héctor ciria ‒ ceo quirónsalud - fresenius.de · key take-aways • leading hospital group in...

Quirónsalud Overview

Héctor Ciria ‒ CEO Quirónsalud

8 June 2018

The Best of Both Worlds

LOS

Short waiting times

Process Outcomes

Service

Procurement

Quality Peer- &

Management-

Reviews

Service-App

Outsourcing & Cooperations

Standard-ization

Outpatient services

Clustering

Laboratory

2

http://www.quironsalud.es/es/

Key Take-Aways • Leading hospital group in Spain

• Spanish market offers diverse range of financing models

• Multiple opportunities for growth

• Top priorities are medical quality, patient experience

and digital transformation

3

Capital Markets Day | Fresenius Helios 2018 | 8 June 2018

Agenda

01 Management Team

02 Spanish Hospital Market

03 Quirónsalud Group Overview

04 Growth for the Next Years

4


Today’s speakers

5 support areas

Quirónsalud Management Team

Víctor Madera Chairman (non-executive)

Héctor Ciria CEO

Adolfo Fdez. Valmayor IT & Digital Transformation

3 operating areas (“COOs”)

Leticia Moral Quality & Innovation

Juan Carlos González Talent & Organization

Miguel Mascaró Finance & Control (CFO)

Julio Fdez Llamazares Communication

Fernando Camino Occupational Risk Prevention (ORP)

Juan Antonio Álvaro Public Hospitals Madrid

Pedro Rico Private Hospitals

5

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http://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjO44KkjenZAhUJ6RQKHZgKBVAQjRwIBg&url=http://www.actasanitaria.com/hector-ciria-quironsalud/&psig=AOvVaw3TC2o5-OM9Vsgv-oxSRvpM&ust=1521023773520889


Agenda

01 Management Team




6


4.6 4.1 3.9 3.8

3.3 2.8

Portugal Germany Spain Italy France UK

8.1

6.1

3.4 3.2 3.0 2.6

Germany France Portugal Italy Spain UK

Source: OECD 2017, based on data from 2015 and 2016

11.3% 11.0% 9.7% 9.0% 8.9% 8.9%

Germany France UK Spain Portugal Italy

5,551 4,600 4,192

3,391 3,248 2,734

Germany France UK Italy Spain Portugal

Spain vs. European Peers

4,200

3.7

4.7

9.0%

Total health care expenditure (% of GDP)

Physicians density (x 1,000 inhab.)

Total health care expenditure (US$ PPP per capita)

Hospital beds density (x 1,000 inhab.)

7


Spanish Health Care System Snapshot

Universal coverage (100% population)

47 million users

For free No copayments

Financed with taxes

70% of total expenditure

Public System

Private System

Duplicative 10 million insured

(~20% of population)

Paid by users ̴€770/year per user

30% of total expenditure

Why pay for private insurance? • Shorter waiting times • Direct access to specialist doctor • Freedom to choose doctor • Comfortable hotel services (e.g. single room)

Private system supports public

system by releasing resources

Source: Ministerio de Sanidad y Consumo, IDIS, DBK, Company Internal Estimates

8


Care Delivery Market in Spain Amounts to ̴€60bn

45%

28%

27%

Spain GDP ‘17 €1.2 trillion Total health care expenditure ‘17E ̴€100bn

Care Delivery Market ̴€60bn

Private Network: ̴€14bn − Outpatient medical centers − 290 acute hospitals*

• 39 hospitals

63%

11%

26%

Private Network For-Profit Private Hospitals, Sales by Payor

2017E ~€14bn

2017E €6.4bn

For-Profit Hospitals

Outpatient Medical Centers & Specialist Units

Health Insurance Companies (HICs)

Self-pay & others

Public Administrations (outsourced activity to private hospitals)

Public Network: >€45bn − Primary Care − 286 Public acute hospitals*

(including some PPP contracts ) • 5 hospitals

Excluding Occupational Risk Prevention (ORP)

Non-for-profit Hospitals

9

* Excludes geriatric and psychiatric hospitals, rehabilitation hospitals, etc. If those are added, total number of hospitals in the Public Network amounts to 355, and in the Private Network to 444 Source: Ministerio de Sanidad y Consumo, CNH 2017, IDIS, Company Internal Estimates


Spanish For-Profit Private Hospitals Growth

4% CAGR historically Expected to continue growing at 3%–4% p.a.

