We are delighted to share our research on the Hospital segment in India, primarily focusing on the Performance of Key Hospital Groups including their future growth plans, and recent PE and M&A deals in this segment.
This is a report about Indian Health care industry and How different sectors like Hospitals, Pharmacy and Diagnostics industry are growing. What are the new government policies that are implemented for Health care sector in India.
This is a report about Indian Health care industry and How different sectors like Hospitals, Pharmacy and Diagnostics industry are growing. What are the new government policies that are implemented for Health care sector in India.
In the past year, we have experienced the need and importance of a strong Healthcare sector, so if you are looking for a sign to invest in this sector, look no more, because this is it. Invest in a sector that's growing for the greater good and give your portfolio the boost it needs with ICICI Prudential Healthcare ETF.
NFO starts on May 6th, 2021.
For more on this head to https://bit.ly/3ujXO9z
RBSA-RR-Specialty Chemicals-An opportunity for Make in India.pdfRBSA Advisors
These are interesting times for the Specialty Chemicals industry in India, in view of the current global market trends in this sector. The supply chain issues faced by manufacturers around the world, have brought greater momentum to the China +1 theme thereby creating incentives for Indian manufacturers to invest and grow.
More Related Content
Similar to RBSA-RR-A Deep Dive Into The Hospital Industry in India.pdf
In the past year, we have experienced the need and importance of a strong Healthcare sector, so if you are looking for a sign to invest in this sector, look no more, because this is it. Invest in a sector that's growing for the greater good and give your portfolio the boost it needs with ICICI Prudential Healthcare ETF.
NFO starts on May 6th, 2021.
For more on this head to https://bit.ly/3ujXO9z
RBSA-RR-Specialty Chemicals-An opportunity for Make in India.pdfRBSA Advisors
These are interesting times for the Specialty Chemicals industry in India, in view of the current global market trends in this sector. The supply chain issues faced by manufacturers around the world, have brought greater momentum to the China +1 theme thereby creating incentives for Indian manufacturers to invest and grow.
RBSA-RR-Industry Valuation Multiples Series 6th Edition.pdfRBSA Advisors
We are delighted to share our “6th Edition of Industry wise Valuation Multiples” for Indian listed corporates. Our report coverage comprises of 13 largest industrial sectors in India.
RBSA-RR-Demystifying Life Insurance Industry in India (1).pdfRBSA Advisors
RBSA Advisors is delighted to share its recent research on the Life Insurance sector in India. Pandemic across the nation had impacted the country's overall financial system. The unprecedented nature of this crisis created difficult circumstances, including economic shutdowns. The year 2020 was a watershed year in the Insurance sector. Insurer were forced to rethink their business operations leading to enormous changes in the industry. Currently, life insurance industry is at crossroad.
Through this report we are demystifying the life insurance industry in India and sharing our views on the industry outlook.
SEBI streamlines the process of Buy-back of securities.pdfRBSA Advisors
With the intent to simplify the Buy-back process of securities, level the playing field for investors, and encourage ease of doing business, the Securities & Exchange Board of India (“SEBI”) has relaxed certain norms in the SEBI (Buy-back of Securities) Regulations, 2018 pursuant to SEBI (Buy-back of Securities) (Amendment) Regulations, 2023. Further, Operational Guidance on Buy-back was issued by SEBI on 8th March 2023. The amended regulation has come into force w.e.f 9th March, 2023.
RBSA-Budget-Finance Bill 2023-Key Proposals.pdfRBSA Advisors
Keeping a people-centric approach, various amendments in individual tax provisions and amendments providing benefits under the new tax-rate regime is a welcome move.
Through this report, we share our views on the prevailing framework/rules under the Income Tax Act, 1961 for determination of Fair Valuation in case of Shares/Securities.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
RBSA-RR-A Deep Dive Into The Hospital Industry in India.pdf
1. Valuation | Investment Banking | Restructuring
Transaction Services | Transaction Tax | Risk Consulting
A Deep Dive Into
The Hospital Industry in India
2023
JULY
2. A Deep Dive IntoThe Hospital Industry in India
The overall economic development and rising prosperity of the Indian population has led the Healthcare
Sector to become amongst the largest sectors of the Indian economy, both in terms of revenue and
employment. The Indian Healthcare Sector is estimated at around USD 372 Bn. It largely comprises the key
segments of hospitals, pharmaceuticals, diagnostics, medical devices and equipment, health insurance
and medical tourism. It has been growing at a CAGR of ~18% since 2016.
Out of the total size of the Healthcare Sector, the Hospital segment carves out an important share, i.e., ~
35% contributing ~USD 133 Bn.
This Research Report has funnelled its focus primarily towards performance and trends in the Hospital
segment in India. In this Report, we have
Analysed the Techno Financial Parameters of Key Hospital Groups operating in India, including their
future growth plan;
Key PE/VC deals and M&A deals in the Hospital Segment in the recent past.
In the Hospital segment, the expansion of private players in Tier 2 and Tier 3 locations, beyond
metropolitan cities, offers an attractive growth opportunity. According to Invest India’s (an investment
promotion agency set up by the Ministry of Commerce & Industry) investment Grid, there are nearly 600
investment opportunities in the country’s hospital/medical infrastructure sub-sector.
