Global Health Limited (MEDANTA) Q3 FY2026 Earnings Call Transcript & Summary

Ladies and gentlemen, good day, and welcome to Global Health Limited Q3 FY '26 Earnings Conference Call hosted by JM Financial Institutional Securities Limited. [Operator Instructions] I now hand over the conference to Mr. Amey Chalke from JM Financial Institutional Securities Limited. Thank you, and over to you, sir.

Thank you, Pari. Good afternoon, and warm welcome to all the participants on Global Health Limited 3Q FY '26 Earnings Call hosted by JM Financial. Today on this call, we have with us from the management, Dr. Naresh Trehan, Chairman and Managing Director; Mr. Pankaj Sahni, Group CEO and Director; Mr. Yogesh Kumar Gupta, Chief Financial Officer; and Mr. Ravi Gothwal, Head of Investor Relations. I will now hand over the call to Dr. Trehan for his opening remarks. Thank you, and over to you, Doctor.

Thank you. Good afternoon to everyone, and welcome to Medanta's Q3 FY '26 Earnings Conference Call. I hope all of you have had the opportunity to review the results and presentations that were released yesterday. At Medanta, our primary focus continues to be on delivering high-quality patient-centric care across our network, supported by strong clinical governance, robust processes and continuous investment in medical expertise and infrastructure. During the quarter, the company remained firmly committed to strengthening its clinical program, expanding across tertiary and coronary care and ensuring consistent clinical outcomes across its hospital network. As doctors, we remain deeply concerned about the rising cancer burden in India, where early detection continues to be the most effective intervention. In this context, we launched a large-scale cancer awareness program during the last 6 months focusing on breast and prostate cancers. The initiatives were aimed at dispelling prevalent, promoting self-examination and encouraging timely medical intervention. To meet the growing demand for advanced oncology care, our Gurugram facility commissioned its first radiation oncology machine, significantly enhancing treatment capacity and adding some of the latest technology to this field. I would like to acknowledge the dedication of our doctors, clinical teams and support staff whose collective expertise and commitment remain central to maintaining the highest standards of care while delivering personalized patient-centric outcomes across our hospitals. Our recently commissioned Noida hospital completed its first full quarter of operations during this period. The hospital made encouraging progress across clinical onboarding, outreach initiatives and infrastructure activation, thereby laying a strong foundation for the ramp-up of business operations and the delivery of high-quality health care services, not only to Noida cities, but also across Western Uttar Pradesh. I am also pleased to share that Medanta, Lucknow has received the prestigious Joint Commission to the National Short Form JCI, Quality Accreditation in January 2026. Medanta, Lucknow is the first hospital in the region to be accredited by JCI. This certification reaffirms our commitment to deliver the highest global standards of clinical quality and patient safety in the region where we operate. With that, I will now hand over the call to Mr. Pankaj Sahni, our Group CEO, who will take you through the financials and operational performance in detail. Thank you.