Sector growth above GDP in all economic cycles

6.9%

1.8% 4.0%

1.1%

-0.6%

3.3%

2005–2009 2009–2014 2014–2017E

Growth fueled by Health Insurance Companies (HICs)

5.2%

2.0% 2.6% 4.2%

HICs Self-pay &Others

PublicAdmin.

TotalMarket

3.9 6.0 6.4

2005 2015 2017E

+4.2% +3.9%

HICs Self-pay & others

Public Admin.

For-profit Hospitals

Spanish GDP

2005 2017E 56%

13%

63%

11%

26%

For-Profit Private Hospital Market (€bn)

Private hospital market vs. Spanish GDP growth

Sales CAGR 2005-2017E Breakdown by payor

Source: OECD 2015, IDIS, DBK, Company Internal Estimates

31%

10

For-profit Hospitals

Spanish GDP


Agenda

01 Management Team



General Overview

Business Units

Integration with Fresenius Helios


11


#1 hospital group in Spain

€2.8bn sales in 2017, +10% vs ‘16 (+6% organic)

>100 health care centers, including 45 hospitals with c.7,000 beds

40,000 employees

Over 300 ORP centers, direct access to 5 million workers

Strong commitment to quality, education and innovation

Already present in LatAm

500

449

365

336

277

247

174

2,539

#Hospitals

3

7 1

3 3

3

5

11

3

1

2

2

Publicly available figures

Quirónsalud Group Snapshot

Source: annual accounts, internal analysis, press releases

Largest Spanish hospital operator (2016 Sales in €million)

12

~

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Quirónsalud Group KPIs

2017 Total Growth YoY*

* Includes organic and inorganic growth

Outpatient consultancies 8.6 million +12%

Emergencies 2.6 million +8%

Inpatient Patient Days Discharges Avg. Length of Stay Occupation rate

1.5 million

350 thousand 4.3 days

62%

+5% +5%

– + 1 p.p.

Surgeries 400 thousand +8%

13


A History of Growth

Sales evolution (€ million)

€32m €313m

€559m

€2,185m

~€2,800m

2000 2005 2010 2015 2017 # Hospitals 4 8 10 42 45

+30%

+ =

• Sustained organic growth, above market

• 10 greenfield projects

• More than 25 acquisitions including 5 turnarounds, 6 ORP companies and 1 hospital in Peru

2013 19

€817m 2013–2017 significant growth. Intense M&A

activity, mainly focused on private segment

14


Over the Last 4 Years, M&A Has Played a Transformational Role

Creation of Spanish market leader (#1 Group acquired #2) 1

+ =

Lima (Perú)

Illustrative

About €100m of annual synergies, most of them already realized and in a steady state

20 acquisitions between 2014–2017... … with significant value creation

Acquisition of prestigious hospitals in local markets 2

Creation of market leader in ORP sector 3

Mainly coming from… • Procurement • Internalization of services (laboratory,

cleaning, catering, etc) • ORP network rationalization • Headquarters

Development of Permanent Improvement Program

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https://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjAztXJs5DSAhUSGhQKHfOFCEAQjRwIBw&url=https://twitter.com/medycsa&psig=AFQjCNHDMLhkmo6-u1su7M7cMrh3qfFJYw&ust=1487189719418165

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Our People

More than 32,000 employees and 8,000 mercantile doctors

75% female and 74% indefinite contracts

Among Top 10 employers in Spain

Unifying cultures after 20 acquisitions in the last 4 years

Quirónsalud Campus corporate university

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Prestigious Hospitals in Every Large Spanish City

Top 10 Spanish provinces Celebrities at Quirónsalud

Province Population (million)

Quirónsalud # hospitals

Madrid 6.5 11

Barcelona 5.6 7

Valencia 2.5 1

Sevilla 1.9 2

Alicante 1.8 1

Málaga 1.6 2

Murcia 1.5 1

Vizcaya 1.1 1

La Coruña 1.1 1

I. Baleares 1.1 3

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Management Priority on Quality and Patient Experience

Focus on patient experience Collaboration with Cleveland Clinic

Top quality standards and certifications

Continuous monitoring of NPS

International Seminar on Patient Safety and Clinical Excellence, 5th edition in May 2018

18

CM Teknon

#1

La Fundación Jiménez Díaz recibe el sello de calidad EFMQ 5 Star 650+ por su excelente gestión

