Good morning, and welcome to the audio conference of Oncoclínicas. At this moment, all of the participants are connected only as listeners, and later on, we will start the session of questions and answers when instructions will be given to participate will be given to you. If you need any assistance during the audio conference, please ask for help from one of our operators by dialing asterisk zero. This audio conference is being recorded. I would now like to pass the word to Dr. Bruno Ferrari, founder and CEO of the Oncoclínicas group. Dr. Bruno, please go ahead.
Thank you for all of you present in our conference call. In the year 2023, Oncoclínicas continued to deliver a differential performance, combining robust organic growth with an increase in our profitability. We had approximately 635,000 procedures realized for our patients through 143 units spread over 38 cities in the country.
This was verified even in the middle of a scenario that has continued to be challenging for this health sector, as in all its chain, being pressured by the high rates of claims observed together with the health plans. If we look if this brought any impact on our gross margins and our working capital cycle, we have more than compensated these factors through gains in efficiency and in expenses and unlocking value on the bottom line. When we address the effective rate of income tax, the company also reduced substantially our minority participation in our net profit. To point out some of the financial results, we start with the gross revenue. We reached a level of BRL 6 billion in 2023, a growth of 35% compared to 2022. Looking just at the fourth quarter of 2023, gross revenue reached BRL 1.6 billion, 18.7% above the same period in 2022.
This growth being completely organic. It's important to mention that 75% of this organic growth in gross revenue came from the increase in the number of procedures, which makes it clear, once again, a series of competitive advantages that we continue to mention for all of you. First of all, we operated in a very robust growth in the number of patients. In second place, Oncoclínicas has gone forward gaining market share in 2023. By our estimates, we closed the year of 2023 with a market share of approximately 8%, and this happened mainly from the increase in volume of procedures realized. In third lugar, we continue offering a medical practice and a sustainable assistance we no longer need. In the majority of cases, we have no variable in the average ticket to grow our top line, having become a reference in cost-effectiveness.
The EBITDA, including the non-cash effect of the PILP, was almost BRL 1.1 billion in 2023, 63% above 2022. The EBITDA margin without the PILP was 19.6% for the year, well above the 16.1% registered in 2022, principally due to the gains in efficiency and expenses that we continue to deliver. A proof of that is the evolution of the indicator that measures our operational expenses, cash expenses as a percentage of net revenue. We went from 19.4% in 2022 to 15.8% in 2023. Another big highlight of the year was the net profit of the company. We reached on a big ex-PILP BRL 359 million in 2023, a growth of nearly three times compared to the BRL 125 million of 2022. The growth of the company, the expansion of our operating margins, and the addressing of the tax inefficiencies are the principal factors behind this growth.
Oncoclínicas went forward in delivering an important combination of growth with an increase in profitability. All of this without ever giving in to lowering our quality of care. The strategic agenda of the company brought in a series of important realizations in 2023. Among them, the beginning of the operation together with Porto Seguro Saúde of the strategic partnership with the Grupo Santa Lúcia in Brasília, which permitted our quick entry into the hospital segment in that region. Our partners have perceived more and more the value added in the integral solution of oncological care with quality care and cost-effectiveness. Beyond that, with the subsequent events to the fourth quarter of 2023, and those which happened before the publishing of our results, I would like to mention two important realizations.
First, the announcement by the company and the approval by the CADE of our strategic partnership of 30 years with Unimed Salto/Itu. Unimed Salto/Itu does the management of more than 80,000 beneficiaries in its own portfolio in exchange with the Unimed system, one of the most important regions in the state of São Paulo, where Oncoclínicas now establishes a presence. In the second place, we want to point out the beginning of our operation of our cancer center, of the construction of our cancer center in Goiânia, which should be ready in 2026 and will count with approximately 400 beds for high-quality care of patients in Goiás and the region.
