Aster DM Healthcare Ltd
NSE:ASTERDM
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Aster DM Healthcare Ltd
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Good morning all. I welcome you to Aster DM Healthcare's Earnings Conference Call for the Fourth Quarter of Financial Year '23. The company declared the Q4 FY '23 results last evening. I hope you have got a chance to review them, along with the other materials which were posted on the stock exchanges, and also uploaded on the company website. Today, to discuss the quarterly business performance and future business outlook, we have the senior management at Aster DM Healthcare available with us. It includes Dr. Azad Moopen, Chairman and Managing Director; Ms. Alisha Moopen, Deputy Managing Director; Mr. T.J. Wilson, Non-Executive Director; Dr. Nitish Shetty, CEO of India Vertical; Mr. Amitabh Johri, Joint CFO; Mr. Sunil Kumar, Joint CFO; and Mr. Hitesh Dhaddha, Chief of Investor Relations and M&A. [Operator Instructions]
Finally, before we get started, the safe harbor related to earnings conference call. Certain statements that may be discussed in this meeting that are not historical facts and might be forward-looking statements. And such forward-looking statements are subject to certain risks and uncertainties, like government actions, local political or economic developments, technological risks and many other factors that could cause actual results to differ materially from those contemplated by the relevant forward-looking statements. Aster DM Healthcare Limited will not be in anyway responsible for any action taken based on such statements and undertakes no obligation to publicly update these forward-looking statements to reflect subsequent events or circumstances.
With this, I will request Dr. Moopen to start with the opening remarks. Over to you, sir.
Thank you, very much. Thanks a lot, Bala. Good morning, everyone. Thank you all for joining us for the earnings call for the full year and fourth quarter of financial year '23. With COVID -- with the world organization declaring that COVID-19 is no longer a public health emergency, we are moving out of the clouds of the pandemic. While this is comforting, we have to be cautious and also mindful of the long-term complications of COVID impacting health.
India has now become the most populous country in the world and along with urbanization there is significant increase in the healthcare expenditure due to the -- also along with the very higher -- high incomes, increasing insurance coverage and government schemes.
The government initiatives through the schemes reflect the growing importance of healthcare sector and is a necessity for providing health -- quality healthcare services to the expanding and marginalized population. Despite efforts to increase public healthcare spending, India still lags its peers, both developed and developing countries in terms of healthcare infrastructure and delivery. The private sector has been playing a vital role in boosting the healthcare infrastructure of the country.
In GCC, the oil and non-oil sector in the UAE continues to do well with good growth being predicted in 2023, showing resilience in the face of global economic headwinds. While the introduction of corporate tax shall have an impact on the profitability of the businesses in UAE, the flow of people to the country due to ease of doing business and new residency rules can increase the business and offset this. One of the major opportunities in the GCC is Saudi Arabia, which is becoming more investor-friendly and has large population and their thriving economy.
Before going into the highlights of our business performance in India and GCC, let me begin by sharing some important leadership changes. We have appointed Dr. Nitish Shetty as CEO of Aster Healthcare, India. Dr. Shetty is seasoned healthcare management professional, has been instrumental in extraordinary growth of our Karnataka operations since joining in 2014. Under his guidance, Aster DM Healthcare, India, should undoubtedly flourish, reaching new milestones and setting new benchmarks in the industry.
We had appointed Amitabh Johri and Sunil Kumar, who have been with us already, with proven track record, as Joint CFOs of the company, who shall be taking care of the GCC and India regions, respectively. Hitesh Dhaddha, who has over 18 years of experience in finance, M&A and strategies, has taken charge as the Chief of Investor Relations and M&A of the company.
On the financial performance of Aster for the year '23. While there has been significant revenue and profit growth in India, the EBITDA growth and percentage was muted -- the margins were muted in GCC due to the major expansions leading to early EBITDA loss. On the consolidated basis, the year saw an unprecedented addition of 5 hospitals across India and GCC, 150 pharmacies and 7 clinics. We furthered our commitment for expansion in India through adding 126 pharmacies and 91 diagnostic centers and patient experience centers. These investments have although impacted our near-term EBITDA and PAT performance, should enable us to deliver improved performance in the years to come.
The business successfully substituted COVID and PCR revenue, which formed 8% of the revenue in financial year '22, with core healthcare revenue growth, especially in GCC, which is visible in our hospital and pharmacy growth. High-margin COVID testing revenue of INR 869 crores in '22 has been replaced by core healthcare revenue, which has grown by 26% year-on-year. At a consolidated level in financial year '23, we posted a revenue of INR 11,933 crores, an increase of 16% as compared with the last financial year. EBITDA was INR 1,565 crores when compared to INR 1,483 crores in financial year '22, an increase of 6%. The EBITDA growth was impacted due to losses from new hospitals. Adjusted for this loss, EBITDA was INR 1,655 crore, an increase of 11% over the last year.
Profit after tax, post NCI stands at INR 425 crores when compared to INR 526 crores in financial year '22. The impact of new hospitals, including the depreciation and interest costs on account of the capital allocation towards these investments was visible. Profit after tax, post NCI, excluding losses from new hospitals and post adjusting for onetime other income is INR 581 crore, a growth of 7%.
The Aster India business continues to grow well with revenues growing at 25% to INR 2,983 crores and EBITDA increasing by 28% to INR 453 crores, and profit after tax post NCI standing at INR 147 crores as compared to INR 60 crores financial year '22, a growth of 46%.
With respect to the GCC business, revenue grew 14% year-over-year to INR 8,950 crores, and EBITDA was flat year-on-year at INR 1,112 crores as compared to INR 1,130 crores for the last financial year.
On the financial -- on the financial performance of Aster for quarter 4 financial year '23 now. At a consolidated level, in quarter 4 financial year '23, we posted a revenue of INR 3,262 crore, which is an increase of 20% when compared with the same period last financial year. EBITDA was INR 506 crores when compared to INR 463 crores in the quarter 4 financial year '22, an increase of 9%. Given this an year of significant investment for us, it was an unprecedented feat of us to open 5 new hospitals in 1 year. Hence, the EBITDA growth was impacted due to loss from new hospitals. Adjusted for this, the EBITDA was INR 532 crores, an increase of 15% over last quarter 4 -- last financial year. Profit after tax post NCI stood at INR 171 crores when compared to INR 226 crores in quarter 4 financial year '22. The impact of new hospitals, including the depreciation and interest cost on account of capital allocation towards this was visible. Profit after tax post NCI, excluding losses from new hospital is INR 235 crores.
