加拿大医疗行业研究报告2009年1月

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Health Care Services
Healthy Returns For Canadian Investors
Investment Summary
This research report provides an investment window into the dynamic $2 trillion
U.S. Health Services market. Our focus segments – Medical Imaging and Specialty
Surgical Care – look poised to benefit from a confluence of compelling
demographic, regulatory and clinical practice trends. Our featured investments are
the high yielding securities of companies with established positions in their
respective Health Care segments.
• We are initiating coverage on Medical Facilities Corp. (DR.UN-T) with a
BUY rating and a C$10.00 target price. We believe that Medical Facilities is
well positioned to capitalize on the migration to outpatient surgical care, and
away from traditional hospital settings. Medical Facilities has delivered aboveaverage
profitability from an established regional network of specialty hospitals
and Ambulatory Surgery Centers (ASCs). Medical Facilities is also one of
several primary consolidators in the highly fragmented U.S. ASC landscape.
Accretive acquisitions of ambulatory surgery centers are likely to provide the
key catalysts over the next 12 months.
• In this research report, we are also revisiting CML Healthcare Income Fund
(CLC.UN-T). We rate its units a BUY, with a C$18.00 target price, based on
a combination of the upside created by its February 2008 entry into the U.S.
medical imaging market, and its entrenched leadership position in the high
visibility Canadian Health Care Services markets.

Table Of Contents
Investment Summary ............................................................................. 1
The Summary Case ................................................................................ 3
Featured Companies............................................................................... 4
U.S. Health Care Services ...................................................................... 7
The Medical Imaging Opportunity..................................................... 10
The U.S. Surgery Market Opportunity .............................................. 12
Medical Care Facilities Corp............................................................... 25
Investment Summary................................................................................... 25
Medical Facilities – Company Overview .................................................... 26
Medical Facilities – Strategic Overview – What To Expect ....................... 30
Medical Facilities – The Operations............................................................ 32
Medical Facilities – Two Key Operating Metrics ....................................... 34
Medical Facilities Financial Forecasts ........................................................ 36
Investment Thesis........................................................................................ 38
Valuation ..................................................................................................... 38
Justification of Target Price......................................................................... 38
Key Risks to Target Price............................................................................ 39
CML Healthcare Inc. ........................................................................... 41
Investment Summary................................................................................... 41
CML’s U.S. Strategy ................................................................................... 42
Leveraging ARS’s Management Team ....................................................... 45
Financial Forecast........................................................................................ 47
Investment Thesis........................................................................................ 49
Valuation ..................................................................................................... 49
Justification of Target Price......................................................................... 49
Key Risks to Target Price............................................................................ 50
Appendix I. Medical Care Facilities Corp.’s Management Team ... 52
Appendix II. Medical Imaging Terminology ..................................... 53
Appendix III. Key MRI Applications................................................. 54
Appendix IV. Company Models.......................................................... 55
APPENDIX A. IMPORTANT DISCLOSURES ............................... 61

The Summary Case
We are initiating coverage on three segments of the U.S. Health Care Services
industry – Ambulatory Surgery, specialty hospitals and Medical Imaging providers.
The U.S. Health Care Services industry provides investors with exposure to
compelling demographic and technological drivers in one of the largest sectors in
the U.S. economy (15% of GDP). U.S. Health Care is also a heavily regulated sector
in which policy and reimbursement terms are often in flux. We believe that recent
and pending policy changes are creating investment opportunities in the independent
medical imaging providers and the ambulatory surgery groups.
Investing In Health Care Services – Three Key Screens
We believe that the Health Care Services sector presents investors with attractive
defensive growth attributes; however, it is also characterized by a unique set of
potential pitfalls. Following is a synopsis of some of the qualitative screens through
which we view the sector.
• Quality Care, Quality Operators. The U.S. Health Care market is highly
competitive, heavily regulated and very litigious. Moreover, U.S. service
providers can be subject to rapidly changing policy and pricing dynamics. As a
result, we strongly favour well managed organizations with track records of
clinical excellence. We typically caution against situations involving marginal
performers, restructuring candidates or companies with heightened regulatory
risk.
• Strong Balance Sheets. Difficult pricing trends and poor credit markets have
created a premium for well capitalized Health Care Services companies
(particularly in medical imaging). Not only are well capitalized companies more
likely to survive the current price pressures, but they are also exceptionally
positioned to capitalize on expansion opportunities, as weaker competitors
either yield market share or put themselves up for sale. In the medical imaging
market, in particular, financially distressed providers are unlikely to survive the
current shakeout.
• Good Regulatory Standing. The U.S. Health Care industry is subject to
extensive government regulation – an area often in flux (Exhibit 7). This
regulatory overlay can be onerous. However, it sometimes triggers investment
opportunities by creating winners and losers within various service segments.
Physician ownership of medical facilities is one such long-standing unresolved
issue we would recommend monitoring. For the medical imaging industry, we
believe that tightening of loopholes through the Stark Law could yield market
share to independent imaging providers as physician groups that own and
provide imaging services are forced to exit the industry. For the specialty
surgical hospitals, future changes could ultimately prove to be more restrictive.

Our Take on Featured Companies
Our key picks are two companies listed in Canada, that are variations of the income
trust structure – CML Healthcare (CLC.UN-T), and Medical Facilities (DR.UN-T).
• Our Top Pick – CML Healthcare (and its subsidiary ARS) is a well managed,
well capitalized player in the U.S. medical imaging industry, in our opinion.
The company is well positioned to exploit the financial fallout created by the
Deficit Reduction Act (DRA). CML also has a high visibility, base business in
Canada, which is driven by dominant positions in the medical imaging and
clinical labs services markets. We believe this Canadian base business provides
an effective counterbalance to the emerging U.S. strategy. Potential catalysts for
the units include accretive medical imaging acquisitions (in the U.S.) over the
next 12 months. Our C$18.00 target price reflects the application of an 11.5x
EV/EBITDA multiple to our fiscal 2009 EBITDA estimate of $159 million. The
implied yield is 5.9% on our fiscal 2009 distribution estimate of $1.07 per unit.
• We believe that Medical Facilities offers investors a relatively early entry
opportunity into a growing surgical market in the U.S. Potential catalysts
include completion of additional accretive ASC acquisitions over the next 12
months. Our C$10.00 price target reflects a 5x fiscal 2009 EV/EBITDA
multiple and an implied yield of 11%.

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