Good morning, everyone. Welcome to the earnings call of the third quarter of 2023 of Rede D'Or. We have here Mr. Paulo Moll, President, Otávio Lazcano, VP of Finance and IR, Investor Relations, Raquel Reis, CEO of Health and Dentistry of SulAmérica. The event will last for one hour, and the recording will be available at the IR website of the company. Our presentation. After the initial presentation, we're gonna have the Q&A. Before we continue, we would like to clarify that any statements that might be done during the earnings call regarding the business perspective of Rede D'Or, projections, operational goals and financial goals, are based on premises and beliefs of the board of directors, based on information that is currently available. Forward-looking statements are not guarantees of performance, involve risks and uncertainties. They are related to events and circumstances that might or might not take place.
Investors should understand that economic and industry conditions and other operational factors might affect the future performance of the company and might lead to results that are different from the forward-looking statements. Now, I would like to give the floor to Mr. Paulo Moll. He will start the earnings call. Mr. Moll, the floor is yours.
Thank you. Have a nice day. I'm gonna start with the operational highlights of the third quarter of 2023 in a consolidated way, Rede D'Or and SulAmérica. If we can compare with the second quarter and the first quarter of 2023, we don't have the consolidated reference for 2022, and the gross revenue, we have the BRL 12.9 billion, 3.6 growth, according in comparison to the previous quarter. The EBITDA consolidated BRL 1.9 billion.
It's a growth of 18.4% against the second quarter of 2023, and a growth of 42% against the first quarter of 2023, reaching a net income of BRL 760 million, 74.6% above the second quarter of 2023, 150% above the first quarter of 2023. To remind you, the adjusted net income, so excluding the amortization of the portfolio of SulAmérica, because of the acquisition, we will reach the, we would reach the number of BRL 811 million, which would be a greater growth. Now, the standalone, we have the BRL 7.4 billion . This is a growth of 8.3% against the third quarter of 2022.
We're talking about the average ticket of a growth of 7.4% based on the third quarter of 2022, so it's very healthy. The occupancy of 80.1%, record number of surgeries, 132,000, a growth of almost 5% in regards to the third quarter of 2022, and the operational beds, 9,950, which is 9,600, which is, less, 46 beds, less than the second quarter of 2023. So we would like to clarify that the company prioritized profitability. We discontinued a series of contracts with operators that had difficulty receiving the pricing or readjustments, annual readjustments. Operators with a lower average ticket than the ticket of the company and with a greater risk, associated risk. The company understand that we would be conservative, and we would discontinue these contracts.
Obviously, part of these patients migrate to other operators or other products that have access to our hospitals. Only three that we discontinued the contract over the last few quarters. We're talking about about 300 beds that these products, these operators, used to occupy in our hospitals, and we managed to get a growth in the other operators, the other products. We replenished almost the totality of the 300 beds that were occupied by the discontinued products. Now, moving on. Let's talk about the materials and total gross revenues of hospital services. So there is the comparison with the order of 2022. We can see that as we signal to you before. Our goal was to reach the goals of 2019, and we're very close to our best quarters in the company.
Let's talk about the EBITDA of Rede D'Or standalone. So we're talking about BRL 1.8 billion. That is 22% above the third quarter of 2022, 13.5% above the second quarter of 2023. We have a series of effects that are non-recurrent in our results, negative and positive effects. We have BRL 330 million positive because of a reduction of other provision and a victory that we had in the PIS and COFINS tax, and two adjustments, non-recurrent, in terms of PDD delinquencies that we wanted to protect some discontinued contracts with the operators. Doesn't mean that we're not going to not seek these receivables. We have the expectations of receiving them, but we are we are going to be conservative, and we're going to do the provision.
With that, we have a net effect of the non-recurrent effects of BRL 151 million positive. So adjusting with the recurring EBITDA, we would have the BRL 1.69 billion Adjusted EBITDA, which would be a growth in regards to the third quarter of 2022. The margin of EBITDA, which was 22.3%, if adjusted by the non-recurrent events, it goes to 25.8%, with a growth of 0.9% in regards to the third quarter of 2022, and with a growth of 0.05 in regards to the second quarter of 2023. Now, let's talk about SulAmérica. We have the net revenue of BRL 6.9 billion, growth of 4.7% in regards to the second quarter.
