16 in the fourth quarter and compared to $1.05 in the first quarter of 2025.

公司成本增加了3,700萬歐元。這主要是由於策略性IT平台投資的計畫性成本所致，包括為轉換至 [SAP S/4HANA] 進行準備。本季外匯換算影響不利，為負3,400萬歐元。第一季美元平均匯率為1.17美元，相較第四季的1.16美元，亦高於2025年第一季的1.05美元。

I will now walk you briefly through the business development in each segment, starting with Care Delivery on slide 9. Care Delivery achieved organic revenue growth of 6%, driven by both care delivery US despite muted US volumes and Care Delivery International.

我現在將簡要帶您回顧各事業部門的業務發展，先從第9頁的照護服務（Care Delivery）開始。照護服務實現6%的有機營收成長，動能來自照護服務美國（儘管美國量能偏弱）以及照護服務國際。

At constant currency, revenue increased by 5%. In the US, growth was driven by a positive impact from the TDAPA reimbursement regulations as well as favorable rates and payer mix effects. Our US payer mix remained strong in the quarter. with relatively low attrition in the exchange patient population. We expect that attrition to increase over the course of 2026 as grace periods expire and affordability pressures grow around higher premium and out-of-pocket costs. We continue to expect an impact of around EUR50 million for full year 2026.

以固定匯率計，營收增加5%。在美國，成長主要來自TDAPA給付規範的正面影響，以及有利的費率與付款方組合（payer mix）效應。本季我們在美國的付款方組合仍然強勁，交易所（exchange）病患族群的流失率相對較低。我們預期隨著寬限期到期，以及較高保費與自付費用帶來的可負擔性壓力上升，流失率將在2026年期間增加。我們仍預期2026年全年影響約為5,000萬歐元。

The impact from divestitures as part of our portfolio optimization plan reduced revenue growth by about 80 basis points. The main driver here was the prior year divestment of our clinics in Brazil. Care Delivery realized strong operating income growth of 26%. This resulted in a margin improvement to 12.1%. Benefits from the TDAPA reimbursement regulation for phosphate binders and catalog solutions where, as expected, a meaningful driver of the earnings development.

作為投資組合優化計畫的一部分，資產剝離的影響使營收成長約減少80個基點。主要原因是去年出售我們在巴西的診所。照護服務的營業利益強勁成長26%，使利潤率提升至12.1%。如預期，TDAPA對磷結合劑與目錄解決方案（catalog solutions）的給付規範帶來的效益，是獲利發展的重要推動因素。

We continue to assume a significant headwind from the TDAPA reimbursement regulation in the second half of the year. Importantly, excluding the TDAPA benefit, the underlying business realized around 6% earnings growth on a constant currency basis.

我們仍假設TDAPA給付規範在下半年將帶來顯著逆風。重要的是，若排除TDAPA效益，基礎業務以固定匯率計約實現6%的獲利成長。

This includes favorable rate and mix effects, lower implicit price concessions, thanks to our revenue cycle management initiatives and partially offset planned strategic investments for the 5008X rollout in our US clinics. Savings from the FME 25+ program contributed positively. The anticipated labor costs increased as well as currency translation effects had a negative impact in the development.

這包括有利的費率與組合效應，以及在我們營收循環管理（revenue cycle management）措施帶動下，隱含價格讓步（implicit price concessions）降低；但部分被我們在美國診所推動5008X導入的計畫性策略投資所抵銷。FME 25+ 計畫帶來的節省亦有正面貢獻。另一方面，預期的勞動成本上升以及匯率換算影響，對整體發展造成負面影響。

Turning to value-based care on slide 10. Value-Based Care realized 3% revenue growth on both an organic and constant currency basis. This was driven by a higher number of member months from contract expansion and positive effects from figures. Prior period contract true-ups also created positive growth in the first quarter. This was partially offset by the change of risk type for a large contract, resulting in a different accounting treatment and lower revenue recognition.

接著看第10頁的價值導向照護（Value-Based Care）。價值導向照護在有機與固定匯率基礎上皆實現3%的營收成長，主要由合約擴張帶來的會員月數（member months）增加，以及來自數據（figures）的正面效應所驅動。前期合約的結算調整（true-ups）也在第一季帶來正向成長。部分則被一項大型合約風險類型變更所抵銷，該變更導致不同的會計處理與較低的營收認列。

We expect revenue growth will turn negative throughout the year, primarily due to the change in accounting treatment. Operating income for Value Based Care increased significantly in relative terms and the margin was enhanced by 100 basis points. Value Based Care was profitable for the second consecutive quarter.

我們預期全年營收成長將轉為負值，主要原因是會計處理方式的改變。價值導向照護的營業利益在相對幅度上顯著增加，利潤率提升100個基點。價值導向照護已連續第二季實現獲利。

The increase in business growth was mainly driven by an enhanced savings rate. FME 25+ program-related savings resulted from the reorganization of the team to take advantage of integration with Fresenius Medical Care and becoming more efficient while aligning staffing with our strategic priorities. Higher inflation and currency translation effects were offsetting factors.

業務成長的提升主要由更高的節省率（savings rate）所帶動。與FME 25+ 計畫相關的節省，來自團隊重整，以利用與費森尤斯醫療照護（Fresenius Medical Care）的整合並提升效率，同時使人力配置與我們的策略優先事項一致。較高的通膨與匯率換算影響則為抵銷因素。

I will turn to Care Enablement on slide 11. Revenue in Care Enablement increased by 1% on an organic and constant currency basis. Organic revenue development reflects continued positive volumes and pricing, excluding adverse regulatory impacts in China, which include volume-based procurement and swifter tender requirements.

接著看第11頁的照護賦能（Care Enablement）。照護賦能營收在有機與固定匯率基礎上增加1%。有機營收表現反映量能與定價持續正向（不含中國不利的監管影響），中國的不利監管影響包括帶量採購以及更快速的招標要求。

Revenue was also supported by strong sales of the 5008X Care System in the United States. Care Enablement earnings slightly increased on a constant currency basis, leading to a 40 basis point margin improvement. Business growth was impacted by adverse regulatory impacts in China and negative currency translation effects. Positive volume and price effect outside of China contributed positively to business growth. Additional FME 25+ savings from continued progress in manufacturing and supply chain initiatives supported margin expansion. Inflationary costs increased and had a negative effect.

營收亦受惠於5008X Care System在美國的強勁銷售。照護賦能獲利以固定匯率計小幅增加，使利潤率提升40個基點。業務成長受到中國不利監管影響與負面的匯率換算效應所拖累。中國以外地區的正向量能與價格效應對業務成長有正面貢獻。隨著製造與供應鏈措施持續推進，額外的FME 25+ 節省支持利潤率擴張。通膨成本上升並帶來負面影響。

Next, I will look at the cash flow growth on slide 12. As always, in the first quarter, we have the seasonality effect in invoicing, which is why the quarter typically represents a relatively low share of the full year operating cash flow. This year, while on the typically lower quarter one level, we realized a strong increase in operating cash flow by 39%. The main driver was favorable working capital management. Free cash flow increased by 94% to EUR40 million.

接下來看第12頁的現金流成長。如同以往，第一季因開立發票的季節性因素影響，通常僅占全年營運現金流相對較低的比重。今年在第一季通常較低的水準下，我們仍實現營運現金流增加39%的強勁成長，主要驅動因素為有利的營運資金管理。自由現金流增加94%至4,000萬歐元。

Total debt and lease liabilities as well as total net debt and lease liabilities were broadly stable compared to the prior year period. As part of our share buyback program, we repurchased a total of 23.3 million shares for EUR941 million by the end of the first quarter.

