Good morning, everyone. My name is Saurabh Paliwal, and I would like to welcome you to Aster DM Healthcare's earnings conference call for the fourth quarter and full year of fiscal year 2022. The company declared the Q4 results last night. Hope you had a chance to review them. They were uploaded on the stock exchange and on the company website. To discuss the results and the future business outlook, we have with us, the senior management at Aster DM Healthcare. It includes, Dr. Azad Moopen, Chairman and Managing Director. Ms. Alisha Moopen, Deputy Managing Director. Mr. T.J. Wilson, who is Executive Director and Group Head of Governance and Corporate Affairs. Mr. Sreenath Reddy, Group Chief Financial Officer. Mr. Amitabh Johri, Chief Financial Officer for GCC, and Mr. Sunil Kumar, Head of Finance for India.
I would like to take this opportunity to remind everyone on how we will conduct this call. All external attendees will be in the listen-only mode for the duration of the call. We will start the call with opening remarks by management, followed by an interactive Q&A session. During the Q&A session, you will get a chance to ask a question by raising your hand by clicking on the Raise Hand icon in the zoom application at the bottom of the window. We will call out your name, after which your line will be unmuted, and you will be able to ask your questions. We request you to please limit your questions to two per participant at a time. Post the completion of your query being answered, we will lower your raised hand. Finally, the safe harbor related to the earnings conference call.
Certain statements that may be discussed in this call are not historical facts and might be forward-looking statements. Such forward-looking statements are subject to certain risks and uncertainties like government actions, local political or economic developments, technological risks, and many of the factors that could cause actual results to differ materially from those contemplated by the relevant forward-looking statements. Aster DM Healthcare will not be in any way responsible for any action taken based on such statements and undertakes no obligation to publicly update these forward-looking statements to reflect subsequent events or circumstances. With that, I will ask Dr. Azad Moopen to start with the opening remarks. Over to you, doctor.
Thank you. Thank you, Saurabh. Good morning, everyone. Thank you all for joining our earnings call for quarter four of financial year 2022. The world is slowly getting into a stage of normalcy, with COVID being subdued and business living back to normal. In UAE, the number of COVID cases are almost nil, and in India also the cases are low, with very few being hospitalized and with minimal mortality. At this stage of nascent recovery across the world, unfortunately, the war in Ukraine alone has put spokes into the wheels of recovery of global economy. The increase in interest rate across the world, fueled by the actions of the U.S. Federal Reserve, is producing reverberations across the world. I sincerely hope that the negative clouds shall disappear, and we shall be on a stronger wicket regarding the growth in all sectors soon.
Before delving into the quarter four performance of Aster DM Healthcare, I would like to bring to your notice our major focus on ESG. All the pillars of including environment, sustainability and governance are being kept at the highest level, with millions of lives being touched by Aster volunteers every year. I am glad to inform you that the, in the CRISIL Sustainability Yearbook released in May 2022, Aster is in the strong category with a score of 64 and is highest among the listed healthcare players in the overall score. I'm extremely happy about that. We also received many other awards, but, Crisil being the one based in India, I thought that, I will highlight this.
I would also like to share with you a brief on the recently conducted first edition of Aster Guardians Global Nursing Award to honor and express our gratitude to the nursing community. The nurses are the backbone of any healthcare system, and they were at the frontline in the war against COVID. We felt that they are underrecognized and undercompensated and had to be celebrated and noted. An esteemed international jury selected nurse Anna Qabale Duba from Kenya as the winner from among 24,000 applicants across the world. The winner was awarded a trophy and a prize money of $250,000 in a function held in Dubai on May 12 this year. Nine finalists from different continents were also honored in the function.
We hope that this will help to increase awareness about the noble profession of nursing and attract many youngsters as the demand for nurses across the world is increasing, and it's estimated to be 6.5 million at present. Now, coming to the financial performance for the full year of 2022. It is a proud moment for us at Aster having crossed the landmark of INR 10,000 crores in revenue in a year, in consolidated revenue. The full year financial year 2022 revenues were at INR 10,253.53 crores, reflecting a strong growth of 19% over 2021. EBITDA at INR 1,483 crores increased INR 420 crores over the financial year 2021.
This growth in top line and EBITDA, combined with reduction in debt by INR 198 crores and low borrowing costs. Our PAT post NCI increased from INR 148 crores in financial year 2021 to INR 526 crores in financial year 2022. The ROC post Ind AS 116 for the group and in India was low earlier and now has started doing well, and during the period reached 9.7% and 7.2% respectively due to the better ramping up of and setting up the existing assets. India contribution to revenue is now 23% of total business as compared to 19% last year, with EBITDA contribution of INR 353 crores for the financial year 2022.
While the focus was on better utilization of existing facilities, we have also increased our bed capacity to 5,065 by adding 158 beds in financial year 2022. Our staff count has increased from approximately 22,000 last year to almost 26,000 at the end of financial year 2022. The major increase in strength is due to the hospitals and labs which we started during this year. I'm happy to inform you that the digital transformation of Aster is moving the right direction, and we expect it to start making a huge impact in our operations and revenues from the financial year, from this financial year onwards. Deputy Managing Director Alisha Moopen shall speak more about this soon. I shall now briefly touch upon the financial and operational highlights for quarter four of financial year 2022.
At a consolidated level, we posted revenue of INR 2,728 crore, which is an increase of 14% when compared with the same period last financial year. EBITDA is at INR 463 crore, an increase of 44%. The profit after tax post NCI is INR 226 crore, an increase of 115% when compared with quarter four of financial year 2021. With respect to GCC business, quarter four was a good quarter overall, delivering growth over last year as well as over quarter three. Revenue has grown 11% year-on-year to INR 2,121 crore. EBITDA increased to INR 384 crore as compared to INR 289 crore in the same period last financial year.
The Aster India business has grown significantly in quarter four, with revenue growth of 26% year on year to INR 607 crores, and EBITDA increasing by 147% to INR 79 crores as compared to the same period last financial year. EBITDA margins improved from 7% in quarter four of financial year 2021 to 13% in quarter four of financial year 2022. Let me now move on to some of the operational updates. In India, we have started operations of the 140-bed Aster Mother Hospital in Areekode in Kerala, fulfilling our promise to kick-start brownfield low CapEx initiatives. This takes the total bed count in India to 4,405 capacity beds. We are looking at such opportunities in various parts of India, which gives a much better return on investment and improve our efficiencies.