The user base, 5 million of beneficiaries, 2.9 in health, the other in dentistry. Comparison year-on-year, we have a growth of 2.3%. In the comparison quarter-on-quarter, we have a reduction that stems from a big contract that the company decided to discontinue, a contract that had a lot of deficit associated. Now, looking at the debt profile, we have 86.1% in the third quarter, the consolidated loss ratio, if we compare it to the 87.3% in the third quarter of 2022. So there is an improvement in 1.2 percentage points. And also quarter-on-quarter, we have a reduction in the consolidated loss ratio if you compare it to the third and the same quarter, 23.2%.
So still, even though we're talking about quarters that have a worse seasonality, second and third, we show an evolution that we are still at a level that we consider high, but with great expectations to continue to evolve down the future. I would also like to highlight that SulAmérica, there has been a great work, and we have the administrative synergies. We are going to show you the numbers. I would like to highlight that in the third quarter, we deliver a level of administrative expense of 4.4% of the revenue. That number, it was in 2022, was above 7%. So there is an important gain of efficiency, as we pointed out, that we would seek, and it is a very efficient number, and we will continue to work with it. Let's talk about the expansion projects.
We have a few projects that are very advanced. Brownfields, such as the new tower of Vila Nova Star. We have the expansion as well of Aliança Hospital, the expansion of Memorial Hospital. Brownfields, that we have a high conviction of occupancy, Vila Nova and Aliança and Memorial, already have occupancy levels in its current beds, very high occupancy levels. In the case of Aliança Hospital, in addition to the high occupancy that we have in the hospital, we covered over 35,000 lives of SulAmérica, lives of products that are above in the Salvador geography, that didn't have access, previous access to Aliança Hospital. So it increases our conviction of our very quick ramp-up of the brownfields. So let's talk about the greenfields as well. They are relatively advanced.
We have Macaé Hospital, Macaé D'Or, in a region that is under service for reference hospitals. We have a great optimism. Also, Alphaville, Guarulhos, in the state of São Paulo. These are regions that have good coverage and good, well, with an income that is compatible with the presence of a São Luiz and lack of quality hospital beds. So we're gonna work with these projects, and also we have a great optimism that we're gonna have a ramp-up that is similar to Campinas. In the city of São Paulo, we launched it in the end of May, and we should get the break-even in the sixth month of operations. This increases our conviction of the other greenfields that were selected in regions that really lacked a lot of beds. I'm going to give the floor to Otávio. I will be here available for the Q&A.
Thank you, Paulo. Once again, good morning, everyone. I'm going to work on what Paulo said. So patient day and surgical volume. We can see on your left, on your graph on the left, we have the occupancy rate of 80.1% in the third quarter of 2023, an increase of 0.5 percentage point if you compare it to the same period in the previous year. The company also reported 707,000 patient stay. This is a decrease of 2.4% in the comparison quarter-on-quarter, a growth of almost 1% if you have year-on-year comparison. On the graph on the right, the company reported 132,000 surgeries total, a growth of 4.9...
Well, growth since the second quarter, and a growth of 4.9% if you compare it year-on-year. The company also reported 96,000 large surgeries, so there's a growth of over 8% and a growth of over 4% year-on-year. 8% was quarter-on-quarter. So hospital beds evolution. On the left, you can see the reported 9,600 operational beds. A stability in comparison quarter-on-quarter and year-on-year. Paulo already discussed this, the decision of the company to reduce its exposure to paying parties where we have an average ticket that is lower, and therefore, the credit risk would be higher, and its impacts in the follow-up of the total number of beds is there.
On the right, we have reported 11,512 total beds for the third quarter 2023. Stability quarter-on-quarter, growth of 450 beds in the comparison year-on-year. We include here the 325 beds of São Luiz Campinas, open doors in mid-May of this year, as well as the brownfield of São Rafael, and other small brownfields bed are in addition. Page seven, gross revenue and average ticket. We have the hospital services. At the left, we reported a total gross revenue for that segment of BRL 7.3 billion in the third quarter of 2023, a growth of 2.5%. In the comparison quarter-on-quarter, a growth of 8.3% in the comparison year-on-year.
In the same way, the total gross revenue of BRL 21.4 billion for the first nine months of 2023, a growth of almost 11% if you compare it year-on-year. At the right, we have the total average ticket consolidated of BRL 10,425 in the third quarter of 2023, a growth of 5.1%. In the quarter-on-quarter comparison, a growth of 7.4% in the comparison year-on-year. Page eight, gross revenue and average ticket. Now in the oncology segment. On your left, the company reported a gross revenue of BRL 699 million in the third quarter of 2023. We have a growth of 5.1% in comparison quarter-on-quarter, growth of 11.6% comparison year-on-year.