The Aster India business continues -- the Aster India business continues to grow well with revenues for the quarter, growing 32% year-on-year to INR 804 crores and EBITDA increasing by 62% year-on-year to INR 127 crores and profit after tax post NCI stood at INR 48 crores as compared to INR 11 crores in quarter 4 financial year '22.
With respect to GCC business, revenues grew 16% year-on-year to INR 2,458 crores, and EBITDA stayed flat year-on-year at INR 379 crores as compared to INR 384 crores in the same period last financial year.
Moving on to some of the operational updates for the quarter. Aster India continues to have excellent growth, as I just mentioned earlier, and is likely to continue to deliver strong growth performance in the coming years. Some of our hospitals have reached almost full capacity, and we are adding new bets in such areas. We are also setting up new hospitals in geographies where Aster is a leading brand. As part of our expansion plans, we have begun construction of Aster MIMS Hospital, Kannur, and we are adding 100 beds to Aster MIMS Hospital, Kannur and Aster Medcity, Kochi, where 100 beds are being added each. Additionally, work has begun on our upcoming 200-bed project at Aster Hospital, Kasaragod, and phase 1 of Aster Hospital in Thiruvananthapuram with 350 beds also has started. The phase 2 development of Aster Whitefield Hospital in Bengaluru, comprising of 375 beds is nearing completion and is expected to be operational soon.
One of the strategies we adopted is to add more beds by O&M asset-light model to take healthcare to the suburban areas without incurring too much cost. We added 390 beds in total during the year under O&M asset-light model. We are happy to announce that Aster Narayanadri Hospital, Tirupati has achieved breakeven within the first quarter of the commencing its operations. Further, we are pleased to announce that Aster G Madegowda Hospital, in Mandya, Karnataka, commenced its operations in April -- on April 1.
Financial year '23 was a year of investment for us and in line with our vision. We will be selectively evaluating mergers and acquisitions opportunities that align with our value and our strategic goals. We remain open on both bolt-on acquisitions that complement our existing operations and transformative opportunities that have the potential to shape our future growth.
Additionally, we are pleased to announce that we have increased our stake in the profitable subsidiary, Malabar Institute of Medical Sciences, MIMS, from 74.14% to 77.93%. Furthermore, we have increased our stake in Ramesh Hospital, our subsidiary that manages 5 hospitals in Andhra Pradesh with a bed capacity of 739. Our stake in Ramesh Hospital has now increased from 51% to 57.49%.
Coming to our asset-light business as on 31st March, we have totaled 257 Aster Pharmacy branded retail stores; 106 in Karnataka, 85 in Kerala, 61 in Telangana, and 5 in Andhra Pradesh, which are operated by Alfaone Retail Pharmacies Private Limited. Aster Labs has established its presence in Karnataka and Kerala, Maharashtra, Tamil Nadu, Andhra Pradesh and Telangana. As of 31st March 2023, there is 1 reference lab, 15 satellite lab and 189 patient experience centers. The restructuring of the lab management with expansion of retail pharmacy outlets will enable us to establish the Aster omnichannel ecosystem more effectively.
In the GCC region, there has growth in core business across hospitals, pharmacy and clinics. We saw better revenue impact from our digital initiatives. EBITDA has adversely impacted during the year due to the losses of new hospitals. Aster Sharjah Hospital, Aster Sonapur Hospital, Aster Royal Hospital, Muscat, which have added 101, 34 and 171 beds acquisition, respectively. The utilization of this bed capacity in coming quarters is expected to improve our revenue and EBITDA performance. Aster Sanad Hospital in Riyadh have now turned profitable with 9% EBITDA margins this financial year. We are looking at other opportunities, including the rolling out of pharmacies in Saudi Arabia. We see Saudi as our next big market, and I would see Alisha cover more of this in the GCC related updates.
We are proud to announce that we have broken the Guinness World Record for most prediabetes, diabetes screening forms completed in 24 hours. Through the largest free screening camp for low-income workers organized on the World Diabetes Day, we successfully screened 12,714 people, demonstrating our unwavering commitment to making a positive impact on the lives of the individuals. It is a matter of pride for us, 3 Aster units have been featured in the top 20 all-India best multi-hospital's ranging and top 10 for the South region according to Outlook 2023 Best Hospital's ranking.
Status of restructuring. As part of the restructuring process, the Board of Directors approved the appointment of investment bankers by the company to explore options to unlock value for the company and the stakeholders. We have made significant progress in the restructuring initiative. The investment bankers have received interest and indicative terms for potential buyers for the GCC region. The investment bankers are working actively with the few shortlisted bidders and their advisory to -- their advice is to negotiate key deal teams -- key deal terms, which will enable us to select the final buyer. The shortlisted bidders have expressed a strong commitment to complete their transaction soon, and we'll shortly announce the last leg of the process.
The proprietary work, including due diligence, et cetera, is largely complete with some minor due diligence aspect spending. The investment bankers have communicated that the binding bids are likely to be received in quarter 1 of financial year 2023-'24. Upon submission of the final evaluation of the investment bankers, the Board shall review the proposals of sale of company's business in GCC. Appropriate intimation and disclosure will be made as and when any conclusions are arrived at -- approved by the Board. We'll come back to the stakeholders with a detailed update on -- in compliance with the law at the appropriate stage.
I now request Deputy Managing Director, Alisha Moopen, to elaborate more on the GCC business, the digital transformation and other strategic initiatives undertaken by Aster. Thank you very much.
Thank you, Chairman. Good morning, everyone. As we look at FY '23, effective management of COVID allowed UAE to gain a status of being a preferred location globally. This impact is visible in the influx of expat population in UAE and migration of people from Ukraine as well as Russia. We have seen this reinstate some of that population loss, which we have seen during the COVID time and there is a restatement of that population in UAE, which is visible in the revenue numbers for FY '23. Leaded be these changes on GCC business, we have witnessed a revenue growth of around 14% in FY '23, which [ received ], of course, our key verticals. As Chairman mentioned, FY '23 was clearly a year of growth investment for us. It is really unprecedented for our UAE and GCC business to have 3 hospitals, 24 pharmacies and 6 clinics in a year. We have -- we also invested approximately INR 100 crores in our digital business. Some of these investments, they were paused during COVID, and we have used FY '23 to further [indiscernible] the sale and complete it. This has unfortunately impacted our profitability for the year.
