Ladies and gentlemen, good day and welcome to Global Health Medanta Q4 FY25 Earnings Conference Call, hosted by Motilal Oswal Financial Services Limited. As a reminder, all participant lines will be in the listen-only mode, and there will be an opportunity for you to ask questions after the presentation concludes. Should you need assistance during the conference call, please signal an operator by pressing star then zero on a touch-tone phone. Please note that this conference is being recorded. I now hand the conference over to Mr. Tushar Manudhane from Motilal Oswal Financial Services Limited. Thank you, and over to you, sir.
Thank you, Yusuf. Good evening and a very warm welcome to all the participants on Global Health Limited Q4 FY25 Earnings Call, hosted by Motilal Oswal Financial Services. Joining with us today from the management side, we have Dr. Naresh Trehan, Chairman and Managing Director; Mr. Pankaj Sahni, Group CEO and Director; Mr. Yogesh Kumar Gupta, CFO; and Mr. Ravi Goswal, Head Investor Relations. Over to Naresh, sir, for the opening remarks.
Good afternoon, everyone. Thank you for joining us for today's Medanta Q4 and full year 2025 earning conference call. Our results were published yesterday, and we have already uploaded the press release and earning presentation on the website and the stock exchanges. I'm pleased to share with you that our flagship hospital in Gurugram, widely known as Medanta the Medicity, celebrated its 15th anniversary. Over the years, we have consistently set benchmarking clinical excellence and higher standard of patient care. I'm also proud to share that all our accomplishments have been achieved because Medanta Gurugram has once again been ranked India's best private hospital by Newsweek for the sixth year consecutive. We are proud to know that we are the only one in the first 150 hospitals of the world. This, of course, is a reaffirmation of our quality and the Medanta quality of care and systems.
Let me now highlight the clinical achievement of this year. In addition to the many new technologies that we introduced for the benefit of the patient, we have accomplished the first set of CAR-T cell therapies, starting with Lucknow, making a significant milestone in the advanced cancer care. Following this, Medanta Gurugram also conducted CAR-T cell therapy, an innovative treatment which leverages the patient's own immune system to combat cancer. Medanta Lucknow has emerged as a center of excellence for robotic surgeries in Uttar Pradesh, having successfully performed over 100 robotic procedures within the first six months of operations. Medanta Lucknow crossed the milestone of 25,250+ kidney transplants since inception and established itself as a leading center for renal transplant in the region. Medanta Gurugram secured a patent for a brachytherapy device known as MAULO, developed for the advanced treatment of cervical cancer in WIB.
This has been appreciated very widely, and we are now in the process of getting a manufacturing individual who can actually bring it to market. Doctors at Medanta Gurugram employed invasive and novel techniques to treat a rare cardiac condition, idiopathic restrictive cardiomyopathy, and many other surgical procedures which were done for the first time. These clinical milestones are not isolated achievements. They reflect Medanta's deep institutional expertise, cross-disciplinary collaboration of highly skilled doctors to deliver superior patient outcomes. During the year, we have onboarded 100 plus doctors across the Medanta network of hospitals. We have also continued to invest in the latest technology to enable our doctors to deliver high-end medicine with precision. As we look ahead, we plan to add approximately 1,000 beds over the next two years as this Noida facility with a capacity of 550 beds is set to become operational in Q2 FY2026.
Further in line with our commitment to expanding to early access to high-quality tertiary and boardroom care, we have announced this year three large format greenfield hospitals in high-growth regions of Mumbai, Pitampura, and most recently, Guwahati. With that, I would like to now hand over the call to Mr. Pankaj Sahni, Group CEO, to share further details and the financial update for the year. Over to you, Pankaj. Thank you.
Thank you, Dr. Chen. Good afternoon and welcome everyone to our Q4 and FY2025 earnings call. Let me take you through the key highlights of our annual performance for the year. After that, I will hand you over to our Group CFO, Mr. Yogesh Kumar Gupta, who will discuss the quarterly performance for FY2025 Q4. During the year, Medanta delivered a total consolidated income of INR 37,714 million, registering a growth of 13% year-on-year. EBITDA was INR 9,562 million, a growth of 9% year-on-year, with a strong EBITDA margin of 25.4%. Profit after tax for the period was INR 4,813 million after adjusting it for one-time exceptional expenses of INR 499 million related to the merger of Medanta Lucknow, that is MHPL, with Global Health Limited. Adjusted profit after tax stood at INR 5,186 million, a growth of 9% with a margin of 13.8%.
I am also pleased to share that the board has recommended the first-ever dividend of 25%, amounting to INR 0.5 per share. Now, moving on to the operational highlights for the year. During the year, 219 new beds were added across the Medanta network, representing a 7.8% growth in bed capacity. This includes the addition of a 49-bedded dedicated floor for mother and child at Medanta Gurugram. 112 beds were added in Patna, and 58 beds were added in Lucknow. The average occupied bed days for the year increased by 10% year-on-year, with an occupancy of 62% on increased bed capacity. ARPOBs were INR 62,722, a marginal increase of 1.3%. Increasing PPP and scheme business has been marginally ARPOB dilutive, but it has been offset by growing contribution from cancer and changing case mix. Inpatient count increased by 12% year-on-year, and outpatient count increased by 10% year-on-year.
