Good morning, everyone, and welcome to IHH Healthcare Berhad's annual briefing. Thank you for taking the time to join us today. My name is Kelvin from IHH, and joining me on the call today are Dr. Prem, Group CEO, Mr. Dilip Kadambi, our Group CFO, Mr. Ashok Pandit, our Group Chief Corporate Officer. Warm welcome and good morning to all. For today's session, we will begin with Dr. Prem sharing an overview, opening remarks for the quarter, followed by Dilip, who will take us through the financial highlights for the quarter. Ashok will then cover key operational updates across the group, focusing on core markets and countries, after which we will open the floor for Q&A session. Dr. Prem, over to you, please.
Thank you, Kelvin, for the introduction. Good morning, and thank you all for joining our Q3 2025 results briefing. Today, we will begin with our Q3 2025 results overview, move into operational highlights, and finally open up the floor for a Q&A session. So, despite a challenging macroeconomic environment, we achieved resilient financial performance driven by an increase in inpatient admissions and higher revenue intensity across all our key markets. On a constant currency basis, we demonstrated double-digit growth of 18% on both revenue and EBITDA. This is a testament to our diversified portfolio. Both EBITDA and PATMI margins remain healthy and are within our guided range. As mentioned the previous quarter, we have received the highest rating, AAA, on our Sukuk program. In October 2025, we have raised MYR 2.35 billion to refinance existing debt, achieving interest savings of 30 basis points.
As mentioned previously, we have adapted for the structural shifts in our operating care model, from inpatient to day care. Through this, we have seen positive effects. For instance, in Malaysia, day care revenue grew by double digits. Also, we are pleased to share that Mount Elizabeth Orchard has been fully reopened, and we expect to see stabilized contributions from Q2 2026 onwards. In India, we continue to strengthen our Pan-India healthcare platform. The Executive Management Services Agreement allows for greater integration and harmonization in areas of clinical synergies, procurement, and IT. In addition, the recent completion of the Fortis acquisition removes significant regulatory overhang. At the same time, this also lifts our capital commitment requirements, which releases funds in our escrow account, leading to cost savings. Furthermore, this completion gives us the flexibility to explore future capital structure for future growth. We continue our progression on our multi-year digital transformation journey.
IHH Singapore achieved a key milestone to be the first private healthcare group to fully participate in the National Electronic Health Records, which will also be beneficial to both doctors and patients. Overall, we remain cautiously optimistic about the financial performance, despite erosion from a strengthening ringgit for the rest of 2025, supported by a robust financial position. With that, I'll pass the time over to Dilip to cover the financial highlights. Dilip, please.
Thank you, Dr. Prem, and good morning to all of you. Our diversified network across multiple geographies enabled us to mitigate risk from other geographies and allows the group to maintain a strong and resilient financial performance. As always, we will focus on the blue box, which excludes MFRS 129, and this more accurately represents our operating performance. Overall, we see a 9% growth on revenue and a 10% growth on EBITDA, following, one, the conclusion of negotiations with payers and insurers, a shift of operating care from inpatient to day care, and number three, on the back of higher patient volumes. On a constant currency basis, we had a robust double-digit growth of 18% on both revenue and EBITDA, demonstrating our strong operational performance in each of our BUs. Despite FX volatility and macroeconomic headwinds, we remain cautiously optimistic about performance for the rest of 2025.
As we continue to navigate through structural shifts towards day care, we remain prudent in our capital expenditure and continue to assess our operating costs. On this slide, on a year-to-date basis, we see a continuing trend of strong core growth, offset by currency translation due to appreciating ringgit on a year-to-date basis. Revenue and EBITDA grew by 7% and 4%, respectively. On a constant currency basis, revenue and EBITDA grew by 18% and 13%, respectively. Again, we remain cautiously optimistic about our performance for the remaining 2025. Similar to our past presentations, the blue box represents reported revenue and EBITDA, and next to it, on a constant currency basis, it also shows revenue and EBITDA. Overall, the group achieved an 18% revenue and EBITDA growth on a constant currency basis, demonstrating strong financial performance.