21 de mayo 2018

https://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwj9ouKnnMbaAhVG8RQKHWKABZQQjRx6BAgAEAU&url=https://www.consalud.es/ecsalud/nacional/quironsalud-se-alia-con-cleveland-clinic-para-liderar-la-experiencia-del-paciente_47847_102.html&psig=AOvVaw03zKxyjoRe0R6UUlpV3fUJ&ust=1524223266103277

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https://www.lancastersurg.com/Joint-Commission.html


Access to medical records

• Started in Q4 2016

• +700,000 patients registered

• +1 million appointments

• ~10% of Quirónsalud’s total outpatient consultations

Online appointment

Fully integrated health care system with doctors …

Internal Developments

… and management … porters, nurses…

Processes standardization (Efficiency & Quality)

Patient experience

Growth opportunities

Human talent

Embracing the New Digital Opportunities

Care Management System (Casiopea)

Patient Portal (app & web)

19


Equipped with the Latest Technology

86 MRIs

60 Multi-sliced CT scans

23 Linear accelerators

12 PET-CTs

5 Da Vinci surgical robots

4 SPECT-TCs

1 Gamma Knife

1 Cyber Knife

Cutting-edge high-tech equipment

1st proton beam therapy center in Spain, to be opened in Q4 2019

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Agenda

01 Management Team



General Overview

Business Units



21


47%

11%

30%

12%

Quirónsalud Group Structure & Business Units

ORPs

Transversal Units (internal services)

• Health & Safety at workplace • Over 300 centers • 5 million workers covered

• Health care services • 45 hospitals, 81 medical centers • Real Estate owned in 30 hospitals

• Laboratory • Radiology • Pathology

• Non-health care services (cleaning, kitchen, cafeteria, maintenance, etc.)

• Central procurement unit • IT & call center 2017A

~€2.8bn

Sales Breakdown

Health Insurance Companies (HICs)

Self-pay & others

Public Administrations

Hospitals 88%

ORPs 12%

Simplified

22

Hospitals

https://www.google.es/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwih59iVlKvbAhVSnRQKHfKODXQQjRx6BAgBEAU&url=https://fedace.org/centros_atencion_rehabilitacion_DCA.html?V_dir=MSC&V_mod=centrosAtencion&V_idmod=170&idn=167&&PHPSESSID=rakpjr6bnp5hqstv4e7a3m75d2&&psig=AOvVaw29nPerYfhC5wHD4-hiyliF&ust=1527691418314634

https://www.google.es/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwiLj7zx2KvbAhWDVxQKHfsfBfAQjRx6BAgBEAU&url=http://www.asmanet.es/ficha/186/centro-mdico-tecnon-&psig=AOvVaw1dPqHb3w27LG8eOFVQZOea&ust=1527709862779768


Hospital Private Activity

31%

17%

15%

7%

7% 23%

CM Teknon (Barcelona) Ruber Internacional (Madrid)

Quirónsalud Marbella Quirónsalud Madrid

HICs • Quirónsalud has agreements with all relevant HICs • 90% national and 10% international • National HICs

− Market growth at 4‒5% p.a. − Top 5 control close to 80% of market − Quirónsalud has improved its positioning vis-à-vis HICs,

establishing recurrent win-win relationships • International HICs cover the travel segment and medical tourism

Self-pay • Prestige and quality • Activity is generated from

− Highly reputed specialists offering private services only − Patients without private health insurance − Treatments not covered by insurance plans (plastic surgery, fertility)

Source: ICEA

HICs market share 2017

23

https://www.segurcaixaadeslas.es/es/particulares

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http://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://clinicasdecirugiaplastica.org/clinicas/hospital-ruber-internacional&ei=EoT1VK-SLYfvObOPgcAM&bvm=bv.87269000,d.d24&psig=AFQjCNH2jBtVhsxU2CIwTEBb7ovDDuPM7Q&ust=1425462662034562

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Hospital Public Activity – General Overview

Long-Term Contracts

• 5 hospitals: 4 in Madrid and 1 in Catalonia • Stable and secure contracts

− Terms: 30 years in Madrid, 10 in Catalonia − Expiration dates in Madrid 2036-2041 − Tariffs adjusted by CPI

• Hospitals integrated in public network with assigned population area

• Revenue model: (i) capitation fee or (ii) DRG /Activity

Short-Term Contracts • Outsourced activity to private players, typically to reduce surgical

waiting lists • Variable length of contracts (typically 2–5 years) • More than 10 Quirónsalud hospitals, broad geographical distribution

