Good morning, everyone. Welcome to the earnings call of the second quarter of 2025 of Rede D'Or São Luiz. We have Mr. Paulo Moll, President; Rodrigo Gavina , CEO; Otávio Lazcano, Vice President of Investor Relations; and Raquel Reis, Vice President of Healthcare and Dental at SulAmérica. The recording will be available at the IR website of the company. We will start the Q&A after the presentation.
Before continuing, any forward-looking statements that are done during the conference call regarding the business perspectives of Rede D'Or , projections, and operational goals are based on beliefs of the Board of Directors available based on the information that is available now, and they involve risks and uncertainties, and they refer to circumstances that may or may not occur.
Investors should understand that general economic conditions, industry conditions, and other operational factors might affect the future performance of the company, and we might have different results in the future. Now, we'd like to give the floor to Mr. Paulo Moll. He will start. The floor is yours.
Thank you, everyone. It's a pleasure to be with you once again to talk about our results on the second quarter. As all of you have seen, the company had strong results. I would like to highlight the main ones, and then with more details, Raquel , Gavina , and Otávio will go over the details. Our revenue is growing 11.5% in the second quarter of 2024, getting to BRL 15.1 billion, consolidated with the BRL 2.5 billion growth of 18.4%, and the net revenue, already excluding the amortization of the SulAmérica portfolio, getting to BRL 1.2 billion, a growth of 16.7%.
In the hospitals, in this semester, we grew the operational beds to 10,413. It's a growth of 556 operational beds. At SulAmérica, we'd like to highlight the growth of lives, 128,000 lives in health, 2.4% of growth in the first quarter. Good dynamic of cash generation, good working capital, reduction of leverage, and we can go over with more details in the operation. It places us at an operation that is very good to evaluate other opportunities, other projects that we have in our organic expansion or in an inorganic movement. I'd like to congratulate the entirety of the team of Rede D'Or , and I'd like to give the floor to you to talk about what we see in terms of opportunity and future gains. Besides the organic expansion that we have announced, 3,000 beds announced until 2028, we see great opportunities for gains of operational efficiency.
We're reaching these results. The healthy margin doesn't mean that we do not have an important set of projects and actions for efficiency gains. For example, we still have 26 hospitals with legacy systems. We're still migrating, and we're still going through a process of another two and a half years to get all these systems and processes that are standard of the company and that will bring relevant gains for the operation of these units. We, in our revenue cycle, are in a path of automation, digitalization, and robotization, certainly with the possibility that is important. We still live with invoicing losses that could have been avoided, and we have the best practices within the network itself, running in part the operations, and the rollout is going to be for the rest of the operation that is going to give us important gains.
I'd like to highlight that our operational model, our sector, will be positively impacted by artificial intelligence, with administrative gains that are important of productivity, and with the hospitals, with the reduction of time that is spent with bureaucracy. Certainly, this is going to help with the assistance and gains of productivity that is important. We started the project. We're very excited with what we can build in the future. At the insurance company, I think that artificial intelligence will be fundamental to increase our effectiveness in the detection of frauds, bringing benefits for our operation. To exemplify the opportunities of tomorrow, in the future, we have nine hospitals in ramp-up.
When we see the potential margins that we should get in the next 24 months, once we get to this margin, we're going to have a contribution of over two points in the gross margin of the company, just to show you the type of gains and the focus of the operations. I also would like to highlight, I'd like to congratulate the teams we got to 67 points of NPS. It's a level that we haven't reached for some time, especially in the acquired units. We see that the maturing of some units with NPS below our average. We can briefly go over the 70 points of NPS, highlighting that our reference units got NPSs above 90 points.
I'd like to reinforce to all of you that regardless of the good results, we have a commitment that is very strong to work with the entirety of the team, seeking a stronger company, and we're not going to accommodate, facing all the opportunities of improvement that we have up ahead. I'll give the floor to Raquel to continue with our presentation, and Gavina and Otávio, and I'll be back for the Q&A. Thank you.