As mentioned, in Malaysia, we saw a shift towards day care as a result in day care revenue going up by double digits. Despite discounts given to payers, we continue to see growing revenues and margins arising from greater operational efficiency and larger patient volumes. In Singapore, despite our payer pressure and price inflation, we maintain our EBITDA margin at 28%, as guided before. We remain confident on Mount Elizabeth Orchard contribution ramping up towards Q2 2026. We have also opened our third ambulatory center in Royal Square, which we intend would probably ramp up over the next six to eight months. Turkey and Europe demonstrated double-digit revenue and EBITDA growth, both on reported and constant currency basis, despite FX erosion. Similarly, India continues its growth trajectory with a double-digit revenue and EBITDA growth on a constant currency basis.
India continues to be a key growth market for the group, and with the recently executed MSA and conclusion of the Fortis acquisition, we continue to build up our Pan-India healthcare platform. Margins for the countries and IHH Group continue to be within our guided range. Overall, we have seen strong growth on a constant currency basis, driven by operational and clinical excellence anchored by our operations in Malaysia and India, and despite headwinds in Singapore, we expect a pickup in the coming months. Ultimately, we remain cautiously optimistic for the remainder of 2025. And similarly, on a year-to-date basis, we are seeing a trend of double-digit growth in both revenue as well as EBITDA, and on a constant currency basis, we grew by 18% and 13%, respectively. This slide shows our financial trends on a quarterly basis. The solid purple line shows our EBITDA margin ex MFRS 129.
In Q3, this was 23%, which is within our guidance range of 22% to 24%. Next, our core PATMI, which excludes EI and MFRS 129, is represented by the bold green line. In Q3, it stood at 9%, which is again within our guided range. Looking ahead, we still maintain our margins to be within the 22% to 24% mark. Our business continues to generate strong operating cash flows for Q3. With that, our healthy cash balances, we are able to fund our CapEx and other investing activities. As mentioned previously, we had received the highest rating of AAA from two rating agencies in Malaysia. On our Sukuk program, in 2025, we raised MYR 2.3 billion to refinance our existing debt, and this was achieved with an average cost reduction of 30 basis points.
As of September 2025, we have a net debt of MYR 14 billion on our books. Excluding net debt from P-Life REIT, our net debt stands at MYR 11.1 billion, with a net debt to EBITDA of two times and a net debt to equity of 0.3x . This concludes the financial highlights segment. Ashok will next take up the operational highlights. Over to you, Ashok.
Thank you, Dilip, and good morning, everyone. Let's start with Malaysia first. Steered by a strong management team, revenue and EBITDA growth continues to be strong, reaching 18% and 24% on a constant currency basis. This was largely attributed to higher occupancy, greater inpatient volumes, and pickup in intensity. As mentioned earlier, we've seen the positive effects of shifting to day care. day care revenues grew around 13%, reaching over MYR 400 million for year-to-date September 2025. This illustrates our efficient use of capital to tap on growth opportunities. We expect day care revenues and volumes to continue to increase through the year 2025.
We continue to benefit from our Island Hospital acquisition, as it reinforces our unique position as a prominent healthcare group with a strong medical tourism segment. Also, following up from last quarter, we'd like to update that we've concluded negotiations with payers and insurers.
The finalized negotiated rates are around 12% to 13% discount. Overall, EBITDA margin grew to 28%, largely due to higher revenue, as well as our cost containment efforts around headcount and OPEX. IHH Malaysia continues on its growth trajectory despite strong and growing competition, and as we continue to grow, we remain prudent in managing our manpower cost and optimizing variable costs through continued rationalization of suppliers and consolidation of procurement. If we look through the next slide, this gives you some more details around our medical tourism, which is a very big focus area for us. Year-to-date, foreign patients contribute around 15% of our Malaysia revenues.
This has doubled since our acquisition of Island Hospital on the back of strong, robust industry demand. Our hospitals in Malaysia have witnessed double-digit growth in medical tourism, underpinned by strong growth in census and high acuity treatment.
Moving forward, we continue to see a growth in medical tourism, and this will contribute to a larger proportion of our revenues in Malaysia. Moving to Singapore, despite lower occupancy rates due to our recent reopening of Mount Elizabeth Orchard, discounts that we paid to insurers are greater cost pressure, our EBITDA remains flat and margins stood around 28%. This demonstrates our resilience of our Singapore business.
In this quarter, we experienced a 4% growth in revenue intensity, helped partially offset the headwinds that we've experienced so far. For Mount Elizabeth Orchard, we expect to see a ramp-up in contributions, and this will get stabilized from second quarter 2026. We continue to collaborate with insurers, offering targeted packages for foreign and local patients, including bundling higher-end treatments into packages to cover under Mount Elizabeth Orchard and Novena Hospitals.