Aster Labs, which has its presence in both Karnataka and Kerala, has now entered into four other states, Maharashtra, Tamil Nadu, Andhra Pradesh and Telangana. As of 31st March 2022, there are two reference labs, 12 satellite labs, and 100 patient experience centers. By the end of financial year 2023, we are planning to have 38 labs and over 400 patient experience centers overall. With respect to the Aster Pharmacy branded retail stores operated by Alfa One Retail Pharmacies Private Limited under the license from Aster, we celebrated the milestone of 100 store launch in Kochi, Kerala on 31st March 2022. There are 131 pharmacies, 82 in Karnataka, 27 in Kerala, 22 in Telangana.
The plan is to reach around 300 pharmacies by the end of the financial year 2023, and it is on track. We signed a memorandum of understanding with the government of Tamil Nadu proposing an investment of INR 100 crore in hospitals, pharmacies and laboratories in the state over a period of three years. We are looking at an asset-light model with someone doing the hospital building for us. We have started rolling out the low cost labs and pharmacies in Tamil Nadu, which is something which will be there even before we start the hospital. Aster CMI Hospital in Bangalore, in association with the Indian Institute of Science, launched an artificial intelligence lab.
The lab aims to build cutting-edge healthcare products and bridge the gap between clinical medicine and technology by training healthcare professionals in artificial intelligence. In the GCC, the 101-bed Aster Hospital, Sharjah commenced operations during the month of April. We also expect to commission Aster Hospital in Muscat, Oman in the next one to two months. These two hospitals will increase our total capacity bed in GCC to 1,406. GCC, especially UAE, is an insurance-driven market. We are focusing on efficiency improvement measures, especially strengthening the revenue cycle management function. For this, we are making investments in talent for the RCM function and expanding the role of shared service center based out of India to bring down the cost. We continue to be recognized for the quality work we do, and external recognitions we receive is testament to the Aster's all-round excellence.
Aster Hospital, Mankhool achieved prestigious HIMSS stage six certification. This multi-specialty hospital is the first private hospital in Dubai to win this recognition. The achievement reaffirms Aster Hospital's commitment to integrate technology into its services to ensure advanced patient safety and error-free treatment. LinkedIn ranked Aster among the top five preferred employers in UAE. The ranking was based on our ability to attract and retain talent, including the career advancement opportunities we provide to the employees in the backgrounds. I would like to give an update on the disinvestment of non-core assets. The Saudi asset divestiture is moving forward, though at a slow pace. While we are at an advanced stage of conversation with one of the prospects, the recent improvement in performance of the hospital has led to interest by a few others, too.
As you may be aware, Saudi has most potential in GCC, with a population of over 30 million, with huge demand-supply gap in healthcare. We are exploring the opportunity for getting a Saudi partner to roll out low cost pharmacies and clinics and labs with, maybe with a partial sell-off from the hospital asset to fund this. We shall keep you informed of the developments in the coming quarters. Status of the corporate restructuring. The subcommittee of independent directors formed to look into the corporate restructuring is actively exploring the various options. We hope to give an update on the status during the next quarter earnings call. I now request the Deputy Managing Director, Alisha Moopen, to elaborate on the GCC business, the digital transformation, and other strategic initiatives undertaken by Aster. Thank you very much.
Thank you, Chairman. Good morning, everyone. As Chairman mentioned, definitely the world has started opening up and easing all the travel restrictions. This has a significant impact in the GCC for us because a large part of the population here is the expat population, rather than in Saudi. When you look at the country, the UAE has managed the pandemic very well, and Dubai in particular has pushed ahead with major reforms to attract more people to establish a base there and live here. Part of the expat population which had left during the COVID has also started coming back. We are seeing a rise in tourism, which is a big driver of commercial activity in this area.
Our resolve to get on with our lives in a normal fashion like it was before COVID is strong, and our own experience dealing with a pandemic-like situation, plus the continuous scientific innovation and research, should keep us in good stead. Going into a little bit more detail in the GCC trends, we have seen a good year-on-year growth of approximately 13% in revenue over FY 2021. I'm pleased to state that this is actually also a growth of 12% over the FY 2020 revenues, since we wanted to compare it with the pre-COVID era. The EBITDA at INR 1,130 crores witnessed an increase of 23% over FY 2021. For the Q4, the revenues for GCC saw an increase of 11% over last year and grew 4% over quarter three of FY 2022.
This has primarily been led by growth in our hospital business. The clinic revenue, it grew by 13%, and EBITDA increased by 6% over quarter four of last year. The pharmacy segment is showing signs of improvement with a marginal increase in revenue sequentially, but the EBITDA has moved from INR 76 crore in Q3 to INR 112 crore in Q4 of this year. We do continue to face some pressures from the insurance companies, and we're seeing some margin pressure both on our OP and IP business. Recently, we've had the DRG-2 implementation and the tariffs that's being finalized. We expect the IP-related rejections to stabilize. Like in any evolved market, there is stiff competition in this market as well.
The positive news is that we believe that the next financial year shall see a near normalcy being returned across GCC, especially in our largest market, Dubai. Just going on to some of the new business initiatives, we know that we need to innovate and explore new business models which involves sharing risks and rewards that will help make our business more sustainable and more resilient. We're working on a few such models with our insurance payers in the GCC. We recently launched a joint product with insurance company for the lower income group. While these are still at nascent stage, they would be critical for us to remain relevant in the coming years. We've also increased our focus on medical tourism as part of the GCC growth strategy.
This is in line with the UAE vision to increase tourism for healthcare as well. In the last quarter, we have been able to attract and treat multiple cases from close by countries for gene therapy, especially from Turkey. We've been able to provide also vaccination and cure to children suffering from SMA, which is quite a niche and advanced therapy. In order to further our growth in the pharmacy business in GCC, we are exploring the franchise model for the pharmacies, as well as looking at expansion feasibility in Jordan and Bahrain. We are working actively towards going to adjacent geographies, which has been able to see a turnaround post-COVID. We have also reset our cost base during COVID, and the business is doing much better in terms of revenue and EBITDA.