Thank you, Dr. Trehan. Good afternoon, everyone, and thank you for joining us today for our Q3 FY '26 earnings call. Let me begin with the financial performance for Q3 FY '26. Total income for the quarter stood at INR 11,428 million, delivering a robust 19% year-on-year growth, driven by sustained momentum across all our hospitals and continued improvements in operating metrics. EBITDA, excluding Noida, grew by 11% year-on-year to INR 2,814 million with healthy margins of 25.4%, underscoring the resilience and operating leverage of our balanced portfolio. EBITDA, including Noida stood at INR 2,494 million with margins of 21.8%, reflecting the expected impact of early-stage operating losses from our newest hospital. Medanta, Noida, which commenced operations in September 2025, completed its first full quarter of operations during Q3 -- the hospital generated INR 343 million in revenue and reported an EBITDA loss of INR 320 million, in line with the investment required to operationalize a facility of this scale and high standard. At Noida, we accelerated the ramp-up with addition of 102 beds, taking total bed count to 328 beds with 9 new operating theaters added this quarter, taking the total count to 14 operational theaters. This is also supported by significant strengthening of our clinical teams. We remain confident of steady improvement in utilization and financial performance over the coming quarters. Consolidated profit after tax stood at INR 950 million, impacted by higher depreciation and finance costs related to Noida, initial operating losses and a onetime statutory impact of INR 366 million arising from the implementation of new labor codes classified as an exceptional item. Adjusting for labor codes impact, profit after tax was INR 1,224 million. We also saw encouraging momentum in international business. International patient revenue grew by 30% year-on-year to INR 703 million, driven by higher volumes, while our OPD pharmacy business grew 30% to INR 465 million. Operationally, the quarter demonstrated strong traction across the network. We added 144 beds, including 42 beds in Patna and 102 beds in Noida. Inpatient volumes grew by 14%, while outpatient volumes increased by 20% year-on-year. Our average length of stay reduced to 3.02 days, a 7% year-on-year improvement, while occupied bed days increased by 7%, translating into an occupancy of approximately 59% on expanded bed base. ARPOB increased by 10% to INR 67,361, supported by improvements in ALOS and case mix. Moving on to mature and developing performance update. Our mature hospital consisting of Medanta, Gurugram, Indore and Ranchi delivered steady performance with revenue of INR 7,020 million, up 9% year-on-year and EBITDA of INR 1,675 million, up 7%, with margins of 23.9% Matured margins during the period were impacted due to increase in employee costs and other operating expenses, including repairs and maintenance. Our developing hospitals, excluding Noida, continue to outperform, recording 22% revenue growth to INR 3,651 million and EBITDA of INR 1,156 million, growth of 13% with strong margins of 31.7% in Q3 FY '26. If you look at 9-month performance, both Lucknow and Patna facility continues to deliver double-digit growth in revenue and EBITDA with Lucknow margins registering over 150 basis points improvement year-on-year, while Patna margins remained stable. Developing hospital, including Noida stood at INR 3,994 million, up 33% year-on-year, while EBITDA stood at INR 836 million with margins of 20.9%, reflecting the expected drag from early-stage operations in Noida. Inpatient volumes across developing hospitals increased by 27% year-on-year with overall occupancy at 62% and ARPOB rising 8% to INR 56,853. Project update. During the first 9 months of FY '26, bed capacity increased by 18% year-on-year with addition of 537 beds comprising 99 beds at Patna, 110 beds at Ranchi and 328 beds at Medanta, Noida. We continue to have meaningful headroom for growth within our existing network with the potential to add 496 beds through brownfield expansions, including 193 beds at Lucknow, 81 beds at Patna and 222 beds at Noida. These additions are expected to drive near- to medium-term growth with minimal incremental CapEx. On the expansion front, our pipeline continues to progress well. In Guwahati, barricading is complete and drawings have been submitted for approvals. In Mumbai, land acquisition is complete, additional FSI approvals have been received and drawings submitted for approval. In South Delhi, construction activities are underway following the completion of site surveys and soil testing. Chidambara project is going through the regulatory approval phase. Overall, the 9 months of FY '26 reflect disciplined execution across the organization. Our core hospitals remain stable. Developing hospitals continue to scale efficiently, and Medanta, Noida is progressing in line with expectations during its ramp-up phase. We remain confident that these investments will create sustainable value for all stakeholders. With this, I would now request the operator to open the line for questions. Thank you.

[Operator Instructions] The first question is from the line of Tushar from Motilal Oswal Financial Services.

Sir, firstly on the clarification, like in your opening remarks, you highlighted about Lucknow and Patna margins. If you could just spell out again?

Yes. Should I go ahead, or do you have another question, Tushar?

Yes. First, if you could address this and then we'll take the second question. I'll have the second question.

Yes. So, if you look at our developing hospitals performance, if you look at the presentation on the investor presentation, I think it is on Slide 16. you will see that we have seen an income growth of 28% from the 9-month period. This is excluding Noida, where the revenue has grown from INR 812 crores to INR 1,040 crores. And if you look at the margins, that has also increased. In fact, the margins have increased from 30% to 31.1%, excluding Noida. And then if you factor in Noida, that is -- because of Noida that is coming to 25%. So, I hope that is the question which you are asking, Tushar.

Sir, on Lucknow, particularly how has been the margin scale up?

Lucknow, we have done very well over the course of the last 9 months or so, as I mentioned in the opening remarks, we have seen a margin expansion of over 150 basis points when you look at it on a 9 months to 9-month basis.

Got it, sir. And secondly, now with respect to Noida, we have almost onboarded 220 doctors. What is the -- like overall are we more or less now done with in terms of onboarding doctors? Or what is the sort of target as far as doctors are concerned? And how it has been like maybe the initial fillers with respect to Noida facility?

Yes. So, as you are aware, we don't stop adding doctors even after several years. But of course, the hiring to be able to start the services is more or less underway. There are some departments which are still not active in Noida. So, some of the departments which are not active in Noida as at December 31 would be the pediatric department, the aesthetics department, liver transplant department, some of the departments in some of the more niche specialties like vascular surgery. So, we are still continuing to look at these departments and hiring. But I would say that the majority of the hiring has been undertaken, including adding in some of the talent to support the key teams. So, we now expect that most of that hiring is finished. But like I said, if we do find that we need to bring in more talent, we will not stop that hiring, that will continue. And wherever the departments are not there, as I mentioned, that hiring will take place. I don't know whether it will happen immediately in the next few months or whether that will happen subsequent to March 31, but that will be as per our availability of beds and our availability of talent and our plans as we move forward.

Got it. And just lastly, now that it's like 3, 4 months into operation. So broadly, what kind of ARPOB is like as a starting point, so to say. Of course, this will further improve with the change in case mix pair mix. But currently, if you could share what kind of ARPOB we are having at Noida hospital.

ARPOBs in Noida hospital are coming currently much higher than Gurgaon. But I would not necessarily use this as a proxy for extending out into many months into the future because we have just started. So, we have now signed up about 4 or 5 major insurance contracts, other insurance contracts are coming on board. We have not yet taken any of the panels in Noida that may come on as we move forward in line with our broader philosophy of serving every society and every category of patients. So, I don't -- I mean, right now, the ARPOBs are similar to Delhi ARPOBs, but I just caution that we should not assume that, that will maintain as we move forward. Once we have a more balanced revenue mix, then you will see a slightly more balanced ARPOBs as we move forward.