As we reflect on FY '23, the year saw the replacement of COVID PCR revenue with core healthcare business. FY '22 had almost INR 869 crores of COVID revenue, which was almost 11% of GCC business. This has -- in this year is represented by only 1% of COVID revenue. The good news is that we've replaced this by growth in OP-IP business, hospital vertical has grew by 14% and pharmacy saw growth in the retail stores and e-pharmacy line of business has an overall growth of 33%. Outpatient revenue of GCC also grew by 29%, excluding the COVID testing revenue. Happy to also inform that we had 3 of our hospitals noted by the [ U.S. Ministry ] Global List. We were in the top 5, top 20 as well as in the Global 115 list with our Aster Hospitals.
FY '23 performance. The revenue for FY '23 was at INR 8,950 crores, which was a growth of 14% over last year. The high-margin COVID testing revenue of INR 869 crores in FY '22, that's been replaced by the core healthcare revenue, which has grown at 26% year-on-year. The GCC business EBITDA for FY '23 stood at INR 1,112 crores, which unfortunately is flat compared to FY '22. The GCC business EBITDA, excluding the operational losses from the new hospitals commissioned during the year will be at INR 1,189 crores, which is a growth of 4%. One of the unexpected incidents that happened during the year was also the World Cup in Qatar where we saw the government take a call of all the schools being shut during the World Cup period, which actually impacted most of the families and expats going back to their home countries during this period. So the effective [indiscernible] 6 to 8 weeks of very reduced and marginalized business during this period.
Going into the Q4 FY '23 performance, the revenue for Q4 FY '23 was at INR 2,458 crores, which is a growth of 16% over FY '22. The high-margin COVID testing revenue of INR 278 crores in FY '21 has been replaced by the core healthcare revenue, which has grown 29% year-on-year. Our hospital vertical witnessed increase in operational bed count from 923 in Q4 '22 to 1,140 in Q4 '23, pushing the revenue from this segment to INR 4,012 crores in FY '23 from INR 3,532 crores in FY '22. The clinics business revenue grew to INR 684 crores in Q4 FY '23 compared to INR 661 crores in Q4 FY '22, which is a growth of 4%. However, the core business in this segment, excluding COVID revenue grew by 39% in the same period.
Our retail business demonstrated robust performance with healthy growth across product lines. The pharmacy segment experienced a jump growing at 31% year-on-year with revenues for Q4 '23 at INR 799 crores as compared to INR 609 crores in Q4 FY '22 The GCC business EBITDA for Q4 '23 stood at INR 379 crores, staying flat year-over-year. The GCC business EBITDA, excluding operational losses during this period was INR 403 crores, displaying a growth of 4%.
Now just to share some of the few important updates. In line with our vision to enhance patient-centric care, we have entered into 3 partnerships. We have entered a partnership with Sukoon, which is a leading insurance provider in UAE to launch 2 new health insurance plan with Aster products with the [indiscernible]. We've signed a partnership with Dr. Reddy's Lab to look at producing quality medication and making it more accessible in UAE and GCC through Aster Pharmacy. The third 1 is with Talabat, which is an online food delivery platform, to offer prescription delivery services in the bike through Aster pharmacies. Under this strategic pact, Aster pharmacies can upload their prescriptions, it's only through that app and make the purchases available and have it delivered to the home through the Talabat delivery network.
Focusing on capacity creation, two important projects are currently in the pipeline. We have planned a hospital network [indiscernible] where a high-end multispecialty facility with a capacity of 126 beds, which is expected to be completed in Q4 of this year. Additionally, we will open up a new block of 59 beds to our existing Sanad facility in KSA. As Chairman mentioned, we are -- in Q4 of this year, we have been seeing a high single-digit margin over there, and we believe that this is the right time for us to open up the next building. We have also started work on our pharmacies for KSA. We expect our first set of pharmacies in KSA to go live by end of Q2 FY '24.
In FY '23, our digital health ambitions took flight as we successfully launched myAster on Android as well as the iOS platforms, operate a range of key services. Furthermore, in response to patient feedback, we have expanded our reach by launching that app on the Huawei App Gallery in Q4 as well. We are very thrilled to announce that our platform continues to achieve remarkable growth with most of the parameters doubling each quarter. For several consecutive months, myAster has maintained its position as the leading medical app in UAE. Currently, it boasts a robust user base of nearly 400,000, witnessing substantial growth from 220,000 in Q3. This quarter we experienced a notable increase in appointments through the app, doubling it from Q3 as well. Teleconsultation remains a popular feature, averaging at around 600 per month in Q4.
In terms of our e-pharmacy business, we are witnessing an exponential growth in both transaction numbers and revenue. The monthly average run rate on e-pharmacy in Q4 has surpassed Q3 by over 40%. To further enhance the e-pharmacy experience, we have continuously added key features to the app, aiming to improve conversion rates and increase the average order value. Additionally, our home delivery business has seen substantial growth with an 18% increase in average monthly revenue compared to the earlier part of the year and an 8% increase compared to Q3. We continue to invest in the business and are building several relevant features that will help us increase stickiness as well as conversions on the platform.
I will now request our GCC CFO, Amitabh and India CFO, Sunil to take you through the details of the financial performance of the quarter. Thank you.
Thank you, Alisha. Good morning, everyone. I shall be covering both quarter 4 FY '23 and full year FY '23 performance. On a consolidated basis, our revenue from operations for quarter 4 is INR 3,262 crores, an increase of 20% on a year-on-year basis. Consolidated EBITDA for the quarter was at INR 506 crores as against INR 463 crores, which is a growth of 9%. As highlighted by Chairman and Alisha, FY '23 has been an year of investment for us. This is the first year we have 5 new hospitals getting launched in a single year, namely Aster Hospital Sharjah; Aster Royal Hospital, Muscat in GCC; Mother Hospital, Areekode, Aster Narayanadri and Adiran IB Hospital, Vijayawada. EBITDA losses from these new hospitals and from Aster Hospital, Sonapur, going into operations together amounted to INR 11 crores in quarter 4 FY '23.