I would like to, before passing this along, I'd like to once again congratulate the entire Oncoclínicas team, who have delivered strong performance in 2023, and of course, thank all of our thousands of patients that every day trust us with the privilege of caring for their lives in the same way as we care for our own lives. I would now like to pass over to Rodrigo Medeiros, who will give us more details about the operational performance. Rodrigo, please go ahead.
Good morning, everyone. Thank you, Bruno.
Again, moving to the next slide on page four for the highlights in the fourth quarter of 2023, the company grew by 18.7% in gross revenue compared to the same period of the previous year, reaching BRL 1.6 billion, and also shows growth of 35% for the year of 2023 compared to 2022, growth led principally by the volume of treatments, as we'll mention shortly. It's also important to emphasize the strong net profit that the company showed of BRL 87 million in the fourth quarter and BRL 312 million for the year of 2023. A relevant expansion, which evidences the delivery of the principal priorities, which we have pointed out in the last two years.
To continue this trajectory of growth, combining the profitability of the business with greater tax efficiency, the effective rate of the company at the beginning in the fourth quarter was 26.9%, compared with a very inefficient rate in previous years. It is a mark that is very positive and relevant to the company, and I would like to congratulate all those involved in this process of tax efficiency, and we have been able to change the trajectory of the company in that aspect. The last thing I would like to mention on this page, which I would like to mention, it is one of the principal priorities that the company has mentioned in the last two years, which is the reduction of the participation of minority shareholders in the net profit of the company. This participation was more than 100% of the profit, and this quarter went to less than 12% of the total.
Very significant reduction, and which generates value for the stockholders. Going to the next slide, page five, I would like to point out the increase of 13.1% in the total number of procedures, reaching 164,000 procedures in the fourth quarter of 2023. For the year of 2023, there was an increase of 27% in the number of procedures and 7% in the average ticket, principally associated with the increase in the complexity and the capacity of the company to repass the costs of inflation. I would like to mention that our growth is very balanced, coming predominantly from the increase in the number of procedures. I would like to pass it over to Cristiano Camargo, our CFO, Director of Strategy and Investor Relations, who will present the details about the results from the quarter. Thank you, all.
Thank you, Rodrigo.
On slide six, we would like to point out on the graph on the left, the growth of approximately 19% in gross revenue in the fourth quarter 2023 when compared to the same period of the previous year, reaching the level of BRL 1.6 billion. This rate of growth is organic. In the graph on the right, in the annual comparison, we see an expansion of 35.1% in gross revenue. In this case, impacted not just by organic growth, but also by the acquisitions, which in 2023 contributed since the beginning of the year. We like to highlight the CAGR of growth of the revenue in the last five years, which was approximately 34% CAGR of growth for the last five years in revenue.
Slide seven shows the growth of net revenue, which was slightly below that shown by gross revenue due to the impact a little bit higher in 2023 when compared to 2022 on the lenient of PCLD, provisions for nonpayment and losses with credits of doubtful recovery. Even so, we see a robust growth in our top line, both organically as well as in total bases. On slide number eight, we show a provisioning of 3.3% of gross revenue for PCLD in the fourth quarter of 2023. This is compared with the 3.6% in the previous quarter, and a slight improvement sequentially, even though it is still above the 3% observed in the fourth quarter of 2022. Both indicators, be they the 3.6% in the third quarter or the 3.3% of the fourth quarter, diverge from our historic average, which is 2.2%.
We continue to observe a scenario of pressure on these health plans and operators with rates of claims still quite high above the historical average, which translates into a management more restrictive in the cash flow on the part of our clients, impacting, again, our indicators of nonpayment and average period of repayment. Since we operate with a conservative policy for provisioning, it is natural that we see this indicator of PCLD higher in this phase of the cycle. But we continue to see this period as transitory, and we also have managed actively our cycle of revenue to minimize these impacts. See the reduction of 30 basis points, which we were able to have in a sequential base in the PCLD on a sequential base. On slide nine, we point out our gross margin, which remained almost as stable in 2023 when compared to 2022 for the whole year.