The next question is from the line of Devarsh Shah from Sunidhi Securities.

So, I wanted to understand -- like could you typically state the employee-to-bed ratio for the hospital because as per my understanding, the employed-to-bed ratio varies for the different specialty. So on the overall basis, what would it be for your hospital?

So we don't look at -- I mean, I'm not very sure, Devarsh, where you are getting these baselines from. We don't normally look at employee-to-bed ratios in any one area because it varies very drastically depending on the nature of the specialty. So, neither have we ever published it nor do we -- nor can I tell you that this is a standard number for a hospital. Just to give you a sense, a liver transplant department may have fewer beds, but very high number of clinical talent, whereas an internal medicine department may have a high number of beds and very few number of doctors. So, it is not a very meaningful metric for us to look at in terms of any of the operational parameters. So unfortunately, we don't have anything which we report out, which I can share with you. I'm not sure if you have something deeper in mind and the question, I can try to assist, but this metric as such, we don't report.

Okay, sir. And the second question was like, could you tell the total census beds for the each unit?

The total census beds in each unit?

Yes.

I think that was in the investor deck. Let me see if I can find it. So, Noida, census beds right now is 187. Let me just pull out the census beds for -- our total is about 2,427 -- and maybe I can get this to...

2,600.

Sorry, 2,665 as at December. And maybe I can get this sent across to you from our Investor Relations team, so we don't waste everybody else's time on the call. Each of the units you get the beds in. Gurgaon is about 120 I remember that number. And I think Lucknow currently is operating at around 600. Patna hospital facility is 569 -- sorry 386 is the census bed. But we will get this to you. I think it's in the deck also.

[Operator Instructions] The next question is from the line of Bansi Desai from JPMorgan.

So firstly, on Noida, how should we think about the losses from here on? I'm assuming these would be the peak kind of losses that we report in the quarter given we've added doctors and a large part of commissioning expenses would be sitting in this quarter. And therefore, as the unit ramps up, should we see losses coming down? And also given the fact that we are expected to add another 200-plus beds here over the next 1 year, how should we see the loss trajectory?

Yes. So, I mean, I hope so that we've seen the peak of the losses. You are right. If you look at our scale up of clinicians, we've added in a whole bunch of clinicians from September to November. And even within this quarter, if I was to really see the performance really was more in terms of volumes growth more started towards the second half of this quarter. So, you don't even see complete 3 months of run rate. So, we are seeing now, especially December and as we move into January, a better run rate trajectory on the revenue. So of course, that will help with the loss containment. I don't know exactly when it will be fully concluded. One thing I just want to clarify for one of the earlier questions I had mentioned on the specialties. One thing which I forgot to mention is our radiation oncology and our nuclear medicine department, which is on board in terms of the talent and the machines. That hasn't started yet. So that is another thing I forgot to mention that the department which is currently missing. But you're right, as we scale up, we should see now the business coming in, our insurance contracts coming on board, our corporate and panels coming on board. And really now the question is getting down and actually ensuring that we are able to service the people of Noida and Western UP. So much of the initial work is done, although some of the project work is still underway. But the hospital is fully functional now, subject to the departments that I mentioned.

And when we think of adding 200 beds here, I would assume those would largely get absorbed with these 300 beds ramping up by that time?

Yes. So, the additional beds would largely get absorbed with the teams which we have, plus some element of the teams which we are adding. So, I can tell you, for example, that we are already underway of creating our dedicated transplant unit. So, although it was not completed and commissioned by December 31, that is one area which we will be having. So, some of these additional beds will come into that. So, with the exception of really transplant, which has dedicated infrastructure, and maybe obstetrics or pediatrics. The rest of the infrastructure will more or less just scale up as and when the need is there and will be part of the existing clinical team. So we don't see that there's any real need to hire new departments for filling those beds.

All right. That's clear. And my second question is on the mature units. We've seen significant decline in ALOS there, 2.9 days. Is it a quarter phenomenon? Or do we expect structurally ALOS coming off there? So that's one. And the second is you mentioned on margins, we had higher employee costs and certain maintenance-related expenses. So, with those behind, should we expect the overall unit to see improvement in margins from the upcoming quarter -- from the next quarters as you see your revenues growing?