Despite being capital intensive in nature, the debt metrics for Hospitals have improved on account of
higher Average Revenue Per Occupied Bed (“ARPOB”) and occupancy levels. Greenfield expansions are
expected to continue, and large players are likely to go in for even inorganic acquisitions cum expansion
leading to increase in bed capacity by about 30% by FY 25.
Executive Summary
02
PE/VC deals in Hospitals
19,039 14,699
58,107
80,044
1,72,555
14
4
14 14
5
0
2
4
6
8
10
12
14
16
-
20,000
40,000
60,000
80,000
1,00,000
1,20,000
1,40,000
1,60,000
1,80,000
2,00,000
2019 2020 2021 2022 H1-2023
INR Mn Number of deals INR Mn Number of deals
M&A deals in Hospitals
9,558
26,625 26,762
30,272
31,546
7
7
12
19
6
0
2
4
6
8
10
12
14
16
18
20
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
2019 2020 2021 2022 H1-2023
Source: CapIQ, Venture Intelligence, RBSA Analysis
The above data captures deals for which details are available in public domain
3. A Deep Dive IntoThe Hospital Industry in India
03
Private equity deals rose to INR 172 Bn in CY 23 (6 months only) from INR 80 Bn in CY 22 (full year). The
number of deals has decreased indicating a massive increase in the deal ticket size in 2023. Key PE-VC
deals include:
• Investment by Temasek in Manipal Hospitals – INR 1,64,380 Mn
• Investment by IIFL AMC in Kauvery Medical Centre & Hospital – INR 5,785 Mn
Key M&A deals include:
• Acquisition of AMRI Hospitals by Manipal Health Enterprises – INR 24,000 Mn
• Acquisition of Grecian Hospital by Park Hospital – INR 2,870 Mn
Post Covid-19 pandemic, there is an increased call for self-reliance in the Indian Healthcare Sector with
focus shifting to innovation and research, drug and equipment manufacturing, digital transformation in
health services, fair access to healthcare solutions. Above all initiatives augers well for a consistent &
sustainable growth in the Hospital sub-sector in India.
HAPPY READING!
Executive Summary
Rajeev R. Shah
Managing Director & CEO
4. CONTENTS
TABLE of
01
02
03
04
05
A Deep Dive IntoThe Hospital Industry in India
04
Global Healthcare Industry 05
Indian Healthcare Industry 07
Ecosystems for Hospitals in India 11
Key Industry Players 13
PE and M&A Deals in Hospital Segment 27
6. Global
Healthcare Industry
In 2020, global spending on health reached USD 9 Tn (10.8% of global GDP) from USD 8.5 Tn (9.8% of
global GDP) in FY 19.
Across countries, health spending in 2020 rose in per capita terms as well as share of GDP across all
income groups with highest spending by USA at 18.8% of GDP.
Government spending was the main driver of the increase in total health spending from 2019 to 2020. Per
capita government spending on health increased in all income groups and rose faster than in previous
years.
Out of the global healthcare spending of USD 9 Tn, 63% was from government sources, 36% from private
sources (including out of pocket spending) and 0.2% from external sources
Source: World Bank, WHO
Data Source: WHO Global Health Expenditure Database, 2022. A Deep Dive IntoThe Hospital Industry in India
06
Healthcare Expenditure as % of GDP in CY 20
Global spending on health, 2020
USD 9.0 Tn
10.7% 10.3%
11.7%
5.6%
12.2%
3.0%
10.9%
6.2%
7.6%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
USA Australia Brazil Canada China France India Japan Mexico Russia
Government
USD 5.7 Tn (63%)
External
USD 17 Bn (0.2%)
Private
USD 3.3 Tn
(36%)
18.8%
8. Indian
Healthcare Industry
The overall economic development and rising population of the country has led the Healthcare sector to
become amongst the largest sectors of the Indian economy, both in terms of revenue and employment.
The Healthcare sector has been growing at a CAGR of 18% since 2016.
The Healthcare Sector largely comprises the key segments of hospitals, pharmaceuticals, diagnostics,
medical devices and equipment, health insurance and medical tourism.
Out of the total size of the Healthcare Sector, the Hospital segment carve out an important share i.e.~ 35%
contributing ~USD 133 Bn.
In 2023-24, the Ministry of Health and Family Welfare has been allocated INR 891.6 Bn depicting an
increase of 13% over revised estimates for 2022-23.
Source: Budget Document, Fortis Healthcare Annual Report A Deep Dive IntoThe Hospital Industry in India
08
Indian Healthcare Sector Market Size (USD in Bn) Budget Allocation for Healthcare (INR in Bn)
45
60
73 81
140
CAGR 16.3%
160
194
372
0
50
100
150
200
250
300
350
400
2008 2010 2012 2014 2016 2018 2020 2022
806.9
844.7
791.5
891.6
740
760
780
800
820
840
860
880
900
FY 21
(Actual)
FY 22
(Actual)
FY 23
(Budgeted)
FY 24
(Budgeted)
9. Indian
Healthcare Industry
According to the Global Health Expenditure Database compiled by the WHO, in CY 20, India's
expenditure on healthcare was 3.0% of GDP.