The company also reported a gross revenue in that segment of BRL 2 billion for the first nine months of this year, a growth of almost 18% in the year-over-year comparison. On your right, we have the reported average ticket for that segment, BRL11,739 in the third quarter of 2023, a growth of 4.2% in the quarter-over-quarter comparison, a growth of 12.6% in the year-over-year comparison. Page nine, costs and expenses for the hospital services. As usual, on the left, we will start with the cost with hospital services. The reported costs of BRL 4.949 billion in the third quarter of 2023, a growth of 1.3% in the quarter-over-quarter comparison, a growth of 8.6% in the year-over-year comparison.
As Paulo has previously stated, except the amortization of the event of the portfolios of SulAmérica and the exclusivity contracts, that growth and the annual growth would be 7%, in the same analysis, in the same period. Also, the company reported costs of BRL 14.553 billion for the first nine months for the FY of 2023, a growth of 9.8% if you compare it to the first nine months of 2022. With the same adjustments, the growth would be lower, would be a growth of 8.1%. Once again, lower than the growth of the revenue for that comparison, nine months of this year in comparison to the FY 2022.
If you compare it to the right, the company reported expenses, general administrative expense, - 400 of BRL 275 million. Of BRL -54 million, I'm sorry. Once you disregard the reversal and the provision of the contingencies, it would be, it would be BRL 275 million, a growth of BRL 13 million, facing the second quarter in the same FY 2023. The BRL 13 million can be justified, with a growth of expenses and personnel, and a growth of subcontracted services, which is included the IT, maintenance and so on and so forth. The company reported SG&A of BRL 474 million for the first nine months of this FY.
Once again, if you adjust it by the reverse of the provision for the contingencies of PIS and COFINS , it would be a growth of BRL 110 million facing the first nine months of 2022, which can be justified as a growth of expenses of depreciation of the investments in the area of IT, of BRL 34 million, with an increase of BRL 45 million. Other expenses with personnel here, provisioning for the payment of the profit sharing for the FY of 2023. Once in 2022, the company was away from getting to its goals at that time. Page 10, EBITDA and net revenue. Once again, at your left, company reported an EBITDA, accounting EBITDA, BRL 1,841 million in the third quarter of 2023, a growth of 13.5%.
In the previous quarter comparison, a margin of EBITDA of 28.3%. Paulo highlighted, adjusted by the non-recurring events, this EBITDA accounting would be BRL 1.69 billion. The margin EBITDA would be 25.8%.... The same way, the company reported an EBIT accounted for the first nine months of BRL 4.9 billion, a margin of 25.8%. Once again, once you adjust it for the non-recurring events, it would be BRL 4.771 billion, and a margin EBIT 25%, and still a growth in the EBITDA in the year-on-year comparison of 70%. On your right, the company reported a net revenue, net income of 1.4 billion BRL for the first nine months of 2023.
Once you adjust the accounting effect of the amortization of the value of the portfolios of SulAmérica and exclusively the contracts, it would be having BRL 811 million, BRL 1,673 million for the third quarter and the nine months, respectively. Page eleven, SulAmérica. On your left, the company reported the net revenue in that segment of BRL 6,951 million, a growth of 14.1% in the year-over-year comparison. On your right to the top, consolidated loss ratio of 86.1%, drop of 0.2 percentage points in the quarter-over-quarter comparison, drop of 1.2% in the year-over-year comparison.
Still on your right below, the beneficiaries for health and dental, we have 4.9 million, a small drop when you compare it to the previous quarter, and an increase if you compare it to the third quarter of 2022. Page 12, debt profile. Company reported the cash and cash equivalents, sorry. The total gross debt, BRL 33.4 billion. If we exclude the technical provisions, BRL 17.5 billion for net cash for technical reserves, the leverage with the net debt over the EBITDA LTM, 2.3x, the average deadline, five years for indebtedness. So with the cost of CDI + 0.9%. On the right, we have the schedule for the debt amortization of the company that can be easily faced with the available cash for the company.
There is no big refinance, no rollout of the debt up ahead that couldn't be easily faced with the available cash for the company. Page 13, almost finishing. Always starting on the left. The reconciliation of the managerial cash flow with the company, if you start with the reported EBITDA for the first nine months of BRL 4.8 billion, we have an adjustment positive for the working capital of BRL 518 million. Thereafter, we have the negative adjustment of BRL 429 million for other balance sheet items. Here we have BRL 330 million of the reversion of the provision for the PIS and COFINS tax. There's gonna be an accounting effect immediately for the company. We have a cash effect as we remove the judicial deposits that were done with several causes related to this issue.