Yes. So let me take that in 2 parts. First, when you look at the ALOS, I think just picking up 1 or 2 quarters may not be always appropriate because there is some effects of how the seasons play out, how the Diwali holidays play out, how the certain seasonal diseases like dengue, et cetera play out. Sometimes it's more in September, sometimes it's more in October. So, I would suggest we look more at an annual or a 9-month basis at a minimum rather than quarter-on-quarter, just to get the numbers correct. That being said, the ALOS reductions are also driven a lot by the increasing work for cancer. And given the growth, which you'll see on the sales mix, and I think it's phenomenon across the country where cancer treatment and cancer detection is increasing. So a lot of the cancer work is in the nature of radiation oncology or medical oncology, which has a day care component to it. So there is an increase in daycare. There is also some amount of difference this year versus last year with respect to patients who are more in the dengue and some of the other respiratory diseases, which tend to have a slightly longer length of stay vis-a-vis some of the shorter procedural departments. Other than that, I don't see any very significant structural change. I mean we already have a very aggressive length of stay. That being said, we continue to work, especially in some of the units like Patna and maybe even in Gurgaon to actually ensure that we are optimizing our length of stay. And we will continue to try to see if we can convert a lot of the work from night stay to daycare. So we want to work on how we also do things like improving discharge processes, streamlining the discharges for patients who are credit patients. So I mean, there is still some operational efficiencies, I think we can bring in, but I think the 3 days length of stay for an ecosystem as complex as ours is very, very robust.

Understood. And just on margin, are we done with our investment into maybe adding employees and maintenance expenses? Or we expect that to recur?

Yes. So, I don't think that there is any kind of -- I mean, obviously, the employee costs are recurring costs they incur every month. But I think if you go back to last 3, 4 quarters, I had been mentioning that there is some amount of war for talent that is coming is likely to come. We are also aggressively hiring across the units. So there will be some amount of optimization and balancing out of this as we stabilize our hiring as well as how other hospitals look at hiring in the market. We'll also look at operational efficiencies where we can bring about as much as possible, both on the manpower cost as well as on the -- some of the other expenses. Some of these are cyclical in nature. So, for example, we do notice in our P&L that repairs and maintenance cost is whenever we have annual maintenance contracts coming up, which is out of warranty, new equipment comes out of warranty after maybe 3, 4 years of procurement, those come in and then they balance out over time. So, depending on which horizon you're looking at, they more or less balance out. I don't see any very significant structural issues on the margins. I do believe there are efficiencies, especially in some of the older units that we can keep out, and we will work towards that. You will see some of those efficiencies are already playing out on some cost items. So material costs have been -- are currently in the process of being optimized as we move, and we've seen some of that captured in the numbers so far. We hope that will continue. So there will be some up and down across cost items. But overall, I think that we'll be looking at trying to see whether we can get a couple of -- 100 basis points of efficiency out of the system as well.

The next question is from the line of Manish Poddar from Invesco AMC.

So just 1 question. So, I got that you said I hope so for the peak losses to be behind for Noida. How are you thinking actually of the ramp-up the other way around, let's say, versus the initial expectation versus what you would have seen in the last few months, how are you thinking about getting to utilization, let's say, 40%, 50%, 60%? And how -- is the journey faster than earlier expectation? Just any color on that would be helpful.

So I think, Manish, the journey is very much as per our expectations. I think that as we look at getting everything settled not only operationally, but also some of the project teams moving out of the system. We started out this hospital while it was in the -- currently being constructed as well. So, some of these things will stabilize, like I mentioned, just as an example, our radiation oncology doctor is on board, but the machine is not yet live because we are waiting for the approvals from the ERB. So, there will be some teething issues around this next couple of weeks, maybe months. But I think that for the most part, we are now ready to fire on full cylinders. What that time frame exactly will be, I'm not sure. But I don't think that we are -- we have seen anything happen in Noida, which is totally counter to what our expectations was, either on the hugely negative side or on the usually positive side, more or less moving in line with what we expected.

The next question is from the line of Damayanti Kerai from HSBC.

My first question is again on Noida, where you mentioned it's ramping up as per your expectation. So just to clarify, the additional bed addition plan which you have, that will only be done once we have achieved breakeven at the existing, right? Or how do you...

No, I don't think that's the right way to think about it. So again, without getting into too much specifics, our Noida facility is a single tower facility as opposed to Gurgaon, Lucknow and Patna, where we had 2 towers where we were able to build 1 tower, then build out, fill it and operationalize the second tower. Because of the structure of this building, we intend to complete the project work as and when the project teams are able to do it. So, we will not actually demobilize and start again once the occupancy increases. We will continue to build out throughout. It just ends up being more efficient that way. And while it may be beds coming in a few months before we need it, we feel it's the most efficient way. So we would not stop the build-out is the answer to the question.

Okay. So both will happen simultaneously, right? The ramp-up on the existing beds...

Correct. So, we ramp up the adjacent beds. We will build out now you may not hire every department, you may not hire the nurses for running one ward if the ward doesn't have patients. But the infrastructure and CapEx and the fit-outs and all we will conclude. And then we will see as and when we move out. We may also have some things in the back pocket for maybe 1 floor or so, depending on whether we need more ICUs or more OTs, you may need to optimize there. We are now seeing this after about 4 years performance in Patna, we are actually realizing that we may have a demand for additional procedure rooms as opposed to beds. So, we may actually redeploy some of the spaces which were allocated for beds to procedure rooms. So today, I believe Patna is about 560 beds. So from the remaining 80, 100 beds, I may choose to redeploy some beds to procedure areas or we are trying to find if we can optimize there. So barring the small adjustments, we will continue to build out Noida.