Specifically to UAE, we are actively investing into widening our range of offerings. We are setting up clinics which are focused on wellness, where we shall provide a wide range of services, including functional medicine, cosmetics, aesthetics, IV drip therapy. This is also going to be increased focus on growing other cash-related business like dental and mental health. Further, as chairman mentioned, the market in GCC, especially Dubai, remains competitive. We at Aster, we are exploring innovative business model in partnership with payers and leverage our scale in the region. This we believe will help us compete more effectively and service certain demographic segments in the coming times. Of course, our major focus for the last year has been building the whole digital muscle for Aster. As stated a few quarters ago, we continue to.
On our pursuit to make Aster more future-ready and increase and create a better experience for our patient care. We do recognize the fact that digital is really the way to further our mission of healthcare as well as wellness. We have been making some very strategic investments and building on some strategic partnerships on bolstering our digital backbone. We'd like to summarize some of the progress that has been made during FY 2022 and what's planned for FY 2023. We have been building our core digital team with a CEO that was hired last year. As chairman mentioned, we continue to make investments in talent in this area and continue to strengthen our engineering as well as the product team.
Our app, which is myAster, shall be the primary omni-channel mode of engagement and which will allow us to have a unique integrated view of patient care across all healthcare touchpoints. This will house appointment booking, teleconsults, e-pharmacy, home health, e-diagnostics, chronic disease management, and creating various streams to support patient wellness. The app is on the App Store and Google Play Store. We did a very controlled launch of the latest version in April 2022 to a select few, and we saw more than 10,000 users and 2,000+ registrations. This is only virtual consult being launched at this point, and we are yet to launch the e-pharmacy, which will be launched in a few days from now. Post the successful launch in the UAE, we plan to replicate this omni-channel care model in our top core markets in India in a phased approach.
It is expected to start piloting within our Kerala cluster in the second half of FY 2023. There's also a big focus on personalized and guided care to patients through the digital CRM, which we have launched in obs and gynae, as well as ortho across all our brands of hospital, and we have seen success with these pilots. We will be now making this a mainstream revenue initiatives. We have also launched a data lake digital initiative across Aster. This cross-vertical data lake is to leverage native data across our verticals and shall help in unlocking cross-vertical opportunities as well as engagement for our patients and customers. This shall have use cases across marketing, finance, clinical, and operations. We're working with some technology partners, and we started work on this already this year.
We have a total planned cash outflow of INR 175 crore towards digital investment, out of which we have spent over INR 56 crore as of March 31, 2022. Cash outflow for the business is expected over the next two years. Riding on the back of digitalization, we've also set up our Aster Global Delivery Center in India, mapped to our centers of excellence in UAE. This center is now one year old. Numerous process improvements plans have been implemented, thereby making processes more agile across all functions like F&A, procurement, HR, IT, RCM, to name a few. We have over 350 people operating out of three locations in India, in Bengaluru, Calicut, and Gurgaon.
The Aster Global Center is poised to become the center of innovation in the coming years, piloting some of the most critical and important processes and products. I will now request our Group CFO, Sreenath Reddy, to take you through the details of the financial and segmental performance of the quarter. Thank you.
Thank you, Alisha. Good morning, everyone. On a consolidated basis, our revenue from operations for the quarter has increased by 14% to INR 2,728 crore year-on-year. India revenues have increased to INR 607 crore, up 26% year-on-year from INR 481 crore. Revenue from our GCC operations is INR 2,121 crore, an increase of 11% year-on-year. Consolidated EBITDA for the quarter is INR 463 crore, an increase of 44% year-on-year. EBITDA from India operations has more than doubled year-on-year to INR 79 crore, and EBITDA from GCC operations is INR 384 crore, an increase of 33% compared with the same period in the previous financial year.
EBITDA margin is 17% as against 13.4% in the same quarter of the previous year, an increase of 360 basis points. PAT post NCI increased by 115% from INR 105 crore in Q4 FY 2021 to INR 226 crore in the current quarter. In terms of performance for the year, consolidated revenue from operations increased by 19% year-on-year from INR 8,608 crore- INR 10,253 crore. EBITDA for the year has increased from INR 1,063 crore- INR 1,483 crore, up 40%. India revenue for FY 2022 is INR 2,384 crore, up from INR 1,654 crore in the previous year.
EBITDA now is INR 353 crore, up from INR 144 crore in the previous year with a margin of 15%. India's contribution to the group EBITDA has increased to 24% compared to 15% in the previous year. PAT for the group post NCI is INR 526 crore compared to INR 148 crore for the previous year. Coming to the segmental performance for the quarter, GCC hospital revenue is INR 944 crore, an increase of 14% year-over-year, primarily driven by better performance of our hospitals, including Saudi. GCC clinics revenue is INR 661 crore, an increase of 13% year-over-year and 4% sequentially. EBITDA increased by 6% year-over-year to INR 122 crore and EBITDA margin is 18.5%.
With COVID cases seemingly under control, drop in RTPCR revenues and uptick in normal business has resulted in lower EBITDA margins in comparison to the previous year. GCC pharmacies revenue increased 9% year-on-year from INR 559 crore to INR 609 crore. EBITDA increased from INR 67 crore- INR 112 crore, an increase of 68%. EBITDA margin for this segment also increased to 18.5% as compared to 9.9% for the same period last year. The increase in margins for the quarter is primarily on account of purchase benefits earned due to ramp up of sales post COVID. Consolidated net debt as at 31st March 2022 stands at INR 1,806 crore compared to INR 2,004 crore as at 31st March 2021.
A reduction of INR 198 crore. India net debt stands at INR 319 crore compared to INR 306 crore as at 31st March 2021. GCC net debt has reduced to $197 million from $231 million as at 31st March 2021. The reduction in the consolidated net debt combined with an improvement in our EBITDA reflects in better net debt to EBITDA ratio of 1.6 for FY 2022 as compared to 2.7 for FY 2021. Capital expenditure during the year was INR 544 crore. In addition, another INR 43 crore was incurred towards acquisition of wholesale pharmacy business and additional stake acquisition from minority shareholders, both in India. On that note, I conclude my remarks. We would be happy to answer any questions that you may have.
I now request Saurabh to open the question and answer session. Thank you.
Thank you, Sreenath. Ladies and gentlemen, to ask a question, please click on the raise hand icon at the bottom of the zoom application. Reminder again, please limit your questions to two per participant. To ask a question, please raise your hand. The first question is from Karan Vora from Goldman Sachs.
Saurabh, can you hear me? This is Shyam. Hi.