Additionally, since we have caused the Cayman Hospital project, given the lapse of time it has been impaired in the books as per the IFRS accounting requirements. The impact of this is INR 16 crores. We continue to hold the right to use of the land and government permission to start the hospital work again. The same shall be considered on an opportunistic basis. Excluding these losses, the EBITDA stands at INR 532 crores as against INR 465 crores during the same period last financial year, which is a growth of 15%. Consolidated PAT post NCI is at INR 171 crores as compared to INR 226 crores in quarter 4 of FY '22. Excluding losses from the new hospitals, PAT post NCI, stands at INR 235 crores.
Coming to the full year performance, the revenue from operations stood at INR 11,933 crores, a growth of 16% compared to the same period last financial year. EBITDA was at INR 1,565 crores compared to INR 1,483 crores in FY '22. Excluding losses from the new hospitals and the onetime write-off of Cayman, the EBITDA was at INR 1,655 crores, which is a growth of 11%. PAT post NCI was at INR 425 crores compared to INR 526 crores in FY '22. Excluding losses from the new hospitals and onetime other income, PAT stood at INR 581 crores, which is a 7% growth. In addition to the investment in the new hospitals, we have spent approximately INR 100 crores in digital initiatives in FY '23, a significant portion of which directly affected our EBITDA and PAT. However, as highlighted by Alisha in her speech, this was also an year where we were able to reach key milestones in our digital initiatives with reference to the launch of app, reaching targeted downloads, increasing our active users and significant ramp-up of pharmacy orders. We expect this to be a key growth driver in the coming years.
Coming to GCC performance. Revenue from our GCC operation in quarter 4 FY '23 was at INR 2,458 crores, an increase of 16% on a year-on-year basis. Previous year had significant COVID revenue, which makes some of the revenue and EBITDA numbers not comparable. Quarter 4 of last year had almost INR 217 crores of COVID revenue and the core business revenue growth, excluding COVID testing was -- is at 29% year-on-year basis. EBITDA from GCC operations stands at INR 379 crores as against INR 384 crores in quarter 4 of FY '22. Excluding losses of new hospital in GCC, the EBITDA stands at INR 403 crores in quarter 4 FY '23, a growth of 4%.
With respect to our full year GCC performance, revenue grew from INR 7,870 crores in FY '22 to INR 8,950 crores in FY '23, an increase of 14% in revenue. High-margin COVID testing revenue of INR 869 crores in FY '22 has been replaced by core health care revenue, which has grown at a 26% year-on-year basis. EBITDA from GCC stands at INR 1,112 crores as against INR 1,130 crores in FY '22. Excluding losses of new hospitals, EBITDA had grown of 44% to INR 1,109 crores.
Coming to the segmental performance for the quarter. GCC hospital revenue was at INR 1,090 crores, it's an increase of almost 15% on a year-on-year basis. EBITDA stands at INR 149 crores compared to INR 190 crores in FY '22 quarter 4, excluding losses from the new hospitals and Cayman write-offs, the hospital segment had an EBITDA of INR 173 crores. The EBITDA margin adjusted for losses from new hospital was at INR 17.1 crores.
GCC clinic revenue stands at INR 684 crores, an increase of 4% on a year-on-year basis. Normalized for COVID testing, the core business for the clinic revenue grew at a rate of 38%. EBITDA for GCC business -- GCC clinic segment stands at INR 151 crores at a margin of 22.1%.
GCC Pharmacies revenue increased 31% year-on-year from INR 609 crores to INR 799 crores EBITDA increased -- INR 799 crores. EBITDA increased from INR 112 crores to INR 128 crores, an increase of 14%. EBITDA margin for this segment in quarter 4 FY '23 was at 16%.
Moving to segmental performance for full year FY '23. GCC Hospital revenue was at INR 4,012 crores, an increase of 14% on a year-on-year basis, and the EBITDA stands at INR 584 crores compared to INR 608 crores in FY '22, quarter 4. Excluding losses from new hospitals and Cayman write-off, the hospital segment saw an EBITDA of INR 661 crores. The EBITDA margin adjusted for losses for the new hospital is at 17%. GCC clinic revenue stands at INR 2,412 crores as against a revenue of INR 2,440 crores in FY '22. Normalized for COVID testing, the core business of clinic segment grew at a rate of 29%. EBITDA for GCC clinic segment stands at INR 450 crores at 18.7% margin. GCC Pharmacies revenue increased 33% year-on-year basis from INR 2,245 crores to INR 2,984 crores in FY '23. EBITDA increased from INR 290 crores to INR 350 crores, an increase of 21% on a year-on-year basis. EBITDA margin for this segment for FY '23 was at 11.7%. GCC net debt stands at INR 163 million as of 31st March compared to INR 197 million as of 31st March '22.
Now I would request Joint CFO, Mr. Sunil Kumar, to take you through the India performance during this period.
Thank you, Amitabh. Good morning all. For the quarter ended 31st March '23, India revenues have increased to INR 804 crores, up by 32% from INR 607 crores in Q4 FY '22. EBITDA from India operations have increased to about INR 127 crores with a margin of 15.8% compared to INR 79 crores with a margin of 12.9% in Q4 FY '22, with a growth of 62%.
With respect to the full year India performance, the revenue from operations stands at INR 2,983 crores with a growth of 25% compared to INR 2,384 crores for FY '22. EBITDA from India operations stands at INR 453 crores with a margin of 15.2% in FY '23 compared to INR 353 crores with a margin of 14.8% in FY '22 with a growth of 28%. PAT post NCI is at INR 147 crores compared to INR 60 crores in FY '22 with a growth of 146% year-on-year.
Coming to segmental performance for the quarter. Revenue from India hospitals and clinics, excluding the O&M asset-light hospitals, stands at INR 751 crores in Q4 FY '23, with a growth of 29% from INR 583 crores in Q4 FY '22. EBITDA stands at INR 145 crores with a margin of 19.3% in Q4 FY '23 as compared to INR 99 crores with a margin of 17% in Q4 FY '22 with a growth of 46%.
Moving to the segmental performance for the full year. The revenue from India hospitals and clinics, excluding the O&M asset-light hospital stands at INR 2,819 crores in FY '23, with a growth of 20% compared to INR 2,343 crores for FY '22. EBITDA stands at INR 527 crores with a margin of 18.7% in FY '23 as compared to INR 407 crores with a margin of 17.4% in FY '22, with a growth of 30%.