India’s healthcare spending as a % GDP trails not just developed countries like UK and USA but also many
developing countries like Brazil, Nepal, Vietnam, Singapore, Sri Lanka and Malaysia.
India’s Out of Pocket expenses as percent of current health spending is 51% as of CY 20, significantly
above than lower-middle income countries, and amongst the highest in the world.
The government of India has introduced schemes such as Ayushman Bharat Pradhan Mantri Jan Arogya
Yojana (ABPMJAY), state sponsored health insurance (AB-PMJAY State Extension Schemes), Employees'
State Insurance Scheme (ESIS), Central Government Health Scheme to increase the coverage of medical
insurance in India.
Source: Global Health Expenditure Database A Deep Dive IntoThe Hospital Industry in India
09
India's Health Expenditure as % of GDP
Out-of-Pocket Expenditure (% of total health expenditure 2020)
3.6 3.5
2.9 3.0 3.0 3.0
0
0.5
1
1.5
2
2.5
3
3.5
4
2015 2016 2017 2018 2019 2020
9.9% 8.9%
22.4%
39.6%
46.6%
8.9%
50.6%
12.6%
38.8%
31.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
USA France Brazil Viet Nam Sri Lanka France India Japan Mexico Indonesia
10. Indian
Healthcare Industry
The paucity of healthcare personnel compounds the problem. At 7 physicians and 18 nursing personnel
per 10,000 population, India trails the global median of 16 physicians and 40 nursing personnel during
the same period.
Even on this parameter, India lags developing countries such as Brazil, Malaysia and other Southeast
Asian countries.
The adequacy of a country's healthcare
infrastructure and personnel is a barometer of
its quality of healthcare. India accounts for
nearly a fifth of the world's population but has
an overall bed density of merely 15.
India's bed density not only falls far behind the
global median of 29 beds, but it also lags that
of other developing countries.
Source: Global Health Expenditure Database A Deep Dive IntoThe Hospital Industry in India
10
Healthcare personnel: India vs other countries (CY 20)
Bed density (per 10,000 population)
38
30 26 23 23 22
10 9 7 6
62
88
157
74
35 31 32 33
18
40
0
20
40
60
80
100
120
140
160
180
Russia UK US Brazil Malaysia China Thailand Nepal India Indonesia
Physicians (per 10,000 popula�on) Nurses (per 10,000 popula�on)
Bangladesh
Malaysia
Brazil
UK
Vietnam
USA
China
Russia
India
19
21
25
26
26
43
71
15
8
12. Categorization
of Hospitals
Primary Care
Offers basic, point-of contact
medical and preventive
healthcare services
A Deep Dive IntoThe Hospital Industry in India
12
Secondary Care
Second point of contact in the
healthcare system. There are two
types of secondary care hospitals
– general and speciality care
Tertiary Care
Provides advanced healthcare
services usually on referral from
primary or secondary medical
care providers
Acute Infection
Primary: Fever
Secondary: Typhoid/ Jaundice
Tertiary: Hepatitis B.C
Government
Brihanmumbai Municipal Corpo
-ration Hospitals, KEM Hospital,
Cooper Hospital (Mumbai)
Private
Asian Heart Institute, Apollo
Hospitals, Medanta, Fortis, Max
Healthcare, Jupiter Hospitals
Trust
Lilavati (Mumbai), Hinduja
(Mumbai)
Owned by one private player,
managed by another
East Coast Hospital in
Puducherry was earlier
managed by Fortis Healthcare
Trust owned, but managed
by private party
Two model are followed by trust
and private parties
• Medical service agreement -
Max Super Specialty Hospital,
Patparganj
• Operation and management
contract - Balabhai Nanavati
Hospital in Mumbai
Accidents/Injuries
Primary: Dressing
Secondary: Fracture
Tertiary: Knee / Joint
Replacements
Chronic Diseases
Primary: Diagnosis/ Check-ups
Secondary: Post diagnosis
treatment
Tertiary: Surgery
Maternity
Primary: Diagnosis/
Check-ups
Secondary: Normal delivery/
Caesarean
Tertiary: Post delivery
complication
Quaternary Care
Extension of tertiary care in
reference to advanced levels of
medicines which are highly
specialised and not widely
accessed and is usually offered in
a very limited number of
hospitals.