總負債與租賃負債，以及總淨負債與租賃負債，相較去年同期大致持平。作為我們庫藏股回購計畫的一部分，截至第一季末，我們以9.41億歐元回購合計2,330萬股。

This represents 7.9% of share capital. On April 30, we successfully completed our initial share buyback program of EUR1 billion. We bought back in an accelerated way, 24.8 million shares or 8.5% of share capital. With 2.6 times our net leverage ratio continued to be around the lower end of our self-employed target corridor of 2.5 times to 3 times.

這相當於股本的7.9%。4月30日，我們成功完成首期10億歐元的庫藏股回購計畫。我們以加速方式回購2,480萬股，約占股本的8.5%。在淨槓桿比率為2.6倍的情況下，仍大致位於我們自訂目標區間2.5倍至3倍的較低端。

I will now hand back to Helen.

我現在把時間交回給Helen。

Thanks, Martin. I will pick up with the outlook slide on slide 14. Given our strong first quarter performance and current expectations for the remainder of 2026, we are confirming our full year outlook. We continue to expect a broadly flat revenue development.

謝謝，Martin。我將接續第14頁的展望頁。鑑於我們第一季的強勁表現，以及對2026年剩餘期間的目前預期，我們確認全年展望不變。我們仍預期營收發展大致持平。

For earnings, we assume operating income will remain on a consistently high level as 2025 with an upside downside range of a mid-single-digit percentage change. We clearly target to maintain our enhanced profitability. Unchanged to our assumptions, we do expect a positive earnings growth in the first half of 2026.

在獲利方面，我們假設營業利益將維持在與2025年同樣的高水準，上下行區間為中個位數百分比的變動。我們明確以維持提升後的獲利能力為目標。依我們的假設不變，我們確實預期2026年上半年獲利將呈正成長。

Due to the phasing of the regulatory TDAPA effects, which should present a significant headwind in the second half of the year, we assume a negative earnings growth in the back half of 2026. As you will be asking about the impacts from the Middle East crisis, I want to say that we are closely monitoring inflationary impacts from higher oil prices, raw material costs and other supply chain and transportation cost related topics.

由於監管TDAPA效應的時點分布（phasing），其在下半年應會形成顯著逆風，我們假設2026年下半年獲利成長為負。考量您可能會詢問中東危機的影響，我想說我們正密切監控油價上升、原物料成本以及其他與供應鏈與運輸成本相關議題所帶來的通膨影響。

So far, there were no meaningful interactions of our local operations during the first quarter, and the financial impacts are currently absorbed within our range of inflation assumptions for our 2026 outlook. We are closely monitoring this, have implemented mitigation measures and we'll keep you updated.

截至目前，第一季我們的當地營運並未出現任何重大干擾，而財務影響目前亦已在我們對2026年展望的通膨假設區間內吸收。我們將持續密切監控，已實施緩解措施，並會隨時向各位更新。

This concludes my prepared remarks, and I now hand back to Dominik to begin the Q&A session.

以上為我預先準備的發言，現在我把時間交回給Dominik，開始問答環節。

Thank you, Helen. Thank you, Martin. (Operator Instructions). And with that, I hand it over to Valentina to open the Q&A, please?

謝謝你，Helen。謝謝你，Martin。（接線員指示）。那麼，我把時間交給Valentina，請她開啟問答環節，可以嗎？

(Operator Instructions) Back over to you, Dominik, for the first question.

（接線員指示）Dominik，交回給你進行第一個問題。

Graham, UBS.

Graham，瑞銀（UBS）。

Good morning, guys. (inaudible) Congratulations on the 5008X rollout that's obviously just undertaking. I was hoping you might be able to contextualize that and some of the other growth drivers expected to build through the year. It's just when I look at the growth for Q1, if you were you adjusted to TDAPA it looks like there's quite a bit of work to do as we go through the year when we think of the kind of mid-teens implied growth in consensus for 2027. So I just wanted just thinking how do you get there? How do you get to that sort of mid-teens growth for next year?

各位早安。（聽不清）恭喜5008X的導入推進，顯然目前正在進行中。我希望你們能協助把這點以及今年內預期逐步發酵的其他成長驅動因素放在脈絡中說明。因為當我看第一季的成長，如果你把TDAPA調整掉，看起來今年接下來還有不少工作要做；尤其當我們思考市場共識對2027年所隱含的約中十位數（mid-teens）的成長。我的意思是，我想了解你們如何達成？明年如何達到那種中十位數的成長？

What do you exit that TDAPA piece? So is it more cost savings? Is there another TDAPA coming presumably the volume of it won't start just yet from HVHDF. But it would be good to get a sense as to which of those drivers are making you confidence on that. Thank you.

當你們走出TDAPA這一塊之後，會是更多成本節省嗎？還是可能會有另一個TDAPA？我推測HVHDF的量可能還不會立刻開始。但如果能讓我們了解哪些驅動因素讓你們對此有信心，會很有幫助。謝謝。

Thanks, Graham. I'll take that. Obviously, we outlined a lot of the drivers for reignite and how we get to those mid-teens margins. Kind of the specific building blocks clearly are ongoing FME 25, as you rightly said, the 5008X obviously is expected to ramp up, not just over this year, but over those next couple of years as well.

謝謝你，Graham。我接受這點。顯然，我們已經概述了許多重新點燃成長的驅動因素，以及我們如何達到十幾個百分點的利潤率。具體的組成要素很清楚，包括持續推進的 FME 25；正如你所說，5008X 顯然預期會逐步放量，不僅是在今年，未來幾年也會持續爬坡。

The work that we are doing and have constantly spoke to about improving inflows and outflows is quite multifactorial there. We're obviously working on improving our internal processes and even the work that we're doing on the catheter lock solutions in improving patient safety, patient quality will have a positive effect as well HDF on treatment volumes, reduced hospitalizations, reduced missed treatments and of course, longer mortality or improved mortality, I should say.

我們一直在談、也正在做的改善流入與流出（inflows/outflows）的工作，其實是多因素共同作用。我們當然在改善內部流程；此外，我們在導管封管（catheter lock）解決方案上的工作，提升病人安全與照護品質，也會帶來正面效果；同時 HDF 對治療量、降低住院、減少缺席治療，以及延長存活或說改善死亡率，也會有幫助。

As we think about the rev cycle management. We've got some nice contribution coming in for that. That will continue to ramp up over the course of the year. And then as you can appreciate, the clinic closures, which is a big part of the onetime cost in Q1. We'll start to get those savings continuing to compound over the course of the year. So a lot of building blocks there, not new building blocks, but ones that we're continuing to work through.

再談到營收循環管理（rev cycle management），我們已有不錯的貢獻進來，並且會在今年持續放大。然後如你所理解的，診所關閉是第一季一次性成本的重要部分；我們將開始看到這些節省在全年持續累積、複利式地顯現。所以有很多組成要素；不是新的要素，而是我們持續在推進與落地的項目。

I think the other piece is we go then specific that maybe most of those are specific to Care Delivery, as we think about Care Enablement, obviously, there's FME 25 there. And I think the China piece, and I'm sure there'll be questions on that, we've sized that for the year and knew that we'd have a bigger impact in Q1, that should also be behind us or kind of the full number more heavy loaded in the first half.