Coming to the matured and developing hospital performance update, our matured hospitals' revenue from them was INR 26,118 million, reflecting a growth of 10% on a year-on-year basis, driven by a combination of increased patient volumes and improved realizations. EBITDA was INR 6,481 million, up by 8% year-on-year, with an EBITDA margin of 25%. Occupancy was at 64%. Our developing hospitals, which includes Lucknow and Patna, registered a year-on-year revenue growth of 10%, amounting to INR 10,940 million. EBITDA was INR 3,290 million, a growth of 3% year-on-year, with strong EBITDA margins at 30%. The occupied bed days at our developing units increased by 19% year-on-year, with an occupancy rate of 59% on an increased bed capacity. ARPOB declined by 4% year-on-year to INR 54,303, largely due to increased share of PPP patient and scheme patients in Patna and Lucknow.
We continued to see strong financial performance in Patna despite the lower realizations, with extremely high revenue and EBITDA growth numbers and very robust EBITDA margins. As highlighted in the past, our Lucknow operations have stabilized, and we remain committed to further strengthening our clinical capabilities in Lucknow. In line with this, we have added seven new directors and over 20 senior clinicians across various specialties. We have also commissioned a Da Vinci XI surgical robot and a new cath lab, significantly enhancing our surgical and interventional capabilities. Additionally, we enrolled the Ayushman Bharat and CGHS and other schemes, enabling us to serve a broader patient population. In other key updates, our revenue from international patients increased by 8% year-on-year to INR 2,086 million, contributing approximately 6% of our total revenue.
Our OPD pharmacy business continues to register strong growth, with revenue increasing by 26% to INR 1,400 million in FY2025. During the year, we have launched Medanta Clinics at Golf Course Road in Gurugram and at Ranchi in the city center, bringing high-quality outpatient services closer to the patients, making healthcare more accessible to them. CapEx of INR 6,449 million was incurred during the year, of which INR 1,367 million was towards the Mumbai hospital, while the remaining was spent towards expanding bed capacity, upgrading technology, and our Noida construction. Overall, we ended the year with a strong net cash surplus of INR 8,123 million, positioning us well to drive future expansion plans and growth.
Moving on to our various projects, in Ranchi, we have signed an O&M agreement this year to operate a 110-bed hospital with advanced OT and critical care facilities, and we expect to operationalize this in the first quarter of FY2026. This is in addition to our existing 200-bed hospital in Ranchi. In Noida, the development of our 550-bed greenfield hospital is in full swing and is expected to be operational in Q2 FY2026. Mumbai, during the year, we acquired 9,288 sq m of prime land in Oshiwara to develop a 500-plus-bed super specialty hospital there, and that activity is also underway. In Pitampura and Delhi, we have signed an operations and management agreement to jointly build and operate a 750-bed super specialty hospital at Pitampura. Both Mumbai and Pitampura hospitals are in various stages of drawing preparation and regulatory approvals.
Most recently, our board has approved a new project to acquire land and build a 400-bed super specialty destination care hospital in Guwahati, Assam, with the aim to serve the entire northeastern region of India. Overall, we have built a strong pipeline to add approximately 1,000 beds in the next two years and another 2,000 beds across various greenfield projects over the course of the next three to four years. With this, I hand over the call to Yogesh to share with you the performance for the quarter.
Thank you, Pankaj. Now, I would like to discuss consolidated financial and operational performance for the quarter. Financial performance for Q4 FY2025. During the quarter, Medanta delivered total income of INR 9,542 million compared to INR 8,361 million same quarter last year, registering a strong year-over-year growth of 14%. EBITDA for the quarter was INR 2,476 million, an increase of 20% year-on-year, with an improved EBITDA margin of 26% compared to 24.7% in the same quarter last year. Profit after tax for the period was INR 1,014 million, with a PAT margin of 10.6%. Overall, our growth during the quarter was primarily driven by the consistent volume growth over the network. Operational performance for Q4 FY2025. Our inpatient volumes during the quarter increased by 15% year-over-year to 42,901, and outpatient volumes increased by 13% year-over-year.
Average occupied bed days for the quarter increased by 12% year-on-year, with the occupancy of approximately 61% on increased bed capacity. Average revenue per bed for the quarter was INR 63,629, a marginal increase of 1%. During the quarter, revenue from international patients increased by 17% year-over-year to INR 557 million. Now, coming to the developing hospitals. During the quarter, developing hospitals cluster continued to grow strong, registering a total income of INR 2,814 million, a growth of 24% year-over-year. EBITDA for the quarter was INR 871 million, an increase of 40% year-on-year, with the improved EBITDA margin of 31%. Average occupied bed days increased by 36% year-on-year, representing improved occupancy of 60% on increased bed capacity. ARPOB during the quarter was INR 53,818 compared to INR 57,696. Same quarter last year, decreased primarily due to uptake in the scheme patients at Patna and Lucknow.