Thank you, Paulo. Good morning. Very happy to be here once again. Now to talk about the results of the second quarter. Once again, very positive in our evaluation. Once again, the highlight is for our capacity to continue to grow with an improvement of profitability, which has been the mantra quarter after quarter. We added almost 150,000 new beneficiaries in this quarter, 65,000 in health, 84,000 in dental.
We've kept the rhythm of growth over the last periods, and this reinforces the proposal, value proposition, the commercial policy, the strategy for the retention of clients with the creation of concierge board of directors, and the partnerships with the salesmen that we have throughout our history. All the strategy that has been very on point. In regards to the claims, we have another gain in regards to the previous year, 2.4 points. We have an improvement in regards to the previous quarter. As you know, we have seasonality: the flu and mosquitoes, and this is expected. We are going to continue to balance these with the profitability that is healthy for our clients. To close with balance, the administrative expenses are in a very controlled standard, keeping the focus in the operational efficiency. We are not confirmed still, and we want to improve.
Now I will give the floor to Gavina, and I will continue with you for any doubts. Thank you.
Good morning, everyone. Page five. Now, I'd like to thank the Rede D'Or physicians, family members, for the trust that you deposit in us and our services every single day. You bring to us, you take and you produce trust that is respectful. For us, it's very important that credibility. If we see the table to the left, we realize that it was a record of patient days, 180,000 with the occupation of 83%, which is a high occupancy, as you know. Besides we grow in beds, as Paulo has said, we grow the beds, we kept them busy, and we brought, because of all of this trust and safety, more patients, more physicians, and more people to our system.
Due to this, we can see to the right, we are growing the number of surgeries, record number with over 130,000 surgeries, and showing you the subproducts, so to speak, that we have that not always we have. We have 11,000 Brazilians being born with us. It's a very relevant number for any healthcare system. 11,000 new people came to light through our structure, physicians, and collaborators. We serviced over 3 million people in our medical centers. This is a very expressive number. This shows that the work and the trust has more and more repercussions in our medical team and family members. Page six. Paulo already mentioned we got to over 10,413 beds. We grew 256 beds quarter on quarter. In the year, we grew over 1,100, almost 1,200 beds. We got a total number of beds over 13,000.
The challenge is to sustain the quality, the trust, so that more beds will come in places that are necessary for the system. We can do what we said with efficiency so that all of our operational efficiency, improvement of processes gives a better treatment for our patients. Now I'll give to Otávio.
Thank you, Gavina. Once again, page seven, gross revenue and average ticket hospital services. Starting with the graph on the left, we reported in the second quarter of this year, total gross revenue of BRL 8.882 billion, with a growth of 13.8% comparison year on year. The increase of the average ticket in 10.4%, the increase of day patients 3%. Growth of 13.4% in the quarterly comparison result that is the increase of the average ticket of 1.5% and an increase of patient days of 11.7%. Center of the page.
Gross revenue accumulated in six months of BRL 16.905 billion, 10.4% higher than the one reported for the same period with the fiscal efficiency and is the result of the average ticket of 2% increase of the number of patient days of 8%. At the right, we present graphically the evolution of the average tickets in June of 2020, a year of 7% in this temporal window, and it's a strong evidence for once again reaffirming our model of processing of the services provided and the IPCA two percentage points. We bring more complexity to our solutions. We see this playing a part. Page eight, gross revenue and average ticket in oncology. Once again, graph to the left. Company reported in the second quarter of this year, gross revenue in the segment BRL 940 million, a growth of 17.7% in the comparison year on year.
The increase of the average ticket of 12.5% and increase of the number of infusions of 4.9%. Same way, growth of 8.1% in the quarterly comparison, and an increase of the average ticket of 3.4% and increase of the infusion numbers of 4.6%. In the middle of the page, gross revenue of the segment accumulated in six months, BRL 1.809 billion, 17.1% higher than the one recorded for the same period in the last year, an increase in the average ticket 12.4% and increase in infusion 4.4%. On the right, graph presentation of the average ticket of the segment since the second quarter of 2024, growth of 12.2% in the comparison year on year. Once again, a growth of 3.4% comparison quarterly comparison. Page nine, cost and expenses. Once again, just two hospital services. On your left, the company reported total cost of the second quarter of the fiscal year of BRL 6.033 billion.