See the graph on the right. The comparison between the first and second half of the year on the chart on the left are slightly hurt by the PCLD, which was slightly higher in the second half of 2023. If we adjust for this effect and we apply the normalized PCLD of 2%, plus closer to our historical average, the gross margin normalized would have been 36.1% in the second half of 2023, compared to 35.6% in the first half, as you see on the red line on the graph. Passing to the next slide, number 10, we observe that the gains in efficiency in operating expenses was quite expressive.
We were able to deliver a reduction of 2.1 percentage points in relation between operating expenses and cash and net revenue between the fourth quarter of 2022 and the fourth quarter of 2023, with an absolute value of expenses of BRL 240.1 million, including the growth below inflation, accumulated inflation in the last 12 months. Looking at the indicator for the full year, a longer series, since 2019, we also verify a material advance. We closed 2023 with operating expenses representing 15.8% of the net revenue, compared to 19.4% in 2022, a reduction of 3.6 percentage points. On slide 11, we go from the analysis of EBITDA ex-PILP. We reached BRL 1.1 billion in 2023, with a margin of 19.6%, or 3.5 percentage points above that observed in 2022, as we can see in the graph on the right-hand side of the slide.
We have been increasing our margin at an accelerated rate. If we observe the rate in 2019, it was 10.8%, almost 9 percentage points lower than its current rate. The combination of gains of gross margin as we have gained scale with the efficiency and the management of our operational expenses has resulted in this expansion of our EBITDA margin. On the next slide, number 12, we report a net revenue ex-PILP of BRL 99 million, compared to a profit of BRL 85 million in the same quarter of the previous year. Principally, the fruit of the growth of our operations, increase in profitability, operational profitability of the company, and initiatives to unlock value on the bottom line, addressing the tax inefficiencies which historically were offensive to our net profit.
In the comparison of full years on the graph on the right, you see the growth of net revenue is almost three times between 2022 and 2023, going from approximately BRL 125 million to more than BRL 359 million. Looking to a longer series, the company delivered in 2019 a net revenue of approximately BRL 19 million, and today we're at the level of BRL 360 million, almost 19 times more. On slide 13, we touch on another relevant topic connected with the initiatives placed in practice to unlock value for our stockholders, which would be the participation of minority partners in the net consolidated net profit of the company. As we see on the graph, the minority participation in net profit, excluding the PILP, which had been 52.5% in 2021, closed the year of 2023 in 24.7%. This participation was even smaller in the fourth quarter of 2023, 11.7%.
On the next slide, we demonstrate the consistent expansion of our net profit over the last two years in quarterly basis, always looking at the last 12 months ended in each quarter. We observe a clear correlation between the increase in net profit and the increase of operating margins allied with the addressing of the fiscal inefficiencies. In other words, it has been necessary to work on several fronts that the company has been able to execute even in the middle of a challenging scenario for the health sector. On the next slide, number 15, we detail the behavior of the cycle of working capital of the company.
The fourth quarter of 2023 was marked by a sequential worsening in the average period for receivables, which went from 101 days in the third quarter to 106 days in this last quarter as a result of the difficulty that our clients, the health insurance plans, continue to experience in the relations of claims, and consequently, in their cash flows. To try and mitigate this, at least partially, this effect, we have continued working together with our suppliers, seeking commercial conditions that are more favorable, which has been translated into an average period of payment to suppliers of 77 days. An important evolution in relation to the first quarter of 2023, and in line with the second and third quarters. The average period for stock inventory is in line, as observed in the fourth quarter of 2022.
The combination of these factors resulted in an increase in the net days of working capital that has totalized 49 days in the fourth quarter, compared to 34 days in the third quarter. On slide 16, cash flow. As a consequence of this scenario, still adverse and intensive in working capital, we had a cash burn, operational cash burn, during the fourth quarter of 2023 on the order of BRL 41 million. On the other hand, we have paid out in CapEx an amount 49.1% below that which was executed in the previous quarter. Even with the fourth quarter below what we expected in terms of the generation of operating cash, due mainly to a variable on which we have no control, which is the average payment of receivables, the accumulated for the year 2023 has shown a generation of operational cash, recurring operational cash, of BRL 439 million.
