
Polar Capital Global Healthcare Trust plc • Annual Report and Financial Statements 202212
Manager’s Report
Investment Manager’s Report continued
Over the financial year to the end of 30 September 2022, the
Company delivered a NAV per share total return of 5.59%,
1.34% behind its benchmark, the MSCI All Country World/
Healthcare Total Return Index. The absolute performance
of the healthcare sector was positive, up 6.93% over the
reporting period, with the sector comfortably outperforming
the broader market, as tracked by the MSCI All Country
World Net Total Return Index (all figures above are in sterling
terms) which was down 4.04%. Despite being faced with a
cocktail of rising inflation, hawkish central banks and the war
in Ukraine, equity markets were remarkably resilient during
the first six months of the financial year. Unfortunately, that
resilience faded heavily in the latter half of the period as
inflationary and supply-chain pressures accelerated, economic
activity started to slow and the markets started to digest the
possibility of a recession.
Reflecting on performance, strong stock selection across the
market-capitalisation spectrum was offset by the negative
allocation effect of having a relative overweight position in
small and mid-capitalisation stocks. Distributors, managed
care, healthcare services and pharmaceuticals all performed
strongly over the period. Pharmaceuticals had a relatively
strong year, primarily driven by companies’ resilience to
inflationary pressure given their high gross and operating
margins, coupled with the essential nature of their products.
At the other end of the scale, the past 12 months have been
difficult for the healthcare supplies, life sciences tools and
services, equipment and facilities subsectors. The US-based
multinationals had the strain on their earnings of significant
upward pressure from the appreciation of the US dollar. The
struggles witnessed in the healthcare facilities subsector reflect
rising wage inflation coupled with volumes that have been
hampered by COVID-19-related staffing shortages.
As set out in last year’s annual report, the focus was very much
on three key investment themes that accelerated through
the COVID-19 crisis; disrupting the delivery of healthcare,
outsourcing and prevention, all of which remain relevant today.
The dynamism within the healthcare market has, however,
shifted our focus to areas we feel will be more relevant for the
year ahead. More specifically, delivery disruption, accelerating
utilisation and consolidation. Disrupting the delivery of
healthcare continues to be a critical component when it comes
to generating much-needed efficiencies, with recent momentum
likely to continue in the near and medium term. Increased
utilisation could be a significant revenue driver as the healthcare
industry works its way through the ever-expanding backlog
of patients who require medical attention. Last, but not least,
we expect the recent wave of consolidation in the industry to
continue as management teams look to use generally strong
company balance sheets to either expand their pipelines, access
innovative technologies and platforms or accelerate near-term
revenue and earnings momentum.
After a period of relative calm, US healthcare reform came
to prominence again in 2022 with a healthcare reconciliation
package signed into law in August 2022. Included within the
Inflation Reduction Act, the major healthcare provisions include
price negotiations for certain Medicare drugs towards the end
of the decade, mechanisms to control drug-pricing inflation and
caps on out-of-pocket spend for US seniors. Encouragingly, the
Act also extended premium subsidies to ensure ongoing access
to healthcare cover, a positive not just for US citizens but for
the pockets of the industry that benefit from either providing
healthcare insurance plans or from sustained utilisation. With
reform now very much in the rear-view mirror, investors can
focus their attention on a healthcare sector that is highly
innovative, possesses strong fundamentals, is attractively valued
and defensive. These are all extremely appealing characteristics
in the current, challenging macroeconomic environment.
Performance review
Over the financial year to the end of September 2022, the
overall healthcare sector comfortably outperformed the broader
market, with the MSCI All Country World/Healthcare Total
Return Index returning 6.93% in sterling terms, compared to a
decline in the broader equity market of 4.04%, as represented
by the MSCI All Country World Net Total Return Index. The
Company achieved a return on net assets of 5.59%, which
was 1.34% behind its benchmark, but significantly ahead of
more volatile areas of healthcare such as smaller stocks and
biotechnology. Global equity markets posted positive returns
in the first three months of the financial year, but a sustained
downtrend started in mid-January as investors grappled with
a deteriorating macroeconomic environment characterised by
persistent inflation, slowing growth and geopolitical tension.
The Company entered the financial year with approximately
6% net gearing and a large exposure to healthcare facilities,
managed care, healthcare distributors and healthcare
equipment and supplies, with the biggest underweight in
the pharmaceuticals sector and a smaller underweight in life
sciences tools and services. As the year progressed and the
macroeconomic picture became more challenging, the portfolio
was shifted to a more defensive position, with increased
exposure to pharmaceuticals, biotechnology and healthcare
facilities, and reduced allocation to healthcare equipment
and supplies. Healthcare equipment was the biggest positive
contributor to performance thanks to strong stock selection.
Biotechnology and managed care were also positive.
On the other hand, pharmaceuticals detracted the most due
to negative allocation and stock-picking. Solid selection in
healthcare facilities was not enough to offset the negative
allocation effect, while distributors suffered due to poor stock
selection. In summary, the underperformance relative to our
benchmark during the financial year was caused by adverse
allocation which marginally outstripped the positive contribution
from stock selection.