Got it. My second question is on the update which we heard on the CGHS rate revision some time back. So anything you're picking up on that part in terms of your operations?

So CGHS rate revision has, of course, been beneficial for the industry. It has been a long demand after many, many years. There has been positive movement across the group on that in terms of tariff increases. We have captured some of that in the 9-month numbers that you see. I think high single digit in terms of crores is the impact on that. And hopefully, some of that will fall to the bottom line also. As we roll out because these increases, I think, came middle or late Q2. So it's not even a full 12 months of impact yet. So if I remember correctly, it was maybe sometime around October. And then also what happens is some of the other institutional companies that follow CGHS rates, they then follow up with their own orders like the railways will follow up saying we also will activate these rates and so on and so forth. And also, we are working with our partners in Bihar that those rates are where we have ARPP, those rates also get adjusted. So the full year impact of this, I think, has not yet played out. But so far, it's been positive.

And did you mention some high single-digit impact?

I think Yogesh will correct me if I'm wrong, I think it's somewhere in the range of INR 7 crores to INR 10 crores of impact in 9 months, right?

INR 7 crores to INR 10 crores, okay. Okay. That's helpful. And my last question is on your plan for price increase, which is obviously not your focus, but as you focus more on the volume growth. But in terms of taking price hikes for some of your units where you haven't taken price hike for long, are those done?

So if I remember correctly from our last call in September till December, I think no real price increases have been taken, except maybe in Patna. Patna we haven't taken, Gurgaon and Lucknow, we have taken. But I think more important than that is that some of the insurance contracts, which were not renewed for almost 2 to 3 years, they are now getting renewed across the group. So, there will be some potential benefit for those price renegotiations as we move forward. So I think probably when we come to maybe June or September of next year, you will see more of a realistic picture of a full year of pricing impact across CGHS, our increases and insurance negotiations.

Just a clarification on the rates which you renegotiated with your insurance partner, what kind of hike you might have got just some indication, say, compared to the last contract when you signed the new contract, what is the difference?

So let me put it this way. When we sign up the contracts with the insurance companies, they were on a tariff list, which I think was somewhere around 2 years or 3 years ago, 2024 tariffs or I think 2022 tariffs. So now when insurance companies negotiate, they negotiate it with our 2025 tariffs, which was what we had done last year. So, depending on how those tariffs increase, we kind of renegotiate basis that. So, it will be different in different units depending on when the insurance company signed up. But typically, insurance companies will sign up for a 2-year time frame. And now it's already been a little over 2 years. So, you can say about 2 years plus of increases. And then insurance companies ask for different levels of support in terms of discounting, et cetera. But on the whole, I think it will be a positive benefit for us from a tariff point of view.

[Operator Instructions] The next question is from the line of Ashutosh Nemani from JM Financial Office.

My question is on the earlier answer you told that war of talent coming up in the next 3 to 4 years. So, I wanted to understand more about it. Like in particularly what locations do we see this doctor supply and nurse supply are more severe as compared to other on a national level? If you could just highlight on that.

I mean I'm not fully an expert to tell you at a national level in which city there will be more or less war for talent. I think this is a phenomenon in the industry is facing to the best of my knowledge across the board. I can tell you in the regions where we operate, which is more on the northern side, there are 2 ways in which we look at it. One way is where there are existing facilities where there are lots of doctors and there's lots of demand for talent. There it is a little bit driven by some forms of competitive intensity. Doctors are trying to get posted by other hospitals. Obviously, we would be also looking at hiring doctors from other institutions, some amount of retention also. We have been very lucky. We've been able to retain most of our senior doctors, if not all even after 15 years in Gurgaon. Then when you come to units which are in cities where there may be a slightly shorter tail of talent in terms of super specialists, we've been able to get in doctors from other cities. Sometimes you have to pay for getting doctors to move into certain locations or you're actually looking at building up a talent base over there vis-a-vis taking time to build that specialty. So just to give you an example, if I bring in a very talented, say, robotic surgeon from one part of the country, they may not have a patient base, say, in Bihar or in UP. They build up that, so that takes a little time to build up. So, these are the kinds of things that we have seen. From my conversations with colleagues in the industry, I think this is a phenomenon everybody is facing. Obviously, there's a lot of talk about hospitals, so everybody's getting very excited. One thing though we have seen is that I think clinical talent understands the value of strong brands and strong institutions. Medanta has been very lucky to be kind of what we believe is a preferred employer for clinicians. So, we've been lucky on this front. But I do believe that given the talent is scarce, this is something that the industry and the country will face for some years to come. I don't think this is something going to get solved in the next quarter.

Understood. Understood. Sir, my second question is in the next 2 to 3 years, what should be the like ARPOB growth that we could assume for Medanta?