We continue to find ways to boost occupancy, offering discounted weekend room prices in Gleneagles Singapore. We also actively manage manpower costs, boost productivity through various means, including automation. Overall, we remain committed in Singapore, and we are confident that the business will pick up. Next, moving on to Turkey and Europe, which is our Acıbadem business. On both reported and constant currency basis, revenue and EBITDA demonstrated a very strong growth of 42% and 54%, respectively.
Despite the drop in occupancy, revenue intensity grew by 20% from more acute patient case mix. EBITDA margin recovered back to 21% following the absence of pre-operating costs at Kartal and Vitosha. Despite FX volatility and translation effects, our Turkish and European businesses have done well and continue to contribute significantly to the group.
Year-to-date, foreign patient contribution stands around 14%, mainly due to faster increase in local patient revenue, which grew at more than 50% from last year, coupled with a lower depreciation of lira versus the dollar and ringgit. We remain confident about Turkey's outlook as its economy continues to grow, following the move back to more conventional economic policies. Moving to India, IHH India continues to grow strongly.
India remains one of the key growth markets for IHH. It has continued on its EBITDA and revenue growth trajectory with a double-digit growth in revenue and EBITDA on a constant currency basis. With the recently signed MSA in July 2025, we remain optimistic on seeing conversions of margins through operational synergies. The recent Fortis results were healthy. There was some FX impact on revenue, which grew even more on a constant currency basis.
Admissions are off 7%, and revenue intensity increased by 8% with complex case mix. EBITDA now is at a healthy 20%, and occupancy stands at 75%. Continuing with India, more recently, as updated by Dr. Prem and Dilip, we completed our Fortis acquisition with a marginal increase in stake.
Upon the completion of the Fortis acquisition, IHH capital commitment is expected to be lifted in Q4 2025, which releases our escrow funds and saves our costs further. Also, Fortis will benefit from greater flexibility in its capital structure to explore growth going forward. Since our investment in Fortis, India continues to be a significant EBITDA contributor to the group, reaching Rs 723 million in FY 2024. This is a testament to our efforts in India, and we remain committed as India is one of our key markets.
Moving forward, Fortis will continue to execute on key expansion plans to enhance its offerings and footprint across India. The MSA that is signed between Fortis and Gleneagles will continue to strengthen IHH's Pan-India healthcare platform, leading to greater harmonization of back-end procurement and IT systems, synchronization of clinical programs, and improving clinical excellence and enhancing operational scale and geographical reach in the country. Moving to Hong Kong, Gleneagles Hong Kong, our operations continue on a steady growth trajectory with an increase in beds, bed capacity increased by 18 beds, 50 beds increased in 2025.
The revenue intensity rose by 15%, and we are now focusing on driving inpatient admissions through the care continuum by driving volumes through our clinics and more specialist consults. Q3 operations were slightly impacted by the two typhoons hitting the city in Q3. Year-to-date 2025, we've seen a 13% increase in day care volumes.
As such, in October 2025, we opened the first ACC in Hong Kong, Gleneagles Medical Centre, offering oncology care, endoscopy, minor surgeries, plastic surgeries, and medical aesthetics. We expect a new ACC to contribute positively for Hong Kong and the group in the long term. We managed to focus on our costs and maintain our initial guidance of high teens in the long term. IHH Laboratories, it's stable business. We saw a much-improved EBITDA margin, 24% for Q3 due to higher revenues and better cost management.
A big focus for the laboratory remains on the high-end tests, and the laboratory business overall continues to grow on a steady and strong basis. A few key milestones highlighted, some of them mentioned by Dr. Prem and Dilip earlier on the next few slides, and with that, I'm going to hand it over to Dr. Prem for key takeaways and outlook.
So we remain cautiously optimistic about the financial performance for the rest of 2025. Supported by a robust financial position, we will continue to drive growth through transformation and clinical leadership anchored by our framework set out back in 2023. We remain steadfast in our operations in our key markets and will continue to grow them further. We will now move on to Q&A, and I will pass this back to Kelvin.
Thank you, Dr. Prem, Dilip, and Ashok for the insightful updates. We will now begin the Q&A session. Just to remind participants today that Q&A is text-only, or rather the questions are text-only. So please key in your questions into the Q&A section in the Zoom box that you see. So we have a large number of attendees today. As usual, may I kindly request that each participant limit themselves to two questions? If you have additional questions, we'd be grateful if you could rejoin the queue after your initial round. So we have two questions from Wee Kuang, CGS.
