Ladies and gentlemen, good morning and welcome to IHH Healthcare Berhad fourth quarter 2025 analyst presentation. At this time, all participants are in a listen-only mode. There will be a presentation followed by a question-and-answer session. At which time, if you wish to ask for a question, you need to press star one one on your telephone keypad. I must advise you that today's conference is being recorded. I would now like to turn the call over to our first speaker today, Mr. Kelvin Chong from Investor Relations at IHH. Please go ahead, Mr. Chong.
Thank you. Good morning, everyone, and welcome to IHH Q4 or full year financial 2025 analyst briefing. Thank you for the time to join us today, early Monday. My name is Kelvin from IR. Joining us on the call and the meeting today are Dr. Prem Kumar Nair, Group CEO, Mr. Dilip Kadambi, Group CFO, Mr. Ashok Pandit, Group CCO. Very warm welcome and good morning to all. Today's session will begin with Dr. Prem sharing some opening remarks about the quarter and the financial year, followed by Mr. Dilip, who will walk us through the financial highlights for the quarter and the year. Mr. Ashok will cover the operational updates across key market geographies for the group, after which we will open up the floor to Q&A session. Dr. Prem, over to you, please.
Thank you, Kelvin, for the introduction. Good morning, everyone. Thank you for joining our Q4 2025 results briefing. Today, we will begin with our Q4 2025 results overview, move into operational highlights, and finally open up the floor for a Q&A session. Despite a challenging macroeconomic environment, we achieved resilient financial performance driven by higher inpatient admissions and greater revenue intensity across our key markets. In Q4, we demonstrated strong core growth with MYR 6.8 billion of revenue and MYR 1.5 billion of EBITDA. On a constant currency basis, we demonstrated double-digit revenue and EBITDA growth of 20% and 21% respectively. This is a testament to our diversified portfolio of hospitals across our 10 geographies. Both EBITDA and PBTMI margins remain healthy and are well within our guided range.
ROE has also improved to about 9%, increasing by 20 basis points from the previous year. We will continue to sweat our existing assets better as we aim towards a double-digit ROE figure by 2028. Given our financial performance in 2025, the board approved a final dividend of 5.5 sen per share, bringing the total dividends for the full year 2025 to 10.5 sen. Our growth in daycare continues to be successful as we see greater daycare volumes in Malaysia. In Singapore, while Mount Elizabeth Orchard has been fully reopened, we have experienced a slower than expected recovery. We believe that this is an inflection point, and we foresee stabilized contributions from the second half of this year. In India, with the completion of the Fortis MTO, India is well-positioned for greater growth.
The MSA that was executed previously between Fortis and Gleneagles continues to be on track. We are starting to see greater efficiencies in our operations. We continue on our multi-year digital transformation journey with multiple projects underway, including an ERP tender process, evaluation of a GBS model for process standardization, and ongoing product engineering works for our hospital management systems. Overall, we remain cautiously optimistic about the financial performance of IHH in 2026. As mentioned earlier, the board has approved a final dividend of MYR 0.055 per share for the full year ending 31st December 2025. Combined with the interim dividend of MYR 0.05 that was paid earlier, the total dividends declared for full year 2025 is MYR 0.105 per share. This represents a 5% increase compared to full year 2024.
At MYR 0.105 per share, this translates to a dividend payout ratio of more than 40% of PBTMI, reflecting our disciplined capital management approach and confidence in IHH earnings sustainability. The increase in dividends underscores our commitment to deliver sustainable returns to our shareholders, and we recognize your continued and steadfast support for IHH. This slide demonstrates our 2030 strategy. Our goal is to be the most trusted multinational healthcare leader, and we have laid out five strategic priorities and seven focus areas to achieve this goal. In Malaysia, we want to strengthen our payer-provider relationships while growing our day cases and medical tourism segment. Where required, we will also allocate capital for brownfield bed expansion. In Singapore, we maintain our dominant leadership position through packages at Gleneagles and Parkway East, and for Mount E, continue to focus on high-value and high-intensity cases.
We also aim to scale up contributions from Mount Elizabeth Orchard following its reopening and growing our medical tourism segment. For India, we have completed Fortis MTO, and with the MSA, we aim to integrate Fortis and Gleneagles, driving up our leverage as a pan-India healthcare platform. We also aim to accelerate growth via brownfield expansions and M&As. In Türkiye, we aim to maintain market leadership and drive more operational resiliency. In Hong Kong, we aim to ramp up operations and continue with our margin expansion. We also plan to open more Ambulatory Care Centres in the long term. On a group level, we are also progressing on our tech transformation to harmonize core systems across hospitals, and we'll continue to invest in AI and data to improve operational efficiency. We will also continue to drive synergies across the group.
Overall, by 2030, we aim to maintain our dominant clinical leadership position in healthcare with greater expansion of scale and improved operational efficiencies to realize sustainable growth and returns for stakeholders, all whilst maintaining a disciplined capital allocation policy. With that, I'll now pass the time over to Dilip to cover the financial highlights. Dilip, please.