Complexity of Ailment
Types of Services Ownership
Hospitals
15. 48
Key
Industry Players
Note: The above data pertains to FY 23
Source: Investor Presentation, Kotak Research, RBSA Analysis
ALOS : Average Length of Stay
ARPOB : Average Revenue per Occupied Bed
A Deep Dive IntoThe Hospital Industry in India
15
No. of Hospitals
9,957
No. of Beds
7,860
Operating Beds
64%
Occupancy
3.4 days
ALOS
51,668
ARPOB per day
86,768 Mn
Hospital Revenue
25%
Hospital EBITDA Margin
8.6%
ROCE
Future Strategy
2.7 Mn
EBITDA/Operating Bed
The company expects to increase occupancies to 70% for existing
beds from 64% in FY 23, led by the hiring of new doctors, tapping the
24/7 network funnel, leveraging corporate relationships and
international patients
Company has plans for brownfield bed addition in Bengaluru and
Mysuru
16. 17
Key
Industry Players
A Deep Dive IntoThe Hospital Industry in India
16
No. of Hospitals
3,504
No. of Beds
3,282
Operating Beds
76%
Occupancy
4.3 days
ALOS
67,400
ARPOB per day
62,360 Mn
Hospital Revenue
26%
Hospital EBITDA Margin
8.2%
ROCE
4.9 Mn
EBITDA/Operating Bed
The Company has plans of new construction and commissioning of
various facilities
Max plans to increase its bed capacity to over 7000 beds in next 5
years
The Company has plans to acquire Care hospitals, however the
matter is under arbitration
Future Strategy
ALOS : Average Length of Stay
ARPOB : Average Revenue per Occupied Bed
Note: The above data pertains to FY 23
Source: Investor Presentation, Kotak Research, RBSA Analysis
17. 29
Key
Industry Players
A Deep Dive IntoThe Hospital Industry in India
17
No. of Hospitals
4,500
No. of Beds
4,032
Operating Beds
67.1%
Occupancy
3.7 days
ALOS
55,101
ARPOB per day
51,070 Mn
Hospital Revenue
18%
Hospital EBITDA Margin
5.7%
ROCE
2.3 Mn
EBITDA/Operating Bed
The Company has plans of new construction and commissioning of
various facilities
Fortis plans addition of 1400 beds over next 5 years. Majority of beds
to be added at units located at Mohali, Noida, Shalimar Bagh, FMRI,
Anandapur, BG Road and Amritsar
Future Strategy
ALOS : Average Length of Stay
ARPOB : Average Revenue per Occupied Bed
Note: The above data pertains to FY 23
Source: Investor Presentation, Kotak Research, RBSA Analysis
18. 23
Key
Industry Players
*The details of Narayana Health is excluding one hospital in Cayman Islands
Note: The above data pertains to FY 23
Source: Investor Presentation, Kotak Research, RBSA Analysis A Deep Dive IntoThe Hospital Industry in India
18
No. of Hospitals
6,076
No. of Beds
5,778
Operating Beds
48.5%
Occupancy
4.5 days
ALOS
35,482
ARPOB per day
36,424 Mn
Hospital Revenue
18%
Hospital EBITDA Margin
18.1%
ROCE
1.2 Mn
EBITDA/Operating Bed
The Company expect further margin expansions as it focuses on
sweating existing assets
The Company is investing in new age equipment for robotic
surgeries and continues to explore expansion opportunities in
neighboring islands in Cayman
The Company plans to expand its bed capacity to 6550 by FY 2026
Future Strategy
ALOS : Average Length of Stay
ARPOB : Average Revenue per Occupied Bed
19. 5
Key
Industry Players
A Deep Dive IntoThe Hospital Industry in India
19
No. of Hospitals
2,697
No. of Beds
2,049
Operating Beds
59%
Occupancy
3.3 days
ALOS
59,098
ARPOB per day
27,592 Mn
Hospital Revenue
25%
Hospital EBITDA Margin
9.2%
ROCE
3.3 Mn
EBITDA/Operating Bed
The Company plans to expand its bed capacity to 3500+ by FY 2025
The Noida facility under construction is expected to commence
operation from FY 2025
The Company has also identified a site in India for a asset light
hospital partnership which is expected to start in FY 2027
Future Strategy
Note: The above data pertains to FY 23
Source: Investor Presentation, Kotak Research, RBSA Analysis
ALOS : Average Length of Stay
ARPOB : Average Revenue per Occupied Bed
20. 12
Key
Industry Players
A Deep Dive IntoThe Hospital Industry in India
20
No. of Hospitals
3,940
No. of Beds
3,468
Operating Beds
69.3%
Occupancy
4.1 days
ALOS
29,946
ARPOB per day
21,977 Mn
Hospital Revenue
27%
Hospital EBITDA Margin
13.9%
ROCE
1.7 Mn
EBITDA/Operating Bed
KIMS had plan to increase bed capacity to 5615 by FY 2026 from
currently 3940 in FY 2023
Moreover, KIMS is focusing towards multi specialty hospitals across
different locations in southern India (Telangana, Bangalore and
Andhra Pradesh) and in western India (Nashik)
Future Strategy
Note: The above data pertains to FY 23
Source: Investor Presentation, Kotak Research, RBSA Analysis
ALOS : Average Length of Stay
ARPOB : Average Revenue per Occupied Bed
21. 16
Note: The above data pertains to FY23
Source: Investor Presentation, Kotak Research, RBSA Analysis A Deep Dive IntoThe Hospital Industry in India
21
No. of Hospitals
1,655