Aster India net debt stands at INR 510 crores as on 31st March 2023 compared to INR 319 crores as at 31st March 2022. The capital expenses for the year FY '23 is at [ INR 2,280 crores ].
On that note, I conclude my remarks. We would be happy to answer any questions that you may have. I now request Balachander to open the question-and-answer session. Thank you.
Thanks, Sunil. As discussed I think we can move on to the question-and-answer session. I already see a few hands. So I think if -- Ashwin Agarwal, if you can raise your question, please?
Thanks for the detailed update on the operation. We are very delighted with the old restructuring process, which you have announced. Could you give us more details what kind of valuations can the GCC business get? It is like around 10 to 12x EBIT-to-EBITDA, what can we expect? And does the Indian entity own 85% stake in the GCC operations?
Yes. Thank you. I'll answer the second part first. India owns 100% of the GCC entity. It's not 85%, it's 100%. The second part, we can't give any numbers now unless the -- I mean the binding bids are received, and we signed papers and all, which we hope that will happen this month. That's our expectation. So it's not possible for -- to give any indicative numbers on that. You know that.
Would it be right that the entire sales proceeds, say if the EBITDA is around INR 1,100 crores. Say, if it goes by 10x EBITDA, the entire sales proceeds of around INR 10,000 crores or whatever that number is comes to the Indian entity?
Yes, I agree to your whatever that number is. If this goes through the Board approves, the amount -- entire amount will come to India. But how much is that, I won't be able to tell you. That amount will come into India. The entire amount will come into India.
And it would be sold out as is when is -- on operational basis. It means the debt of GCC will go to the new buyers?
Yes, yes, definitely. Now what comes to India will be after deducting the debt, the equity value will be coming to India.
Sir, how would we use this large amount of cash? Would we be looking at acquisitions? How would we use this money which will come into the Indian operations?
Yes. So the Board has to decide on that. So we hope that the Board will take the appropriate decision. But what we definitely will -- would like to do as part of the promoters and the management is there that has to be a dividend to the shareholders. But the Board will decide the quantum of that.
Sir, lastly, in the promoter holding, the entire promoter holding is almost pledged of around 40% odd. So what is the reason of this pledge?
So we have taken a 4% additional stake in the company, which is now our stake has gone from 38% to 42% around. And even though this amount required was only minimal when compared to the value of our stock, there was a technical issue of us doing this. But this is only very, very technical. We have only very limited exposure to debt of about $75 million.
So going forward, this pledge should come down?
This will be completely over in a period of -- we hope, in a period of 1 year, the pledge will completely go up.
Sir, would you be looking at enhancing your stake further in the company because few of the large FII and investors are holding. So would you be interested in acquiring additional stake?
I won't be able to comment on that now. We will have some change in our holding, but I won't be able to give you exact detail at this point of time.
Next in line is Prakash. Prakash, if you can go ahead and ask your question, please.
My first question is on restructuring. So how I understand is -- so since you said 100% is going to be sold and the proceeds will come to an Indian entity. How are promoters thinking in terms of being part of the GCC asset? Would they have a stake in that?
Yes, we have already announced that. We will be part of the management as well as the -- I mean, the shareholding in both GCC as well as India. We'll be there on both sides is what we are thinking.
Okay. And then -- so that's why the question is on the valuation. Just -- I know it's still getting discussed, close, et cetera. But in terms of understanding, it should be with the peer comps and who are the peer comps be?
Yes. So there aren't too many in UAE when you look at, but there are different methods. So this whole process is not run by us. It is run because we have a conflict in interest. It's run by the Independent Directors. They have constituted a committee, and they are running this. We are completely out of that. So the investment bankers are interacting with them, and they have different methods by getting at the valuation by way of appointing councils as well as investment bankers apart from this valuation -- finding out the valuation -- I mean, comparables and all. So that whole process will be very, very transparent, and it's not being done by us. It is done by the Independent Directors and the Board will finally decide that.
I understand that. But who would be your peers as per you? Like in the UAE, you mentioned there aren't any, but who would be the peers?
Listed players as such, we don't have too many. There are only -- Alisha, if you can just give the people who are -- who could be the comparables.
So Prakash, we think our closest comparable is probably Mediclinic, which had -- there is [ least ] operation where they have a fair amount of business in GCC. We are also, of course, there is Burjeel that is there listed in the local Abu Dhabi market as well. I think when we look at the Saudi market, it is quite different from UAE because it's quite deep, and it's got a lot of transactions that happened there. So -- it might not be directly comparable to what we think a lot of the transactions that happen there are private. So the only 2 listed entities is 1 which is listed in the U.K. and the other one, which is in Abu Dhabi. So that would be the [ peers ].
That is very helpful. And second question is on -- again, on the sale proceeds. So if you look at -- you mentioned about a part being as dividend -- distributed as dividend. But if we see Indian assets, they have gone up significantly higher in terms of valuation. I mean they range anywhere from 15x to 25x. So just trying to understand, we would be selling something which is lower multiple business, and we would be -- since India is our focus at a listed entity level, we would be buying. So would the interest be again South Indian markets to go deep or you would like to explore newer markets as well?
So regarding this utilization of the funds, I'm not commenting because that's something which the independent directors and the Board has to decide. But regarding the focus of business, yes, we will be focusing more on South because we already have a presence there. But we are not agnostic to growth in other places, depending on the availability of assets. So it's possible that we may go beyond where we are now, maybe in the South or even beyond that.
Okay. And third 1 with your permission, and the time lines, you mentioned you are likely to get bids by end of Q1 and close out should be by Q2.
That's our expectation. That's what we want as management. Before end of Q2, we should be able to close it out.
Next in line is Nirali Shah.
Congratulations on good set of numbers. My first question is about the 3 recently opened hospitals. So -- when can we anticipate these hospitals to come to a breakeven level and start witnessing a positive cash flow? And if you could quote a number about the sustainable margins that we can expect from them?
Alisha, you would like to -- or Amitabh, you would like to answer that.
So typically, we aim for breakeven between 18 to 24 months since the hospital opens and a sustainable margin for our hospital segment is between 17% to 22% that we see in the Aster segment.