Thank you, Dr. Prem. Good morning to all of you on the call. Appreciate you taking time off early this morning to join us. As always, we focus on the blue box, which excludes MFRS 129, since this is more accurately representing our operating performance of each of our BUs. Overall, we see a 10% growth on both revenue and EBITDA following; One. a higher patient volume. Two, revenue intensity from those patients with higher acuity. Continued growth in our medical tourism segment, and continued shifting of some of our operational operations into the daycare model that we spoke about earlier. On a constant currency basis, we had a robust double-digit growth of 20% on revenue and 21% of EBITDA, demonstrating our strong operational performance across all our BUs.
Despite some of the macroeconomic headwinds, our performance remains within our guided range, and we continue to be cautiously optimistic about our performance in 2026. We exercise prudence in our CapEx as we continue to grow our daycare business in some of our BUs. On the next slide, For 2025, we continue to see a trend of strong core growth offset by currency translation losses due to an appreciating ringgit. Revenue and EBITDA reached a new high of MYR 26.2 billion and MYR 5.8 billion respectively. On a constant currency basis, revenue and EBITDA grew 18% and 15% respectively. We also noted that the analyst consensus had projected a PATMI of MYR 2 billion, IHH has outperformed and closed at MYR 2.3 billion.
Overall, we are delighted with the FY 2025 results. Moving ahead, we remain cautiously optimistic of our performance in 2026. As with our previous presentations, the blue box represents our reported revenue, EBITDA, and next to it, constant currency revenue and EBITDA. Overall, a constant currency basis, the group achieved a 20% growth in revenue and EBITDA, demonstrating a robust financial performance. In Malaysia, we continue to see results shifting towards daycare cases as net daycare revenue continues to grow double digit. Medical tourism continues to be a key growth factor for our operations in Malaysia. In Singapore, the recovery of Mount E Orchard has been slower. Q4 2025 was an inflection point. We foresee contribution to stabilize by second half of 2026.
We continue to ramp up on our ACCs and decant more hospital capacity towards lower acuity procedures in our ACCs. Türkiye and Europe demonstrated robust double-digit revenue and EBITDA growth, both on reported as well as constant currency basis despite the FX erosion. Similarly, India continues its growth trajectory with double-digit revenue and EBITDA growth on a constant currency basis. India remains to be a key growth market for the group, especially after the MSA and as the integration is on track. Margins for the countries and the IHH group continue to be within our guided range. Overall, we have seen continued growth on a constant currency basis, driven by operational and clinical excellence, anchored by our operations in Malaysia and India. Despite the slower than expected recovery in Mount E Orchard, we remain confident in Singapore's trajectory over the second half of 2026.
Similarly, for the full year FY 2025, we saw strong double-digit growth in both revenue and EBITDA on a constant currency basis, growing by 18% and 14% respectively. Overall, at MYR 26 billion, the company, we have demonstrated a strong growth in all our key markets. This slide shows our financial performance trend for a quarterly basis. As indicated by the solid purple line, our EBITDA margins ex-MFRS 129 in Q4 was at 22%. This is aligned with our guidance of 22%-24%. The bold green line indicates our core PATMI margin, which excludes EI and MFRS 129 in Q4. This stood at 9%.
While our EBITDA and PATMI margins have remained stable within the guidance, we continue to demonstrate strong growth in absolute value of our earnings, reaching a new high of MYR 26 billion in revenue and MYR 5.8 billion in EBITDA. Looking ahead, we continue to maintain our EBITDA margins within the range of 22%-24% as a group. Our business continues to generate strong operating cash flows for Q4. As at 31st December 2025, we have a cash balance of over MYR 1.5 billion. Our gearing levels remain healthy with net debt to EBITDA at 2.4x and net debt to equity at 0.5x. This concludes the financial highlights segment.
With that, I will probably hand over to my colleague, Ashok, who will take you through the operational highlights. Thank you.
Thank you, Dilip. Starting with Malaysia. I think Malaysia saw very strong double-digit growth in both revenue and EBITDA. This is steered by a competent management team, which saw EBITDA growth of 15% and 29% on constant currency basis, and largely attributed to higher revenue intensity and higher occupancy. Despite strong and growing competition, IHH Malaysia continues on its growth trajectory and continued expansion into daycare and medical tourism, as mentioned by Dr. Prem and Dilip as well. Our daycare revenue continues to grow, reaching more than MYR 550 million for FY 2025, an increase of 10% compared to the previous year. This illustrates our efficient use of CapEx to capitalize on growth opportunities. We expect daycare revenue and volumes to increase in 2026.