That's a growth of 15.7% in the comparison year on year, growth of 9.3% in the comparison quarter on quarter. Center of the page, accumulated cost in six months, BRL 11.553 billion. These are 12.9% higher than the ones reported for the same period of the previous fiscal year. To the right, we see graphically administrative expenses in the second quarter of 2025 of BRL 326 million, absolutely stable in regards to the previous quarter, and the stability in the historical series that was presented. Accumulated in six months, administrative expenses BRL 664 million, BRL 654 million, sorry, growth of 18.7% in the annual comparison in regards to the period of six months of 2024. We had a few non-recurrent events. A highlight for the reversal of provision in the amount of BRL 65 million with the historical cause of SulAmérica because of E&G, the capital of the insurance company, many years ago.
If it wasn't this event registered in the six months of 2024, the growth of the administrative expenses in this comparison in this temporal window would be 6%. Let's see page 10, EBITDA and net income. To your left, an EBITDA accounting of BRL 2.059 billion in the second quarter of 2025. Growth of 12% in the comparison year on year. It's a growth of 23.1% in the quarterly comparison, a margin EBITDA of 25.9%. At the center of the page, EBITDA accumulated in six months by the hospital services segment BRL 3.731 billion, 6.7% higher than the one reported for the same period of the previous fiscal year, EBITDA margin of 24.9%. To your right, net income accounting an adjusted of BRL 1.129 billion and BRL 1.182 billion, respectively, in the second quarter of 2025. In six months, a net income and the adjusted net income of BRL 2.148 billion and BRL 2.253 billion, respectively. Next page. Data of SulAmérica.
Let's start with the graph on your top left, the net revenue of BRL 8.148 billion, or maybe higher, 11% higher than the year-on-year comparison. On the top right, we see a consolidated loss ratio of 81.3%, 2.3 percentage points lower than the one reported in the second quarter of the previous fiscal year. To the right, top bottom, health and dental beneficiaries. We see a graph that is consistent of the client base of the company. Last, bottom left, an adjusted EBITDA of BRL 730 million for the second quarter of 2025, growth of 50% in the comparison year on year. The adjusted EBITDA consolidated with the company in the quarter of BRL 2.745 billion is 16.3% higher than the one reported for the same period of the previous fiscal year.
In the same way, the consolidated EBITDA adjusted accumulated in six months of BRL 5.386 billion is 18.6% higher than the one reported in the fiscal year of last year. Page 12, debt profile. We have BRL 37.1 billion in gross debt, net debt BRL 17.3 billion. The net debt over EBITDA 1.65 x. If we add the cash position of the company, the technical provisions for insurance, the net debt drops to BRL 9.2 billion, and then a relationship of net debt over EBITDA slightly less than one time. The average cost of debt, 5.4 years, cost of capital of third-party CDI + 1%. On your right, we have the debt amortization schedule, a very comfortable position of liquidity, good money to finance the activities, the cash, the working capital to digest all the investments in execution, good money to face the deadlines up ahead. Page 13.
Let's start with a graph on your left. Reconciliation of the EBITDA reported with the six months with the cash variation of the company. We start from the EBITDA reported of BRL 4.79 billion. Moving to the right, we have a variation positive of working capital BRL 1.1 billion in six months, and the consumption of working capital in the hospital, BRL 851 million, and a positive working capital that comes from the SulAmérica activities, BRL 1.952 billion, including here, BRL 992 million that come from the Social Security segment. Other items of negative balance, BRL 220 million, payment of leasing, BRL 387 million, plus to the right taxes, BRL 666 million. The variation of cash due to the financial activities, BRL 1.878 billion, I apologize. Finally, cash flow due to the investment, BRL 813 million.
Here we have BRL 232 million of investments in maintenance, BRL 1.036 billion in greenfields and brownfield investments, and a receivable of cash, BRL 454 million of our participation in the consulting and the reimbursement of the CapEx over the Hospital of Campinas, within the context of the migration of this hospital for JV with Bradesco. To your right, we have graphically the average days receivable, inventory outstanding, the IO, and days payable of hospital services. We finish the presentation, and I open for Q&A. Thank you.