It's what shows what we see on slide 17. This resulted in a conversion of 42.8% of EBITDA in 2023. One indicator without precedence in the history of the company, as we see in the following slide. Remembering that this conversion was 18.7% below that of 2022. To increase this conversion is one of our major focuses for 2024. On slide 19, we comment about our net debt and our level of leverage, which increased in the quarter due to the consumption of operating cash which we observed, and the concentration of payments of semiannual interests, which are more concentrated in the second and fourth quarters of each year, and the inclusion of an acquisition to pay for because of the participation of 25% acquired in a joint venture with Unimed Nacional, whose closing occurred in the fourth quarter of 2023.
Due to these factors, the leverage closed at 3.4 x EBITDA. Remembering that this indicator considers approximately BRL 324 million in future payments for possible earn-outs and acquisitions, which are not considered guaranteed. Without the component of the earn-outs, the leverage would be at 3.1 x in the fourth quarter of 2023. On the next slide, finally, we publish our current plan for the amortization of our debts, which is very well distributed. With this, we conclude our presentation of the results of the fourth quarter of 2023, and for the entire year of 2023. We take advantage to open the session of questions and answers. Thank you all.
Thank you to everyone. Ladies and gentlemen, we will now begin the question-and-answer session. To make a question, please type asterisk one. To remove your question from the line, type asterisk two.
Our first question comes from Vinicius Figueiredo from Itaú. Vinicius, please go ahead.
Good morning, everybody. Thank you for taking my question. I wanted to exploit a little bit. We had a quarter which, as you said, was still PCLD very high as we saw. When we look at the balance, we see that you had better coverage. I wanted to understand if looking forward, in a scenario not necessarily better of receivables, that this line of construction will have any relief and this line of PCLD will fall in the beginning of 2024. A second question is in question to the way internally you had a reorganization to bring more efficiency in the tax situation.
I wanted to understand, not just in the cash situation of you, if we can try to unlock value also perhaps in a more accelerated way over 2024, and if we'll be able to see this rate of cash in 2024. Thank you.
Hi, Vinic. This is Chris. Starting with the PCLD, in the third quarter and fourth quarter, we have continued to see a rate of non-payment, as we mentioned earlier in the presentation, higher than has been our historical average, the incidence of non-payments. We understand that this is very much connected to where we are in the cycle in relation to cash management on the part of the health insurance operators. This winds up being reflected in a PCLD, which is higher. Remembering that the PCLD is the sum of provisions for non-payment and provisions for doubtful credits.
This is the aging of our receivables, and we have a policy of non-payment of these losses, which is conservative and is punitive in the first moment because we provision 25% of this non-payment at the moment that it appears on our books. If you can imagine how punitive this is, we recognize right up front 25% of these losses, penalizing our P&L even before we begin the processes of trying to recover these losses. We have seen, in fact, a higher incidence of losses of non-payments. From the technical standpoint, it is totally recoverable because it is more connected to a question of cash management and cash flow management on the part of the health plan operators.
We believe that it is reasonable to expect that in the measure that we see the process of normalization in the healthcare plans, this is also reflected in the cash flow, in the release of cash flow for them, and we should see a tendency, a reversion of these provisions. In relation to the effective rate we had in the year of 2023 as a whole, an effective rate, cash effective rate, of approximately 32%. Looking at our analyses, since we have a stock of goodwill which is relevant to be amortized over the next few years, we are talking about a stock of approximately BRL 1.6 billion in goodwill. This should truly be a point which favors the effective rate of cash looking at 2024 and the following years.
Okay. Very clear. Thank you. Thank you, all.
Our next question comes from Fred Mendes from Bank of America.