我想另一個部分是，若更具體來看，剛才多數可能偏向照護交付（Care Delivery）；而在照護賦能（Care Enablement）方面，當然也有 FME 25。還有中國的部分——我相信會有人問到——我們已把全年影響納入規劃，也知道第一季影響會更大；這應該也會逐步過去，或說整體數字在上半年會更偏前置。

And then the ongoing work on on good contracting, pricing, reimbursement and volume. So I'm confident in the plans. We've clearly underscored and underpinned the initiatives across all three segments, and we're executing against that to crystal player on the aspiration to be at mid-teens margins for all segments, I should say segment say VBC, [Tommy] will tell me, but definitely Care Delivery and Care Enablement. And I think that's why it's important. We understand that you have the piece. We understand the class that will happen.

接著是持續在良好合約、定價、給付（reimbursement）與量（volume）上的工作。所以我對計畫有信心。我們已清楚強調並支撐三個事業部門的各項倡議，並正據此執行，以更清楚地對齊我們的目標：所有部門都要達到十幾個百分點的利潤率——我應該說各事業部門；至於 VBC，[Tommy] 會提醒我，但至少照護交付與照護賦能是如此。我想這就是為什麼它很重要。我們理解你所提到的那一塊，也理解接下來會發生的情況。

We are really focused on that underlying improvement and personally really encouraged by that 6% underlying improvement in Care Delivery in the quarter. So recognize a lot of moving parts, a lot of good initiatives, and I think we're really starting to see them come through. But the clear building blocks of how we get there.

我們非常聚焦在底層改善；就我個人而言，也很受鼓舞，因為本季照護交付的底層改善達到 6%。所以我理解有很多變動因素、很多好的倡議，我想我們真的開始看到它們逐步反映出來，也更清楚看到我們如何達成目標的組成要素。

Also maybe just a quick follow-up on DefenCath. Are you guys seeing a benefit fairly quickly? It seems like something you might see a little bit of a tailwind relatively quickly.

另外也許快速追問一下 DefenCath。你們是否很快就看到效益？看起來這可能會相對快速帶來一些順風。

So which brand do you say HDF?

所以你說的是哪個品牌？HDF 嗎？

DefenCath, (inaudible) for the other products.

DefenCath，（聽不清）以及其他產品。

Yes, for sure. With having more than 90% of our patients on that, we are really starting to see a real improvement and reduction in bloodstream related infections. So really encouraged by that work. Of course, we know with the DefenCath that's TDAPA period. But the underlying catheter lock solution is really good for the patient safety, patient quality. So outside the financial impact of that clear improvement that should it be expected to translate into reduced hospitalizations and reduce missed treatments with the patients over time.

是的，當然。由於超過 90% 的病人使用它，我們確實開始看到血流感染相關事件明顯改善與下降。因此我們對這項工作非常鼓舞。當然，我們也知道 DefenCath 有 TDAPA 期間。但底層的導管封管解決方案對病人安全與照護品質確實很好。所以撇開其財務影響不談，這種明確改善預期也會隨時間轉化為住院減少、病人缺席治療次數降低。

Hassan, Barclays.

Hassan，Barclays。

Good afternoon. Thank you for taking my question. Firstly, on the TDAPA benefit in the quarter, can you talk to the split of the EUR80 million, be it phosphate binders versus catheter lock in the quarter? And how you see Q2 and H2 and if this is consistent with the expectations that you set out in February?

午安。謝謝讓我提問。首先，關於本季 TDAPA 的受益，你能談談這 8,000 萬歐元的拆分嗎？例如磷結合劑（phosphate binders）相對於導管封管（catheter lock）在本季各占多少？以及你如何看待第二季與下半年（H2），這是否與你們二月提出的預期一致？

And then secondly, on same-market treatment growth. If you could help unpack some of the underlying dynamics and if possible, how much of a headwind you think you may have seen from weather in Q1. And with no second flu spike, do you expect growth to swing quite meaningfully in the second quarter, all else equal? And perhaps into positive territory? Or is there something else in Q1 that should constrain that improvement that you might be seeing, be it inflow or mortality? Thank you.

第二個問題，關於同市場治療量成長（same-market treatment growth）。你能否協助拆解一些底層動態？如果可以的話，第一季天氣因素你認為帶來多少逆風？另外，在沒有第二波流感高峰的情況下，若其他條件不變，你是否預期第二季成長會相當明顯地回升，甚至轉為正成長？或者第一季還有其他因素會限制你們看到的改善，例如流入或死亡率？謝謝。

Thanks, Hassan. Martin, do you want to unpack the financials on TDAPA. I suspect many have the same questions. So why don't you walk through that, and I'll take the same market treatment growth question.

謝謝你，Hassan。Martin，你要不要先拆解一下 TDAPA 的財務細節？我猜很多人都有同樣的問題。你先說明，我再回答同市場治療量成長的問題。

So the contribution of the TDAPA for the first half, for the first quarter, as you said, was about EUR80 million on a constant currency basis. We have also told you and shared with you that the catheter lock solution contribution from '25 to '26 would be in equal size, meaning EUR90 million for the first half year. And we saw about half of that come through in the first quarter as well. And the remainder between that and the EUR80 million is a binder contribution.

如你所說，第一季 TDAPA 的貢獻以固定匯率（constant currency）計約為 8,000 萬歐元。我們也曾告訴並與各位分享，導管封管解決方案在 2025 到 2026 年的貢獻規模相同，也就是上半年為 9,000 萬歐元。我們也看到其中約一半在第一季反映出來。而在這 8,000 萬歐元與上述之間的差額，則是結合劑（binder）的貢獻。

Overall, our TDAPA contribution has developed as expected. And we have, as a reminder, positive contributions for the first half of 2026, and we expect negative headwinds in the second half. And that's why we also have, when we talk about operating income improvement for the first half a positive growth and for the second half, a negative growth expectation year over year.

整體而言，我們的 TDAPA 貢獻如預期發展。提醒一下，我們預期 2026 年上半年仍有正向貢獻，而下半年會有負向逆風。因此，當我們談到上半年營業利益（operating income）改善時，預期年對年為正成長；而下半年則預期年對年為負成長。

Thanks, Martin. And that, I'll take the same market treatment growth because I expect people to have a similar question here, too. Look, it's, we all know we're in small numbers on small numbers here. The, we know that we had weather in January and February that did result in missed treatments, flu was similar in Q1 '26 to what it was in Q1 '25.

謝謝，Martin。接著我來回答同市場治療量成長，因為我也預期大家會有類似問題。你看，我們都知道這裡是小數字疊在小數字上。我們知道一月與二月的天氣確實造成缺席治療；而流感在 2026 年第一季與 2025 年第一季大致相同。

We are kind of unpacking. We did see slightly lower referrals in the first part of the year. And obviously, we know we've got a lot of kind of closures and restructuring underway. We also know that the ACA piece did cause a lot of uncertainty on patients, and we're also refining our own patient insurance verification processes.

我們也在拆解原因：年初前段確實看到轉介（referrals）略低。顯然我們也知道目前有不少關閉與重整正在進行。我們也知道 ACA 的部分確實讓病人感到不確定；同時我們也在精進自身的病人保險資格驗證流程。

So look, our guide is unchanged. We do still expect to be flat full year not, I haven't even seen April numbers yet, so not in a position clearly to give insights into Q2. We do expect to continue to improve over the course of the year.