We have a negative adjustment of BRL 544 million regarding the leasing and the application of IFRS 16. Once again, on your right, we have the payment of taxes, BRL 390 million. Once again, on your right, we have the investments, 2 billion, 171 million. Here we have BRL 1,960 million for the development of greenfields and brownfields, BRL 212 million, and in other 43 million in M&A expenses. We have an adjustment negative for BRL 695 million regarding the financial activities: treasury, amortizations, payment of JCP, and net financial expenses of the bank of the company. A positive variation in the cash flow of 1 billion, 160 million in the first nine months of 2023.
Last but not least, on your right, we have the average days receivable, and the DIO exclusively for the services of hospital services. We have a stability in the records. So therefore, I finish the presentation of the results. Once again, thank you very much, and I open for Q&A.
We will start the Q&A session for investors and analysts. Should you want to ask any questions, please, raise your hand. If your question has been answered, you can lower your hand. Due to the limitation of the time on this earnings call, we kindly request the analysts to limit themselves to just two questions, so that more people can take part. Please wait while we gather the questions. First question, Mr. Joseph Giordano from JP Morgan. The floor is yours.
Good morning, everyone. Good morning, Paulo and Otávio. Thank you for this opportunity. I wanted to explore two issues on the hospital. The first one, Paulo commented at the opening bit about the ramp up of the hospitals that were recently launched. If you can give us some color and the movement of beds all throughout the last months and the last year. We're talking about capacity, but we do not see an addition of operational capacity per se in the period. So I understand that there was discontinuity in some operations of maternity and Rio, and that brings efficiency to the group.
So if you can give us a bridge so we can understand what was the opening of new beds and rationalization for the portfolio. I understand that you finished a few contracts that end up affecting, temporarily speaking, a bit of the demand. So that's the first question. Second question is along the issue of provisions and, PDD, debtors that are, in doubt. What is the recurrent—I mean, I understand that there's been some agreements, and it's larger on the long term, but what would be, the percentage of the revenue from up ahead, that line of PDD?
Hello, this is Paulo. Let me try and give you more, on the ramp up and the movement of beds. Well, here are the hospitals that we have the biggest impact. We have three operators for the adjustments of registering. They occupied. They ended up occupying in these products, on average, 300 patients, 300, for Rede D'Or. Concentration was in four hospitals, the Hospital São Carlos, Fortaleza, Aracaju, São Lucas, and two of our hospitals from Brasília. So we're talking about, Santa Lúcia and Santa Helena.
These are important volumes, very relevant. So the 300 beds, they were distributed amongst those hospitals that I just mentioned. In the case of Aracaju and São Carlos, I would like to say that about 50% of those beds that had the occupancy, because through those products, we managed to replenish with a migration of the lives, with a natural growth with the other operators. In the case of Brasília, I would like to say that even more, 60%. And we have the expectation that those 50%-40%, all throughout next year, we manage to replenish them. This is the big impact in the reduction of capacity. Of course, we did not reduce our capacity in 350, 150 beds, because we have other effects of opening different beds in different units.
For example, Campinas, you remember that always in the green fields, we have a projection that we think is conservative of opening 80 beds per year. In the case of Campinas, we have over 50 open beds that occupied with almost 70% occupancy, gets us to the break-even that I commented that we are reaching now in the sixth month of operations. So we are launching in the green fields. We have the same mindset and the projections, and we have the capacity and demand. We're getting into markets that are not well-served. So the demand that exists, and it's not serviced locally, so the patients are going to the central area. In the case of Guarulhos and Alphaville, they're going to the city of São Paulo in the conurbation of São Paulo, and seeking service of quality.
Well, around those geographies, there is lower quality, so we are sure that we're gonna do the ramp-up of those units. Even thinking about the size of the challenge, Campinas, in regards to the other units, it has a larger challenge because you have 70% of the lives concentrated in operators that we do not service within the hospital. So that reality is very different once we go to Guarulhos and Alphaville, and Macaé as well. And when we're talking about brownfields, of course, comfort is larger with the demand that we know. The hospital is already operating and with high utilization, and we are more at ease. In the case of the bad debt, it's a one-off, based on the contracts that we do, we do not continue.
We have a horizon that this shouldn't happen in the next quarters. It's not in the plans. We have in the hospitals, acquired hospitals, a variation, and after observing them for a longer period and seeing the recovery of delinquency and the delinquency levels, they should have a provision for the delinquency that is larger. And the impact of that, if I tell you the number, Otávio, correct me if I'm wrong, the impact in the consolidated is 0.3%. So we're talking about removing with our provision of delinquency for, to 5.3%, and this is a recurring effect.