Let's start the Q&A for analysts and investors. If you want to ask a question, please raise your hand. If you have had your question answered, then you can lower your hand. We ask kindly that the analysts limit to two questions so that more people can take part. First question. Vinicius Figueiredo from Itaú BBA. The floor is yours.
Good morning.
Thank you for taking my question. It's a question regarding the hospitals. In regards to hospitals, I wanted to explore the ticket. It was a positive surprise in the acceleration of the revenue, bringing the best dilution of costs and expenses. There are a lot of things in this number, but what brought your attention is the growth of the ticket quarter on quarter, even though you have a seasonality that plays against it. Looking to the next quarters, there's a ramp-up of hospitals that should be incremental to the ticket in the state of Rio de Janeiro, and there is a readjustment with the pain party. What could you discuss in regards to the expectation of the table readjustment that happens in the second quarter? Does it make sense to think that in the third quarter you could have a better ticket?
In regards to the growth, it has been a great highlight. The gain of market share is very expressive, and this is a differentiated product, very competitive. I wanted to understand if there is a product that you highlight or that has had a great attraction within the framework, or is there any focus in any region to sustain an accelerated ramp-up with Ribeirão Preto? These are my questions.
Let me ask. Let me get the first part, and then I'll give the floor to Raquel. The evolution of ticket, we've had several factors contributing. The readjustment, we have a mix of operators. You know that we throughout the year have done a few readjustments in operators that we had relationships and some we discontinued. That has impact, has impact with complexity. There is a goal of the company, and we want to do that.
We want to qualify within the hospitals, the type of procedure and surgeries that we do, trying to find some gains of ticket base in this complexity. We have the mix of hospitals that we're growing. We're growing beds in hospitals that are in a position of average ticket that is above the ticket of the company. All of these factors give this variation of ticket that you've seen. We always warn that you shouldn't just look at a quarter. Sometimes we have a quarter on quarter that there is a variation that is below the inflation or some really above. We always suggest that you see a period for 12 months to normalize any variations that we might have of complexity.
In a quarter that is very little to watch, you remember that in the second quarter of last year, we had a record number of emergency, a great volume of dengue fever, and there is a complexity that is different. There are those considerations to do. For protection purposes, we reinforce that we will always try to find a variation above the inflation, but not so much above the inflation. One or two points above IPCA rates. That conservative will allow us to move forward. I'll give the floor to Raquel.
Hi, Vinicius. Thank you for the question. Growth, we have 2023. We did the launch of the products with the modular reimbursement. You saw some on the fronts of the combat of fraud. We've kept most of the reimbursement medical honorarium, removing the reimbursement where the fraud was more evident with exams and therapies.
These products from here on in are over 600,000 lives. It's a growth that is very accelerated and a great acceptance of the client and the insurance broker because we have readjustments that are lower for our client. For me, that's one of the reasons that it justifies the growth of our base. There is an important growth with that you've seen with the products with co-participation. They were very important with the companies. They represent an important branch. They represent over 80% of the stock of the entrepreneurial plans and almost 90% of the sales. Recently, that has become a trend in the wholesale, which is great. The PME, small SMEs, are 40% of everything that we sell in products with co-participation. In the adherence, 100% of them sold with co-participation.
Of course, we launch with regions where we have growth of Rede D'Or or with the opening of hospitals such as Ribeirão Preto, Macaé, Guarulhos. We observe opportunities that are potential for Rede D'Or or commercial opportunities that can exist, not necessarily connected to the expansion of beds. Something that is very good, we have seen in the last quarters, in a very consistent way, is the concentration of growth in average products of average ticket that is higher. With the birth of SulAmérica, the inception was special executive prestige products. Very accelerated products there. These are the highlight points. Thank you.
Thank you for the answers. Congratulations.
Thank you, Vinicius.
The next question is Gustavo Miele, Goldman Sachs. The floor is yours.