Yes, Shyam. Please go ahead.
Yeah, sorry. I think, congratulations on the good set of numbers. The question is more on when I look at, how are we thinking about fiscal 2023 at this point of time in terms of either outlook for, revenue or how you're looking at margins. That's first question. Point number two is on the hospitals business. It's done well. You know, specifically a combination of both volume growth and, price, in terms of ARPOB increase. If you can help us understand how the hospital business will likely grow, what are some of the drivers of growth? I'm more keen on, how the ARPOB dynamics are. These are my two questions. Thank you.
Sreenath, you would like to answer?
Yeah. Shyam, yeah, in terms of going forward, it's a little bit early to give any kind of a guidance. Maybe another one quarter is something we would like to observe, and by second quarter we'll have a bit of clarity. At least, what we are seeing is that the current year looks more normalized in terms of if you look at the previous years in the GCC region, quarter one and quarter two used to always be low, and quarter three and quarter four performance will always, you know, be better. That is what we are likely to see in the current year.
Definitely, the RTPCR tests have gone down, and therefore the margins in the clinics we will see a drop for quarter one and as well as quarter two. In terms of the hospital business answering the question, we are coming up. In fact, one hospital has already launched in Sharjah, and the Oman hospital sometime during this quarter we are likely to launch. In terms of the existing hospitals, we will continue to see the same margins. We don't see, maybe in quarter one, quarter two we could see some a small drop, maybe of 50 basis points. But we feel that in terms of hospitals we should continue the margins what we have got at this point of time.
We could see a drop in the clinics mainly because of the RTPCR. Pharmacies is something which the volumes we are seeing an uptick. In fact, during the last quarter, even the sales of the pharmacies, the footfalls have started going up. Therefore, we are positive and with all the e-commerce initiatives and other initiatives being taken. Pharmacies, which was flat for some time, we feel that should now pick in terms of growth.
Just to add to that, Shyam, I just wanted to tell that one of the initiatives which we started and which we mentioned earlier was about this, the brown field opportunities, operations management of hospitals, with very minimal investment CapEx, almost nil capital. We hope that we'll be able to have significant number of hospitals in India, in the geographies that we operate. This can add to our number of beds to a great extent without CapEx being brought in. That's something that we are focusing, and if that model works, that will be a way in which we can increase our number of beds as well as with the. We see that there is an opportunity for good margins without investment, where the ROC goes up significantly.
Shyam, in terms of the hospitals we continue to see the growth. It could be something similar to what we were at in quarter four, at least for the quarter one. That is something hospitals in India continue to do well.
Yeah. My question is specific. You know, the second part of my question was on the, you know, your growth, but how are we seeing the ARPOB dynamics, either in terms of in an inflationary environment, are you able to take medical inflation linked price increases? How should we look at the mix change from a hospital perspective? Medical tourism, I think you touched upon in the opening remarks. Just those dynamics around how we should think about, you know, the growth coming from volume.
One of the things which I just wanted to mention is that we definitely know that there is a requirement for price increase and to see the inflation, how it's being covered. In India, some of the hospitals we already have, I mean, taken the price increase. Sunil, if you can just give what is being done already in India.
Thank you, Shyam. Yeah, in India already, majority of our hospitals, specifically the Kerala and the Karnataka cluster, we've already taken the price increase, both in the quarter one itself and some of them took in the last quarter four, in the end of the quarter four. These price increases range somewhere between 5%-10%, and it is not across the board. We have gone through some of the services wherever we feel it was underpriced. Looking at the competition also, we have done the price increases. I think this will be enough to ensure that whatever the ARPOB increase we have seen from FY 2021 to FY 2022, the similar uptick can be, you know, looked at at least in the way forward also.
That is in India what Sunil gave before. In GCC, we expect similar ARPOBs to continue. We don't see significant increase because, like what in our opening statement what we said, there has been some pressure from the insurance companies. The ARPOB levels will continue to be almost similar. There may not be a price increase as such, but we are looking at bringing in efficiency and increasing the volumes.
I'll just
Just to add to that, Sham, I think you will remember the point on the MDT. That's one area that we're focusing on for increasing the occupancy levels. Another one is we are fully shifting the mix of cases within our hospitals as well. When you look at Aster hospitals, for example, we have added neurosurgery, we've added oncology. There is an increase, a slight increase in ARPOB that you're seeing in the GCC hospital on account of this case mix.
We believe that while inflationary linked tariff increases is a little bit more of a challenge in insurance-led businesses, but what we have in our control is how do we have an occupancy that's something to work on, which between MDT and service level changes, where we are moving much more into tertiary care services and procedures here. I think that's where we will see the uplift on ARPOBs coming in.
Thank you and all the best. Thank you.
Thank you, Shyam. The next question is from Amrish Thakkar. Please go ahead.
Thank you for the opportunity and, congratulations on a fantastic quarter and a fantastic year.
Thank you.
To everyone in your team. The two questions I had were on the new initiatives, first in the digital and then the hospitals and clinics, the clinics and labs in India. For the Indian operation, is there some color you can provide? We've now got some very good numbers in terms of pharmacies, in terms of labs and PCs. Is there something qualitatively you could share on good and bad and how this fits into our strategy and thinking of having these in reasonable proximity to our hospitals and having some sort of an ecosystem around this? Is there any visibility you can share on a qualitative basis at the moment?
Right. From the qualitative side, as has been mentioned by Alisha, she will mention more about what is happening in the digital, and Amitabh also will mention about that. We would like to create an ecosystem where the hospitals are connected with the clinics, with the pharmacies, with the home care, and all these are tied up through the one Aster, where virtual consultation also will be available. We have been talking about this omni channel, where we want to provide this to our patients, and this is going to be a reality within the next six months once the app is rolled out in different parts of the GCC as well as in India.
That we think that will be a force multiplier, which will have significant impact on our revenues as well as our patient comfort. That is what we are looking forward. The digital driving that along with the physical, which is getting ready in India especially, so that we are now closer to the people. We always say that we have to take healthcare closer to people. That's what is happening through the physical ways. Just by online, we don't think that we'll be able to do that. Even if it is a pharmacy, if a medicine has to be supplied, we think that if we are closer to a location, it will be easy for us to provide even an online order coming in.