Fred, please go ahead.
Good morning, everyone. Thank you all for the call. I have two questions here. The first is a million-dollar question, but just to hear from your point of view, this moment of the relationship with the healthcare plans, if you understand that this is something that is more transitory and we should come back to the pre-COVID levels at some point in time, or if eventually we better get used to this, and that this may be the new normal realistic level that we should get used to this. That is my first question. The second question, a more strategic question from the working capital. We understand that the sector has suffered, but have you been able to work this out with your suppliers, elongating their payment periods and so forth?
This is a specific point, but just to understand for 2024, if you foresee that you will be able to pass through any of this pain to your suppliers as well. Thank you.
Chris, if you allow me to start here. This is Dr. Ferrari.
Go ahead, Bruno.
As far as the suppliers, thank you for the question. Good morning. [Non-English content ] Okay. I think it is a question of a little more time so that things get normalized. We have the impression that starting in the second quarter, things will start to normalize. I am sorry, we have lost his audio again. This has brought to us a series of things to the table, negotiations of new forms of remuneration, a smaller network of suppliers, and together with the holding back of these funds. What I am telling you here is public knowledge.
I think there has been a reorganization of the market which will favor a better relationship with the healthcare plans and a step-by-step that's a bit more fair between the operators and the service providers.
Thank you, Bruno. Fred, just to clarify, to illustrate what Bruno said, this is an opportunity for us. We have, for example, a situation today in which our second-biggest commercial partner represented something like 5% of our revenue two years ago, and today it's close to 10%. Why? Because we're growing and gaining wallet share. The healthcare plans, our growth of volume, we see a growth in volume year-on-year of 13.4% organically. This is all becoming an opportunities in relation to the extension of payment periods with the pharmaceutical supplier. This is a continuous relationship. It's a long-term relationship.
We obviously use this relationship to bring our average payment period to the level that we are currently at, of approximately 80 days. There are oscillations. We've seen 76 days in this quarter, and we've already had periods when it was worse than that, closer to 80 days. So it oscillates and pull a little bit in this margin of error. But as we grow in volume and in purchases, we see this continuing to happen. Obviously, we will always bring to the table all of these elements in a commercial discussion with the suppliers.
Okay. Very good. Very clear. If I could just make one quick follow-up question, please forgive me. This scenario in which you put about the increase from 5- 10, we, at least in our numbers here, we see the average ticket as we look at your passthroughs and other players.
Theoretically, in our head, in our mind, this should be together in 2024, and it would have a relevant increase in this attempt to I don't know if that makes sense for you or the more pressure, or is that not necessarily the case, or is that just the sector?
Yes, it's exactly how we see it, Fred. We've been touching on this for quite a while. The pressure that the sector is suffering and through which we have been passing has forced even more the agents to seek out solutions of cost-effectiveness. Everybody is working on that. In a moment like this, we have seen the conventional relationship of having a healthcare plan using multiple suppliers and fragmenting their oncological care. They're now moving towards a different way.
They're going in a route in which you concentrate all of your volume in one supplier who's specialized, who has scale, and who covers the entire journey without being fragmented and without causing the waste in this journey. That's why I've been gaining market share. We're clearly gaining market share. The numbers show that. In this phase that we find ourselves in the cycle, for us, has been seen as an opportunity, and the fact that we have delivered 75% of our growth through volume and not through expansion of average ticket. We think that that's very beautiful, and we're proud of that because our growth is a sustainable growth, which has been coming due to the gain of market share in the measure that the operation plans have been seen, that we have the more cost-effective and more efficient way to do that.
Thank you. Very clear.
The next question comes from Yan Cesquim of BTG Pactual. Sir Yan, please go ahead.