Paulo, Otávio , Raquel , Gavina , thank you for the presentation. I also wanted to ask two questions.
First, in the hospital context, there is another important highlight, which is the performance of the average days receivable, which after a few quarters shows a substantial improvement. I wanted to crisscross that data with the increase of the revenue that goes to minority shareholders, so that SME is being helped by a greater penetration of the results within the conglomerate as a whole. We should foresee maybe more space for these SMEs are reduced as the assets that are ramping up very good. They have more representativeness. I can understand that working capital. That would be the first question. The second one in SulAmérica, I wanted to get what Vinicius said. When we look at the ANS in a window of 12 months, SulAmérica seems to be one of the insurance companies that recycles the most portfolios, 40% of the total base.
I wanted to understand if we look at the uptake year on year, how much, Raquel, would you attribute of readjustments, or even if it's fighting fraud with a legacy product, and how much is the contribution of these new products that are getting in the base? Looking at the granularity of the beneficial impact that these products have, lower tickets have, and they bring more EBITDA margins. Those are the two points.
Thank you for the question. Being direct, it's not an impact. We have an improvement, general improvement in a number of days, and this is connected to the better organization of our processes in the revenue cycle and some impact because of the adjustment that we've done over the last quarters, the last years of operators that lived in a more difficult operation, and they were longer, and now we discontinued the operation.
Now the mix is better, and within that mix, with a lot of internal work, as I told you, it's still on course, a lot of things to be done, but we see some results. Raquel?
Thank you, Gustavo, for the question. To be able to weigh down both, I will say it's half and half. It's undeniable that since the beginning of 2023, we've had a big work for our operational team of claims, renegotiation with several service providers, several packages, models of remuneration that share some risk with the service provider. That happened from then on, and it didn't stop in synergies with Rede D'Or when we look at the purchase of materials and medications. All of that contributes a lot with the reduction of the growth of our claims per capita.
When we look at the commercial, at sales, and the post-sales, there was a launch of the new products that I've mentioned with Vinicius. It's an important growth of the base for us, but an important work for the post-sale. In 2023, there are some clients leaving that we saw that it was very difficult to recover the result. Getting those that were misguided, now they're at cruise additional tickets, so to speak. That involves a downgrade of products sometimes or the maintenance in the same line of product with the same network offering, but now the modular reimbursement, the extension of deadlines of contracts, co-participation that could have existed, but we existed 10% and 15% of co-participation, and now when we have 30%, that has a lesser impact with readjustment.
When we get that in the blender, so to speak, I can answer your question in regards to the improvement. Health is a transatlantic. We don't have a silver bullet. It's 100 things that improve stuff. All the harvests since 2023, we're doing better. Thank you.
Thank you, Raquel and Paulo.
Thank you, Miele.
Our next question comes from [Andres Sales] of UBS. You can open your microphone.
Good morning, Paulo, Otávio, Gavina, Raquel. Thank you for the space to ask the question. You commented on the potential of operational improvement within hospitals and legacy systems. For us, if you can help us quantify, if we get the threshold of the company, what would be the interval between the operations that you understand that are more mature and the operations that you understand that there is a space for improvement?
The second question, you commented on the solidity of the balance of the company where the opportunities open. Now, on an inorganic front, if we think about the leverage level that you would consider an inorganic relevant movement, what would be in terms of net debt/EBITDA?
Hi, [Andres]. The data that I gave you, we don't have any data besides this one to give us guidance. Many things to do. Many hospitals that we are still beyond the potential. The more specific number that I give you as an example are the nine hospitals in ramp-up that go into the margin of the target hospitals, similar hospitals that would bring in these nine hospitals an impact for our net margin, gross margin, but I'm not calculating the impact of improvement.
To give you a precise estimate, the other hospitals that are not using our systems or processes, we are very excited, and we can continue to find efficiency in these structures. In regards to tolerance for leverage, with the history of the company, we leveraged the company four times the net debt/EBITDA, but I wouldn't say because of the size of the company, the interest rate levels, even considering that we have a debt profile that is very delayed, we do not see any movement that would take us to the need of doing a big leveraging of the company. I wouldn't, very difficult that something would make us go over 2x- 2.5x of the net debt. If we are comfortable, we have a movement that is important that we need to do.