No. of Beds
1,186
Operating Beds
55.4%
Occupancy
2.8 days
ALOS
48,932
ARPOB per day
11,736 Mn
Hospital Revenue
34%
Hospital EBITDA Margin
13.7%
ROCE
3.3 Mn
EBITDA/Operating Bed
Rainbow is planning to add another 1000 beds over next 3 to 4 years
out of which two greenfield hospitals (300 beds and 100 beds each)
will be opened in Gurugram within the next 3-3.5 years
Future Strategy
Key
Industry Players
ALOS : Average Length of Stay
ARPOB : Average Revenue per Occupied Bed
22. 14
Note: The above data pertains to FY23
Source: Investor Presentation, Kotak Research, RBSA Analysis A Deep Dive IntoThe Hospital Industry in India
22
No. of Hospitals
2,112
No. of Beds
1,260
Operating Beds
45%
Occupancy
3.9 days
ALOS
34,842
ARPOB per day
7,274 Mn
Hospital Revenue
22%
Hospital EBITDA Margin
5.1%
ROCE
1.3 Mn
EBITDA/Operating Bed
The Company has two upcoming units in Maharashtra. One facility in
Mumbai - 175 beds and Nashik- 146 beds. The estimated cost for the
projects INR 1,910 Mn
Future Strategy
Key
Industry Players
ALOS : Average Length of Stay
ARPOB : Average Revenue per Occupied Bed
23. 25
Note: The above data pertains to FY23
Source: Investor Presentation, Kotak Research, RBSA Analysis A Deep Dive IntoThe Hospital Industry in India
23
No. of Hospitals
2,444
No. of Beds
1,833
Operating Beds
65%
Occupancy
Not Available
ALOS
38,042
ARPOB per day
16,944 Mn
Hospital Revenue
19%
Hospital EBITDA Margin
4.7%
ROCE
1.8 Mn
EBITDA/Operating Bed
The Company intends to expand its capacity in high-growth areas by
adding six linear accelerators (LINACs) to its own inventory within the
next 1-2 years and adding 125 beds through ongoing greenfield
expansion at Ahmedabad and Bengaluru
Future Strategy
Key
Industry Players
ALOS : Average Length of Stay
ARPOB : Average Revenue per Occupied Bed
24. Peer
Analysis
A Deep Dive IntoThe Hospital Industry in India
24
Most companies have indicated plans to expand bed capacities by approximately 30% to 90% over the next
4 to 5 years. Max has the most aggressive capacity expansion plan of ~97% as it intends to add ~3400 beds to
existing capacity of ~3500 beds over the next 4 to 5 years.
Among the industry, Max having the highest gross block per bed. Also, Max having the highest EBITDA per
bed resulting into ROCE of 29% in FY 22 compared to industry average gross block per bed of ~INR 7.7 Mn
with ROCE ~21% in FY 22.
Expansion Plan and Gross Block Per Bed
Expansion plan as % of existing capacity
Gross Block per bed (FY 22)
20%
31%
97%
8%
43%
5%
60%
15%
0%
20%
40%
60%
80%
100%
120%
0
500
1000
1500
2000
2500
3000
3500
4000
Apollo For�s Max Healthcare Narayana (India) KIMS HCG Rainbow Shalby
Incremental beds to be added (FY 23- FY 27) Expansion as % of exis�ng capacity
11.2
13.1
17.3
4.8 4.3
8.5
5.5
6.8
-
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
18.00
20.00
Apollo For�s Max Healthcare Narayana (India) KIMS HCG Rainbow Shalby
25. A Deep Dive IntoThe Hospital Industry in India
25
Peer
Analysis
While Rainbow, KIMS, Max, Medanta and Apollo
are now operating with ~25- 35% EBITDA margins,
Fortis, HCG and Narayana’s (India hospital
operations) margins at ~18-19% are comparatively
below industry average of ~23%-25%.
Owing to its predominant presence in metro
markets (~85% bed capacity in metros), Max has
industry-leading EBITDA per bed of INR 5Mn (on
operational bed capacity).
EBITDA Margin and EBITDA Per Bed
EBITDA Margin FY 23 EBITDA per bed FY 23 (INR in Mn)
25%
18%
26%
18%
27%
19%
34%
22%
25%
0%
5%
10%
15%
20%
25%
30%
35%
40%
2.7
2.3
4.9
1.2
1.7 1.8
3.3
1.3
3.3
-
1.0
2.0
3.0
4.0
5.0
6.0
26. Peer
Analysis
A Deep Dive IntoThe Hospital Industry in India
26
Revenue, ARPOB, Patient Volume CAGR
Combined hospital revenue for the 9 listed
hospital players has grown at ~12% CAGR over FY
19 - FY 23, driven by IP volume growth of ~7%
CAGR and ARPOB growth of ~5% CAGR.
Smaller players such as KIMS, Rainbow, HCG,
Shalby and Medanta have grown revenues at
~9-19% CAGR over this period, as IP volume
growth for these players were at ~7-10% CAGR is
comparatively above industry volume growth of
~7% CAGR.
IP volume growth for larger players (Apollo,
Fortis, Max and Narayana) has been tepid at
~0-5% CAGR. It seems that smaller players have
been able to demonstrate better volume
growth, given they have continued to expand
capacities over the past 4-5 year period, through
both organic and inorganic measures. Larger
players, on the other hand, have been focused
on maximizing their revenue from existing
capacity.
For smaller players, the skew of growth is more
towards volumes rather than ARPOB. We
underscore that ARPOB increases have
contributed only ~36% to the small player overall
revenue growth from FY 19 - FY 23, as against
~54% for the industry.