For fulfillment, it will be easier for us rather than many others who will have to bring it from faraway places. In all these ways, this, saturating the market with our pharmacies, our clinics, as well as with our hospitals as the backbone, I think we'll be able to provide a bouquet of services which are connected with each other. Alisha you wanted to say about the digital part?
Yeah. Amrish, I think, just echoing what the Chairman said, right? For us, in India, as the clusters are there with the hospitals, we do really think that still the funnel comes from the primary care. Primary care, while digital is a major unlock, you would still need the physical presence as well. We've got 4,000 doctors. How do we really give them access to a wider population? Definitely digital will enable that. When you're looking at combining that with the pharmacy and the medicine delivery, having these units, it really fits into making sure it's a tight ecosystem where people do think about Aster, not just for tertiary and quaternary care, because that's what we've built over the last 15 years in India.
We also wanna make sure that anything which is for primary care as well as post-op care, we are able to have that connect across from the primary care all the way to quaternary care and the post-op care, which requires both this digital as well as the physical infrastructure and network to be created. I think qualitatively from a patient's journey and experience, it gives them multiple options, and that's really what we wanted to kind of enable, right? The convenience. Whether if you want it at home, you have that option to have it at home. Whether you want to go to the store that's next to you, that's also available. We do think the whole idea is how do you empower the patients to have more choices and more access and more convenience.
We really believe that these needs to go hand in hand. It cannot be only a physical plan. It cannot be only a digital plan, which is where these have been for us. We've been trying to run these in parallel to give that dual choice for our customers and patients.
Thank you.
Just to add to what Alisha is saying. If you look back at the last year, where we haven't launched our e-pharmacy as an app, just by WhatsApp orders that have been received by us, we've been able to generate almost INR 50 crores of revenue. These are the places where we see that there's a great opportunity because the moment these are orders that are coming on WhatsApp. The moment you launch an app where your captive patient base is automatically given the option of getting the medicine delivered to home. We're also launching a lab business in UAE, so the phlebotomist can reach your home to do a test. All this ecosystem of a patient care integrated at one app is expected to give us significant revenue potential in the UAE.
Thank you all. I mean, we look forward to this over the next 12 months. I suppose as we start rolling it out, it looks very interesting. Just as a follow-on and the second question, effectively to this. So on the app itself with myAster, INR 175 crores, we've spent a little less than a third of that and will spend the remaining next two years. I think that's open, you talked also about monetization. I'm just trying to understand, beyond of course, the customer experience and the stickiness that that will create, and I guess we already have a use case in e-pharmacy kind of sales. Are there any other monetization pillars that we can see?
Sort of what metrics should we be thinking about for this digital business?
Sure. I'll ask Alisha or Amitabh to give the details. We have launched programs, chronic disease management as well as the ways in which, you know, we can avoid dropout of patients, as well as follow-up of patients who come to us and go back and then don't come back for medicines or for treatment. If you can give some details on that, Alisha or Amitabh.
Amitabh, you want to
Yeah.
Take the number.
Sure. Thank you, Alisha. Thank you, chairman. You know, if you look at, Amrish, last year, we also launched two more initiatives. One was what we internally call it as revenue augmentation. It's an initiative which allows us to ensure that a visit to a GP is referenced to a hospital. There's no handoff. It's more towards the patient care, where a patient clinical walk between a clinic and a hospital is managed. We've seen that there's a significant acceptance to that. If you look back last financial year. Even in last two and a half quarters, we generated almost INR 18 crore of revenue. Again, as Alisha mentioned in her speech, it is very limited. We just launched it at a few clinics for ortho and OB/GYN.
Similarly, when we call it as a DCRM, we've been able to create a platform which pulls the information from our HR system. For chronic cases where there is a need for a medicine or a regular checkup, a reach-out is made to the patient to further the patient care. We've seen that it has helped us get the patient back into our clinical consultation, the e-pharmacy, you know, things of multivitamins and other places. We have seen that this has led to, in the last 1.5 quarters, gave us revenue of almost INR 10 crore. Amrish, the reason I'm bringing out the numbers is because on a limited pilot launch, we've been able to see significant growth potential on this. That's why we believe that for this geography, this can be a strong growth propeller for us.
Thank you. I think that's very helpful. Hopefully as we go forward, we'll find a metric also some way to measure this because I suppose the sales will get captured or the revenue will get captured in one or the other division. Would be really interesting to track this. Thank you very much.
So-
Yeah, what we are hoping for is, over time, as the app is launched, like you said, we would be able to say about our unique number of customers which are there on the app and how much is the sort of realization per patient, right? We have kind of the data on how much that is right now. Are the pharmacy orders changing? Are the visits changing? I think those are the kind of metrics we are working towards developing.
Fantastic. Very helpful. Thank you for your detailed replies and all the best for the next year. Thank you very much.
Thank you.
Thank you, Amrish. The next question is from Ranvir Singh. Please go ahead.
Hello. Yeah. Thanks for taking my question. My question was related to on balance sheet side, the current net debt of INR 1,800 crore. Can you give year-wise repayment plan, how we are going to pay? If you could give the CapEx also year-wise, on expansion related to expansion updates.
Yeah. I can just provide the summary, but anything in detail, Saurabh can always provide. This debt, the repayment, most of this debt is in the GCC. This debt is going to be repaid in the next six years. There is a step up which gets repaid in the next six years. In India, the debt whatever we have got, that is a long-term debt in terms of close to around 12-13 years. That is on the repayment schedule. Your second question was? Sorry, I didn't get the second question.
That's CapEx. CapEx related.
Yeah. CapEx is something which we have guided earlier itself, so that every year for the next three years, including the current year, we have said that we'll be around INR 500 crore. That is the number of CapEx which we look also going forward for the next two to three years. Every year we'll have a spend of around INR 500 crore. We need to create new, newer facilities for the growth. A major part of this, almost INR 300 crore we are earmarking it to India.
That INR 500 crore would be related to that expansion plan in GCC and India that some 300 beds we are going to add in 2023?
Yeah. This CapEx is for everything that is hospitals, clinics, pharmacies, and also we have got those digital activities happening. It's a combination of all that. Out of which, out of the INR 500, INR 300 is for India, mainly for in India, it is for the hospitals. Also we are investing certain amount in the rollout of the labs. That is the plan. We have got labs and pharmacies. Labs is the one area which we would like to scale it up for. Mainly our focus is going to be on hospitals. Like Azad Moopen said, we would like to create the ecosystem in the places wherever we are present.