Now, coming to the mature hospitals. Total income for the quarter was INR 6,389 million, up by 5% year-over-year. EBITDA was INR 1,535 million compared to INR 1,548 million same quarter last year, down by 1%. Average occupied bed days increased by 2%, representing an occupancy of 62%. ARPOB grew by 6% to INR 69,592 quarter for FY2025 due to a change in the case mix. Now, coming to the CAPEX plan, as Pankaj highlighted, Medanta is on a track to double its bed capacity by adding approximately 3,000 beds across multiple projects over the next three to four years. We have earmarked the total capital outlay of around INR 4,000 crore for this expansion, which includes both bed capacity addition and ancillary support services, along with the maintenance CAPEX of about INR 450 crore.
The majority of this investment is expected to be back-ended, and the project will be funded through a combination of internal accruals and debt financing. I would like to draw your attention to the statutory standalone financials filed with the stock exchanges. Pursuant to the merger with MHPL, which was holding a Lucknow unit entity with the holding company GHL, the standalone financial results now include the performance of Lucknow unit. According to the figures of comparative periods, they have been restated to include Lucknow unit as well. The key benefits of the merger are export benefits under EPG scheme will now be available to Lucknow against the Forex earnings of GHL.
Free cash flow generated by Lucknow unit can be utilized by GHL without any additional tax obligations, enabling optimized fund deployment for both organic and inorganic growth, maximizing shareholder value, and streamlining of legal, regulatory, and record-keeping processes, reducing complexity and compliance costs. With this, I request the operator to open the line for the questions. Thank you very much.
Thank you very much. We will now begin the question and answer session. Anyone who wishes to ask a question may press Star and one on the touchstone telephone. If you wish to withdraw yourself from the question queue, you may press Star and two . Participants are requested to use handset while asking a question. Ladies and gentlemen, we'll wait for a moment while the question queue assembles. First question is from the line of Vinayak Mehta from Axis Asset Management. Please go ahead.
Hello. Yeah, am I audible?
Yes, please go ahead.
Yeah, perfect. Sir, could you please repeat the CAPEX number? I just went out on the total CAPEX for the beds. Did you say INR 4,000 crore?
Yeah, I said INR 4,000 crore.
Okay, perfect, perfect. The second question I had, could you give a sense of how many transplants have we done in this quarter and in FY 2025, and how have those grown on a year-on-year basis or maybe on a trajectory-wise? How have transplants grown for us?
I do not have the number upfront with me. I just wanted to, however, quickly clarify two or three points because there are many different types of transplants. We do kidney transplants, liver transplants, bone marrow transplants, heart transplants. I do not have that number, I am sorry, with me off the top of my head, but our investor relations team will be able to get that back to you. The only thing that I mentioned in our script is that in Lucknow now, we have crossed 250 transplants in the kidney area. I think that we do a significant number of transplants across liver, kidney, bone marrow, of course, in our Gurgaon facility. We do liver and kidney and bone marrow in Lucknow as well. In Patna, we have not yet started liver transplants, but we are doing all the others.
Understood, understood. The last question would be, how are you seeing the competitive intensity across your major markets? I mean, all the larger players, I think except for Patna, at least in Lucknow as well as in the NCR region, have been expanding and doing their own work as well. Just a sense on how are you seeing that competitive intensity play out across the board?
I think there are two ways to look at this. One way that you see is a lot of what you may hear because of the various listed players that you mentioned who are expanding their buildouts across various cities of India, not only in the north but also in the south. We do see an increase in the amount of beds announced, the amounts of hospitals announced. Although I also want to caution, a lot of the announcements are just that, announcements. The hospitals are not yet being built. That will, of course, take a certain amount of time to build the hospitals. We do see some amount of that. The second thing that may not be so visible to our capital markets investor community is that we do also see a scale-up of local hospitals.
You see renovations, you see increasing amounts of innovation coming in and new talent coming into the smaller local hospitals that may not be listed but may be relevant in one city or the other of the country. Now, our point of view actually is that all of these things are very, very positive for the industry as well as, of course, for the patient community. The reason I say that it's very positive is that if you look today at the Gurgaon market, many people refer to Gurgaon as a medical hub. What that results in is two things. One, of course, we get patients coming in from all parts of the country or at least the northern part of the country.
We also get clinical talent that is gravitating towards the city, and that enables people to hire better and so on and so forth. This idea that Gurugram today is a medical hub is not something that was always there. In fact, before Medanta Gurugram opened, there was hardly one or two smaller hospitals in Gurugram. We were very much part of building it into a medical hub, and that actually creates a phenomenon where, to put it frankly, it's a rising tide will lift all boats type of phenomenon. We believe that that is likely to happen in several markets. We have already seen when we initially went into Lucknow, there was a lot of skepticism about why are you going to tier two. We have seen our competitors following us into those markets.