Hospital Revenue CAGR (FY 19 - FY 23)
ARPOB CAGR (FY 19 - FY 23)
In-patient Volume CAGR (FY 19 - FY 23)
11%
8%
12%
8%
19%
12%
17%
9%
14%
12%
0%
5%
10%
15%
20%
25%
4%
0%
1%
-3%
10%
7%
10%
9%
10%
-4%
-2%
0%
2%
4%
6%
8%
10%
12%
9%
6%
8% 8%
10%
4%
6%
2%
6%
0%
2%
4%
6%
8%
10%
12%
28. Deals In
Hospital Segment - PE Deal
A Deep Dive IntoThe Hospital Industry in India
28
Date Target Buyer/Investor
Stake
(%)
Amount
(INR in MN)
Enterprise
Value
(INR in MN)
EV/
Revenue
Multiple
EV/
EBITDA
Multiple
Jun-23 HealthCare Global
Enterprises Limited
CVC Capital Partners 1.7
1,140 5,027 0.3
3%
Apr-23 Manipal Hospitals Temasek 40.7
1,64,380 4,19,049 10.3
41%
Jan-23 Mumbai Oncocare
Center
Tata Capital Healthcare Fund NA
749 NA NA
NA
Nov-22 Sukoon Healthcare Lightrock India 88.7
1,236 799 9.6
61%
Mar-21 Manipal Hospitals NIIF 58.5
21,000 2,68,273 12.2
8%
Feb-21 Manipal Hospitals TPG Capital, Temasek, Others NA
11,368 NA NA
9%
Jan-21 DCDC Health Services IFU, ADB 25.5
1,500 2,125 3.7
NA
Mar-20 Saket City Hospitals KKR NA
4,870 NA NA
43%
Sep-22 KIMS Hospital ChrysCapital 46.3
1,931 98,237 6.3
2%
Feb-22 Asia Healthcare
Holdings
GIC NA
13,000 NA NA
NA
Dec-21 Nephroplus InvestCorp Group, IIFL AMC,
Bessemer, Others
43.0
1,817 18,105 6.2
9%
Oct-21 Marengo Asia
Healthcare
Havells Family Office, Godrej
Family Office, Samara
Capital, Others
23.5
7,685 2,270 1.5
90%
Aug-22 Sahyadri Hospitals Ontario Teachers’ Pension Plan 16.3
25,000 26,102 3.6
NA
Jun-22 HealthCare Global
Enterprises Limited
CVC Capital Partners 24.7
500 43,990 3.2
1%
Jun-21 KIMS Hospital ICICI Venture 16.8
1,600 63,875 4.8
3%
Mar-21 HealthCare Global
Enterprises Limited
CVC Capital Partners 19.1
866 31,841 2.9
3%
Jun-20 HealthCare Global
Enterprises Limited
CVC Capital Partners 10.8
9,636 17,965 1.6
53%
Jun-22 Sterling Hospitals Arpwood Partners, Somerset
Indus Capital Partners,
Siguler Guff, Others
8.7
6,500 8,172 1.6
93%
Apr-22 Ayu Health Fundamentum, Alteria
Capital, Capier Investments,
Stellaris Venture Partners,
Vertex, Others
NA
1,633 4,553 NA
26%
29. Deals In
Hospital Segment - PE Deals
A Deep Dive IntoThe Hospital Industry in India
29
Date Target Buyer/Investor
Stake
(%)
Amount
(INR in MN)
Enterprise
Value
(INR in MN)
Nov-19 Nephroplus InvestCorp Group, Others 38.6
3,230 6,547 3.2
NA
May-19 Apex Hospitals Somerset Indus Capital
Partners
8.8
250 769 0.9
38%
May-19 Manipal Hospitals Morgan Stanley NA
1,450 NA NA
NA
Feb-19 Max Healthcare
Institute
KKR 48.6
3,614 81,320 4.6
5%
Median 24.7
3.6
NA = Not Available
Source: CapIQ, Venture Intelligence
EV/
Revenue
Multiple
EV/
EBITDA
Multiple
30. Deals In
Hospital Segment - M&A Deals
A Deep Dive IntoThe Hospital Industry in India
30
Date Target Buyer/Investor
Stake
(%)
Amount
(INR in MN)
Enterprise
Value
(INR in MN)
May-23 Grecian Hospital Park Hospital 17.7
2,870 3,245 3.8
100%
Mar-23 AMRI Hospital Manipal Health Enterprises 14.8
24,000 24,000 2.7
100%
Feb-23 Dr. Ramesh Cardiac
and Multispeciality
Hospital P Ltd.
Aster DM
Healthcare Limited
NA
217 3,339 1.6
6.49%
Oct-22 AyurVAID Hospitals Apollo Hospitals NA
264 344 4.4
60%
Sep-22 SPARSH Hospital Narayana Health NA
2,000 2,000 4.1
100%
Aug-22 CHL Hospitals Care Hospitals 12.8
4,190 4,021 2.8
100%
Jul-22 United Ciigma Hospital Care Hospitals 96.6
4,000 6,227 33.1
70%
Mar-22 Apple Hospitals and
Research Institute
Aurelius Healthcare 1.9
2,000 290 1.4
100%
Oct-21 Sunshine Hospitals KIMS Hospital 9.7
3,628 7,300 1.8
51.07%
Oct-21 CIMS Hospital Marengo Asia Healthcare 12.4
5,256 6,794 2.5
75.69%
Aug-21 SuVitas Holistic
Healthcare
HCAH India NA
276 259 1.7
100%
Jun-21 Vikram Hospital &
Heart Care
Manipal Health Enterprises 9.4
3,737 3,203 2.0
100%
Mar-21 Saket City Hospitals Max Healthcare 41.8
4,663 13,677 29.6
42.80%
Mar-22 Thumbay Hospital
New Life
Care Hospitals 366.8
400 547 1.2
100%
Feb-22 Kohinoor Hospital CritiCare Asia Hospital 8.5
1,250 1,250 2.3
100%
Jan-22 Medica Synergie Sheares Healthcare 11.8
7,440 6,606 1.3
NA
Nov-21 Sanghamitra Hospitals
Pvt Ltd.