So again, next 2 to 3 years, I don't know how things will play out, but we have always maintained that ARPOB growth will be 5% to 7% a year as opposed to what we have seen maybe last 3, 4 years where we've seen much higher growth. Again, ARPOB is a little bit dependent on length of stay and case mix, but we don't project anything more than a 5% to -- if you are very enthusiastic, maybe a 7% growth in ARPOB on an annual basis. In fact, Medanta typically projects much lower, 3% to 5% is what we try to think about. But again, that's more on -- for us on tariff or realization side. ARPOB, again, if you optimize length of stay, then ARPOB will grow. But I think that pace of 10%, 15% ARPOB growth or realization growth, which we were seeing maybe 1.5 years to 2, that has already stabilized. You can already see it in the results of all companies. Last maybe to 18 months, you'll see a significant slowing down of the ARPOB growth that was there 2, 3 years ago. So, I think 5% to 7% is a reasonable number to project out if you're thinking about building a model. I would not go more aggressive than that. Definitely not single digits. I would keep it to -- not double digits, I will keep it to single digits.

The next question is from the line of Rahul Jeewani from IIFL Securities Limited.

Sir, on the Noida hospital for, let's say, these 300-odd beds which we have operationalized, what kind of an exit occupancy we would have seen either for the December month or the Jan month? And if you can also talk about the occupancy which you need to achieve to, let's say, hit EBITDA breakeven on these 300 beds.

So we don't normally look at occupancy from a breakeven point of view because of the fact that we believe more -- much more in the volumes and the procedures rather than the midnight occupancy. So at least Medanta doesn't necessarily look at that. That being said, I think normally, what we find is in a big system somewhere in the range of 40% to 50% or maybe 40% plus, occupancy typically breaks even on a long-run basis for the kind of fixed cost model that Medanta employs. It may be very different in our other industries. Our goal is very simple in Noida. Our goal is that we have put everything that is required to deliver the highest standard of care. That is investment in the infrastructure, the technology, the clinical talent, the processes, the IT systems, et cetera. Our goal is to drive this occupancy through and through -- sorry, to drive these volumes and this business through and through. Once we do that, whatever occupancy falls out of that, it falls out of that. Our focus is that we must be ensuring that we invest to deliver the highest end of care. We have done that. And basis the trajectory we see in the last few months, including post December, we are pretty happy with how things are moving and pretty confident of the success of this institution. So, whether this occupancy will break even at 30% or 40% or 50%, I don't know. It's also not a percentage number which we are chasing. Our goal is to ensure that we are able to drive as much patient volumes into the system. And we are pretty confident, given our track record, these things will then work out well.

Sure, sir. And for, let's say, these another 200 beds, which you would commission at Noida, how many incremental doctor hirings would we need to do given that, obviously, for the initial phase of 300 beds, we have already onboarded 200-odd doctors?

So not many. As I mentioned, I think in response to an earlier question, we have some departments which we may add. So, they, of course, are not linked to beds. They would have addition. So, Stealth is an example of that, which is a totally new department. The rest of the departments, all the seniors or most of the senior talent is already there. So, when you add in beds, it's really more of the junior staff who need to do more of the maintenance management and taking care of the care. Nurses, of course, will get added and other stuff. But the senior doctors, I don't think are necessarily linked to the bed addition.

Okay. So, the incremental OpEx for these another 200 beds, obviously would then be lower?

Yes, correct.

Sure, sir. And sir, last question from my end. In terms of the mature hospitals, where we have seen some sort of a margin pressure this year, while you alluded to higher employee and maintenance costs. Is the Ranchi O&M hospital also led to some sort of a margin drag for the mature units?

I mean definitely, the new Ranchi hospital also has a little bit of impact. I'm not sure it will play out in the numbers which you are seeing because it's very small. It's only about 100 beds on a 2,000, 3,000 bed overall base. So, I don't think it has an impact as to what you see. Of course, it is a drag, but I don't think it's significant or material on the financial -- on the absolute rupee amount. I mean, just to let you know, obviously, Ranchi and lower margins are, of course, lower than Gurgaon and Lucknow. So -- and Gurgaon, sorry, Lucknow is coming and developing still. But other than that, I don't think it's a very significant drag.

The next question is from the line of Nitin Agarwal from DAM Capital.

On the -- over the last few months and quarters, we've had multiple sort of media items, news flow around increased patients between hospitals and insurers. I mean, 2 questions here. One is, A, is there a change in relationship between insurers and corporate hospitals in a sense as insurers become larger in cloud? And two, what kind of implication does it have for rates and business as we go along?