Morning, Dr. Prem and the management team. Two questions from me. Number one, EBITDA margins have seen an uplift, which I believe highlights the contribution from foreign patients. But there was also mention of higher day care revenue. Can I check if day care itself has lifted margins?
Also, to clarify that the foreign patient contribution is from, perhaps I'll take the latter part first. Foreign patient contribution in Malaysia is predominantly from Indonesia. And in terms of the contribution of day care towards the margin mix, Dilip, if I can trouble you to answer that, please.
Sure. Definitely, day care volumes really help because we have a certain fixed cost base, and the more patient volumes we put through, the better it is from an operational efficiency standpoint, so any volume, day care or inpatient, actually helps in margin expansion.
Thank you, Dilip. Second question from Wee Kuang.
We have seen the market temper expectations for capacity expansion. And there was some mention in previous quarter as well. I would like to check if there's more that management could share on this across the various regions, if possible. Ashok, if I can trouble you to answer that, please.
Thanks, so I think our strategy remains pretty market-centric. I think we will continue to grow out-of-hospital ambulatory care centers in Singapore and Hong Kong. In the other markets, while Dilip mentioned, we continue to focus on day care in Malaysia, but we will look at selective bed expansion as well. In India, the focus remains on bed expansions, and similarly, in Turkey as well, wherever we see the opportunity, especially through brownfield, the focus will remain in making sure that we are absorbing any additional demand in our geographies.
Thank you, Ashok. We have another question.
Expectations of patient volume for Singapore for the rest of 2025 on a year-on-year basis? Ashok, could I trouble you to answer that, please.
So I think we mentioned earlier that we now have Mount Elizabeth Orchard fully operational, some additional bed capacity coming up. And we are working through the various insurance companies and payers to make sure that we get the volumes back. As mentioned earlier, we are looking at a more stabilized performance for Mount Elizabeth Orchard by second quarter of 2026. The big focus in Singapore remains out-of-hospital care through the third ambulatory care center that has recently been opened.
Thank you, Ashok. We have a question from Amanda Macquarie.
Good morning, Dr. Prem, Dilip, and Ashok. Thanks for the briefing. IHH India, congratulations on reaching the 20% EBITDA margin mark. Wanted to ask how much more upside can we expect for India now that consolidation efforts have begun? And can I check what is the latest shareholding of Fortis?
In terms of the shareholdings of Fortis, it's remained at 31%. We saw the announcement on the close of the offer. There was a very minimal, almost immaterial uptick in terms of the offer due to the price versus market price. In terms of the upside, we can expect for India now that consolidation efforts have begun. We've mentioned before we are optimistic and cautiously so that the numbers for Gleneagles, India will start to track that of Fortis in time.
In the short term, slight uptick, and in long term, convergence towards Fortis margins. Dilip, anything else to add on this?
Sure. As Ashok had mentioned in this presentation, we are putting the back end together in terms of procurement, in terms of IT, even some of the clinical program in terms of trying synergies between Fortis and Gleneagles. So we do expect some amount of convergence in the short term, and over a medium term, I see no reason why Gleneagles India cannot contribute the same kind of margin that Fortis does.
Thank you, Dilip. Second question from Amanda on Singapore.
Can we expect the worst to be over with 3Q behind us for Singapore? Can you update us how occupancy rate has been trending on the ground quarter to date?
And related to that, Wei Kuang has a follow-on question, similar theme.
How does normalized operations look in occupancy for Singapore after Mount Elizabeth Orchard stabilizes by next year's second quarter? Dr. Prem.
So maybe I can elaborate a little bit on Singapore. We've spoken about the new beds that have come on stream in Mount Elizabeth. We've spoken about the ambulatory centers. We've also spoken about the payer pressure that is requiring us to make some tactical shifts in the way Singapore is operated, you will see. So what's actually happening is that there is a significant shift to ambulatory as well as day care, as is in Malaysia as well. And this is good for our relationship with the payers. That's the first thing. Secondly, Singapore continues to be, despite some foreign patients moving over to Malaysia, to our other entities in Malaysia like Johor, Melaka, and Kuala Lumpur, the increase in medical tourism in Malaysia is not only because of Island. It's also in the Klang Valley and also now in Johor.