所以我們的指引沒有改變。我們仍預期全年持平——我甚至還沒看到四月的數字，因此也不適合對第二季提供洞見。我們確實預期在全年過程中持續改善。

And obviously, the other impacts that I spoke to on Graham's question about like bloodstream related infections, HDF and the ongoing work we're doing across the operation on improving inflows and outflows is important. I think the other thing worth noting is mortality is still elevated.

另外，我在回應 Graham 的問題時也提到其他影響，例如血流感染、HDF，以及我們在營運端持續推動改善流入與流出的工作都很重要。我想另一個值得注意的是，死亡率仍然偏高。

So that is something that we continue to try and impact through some of these other measures. All in all, I would say it's small numbers. Obviously, I know we're all looking for that to turn turn positive. But because of the small number, it's not really impacting OI as we have kind of maybe consistently said but really feeling good about the work that's underway. And obviously, we'll continue to see more as Q2 develops.

因此這也是我們持續嘗試透過其他措施來改善的部分。總體來說，我會說這是小數字。顯然我知道大家都在期待它轉為正成長。但由於基數很小，它並未真正影響營業利益（OI），正如我們可能一直以來所說；不過我們對正在進行的工作感覺很好。當然，隨著第二季進展，我們也會看到更多。

Veronica, Citi.

Veronica，Citi。

(multiple speakers) Good afternoon and thank you for taking my question. Two for me, please. The first one is sort of a slightly bigger question, I guess, Helen, I know we're early in the HDF roll out, but just curious to get some feedback from you, both in terms of operationally how that rollout is going out, going on in your own clinics, how you're feeling about some of the early signs of mortality benefits that you're seeing, if any? I know it's very early, but to the extent that you could talk about it.

（多位發言者）午安，謝謝讓我提問。我有兩個問題。第一個算是比較大的問題：Helen，我知道 HDF 還在早期推廣（roll out）階段，但想請你分享一些回饋，包含在營運面上，這個推廣在你們自有診所的進展如何；以及你對目前是否看到任何早期的死亡率改善跡象有何感受？我知道還很早，但若你能談到的範圍內，請分享。

And I guess some of the training costs that you've budgeted for in the year how you're tracking against those? And then I have a bigger picture follow-up question, but maybe we can get this out of the way first.

我想問一下，你們今年預算中編列的部分訓練成本，目前執行情況相對於預算的追蹤如何？另外我還有一個更宏觀的追問，但也許我們先把這個問題處理掉。

Sure. And as you know, it's my favorite topic, so we can spend the rest for the call talking about HDF, if we like. (inaudible) aside, really, really happy and excited about how it's going and the progress we're making we are accelerating at speed now. I mean if you look at our website, you'll see clinics coming soon and we're already past the 100 that we were at by the end of the quarter. So training is going well.

當然。而且如你所知，這是我最喜歡的主題，所以如果願意的話，我們可以把接下來整通電話都用來談 HDF。（聽不清）先不說這個，我們對目前的進展非常、非常滿意也很興奮；我們現在正在加速推進。我是說，如果你看我們的網站，你會看到「診所即將上線」，而且我們已經超過了季度末的 100 家。所以訓練進展得很順利。

Those costs are incurred and being incurred as we had had forecast. So that's all fine. The adoption in the clinics is really, really positive. It's easier to train the staff are loving it. It's less noisy, less disruptive with alarms and beeps and things going off. But more importantly, the feedback from our patients is to affect we're clearly seeing the immediate benefit of patients feeling better on these treatments, feeling less tired, et cetera.

這些成本已經發生、也正在發生，與我們先前的預測一致，所以一切都沒問題。診所端的採用情況非常、非常正面。員工更容易受訓，而且他們很喜歡；警報、嗶嗶聲等噪音更少、干擾更低。但更重要的是，病患的回饋是：我們清楚看到病患在這些治療下立刻感受到好處，覺得狀況更好、比較不疲倦等等。

Now I've been pretty consistent on this and it's kind of maybe just a caution, Obviously, we are tracking a data set from patient one. We've had, we've got 100,000 treatments here and over 100 clinics. We are starting to get that data set into a form that we can kind of start to tease out some KPIs and report out on it. But obviously, we want to get a little bit more the data sets and dropout.

我在這點上一直說得很一致，這也算是一個提醒：很顯然，我們從第一位病患開始就在追蹤資料集。我們已經有 10 萬次治療、超過 100 家診所。我們正在把這些資料整理成一種形式，讓我們可以開始萃取一些 KPI 並對外報告。但顯然，我們希望資料集再更完整一些，並把流失（dropout）等因素納入。

So we had kind of said we'll start to, once we're maybe through half one year, start to give more color on those KPIs. But everything so far is in real-world evidence is supporting what we had seen through the studies. So yes, obviously, it's big. It's the biggest thing we've ever done, but the level of excitement and engagement and adoption by our teams, our physicians and our patients is to effect. So that very, very happy with how that's going.

所以我們之前大概說過，等到大約過了上半年、接近一年中的一半時，我們會開始就這些 KPI 提供更多細節。但到目前為止，所有真實世界證據都支持我們在研究中看到的結果。所以是的，這當然很重大——這是我們做過最大的一件事——但我們的團隊、醫師與病患的興奮程度、投入度與採用速度都非常明顯。因此我們對目前的進展非常、非常滿意。

That's super helpful, and I think maybe just to sort of lead it into my second question. I guess we're all anxiously awaiting that return of the same market to a positive territory. I know you can't predict when that happens. But I guess just fundamentally for here again in 12 to 18 months' time, and we haven't seen any progress on same-market treatment growth. How will you think differently about operating the business or running the business?

這非常有幫助，我想也可以順勢帶到我的第二個問題。我想我們都在焦急等待同店市場回到正成長區間。我知道你無法預測何時會發生。但我想從根本上問：如果 12 到 18 個月後，我們仍然沒有看到同店治療量成長有任何進展，你們會如何用不同方式思考或經營這門業務？

We're seeing more clinic closures this year? Just curious kind of high-level thoughts. I know that's not your working assumption, but to the extent that we're there in 2027. What should we be expecting from you in response to that? Thanks so much.

我們今年看到更多診所關閉？我只是想了解一些高層次的想法。我知道那不是你們的基本假設，但如果到了 2027 真的出現那種情況，你們會如何回應？我們應該期待你們採取什麼作法？非常感謝。

Yes. Look, I, first of all, my expectation is 12 to 18 months, we wouldn't be at negative same market treatment growth. I do expect this to continue to improve. I feel really good about the work the FKC and CD team are doing in addressing a lot of these operational improvements and efficiencies and both addressing inflows and outflows.

是的。首先，我的預期是 12 到 18 個月後，我們不會仍處於同店治療量負成長。我確實預期這會持續改善。我對 FKC 與 CD 團隊在推動許多營運改善與效率提升、同時處理流入與流出方面的工作感到非常有信心。

Look, I think if we, if, and it's a big, big if we are in a situation where even with, you have to think about 18 months from now, Veronica, we would have technically also converted about 40% of our machines. So we should also be seeing the real nice impact coming through on HDF.