Good morning, Bruno, Chris, and the other directors. My first question about the margin, I'm sorry, his audio is very low. The question of PCLD and cash margins, 2023 compared to 2022, which is more difficult than an annual comparison, year-on-year comparison. Thinking about in the margin, especially gross margin and a negative variation, I wanted to see if these other components, this margin, which is a little bit more pressured, what do you expect to see going forth? That is my first question. The second question is, we see that you had a partial discount of the losses that were already recognized, and what can we expect in the coming quarters in regarding to the losses? Thank you.
Good morning, Rodrigo speaking here.
I am going to answer the first one, then I will pass over to Cristiano to answer the second question. The fourth quarter, in fact, had a bigger effect on the gross margin, was the holding back of readjustments, price readjustments, the increase in prices from medications, which we did not pass through to our revenue. As we mentioned previously, and Bruno mentioned, this is a dynamic which has been more favorable starting in the second quarter when the plans started to reimburse their users, and we are able to readjust our contracts. As far as the question of the savings, a antecipação de future payments for M&As, what we have done in the fourth quarter, the company captured a new debt in very favorable conditions. Looking at the context of our liability management, we got a CRI of BRL 1 billion.
We are at CDI + 1.3%, which is a cost well below the average cost of debt of the company, and the idea was to do the prepayment of more expensive debt and also more short-term debt because this CRI was also a very favorable capture in terms of periods of time. It has a series of five, seven, and 10 years with a bullet payment at the end. We are working on doing a very structured work on the question of reprofiling the payment periods of the company. We started this two years ago, and it is continuous. We are always going to do that because as the company executes these plans and makes these deliveries, we are going to be able to improve our cost of capital, and this is a project which never ends.
With the liquidity of these sources from the CRI, we looked at our debt in the global context, not just the bank debt, but also debts with the capital markets and debentures, but we also look at our sellers financing, which is debt, and also an opportunity for refinancing. What we have done basically was that we launched, in practice, a buyback of our debt, of seller financing debt, offering for those who would like to adhere the anticipation of future payments of the sellers financing to several people that hold this debt. However, at a discount rate very attractive to the company.
We did not simply apply the regular discount, our average cost of debt, but we put a discount rate that was quite a bit higher than our cost of capital, which made it a transaction which gave a financial benefit to the company and which was an arbitrage of value, which brought value to our stockholders. In our mind, it's a question of looking at the creation of value for our stockholders in all angles. It's the operational question, strategic question, and also the financial question. Where we see the opportunity for the creation of value, we are going to operate.
There was an expressive adhesion to this buyback of sellers debt, which we launched, which was almost BRL 400 million of debt which we repurchased and has generated an expressive financial gain of approximately BRL 50 million and also impacted favorably the bottom line of results in the fourth quarter. So, this was clearly an initiative which, the creation of value, bringing a financial gain to the company by using this form of liability management.
Thank you, Chris. Thank you, everybody.
Our next question comes from Gustavo Miele of Goldman Sachs. Gustavo, please go ahead.
Good morning, Bruno, Chris. Thank you, Rodrigo. Thank you for the presentation. I had two quick questions. The first one is trying to project a little bit the first quarter of 2024 payments that are contracted for partnerships, which you have been doing.
In the release, you said that the partnership with Unimed Recife, you have a payment of something close to BRL 160 million. We look at the financial bit, you put a calendar of amortization of M&As to pay, and in 2024, you have BRL 160 million in payments. I wanted to understand, within this M&A portion, if there's any concentration in the first quarter, or if this is something more concentrated in the second quarter, so that we can touch on these M&As. A second question, also to understand a little bit the dynamic of the G&A quarter- by- quarter. We see for three quarters, there's been an increase in nominal increase. If this has any one-off effect, or if you can give us a little more color on that regarding your G&A expenses.
Miele, as far as the question of the M&As to be paid for 2024, and in the first quarter. What we had in the first quarter, which has already been paid, we had the parcel relative to the transaction with Unimed Recife, which was an amount of BRL 168 million. The rest comes in as M&As to pay. But this is a schedule which follows over the next five years and is subject to milestones. So, it goes into this category of the future possible earn-outs. The rest, taking away Unimed Recife, what we have in the way of M&As payable for 2024 is more concentrated in the second half of the year.