Understood. And about the labs also, lab business. So we are hoping to break even that in around 6 to 9 months, am I correct?
Are you asking for the...
Yes, yes, lab. Sunil, you could give an answer on the lab. So the first 1 was, Nirali, as I understand this on the hospitals. Large part of the hospitals are the new hospitals and Alisha was answering on that. On the lab, our India CFO, Sunil will talk about the -- I mean, how it is looking and what is expected, I mean, breakeven.
Thank you, Chairman. So Nirali, in terms of labs, we have -- if you've seen the numbers, right, we added many FPCs now. So basically, we are not expanding more on the satellite labs, but we are concentrating more on the FPCs basically to drive the volumes. See, satellite labs are more into the processing of the samples. So that will not really yield the volumes there. So we are more concentrating on B2B pickup points. We are working on the FPCs where the collection centers happen, then we're also working on the home collections. So these are the 3 main drivers for us to drive the volumes. And we've seen that from the current year, from the H1 to H2, the losses have considerably reduced. And we see that -- and if I'm right in the previous Investor Analyst call also, the Chairman has told that in FY '24, we should be able to break even. And I think we are on the way to the plan. So we are expecting another 6 to 9 months we should be able to break even in terms of labs.
So ideally -- actually 6 to 9 months, right? So in Q3 concall you mentioned 6 to 9 months. So can I expect like Q2 of FY '24, we can see some green shoots in that?
Yes. Q2 to Q3, somewhere in between that, we should be able to breakeven.
And my third question was about the occupancy rate. Like there are a few areas where the occupancy rate is really low in some low-performing regions. So we were to implement certain initiatives to fill up those gaps. So have you untapped at that?
So Nirali, I would request you to be more specific, whether it's GCC or India, because these are 2 areas managed by 2 finance teams and management teams. So if you can be specific there, you were asking about...
Talking about the India business.
Yes. Nirali, I think you're referring to our Andhra cluster. Because if you look at our occupancy, Kerala is at 80% occupancy, Karnataka is almost -- Karnataka and Maharashtra cluster is at 60%, and Andhra and Telangana is at 50%. And yes, that occupancy has been increasing very steadily, but it's not ramping up the way we expected in other regions. So for example, that is indirectly having the impact on the EBITDA also. So occupancy, we'll talk about average is 50%. But when you look at the Q4, it has gone up around 50%, 51%. So that's the number currently, which we have. And we've also seen that the new hospital, Adiran IB in the Vijayawada, which is just 500 meters from our main hospital, which opened up, will treat the skin patients. We saw a liquid ramp-up in the month of March and April and May numbers also was quite promising. So considering that, we already hit the EBITDA margins in double digits now. And we are looking at touching the mid-teens by end of this financial year.
The next question is from Harith.
My first question is on the GCC Hospital segment, and I'm looking at the mature hospitals here, and the EBITDA margins for the mature hospitals are at 17%. So given that the ARPOBs in this segment is quite high, and I'm seeing more than INR 2 lakhs per day, and then these are post [ Ind AS ] margins that I'm referring to. It appears to be on the lower side at 17%. So do we have some levers here to take the margin profile of the mature hospitals in the GCC further from current levels?
Amitabh, you would like to answer that.
Thanks for the question, Harith. So you're right that the ARPOB for GCC is significantly different than India. But the fact is that even the cost points are very different between the 2 locations. If you look at it, the doctors costs and other costs are fairly different -- establishment costs are different in GCC. And accordingly, the margin of 17% is maintained at 17%.
However, to your question that are there levers available over there? Yes. Potentially, yes. Because we are looking at for a mature hospital, a utilization of 54%. As and when that goes up, that gives you an added advantage of having a higher margin. There are cost optimization opportunities sitting across material cost and the manpower cost. And we are actively working towards those.
Okay. I was also trying to understand, is there a major impact of Sanad here? And if you could share a margin number, excluding Sanad, that will be helpful.
Sure. So the Sanad Hospital, which was perhaps the previous years -- for the last few years was, and I said that was loss-making. That asset has turned around significantly. It was at a margin of 5% last year. We are looking at an 8% plus margin for this financial year, which is FY '23. It doesn't have a significant impact overall because from the point of view of a location, it only forms 5% of our overall revenue. However, we can come back to you separately in terms of taking that off, what is the margin like.
So Harith, I just wanted to add here. You asked about the levers. So 1 of the major levers that we have in the hospital sector, as per as even the clinics is the HR cost. We have a significantly higher HR cost than what we want, and due to many reasons, including the increasing competition in GCC and all. So we are trying to -- various ways, including shared services and all, we are trying to reduce the HR cost. So there is a 5% HR cost, I mean, decrease which could happen. If not 5%, at least 3% could be achieved if we are able to do all these things as we want. So there is a lever there where it can be reduced.
The second thing, answering your question on the Sanad. Sanad is a struggling asset. It has been struggling for a long period. It has come out of that and it's reached near 10%. But we see a significant opportunity in Saudi Arabia, and this will be an anchor for that. We are starting now the pharmacies, and we are also planning to start other establishments there as we go forward. So in the future, we think that having this hospital there will add a lot of benefits by way of a hub for all the other activities.
My next question is on the clinics business in the GCC segment. So this year, obviously, there was an impact of COVID testing in the base. So that explains the decline. But when I look at the business over the last 3 to 4 years, maybe from FY '18 or '19, we haven't had much growth in the business on a constant currency basis. And in the past, we have talked about some pressures around pricing, et cetera. So how should we think about growth in the clinic segment and GCC going forward?
Alisha, you would like to answer that.
Sure. So thanks, Harith. So you're right, I mean, when you look at the clinics, especially, I think they were -- that was a unit that has been [ more space ] during COVID as well. We saw 2 years, it was pretty much sustained completely on COVID revenue. And then this year has been really just sort of turned around year where we had almost 70% -- 80% of our business that came from COVID last year getting restored by normal business. We have this challenge where the margins were getting squeezed with insurance on outpatient. But 1 of the interesting things that has happened is the change in the population mix and the demographics in UAE as well.
So if you see now it's more higher-end population that is coming in and that has been kind of 1 of the key strategic goals that we're working on with Aster Clinics where we are trying to move from the lower net worth, while we still have some portion of it, reduce the proportion of the lower net worth to kind of have a higher proportion of the better net worth. So we are hoping to improve the margins by changing the mix of population, that is our patient, because that will be more representative of the UAE population going forward as well. So that's 1 way. We hope that we think that would be definitely able to demonstrate growth over there.