Thank you, Paulo. Next question from Mr. Ricardo Boiati from Safra Bank. The floor is yours.
Good morning, everyone, Paulo, Otávio, and all the participants. I have two questions.
First, if you can complement the issue of expansion, if there are some interesting clues in regards to the expansion, but if you can give us an update of what are the openings expected for the fourth quarter and all throughout 2024, how you're going to implement the expansion of the brownfield, greenfield, how has it been implemented in accordance to your projections? And if that movement for normalization of the delinquency can benefit this expansion for 2024. We see a lot of operator healthcare plans to correct this. Can this help you with the equalization in the... And maybe there is an acceleration in the expansion. And the second point is in regards to SulAmérica.
SulAmérica has shown an increase of sequentiality in the delinquency, so there might be an acceleration that is stronger from the fourth quarter of 2024 as the readjustments start to accumulate in the portfolio, and so they can be more relevant and in regards to the evolution of SulAmérica's delinquency, that has evolved a lot.
So I'm going to get part of your question, and then in regards to the expansion, I'm going to give it to Otávio. I'm gonna give it to Otávio, so he can be more specific. In regards to the part of the normalizations of these accidents in the healthcare plans, we have the expectation of an improvement for 2024. We still imagine that 2024 is gonna be a year of replenishing. We see the market worried about getting a profitability and rebalancing.
So we imagine that this is going to have an improvement in the claims in 2024, I apologize. And this is gonna be a more balanced scenario when you have more balance in between the healthcare operators. In the case of SulAmérica, we have shown an evolution. Still, we have a high standard, but we have the expectation of continuing with an improvement, progressive improvement in the claims. There's still a lot of work to do, but the great perspectives, we expect them to be aligned with what we discussed over the last earnings call, progressive improvements in the claims. Once you observe the seasonality between the quarters, there are some quarters that are more under pressure than others, but we expect to improve quarter-on-quarter, observing the seasonality.
I'm gonna give it to the floor to Otávio, in regards to the more specific dates of our launches.
Paulo commented that the investments are substantially aligned with the temporal align plan for them. So the answer here, so we don't go over project and project, we have the reference form of the company, and we present from page 209 onwards, project per project, the number of beds, the budget, the geographic placement, the difference between brownfields and greenfields. This is the best information of the company at the time, what is in the reference guidelines.
Thank you very much. Next question is from Samuel Alves, from BTG Pactual. The floor is yours.
Good morning, Paulo, Otávio, Raquel, everyone. Two questions on my side. First, regarding a subject about that Paulo talked about, the claims in SulAmérica in the previous call, in the second quarter, the company mentioned that they really believe in a normalization of 18-44 months and maybe before. Question is: Is that affirmation still true, or there is any new variable than we, that might change that?
Second question, about the synergies with SulAmérica, a company showing once again the amount of synergies that is a big volume of over BRL 600 million of synergies already captured. But looking at the DRE of SulAmérica, we see that the general administrative expenses even went up quarter on quarter in the third quarter. Question, is that due to the non-recurrent that initial synergy, or should we see these synergies, these capture of synergies, flowing for the administrative expenses that are lower in the P&L of SulAmérica? That's it.
Samuel, I'm going to answer the part of SulAmérica, along with Raquel. The best way for you to follow those synergies is for you to see that we are delivering the administrative expenses in regards to premiums. We're talking about a reduction of 7.4% to 4.4% now in the third quarter of 2023. As we pointed out, great deal of the BRL 600 million, there are things that are impacting the claims volume. We are talking about the negotiation of medications, materials, Mat/Med, the procurement that we gather with the regulator, to gather the benefits. But a great deal of the BRL 600 million is in the administrative, and you see that dilution, which is very relevant. Maybe there are some contingency effects. When you see the aggregate, you cannot do the follow-up of those reductions.
But if you observe it in an isolated way, the administrative, we are at a more efficient and non-exhaustive threshold. We are still gonna capture a few things. There is an execution. One of the example is the building that we are going to migrate to a rent that is lower in an area that is less than the area that we occupy. Now, and it's gonna be within the BRL 600 million that is mapped as an execution, but is not in the numbers of the third quarter. It will be in from 2024 onwards. I'm gonna give Raquel the floor to complement your questions about our vision of improving progressive improvement of the claims volume. Reinforcing that our vision is still intact, we are positive still at a high threshold about the future and the improvements quarter-over-quarter. Raquel?