Rodrigo, just to answer the question about G&A, in truth, it was a combination of factors in the absolute value and also percentage of cash OpEx above revenue in the fourth quarter we contributed, so it was a little bit of a point outside the curve. Several projects, especially related to the idealization of new lines of organic growth, the acceleration of organic gains and efficiency. A good part is already giving fruit during this quarter and going forward. This is in effect also a little bit in the dynamic of gross margin, which you commented previously, and also an effect of different seasonality between December and the end of the year. We had a little bit more in the way of procedures for January.
This combination, both in the absolute value of G&A as well as this percentage of G&A versus revenue that we see the normalization going forward, and the fourth quarter was a point outside of the curve.
Okay, that's very clear. Thank you, Rodrigo.
The next question comes from Rafael Barros of XP. Please go ahead.
Good morning, everybody. Thank you for taking my question. I wanted to understand a little bit better how the partnerships done with the If they've been delivering what you expected is the first part of the question. The second part of the question is if you see space to do new partnerships in relevant sizes with providers, average, medium, and large providers. Thank you.
Hi, Rafael.
Yes, they have performed within the expectations as budgeted, and we, again, since the moment is that the healthcare plans have been living through has forced everyone to look at their cost effectiveness and management which is not fragmented of oncological care, the answer is yes. We have seen more opportunities for partnerships in the molds of that which we already have because, in fact, the track record of those which are already in operation shows clearly that the solution for oncological solution that Oncoclínicas has delivered with its cost effectiveness, represents for oncology with the result of the people have worked this for a while, has seen a competitive advantage by using this plan. Those who have worked with us have seen these opportunities. These opportunities will continue. Going forward, we see further advantage.
Okay. Thank you. Just to add here, this may be the most relevant point, perhaps.
It's a win-win. A true win-win situation. It's good for Oncoclínicas in all of the aspects, and it's good for anybody who's on the other side, such as the pharmaceuticals, due to the cost effectiveness. We've seen this, we've heard this from several partnerships, which are with public companies who have also published these results. So, it'd be that this is a tendency, and yes, there is space for us to continue to develop this in a way that is more dynamic.
Thank you, Chris. Thank you, Bruno.
Our next question comes from Leandro from Citibank. Please go ahead.
Two questions. The first is the ticket as you the performance during the year. I'm sorry, the audio is very poor. If you can speak a little bit about what you see in the way of benefits with the current negotiations with the operators, the healthcare operators, healthcare plans.
And the second question is, you announced a few months ago that Unimed-Rio, what is the contribution of this purchase and the effects of this in terms of working capital, how has this been working out?
Chris, let me start.
Go ahead, Bruno.
Okay, Leandro, I think that when we look within the company, and we think that we have had several interactions with you and the market as a whole, the performance was within that which we expected. In fact, within what we promised to our board. So, if we would analyze all of the points which were critical and which we placed, they were delivered and delivered in a short period of time. When we look at the window and look at the macro-opportunities , obviously, we are a little bit attentive because there are factors that we are not able to control.
For example, the performance of those who pay us for these services. So, this generates a point of attention and a series of improvements and opportunities for us to improve our interactions with the payers. The moment is much better now because we are at the table constantly, even with these seeking to bring new opportunities. But I think that from the standpoint of the fundamentals of the company, as Chris mentioned, the fundamental point, it is a company that is much better than when we started the year in every aspect: operationally, quality, and financial. Chris, would you like to add to that? Rodrigo, also, if you have anything to add.
Thank you, Bruno. Yes, Leandro, specifically in the question of average ticket, our ticket grew over the year-on-year. Between 2023 - 2022, grew by 7%, our ticket.