24

http://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://www.gencat.cat/piv/descarregues/dptSalut/07_serveiCatalaSalut.html&ei=xhLzVL6rJ4KdPanhgMAJ&bvm=bv.87269000,d.bGQ&psig=AFQjCNHNSgIhe7BhpBiG926P15zcN75aCw&ust=1425302589313785

http://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://www.gencat.cat/piv/descarregues/dptSalut/07_serveiCatalaSalut.html&ei=xhLzVL6rJ4KdPanhgMAJ&bvm=bv.87269000,d.bGQ&psig=AFQjCNHNSgIhe7BhpBiG926P15zcN75aCw&ust=1425302589313785

https://www.google.es/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwiTh-GctYrbAhVH0xQKHXasCD4QjRx6BAgBEAU&url=http://www.premir.es/premir/index.php/es/blog-sanidad/item/386-novedades-en-las-convocatorias-del-sergas&psig=AOvVaw3aBvf66DHHqPZQKUIk6rQz&ust=1526566422469026

https://www.google.es/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwi-y9OltYrbAhVHbxQKHbYvBOoQjRx6BAgBEAU&url=https://oposanitaria.com/2017/08/29/ope-sescam-2016-publicadas-las-convocatorias/&psig=AOvVaw3CcPCG2ABmW_6tVyv8dp6a&ust=1526566440440788

https://www.google.es/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwiN6eSytYrbAhUQGhQKHY8DBncQjRx6BAgBEAU&url=http://www.losardelavera.com/web/index.php/ayuntamiento/noticias/63-permanentes/666-convocatoria-de-procesos-selectivos-para-instituciones-ses&psig=AOvVaw1fdqpWqobMTeb9fJkEVmEn&ust=1526566460454261

https://www.google.es/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwjlm8m-tYrbAhUBjxQKHRj9BfoQjRx6BAgBEAU&url=https://es.wikipedia.org/wiki/Servicio_Canario_de_la_Salud&psig=AOvVaw1bK2JQ-eNOjG0h81Olxqv7&ust=1526566493315930


Hospital Public Activity – Patient Satisfaction in Madrid

92.7% 96.1% 92.4% 93.2%

FJD Hosp. Villalba Hosp. ReyJuan Carlos

Hosp. InfantaElena

#1 #1 #1 #3

Group III Group II Group I

Quirónsalud hospitals consistently lead the user satisfaction rankings in Madrid’s public system

8 13 6 Complexity # Hospitals

2017 Patient Satisfaction Survey in Madrid

Source: Servicio Madrileño de Salud

25

Quirónsalud

FJD

Hosp. Rey Juan Carlos

Hosp. Infanta Elena

Hosp. Villalba

-

-

2010

-

-

2011

-

2012

-

2013

-

2014 2015 2016 2017

1 1 1 1 1 1 1 2

1 1 2

1 1 1 1 2 3

2 2 2 2 1 1 1 1

Group III

Group II

Group I

Evolution of Quirónsalud hospitals in satisfaction rankings


ORP Business Unit

12%

Main Groups

Rank by Sales

ORP Centers (approx.)

Leader in a ̴€1.3bn market

Source: annual accounts, internal analysis, Aspren, press releases

• 5 million workers covered • 2 million medical checkups per year • 300 ORP centers network • New services contracted with Quirónsalud: laboratory, imaging, etc. • Direct dialog with largest Spanish corporates (Ibex 35)

Large potential for hospital growth (cross-referral)

2016 2017

3.3% 3.1%

19% 17%

2018E

2.7%

15%

Spain GDP growth Unemployment rate

• Sector is growing thanks to positive cycle • Further expected synergies

Growth & synergies in the ORP sector

#1

300

#2

130

#3

200

#4

200

#5

60

26

Publicly available figures

http://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCIuvur3f9McCFcTZGgodYioAmQ&url=http://www.telefonica.com/es/&bvm=bv.102537793,d.d2s&psig=AFQjCNG0NJ1J37GUATSmRgMZVKgQhYN_4Q&ust=1442258966707795

http://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCLDJoMbf9McCFUe9GgodIqwCFA&url=http://www.underconsideration.com/brandnew/archives/let_the_repsol_shine_in.php&bvm=bv.102537793,d.d2s&psig=AFQjCNFMU-Byk9m37gwAC7PjKoFO9ulWXg&ust=1442258985307723

http://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCNm6vtbf9McCFQpVGgodzC8PWg&url=http://www.indeed.es/cmp/Inditex&bvm=bv.102537793,d.d2s&psig=AFQjCNFM21CE2D6LRnLqnnPezN6HVbHKcQ&ust=1442259019594103