你看，我認為如果——而且這是一個非常、非常大的「如果」——我們真的處在那種情況下；你必須想到 18 個月後，Veronica，從技術上我們也大約會完成 40% 的機器轉換。因此我們也應該會看到 HDF 帶來非常好的實質影響逐步顯現。

As we have shown this year, where we know we have underutilized capacity or we don't have profitable growth. Clearly, we were to trim the network accordingly, but that is not our working assumption. But obviously, every month, every data point gives us a new insight and I think what we're seeing and the work that we're doing both on the patient safety, patient quality initiatives as well as HDF, I think over signs are pointing to that improving mortality, improving missed treatment, improving hospitalizations and as always, we know that we would have to flex a different cost muscle if we'd be along the way.

如同我們今年所展示的，當我們知道有未充分利用的產能，或沒有獲利性的成長時，很明顯我們會相應地精簡網路，但那不是我們的基本假設。不過，顯然每個月、每一個數據點都會帶來新的洞見。我認為我們在病患安全、病患品質倡議以及 HDF 方面所做的工作，跡象都指向：死亡率改善、缺席治療（missed treatment）改善、住院率改善。而且一如既往，如果一路上情勢需要，我們也知道必須動用不同的成本調整手段來因應。

And I think what I'm also would commend the team on is as we were looking at this 100 that we've teed up on (inaudible) closures, not just 64 in the first quarter, but that should be done sometime in May. We've already got, I think, close to 90 done through April. So that's also a good proof point that we can move at speed should we need to go deeper here.

另外我也想稱讚團隊的是：當我們在推進這 100 家（聽不清）關閉計畫時，不只是第一季的 64 家，而且原本應該在 5 月某個時間完成；但我們到 4 月已經完成了接近 90 家。所以這也是一個很好的佐證，顯示如果需要更深入調整，我們可以快速行動。

Got it. Thank you so much.

了解。非常感謝。

Hugo, BNPP.

Hugo，BNPP。

Hey, guys. Thanks for taking my question. I have two, please. First on the EUR200 million to EUR300 million inflation headwind that's in the guide. Could you maybe give us an indication of how a against that guide and given to intestines, what the well room you are with either the top or the renovated.

嗨，各位。謝謝讓我提問。我有兩個問題。第一個是關於指引中提到的 2 億到 3 億歐元通膨逆風。你們能否說明一下目前相對於該指引的進度如何？以及考量到（聽不清），你們在上行或（聽不清）方面有多大的空間？

And second, please, Martin, you mentioned ACA subsidies expiring, have you or will you account for patients that have signed up in ACA marketplaces in January, but as the one, three months risk period for the payment, I guess, in other words, would there be a stronger impact in Q2 from your EUR50 million and means or some type of (inaudible)

第二個問題，Martin，你提到 ACA 補貼到期；你們是否已經、或將會把 1 月在 ACA 市集註冊的病患納入考量？但因為我想付款有 1 到 3 個月的風險期。換句話說，第二季是否會比你們提到的 5,000 萬歐元影響更大，或是某種（聽不清）？

Martin, do you want to take the inflation question.

Martin，你要不要先回答通膨的問題。

Thank you. So, so far for the first quarter, we are tracking in line with our assumptions on the inflation side. We also saw only minimal impact from the conflict and from the macro environment. We are closely monitoring that, as Helen outlined, and we are also taking mitigating actions. But for quarter one, this is well in line with the development, and as we see it as of today, this is also something that is within the band of our assumptions for inflation as well.

謝謝。到目前為止，就第一季而言，我們在通膨方面的表現與假設一致。我們也只看到來自衝突以及宏觀環境的影響非常有限。我們正如 Helen 所說密切監控，同時也在採取緩解措施。但就第一季來看，發展完全符合預期；而以今天我們所看到的情況，通膨也仍在我們假設的區間範圍內。

Yeah. And then maybe on the ACA subsidies. You know that we had guided this impact of around $50 million. Obviously, what we're watching closely is what happened through open enrollment, what the uptake of patients or where patients are getting their insurance coverage.

是的。然後關於 ACA 補貼。你知道我們先前指引這項影響大約是 5,000 萬美元。顯然我們密切關注的是：在開放投保期間發生了什麼、病患的投保承接情況如何，或病患是從哪裡取得保險保障。

Since open enrollment closed, we always said it would take Q1 to play out to see how that was. What we've actually seen in Q1 is maybe lower than planned lower than thought patient attrition, some of that, the mechanics of how it worked was the auto enrolled. They have got, they had to make their first payment for their first month of coverage. We don't know after that first month whether they stayed on or didn't. There is this grace period that is happening.

自從開放投保結束後，我們一直說需要等第一季走完，才能看清楚情況。實際上我們在第一季看到的，可能是低於原先規劃、也低於原先預期的病患流失。其中一部分的機制是自動續保（auto enrolled）：他們必須先支付第一個月保費才能啟用第一個月的保障。我們不知道在第一個月之後，他們是否會繼續留在計畫內。這裡有一個正在發生的寬限期（grace period）。

And then we don't know from an affordability standpoint, whether they will stay on, on an exchange and a move to Medicare or Medicare Advantage after that. So we're roughly at the point where they should be making their first premium. And I think that's a real test kind of test point for us.

此外，從可負擔性角度來看，我們也不知道他們是否會繼續留在交易所（exchange）上，或之後轉到 Medicare 或 Medicare Advantage。所以我們大致正處在他們應該要支付第一期保費的時間點。我認為這對我們來說是一個真正的測試點。

So while we didn't see much impact in Q1, our expectation is affordability will become an issue. So right now, we believe our assumption for $50 million for the year is still a good estimate, but we would not necessarily start to see that impact until Q2 and obviously then compounded Q3, Q4. So it's something we're watching closely, but holding the assumption for now.

因此，雖然我們在第一季沒有看到太大影響，但我們的預期是可負擔性會成為問題。所以目前我們仍認為全年 5,000 萬美元的假設是合理估計，但我們不一定會在第二季之前開始看到影響，而且顯然第三季、第四季會疊加放大。我們會密切關注，但目前先維持這個假設不變。

Aisyah, Morgan Stanley.

Aisyah，Morgan Stanley。

Hi, everyone. Thanks for taking my question. My first one is hopefully a quick one on China. Could you quantify the impact from VBP and the tender exclusion in the quarter versus the guidance of, I think, EUR50 million or a bit less than EUR50 million that you saw last year? And do you have a clearer view on when you could reenter the tender this year?

嗨，各位。謝謝讓我提問。第一個希望是個關於中國的快問快答。你們能否量化本季 VBP 與投標排除（tender exclusion）的影響，相較於指引中——我記得——去年大約 5,000 萬歐元或略低於 5,000 萬歐元的影響？另外，你們對今年何時能重新進入投標是否有更清楚的看法？

And then the second question, also hopefully quick is on value-based care. So your performance in the quarter was clearly ahead of your expectations of a decline for the full year. Would this mean that we just see a steeper decline for the remainder of the year? Or does this drive a bit of upside to the original guidance? And at what point do you think you'll have better visibility on the margin side of things? Thank you.

然後第二個問題，也希望能快速問一下，關於價值導向照護（value-based care）。所以你們本季的表現顯然超出你們對全年下滑的預期。這是否意味著我們在今年剩餘期間會看到更陡峭的下滑？還是這會對原先的指引帶來一些上行空間？另外，你們認為在利潤率方面，什麼時候會有更好的能見度？謝謝。

Yes. Martin, do you want to take those two financial questions.