We remain prudent in managing our manpower costs and have continued to manage our variable costs through continued rationalization of suppliers and consolidation of procurement and several level efforts. Overall, our EBITDA margin grew to 29%, highest in our record, on the back of higher revenue and better cost containment and probably demonstrates our leadership position in Malaysia. In the long term, we maintain our guidance of mid-20s to our Malaysian operations. If you go to the next slide. If you dive deeper into our medical tourism in Malaysia for 2025, our foreign patient contributed around 15% of our revenue. The contribution from foreign patients has doubled since our Island Hospital acquisition. On back of robust industry demand, our hospitals in Malaysia continue to see double-digit growth in medical tourism, underpinned by steady growth in census and high acuity treatments.
Moving forward, we do expect to see continued growth from medical tourism, and this will be a larger proportion of our revenue in Malaysia going forward. Moving on to Singapore. In Singapore, as mentioned by Dilip earlier as well, we have experienced slower than expected recovery following the reopening of Mount Elizabeth Orchard. Coupled with, you know, seasonality and season holiday in Q1, Chinese New Year and Hari Raya, we expect the contribution from Mount Elizabeth Orchard to stabilize towards the second half of 2026. Further, our lower occupancy is also partially attributed to newly opened transition care facility since 2025, which has seen an increase in our bed count by 200. Despite this, our revenue growth remains flat, and we see our EBITDA margin at a pretty healthy 27% levels. This demonstrates our resilience of our Singapore business.
In this quarter, we experienced a 6% growth in revenue intensity that has partially helped to offset some of the headwinds we experienced in our Singapore business. To boost our Singapore operations, we continue to collaborate with our insurers to offer targeted packages for our patients. Also including bundling of higher-end treatments into our packages to cover for both Mount Elizabeth hospitals. We've also positioned Gleneagles and Parkway East to compete with public healthcare system grade Class A wards by offering price competitive packages with shorter waiting times. We remain active in managing our manpower costs and other operating costs and to boost our productivity through various means, including AI and automation. Overall, we believe that the headwinds are temporary. We are at an inflection point.
As we continue to ramp up our utilization across our facilities, we are confident that the Singapore operations will recover and grow further. Moving on to Turkey and Europe, a very strong quarter. This is our Acıbadem business. On both reported and constant currency basis, we saw revenue and EBITDA demonstrated growth at 45%-50% respectively. Occupancy was at 71%, and revenue intensity grew at 16% from more acute patient cases. EBITDA margin climbed to 23% in Q4 of 2025. Despite higher FX volatility and translation effects, our Turkish and European business continue to perform quite strongly and has contributed significantly to the group. In FY 2025, our foreign patient contribution stands at 14%, mainly due to faster increase in local patient revenue, which grew at more than 50%.
We remain confident about Türkiye outlook as its economy continues to recover following a shift towards more conventional economic policies. Moving on to India. In India, we remain confident of its growth trajectory following the implementation of MSA, which seems to be on track. It's taken a little bit time for the operations, especially the Gleneagles operations under Fortis to stabilize, but I think they're on a good track as we get into 2026. In Q4 of 2025, there was a slight drag from the Gleneagles India operations. With the implementation of the MSA, we remain confident of the growth of our India operations. The inpatient admissions and revenue intensity have increased by 9% and 6% respectively.
On a constant currency basis, we have seen a double-digit revenue and EBITDA growth of 17% and 11% respectively. You may have already seen the Fortis results. They were pretty healthy. A double-digit growth in revenue at 17.5% and EBITDA growing by 34.8%. EBITDA margins for overall India business stands at 16% and occupancy at 70%. In the long term, we continue to make headway with the MSA, and we remain optimistic in seeing convergence of margins between Fortis and Gleneagles through greater clinical and operational synergies. Hong Kong. For Gleneagles Hong Kong, our operations continues to be on a steady growth trajectory.
Our relentless efforts in driving volumes through our clinics and more specialist consult have resulted in a rise in inpatient admissions and greater revenue intensity, leading to a 12% increase in revenue and a 25% increase in EBITDA. In December 2025, GHK has achieved PATMI breakeven despite a HKD 4 billion of bank borrowings and HKD 4 billion of shareholder loan at more than 3% yields. A new ACC, Gleneagles MediCentre in Admiralty, has contributed positively to our operations in Hong Kong as we continue to see increase in daycare volumes. Overall, we continue to project growth in our Hong Kong operations, and we maintain our guidance of high teens in the long term. The laboratories had a softer Q4. Our lab segment volumes grew by 4%-6%.
On a constant currency basis, our lab revenue increased by 6%, whereas EBITDA remains flat with a margin at 17% in Q4. Our focus remains on high-end tests, we continue to expand the number of tests, especially in the high-end tests, to more accurate and effective tests availability to both our hospitals and our outreach patients. Passing on to Dr. Prem.
Maybe just a few other points before we end this. I think many of you would know that our Island Hospital in Penang, Malaysia, was awarded the first flagship medical tourism hospital by Malaysia Healthcare Travel Council, outperforming three other well-established hospitals. In Singapore, as Ashok mentioned, we've opened our first 200-bed transitional care facility. This is in a partnership with the Ministry of Health, this caters to patients with chronic disease, lower-risk patients, doubles up as a treatment facility for the next pandemic as well. In Turkey and Europe, our landmark solar energy plant, this is actually a very big achievement. It supplies 80% of Acıbadem's total annual electricity spending. This is a significant step in achieving our net zero goals by 2050. Maybe just to reiterate the key takeaways.