We do believe that the Lucknow-Kanpur region will also become a medical hub in the years to come. Similarly, we believe that there will be additional development of the Delhi region, all aspects of it, frankly, both the central Delhi region as well as places like Noida, into other medical hubs. Of course, with the huge and expanding population of Delhi, we personally feel that there's still a lot of capacity addition that is required to service that need over there. Lastly, if you look at some of the movements that you've seen over the course of the last year or two in the western part of the country, which again was not very active with the established players, you see now a lot more activity happening in Maharashtra, Mumbai, Nagpur, Pune, etc.
These, in our personal opinion, are actually all very positive for the industry and very positive for the patient community. We are not overly worried. We feel that in the long run, this will be very beneficial.
Perfect. Great. Thank you. Thank you so much.
You're welcome.
Thank you. Next question is from the line of Damyanti Keria from HSBC. Please go ahead.
Hi, good afternoon, and thank you for the opportunity. My first question is in Lucknow and Patna hospitals. I understand most of the patients are cash-paying patients, like self-pay. You mentioned you have now empaneled Ayushman and some other schemes. I just want to understand, should we assume these two hospitals will mostly remain cash-heavy and the contribution coming from the insurance channel might not be very significant in the near term, near to medium term? How should we look at the payer mix there?
I think just to clarify, Damyanti, I'll let Yogesh also chime in on the numbers. Just to clarify, I think when we use this word cash, we typically actually mean cash plus TPA. I think the more appropriate word would be to use our listed tariffs rather than the actual mechanism of cash. I think the intention is not to define cash versus credit in the sense cash versus insurance, but a lot more to say that these are the published rates of the hospital, which are a little bit, of course, the scheme rates, as you're aware, are lower than the published rates. If you look at our payer mix across the group, we still have about 82% of our payer mix coming from the cash TPA market.
If you look at our Lucknow and Patna markets, I think that may be even closer to 90%. Of course, we do have some TPP business in our Patna market. As we had mentioned, I think maybe a year-ago plus earnings call, we did always intend to take some of the scheme business in Lucknow to serve those patients. Yogesh can correct me on the numbers. I think still upwards of 80-85% is cash.
Okay. Yeah, I think I was considering only cash, but thanks for clarifying it's cash plus TPA. Okay, that's the first question. Second is your ARPOB, as we saw in last few quarters, single-digit growth. So just want to understand whether you have any plans to take any tariff hike or like in the past, you will just continue to focus on volumes and business mix?
No, I think we will be taking some tariff hikes. We have, in fact, taken some tariff hikes already, which in Gurgaon at a nominal rate. As you're aware, some of our discussions and negotiations with the insurance companies, they happen typically once in a two-year time frame. Those negotiations and discussions will also happen. As you rightly pointed out, we have not yet taken a tariff hike in Lucknow and Patna. That may also be something that we may do over the course of this financial year. However, as I've always mentioned, our tariff hikes are typically nominal. We don't make very big jumps in tariff hikes, preferring to maybe stick to numbers which are near about maybe the routine inflation. The intention is not to overly burden the patient community with increased tariff, but just to cover for the inflationary and input cost aspects.
Got it. So very broadly.
It will be selective unit by unit. Even within the units, it may be selective for certain departments because we do take the clinicians into confidence before doing any of these things.
Okay. So for ARPOB, the growth trajectory which we should look for next few years should be in single digit, right? Maybe low to mid-single digit range?
I mean, I think that would be fair. I would be a little hesitant to say that it would be in double digits, barring some very strange kind of input cost changes which we saw right after COVID. Typically, if you go back to earlier times pre-COVID, we did see it in the single-digit, maybe mid-level single-digit time, which is broadly in sync with how it moves globally, a little bit more than inflation is typically healthcare inflation.
Got it. My last question is on your Pitampura unit, although it's a bit away. Nonetheless, in your presentation, it mentioned you'll be incurring around INR 6 billion of CAPEX. You are doing this hospital jointly with the society. Is this INR 6 billion your portion or is that the total CAPEX which you have planned for the hospital?
This is our portion because the structure, etc., will be built by the society. We are not counting that to our CAPEX output.
Okay. This will be obviously much back-loaded, right? Nothing maybe in, say, next one or two years. It is a bit late in terms of, yeah. Okay.
Some nominal amounts because this design development is all, so we'll incur some expense on the design side. Mostly, this expense will be after we have built the.
Got it.
Just even to clarify, even our greenfield projects which we build completely are typically from a cash flow point of view, typically also back-end loaded because a lot of the expenses come in the interiors and medical equipment. The greenfield projects upfront have typically the civil cost. I would say even if you are taking 100%, I would say almost 60% or so is back-loaded in the routine cash flow of a greenfield project.
Okay. Pankaj, can you also clarify in a typical greenfield, again, the majority of cost is towards the medical equipment and servicing, etc., and the civil constitutes a relatively smaller part? The way you said, maybe it's 40-50, or how should we look at that?
No, I was referring to the cash flow, not the breakup between civil. Any project has basically, I would say, four major buckets. One, of course, is, I am not including the land cost. If you take out the land cost, there would be the civil and the construction-related activities. There would be all the services, which is your electrical, mechanical, air conditioning, HVAC services. That is the second component. The third component would be your interiors. The fourth component would be your medical equipment. This broadly is how you think about the project cost. I am not including any of the pre-operative expenses and all the consultancy expenses, etc., but those are also there. Most of the costs beyond civil are back-end loaded because it does take about a year, 18 months to get the civil structure up.