Dr. Ramesh Cardiac
and Multispeciality
Hospital P Ltd.
NA
594 1,213 2.0
49%
Nov-21 Excelcare Hospital Apollo Hospitals 25.4
1,000 2,100 2.5
64.42%
Nov-21 Suchirayu hospital HCG NA
330 1,645 1.0
60.90%
Oct-21 Sarvejana Healthcare
Private Limited
Krishna Institute of Medical
Sciences Limited
NA
3,628 7,103 1.7
51.07%
EV/
Revenue
Multiple
EV/
EBITDA
Multiple
31. A Deep Dive IntoThe Hospital Industry in India
31
Date Target Buyer/Investor
Stake
(%)
Amount
(INR in MN)
Enterprise
Value
(INR in MN)
Nov-20 Apollo Gleneagles
Hospital
Apollo Hospitals 15.3
4,100 8,076 1.1
50%
Nov-20 Columbia Asia Group Manipal Health Enterprises 13.9
17,920 23,357 2.5
100%
Nov-20 Medics Super
Speciality Hospital
Apollo Hospitals NA
40 3,976 3.4
1%
Sep-20 Crosslay Remedies
Limited
Max Healthcare Institute
Limited
NA
987 4,476 1.2
22.05%
Jun-20 HealthCare Global
Enterprises Limited
Aceso Company Pte Ltd 19.4
3,386 28,612 2.8
20.79%
Nov-19 Cygnus Medicare Amar Ujala 89.7
1,300 2,100 1.7
72.97%
Oct-19 Sri SaiNatha Multi
Speciality Hospitals
Pvt. Ltd.
Aster DM Healthcare
Limited
NA
31 643 1.1
4.89%
Sep-19 Sri SaiNatha Multi
Speciality Hospitals
Pvt. Ltd.
Aster DM Healthcare
Limited
NA
61 644 1.2
9.49%
Jul-19 Fortis JK Hospital Paras Hospitals NA
2,520 3,041 11.5
NA
Median 14.8
2.2
NA = Not Available
Source: CapIQ, Venture Intelligence
Deals In
Hospital Segment - M&A Deals
EV/
Revenue
Multiple
EV/
EBITDA
Multiple
32. A Deep Dive IntoThe Hospital Industry in India
32
• Business & Equity Valuation
• Valuation of Brands, Goodwill, Other Intangible Assets &
Intellectual Property
• Valuation of Financial Securities, Instruments & Derivatives
• Valuation of Industrial Assets and Plant & Machinery
• Valuation of Real Estate
• Valuation of Infrastructure Assets & Specialized Assets
• Purchase Price Allocations (PPA) for Mergers & Acquisition (M&A)
• Impairment Studies for Tangible Assets
• Impairment Studies for Cash Generating Units, Intangible
Assets & Goodwill
• Mines, Mineral Advisory and Valuation
• Valuation of ESOPs and Sweat Equity
• Valuation for Tax, Transfer Pricing and Company Law Matters
• Fairness Opinions
• Valuation under Insolvency & Bankruptcy Code (IBC)
• Determination of Swap Ratio under Mergers and Demergers
• Valuation of Inventory / Stocks and Debtors / Receivables
• Litigation and Dispute Valuation Services
Valuation
• Valuation Services
• Damages & Loss of Profit Analysis
• Independent Expert testimony
• Anti-trust & Competition Advisory
• Post-Acquisition Disputes, Joint Venture & Shareholder Disputes
• Civil & Construction Disputes, Real Estate Disputes
• Intellectual Property Rights Dispute
Dispute & Litigation Support
• Buy side due diligence and closing due diligence
• Vendor due diligence and vendor assistance
• Setting up and managing dataroom
• Advice on sale and purchase agreements (SPA) and business
transfer agreements (BTA)
• Assistance in deal negotiation
Transaction Services (Due Diligence)
• Insolvency Professional services as per IBC
• Turnaround Advisory and Business transformation
• Interim Management Services
• CRO (Chief Restructuring Officer) Services
• Process Improvement and Financial Restructuring
• Outside NCLT – Restructuring Services
• Priority and Interim Funding
• Process Advisors
• Pre-pack and Cross Border Insolvency
• Advisor to Committee of Creditors
• Preparation of Resolution Plan and Information Memorandum
• Independent Bid Evaluation Services
Restructuring
Deal Tax Advisory (Strategic, IBC, PE/VC)
• Tax Due-Diligence
• Tax Structuring
• Deal Negotiation Review
• Transaction Documentation Review
• Post-Deal Integration
Corporate Restructuring
• Group Restructuring
• Financial/Capital Restructuring
Succession Planning
Holistic Implementation Support
• Merger/Amalgamation