That is the reason we are creating this labs because we want to go to the doorstep of our customer, labs and pharmacies. That ecosystem is being created in the places where we are present. Now that as a pilot basis, we may get into other geographies where we are not present, but those numbers will be minimal at this stage.
Just adding to that, I just wanted to add on. One, wherever possible, what we are doing now in India also, earlier we used to do this in GCC only. We make it asset light, even hospitals that we have to construct, which is greenfield. We have people who are ready to construct it for us and give it on a long-term lease. While it may come onto our balance sheet with the new standards, we will have the cash flow advantage.
We are looking at that with the very attractive rates at which people are ready to construct it for us. The equipment we bring in, but half of the cost, which is the land and the building, that we don't take on our balance sheet as much as possible. The second thing, apart from these expenses, which INR 550 crores, there's some amount of replacement as well as maintenance CapEx also which comes into that because we have 5,000 beds, so naturally there'll be some replacement also which is required.
Understood. Well, just wanted to understand where the debt because we have, you know, high intensity CapEx going forward for next three years. Debt repayment may be calibrated, but still I feel that on balance sheet side, do you think by debt equity ratio would significantly improve in the next two years or maybe by year FY 25?
Yeah. Sreenath, do you want to answer?
Yeah. Definitely. If you look at it because of the financials year-on-year, we'll keep improving, right? Naturally, in fact we'll have free cash flows. If you look at the current year as well, we do have free cash flows. Going forward, because the CapEx is restricted, and we don't have any significant borrowings to make because internal cash what we are generating is sufficient mostly for our CapEx. Therefore, the repayment of the debt will happen at a faster pace. In fact, last year during the COVID time, we in fact even based on the collections that we made, we reduced the loan as well.
There is every possibility that in the next two to three years, we should have sufficient cash to reduce the debt further from the present levels.
Okay. Thank you. Just on Q4 performance, do you feel part of performance is related to pent-up demand? Because we came out with you know COVID scenario and so obviously there will be some outpatient from outpatient side also, I mean, patient side also. That 66% occupancy may have some you know related to you know pent-up demand. Do you feel any element is there in Q4?
In fact, not. Because what we have seen during this quarter also is that there is that business continuing. As well as, see, during COVID, you had all the revenues coming through COVID testing, PCR and all, which has gone away. In spite of that, we were able to have fairly good quarter. Now when we look into this quarter also the performance appears to be, it's showing that there is that traction which has happened even in the post-COVID period, even without that pent-up demand.
Going forward, occupancy because now bed capacity is also being increased, so occupancy, can we assume that 60%+ occupancy will continue in FY 2023 and FY 2024?
No, we hope so.
Yes.
It's unpredictable, but we hope so. We have been having better occupancies in some of our hospitals, especially the new hospitals, which ramped up quite fast. We hope that we'll be. We want to go up and we are seeing that trend and we will have better occupancy as we go forward. Like what has been told earlier, see, this whole idea of this ecosystem being created where there is a primary care, where there is these labs, the pharmacies, everything becomes a funnel which brings patients into the hospital. That is the whole idea of increasing the occupancy. It is Aster being seen everywhere and having points of contact in all the areas where we are.
We hope that more and more doctors as well as patients directly will come into our system and our occupancy can go up.
Okay, nice. All the best. Thanks a lot.
Thank you.
Thank you, Ranvir Singh. The next question is from Sri Shankar. Please go ahead.
Yeah. Hi. I've got three quick questions. Just wanted to know what is the breakdown of your capital employed between GCC and India?
Sreenath. You're on mute.
Yeah, I'm just taking those numbers. Can we move to the next question? I'll get back on that quickly.
Okay. The next one is the CapEx between GCC and India over the next three years. You mentioned INR 580 crores. I've heard you say that it is INR 300 crores for India over the next three years or so. The third one is receivables levels. What is also the receivable difference between GCC and India, the amount?
Yeah. In terms of the CapEx, INR 300 crore is what we are looking every year in India for the next three years.
Okay.
Have I answered that?
Yeah. That I got it. You answered that to an earlier question. Yeah.
Yeah. Your third question was?
What's the receivables difference between the two geographies?
Yeah. Receivables, see, if you look at the geography in India, and there is a big difference between how business happens in India and GCC. GCC mainly is an insured market. India is a cash market. Now, insurance during the last few years has been steadily increasing, more so in the bigger cities. Normally speaking, in the GCC, the credit period is anywhere around 90 days. You always will almost have 90 days receivables showing the books of the sales, whatever is there. That is on the GCC side. India side, because in terms of the total credit business what we do is around 20% because some of the geographies are about 15% insurance.
Some cities, bigger cities like Bangalore has about 40% insurance. The credit business, what we do is around 20% of the total sales. Even that, over that we'll have 90 days of receivables on the credit sales. In terms of your first question, capital employed, in GCC it's INR 6,500 crores, and in India it is INR 2,500 crores.
Okay. In receivables, in absolute numbers, can you give me in GCC and India?
Yeah, I can give you that. We can give you that. Just give me a minute. I'll come back with that.
Now, if I could-
Give me a break. Yeah.
Sorry. The blended rate, Sri Shankar, is the blended receivable days is 72, as we have reported in our consolidated financials.
I got it.
Yeah. Sri Shankar, just give us a couple of minutes.
Yeah, sure.
We'll give you the exact numbers in terms of receivables in the GCC and India.
Okay.
We will come back post the next question.
Thank you.
Sri Shankar, before you go off, the GCC is 88 days and the blended is 72, if that helps.
Amitabh, he wants the absolute number, so I can give you the absolute number.
Sure.
The absolute number in terms of GCC is INR 1,080 crores.
Okay.
India is INR 140 crore.
Thank you.
Thank you.
Thank you, Sri Shankar. The next question is from Deepak Poddar.
Can't hear. Hello?
Yes. Deepak, you may go ahead.
Yeah. Thank you very much, sir, for the opportunity. I just wanted to understand, firstly, the sustainability of the better margins that we have seen in this quarter at 17%. My second query is I think we currently are at about 5,000+ kind of operational bed capacity at 5,065. What's the capacity we are looking at by FY 2023 end? Yeah. Those are my two questions. Yeah.
Regarding the sustainability, from GCC, you want to take it up, Amitabh, and if from India, I think Sunil can take it up.