Then probably another 18 months or so, maybe a little bit more, to get the interiors. Then the medical equipment is the last, of course, to come in. The cash flow is back-loaded. I would say the breakup between these four components, maybe a little bit more on the interiors and services part because obviously, it depends on how many operating rooms, etc. Civil is probably the lowest component of it. I would say it's probably between 20-30% is each component, maybe with civil being a little bit lower.
Okay. That's helpful. Thank you. I'll get back in the queue.
Thank you. Before we move to the next question, a reminder to the participants to ask a question. You may press star and one. Next question is from the line of Janil Kothari from Vasuki India Capital. Please proceed.
Hello. Hi. My question actually revolves around a gross block per bed or maybe CAPEX per bed. Our gross block has always been around INR 9.5 million-INR 10 million per bed. Our country is actually witnessing a good acceptance of pre-engineered buildings, especially in a very CAPEX-heavy business, which helps to lower down the CAPEX spend and which eventually helps to have a superior return profile. Hospitals being a very CAPEX-heavy business along with a good gestation period, break-even, what's your point of view regarding the acceptance of pre-engineered buildings in this sector?
We have been looking at this very closely. I think that the jury is still out on this. I can give you two very specific challenges or concerns. One, of course, as you understand, hospitals have significantly higher requirements for various types of services because of our operating rooms, our ICUs, etc. The way in which Medanta builds these facilities in line with the best international standards, we may have even higher than many others in the industry. We do need to be cautious about these pre-engineered types of buildings. We have also looked at steel structures versus cement structures. The second major concern in all of this construction is around safety. Some of that safety is related to fire safety and the ability to bear the fire ratings as well as the structural safety of the building.
Unfortunately, we have not yet seen very mass adoption of this in the hospital sector, probably because of these two reasons. That is the reason why till now we have not gone with any of these structures. New technologies, new materials, new techniques are being done. We are evaluating this and also evaluating whether kind of a hybrid structure can be put in place. We are looking at this hybrid structure for, say, for example, our Mumbai project to see if that is possible. That may help with, more than anything, maybe speed to construction. It is still to be determined.
Thank you. That helps a lot.
Thank you. Participants, to ask a question, you may press star and one. Next question is from the line of Anshul Agarwal from MK. Please go ahead.
Hi. Thank you for the opportunity. Am I audible?
Yes, please go ahead.
Yeah. Great. So a few questions or clarifications on upcoming projects. Could you help us with the timeline for the DLF project and the Pitampura project?
Let me go one by one. Our DLF project is currently in the phase where we have started the barricading activity and the soil testing activity. That construction activity will still probably take about three years, I would say, to go to complete finishing. We've started in our Pitampura facility doing the drawings, and we are ready to do those submissions. As soon as we get the approvals, we'll be in a position to start that activity as well. That also is likely to take somewhere around three years. Both the projects are about three years out.
Got it. Just follow up on these two projects, sir. Will we be sharing rent or will we be sharing part of revenues in both these projects?
I mean, it's more or less the same thing. Part of revenue is, in a way, a rental income only for the party that owns the land. Depending on the commercial arrangements with the party, it is typically rent or revenue share or some combination of both with a minimum guaranteed rent.
Okay. We have the same kind of conditions in both the projects, similar or same?
Yeah. I mean, there are slight differences in both of the projects. Really, that is a question of what is the commercial arrangement that you come to terms with with respect to the landlord or the other party that is in the construction in the hospital partnership.
Sure. The second question I had was on.
It depends on how much money the other party may be putting in in building. Obviously, if somebody gives you just the land, it's a different rate. If somebody gives you land and the cold shell, it's different. If you get land plus warm shell, it's different. That's how it typically works in the industry.
Sure. Second question I had was on the Noida project. We would have already hired certain doctors, clinicians for this project. Are those costs sitting in our Q1? Have we incurred any of these costs in the current quarter? Q4, I'm aware.
It's not hired any doctors as of now. Because doctors will get hired near to the opening of the facility. We are talking to various people.
Offers are out in the market, but the cost is not yet in the P&L, except for the people that are already sitting in our other units who may move to Lucknow, who may move to Noida, sorry.
Great. Thank you so much. That's it from my end.
Thank you. Next question is from the line of Sumit Gupta from Centrum. Please go ahead.
Hi. Thank you for the opportunity. Am I audible?
Yes, please proceed.
Yes. Sir, strong momentum was visible in developing units in this quarter. Do you see the momentum continuing for the, let's say, foreseeable future for the next at least one to two years?
I mean, I always caution on these calls and in my meetings that we do not run this business quarterly. We do not really look at how things move quarterly. Those just happen to be the outcomes based on how you put the calendar reporting together. What I would say is that we feel still fairly confident about the future growth, both in the short term as well as in the longer term on all the developing hospitals. Now, just to kind of keep in mind that as we move Lucknow into what we had originally at the IPO time classified as developing and non-developing, I think we had taken about a six-year time frame. Theoretically or technically, I guess Lucknow will now start to move into the mature hospitals depending on how you define that. That is really just how you report out in the investor presentation.