Yes. So, I think maybe I'll give 3, 4 specific points on this. I think, first of all, as with many things, the media likes to sensationalize things much more than they are in reality. So, I wouldn't always necessarily go with either the substance or the tone of what we hear in the media. That's point number one. Point number two, just again at a higher level, see, every player in this industry, whether it is a provider like us, whether it is an insurance company or whether it is even the government authorities, including at every level of government. They all understand that our collective responsibility is, first and foremost, towards the patient. Neither can we survive without the insurance companies, neither can the insurance company survive without the providers. And by the way, the same logic applies to the pharmaceutical and medical device companies, which are also part of this ecosystem and also part of some of these conversations that you're alluding to, right? So I think we all get it, and everybody is reasonably mature in that. That being said, there is always a commercial negotiation and a commercial discussion that happens between any 2 parties engaged in a commercial conversation. Now we have so far been very, very clear on our approach that we are open and ready to talk to anybody, and we have. We have been successful with those activities. And all conversations in good faith between 2 parties in a professional and in a non-collusive manner are something that we stand for, and we have been successful in moving that forward. Of course, if I would like to pay INR 10 and you would like to pay INR 5 or I would like to charge INR 10, you would like to charge INR 5. Of course, we will negotiate on that price. Nothing wrong in that. And we've been successful in closing out many of these contracts and many of these negotiations. I think that we could have been faster and more efficient. I think that some of the players in the industry who are maybe trying to project that we'll only talk as one body or that we -- that only -- it's only the hospitals that are making money and the insurance companies are not making any money. I think these are facts which are being a little bit manipulated one way or the other. I think the truth is obviously somewhere in the middle as in most cases. We do realize that the insurance companies have challenges, but many of those challenges are also linked to their operating model and some of the issues in the industry. Similarly, I think they understand that while you look at EBITDA many times, but the real money at the bottom line coming on the profit after tax, which is the money that has to go into CapEx refresh and investing in all of these areas is required for hospitals to be able to grow and for, frankly speaking, people like us to invest in places like Patna and Bihar and Ranchi and Northeast. And the government also understands that, that it's very important that they encourage private investment in all these areas because that's how the care will get delivered. So, I, frankly speaking, see that there is no long-term relationship impact between the 2 parties. We have been very comfortable interacting with everybody. But of course, we will negotiate on price. I don't see that stopping this year, next year or any time in the future. As any entity has -- feels they have more power, they would like to be stronger in a negotiation position. It is exactly the same thing that I would do with my suppliers. So, it's normal. I think some of it is blown out of proportion and some of it as few stakeholders in the ecosystem on both sides are probably mischaracterizing, misusing one party or another party on their side of the industry for their own personal benefits, which is also not correct.

Very helpful. And secondly, sorry, if I missed it, did we guide to a time period when we expect Noida to breakeven on EBITDA?

No, we don't guide on future earnings as a policy. All I did allude to was the fact that we are pretty hopeful that we are now in a position to see strong positive momentum into the system. I do not know when that breakeven will happen, but we are not worried that it is all slipping south or something like that. It's very much as per our expectations on how the ramp-up of these units will do.

But is it fair to say that this quarter EBITDA loss is kind of close to the peak-ish EBITDA loss we'll do on the asset?

That is the question which I said. I hope so. I don't want to commit to you one thing or the other, but I'll leave that to you guys to figure out. But yes, we are feeling confident that things are moving in the right direction.

The next question is from the line of Naman Bagrecha from IIFL Capital Services Limited.

On the mature hospital margins again. So, if you look earlier we used to make almost around 24.5%, 25% kind of margins but is it because of now the incremental costs or on talent, et cetera one should look at, let's say, lower margins structurally, let's say, around 100 bps lower versus what was value earlier on mature hospital?

No, I think that -- I mean, so I wouldn't necessarily agree with that, right? I mean if you look at the margin profile, which we have in the 9-month period in the mature facilities, it's just under 24%. We have maintained for a long time, and I have maintained for a long time that anything in the range of 22% to 25% is very strong performance for a system like this, especially such a big system like the ones which we have. I think that 100, 90, 80 basis point swing here and there, especially in one period over the other is fairly insignificant. I mean our industry have to look over this over 3 to 4 years, not 9 months or even 1 year. And even within the 9 months, the swing to me doesn't seem very significant. So, I don't think there is a structural difference. There was a structural reset post-COVID, which we have talked a lot about on various calls. I think we are now in a fairly balanced way around that. I also had always maintained that I don't see this margin profile jumping up every year, 30% or 300 basis points to head towards the 30% margin. I had always said that those were expectations that were being incorrectly set in the market. This is a fairly balanced range, 22%, 23%, 24%, 25%, this number is a very balanced range. You do a little bit better, it could go up. But I don't think -- see, there's any big structural issue. Between one period or the other, you try to eke out as much efficiencies that you can. We will see this stabilize in these ranges only. I don't think they are going to change significantly. The only thing in Medanta's case in this, how we report out is -- which is a little different, just so that you're aware, is all our corporate costs are loaded in our Gurgaon unit. So what you see as the margin of the individual units is a little bit deflated because of the corporate costs. Probably if you took out those corporate costs and you allocated them across, you would see a slightly more balanced margin profile between all of the bigger units at least in our group.

Fair. Fair. Thanks. And just one bookkeeping question. What would be our net cash position as of December?

Net cash as at December?

INR 600 crores.

About INR 600 crores. Go ahead, Yogesh.

We have a loan of about INR 600 crores and in a cash position of about INR 500 crores. So net cash is about INR 600 crores.

The next question is from the line of [indiscernible] from JM Financial Institutional Securities.

Am I audible?

Yes.

So sir, while you did allude to the kind of ARPOB growth that we can be expecting. But in the -- my question was regarding the newer clusters. While we add more complex facilities, while we add on to the newer ones, what kind of dynamics do you see regarding the kind of ARPOB that can change in EVs specifically? And if you can give some color on that dynamic?