Hi. Hi, Samuel. Thank you for the question. In regards to the claims volume, as Paulo has stated, we expect to continue with this gradual trajectory of improving in the claims over the next quarters. We know that historically, the first quarter ends up having a lower seasonality, but with the pandemic, we still did not feel a normalized fourth quarter, so we need to see what's up ahead. We continue to believe. I would like to say that over the next 18 months, we should have a threshold that is more stabilized or closer to what we knew in the pre-pandemic scenario. This is due to several levers. There is readjustment, there is sales, there is the management of the claim itself, and creativity in the budgeting of products.
For example, now, if you remember, two calls back, we commented on the launch of the new portfolio for the retail, that have a more intelligent reimbursement, and we zeroed the reimbursement for the base of the pyramid, and we have a reimbursement that is more adequate for the top of the pyramid. So this sell, over the last two months, was integrally of these new products, and we didn't have any loss of volume. So this is a great news because it plants harvests that are more, that are healthier, that should have a lower claims volume. For the next year, we still expect levels of readjustments that are above the thresholds that we used to see due to this adjustment post-pandemic, and the explanation is. Well, it was...
The operation is still affected, but it's still moving along the lines that what we commented in the previous talks. Thank you.
Thank you, Raquel and Paulo.
Thank you, Samuel. Next question is from Mr. Gustavo Ortiz, Bank of America. The floor is yours.
Good morning. Thank you for the opportunity. Two questions. First, I want you to talk about the SulAmérica. There was an increment of BRL 1 billion in the third quarter. It's above what what happened in the first semesters of BRL 1.6 million. Is there maybe the PEONA, that's what really withhold the claims in SulAmérica? And the second question is oncology. Oncology, it has a volume that is very flat in the first quarter, and the third, if you compare it year-on-year, there was a drop.
Is there anything specific, the increase in competitiveness, that makes that volume more stable? Those are the questions.
Thanks. I'm gonna get the first one. From oncology, we didn't have a growth of volume due to the discontinuity of products, specific products, that we used to service in one of our regional geographies. So we would have a growth, but we discontinued services. It's a very similar analysis to what I provided to the hospitals. In regards to PEONA, I'm gonna give the floor to Raquel. Thank you.
Thank you for the question. As I always prefer to talk about PNB, which reflects the provisions, general provisions that we consider PEONA and PSL and everything that was discussed. There is no change in methodology we still practiced over the last few years.
I think that we should say that there is a degree of conservative, being more conservative, because of all the scenario of uncertainties, and the post-pandemic moment. But the constitution of, of these clients, PEONA and PSL, are due to the seasonality that we are observing in the quarters and the books. Of course, if we need to adjust it up or down over the next few months, it should happen. But we, for now, are seeing this constitution that is very adherent to our day-to-day operations.
Thank you.
Next question, Mr. Gustavo Miele from Goldman Sachs.
Good morning, Paulo, Otávio, Raquel. Thank you for the presentation. I wanted to ask two questions as well. More, the first one, related to the hospital operations ticket. There was quarter-on-quarter variation, 5%, a threshold that is close to the third quarter of last year, with an inflation of this year and a threshold that is lower. I wanted to hear from you, if you can help us see the performance of this ticket and the technical level with the readjustments that you implemented in the third quarter.
I wanted to I followed a concentration, a reasonable concentration of adjustments in the quarter of this year, and an increment in the mix, as Paulo has commented at the beginning, about the increase in the volume of surgeries. I wanted to know if there is a relevant impact in the performance of the ticket in this quarter. Second question, I wanted to restart the discussion of the claims of SulAmérica, focusing on the claim itself.
If you look at the ANS data, you see the percentage of the reimbursement for the claim. Total claim of SulAmérica was about 10%. In 2023, we have a threshold close to 12%. So I wanted to understand, what is the space that you see to maybe, with the rationalization of reimbursement, you have a diligent fight against fraud. So it would be factual for us to think about reimbursement with the percentage of the claim that is going back to the threshold pre-pandemic, close to 10% or maybe something larger, so we can try to map what can be mitigated in terms of costs. Those are the two questions.
About the hospital ticket. Of course, when we increase the number of total surgeries and big complex surgeries in a company, we have a positive impact in the ticket. As time goes by, we have a cumulative effect of all the readjustments, of all the healthcare plans, all the paying parties that were done within the fiscal FY, that are appearing in each of the quarters. You are correct. In fact, we have a concentration with readjustments, with the paying parties that are relevant in the context of invoicing as a company that happened in the third quarter. That sum of factors results in a growth of 5.1% and a variation of the average ticket year, quarter-on-quarter. In regards to the claim and reimbursement, here there is no silver bullet. Here is a series of actions, and we are very diligent.