So there are patients who are shifting over there as well. But Singapore continues to be a hub for banking, for finance, for travel, and there's a spillover into the medical arena as well. So we expect Mount E to ramp up quite nicely. At the same time, we will have more ambulatory centers to cater to a lot of the procedures that today can be done very, very safely in the ambulatory setting. And finally, we are also tactically making a shift in the ways two of our hospitals are run, Gleneagles and Parkway East, where we can have more bundles, packages to address the concerns of the insurers. So we are developing partnerships with almost all the insurers in Singapore at the moment. So that's the broad plan for Singapore.
Thank you, Dr. Prem. We have a question from Jun Song.
Can you give us an update on your negotiation process or progress with Great Eastern at Mount E Hospital? What's the revenue contribution percentage from CGHS patients to India total revenue? And related to the second question, there's a follow-up on the CGHS as well. India recently revised CGHS rates. Could you give a color on the potential impact?
So in terms of the first question, Jun Song, the negotiation progress and process with insurers across the board in this iteration has largely concluded. And as Dr. Prem mentioned just now, we are working on a two-tier approach in Singapore. Gleneagles and Parkway East will be on the package side. And both the Mount Elizabeth will be focusing on the higher-end side. In terms of the CGHS questions, Dilip, can I trouble you?
The first question is revenue contribution percentage from CGHS patients to India and any impact on the revision to the CGHS rates.
There is, as you know, CGHS does have a pretty large contribution, I would say double-digit in terms of percentage-wise contribution to revenues in India. I must also say that there's a revision in CGHS pricing, which is actually beneficial to our network as well as we work with various CGHS partners in providing care for the central government employees across the country.
Thank you, Dilip. Question from Shen.
Can you explain the year-on-year decline in PATMI, excluding EI for 3Q 2025? Interest expense seems to have increased significantly. And if we assume that this is due to the Island acquisition, then was the acquisition dilutive?
In terms of the interest expense, yes, its pickup is due to the Island acquisition, which was done in November last year. So you are seeing the full nine months of that impact. Shared before, we've closed first the unrated Sukuk in November last year with a best-in-class under 4% financing cost. And we recently compressed that further by a further 30 basis points through the rated route. In terms of whether the acquisition is dilutive or will it be accretive in time, Dilip has shared before, year two, latest year three. So far, it looks to be on track.
When is the next discussion for insurer discount rates? Is it annually? Just before Dr. Prem takes this on, I think we've shared before, insurer payer pressure will always be there. That's why we share that in this iteration, it has largely concluded. Dr. Prem, any views on the next discussion? Is it annual?
Sure. Thanks. So insurer discussion can take place in many different ways. With some insurance contracts, with our long-standing insurance contracts, we do have annual reviews. May not necessarily result in a revision, but at least we do have discussions. The recent events that took place in Malaysia and Singapore obviously required us to have ad hoc discussions and reviews with the insurers. And we have given you some color on it already. In India, as Dilip mentioned, it may not be annual, but at certain intervals, there will be some revisions to the public sector and defense insurance contracts. So it is not annual, not necessarily, but there will at least be a review from time to time. That gives us an opportunity to revise according to medical inflation and manpower increases.
Thank you, Dr. Prem. Next question.
How big is your ACC and day care contribution as a percentage of Singapore operations currently and differential in margins?
Our ACC and day care is in a very ramp-up and nascent stage. However, given the framework that Dr. Prem, Dilip, and Ashok have laid in place, this has allowed us to anticipate the structural shift. In terms of contribution, and if Dilip wants to add more after this, it's ramping up. And in terms of margin, you would expect primary care touchpoints and somewhat secondary to be lower than tertiary. Dilip, is there anything else you want to add on in terms of contribution for day care?
At the end of the day, if you look at our network in Singapore and the patient intensity in the hospitals, the hospitals always remain a large contributor to our overall revenue. The day care contribution will grow and will grow substantially over a period of time. But as I said, the hospitals always will be a large part of our contributions for our revenue. From a margin standpoint, what you should remember is the cost of delivery of day care is also lower compared to inpatient beds. Though the margins are, I would say, slightly lesser than inpatient revenue, I would say that it'll more than make up in terms of dollar EBITDA because of the velocity, which means lower ALOS and higher throughput. That is one point that I'd like to make.
The second point that I'd like to make is really the objective of setting up day care is also to decant the lower acuity procedures outside the hospital into our day care facilities, which allows us space within the hospital to increase the acuity that we manage in there, and hence, higher acuity equals higher margin as well, so that's something that we should remember as well as we go along.