And we grew in the fourth quarter of 2023 compared to the fourth quarter of 2022, 5.8%. So, it is a growth that is very much in line with inflation, with the headline inflation, the IPCA. And our history is a history of growing inflation + 100 or 150 basis points. So if it is a little bit below what is our historical CAGR, but due to a dynamic, a sectorial dynamic, and all that we are seeing the sector go through right now, and the amounts of claims that have been filed with the healthcare plans, et cetera.
But nonetheless, we see as very positive the fact that our growth does not depend principally on ticket. We grew during the year looking organically at the fourth quarter of 2023 versus 2022. 13% of this was volume, and the rest was ticket. And that is because our model does not depend on average ticket.
I would be sad to say that the ticket grew by less in the double digits in the last year, since the sector it is passing through is not this type of partner that the healthcare plans are looking for. So, we see things in the opposite way. Yes, our growth did not depend on tickets, but yes on volume. And from the standpoint of receivables, which is the other point, we see the dynamic of, in line with what Bruno said, it is a situation which is transitory, and we have seen these things happen over the last quarters, and at some point, in time, it should be a catch-up. Historically, it has always been like that in the previous cycles. So, in our vision, it should not happened, an accentuated improvement probably will not happen before the second quarter because that is when the healthcare plans have their readjustments.
And once they start to have a relief in their number of claims, we will start to see this number of claims normalizing and our cash flow and our payments should normalize as well. Our income should normalize as well.
Okay. Thank you for taking my call.
The next question comes from Caio Moscardini from Santander. Please go ahead.
Hi, everybody. I wanted to take with you the cancer centers, how they've performed, your cancer centers, how's the ramp-up going and these things? If you could give me a little bit more information about the expansion plans as you have mentioned, if these are in line with the expectation and delivery, and a little bit about the receivables. If your receivables have been pressured.
You know, historically, hospitals have received, and clinics as well. I'm sorry, his audio is also very poor.
But I'm going to start here with the cancer centers, and please feel free to add anything. Both those that are in operation, which are performing in line with our budgets, as well as those which are in development, are also following the chronograms which have been announced. We continue with the expectation of deliveries on the dates as published to the market. Some that are built to suit our CapEx will be more at the end of this investment cycle, much closer to the openings of those. Receivables, we have seen a dynamic so far which is very similar to what we saw in the fourth quarter.
It's a scenario of stability, at least the photo up until February, where we have a clearer picture, a scenario which is very similar to the number of days, and again, in line with what we have been saying for some time now. In the next cycle of readjustments, we don't expect that much of an improvement in this point going forward.
Thank you. Thank you very much.
Next question comes from Stella from JP Morgan. Please go ahead.
Good morning. Thank you for taking my question. Again, the audio is very poor. In the company in recent years. Is there any effect over the year? Also, another question, if you can give us an update on your partnership with the clinics.
Hello, this is Rodrigo. Start with your. Then please feel free to join us.
The acquisitions as such, we are still looking at what's expected in the business case of each deal in terms of synergies, but there's also the continuity of the operational point of view. We continue to see a dynamic of costs growing below revenue, below gains. We have a more and more scalable and standardized model, and as was mentioned here, there's a series of initiatives which are under development with more technology and bringing more efficiency, but which will not be anything that is in this level. It'll be a gradual process. We still have this opportunity to continue seeking new opportunities of efficiency. As far as with Porto, our partnership with Porto has been performing even a little bit better than what we had originally foreseen, had shared in our business plan with the approval of that internally. So we're very satisfied with that partnership.
We also have opened two new units to attend them, and so it is ramping up at a very good speed, Stella.
Thank you all very much.
Thank you. At this point, we close the session of questions and answers and would like to pass the microphone to Cristiano Camargo for his final consideration. Cristiano, please go ahead.
Okay. Thank you all very much for your participation in the call. We thank you for your questions and continue at your service. For any doubts or questions, you might have, we are available at your service. A hug and a good day to all.
Thank you. The audio conference of Oncoclínicas is now closed. We thank you all very much, and have a good day, and thank you for using Voxconf.