Sure. See, Deepak, on the sustainability of margin, we do believe that given the fact on the hospital side we are seeing better utilization and the loss has been coming down, we do believe that the margins are sustainable. However, in the immediate future, when we talk of Q1 of FY 2023, we do believe that GCC will have some impact of the Eid and Ramadan holidays that pretty much impacted most of April and part of May also. However, on the overall year, if you look at it from the perspective of clinics as well as pharmacies, we do believe that there will be some impact of PCR on clinics. On pharmacies, we have been seeing the footfall increasing.
With all the new initiatives we are launching, the margins overall on a blended basis will be sustainable.
Blended margin in GCC, right?
Sunil, you wanna talk about India?
On India, Deepak, as you know, current year we are at 15% consolidation rate at India level for the full year. Next year we are looking at the higher teens. We're talking about upwards of 19% addition to the hospitals bit of it. But maybe that is again, I'm talking about excluding the new hospitals which is coming up. In terms of bed capacity, you know that we are already at 3,900, and by FY 2023 ending, I think we'll be adding another 400 beds, you know. With that we should be around 4,300-4,400 beds for the FY 2023 year. This is something which we already signed off. This is excluding the what chairman called out about the brownfield projects with the less CapEx.
If that also comes into the picture, the number of beds will be more than that.
3,900 going up to 4,400, right?
Yes. Yes.
This is on an overall basis, right?
I'm talking about only India.
Okay. On overall basis?
You'll have to add $100, $400, $1,400 from GCC also on top.
Understood. Regarding your comment on margins, basically India segment can see improvement in margin, while the GCC segment we expect the margin to be sustainable. Overall on an annual basis, you are expecting margin to improve, right? On a consolidated basis.
Yeah. I'd like to comment there. The GCC, like what we said, the clinics margins are unlikely to go down mainly because of the RT-PCR test which we will not have.
Okay.
That is something which will bring down the clinics margins. On a consolidated basis, India definitely the margins will continue to improve. Hospital segment and the pharmacy segment will maintain our margins. We should continue to improve our margins from the present levels.
From present level, we are talking on an annual basis or the.
Annual.
Year to date basis?
Annual.
Annual. Not the fourth quarter basis, right?
No. Annual basis.
Annual basis. Okay. Understood. Sure. Yeah. That's about it from my side. Thank you very much. All the very best.
Thank you, Deepak. The next question is from Mehul Sheth. Please go ahead.
Yeah. Thank you, sir. First question on again, on India business side mainly. When we say we are seeing improvement in the margins, but considering that you will be adding new beds as well as there will be spending towards your digital initiative combined with your expansion plans in lab as well as in the pharmacy side. Do you feel that this will have some drag down impact at least in near term? Can I have your view on this?
Are you talking about the return on capital or on the?
On the EBITDA margins. Operating margins which is.
Yeah. The margins in the hospital is likely to go up because of the improved efficiency. See, the labs, pharmacies and all which are being rolled out and new being added, those areas, the margins will be less definitely, but, that's only a minor part of the overall business. Overall that impact, by way of, you know, impact of the margin will. I mean, overall revenue will be much less.
Okay, so when
Sunil, you wanted to add?
Yes, sure. Thank you. Mehul, the thing is that, as you know, even though we are adding the number of beds, you can see that the majority of the projects are going to come in FY 2025 and FY 2026. At least the next year, that is the FY 2023, we're only looking at Whitefield coming through. Majority of our other assets, whether it's in Karnataka and Kerala cluster, are above three years. They can sustain the, you know, the new losses which is going to come up from the new units. The drag will be very less, you know. At the consolidated level, at the India level, margins will not be more than 100 basis points. That's why we.
I said that, you know, we should be able to have a higher EBITDA margin and consistent growth which we can achieve.
Okay, sir. Sir, one question on your thousand-bed addition through your O&M model, basically asset-light model. Can you provide some timeline of this addition, as well as your focus region or the state for your O&M led model?
Yeah, we already have added 140 beds in Kerala, which is the Aster Ernakulam Mother Hospital. We hope that we'll be able to add between 500-1,000 beds in this financial year. Our target is 1,000, but we could be anywhere between 500-1,000. The larger part of this is likely to be in Kerala, but we also will have in Karnataka as well as in Andhra Pradesh and Telangana. We are perfecting that model, but it's also already become operational, and we hope that we'll be able to have at least 500 beds, if not 1,000 beds, during this financial year.
Okay, sir. Thank you. Sir, moving to your GCC Pharmacy business, when we say there is some benefit of purchasing and all in, which has led to EBITDA improvement. Can you break it down like, as I see the sales growth is something like 9%, but against which the EBITDA has grown more than 65%. Can you quantify some, or can you break it down this, or can you basically brief the margin expansion?
Amitab?
Mehul Sheth, what typically happens is when we have a full year of a purchase, there are certain purchase benefits that get passed on by the OEMs to us in terms of through our, I guess, volume commitment. In this particular quarter that has gone by, we have almost INR 40-odd crores of sales benefit which has come in, which is purchase benefit which has come in. Which is mainly towards the purchase deals that we have made during the year because of post-COVID. If you look at the last financial year of the same period, it was not INR 40 crores, it was a little less at that point in time.
As you look at a year-on-year comparison, this benefit will come to us in the year FY 2023 also because it's a part of an annual benefit and thus a part of a sustainable margin on the year-on-year basis.
Adding to that.
Mehul, just to add one more point is, like what Amitabh said, there's obviously been a restoration of sales. Again, as far as the breakup is concerned, we have, I think we've mentioned before also that we were trying to increase the ratio of non-pharma business in pharmacy. We used to do 75% medicines and 25% non-pharma. With that, by the year-end has shifted to 70% of medicines and 30% of non-pharma. The margins that you get in the non-pharma is also higher. It's our own products, white label products. That's also one part which is where we are thinking about sustainably increasing our margins and helping us have that margin expansion coming in.
Yeah. I would like to add on to what Alisha said. I would request you not to go just with quarter four margin numbers. That is better to look at the full year margin numbers. Because in the coming years this could get spread out. As much as possible, we are trying to get those benefits as and when it accrues. We don't want it to go into the quarter four. Generally what happens because the volume numbers do come up in the target numbers somewhere in quarter four. Quarter four, the benefits what we get will be significantly higher compared to the other quarters. On the segmental, I would request you to look at the full year margin numbers for the pharmacies.