As you highlighted, we have a big team that is anti-fraud team, and we have protocol, several judiciary issues. So we cut the intermediaries that were benefiting, and this continues to be accelerated. In regards to the percentage that you mentioned, over the last few months that are outside of the period that we discussed, we still see a curve of trends in reducing the representativeness of reimbursement. There was a month that we already got to the 10%, but it's not good that we have a goal. So let's just say that this operation will be healthy when it's at 10 or 11. No, it's not that, because that depends on your portfolio mix. Once you have products, it's not reasonable that the percentage of reimbursement is above 1%.
So five years ago, we had the basic lines. The reimbursement would represent half of the claim. When we talk about products with an average ticket that is higher, a hospital network that is broader, of course, that would mean more. So, products that run with a good claims, and there is a participation and reimbursement in the even 40%. So we have to see the mix of products to try and understand if the representativeness of the reimbursement is at a better or not. But being very objective, in over the last few months, we are seeing a continuous drop of that representativeness of the reimbursement because of all the legal actions that we implemented. What's always. What's also going to accelerate this is the harvest that is being planted for sales. So all those products that-...
I sell monthly 15,000 lives that get in of the retail that come with a modular reimbursement. So that means that the basic plans, they have a reimbursement only for emergency appointments. So there is no reimbursement for exams. That was a big offender. There is no reimbursement for therapy, which was another offender. A well-dimensioned reimbursement network for the basic is not necessary.
Clear. Thank you. Otávio, Raquel. Next question is from Mr. Vinicius Figueiredo, Itaú BBA. The floor is yours.
Good morning, everyone. I wanted to start talking about SulAmérica. Regardless of the fact that we've seen in this quarter, the average ticket expanding a lot in the quarter-over-quarter, I think it was 7% or 8%. We've also seen a strong increase in the claims for the beneficiary that grew 6% quarter-on-quarter. So I wanted to understand, what would you attribute that increase, the increase in complexity, surgeries that we've seen in the hospital side and Rede D'Or? Was it something that you've observed in the network of accredited in SulAmérica?
Is there still a lot of negotiation with SulAmérica and the registered network that might mitigate the cost that is growing so high over the next quarters? And my second theme here would be, given that we are seeing the medical materials and the improvement on the quarters, and we've seen the delinquency that you commented that would be larger with a recurrent, the supplementary parties related to the complexity, maybe. But the expectation of you closing the gap of a bit, accounting and adjusted in one or two years still makes sense?
Thank you. Hi, Vinicius. Raquel, I'm gonna get the first question. We always try to see that ticket, well, if the premium is going higher than the, than the claim, that would be the ideal. So what would be, how can we attribute the numbers that you gave us? The seasonality, of course, we know that the third quarter is very complex in terms of, frequency. It's also affected by the payments in regards to the, well, you know, the admittance due to the flus and, and the mosquito-borne diseases. And there is the seasonality of also in oncology. We live a moment of, incorporation of new medications that were medications that...
I mean, when would you hear about a drug of BRL 8 million for one application? So, you know, the incorporation of gene therapy, let's just say, that increases the average, the average claims, it increases. So seasonality, there is still several lines of renegotiation happening, several partners sitting down with us. What we are always seeking is an alignment of interest. So it has to be good, it has to be sustainable for all the parts of the chain, even for the service provider. So that's strong with all the claims team.
Vinicius, these are two different things. The dilution of the relevance of the category, hospital and medications, all throughout time, is our, as we is this means more efficiency and with the exercise, with the lever of operations that are very strong, which is our relevance within our healthcare sector, in regards to the providers of medication and MedMed. I would like to highlight that a 19.4%, reported in the third quarter of 2018 9%. When we adjusted the mix between hospital services and the oncology business, it already gets us in the hospital business, in a position that is even lower than the one that prevailed at the pandemic. That's one thing. The increase in provisioning for delinquency to 5.3%, the impact in this quarter of BRL 85 million and the full period of nine months within this FY.
This reflects on our decision to protect more the operational results and accounting results in a transitional moment that we still have a lot of the claims dispute of working capital and the paying parties and service providers. So the Adjusted EBITDA that made sense at the worst times of the pandemic, where a lot of items above all, medications, we didn't have coverage in the paying party, so we wouldn't even have the right to invoice and receive that. So it would make sense then that we would have to highlight the Adjusted EBITDA. But as time goes by, and as the pandemic is left behind, those differences between the accounting EBITDA and adjusted data tend to be very small in the future, and they should be just limited to VRSO and long-term mechanisms that are similar and M&A expenses.