We have demonstrated strong performance in 2025, and we remain cautiously optimistic for 2026. 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 key markets. We'll continue to grow them further. With that, we'll now move to Q&A, and I'll pass this back to Kelvin.
Thank you, Dr. Prem, Dilip, and Ashok for the insights and updates. Before we start, we'll first take questions from participants on the call before moving to questions on the webcast. I'd like to request each participant to keep your questions to two, given the number of participants joining us today. You may rejoin the queue after. With that, operator, please proceed with the Q&A. Thank you.
As the reminder, to ask a question, please press star one one on your telephone and wait for your name to be announced. To withdraw your question, please press star one one again. Just a moment for our first question, please. First question comes from Ian Hui from JPMorgan. Please go ahead.
Hi. Good morning, Dr. Prem, Dilip, and rest of IHH Management team. On the first question, for your 2030 strategy on slide 6 there, you are still guiding for 4,000 beds. Can you give more details which countries, and more importantly, I guess, for investors, where are these CapEx spent, and why should we believe that the CapEx cycle will raise the ROE above 9% target? That's the first question.
Okay. I think this is consistent with what we have been mentioning to the investors and analysts over the last couple of years. A large part of this growth is coming from India and the other growth centers remain Malaysia and Türkiye. We do believe some of these are brownfield expansions. Therefore, from a CapEx point of view, these are well captured within our cash flows. Therefore, you know, given that these are brownfield expansions, mostly these are definitely gonna be ROE accretive compared to, you know, a new acquisition or greenfields.
maybe just to Yan, if you remember previously we'd spoken about 4,000 beds by 2028.
Yep.
to day care, especially in Malaysia and maybe, also the ramp-up in the ACCs in Singapore, et cetera, right? That's why we are saying this 4,000 beds now will be, you know, extended over a period of time, which I've always mentioned to all of you. Hence, we are saying this 4,000 bed capacity rather than come in by 2028 can actually come in by 2030. Fundamentally, if you look at our markets, there is still a secular need for growing demand in healthcare, whether it is Malaysia or India. You will need beds, you will need higher acuity beds. Just that given that we are pivoting to day care, especially in Malaysia, we can push the CapEx cycle over a longer period of time.
We can expect this would not be front-loaded, but more back-end loaded, yeah? Will be funded by your
That-
-free cash flow.
That is right. That is right. You know, all of our brownfield expansion will be funded by, you know, cash. Again, as I've always mentioned, you know, it'll be the brownfield expansion also will be on a case to case basis, where there is need for beds where we're already operating at, you know, 80% plus utilization, we will add on brownfield beds. Again, where there is, ability to put on, you know, day care centers, that's something that we will focus on as well because the cost per bed on some of these, day care centers are, more efficient and hence, from an ROE perspective is more ROE accretive as well.
Maybe I can give a bit of nuancing so that you'll understand what we are doing now and for the future as well. I could almost say there's a little bit of a strategic shift in the way we think about healthcare operations. I've said this many times before. The fact is that there's been a big shift in payer-provider relationships. Because we have been working very well with our insurance partners in the two countries that are affected, Malaysia and Singapore, you'll note that in Singapore we are doing a lot more packages and it's at our, the two hospitals, Gleneagles and Parkway East. In Malaysia, day cases volume has grown tremendously. This is partly due to changes in the way we manage patients and improvements in clinical treatment.
For example, a total knee replacement that would have required a few days of stay, today you can discharge the patient on the same day or the next day. You shorten the stay, you turn around the beds faster. We don't really need a 100 bed expansion, for example, in a big hospital like Gleneagles KL or Pantai KL, right? You can do it as a day case. This is actually shifting our thought on large CapEx developments in our hospitals. The 4,000 beds will still remain because in a country like India, demand still far outstrips supply. You'll see that Fortis will continue to put in more and more beds. They're not...
That may not be the case in a country like Malaysia, where the expansion will primarily be in our secondary hospitals where they are operating at a very, very high occupancy of anywhere between 80%-100%.
That's clear. Thank you so much. If I can move on quickly to my second question, it will be around the EBITDA margin, especially for Malaysia. The fourth quarter was a very good number. Can we expect this trajectory to stabilize at this level?
Thank you. Again, this is something that we've always told the market. As Ashok mentioned previously in the call, there is a lot of cost containment efforts ongoing and efficiency improvement efforts ongoing in Malaysia to make our operations more efficient.
You know, I can also tell you that the price increase is very, very minimal. You know, it's probably even, you know, at or below inflation, right. Bulk of the margin expansion has really come from cost containment and efficiency improvement, right. If you ask me longer term, what do I see in terms of a steady state EBITDA, we would actually be quite happy with mid-20s, you know, let's say between 25% to, you know, 26% kind of margin for Malaysia in long-term basis.