And then on the pricing front, is it a stable environment that we're seeing?
So pricing will always be a challenge when we are -- we have a large part in the lowest net worth, which is why we are kind of upgrading the brand to be -- even when we talk about -- yes, it's clearly -- we are building out more of the premium customers and sort of detecting some of the lower worth. So that's the best way for us to adjust the price and improve the quality of the revenue. Otherwise, at the lower segment, it's very price competitive and it ends of the company -- kind of creating a portion of margin. So post-COVID, we are actually planning on reducing this proportion, and we are seeing that moving in that direction in the last 6 months as well.
Just to add to what Alisha mentioned, might be also good to start seeing GCC business more as an investment on the balance sheet of the company, given that we will gradually get into the process of monetizing this investment. So it might be appropriate for the analyst community to start thinking about GCC business in that particular way if that makes sense, Harith.
Last 1 with your permission. It's an accounting-related one. When I look at the lease payments from your cash flow statement, it's gone up sharply. For this year, it's around INR 450 crores -- INR 445 crores versus around INR 330 crores last year. I understand it's coming from the new hospitals. But how should we think about this, especially next year we'll have the full year impact from these new hospitals. So will this number go up materially from the FY '23 level?
So if can I take on that one. Harith, we have had 1 significant increase of INR 400 crores lease adjustment that has happened in this lease lability that has come in. And that is from the hospital, the new lease that we have signed on 1st of February in Dubai. As of now, to your question of FY '24, we may have 1 more hospital coming up in FY '24 as we go forward, at least in GCC. And Sunil, I would request you to also add on to that. So there could potentially be more hospitals being signed up and accordingly an impact would come on the financials, from an accounting perspective.
On the India front, the lease liabilities has increased from INR 444 crores to INR 590 crores. That's basically -- INR 520 crores actually. So that's basically coming from our Whitefield Hospital because the rents are commenced. So that is the ROE of certain liability which were created.
Next question is from Amrish.
Congratulations on a very good year. My question is regarding the O&M hospitals in India, and thanks for the additional disclosure that you have provided from this quarter onwards. I'm just trying to understand the economics a little better going forward. I think you've already explained in the past roughly how many rooms -- how many beds you might be adding, plus I think there's a revenue share with margin of about 15%. Is there some way to think about the ARPOB and occupancy of this? Is there some rule of thumb? Or is it too diverse?
Sunil, you would like to answer that?
Thanks, Amrish. Yes, we started giving that O&M separately because we had told initially itself that this will be a low-margin business, and we didn't want that to dilute our core hospital clinics where we get almost 90% of the business.
In terms of occupancy, it's very starting, right? Occupancy will not be different from how the other hospitals perform. It will be very similar. Starting it will be around 10% or 20% to 30%. And it will ramp up quickly [indiscernible] because here we don't restrict from the schemes or ESA and other patients, right? So that will be always on. So here the idea is to have a faster ramp-up because we are not restricting the patient profile. At the same time, the occupancy will be faster because the usual greenfield projects -- when you talk about 60% to 70% occupancy, it will take at least 6 to 7 years to reach there. But in this case we can do it half the time. So that's the whole thing.
And losses and profits, as I said, right, we also talked about Aster Narayanadri. Total beds we added is 390, out of this 290 is operational by Q4 last year. And out of that, Narayanadri we started in [ Jan 2024 ], that has already broken in the first quarter itself. So there we don't have losses. So whatever the losses which you are seeing in the presentation, that's only with respect to the Aster Mother, Areekode hospital. And even that, we are expecting breakeven very quickly because that's the hospital where it was not already running. It was more of a hospital, which had very, very less occupancy as compared to Narayanadri. So we should do quite well in terms of O&M hospitals.
Just a follow-up on that. And is there some way to think about ARPOB given they are...
ARPOB will be -- yes, ARPOB will be somewhere between 15k to 20k.
Amrish, I just wanted to add here. Apart from the financial aspects, profitability and all, this is something which is required in the country. We think that while we make profits in the hospitals in the -- I mean, urban area as well as in the metros and all, it's very important that we go into that area of suburban areas where these hospitals are. And we have the advantage of providing them high-end care, quality care using our doctors and our expertise. So that is 1 of the important things. While our margin may slightly get diluted, still because it's very low CapEx, our ROC everything can go up, but more importantly, it's -- we are providing that service. So there's also an ESG element to that where we want to take it to the grassroot level where our services can be provided, Amrish.
Understood. Very clear. Good luck with the restructuring in FY '24.
The next question is from Nitish.
I have a question on tax implications of GCC restructuring. So can you give any indication on what can be the capital gains tax on sale of assets in GCC?
Amitabh, you would like to answer that.
Sure, Chairman. Thanks for the question, Nitish. So Nitesh, we have evaluated tax implications across all the transaction flows. And for the purpose of this trade, given the holding -- holdco is setting out of Mauritius, and it enjoys the benefits of the Mauritius-India tax treaty, there is no capital gain tax on the sale of investment.
Understood. Second question is on the India business. Would you like to give any guidance on EBITDA and revenue growth, let's say, 2, 3 years out? Any color on that?
So Nitesh, we don't give any guidance, definitely not in the long term. But what I can tell you is that we see significant opportunities in India. There's a huge demand supply gap as we know the market. And when we look at our peer group and all, they are doing extremely well. And we think that we have built up a lot of assets, and we are also building up. And there's no reason why we shouldn't be at those levels as we go forward. That's what I can tell you, but giving a number won't be appropriate, as you know.
The next question is from Nikunj.
Just a couple of bookkeeping questions. First is, what's our net debt as of FY '23?
So you're asking on the -- I mean, the comprehensive level or...
Comprehensive level, then I would just wanted to break up on both the GCC and India level.
So Amitabh, if you can provide him...
Mr. Chairman, I'll do that. So thanks for the question, Nikunj. If you look at the net debt number, the number for FY '22, 31st March, was a number of INR 1,806 crores. That number has gone to INR 1,848 crores as of 31st March '23. Looking at the combination of the debt, when we look at the debt for the GCC business, purely in dollar terms, the debt has reduced from -- net debt has reduced from $197 million to almost $163 million, which is a reduction of 34-odd million between these 2 financial years. And this is largely emanating from the scheduled payment that was sitting there for the long-term loans that was there.