Yeah, if I can just add on to Dilip, one of the advantages we have in Singapore is that we have a truly integrated healthcare system. Everything from primary care to ambulatory centers to now hospitals as well. In addition, we've got ambulatory physiotherapy centers, radiology centers, and a full laboratory. Part of having an integrated system is to have a referral network. So our large Parkway Shenton primary care clinics, while it may have a lower margin than the hospital business, but it's a key source of referrals into our hospitals, especially with corporate contracts. And with insurers now also beginning to pay for outpatient care, that's something the Singapore government is encouraging. And the insurers are beginning to do that. I think you will see that Singapore has a total ecosystem approach. And to some extent, that's also taking place in Hong Kong.
There are different strategic reasons for having an integrated system versus a purely hospital system that delivers higher margins.
Thank you, Dilip. And Dr. Prem, another question from Shen.
With regards to your stake in Fortis, what is the level that you would like to get to over the next 12 or 24 months? What are the various options that you're considering and pros and cons of each? Before maybe you can get Ashok to answer, I think now that the tender offer is behind us, all options are on the table. Ashok, if you can elaborate a little bit more on this, please.
Yeah, I think we've mentioned this earlier several times. I think Fortis remains a key business operation for us. We would want to consolidate our stake in Fortis. I think it's difficult for us to give you any clear timeline here, but we remain focused on increasing our stake in Fortis in the medium term. I think that's what I can say at this stage. I think just going back to one other question that came up earlier on Island, I think we're actually very happy and satisfied with that transaction. Strategically, it has been a very good deal for us. And I think in terms of performance, it's tracking whatever assumptions we had made at the time we went into that transaction.
Thank you, Ashok. Next question and related to Island from Siang Chi.
If I take out Island, is Malaysia still growing year on year? If not growing, what caused the year-on-year decline?
I think we shared before, if you take out Island before third quarter, the growth is flat. However, if you look at the Malaysian numbers this time around, there's an uptick in the numbers. Dr. Prem, Dilip, anything to add on to this in terms of how Island is additive to the network?
As mentioned earlier by both Kelvin as well as Ashok, Island, as you can clearly see, we identified medical tourism as one of the main growth areas in Malaysia. And from just about 6% to 7% a few years ago, now we are at close to 15%. And for the quarter, almost 16% contribution of revenue for medical tourism. And this portion is actually growing double-digit as well. So, I feel that it's a timely acquisition. And as Ashok mentioned, we are on plan, on target in terms of what we thought we would achieve as we went into that.
Thank you, Dilip. Next question from Yen.
Good morning, Dr. Prem, Dilip, and Ashok. Revenue intensity is up. Can you break out how much is pure case mix uplift versus medical inflation? We're looking at 60-40, 70-30, or is there another mixed play? Doctor retention is a real swing factor for service levels and throughput. What is your current annual turnover rate for specialists in Malaysia? And what is the target level you are managing as peer competition intensifies?
For the first question, if I can trouble Dilip, in terms of revenue intensity, how much of it is case mix and how much of it is medical inflation?
We have been from a price increase perspective. We had mentioned earlier as well, we are cautious in terms of price increases. The price increases, including medical inflation, can only be at best inflationary adjustments. It cannot be more. And hence, bulk of it has come through case mix. We do see higher volumes in terms of surgical volumes that go through our hospitals. And also bear in mind, once you take out the day care, obviously your intensity goes up as well. We had also mentioned, I think Q2 of this year, that the number of medical cases actually has come down in Malaysia, which further has improved intensity. And by medical cases coming down, it's given us capacity to actually shift and pivot towards day care within some of our existing facilities.
To address the question on turnover of doctors, we really need to look at the model of physicians that we have in our system. In Singapore, the doctors are independent, and once they leave public sector, they will accredit themselves to our hospital.
Sorry, let me repeat that. So the doctor models in our countries are quite different. And the doctor turnover is a function of that model. So if you look at Singapore, we have more than close to 1,800 doctors who are accredited to use our four hospitals. Because we are the biggest operator of hospitals, almost any specialist that leaves the public system will accredit to us. So in all our hospitals, you have a large number of subspecialty physicians that patients can choose from. So the question of turnover doesn't really arise because all of them would either be located in the clinics within our hospitals or in the neighboring areas like Novena and Orchard. In Malaysia, although the doctors are nominally independent, but all of them would like to sit in our hospital consultation rooms. So they are extremely prized.