Okay. On group basis?
Group basis, we've always maintained 20%-24%, and I think we'll stick to that guidance in terms of EBITDA margins, 20%-24%.
Okay. Thank you. I'll jump back in the queue. Thank you so much.
Thank you. Next we have Amanda Foo from Macquarie. Please go ahead.
Hi. Good morning, Dr. Prem, Dilip, Ashok, and Kelvin. Thanks for the call, and congratulations on the strong set of results. Two questions from me. Firstly, you know, I just wanted to kind of dive a little bit deeper into Malaysia. You know, the fourth quarter we did see 29% EBITDA margins, but we are still keeping with the mid-twenties kind of long-term guidance. Are there headwinds ahead that we should be watching out for? Also related to Malaysia, can you share with us, daycare or ACC, what's the revenue contribution in terms of % at this point? Thanks.
Sure. Look, you know, again, this is something that I've always, you know, kind of mentioned to all of you. Amanda Foo, as you know that, you know, I've said that, look, wherever possible in order to improve our efficiency, in order to better our cost, that is what we're focusing on each of our countries, not just in Malaysia, but in each of our countries, right? By virtue of harmonizing processes, by virtue of, you know, adapting or adopting technology, et cetera, we are able to do this, right? In various fields, whether it's in normal workflow or procurement harmonization, so on and so forth, right? We've been trying to do that. You know, however, sometimes, as I said, there is always a lead lag effect, right?
There could be, you know, wage increases that, you know, would come through. There would also be some of the other stuff that would come through. I think longer term perspective, somewhere around the mid-20s is what I would definitely guide towards in terms of a steady state margin to my mind. In terms of your second question with regards to the ACC, the day cases growth in Malaysia has been double-digit, has been excellent. However, if you compare that to our overall inpatient revenue, it's still a small %, right? However, it's growing double-digit.
If you ask me, let's say five to seven years out, you know, how do you see day case revenue as a percentage of overall revenue, I would probably put it around, you know, somewhere between, you know, 10%-15%. Because by virtue of growing your day cases, your bill sizes are smaller, but also bear in mind that the intensity within the hospitals will also go up, which means the inpatient revenue will also grow quite significantly because of higher intensity cases going into higher acuity beds. So I would say if you look out, let's say five years or so, I would probably say it is about somewhere between 10%-15% of our overall revenue.
I think, Dilip, if I can just add. You know, if what we've shown on slide 14, in the Q1 2025 you were at 24%, and we've ended Q4 2025 at 29%. It just shows, you know, a few things that we are large, we are market leaders, but we have the ability to also on a show operational strength. show, you know, how we can pivot our operations more towards, you know, like in 2025, we've gone more towards a little bit daycare. There's been very strong focus on, you know, cost optimization to get the right sort of outcome from a financial point of view for the market. I think that shows the nimbleness and strength of IHH Healthcare as well.
Thank you. That's very helpful. If I could just squeeze one more. On India, on the latest Fortis earnings call, I believe they mentioned that Gleneagles is in a loss at this point, I think about 4%, if I remember correctly. you know, with this merge or merging of operations, when can we expect this to turn around, and what would be a more stable state EBITDA margin we can expect out of India once this is done? Thanks. That's all from me.
you know, as you know, Fortis is already doing well in terms of margin expansion. On a run rate basis, they are steadily progressing towards the 25% mark that they've set for themselves. you'd also see that on a run rate basis they've been, you know, doing somewhere between 22%-23% and, as I said, steadily progressing toward the 25% mark that they've set for themselves. On the other hand, IHH India, you know, again, this is something that is not new. When we took over that company in 2023 from the minorities, it was, I would say a fairly distressed asset. We had low single-digit EBITDA margins, and we stabilized the operations, all of 2024.
Hence, in 2025, we thought it was, you know, with the MTO done, we thought it is timely to integrate the IHH India platform under Fortis' management. We think over a period of time, we would expect the IHH India platform in the medium term to get to about, you know, the mid-teens kind of mark, and from there on start converging towards the Fortis margin in the long run. That's what we're expecting as a India platform together.
Thank you.
Thank you. Just a moment for our next question, please. We have Charul Agrawal from Bank of America. Please go ahead.
Hi. Thank you for taking my question. My first question is on the capital allocation plan. Fortis has indicated that IHH might be looking to infuse funds. In that direction, wanted to understand that what would be your capital allocation priority with respect to either increasing your stake in your India entity versus looking at other geographies like other Southeast Asia. How should we think about capital allocation for you?
Yeah. No, thank you. Thank you for the question. This is something again that we've kind of highlighted in the past, I would say six-eight months. In terms of capital allocation, the two countries that would probably get the largest share of the pie is India, followed by Malaysia. India with the MTO done, we have the ability to increase or infuse capital into Fortis as and when required. If there is a need for capital, I think that's somewhere we would definitely deploy capital into, as they grow their brownfield beds and as they, you know, acquire some assets on an opportunistic basis.