• Demerger/Spin-off
• Capital Reduction
Transaction Tax
• Share Buyback
• Business Transfers
• Liquidation/Wind-up
• M&A Advisory:
• Sell Side & Buy Side
• Domestic & Cross Border
• Partner Search, Joint Ventures & Strategic Alliances
• Government Disinvestment & Privatization
• Fund Raising - Equity, Mezzanine, Structured Finance & Debt
(Corporate & Project Finance)
• Distressed Investment Banking - One-Time Settlement, Priority
and Interim Funding, Rescue Financing, and Buyouts
• Capital Market Advisory
Investment Banking (Category 1 Merchant Bank)
Risk Consulting
Strategic & Risk Advisory Services
• Techno Economic Feasibility Studies & Viability assessment
• Business Plan Review
Technical Support Services
• Lender’s & Investor’s / Independent Engineer Services
• Technical Due Diligence, Technical Opinions
• Chartered Engineers Opinion & Certification
• Project Cost Investigation and Monitoring
Agency for Specialized Monitoring (ASM)
• Cash outflow / Inflow and project monitoring, Ensure the end
usage of the Fund
Financial & Treasury Risk Advisory
• Assessment of risks - ALM, Credit, Market, Interest Rate &
Liquidity Risk
• Asset Quality Review & Stress Testing
• Assessment of Expected Credit Loss
Business Risk Advisory
• Risk based Internal Audits & Enterprise Risk Manangement (ERM)
• Flow Chart Base Process Mapping & Process Excellence Studies (SOP)
• Compliances Studies, Assets management & Business support
Services
33. A Deep Dive IntoThe Hospital Industry in India
33
Contact Us
Research Analysts
Akriti Banka
+91 79 4050 6077
akriti.banka@rbsa-advisors.com
Jinal Gosaliya
+91 79 4050 6077
jinal.gosaliya@rbsa.in
Nitin Mukhi
+91 79 4050 6074
nitin.mukhi@rbsa.in
Ajay Malik
Managing Director & Head
Investment Banking
+91 22 6130 6015
ajay.malik@rbsa.in
Vinod Nair
Managing Director & Head
Risk Advisory Services
+91 22 6130 6015
vinod.nair@rbsa.in
Management
Rajeev R. Shah
Managing Director & CEO
+91 79 4050 6070
rajeev@rbsa.in
Manish Kaneria
Managing Director & COO
Co - Head Valuation
+91 79 4050 6090
manish@rbsa.in
Mitali Shah
Managing Director & Head
Banking & Restructuring
+91 79 4050 6050
mitali@rbsa.in
India Offices Global Offices
Project Leader Creatives
Tarun Vataliya
+91 79 4050 6033
tarun.vataliya@rbsa.in
1121, Building No. 11, 2nd
Floor,
Solitaire Corporate Park, Chakala,
Andheri Kurla Road, Andheri (E),
Mumbai - 400 093
Tel: +91 22 6130 6000
Mumbai
6-3-248/B/1, 4th
Floor,
Dhruv Arcade,
Road Number 1, Banjara Hills,
Lane opp. Kotak Bank,
Hyderabad - 500 034
M: +91 90526 60300
Hyderabad
Bengaluru
104, 1st
Floor, Sufiya Elite,
#18, Cunningham Road,
Near Sigma Mall,
Bangalore - 560 052
M: +91 97435 50600
Tel: +91 80 4112 8593
Dubai
6001 Beach Road,
#22-01 Golden MileTower,
Singapore - 199589
M: +65 8589 4891
Email: singapore@rbsa.in
Singapore
Unit No. 1102, Al Jamal Building,
Al Ghatfah St, Al Danah,
Abu Dhabi
M: +971 52 617 3699
Email: abudhabi@rbsa.in
Abu Dhabi
2001-01, Level 20, 48 Burj GateTower,
Downtown, Sheikh Zayed Road,
PO Box 29734, Dubai, UAE
M: +971 52 382 2367
+971 52 617 3699
Tel: +971 4518 2608
Email: dubai@rbsa.in
Ahmedabad
912, Venus Atlantis Corp. Park,
Anand Nagar Road,
Prahladnagar,
Ahmedabad - 380 015
Tel: +91 79 4050 6000
2nd
Floor, IAPL House,
23 South Patel Nagar,
New Delhi - 110 008
M: +91 99585 62211
Tel: +91 11 2580 2300
Delhi
Ravishu Shah
Managing Director
Co - Head Valuation
+91 22 6130 6093
ravishu.shah@rbsa.in
Ravi Mehta
Managing Director & Head
TransactionTax
+91 22 6130 6052
ravi.mehta@rbsa.in
Chetan Khandhadia
Managing Director & Head
Transaction Services
+91 22 6130 6095
chetan.khandhadia@rbsa.in
Gift City (IFSC)
Unit No. 16, Office No. 7,
Wing D GIFT Aspire Block 12,
Road 1-D, GIFT SEZ,
Gandhinagar - 382 355
M: +91 97243 43847