http://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCP6r_9vf9McCFUR-Ggodwy8PNA&url=http://www.europapress.es/epsocial/rsc/noticia-endesa-proyecto-growsmarter-soluciones-innovadoras-ciudad-20150422115100.html&bvm=bv.102537793,d.d2s&psig=AFQjCNH7W3IPXcdoLEBDRxlBrelAqZOBbQ&ust=1442259030524817

http://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCODU0_bf9McCFcFXGgod-ioOaw&url=http://www.libremercado.com/2013-10-15/iberia-estrena-nuevo-logotipo-sin-corona-1276501844/&bvm=bv.102537793,d.d2s&psig=AFQjCNHQ6b58J9EaW6q8KzZ6CRFt81so8Q&ust=1442259070096572


Agenda

01 Management Team



General Overview

Business Units



27

Integration with Fresenius Helios on Track, Promising Start

Short waiting times

Process Outcomes

Service

Procurement

Service-App

Outsourcing cooperations

Standard-ization

Outpatient services

Clustering

Laboratory

Quality Peer- &

Management-

Reviews

LOS

28

http://www.quironsalud.es/es/


Agenda

01 Management Team




29


• Internalization of services (Transversal Units)

• Corporate projects − Shared services centers − IT systems convergence − Revenue assurance program

• Permanent operational improvement program

• Spain is leading growth in EU − +2.7% GDP ’18E growth − Reducing unemployment

• Private hospital market to grow at 3–4%, outperforming Spanish GDP

Organic Growth in all Segments

Laboratory

Kitchen, Cleaning

Hospital Public

Hospital Private

ORPs

Focused on patient

experience Expansion projects

Most elected hospitals in

“free choice”

Positive employment

cycle Cross-referral with hospitals

Sales opportunities

Driven by quality of services

Growth above market

Moderate growth

HICs agreements

Positive macro trends ... Top line growth in all units ... Various efficiency levers ...

30


New Greenfield Centers – 5 Openings Within the Next 3 Years

Córdoba Hospital (2018) Proton Therapy Center (2019)

Alcalá de Henares Hospital (2020)

Quirónsalud Madrid new hospitalization building (2018-2019) Torre Vida Project (2020)

31

https://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwju37Do7MXaAhUH8RQKHa9iASIQjRx6BAgAEAU&url=https://lalunadealcala.com/quironsalud-abrira-un-hospital-en-alcala-de-henares-en-2019/&psig=AOvVaw2_BbX-F7m7eSSbgX_29bja&ust=1524210501519910

https://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwjSq7zM7MXaAhVHwBQKHVk7AFQQjRx6BAgAEAU&url=https://www.quironsalud.es/es/comunicacion/notas-prensa/hospital-universitario-quironsalud-madrid-celebra-decimo-an&psig=AOvVaw2pSH91t4x3QXErwgx_Ygwe&ust=1524210463495991


Over 200 beds High reputation Excellent doctors

Inorganic – Further M&A Opportunities

Spain LatAm

Analyzing opportunities in growing markets

• Present in Peru since Jan ’17

− Positive performance in our 1st year. Above expectations

• Some countries in Latin America could be attractive

− Improving regulatory and institutional conditions

− Relevant market sizes, with growth potential

− Opportunities for market consolidation

Source: CNH 2017

32

Other hospital groups (more than 20)

Independent hospitals (not belonging to any group)

39

133

118

Selective opportunities in a still fragmented private market

# Acute hospitals in private network

http://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCKXDjMzfjMcCFUy4FAodupMHbg&url=http://www.apmadrid.es/noticias-destacados/2-columnas-a/661438464-nuevo-telefono-para-citas-en-el-grupo-madrid?Itemid=&ei=Eki_VaXyOczwUrqnnvAG&bvm=bv.99261572,d.d24&psig=AFQjCNFynjveo7JLzCf55vNgMCU2nuyH0w&ust=1438685584790138

http://www.google.es/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCIS554TfjMcCFYGyFAodH3gGaQ&url=http://www.cardiosantcugat.com/es/asisa-llega-a-cardioclinic/&ei=fUe_VcSGG4HlUp_wmcgG&bvm=bv.99261572,d.d24&psig=AFQjCNGi06qawPZD7KO9cSZ_MpeotIWFZA&ust=1438685434593119

héctor ciria ‒ ceo quirónsalud - fresenius.de · key take-aways • leading hospital group in...

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