If they leave our system and go to another hospital, we will fill that with a waiting list of doctors. So the turnover is not large because, again, in Malaysia, we are the biggest hospital player, and they would prefer to be in our system. In India, which is a very, very interesting market because rapidly expanding, all medical groups, hospital groups are expanding. There is some movement of doctors between hospital groups. But India is also a large producer of doctors. There is a constant stream of doctors coming out from all the medical colleges. Specialty and subspecialty training is very, very established. So Fortis, you will see, has opened new hospitals. They have successfully recruited new teams of doctors. And the hospitals have ramped up very quickly.
Unlike nursing manpower, which can be a problem from time to time, post-COVID was really an area of concern for us. It is now stable. But we know that nursing manpower requirements may, again, be an issue. Physician turnover is not really a problem in our system. Thank you, Dilip. And Dr. Prem.
Next question on medical tourism.
How much did foreign patient revenue make up in Singapore, quarter and year to date? Moving to Malaysia, what proportion of revenue do you foresee medical tourism making up of total revenue given the strong momentum we've seen so far?
I think on Singapore, we've shared before, and it still tracks. Foreign patient contribution is in the high teens region as a proportion of revenue. Moving to Malaysia, it's currently approaching the mid-teens territory. And in the short term, it tracks what Singapore is doing, I think, when a good place.
Would you be able to share the total bed capacity in Gleneagles, Hong Kong today? Can I confirm year to date bed capacity has increased by 50 beds and 18 beds alone in 3Q? Ashok, can I trouble you on Glen, Hong Kong, the bed capacity and the addition?
Yeah, I think what you mentioned earlier, bed capacity has increased by 18 beds in the second half of the year. Sorry.
Sorry for that. As I mentioned, bed capacity has increased by 18 in the second half of the year and 50 total for 2025.
Thanks. There's a question here from Eddie.
ETR has increased to 25% in 3Q25. Will this be the run rate moving forward? Apologies. Not quite sure what ETR is. Perhaps we'll take this offline. We'll get back to you, Eddie. Next question. Hi, management, trying to understand more on Malaysia's operational growth. Besides medical tourism, are there any drivers behind Malaysia's growth? Is there any specific hospital that's doing exceptionally well? Or is there an increased demand in the premium segment? Dr. Prem, could I trouble you, please.
Okay. Malaysia is now a very interesting market for us. Last year, all the headlines were on payer-provider issues. As you can see, that has really sort of calmed down. Not many press articles about that anymore. It still is ongoing. As you know, there is a joint ministerial committee to address private healthcare costs. That is now going on in Malaysia. We are an active participant in that as well. There's discussion on national procurement to bring down the cost of medical consumables, drugs, and all that. We hope that that will lead to a situation where purchasing costs, procurement costs go down. Beyond that, the other interesting developments in Malaysia, let's talk about foreign patients, which in Malaysia now for us is about 15%. You'll remember just a few years ago, it was 6%, 7%. Island's acquisition bumped that up.
The increase, as I said earlier, is not only due to Island. Malaysia has become a very attractive medical travel destination. We are seeing increased medical tourists in Klang Valley, in hospitals like Prince Court, Gleneagles KL, Pantai KL, Gleneagles Johor as well, and even Pantai Melaka. That has bumped it up 15%. We are quite confident that this will go up further. The revenue intensity for foreign patients tends to be higher because they tend to come with problems that are more advanced or multiple morbidities. The other thing is this big shift to day care. The impression that you will get is inpatient is a lot more profitable than day care. As Dilip explained earlier, in Malaysia, the day care revenue for a single day is actually half that of inpatient stay.
Turnover is faster, obviously, because a lot of patients who come in for day care stay a few hours or at the most for a day before they are discharged in the evening. Inpatient requires three shifts of nurses, overnight permanent shift of nurses. day care requires one office hour shift of nurses, with possibly a few staying back until the patients are discharged. Facility-wise, it's also more compact. We don't need a very big space. So these are all the factors that are contributing to Malaysia's brighter outlook, I would say.
Thanks, Dr. Prem. Next question from Shen.
Interest expense appears to have increased Q on Q as well. Can you elaborate on this given lower rate environment? Can you guide on interest cost outlook for 2026?
I think in terms of the interest expense vis-à-vis the lower rate environment, if you look at the SOFR chart, the decrease started to kick in towards end September. So I think for the rest of the year, if the other key benchmark rates track that as well, together with our refinancing efforts, which we are seeing good support from the banks, we do see interest costs coming off. And as Dilip mentioned before, we are very disciplined in terms of paying down debt where possible. Any spare cash we have goes towards maintaining debt and definitely working towards ROE as well. Next question.