From the India side, the debt profile -- the net debt profile has undergone a change. A number of net debt of INR 319 crores for 31st March '22 has increased to INR 510 crores as of 31 March '23. Sunil, I will request you to come in and give a bit of a color around that.
Yes. INR 510 crores, I think term loan would be around 70% and balance 30% would be in the short term or OD, bifurcation among the India [ benefit ].
Just 1 more. Just continuing on Harith's question, which he was asking earlier on the GCC business. When we look at Indian business also, and I'm talking about mature hospitals. The margins when I compared to peers is lower, right? And now on top of it, like we know that we have started entering into O&M business model where it's more of a -- we have to look at from ROC perspective. And recently, we have started focusing more on the Indian business. So what can be the key levers for -- from here, if I look at 3 to 4 years down the line, where it can increase our margins on the Indian businesses.
Sunil, you would like to answer that, the levers?
Yes, Chairman. Nikunj, if you look at peer groups also, right, what I -- what we see is that, for example, the -- with respect to the [indiscernible] clinics, which we share the information. Last year, if you saw the full year, we closed at 17.4%, only the [indiscernible] excluding the world demo set. And now you can see that, that has increased to almost 18.7% in the FY '23. That shows that almost 130 basis points, which we increased from year-on-year. And in future, right, we will -- what are the peer groups are doing, that's something number which we should be able to map at least in a couple of years. And that is coming from 2 things. One is on the revenue assurance because we see that there is a current -- current level India ARPOB is quite low, that means, say, 36,000 to 37,000. That's 1 of the reasons because we are measured to the asset city in Kerala as compared to Bengaluru or any other metros.
Second is there -- but still we see a lot of scope to optimize the revenue assurance a bit of it and increase the ARPOB. Second is on the cost lines. We already worked on -- and you can see that what are the growth in the EBITDA margin, which we have seen that is coming from the -- working in the cost lines also. Optimize the material cost, that is something which we have taken in the last year, and that has yielded results. And we see the further scope in working on that, and also the other HR costs also. That is something which we are looking at manpower procured and where there is a scope.
And also very important thing is that our occupancy, right? On an overall business, we are 68. Once the occupancy keep increasing, we can help in leveraging the manpower, which is already there. So these are the multiple resources, how or delivers which we have to increase the margins and which is very much possible.
The next question is from at Satish.
Sir, my first question is with respect to your pledge, promoter's pledge. It has increased from 10% to 99%. I believe this is for the purpose of raising funds for your GCC restructuring business. So I just wanted to understand how much are we raising because of the splits?
And second question will be what are the terms for this particular debt? And when will this debt release? And how is this getting released -- the pledge is getting released?
So first of all, I just want to address debt which is raised is a very minimal amount, like I mentioned first. It's for the 4% acquisition, which we did recently, for that the debt was raised, and which was in the range of around $75 million. The total debt that we have is $75 million. It's nothing to do with the proposed -- I mean, increasing our stake or retaining our stake in GCC. So that's not the reason why the $75 million has been taken.
And even though it is only very minimal when compared to our total holding, there was a technical reason for raising funds outside the country and using it for the share acquisition. So we had to use this method by which this was that -- so this $75 million, we hope that this will be released within the next 1 year is what we expect, and it is not -- this won't be a longstanding debt by the promoters.
So I would like Amitabh to give some color to why this -- this is, I mean, covering across a large part of our holding.
Satish, thanks for your question. Given the fact that there was a need for raising funds in order to invest by 4% more of the company. And as Chairman had explained that this pledge was against that. It's a pledge which we have taken for a limited period because given the restructuring it's expected that a significant part of this particular loan would be repaid. And as the restructuring happens, this pledge will fall away from that.
Sorry, if I can add.
Satish, we can't hear you. Satish? Yes, we couldn't hear you in between.
What I was asking is, for a 4% increase in promoter sharing, pledging the entire 99%, I wasn't able to understand that economics. Because for $75 million, 4% stake increase, 99% of the promoter shareholding is pledged.
So Satish, this is largely structural because you are way right in saying for a 4% the underlying security that has been offered is significantly high. But this is largely for structural purposes, given there are certain compliance needs for which we had done this. However, as I indicated that the understanding of the bank is that as we go down the path of restructuring, a significant part of this, in fact, most of this will be repaid and this pledge will fall away.
[Operator Instructions]
If there are no more questions, I just wanted to just request the analysts as well as those who are interested. So 1 -- now Hitesh has joined as the Chief of Investor Relations and M&A, so he is available for you to, I mean, get in touch and have any information regarding the company. Apart from that, anything related to GCC, you can contact Amitabh and anything related to India, you could contact Sunil for financial reasons. And of course, Nitish had some connectivity problem. Dr. Nitish, he has just joined now. He is the India CEO. He's also there on the screen now. So would like you to -- in the interim, we are going through this process to contact these people, if any details are required.
So before we exit, may I request you to give a few lines on concluding thoughts that you have on how -- given we're going through this restructuring and all. How the investors and analysts should look at the company going forward from here on. So just a very high level concluding thoughts that you have, if that's possible.
Yes. So thank you. Thank you, Hitesh, for that. So what we feel is that this will significantly unlock the value for the investors. So that is our hope. We have not been able to pay any dividend for the last 5 years since we were listed, and this is something which is always burning inside. So we hope that. Due to reasons that you all know, the India and GCC, there have been this issue of the GCC not getting that value. So we hope that, that will be realized as we go forward. Apart from that, I also want to tell you that business on both sides are doing well.
India, especially doing extremely well as the market is really booming. And our team has with -- under the leadership of Nitish, we are hoping that we will do extremely well in India, and will be at par with our peer group and going in that direction. In GCC also with Saudi coming in, as well as the digital transformation, we hope that there will be significant improvement in the performance of the company. We know that we have lagged behind in some of the parameters like the EBITDA and patent all, but this is only temporary, and we hope that this will all be -- we hope that this will all be seen better days as we go forward. Thank you very much.
Thank you, Chairman. Ladies and gentlemen, this concludes the earnings call for this quarter. I thank you all and the management for joining us today. If you have any further questions, please do reach out to us. Thank you.