The second part is really in terms of Malaysia, as Dr. Prem said, you know, there are still assets, the secondary hospitals in Malaysia, which still can expand on a brownfield basis, so we will allocate capital to that, and in, you know, the larger Malaysia platform growth as well. These are the two countries where we would really allocate more capital from a growth perspective.
Okay. No other geography, like expanding geographical presence is not on the cards currently?
At this point in time, yeah, we don't see anything.
I think we look at all opportunities from time to time, I think we right now our focus is on our four key geographies.
Got it. Just on this, India piece, another question that, Dilip indicate that we'll integrate, the India platform over time, but do we have any timeline for this?
Yeah. I think, you know, we probably we're giving you more guidance through the course of the year and, you know, clearly demonstrating that the integration is working well. I think please bear with us. Yes, I think you will get... you will hear more from us on this topic as it progresses here.
Yeah. You know, just to kind of add, you know, the integration from an operational perspective is already happening, right? The back end with regards to whether it's procurement or whether it is IT, you know, IT back end, et cetera, some of that is already happening between IHH India and Fortis. From an ownership perspective, what, you know, we are saying give us a runway of about, you know, 12-15 months, and I think, you know, we should probably get there.
Got it. My second question is on the Türkiye and Europe operations. I think there were some discussions on certain regulatory changes that were happening in Türkiye. Wanted to get your perspective of how you see that business progressing from here and any guidance in terms of how, what we can do in terms of margins.
Sure. So if you look at the Türkiye business, the Türkiye business had a pretty strong Q4. We're expecting that momentum to, you know, continue into 2026 as well as we ramp up, you know, some of the newer hospitals. Again, Türkiye has been looking at operational efficiency, you know, as well as productivity, right? I would say, you know, we, we see a robust 2026 for Türkiye.
Also bear in mind, you know, despite all the headwinds that, you know, we've seen in Türkiye over the last four years, whether it is, you know, inflationary issues, you know, FX, you know, devaluation, or some of the other, you know, exigencies like earthquake, et cetera, the Turkish business on a MYR basis has doubled in revenue as well as EBITDA over the last four years. It is a resilient business. They have grown quite nicely. From a margin perspective, you know, there are some issues. We mentioned last time that, we have a re-new regulation with regards to, you know, doctor employment, where, you know, we may have to take clinicians full-time, you know, on our payrolls from June 2026 onwards.
We also had mentioned previously that it may cause a margin erosion of somewhere between 1%-2% impact. If it's a, you know, full pass-through, then it'll probably be about, you know, 2%. If we're able to kind of ensure that we are able to pass on some of that, then it'll probably be somewhere around 1%. It's 1%-2% in terms of impact on margins.
Thanks for that. I'll get back in the queue.
Thank you. Just a moment for our last question. Next, we have Xuan Tan from Goldman Sachs. Please go ahead.
Hi. Morning. My first question is on 2026 revenue growth. Can you give us a broad guidance of the growth and key drivers across your key geographies? Second question is on strategic M&A and opportunities. Can you rank in terms of your top three priorities at this point? Thank you.
From a revenue perspective, let me take from a revenue perspective and then hand it over to Ashok to address the strategic part. From a revenue perspective, overall, the key growth areas that we see is one, Malaysia would continue their growth trajectory. They will demonstrate strong revenue growth as we've stabilized some of the payer issues and we look at, you know, pivoting towards the day cases and also adding capacity where required in the tier two hospitals. We continue to grow, you know, double-digit in Malaysia. We are, as I said, cautiously optimistic on Singapore as well. We've seen two good months in December and January in terms of some of the patient load come back in, especially with regards to the medical tourists in Mount Elizabeth.
We expect the trajectory to continue, hence we think, by the second half of this year, we should start seeing Singapore, you know, in a growth trajectory as well, you know, going into, I would say, again, reasonably high, single-digit growth. India will continue its growth. You've seen strong growth on the Fortis side, both in terms of, you know, the existing organic growth, as well as they've looked at, you know, one or two standalone hospitals. India will continue from a growth trajectory standpoint. As we integrate, IHH India with Fortis, and optimize costs there, we will see an impact, a positive impact on the margins as well in India. Right?
With regards to Türkiye and Europe, you've seen pretty strong performance of Türkiye and Europe in the Q4 of 2025 and hence, 2026 as well, we expect that momentum to continue in 2026. Overall as a group, we are quite comfortable to say we should be, again, subject to ringgit on a constant currency basis, we should be able to kind of do a double-digit revenue growth number.
Then on the question around strategic priorities and investment opportunity, I think main theme is we're gonna be super disciplined on capital allocation. I think that's something that is very clear. We've now got, you know, very good integration with Island Hospital and some of the M&A that was done by Fortis over 2024 and 2025, which gives us more confidence when it, at least when it comes to two markets, which are India and Malaysia, as we think about, you know, future M&A opportunities, you know, going forward. These are the markets which are of focus to us. New markets we're gonna look at very, very selectively and, and carefully.