是的。Martin，你要不要來回答這兩個財務問題。

Yes, more than happy to. So Aisyah, on China, yes, we gave an expectation that we would see a little bit of below EUR50 million for the full year. We did see also in quarter one, about half of that come through as we expected and this is in line with how we looked at China for the full year. And obviously, also then we do see lower effects in the coming quarters to that extent. When we talk about Value-Based Care.

好的，很樂意。所以 Aisyah，關於中國，是的，我們給出的預期是全年會略低於 5,000 萬歐元。我們也在第一季看到大約一半如預期實現，這與我們對中國全年情況的判斷一致。而且很明顯，在接下來的季度，我們也會在相同程度上看到較低的影響。當我們談到價值導向照護（Value-Based Care）時。

Yes, you are right. We had a bit of an uptick in the quarter where we had the mix of revenues being driven also by prior period adjustments, which is helping us to offset the headwinds that we have from the revenue recognition of a differently casted contract.

是的，你說得對。我們本季確實有些上揚，收入組合也受到前期期間調整（prior period adjustments）的帶動，這有助於我們抵消因一份以不同方式設計的合約所帶來的收入認列逆風。

I think it is too early given the volatility of the Value-Based care business, quarter one being a, let's say, proof point, so to say, the positive to change the outlook for the year. So we have given you EUR300 million assumption, and that is still what we currently work with.

我認為，鑑於價值導向照護業務的波動性，現在還太早；第一季可以說是一個正向的「驗證點」（proof point），但不足以改變我們對全年展望。因此我們給出的假設是 3 億歐元，而這仍是我們目前採用的基準。

Thank you. And if Martin, if I could push a little bit as well on the inflation side, which you talked a bit earlier. You mentioned you're monitoring the situation closely. But if in the extent that the current conflict is prolonged, which areas of your cost base would you see most sensitive to incrementally higher inflation as a result. So would it be energy, freight, plastics, et cetera? I appreciate you're not seeing any impact at the moment, but in a worst-case scenario?

謝謝。Martin，如果我也可以再追問一下你先前提到的通膨面向。你提到你們正密切監控情勢。但如果目前的衝突延長，在成本結構中哪些領域會對因而更高的通膨最為敏感？會是能源、運輸、塑膠等等嗎？我理解你們目前尚未看到影響，但在最壞情境下呢？

Yeah. When we look at different buckets, typically, you look at energy, you look at transportation costs, everything that's exposed to oil price, also on the oil price-based materials like plastics and stuff like that. So on the energy side, we are well hedged. So 70% of our exposure is hedged. So I would call that a limited exposure.

是的。當我們看不同的成本項目時，通常會看能源、運輸成本，以及所有暴露於油價的項目，也包括以油價為基礎的材料，例如塑膠之類。在能源方面，我們有良好的避險，所以我們 70% 的曝險已經避險了。因此我會說這部分的曝險有限。

Having said that, when there would be a continued high oil price dependency obviously, transportation like with everybody else or plastic-based oil dependencies would see a potential inflation and cost increase if this is where we must follow. But also, as I said, perhaps one last thing here. We are currently, and that's what I answered Hugo in his question, absorbing that in our guidance assumption for the year.

話雖如此，如果油價持續維持高檔，顯然運輸（和其他公司一樣）或以石油為基礎的塑膠相關依賴，可能會出現通膨與成本上升，如果這是我們必須跟隨的走勢。另外，正如我說的，也許最後補充一點：我們目前——這也是我在回答 Hugo 的問題時提到的——已在我們對今年的指引假設中吸收了這些因素。

Anna, Bank of America.

Anna，美國銀行（Bank of America）。

Hi, thank you for taking the question. I wanted to follow up on what Veronica was asking about the HV HDF rollout. And how the costs are unfolding versus your expectations? I think you said you rolled out 200 clinics versus an implied goal of closer to 500. Should we be thinking that the costs accelerate in Q2 and into the back half of the year maybe compounding the headwind from the TDAPA roll-off.

嗨，謝謝讓我提問。我想追問 Veronica 先前問到的 HV HDF 推廣（rollout）。以及成本的展開情況相較於你們的預期如何？我想你提到你們已推廣到 200 家診所，相較於隱含目標接近 500 家。那我們是否應該認為成本會在第二季以及下半年加速，並可能疊加 TDAPA 到期退出（roll-off）帶來的逆風？

And then I don't want to get ahead of myself, but how are you thinking about that going into 2027 that cost for the ongoing rollout there. I think previously, you've messaged that the savings from the HV HDF rollout would offset the cost. Is that still the right way to think about it? Or maybe it would be more of a similar magnitude. Thank you for taking the question.

另外我不想問得太超前，但你們如何看待到 2027 年持續推廣所需的成本？我記得你們之前傳達的是，HV HDF 推廣帶來的節省將抵消成本。這仍然是正確的理解方式嗎？或者可能會是大致相近的量級？謝謝讓我提問。

Yes. So Anna, our plan is obviously to kind of replace about 20% of the machines of the installed base in 2026 as you can appreciate, the costs are front-end loaded because we have to train. We train, we get installed, we run and then obviously, the benefits lag, so as you can appreciate, the costs will continue to accelerate as we continue to accelerate the clinic closure.

是的。Anna，我們的計畫顯然是在 2026 年替換已安裝基礎（installed base）中約 20% 的機器；如你所理解，成本是前期較集中，因為我們必須進行訓練。我們訓練、完成安裝、開始運行，然後效益會滯後出現，所以如你所理解，隨著我們持續加速診所關閉，成本也會持續加速。

But it's more just kind of linear to the number of machines that we install over the course of the year. I think the piece that you're maybe trying to tease out is we have costs and then the benefits lag, but there'll come a point where the benefits will be absorbing some of those costs in the late years.

但它更多是隨著我們在一年中安裝的機器數量而大致線性變化。我想你可能想釐清的是：我們先有成本、效益滯後，但會有一個時間點，在較後期的年度，效益會開始吸收其中一部分成本。

So it's that lag kind of sorts itself out on an annual basis. But nothing, I don't think anything remarkable to comment on the costs outside of what we had originally guided. Now it's in line with the number of machines that we deploy.

所以這種滯後在年度層面會逐步被消化。但除了我們原先指引所提到的之外，我不認為成本方面有任何特別值得補充的。現在它就是與我們部署的機器數量一致。

Oliver, ODDO.

Oliver，ODDO。

Yeah, good afternoon. Thanks for taking my question. The first one is on the payer mix. So over the last quarters, we have seen or you have reported some progress. This was also again confirmed now. Up from now, how you think about further improvements in the payer mix. Is it still some source for additional profitability? Or at one point of time, it's basically, it's becoming more neutral.

是的，下午好。謝謝讓我提問。第一個問題是關於付款方組合（payer mix）。過去幾個季度，我們看到或你們也回報了一些進展，這次也再次確認。從現在開始，你們如何看待付款方組合的進一步改善？它仍然是額外獲利能力的來源嗎？還是到某個時間點，它基本上會變得更中性？

And the second question is about Value-based Care. So in your report as also shown a solid increase, I think, 5% of enrollment of new patients. Can you provide some data whether the growth now comes more from CKCC or from commercial programs? And how do you think about further patient growth in VBC? Thank you.

第二個問題是關於價值導向照護（Value-based Care）。你們的報告也顯示新病患加入（enrollment）有穩健增加，我想是 5%。你們能否提供一些數據，說明目前成長更多來自 CKCC 還是商業計畫（commercial programs）？以及你們如何看待 VBC 的後續病患成長？謝謝。

I can take both of those. In the payer mix improvement, we are very pleased with how we continue to improve that mix. Obviously, that right now, there's no ACA headwinds in that because we're still holding on to those patients. So there is an expectation that depending on what happens with ACA that might change.