We need to increase the level for levels such as this if it happens, but we would not go over the 2x- 2.5x .
Thank you, Paulo.
Our next question comes from Samuel Alves BTG Pactual . Floor is yours.
Good morning, Paulo, Raquel , Gavina . Two questions. Operational beds. Over the last two calls, the company gave an update. Would you have any number for July and August, any color on operational beds? If that's not the case, if you can reiterate the message of the previous call, if it makes sense for us to think about the seasonality that is different from previous years with more operational beds being activated. That's the first question. The second question, going to SulAmérica, a more strategic question, long-term, and I want to hear from the administration of the company. What is the ambition of growth for SulAmérica?
Does it make sense to think 3%, 4% of expansion per year as a long-term ambition?
Samuel. I'm going to start with the part of hospitals. I think we were clear with the last results, the last calls. The expectation for 2025, it would be a year for operational beds being open that is stronger than the previous years because we have the adjustments, the operators that were done. We didn't expect any movement with the intensity that we've done with 2024, 2023. It's natural a ramp-up for the new units and the growth of other units, and that would bring a level of growth that is higher. We delivered a level of growth that is above in the previous years when we announced that we are 556 beds in front, and we have the expectation of growing.
Of course, that depends on the performance of the different hospitals throughout the second quarter, but we are positive that we will continue to grow. Raquel?
Hi, Samuel. I think that here the first point is that we don't do any type of projection on the very long term. When we talk about the growth by administration, it's kind of dangerous because ambition is always large. We want to grow, but we want to grow in a way that it happened thus far in a responsible, sustainable way without any commercial war, without any action that might place under risk everything that we have had of consistency over the last quarters. What we show you in terms of growth in the last quarters and the last years makes us comfortable with what we see.
The growth depends on other factors, part of them, external factors, and also potential regulatory changes that can change our potential for growth throughout the years. In general terms, we believe that we're very satisfied with what is being presented, and we will continue with an ambition of growth that is positive for the next quarters and the next years.
Thank you, Raquel and Paulo.
Next question, Joseph Giordano from JP Morgan. Floor is yours.
Hello everyone. I wanted to explore two points. With the hospital, there is a good acceleration of growth, and at the same time, we have a cash generation that is very good with the leverage that tends to be very quick. If we get the rhythm of cash generation, my question is looking at the maturation that is higher, which is higher than what we imagined, the plan of CapEx.
I wanted to explore with you how do you see opportunities to add because within the review of the opening plan, we haven't seen anything new coming up, so there might be an opportunity. The second question is for Raquel. You mentioned that SulAmérica continues to grow with the DNA that is premium, but I wanted to understand what are the opportunities in this segment that is more intermediary, more regional, with restricted networks, leveraging with the networks of the group. Do you see any regulatory changes with the pricing of plans for SMEs? Do you see any update in the company?
I'm going to get the first one, and then I'm going to get the other one to Raquel. There is a solid position in cash. We are happy with the ramp-up and the return that we have with the recent projects, and we want to do more.
We've discussed this before. We have opportunities that we have discussed. We don't have any announcement to be done thus far, but cash solidity, as you've mentioned, and the ambition of bringing more growth, we have, and we hope that we can, in the future, we can announce interesting projects in the portfolio. Raquel?
Thank you. I highlighted the point of the products of the average ticket, higher ticket in prestige, because they represent a very relevant part than what they represented in the previous years before the position, aligned with what we saw before, with excellent news. It doesn't mean that we're growing less in the other segments. No. A great deal of the launch of the products that we had over the last two years were years that we had the biggest number of years of products that we worked strongly.