Are your day care and ACC facilities located within existing hospitals, or are they typically located at other places?
Referring to both Malaysia and Singapore, in terms of Singapore, the ACCs are located adjacent to both Mount Elizabeth, the Tong Building, and The Heeren, which is next to Mount E. Orchard, for those of you that know Singapore. Royal Square, just opposite Mount E. Novena. Don't think we currently have ACC standalone in Malaysia. Hope that answers your question.
Do you see any impact from changes to ISPs in Singapore? Yesterday, Integrated Shield Plans.
Dr. Prem, Dilip, and Ashok have shared before. We have a two-tier strategy in Singapore. Gleneagles Singapore and Parkway East catering more to package deals that insurers and payers alike can use. Mount E. Orchard and Novena focusing on the high-end business.
To that end, any pressure from insurers or regulatory changes to this effect, we use that strategy to address this. Dr. Prem, anything else to add in terms of the ISP changes?
The ISP changes were announced just yesterday by the Ministry of Health in Singapore, which is really addressed at the use of riders, which the ministry has announced. With the changes, the cost of the riders is also going to go down. You would have seen some of the figures in the Singapore papers. I think the full effect will have to be studied. I think what it really translates to is lower premium or premium increases for private hospital plans. Of course, there are also public sector plans as well. The patients will have to fork out more money per admission. There's going to be some balancing. We will certainly study the. I mean, these are regulatory changes, and there's really nothing much we can do about it.
But I do not expect this to dampen private sector admissions or attendances because there are many other reasons why patients come to a private hospital.
Thank you. We'll take two more questions, and then we'll wrap up. We'll continue to answer those questions offline given time limitations.
Possible to share what is your current operational bed as at 3Q 2025? Does your previous plan to add a total of 4,000 new beds across your operations by 2028? Is it still intact? Thanks.
Second part of the question, we've shared before in recent interactions with the investment community. Now the focus, because of the structural shift towards day care, it's not entirely fixated on addition of beds. And we can definitely spread it out over a larger time period. There was a question earlier in terms of what management is seeing in terms of capacity. So this goes towards answering that. There's no hard deadline by 2028 for that 4,000 net bed add.
Just to add, now with the split between day care as well as inpatient going forward, we'll start to guide, especially as day care becomes more material in terms of what addition and what types of bed. In terms of the existing operational bed, we'll get back to you the exact numbers since we do not focus on that going forward. Next question.
How much of margin uptick in Malaysia came from medical tourism contribution from Island Hospital?
I think, as Ashok mentioned, Island has done well from us in terms of margin. If you compare that to the blended Malaysia margin, it is definitely at a positive delta to that. How much specifically? It depends on a quarter-by-quarter basis. Last one.
Do we know what the CapEx guidance is for 2026 and 2027?
Tied to the earlier question on the 4,000 bed net add per year, the CapEx guidance earlier was around MYR 3 billion. Right now, we are guiding analysts towards the low MYR 2 billion number, and depending on how the capacity uptick is over the next quarter, next few quarters, sorry, and the day care uptick, which has a different CapEx profile, we will update the analysts as and when that comes along.
If I can just address the point about the 4,000 beds that we mentioned more than a year ago, that expansion still stands because it was predominantly brownfield and in hospitals where the occupancy was very high. So we will have to relieve the occupancy of those hospitals which are running at anywhere from 80% to even 100% in some of our hospitals, mostly in Malaysia and in India. So that continues. And actually, in the last one year, we have added 1,000 beds already. That will go. But what we will be doing in line with some of the shifts in payer-provider issues shift towards day care is we will tweak our plans to set up possibly more ambulatory centers if we are able to do that, number one. We currently have day surgery centers within hospitals.
If we find that there's a hospital with a high occupancy and we were going to put in beds, we could possibly move to an ambulatory day surgery center adjacent to the hospital, like what we've done in Singapore with the two Mount Elizabeths. Then we can free up space to put in more beds as well. There are a number of operational considerations which are open, but we want to remain flexible in order to do that.
Thank you, Dr. Prem. With that, we can conclude the Q&A section, and that marks the end of our analyst presentation for 3Q 2025. As mentioned before, any further questions, please feel free to reach out to myself or Jeremy from IR. Happy to take those questions. Thank you and have a great day.