We continue to see multiple opportunities, but like I said, our focus remains on delivering high ROE and proper capital allocations with two geographies in focus, India and Malaysia.
Thank you. I see no further questions at this moment. I will now hand back to Kelvin.
Thank you. If you can take questions from the webcast. First one comes from Junseong. How significant is the new labor code to India operation? What's the long-term EBITDA margin moving forward? Following such implementation, what was the reason for lower lab revenue? The third one, with the new Integrated Shield Plan ISP that comes into effect by April 2026, how would it affect your Singapore inpatient visit?
Yeah. Maybe... Thanks, Kelvin. Maybe I can take question one, and then I'll probably, you know, kind of hand over question two to Ashok and then maybe Dr. Prem can address question three. In terms of our overall labor code, the impact of labor code in India, we had a one-off of about roughly MYR 30 million impact on our EBITDA margins, Q4. I think over a period of time we expect that to kind of, you know, settle down and, you know, from a margin perspective, I don't think it'll have a material impact on our India business margins, as we drive, as I said, more efficiency and productivity in our India business.
The other point that I'd like to add is in our EBITDA for Q4, we also had a REIT revaluation loss of about, you know, MYR 30 million. We had MYR 30 million, roughly about MYR 30 million from the labor code, which impacted our EBITDA, which is one-off, and another MYR 30 million from the REIT revaluation as well. Those were the two things that kind of, the one-offs that kind of impacted our EBITDA in Q4 of 2025. I'll probably hand over to Ashok to talk about the lab.
I think on the labs, it's a good observation. I think while our focus remains on high-end tests, and I think that we are still seeing a steady volume increase and even, you know, higher contribution to our revenue and EBITDA. In some of the market we had some sort of nuances. Singapore got impacted by lower inpatient, which impacted our lab volumes. Even in Malaysia with higher daycare cases that had an impact on the hospital business contributing to the labs. I think that's some of the nuances we saw on Q4. Hopefully we see those things getting addressed as we get into Q1 and a little bit more stable, you know, lab revenue.
One of the main key drivers for the labs, you know, from our point of view, is gonna be a focus towards high-end growth, coming from high-end tests, especially in some of the bigger markets, in all the four big markets like India, Türkiye, Singapore and Malaysia.
Yeah. Maybe just to add, just like the hospitals, we are looking at, you know, driving some of the efficiencies in the lab as well, both in terms of, you know, cost, you know, reagent costs. On the other hand, also looking at automating, you know, our lab platform to enhance efficiency.
Maybe to address the IP, Integrated Shield Plans issue, we don't anticipate that it will have a major impact for the simple reason that the patients who are shifting to the public sector, who are going into the government A class beds, which comprises about, at the most, 10% of the beds in most hospitals. In some hospitals it is even less. There are very long waiting times for getting a bed in the A class. We are already, after the height of the insurance issue last year, 2020, 2021 and 2025, we are seeing a shift of the patients back into private hospitals. While there will be some impact, but for me, this is always an issue that is sort of to-ing and fro-ing, right?
Patients wanting to move but they can't get a bed. You might have to wait for up to two days before you actually get a private bed. Also with our new packages that we are doing in two of our hospitals, there's also a shift back into our hospitals to utilize these packages.
Right. On to the next set of questions from Jun Song. Believe questions one-three has been answered. Question four: Rising daycare volumes in Malaysia, does IHH have any plans to establish ACCs to cater specifically to this? If not, does treating daycare patients with a hospital setting affect your operating efficiency? Is the impact of peer pressure in Malaysia still persistent in this quarter? How do you expect Malaysia to perform once the premium cap is lifted by end of 2026?
Firstly, on daycare patients, maybe I can just say, in Malaysia today, the bulk of daycare patients are treated within day surgery centers in our hospitals. Other than the wards, there are day surgery centers, and some of the hospitals are doing some work to create dedicated day surgery centers. The advantage of this is obvious. You don't have a lot of CapEx. The beds are trolley beds because patients stay for anywhere from two hours to six hours, and then they are discharged. However, having said that, Malaysia is looking at Ambulatory Care Centres as well. There are ongoing projects reviewing where we can put Ambulatory Care Centres. That will be ongoing.
I can say quite clearly that Malaysia is seeing a significant shift into the daycare space, which I think is positive all around for patients, for us, and for the insurance as well.
Yeah. Maybe just to kind of add there. Again, this is something that I've always mentioned. If you look at even if the day cases are, let's say, somewhere around 60% of the inpatient bill, the beauty of the day cases is the revenue velocity is higher, right? Even though it's 60%, we're able to turn around the beds faster, which means you do more velocity of volume and hence more velocity of revenue. It's actually more efficient in that sense, number one. Number two, bear in mind that this is a separate center within our hospital. From a running cost perspective, as Dr. Prem said, we are able to kind of, you know, reduce the running cost for that particular part of the hospital.