I think if you forget about this nomenclature or classification of developing versus non-developing, and you talk specifically about both the units as well as both the cities, I think we have a good amount of growth to come in both Lucknow and Patna because we still have better additions to do there, first of all. Secondly, we are still doing very aggressive hiring in both the units. Thirdly, if you look at the potential of these markets, both in terms of the city of Lucknow and the city of Patna as well as the surrounding areas, there is quite a lot of scope for all of this to grow. I did mention as well in response to another question that we do believe at least the Lucknow-Kanpur region will develop as a more robust medical hub. We have seen that already with Gurugram.
We've seen that with other cities like Delhi and even places like Bangalore, Hyderabad. They end up delivering a good amount of growth for all the hospitals in the ecosystem once they become these more established medical hubs. I think Lucknow and Patna are very, very early days for those markets from a healthcare industry point of view. They will continue to develop and continue to grow.
Okay. And second question is on the Noida facility which is about to come. How do you see this facility ramping up in the first year? You will see competition from Max or Jaypee will add to the competitive intensity. Some other hospitals are also very big chains. How do you see the competitive intensity in the Noida region particularly?
First of all, just to clarify, Max JP is the same now because Max has taken over JP. If you look at the Noida region, the population explosion just in Noida itself, forget about the surrounding cities all the way up to Agra, Bareilly, Meerut, Saharanpur, etc., is just very, very high, very, very dense. Frankly speaking, historically, Noida has had a very short supply of hospital beds, leave alone quality hospital beds. We believe that there is a very big opportunity in Noida. We believe that even after kind of our hospitals open and some of the other expansion that has been discussed with some of the other hospitals, there is still quite a lot of capacity required in that territory. That is our belief. We do not see any big issue with respect to oversupply, if that is the first question.
As far as the ramp-up goes, look, again, hospitals typically do take a couple of years to ramp up. Medanta has been very fortunate that we've been able to deliver EBITDA break even in our recent facilities of both Patna and Lucknow within the first year. I would say that is good and fortunate. We shouldn't always plan for that. There is a certain build-up time. A lot of it depends on how the clinicians come on board, how the community reacts to our services. We are feeling fairly confident about this. Any normal hospital, especially a hospital of this size, does have a certain ramp-up period. We are planning for that. Of course, we're hopeful for as fast as possible.
Okay. Sure. Thank you, sir.
You're welcome.
Thank you. Next question is from the line of Tushar Manudhane from Motilal Oswal Financial Services Limited. Please go ahead, sir. Mr. Tushar, your line is unmuted. Please go ahead.
Yeah. Am I audible?
Yes, please proceed.
Yeah. So with respect to the addition of operating beds, maybe specifically for FY 2026, 2027, with Noida getting added, is there scope to add more number of beds at Lucknow, at Patna, maybe specifically for FY 2026, 2027, if you can just bridge the bed additions for the next 20-24 months? Even the other projects are under construction phase.
Yeah. If you look, Tushar, at our investor presentation, I think it's slide number 32, if I'm not mistaken, you will see that there is bed addition plan not only in Noida but also in Lucknow and Patna over the course of the next, let's say, 12- 18 months. We do expect to add approximately 1,000 beds across all of these three units in the next few months and years. That does not include, or maybe that's part of that also, we'll have our new 110-bed facility, which we have just taken on board, I think, in January of this year, if I'm not mistaken, in Ranchi, which is augmenting our existing 200-bed facility because we had some capacity constraints there and wanted to upgrade the technology and infrastructure. The Ranchi facility, we hope to come on board this quarter itself in Q1 FY 2026.
All the three other facilities, Noida, Lucknow, and Patna, should have bed additions as well.
Got it, sir. If you could elaborate on this Guwahati as a new addition in terms of location in first place for us, and subsequently, what kind of sort of investment specifically over the next one year or two years, and then subsequently in terms of construction? While you have already highlighted the overall topics, but if you could just break that into, say, construction cost and, let's say, land purchase cost.
Yeah. So we have been looking, actually, for land in Guwahati or in the northeast region for some time. I believe when we announced this as part of the government's Invest in Assam Summit or initiatives, we have been able to get land from the government and to build out a 400+ bed super specialty. We currently have been allocated three acres of land in Guwahati. This is, I don't know how familiar you are with Guwahati, but this is on one of the main highways which actually connects Guwahati to Meghalaya and Shillong as well. It has good drainage not only from the Guwahati region, from the Upper Assam region, as well as from parts of Meghalaya. Very well situated from that point of view. The project cost is about INR 30 crore-INR 35 crore is the cost of the land.
The total cost is approximately INR 500 crore. Like with most greenfields, that should take us about three years or so to get going. We have already triggered some of the planning as far as the clinical planning and the drawing activity of that. Of course, that will take some time. We just got the land, I think, a month or so ago.