So the differences tend to decrease as time goes by.
Thank you. Otávio.
Our next question is from Mr. Leandro Bastos from Citibank. Mr. Leandro, your microphone is on.
Good morning, everyone. Thank you. Two quick questions. The first about SulAmérica depending, well, still working with the comment of Raquel, oxygenation of harvest and modularity adjustments. Can you give us the difference of the claims between the products and the legacy? I mean, what can help with the claims in the future? Second, is a specific question on the financial result of the quarter. The company had a positive result. Usually, that line is negative or close to neutral. So I just wanted to understand if there was anything atypical in the quarter. That's it.
Hi, Leandro. Raquel here. I'm gonna start by answering the issue of the difference in the claims of the new modular product in the portfolio versus the previous one. We still cannot measure. It's still very recent. We are in a period, we still have products that get in. Oh, specifically, retail gets in with the mandatory time period, so these, claims in this, in this product is not gonna be recurrent. But if I saw a basic line running, product, running at 7%-8% of reimbursement, and when I remove the reimbursement, I have to consider that a part of that goes to the cost of network, the other part goes away. So in the limit, we hope for a gap, a difference in the claims between these two products of abo- of about 4%. This is an estimation. I am give...
Well, we have the internal pricing that we still have to observe, and as they're gonna mature over the next few months. For us to have some trust in the numbers, only from 2024, mid-2024 onwards, and then we're gonna have a more mature harvest.
Thank you. How about the financial result?
Nothing extraordinary.
Thank you.
Next question. Mr. Caio Moscardini from Santander. The floor is yours.
Hi, everyone. Thank you for the question. I have two. First, about the registering of new paying parties, specifically in the hospitals, Greenfield hospitals, that you have launched. How has it been? Have they been successful adding new paying parties? And also regarding Bradesco, have you managed to register Bradesco in these hospitals? And the second question is in regards to the working capital.
We've observed a positive working capital, so I wanted to understand if this is a dynamic that should continue up ahead. Maybe the main line that is benefiting the working capital are the technical provisions. So, should we be thinking about those lines up ahead?
I'm gonna answer the first question, and then I'm gonna give the floor to Otávio. The greenfields, if you observe Rede D'Or, it—we selected areas where we are building the best hospital in the geography. We're not just getting a new hospital in a competitive, with, in a competitive region with quality reference beds. No, we are effectively building the hospital infrastructure in places that we understand that there is income or good, good penetration of, healthcare plans, of medium to high tickets, and they're gonna have access to those infrastructures. And this is the situation in Campinas.
In Guarulhos, this is the situation in Alphaville. This is the situation in Macaé, because of the amount of companies connected to oil and gas and Petrobras itself. So when we look at those infrastructures, the more recent one that we launched, we registered almost all the healthcare plans that work, the operators that work with that profile of ticket. As SulAmérica, Porto, Omint, Care Plus, Amil. Once you have a great deal of the operators registered, then you'll have an ease with the client that wants to access that hospital, for them to access, whether if it's by the operator that they already are a client, or if they need seeking an improvement in the healthcare plan level within the operator, they have all the levels, which is the case of São Luiz Campinas as well.
If there is another operator that has interest to access this infrastructure, the family or an HR, we see a lot of movement in the average to high ticket, where we are positioning São Luiz Campinas, we see a growth that is important and a good perspective for these healthcare plans that were registered. Now, I give the floor to Otávio to talk about working capital. In this year, we brought back home BRL 580 million in working capital, and this is one of the several aspects, positive aspects, of the acquisition of SulAmérica. First, you receive the cash, and then you have the use of cash in the future.
But this year, this is one of the positive effects in of this transaction that allows us to include, to have a better management, more efficient management of the working capital.
Thank you very much.
The Q&A session is closed. We're gonna give the floor to Mr. Paulo Moll, so he can close the earnings call.
Thank you very much for everyone that took part. And briefly, we will be together again, and I hope that we can continue with our works for the integration of SulAmérica growth of our hospital network. The moment is a very challenging one, but we are at a position that is unique for the healthcare sector to offer better conditions and for us to accelerate once again the rate of growth. And considering the market conditions, we can deliver in terms of profitability with growth, interesting growth.
I hope that we can accelerate more with the country growing, the unemployment decreasing, and also with a more controlled claims volume. This is very important for work, for the SulAmérica team to work, with Raquel also being a leader of the group. Briefly, we should be adjourned. Thank you very much.