In some of the existing hospital where we do not have a daycare center, we have the ability to grow the daycare center at marginal CapEx. Overall, as Dr. Prem said, I'd like to reiterate, this is capital accretive, earnings accretive. At the same time, you know, clinically, this is how the world is going towards more day cases rather than having inpatient cases.
Thanks. Moving on to the next question, we'll pick up some of these questions that we do not man-manage to answer in the interest of time. From Kok Xiang: Why has EBITDA margin improved quarter-on-quarter from Malaysian operations despite peer pressure? Is 28.6% sustainable? What is the expected EBITDA margin uplift attributable to your digital transformation initiative? Over what timeframe do you anticipate these benefits to materialize? Could you also share Gleneagles India's EBITDA margin for fourth Q, FY 2025, and how it compares with margins reported in first Q to third Q of the same year?
Sure. Maybe I can start with the first one. You know, from a Malaysian perspective, obviously, as I said, there are not just one, but there are several initiatives that we've put through. Whether it is, you know, process harmonization, whether it is, some of the digital transformation, you know, exercise that the team's undertaken, or whether it's procurement, so on and so forth. There is a lot of effort that's being put into Malaysia. Actually not just Malaysia, but as Dr. Prem mentioned in his 2030 strategy, across the group, we are looking at going big on digital transformation, right? It will have impact. It will have a positive impact from an operational perspective to make things more efficient and more productive, right?
It's over a period of the next, I would say, four-five years. Having said that, you know, I would say long term, again, from a Malaysia perspective, I would still like to guide all of you towards a mid-twenties, let's say 25%- 26% in terms of margins, over a longer period of time, is what we think is sustainable for Malaysia. With regards to Gleneagles India, you know, you know the Fortis margin, and hence, you know, if you back calculate, you probably know the Gleneagles India margin as well. Bear in mind that we've just started the integration exercise in Gleneagles.
We expect that some of the synergies that we are able to drive between Fortis and Gleneagles would definitely, as I mentioned, in the medium term, lead Gleneagles to a mid-teens EBITDA margin, and in a longer-term basis, converge more towards the Fortis margin.
If I can just add, I see there's one similar question from Joe Liu as well. I think any M&A integration takes a little bit of time. I think in India specifically with Glen India, with Fortis coming over, we had some churn in people. All the positions on our field, Fortis is fully on track in running those operations, so you will see changes coming through reflected in the financials as we get into 2026. Like, you know, like you would understand, any integration takes some time, and I think this was done very strategically because over time we want, like Dilip mentioned, Glen India to track the growth and margin trajectory of that of Fortis.
Thanks, Dilip and Ashok. interest of time, perhaps we'll pick one or more questions, and the rest we'll get back to you via email or call if necessary. From Natasha: "Hi, congratulations on your set of results. I'd like to check if there are any concerns on the U.S.-Iran war, especially for IHH Türkiye.
Well, we don't think so. If you look now at Turkish operations, other than the big domestic sector that they have in the high A-plus segment, the bulk of their foreign patients come from Europe, from East-Eastern Europe, from Central Asia predominantly, and I think that's relatively unaffected. I mean; to be very honest, these are early days. We don't know how the U.S.-Iran war is going to play out. I think at the moment, probably not too much.
Yeah.
Thank you. Last one from Maliana: "You are targeting double-digit ROE by 2028. What are the biggest levers to get there? Margin expansion? Asset turns? Second, with regards to medical tourism, do you see any slowing down in volume following ringgit appreciation?
Sure. Look, I think ROE there are, you know, several levers, right? As I said, the biggest, you know, ROE. The reason for the ROE expansion would be really from better asset utilization, ensuring that we sweat our assets better, which is what Dr. Prem mentioned in the beginning, and two, making our processes more efficient and improving our productivity. I think these would be really the key in terms of driving our ROE, and that's what we're really focused on at this point in time. These are the levers that we would use from an ROE productivity standpoint. With regards to medical tourism, you know, even though, you know, we do see that, you know, what do you call?
Ringgit has appreciated, bear in mind, some of the competing markets like, you know, Thailand, et cetera, are still quite expensive when compared to where the Malaysian market is from a bill size perspective. I think I do not see any slowing down of medical tourism for in Malaysia. We do see double-digit growth as we go into January as well.
Thanks, Dilip. It looks like we've come to the end of our allocated time. We'll conclude the session here. Joanna, Magad, I see that you guys have questions. We'll come back to you via email, call if necessary. Thank you all once again for your participation and questions. Thank you, Dr. Prem, Dilip, Ashok, for sharing the insights. Should you have further questions, as usual, please don't hesitate to reach out to myself or Jeremy from IRT. Thank you and have a great day ahead.
Thank you.
Thank you.
Thank you.
This concludes today's conference call. Thank you for participating. You may now disconnect.