我可以兩個都回答。關於付款方組合的改善，我們對持續改善的情況非常滿意。顯然，目前這裡沒有 ACA 的逆風，因為我們仍然保留著那些病患。所以會有一個預期是，取決於 ACA 的後續發展，這可能會改變。

The other thing I would say is, clearly, we are focused on improving that weight and be focused on profitable growth. So as we close clinics, we don't hold on to 100% of the patients. We know that. But obviously, the focus here is on the kind of the profitable mix there.

另外我想說的是，我們很明確地專注於提升這個權重，並專注於獲利性成長。因此當我們關閉診所時，我們不會保留 100% 的病患；我們知道這點。但顯然，這裡的重點是在獲利性的組合。

And I think also the opportunity to be talking to payers as well about some of these new initiatives now that we're focused on, notwithstanding HDF and some of the other pieces, so we are pleased with how that is developing and the conversations there and continues to slightly tick up each quarter.

我認為另一個機會是，我們也能與付款方就一些我們目前聚焦的新倡議進行討論，不論是 HDF 或其他一些項目；因此我們對其發展以及相關對話感到滿意，而且每一季都持續小幅上升。

On VBC, obviously, in the quarter, Martin spoke to this already. There was a prior year true-up. But I would say we are, we've got a new leader now. We've kind of got a really good strategic focus here on finding the growth in both the contracts and better contracting and premiums as well as member months.

關於 VBC，顯然本季 Martin 已經提到過，存在前一年度的追溯調整（true-up）。但我想說的是，我們現在有一位新的領導者，我們在策略上有很好的聚焦，致力於在合約成長、改善合約條款與保費（premiums），以及會員月數（member months）方面尋找成長。

So I would say that improvement is coming more from commercial than it is from CKCC. And obviously, we are really focused on improving the contract status that we have there and have had some nice wins and some nice discussions and new relationships with some of the larger payers.

所以我會說，這項改善更多來自商業端，而不是 CKCC。顯然，我們也非常專注於改善我們目前的合約狀態，並且取得了一些不錯的成果，也與一些大型付款方有良好的討論與新的合作關係。

Okay, thank you.

好的，謝謝。

James, Jefferies.

James，Jefferies。

Just a couple, please. Firstly, on operating cash flow. I noticed there's EUR227 million in the quarter, up 40%. I guess this is a summary on slide 12. But just wondering what goes into the other working capital and noncash items that was positive inflow of EUR133 million or nearly 60% of the operating cash flow.

請問兩個問題。第一個關於營運現金流。我注意到本季是 2.27 億歐元，成長 40%。我想這在第 12 頁有摘要。但我想了解「其他營運資金與非現金項目」（other working capital and noncash items）中，正向流入 1.33 億歐元（或接近營運現金流的 60%）主要包含哪些內容？

Because if you want to just adjust for that line. I appreciate there might be some other stuff that goes in there. It implies a 50% reduction in operating cash flow. So I just wonder if you can give some color what goes into that line and also just confirm there's any factoring.

因為如果把那一行調整掉，我理解可能還有其他項目包含在其中，但它意味著營運現金流會減少 50%。所以我想請你們補充一些說明那一行包含哪些內容，並且也請確認是否有任何應收帳款承購/保理（factoring）。

And then my second question is a full year, and there was the slide on the outlook assumptions just because I was missing in the deck this time, can you confirm that all of those are still valid. Thanks very much.

第二個問題是關於全年，以及那張展望假設的投影片；因為這次簡報檔裡我沒有看到它，你們能否確認那些假設仍然全部有效？非常感謝。

Why don't I take the full year outlook assumptions? Why I'll let Martin maybe have a look at the cash flow question, and we may have to follow back up on that. Yeah. Look, we don't include that headwinds and tailwinds side every quarter. We generally talk about it in the full year about what we're mapping and then maybe half year or speak to any major variations.

為什麼我不採用全年展望的假設？為什麼我會讓 Martin 也許看看現金流的問題，我們可能需要再跟進。是的。你看，我們不會每一季都納入那個逆風與順風的部分。我們通常會在全年談我們在對照/映射什麼，然後可能在半年或針對任何重大變動再做說明。

I would say as we look at that internally, that classification that, that is really developing in line with in line with expectations. So nothing significant to point out there. the headwinds and tailwinds are very much from what we've seen in Q1 and our outlook for the year developing in line with as we expected.

我會說，從我們內部來看，那個分類確實是依照預期在發展。所以那裡沒有什麼重大的事項需要特別指出。逆風與順風基本上是根據我們在第一季所看到的，以及我們對今年的展望，都是如我們所預期地在發展。

Perhaps what I can say and I might come back to you (inaudible). We are driving operating working capital improvements for the underlying cash performance. And on that other piece that you refer to, I would have to understand exactly what you referred to in CapEx.

也許我可以說的是，我可能會再回覆你（聽不清）。我們正在推動營運周轉資金的改善，以提升基礎現金表現。至於你提到的另一部分，我需要先確切了解你在資本支出（CapEx）方面指的是什麼。

David, JP Morgan.

David，JP Morgan。

Hey, guys. Thanks for the question. Sorry to rebank on the drama of both ACA and cost inflation maybe first ACA. Just wanted to double check. So have you recognized all the revenues from patients coming through? And then if they fall off sort of going forward them here, will you have to go back and readjust numbers or take a provision or you could make some sort of provision through the first quarter, just in case those guys do come off and then you might be able to write it back later if they don't. And the second question is on cost inflation than from Martin.

嗨，各位。謝謝讓我提問。抱歉又回到 ACA 和成本通膨的議題，先談 ACA。只是想再確認一下：你們是否已經認列所有來就診病人的收入？如果他們之後在這裡往前的期間流失，你們是否需要回頭調整數字或提列準備？或者你們是否可以在第一季先做某種準備，以防這些人真的流失，之後如果沒有流失再轉回？第二個問題是關於成本通膨，想請 Martin 回答。

I just wonder what percentage of your COGS in Care Enablement is particularly associated with plastics and actually what you're seeing in terms of plastic inflation there?

我想知道你們在 Care Enablement 的銷貨成本（COGS）中，有多少比例特別與塑膠相關？以及你們目前看到的塑膠通膨情況如何？

Yes. David, on the ACA question. Obviously, we have a patient we would be billing for that treatment for that patient. So there's no kind of, it's just particularly it's billed. I think our concern is more if they fall off insurance or they go out of the system that we lose that patient and obviously, that that revenue that comes from that.

是的，David，關於 ACA 的問題。顯然，我們會就該病人的治療向其開立帳單。因此沒有那種……就是正常開單。我認為我們更擔心的是，如果他們失去保險或退出系統，我們就會失去該病人，當然也就失去由此帶來的收入。

So I think that's why we can say there's not really an impact in Q1 because our patient census didn't have the attrition that we first thought. Now obviously, we're also looking pretty hard at the front-end process on insurance verification and things like that. So there shouldn't be an impact.

所以我想這就是為什麼我們可以說第一季其實沒有影響，因為我們的病人數並沒有出現我們一開始以為會有的流失。當然，我們也正在非常仔細地檢視前端流程，例如保險資格驗證等。因此應該不會有影響。

We just take it as the patient is there and then doing their insurance verification to make sure we're billing accordingly. So I think that's why we're saying we'll hold the assumption because we don't know if these patients will fall off.