No, we got basically agreement from the government. Now we have to get the registry done and then take a position on that.
Understood. So just on this, you would take INR 500 crore for 400 beds. Given the location is Guwahati, still a crore per bed sort of an investment. Typically, tier two city, correct me if I'm wrong, this is not a tier two city, but this typically takes lower bed costs. Any particular reason why we are just spending it much higher?
You know, Tushar, we at least in the Medanta ecosystem because I think you may have seen on the.
Say you're audible.
You still there?
Yeah. Okay. I was saying if you have seen our kind of hospitals that we have built in Lucknow and Patna, both from a civil and interiors and infrastructure point of view, as well as in terms of the medical equipment that we put in there, whether it's the latest CT, MRI, or in fact, the latest and most advanced Linac machines, we have not compromised on any of the quality in these cities. The basics of construction remain the same. Our belief is that we should be able to deliver this kind of standard of care and build out these kind of facilities.
In fact, one of the reasons why the government was very keen that Medanta come into that region as opposed to maybe many of the other options was exactly because they understood that when we go in, we bring a standard that is second to none. We do not necessarily compromise on the quality of the facility that we put up just because it may be a city that is a non-metro city. Having this in mind, yes, there is a difference between the land cost in Guwahati and, say, a Delhi or a Mumbai. We have been fortunate to get land at very attractive rates thanks to the scheme of the government. The basic cost is more or less the same.
I think today, if you build a hospital with any kind of standards like what we put up, I think INR 10 million or INR 12 million sometimes even going a little bit higher, is a typical cost, especially if you're going for bigger scale. You could possibly do it at less for a smaller 200-bed facility. This will be 400 beds and maybe even higher than that. I do not think it's very different from anything anywhere, frankly.
Got it, sir. And just lastly, while you have outlined the overall INR 4,000 crore capex for the next five years, but if you could maybe highlight the capex for FY 2026 and FY 2027.
Yeah. I'll let Yogesh take it.
Tushar, we haven't done a breakup tier-wise at present. Okay. Okay. Yeah. That's it from my side.
Thank you. Next question is from the line of Dhaval Gut from Jefferies. Please go ahead.
Hi, sir. Thank you for taking my question. Not sure if we covered it earlier, but wanted to know the outlook for Lucknow hospital. Do you expect a significant volume growth to continue? When are you adding additional beds into the unit? Did the quarter have any positive or negative impact because of Maha Kumbh Mela? Have you seen those impacts reversing in the first quarter? How were the trends in April? That's one. Second, needed data point, what's the census bed count in our developing hospital units?
Okay. So a couple of questions. Let me see if I remember all of those. I think the first question was around Lucknow, right? What do you say? What was the growth on that?
Yeah. Yeah. The outlook. When do you see adding more capacities within the unit? Do you see profitability being steady or improving? Growth being higher than what we have seen or steady or any kind of adverse impact?
Okay. If you recall our various quarterly presentations over the course of the last few quarters, you will, of course, remember that we had a little bit of lower growth rates in Q4 and Q1 specifically, as Q4 of last year and Q1 of this year, and some drag of that into Q2 to some extent of this year. We had mentioned significant steps being taken to bring that unit back to the kind of volumes that we had seen earlier. Happy to report, since Q3, Q4, we see fairly strong performance in Lucknow, very good with the margin profiles, very good growth volumes, good amount of performance across all of that unit. Very happy with how that has played out over the last couple of quarters.
Obviously, as you look at all the four quarters together, there's some impact of that on a year-versus-year basis. We do see that growth having come back already. We do see good opportunities as we move forward. We will be adding beds in Lucknow. We have a certain amount of beds to add in on various floors in our existing facility, which is already partially completed. We could be adding currently maybe mother and child, additional number of beds, maybe adding some more beds for some of our transplant and complex specialties. I mentioned, I think Dr. Trehan may have also mentioned, we've added in pretty advanced equipment there in terms of robots. I think we've already done within a period of about six months, we've done over 100 robotic cases, which is the highest number in the Lucknow area, I think, in a short period of time.
We continue to invest in clinical talent as well as technology there. For us, we're not stopping anything in Lucknow, going full speed ahead with all of the activities there. We do believe that there is good potential left in the city. We'll be adding in additional specialties also in the coming months and quarters. There are certain specialties we still don't have there, and we have plans to acquire clinical talent to be able to deliver those specialties as well. That's the story with Lucknow. What was your second question? Sorry, if you can remind me again.
Yeah. Do you think your operations were impacted because of Maha Kumbh during the quarter? Was there any delay in elective surgeries that you felt, and that kind of impacted your occupancy? Maybe that could have started to come in from April onwards. Overall, you were neutral, or you saw some benefit because of a lot of population coming into the UP region and Lucknow region also. Was there any kind of impact because of the entire population moving into this UP region out there?