I highlighted Direto Nacional, that you remember the regional diretos that were launched before the acquisition. It was the first investment in these products that I wouldn't say low cost, but it was more co-management of the claims, and some of the partners already included Rede D'Or in some of them and other partners in others. This product was retrofitted. There is a product, Direto Nacional, that has 250,000 lives, and there is a good acceptance in the market, not only of wholesale, but also of segment, entrepreneurial segment, and it's a product that we can do a launch in several regions. Of course, we're going to launch in São Paulo, in the obvious ones, Rio de Janeiro, Bahia, Recife, but we've launched in several regions that are not so obvious.
By obvious, they don't bring volume of sales that are very expressive, but we can have a capillarity of service, and we can get the flag of SulAmérica in previous regions that we saw more participation of co-ops and group medicine that is low cost. That happened. Within this side of ANS, this is a difficult question. We have, in accordance with the last call, a series of public consultations ongoing, relevant, that require an impact, regulatory impact evaluation, and a discussion with the market as a whole and the Ministry of Health because these are transformational, and there is a vacancy of board of directors with indications in the next weeks. The scenario hasn't changed. There are parts that require our attention, such as technical review, changes of rules, of course, co-participation, readjustments to groups, so middle market. All of that happens.
We are paying attention, but there are no changes from the last call to this one.
Our next question, Mauricio Cepeda, Morgan Stanley. Floor is yours.
Good morning, Paulo, Otávio, Raquel, Gavina . Thank you for the opportunity. Two questions. The first is in regards to hospital expansion. You've had that code that was interesting. You had a ramp-up that was quicker with operational capacity. My question is, do you see any upside versus the pipeline, the reference form, and in the sense of increasing the future expansion? If it's expanding, the future expansion is the cost of capital, or do you not see sufficient demand to continue to grow with a higher rate since you had a very expressive, good success? The second question is also a strategy for the long term of the group. You got to a scale that is very big in the hospital business.
Do you foresee any economical additional or strategic to get into ambulatory businesses? Do you see any reason for that, any synergy, any strengthening of D'Or, also advancing in other ambulatory businesses?
Cepeda, as I mentioned with the previous question, ambition to do more, we always have it. Cash solidity we have. There are some projects that we're interested. There's nothing to launch, but we have an ambition of doing more and understanding that certain markets we would have a more strong position. We are doing the analysis all the time. In regards to the company, we work in a broad way with the medical services provision. We have a position in ambulatory services, whether if it's at appointments, diagnostics, oncology. It's important we have work in the hospital business that is more representative, and there is a position with SulAmérica in the insurance.
We are open to analyze if it makes sense. Thank you, Cepeda.
Next question, Flavio Yoshida, Bank of America. Floor is yours.
Hi, Paulo, Otávio , Gavina . First one, in regards to the EBITDA margin of the hospitals. There is an expressive improvement quarter on quarter, even with the business days pressure in the second quarter. Now in the third quarter, we're going to have more business days. The beds are still ramping up. I wanted to understand if we can wait for, expect for this margin of hospitals to improve for the third quarter. There is a seasonality, I understand, but I wanted to get your opinion. Still, with the margin of hospitals, we realize that when we look at costs, the medical materials has grown a lot. It represented 20% of the gross revenue. Let me see the last 12 months. It's closer to 12.5%.
Is that a one-off effect? I wanted to understand what do you expect?
Thank you for your question. Third quarter barely started, it's difficult to give any guidance on the margins of the hospitals. We don't give guidance on that. That's our practice. We will not change that. There is no way that we can address your question. Your second question, it failed for us, or maybe it's related to the relevance of the medical material in the cost of the company. We understand that it's very controlled. In 2019, before the pandemic, this item represented 18.7%. Of course, afterwards, throughout the pandemic, that grew a lot. It got to 22% in the first quarter of this year, 19.5%, and now it's about 20%. In the second quarter, there is a significant moment in the number of surgeries.
There is a change in the mix of the hospitals, and there is nothing special besides that factor of that small change with the relevance of the medical material measured as a percentage of the gross expenses of the company.
Q&A session is over. I'd like to give the floor to Mr. Paulo Moll to close the session.
Thank you very much for your presence of everyone at our call, and thank our investors for the support that you give us. We will see you in the next call. Thank you.
The earnings call of Rede D'Or is closed. Thank you for your participation. Have a nice afternoon.