我們就是把病人視為仍在，然後進行其保險驗證，以確保我們依規正確開單。我想這就是為什麼我們說會維持這個假設，因為我們不知道這些病人是否會流失。

Once they make the premium payment in Q2, Q3 or rest of the year, they do have to be covered. If they're on, they will get covered by the by the insurance company and what we call this grace period, but it's after that, that is the risk for the patients coming off the exchange.

一旦他們在第二季、第三季或今年其餘期間完成保費繳納，他們就必須被納入保障。如果他們仍在保單上，就會由保險公司承保。我們稱之為寬限期（grace period），但在那之後，才是病人可能從交易所（exchange）退出的風險。

So David, regarding the inflation question. As I said, we are monitoring the situation closely. There is multiple buckets where oil dependencies impacting transportation cost is on plastics or another one. I don't want to give you a number of our COGS because we have a supply chain that has different exposures. Obviously, we are manufacturing also our plastic parts, like the blood lines or like also other consumables in different locations.

所以 David，關於通膨的問題。如我所說，我們正密切監控情勢。有多個項目中，石油依賴性會影響運輸成本，塑膠是另一個。我不想給你我們 COGS 的具體數字，因為我們的供應鏈在不同面向有不同曝險。顯然，我們也在不同地點製造塑膠零件，例如血液管路（blood lines）以及其他耗材。

And as such, it is simple extrapolation. We are working on this. We are mitigating the effect. We have it inside our inflation guidance that we gave for the market. And I think that is from our perspective, the right way to do.

因此，這不是可以簡單外推的。我們正在處理並採取緩解措施。我們已將其納入我們對市場提供的通膨指引之中。我認為從我們的角度來看，這是正確的做法。

Thank you so much.

非常感謝。

Falko, Deutsche Bank.

Falko，德意志銀行。

Thank you. Good afternoon. Two questions, please. The first one, can you remind us how much of your care enablement sales are coming from China? And how was growth excluding China in the first quarter for the segment?

謝謝。午安。請問兩個問題。第一個，能否提醒我們，你們的 Care Enablement 銷售中有多少來自中國？以及該部門第一季在排除中國後的成長如何？

And then secondly, on care delivery, the organic growth in the international business was a tad softer than in previous quarters. Was there any particular reason for that? Or was that just normal quarterly volatility? Thank you.

第二個，關於 Care Delivery，國際業務的有機成長比前幾季稍微弱一些。這有什麼特別原因嗎？還是只是正常的季度波動？謝謝。

Yes, on the China one Falko, we said it's about 7% to 10% of the revenues that we have in Care Enablement, it is a relevant market. It's also an attractive market, and we have not disclosed for the quarter what the top line impact is overall.

是的，Falko，關於中國的部分，我們說過在 Care Enablement 的營收中大約占 7% 到 10%，這是一個重要市場，也是一個具吸引力的市場。我們沒有在本季披露整體營收端（top line）的影響。

Yeah. And then your question on CDI. As you know, we're kind of continuing to refine that portfolio on kind of where that treatment growth is coming. It was, it does look a little bit lower, but don't forget, last year, we had Brazil in the base. So as we look at this market by market, we're not concerned with what we're seeing. So I think it's just maybe a tough comp because of Brazil.

是的，然後你關於 CDI 的問題。如你所知，我們持續在精煉那個投資組合，釐清治療量成長來自哪裡。看起來確實低了一點，但別忘了去年基期包含巴西。因此當我們逐一市場來看，我們對目前看到的情況並不擔心。我想可能只是因為巴西造成的比較基期較嚴苛。

Okay, thank you.

好的，謝謝。

Richard from Goldman Sachs.

Richard，來自高盛。

Thank you so much for squeezing me in. Just a follow-up on China for care enablement. Between the stripped tender requirements in VBP, how are you seeing competitive dynamics in that market change, if at all? And Martin, you just referenced China as being an attractive market. What kind of scenario is embedded in your medium-term plans for care enablement in China, please? Thank you.

非常感謝讓我插入提問。關於中國的 Care Enablement 再追問一下。在 VBP 中剝離式（stripped）的招標要求之下，你們看到該市場的競爭態勢有任何改變嗎（如果有的話）？另外，Martin，你剛提到中國是個具吸引力的市場。請問在你們對中國 Care Enablement 的中期計畫中，內含的是什麼樣的情境？謝謝。

Yeah. Richard, look, China is an attractive market for us. It's a large market. The profitability is there despite some of the the challenges that we've already experienced. I think we're eyes wide open of what it takes to succeed in China. Obviously, there, we're hearing this across med tech. The competitive dynamics are changing.

是的，Richard，你看，中國對我們而言是個具吸引力的市場。它是個大市場。儘管我們已經經歷了一些挑戰，但仍具備獲利性。我想我們很清楚在中國成功需要什麼。顯然，我們在醫療科技領域也普遍聽到：競爭態勢正在改變。

I think for us, it's about having the right strategy and the right go-to-market approach in China and the right portfolio of what is local for local and what is really premium. So we have some good assumptions into our mid-range plans. We are obviously getting under the current environment and what the future portfolio should look like for China.

我認為對我們而言，關鍵在於在中國採取正確的策略、正確的市場進入（go-to-market）方式，以及正確的產品組合：哪些是「在地為在地」（local for local），哪些是真正的高端（premium）。因此我們在中期計畫中納入了一些不錯的假設。我們也正在因應目前環境，思考中國未來的產品組合應該長什麼樣子。

And obviously, if these dynamics continue to evolve, we will strategically adjust accordingly on the portfolio. We know we were, we had, we were later into China than some med tech companies. So we learned a lot, even with that, we obviously had some impact.

而且顯然，如果這些態勢持續演變，我們會在產品組合上相應地進行策略性調整。我們知道，相較於一些醫療科技公司，我們進入中國較晚，所以學到了很多；即便如此，我們也確實受到了一些影響。

You saw that hit us last year. But a lot of the focus is on what is the right portfolio to have in China for the China market, what can we do local, what can we partner? And I think then we have to look at China in relation to the global portfolio that we're developing and see what it is that we need to have offered there for continued success. But I think just more to come here as we continue to look at that strategy and the portfolio in light of these changing regulations that are happening in real time.

你去年就看到那對我們造成的衝擊。但很多重點在於：在中國市場，什麼才是合適的產品組合？哪些我們可以在地化？哪些我們可以合作夥伴？然後我們也必須把中國放在我們正在打造的全球產品組合脈絡下來看，看看為了持續成功，我們需要在那裡提供什麼。我想隨著我們持續在這些即時發生的法規變動下檢視策略與產品組合，後續還會有更多更新。

Thank you very much.

非常感謝。

Thank you. So with that, we have answered all questions. The time is up, so perfect combination. And with that, thank you for being so interested that we said more than an hour. And with that, I will say thank you, see you on the road on conferences and around the world.

謝謝。那麼到此為止，我們已回答所有問題。時間到了，剛好完美配合。也謝謝大家如此有興趣，我們講了超過一小時。那麼我就先說謝謝，之後在各地的會議以及世界各地的行程上再見。

Thanks, everybody. Have a good day. Bye-bye.

謝謝各位。祝大家今天愉快。再見。

Bye bye.

再見。