So I mean, let -- I don't have a number for you, but let me just give you a little bit of perspective, right? So one of the things the industry has been commenting on for the last couple of years or maybe 6 quarters is this entire shift to, say, robotics. Now robotics means a higher realization, but also potentially a lower length of stay because the patient gets to go home faster. So obviously, that has a disproportionate increase on ARPOB because your ALOS will fall and your realization will increase both. So it's one example of something that may boost up when you look at it at an ARPOB level rather than a ARPP level. The second thing, as I said earlier, was that when you get into increasing work in cancer, especially if it is cancer work in the daycare nature like radiation oncology, where you may not admit the patient or medical oncology where the patient just stays for 1 day for treatment, you will find a disproportionate growth through ARPOB because the occupancy is not that long as opposed to, say, somebody coming in for cardiac surgery. So I think that these things are actually in favor of ARPOB growth because ARPOB is a derived metric. I think if you look at it and step back towards realization, which is what the patient bill actually is, I think, as I mentioned earlier, you will see a more balanced realization growth. There will be some growth towards realization because of complex work, some amount of increase in complex work across our newer units in Patna and even in Noida as that gets ramped up to some of the services, including transplant and things like that. We are also starting to see some of this complex work coming into places like Indore with robotic surgery happening there now reasonably well. So, you will see some of this. And then some of the changes of the CGHS rates, as I mentioned earlier, which happened in October and the tariff increases will play out over maybe the course of the next 6 to 12 months. So, you will see some positive trajectory towards this. But I think, again, it will be measured. I would not assume you would see 10%. I would say single digits is a fair number to be looking at.

Got it, sir. Thank you. And sir, if possible, can you give us the kind of expectations on CapEx outlay for next year given that majority of the expansion will be there?

Yes. I think there was a slide -- correct me if I'm wrong, Yogesh, on the CapEx plan in the presentation. Slide 23, I think, laid out the CapEx. We have been somewhere around the INR 1,000 crores range, I think, on next year CapEx. So this is INR 3,000 crores over the next 5 years. Next year, maybe a bit less actually now that a lot of the costs is in Noida.

Noida has already had...

So last year we had, I think announced about INR 1,000 crores CapEx in the year, out of which almost INR 600 crores, INR 700 crores was Noida, if I'm not mistaken, Yogesh?

Yes. Yes.

And I don't see that this year -- this FY '27 CapEx will be of that range. It will be much lower than INR 1,000 crores. Maybe some maintenance CapEx in the new -- in the older units, some CapEx on the margin in Noida. There will be not much CapEx on the other units because they are still in the digging and construction phase. So a lot of the CapEx in the new projects is back-ended towards maybe 2, 3 years from now. So next year, CapEx is probably, I don't know, below INR 500 crores?

Below INR 500 crores.

Below INR 500 crores would be our estimate.

The next question is from the line of Chirag Gupta from Allegro Capital.

I just wanted to understand why the margins in your developing facilities are higher than your mature facilities?

Yes. So I mentioned, I think, to one of the earlier speakers, one reason, of course, is that our corporate costs are fully loaded in Gurgaon, which is part of the mature facility, right? The second question, if you look at our historical performance, is that our Lucknow unit and our Patna units have been doing an exceptionally good performance right through and through barring 1 or 2 quarters in Lucknow. So what we've actually seen is a good amount of growth, a good amount of operating leverage come in. So just to contextualize for you, Lucknow is about a 6-year-old asset. Patna is about 4 years old now. And we've continually been adding beds to these facilities. So what you're seeing in these facilities in addition to the strong growth in these regions, you're also seeing improvements in newer specialties getting added. Just to give you an example, we have added 3 or 4 robots, including orthopedic robots in Lucknow. So we're getting more complex work. We have -- we're adding more complex work into our facility in Patna. And you are also seeing the benefits of operating leverage kick in, depending on which year you are looking at in -- after a couple of years, Patna would've been kicked in. Plus we would have added, I think the last maybe 1 year or 18 months ago, we added almost 200 additional beds, taking Lucknow from about 400, 500 to about 700 census beds. So those beds operating leverage also kicks in after some months. So I think these are the 3, 4 reasons why there's a difference between the developing and the mature. And then the last reason, although it may not be very significant in absolute terms, is that our develop -- our mature units also include Indore and Ranchi, which are significantly smaller scale and have a significantly lower margin profile.

Ladies and gentlemen, due to time constraint, that was last question for today. I now hand over the call to management for closing comments. Over to you, sir.

Thank you. Thank you, everyone, for your questions and for joining us today. Please feel free to reach out to our Investor Relations team in case you have any questions that remain unanswered. I know there's 1 question on census beds. We'll get that information out to you. But if you have any other questions, please feel free to reach out to the team. Thank you once again, and we look forward to speaking with you all soon.

On behalf of JM Financial Institutional Securities Limited, that concludes this conference. Thank you for joining us, and you may now disconnect your lines. Thank you.