Sure, sir. That explains, sir. Sir, last question on your clinic side. It has grown around 21% in FY 2022, but can you give growth number exclude what will be the growth?
This on what? I didn't hear that. On what?
Your GCC clinic business is up around 21% in FY 2022. Can you quantify the number, excluding your RTPCR related revenue? What could be the GCC clinic growth will be?
Okay. The thing is that, I'll answer it slightly different. The RTPCR revenues in the clinics in the GCC for the FY 2022 is around 33%. That is the RTPCR revenues that we had in the clinics. If you exclude that, clinics, we are not looking at a significant growth. Where the growth is likely to come is in the hospitals. Clinics, we don't see much of for growth.
Yeah, just to add to what Sreenath has said. When we look at the revenues of clinics, at least the PCR revenue, we don't expect that to be there in FY 2023. We also believe that the secular traffic, what used to come in clinic, which were not happening in FY 2022 and partly for FY 2021 because of COVID, is expected to resume, and we expect this business to go back to the levels of FY 2020.
Considering the new, our core business will be coming back. At least on the clinic side, we will see something lower digit growth or maybe a flattish kind of growth in the clinics.
Okay, so-
One of the things which I just wanted to tell you that we all found that during the COVID time, many of the respiratory infections, pediatric cases, ENT, all these were very low, which now has gone back to that level of a normal period. This had two impacts. One, this had an impact on the clinics because the numbers were less in all these areas. Second, this also had an impact on the pharmacy revenue, because the pharmacy usually gets a lot of its volumes and profits from acute care medications like antibiotics and all. This was also very low during this period. While there was income coming from RTPCR and all, we were losing this on both sides, in pharmacy as well as on the clinic side.
It's becoming normal and like a normalized year like 2020 now.
Sure, sir. Sir, one last, one small data point. In start you mentioned your budget for your digital spending for next two, three years. What was that number, sir? Already you have spent around INR 56 crore, and what is overall spending budget for you on a digital side?
Amitabh
You take mine.
Yeah , go ahead, please.
Mehul, we are looking at a total estimated spend across India and GCC of close to INR 175 crores, of which INR 56 crores has been spent. This also includes a bit of marketing and other expenses that we will be incurring, because at the end of the day, when you're launching a certain product, it's not only the development, it's the marketing, the other, you know, the org development and everything else that is there. It spreads across both development as well as marketing and the organizational setup. Overall, for this initiative, we expect around INR 176 crores to be spent.
Okay, sir. Thank you. That's it from my side. All the best, sir.
Thank you, Mehul. The next question is from Alankar Garude from Kotak Securities.
Yeah, hi. Thank you for the opportunity. Firstly, can you help us understand what is causing this delay in monetization of Saudi Hospital? Because if I remember correctly, we had mentioned about completing this deal in couple of months in our Feb con call. Can you just help us understand what exactly is causing the delay?
Yeah. Alisha, you would like to or
Um-
Amitha.
Yeah. Alankar, two parts of it, right? One, March was Ramadan. April was Ramadan. It ended up being pretty much a very quiet month. Eid holidays came in. There's definitely been the. In Saudi, pretty much a lot of things close around Eid and Ramadan. Things like chairman mentioned was going a little bit slow. Secondly, there has been a quite big turnaround in the Saudi business over the last six months. We had new business tenders that we have won, as well as complete renegotiation with most of the insurance companies on five-year contracts, which has happened, which restored the business. Now we have more than double-digit margins, which has been consistently seen for the last five months.
We do have some more interest from other parties as well to associate. Like chairman mentioned, we had been anyways exploring options of extending the pharmacy in Saudi. There has been a lot of people who have approached us over the last one year to set up pharmacies, and we've been looking at the right model between franchise or setting up our own. We have had discussions with various parties. We have been just sort of looking at what is the best option for us to conclude. Like chairman said, the deal, the due diligence has pretty much almost concluded.
Since there is a turnaround of the business, do we try and revisit the value or do we try and do a part monetization and go on with the new partner to also expand the pharmacy? We do wanna look at it quite strategically because Saudi is a big market for us. We have been there for a while, and we've been seeing that there is a very big difference post-COVID in the way the reforms have happened within healthcare. The kind of laws that have come in are very attractive towards healthcare investments. We do not want to take a very rushed step when we see a turnaround on the business as well. We're trying to kind of keep it more measured. We will have a stronger update for you by the next quarter, though.
I understood. My second question is on the GCC restructuring. I think we mentioned about giving an update in the next phone call. Just wanted to check whether the internal board committee have they set any timelines for finalizing on this front?
This is a priority item for the board and it's being taken up with right earnest with the frequent meetings of the committee along with the people who are in the know of things. They haven't given any timelines, and we hope that this will be done at the earliest, because this is a top priority for us, I mean, to decide how to go forward. The members are aware about it and we don't want to comment on that. We just want to tell that within by next board meeting, I mean by next investor call, I think we'll have much more clarity on that.
Fair enough. Basically to summarize this, sir, in terms of timelines, between sale of Saudi hospital or maybe not an entire sale, maybe a partial sale, then exploring a partner for pharmacies and labs in Saudi and then the GCC restructuring, in your mind as of now, what would be the pecking order?
No, I think first it should be the Saudi which happens, but maybe both are simultaneous, even both are there. When we are doing a restructuring, then we have to decide, suppose the restructuring happens first and then the Saudi sales comes, so then this has to be in separate verticals or. Because if GCC is separate and India is separate, this happens in the GCC area, and so it has to be done by them. Even that is in our mind, and so we are having this overall thing, the board committee which is formed. Once that happens, this will become little more clearer.
Of course, we know that there is a value ascribed to that asset and that anyway has to be taken into consideration. Overall, without much delay, we hope that both this process will have more clarity.
Fair enough, sir. Thank you and all the best.
Thank you.
Thank you, Alankar Garude. If there are any more questions, I request the forum to raise their hand by pressing the Raise Hand icon on the Zoom application. Since there seem to be no further questions, I want to thank everyone for joining us for the call today. If you've any further queries or questions, do feel free to reach out to me. Thank you very much and have a great day ahead.
Thank you. Thank you very much. Thanks a lot, everyone.
Thank you.
Thank you.
Thank you.
The recording has stopped.