I mean, I don't have any specific data that tells me people who are coming from Maha Kumbh Mela suddenly decided to also use it as an opportunity for any kind of healthcare experience. I don't think it was positive in that way in terms of adding any great population inflow into the healthcare facilities. There is, of course, definitely some impact on these kind of festivals in terms of people having elective procedures. We see this pretty much every season where during, of course, COVID aside, sorry, dengue and some of the seasonal diseases aside, we see that during, say, the Diwali, the Dussehra, Chhath Puja kind of time frame where the festivals are on, we do see some kind of dip in the elective procedures.
To that extent, I guess Maha Kumbh also has more of a negative impact than a positive impact because of the population coming into the UP region, I think. I do not think that I can tell you very specifically exactly what was the number of people who did not come or came because of Maha Kumbh. I do not think we tracked that. Yes, some movement across different weeks, travel constraints, etc., it does impact patient movement to some extent.
Got it. And lastly, just.
Yes, sir.
Yeah. Data point, what's our current census?
Your question on census beds, right?
Yeah. On the developing hospital side. Yeah.
Yeah. If you look at our census beds on the developing hospital side, we have about 600 or so beds in Lucknow and about 320 beds in Patna. Around 930 is the census beds for the developing.
Okay. Thank you. That's it from my side.
Thank you. Next question is from the line of Alankar Garude from Kotak Institutional Equities. Please proceed.
Hi. Good evening, everyone. First question, mature hospital margins have come down on a year-on-year basis by 120 basis points. Can you please call out the reasons for the same?
Margins in developing hospitals, you said?
Mature ones, sir.
Sorry, Alankar. Did you ask mature or developing?
Mature. The question was on mature.
Yeah. On a year-on-year basis, EBITDA margins in mature hospitals have gone from 25.2% to about 24.8%. Nominal dips. I think if you look at it at a macro level, 24.8%, 25.2%, more or less stable. Of course, there is some fluctuation with respect to how we see the various specialties. As we find certain specialties which are maybe more heavy on material cost, they have some kind of an impact. Also, to the extent that we did some hiring over the course of the last year or so, there is some amount of clinician cost and manpower cost that comes in. Broadly speaking, I would say that I would consider these to be more or less stable in nature, not much difference between a 25.2% and a 24.8%. Yes, maybe some amount of material cost increased a little bit between the two years.
If you look at the presentation slide 26, it shows the margins have come down from 25.2%- 24%. That's why I asked that question.
Sorry. You are asking quarter on quarter, right? Or because I was giving you the year-on.
Yeah. If I look at fourth quarter, FY 2024, our margins have been over 24%.
Q4 versus Q4. Yeah. Sorry. I was giving you full year versus full year. Hello?
Yeah. Yeah. The question was on Q4. Go ahead, sir.
Yeah. Q4 versus Q4, again, I think maybe some amount, I'm just looking at some of our numbers, I think maybe about 100 basis points is the swing in material cost. No real significant change in any of the other costs. I would assume that this is broadly pertaining to some amount of increases in the cancer work because the pharmaceutical costs have some impact on the material costs to revenue ratios. As we see some of our cancer work increasing, you may see some amount of material cost increase. Again, just looking at two quarters in isolation does not necessarily, I think, give the whole picture because obviously certain specialties have some impacts in certain months. It is not very, very crystal clear to look at Q4 versus Q4. I would say that a more realistic picture would be to look at full year versus full year.
Understood. So just maybe one clarification there. No acquisition merger-related expenses have been accounted in that margin number, right?
No. No. Not in the EBITDA. That's come in below.
That's below EBITDA in exceptional cost.
Got it. Yeah, the other question was on indoor. I see the second hospital has not been included in our CapEx plan. I mean, is it still possible to go ahead with that, or as a matter of precaution, we decided to kind of not include that in our current plan?
Yeah. Alankar, we had mentioned a couple of times that this hospital had gone to a non-binding agreement some time ago. I felt that it was more appropriate to say that we just put it on the back burner from a disclosure point of view. We haven't terminated our conversations with that party, and we still maintain that there is a door open there for us to do it. I did also mention in some of our earnings call maybe one or two quarters ago that we are looking at alternatives as well. I thought it was more appropriate for us to pull it out of the current disclosure to not mislead that this is something which is imminent because it will require kind of a revisit.
Since we do not have a very clear timeline on the legal case, we do not really know whether it will happen in the next four years or not. That is why we have taken it out and put it into the notes.
Fair enough. That's clear. That's it from my side. Thank you.
Thank you. Ladies and gentlemen, we will take this as the last question for the day. I would now like to hand the conference over to the management for the closing comments.
Sorry. I thought you had one more question. Thank you, everybody, for your questions and for joining us today. Just to wrap up, as we step into our next phase of growth, we, of course, remain committed to our original philosophy of delivering the highest quality of care at the highest standard to the highest values. We believe that through this approach, we will continue to expand our footprint in a responsible manner, invest in our people in a responsible manner, and also continue to bring the highest quality and highest standard of infrastructure as close to the communities as possible. Please do feel free to reach out to our investor relations team in case there are any questions that remain unanswered. Otherwise, all the very best, and thank you for joining. See you soon.
Thank you. On behalf of Motilal Oswal Financial Services Limited, that concludes this conference. Thank you all for joining us, and you may now disconnect your lines.