My name is Nishant Singh, and I welcome you all to the Q1 FY 2026 earnings call of Narayana Hrudayalaya Limited. To discuss our performance and address all your queries today, we also have with us Mr. Viren Shetty, our Vice Chairman, Dr. Emmanuel Rupert, our CEO and MD, Ms. Sandhya Jayaraman, our Group CFO, Mr. Venkatesh, our Group COO, Dr. Anesh Shetty. On a website, I'd also like to remind you. Was I audible, people, investors? No, it was not. I'll just repeat the introduction. My name is Nishant Singh, and I welcome you all to the Q1 FY 2026 earnings call of the company. Is it better now?
Yeah. So to discuss our performance, we have with us Mr. Viren Shetty, Dr. Emmanuel Rupert, Ms. Sandhya Jayaraman, Mr. Venkatesh, Dr. Anesh, Ravi, and Vivek. Before we proceed with this call, we would like to remind everyone that the call is being recorded, and the transcript of this same shall be made available on our website as well as on the stock exchange later. We would also like to remind you that everything that is being said on this call that reflects any outlook for the future, or which can be construed as a forward-looking statement must be viewed in conjunction with the uncertainties and the risks that they face. With that, now we would like to start the Q&A. I request everyone to now use the raise hand features to start asking their questions. Thank you. Yes, Prithvi, please start.
Thanks, Nishant. Anesh, you know I just have a few questions on Cayman. If you have to look at the discharges and OP patients' number, it has come down on a sequential basis, and the decline seems to be quite high. Just we wanted to understand, you know this is something we saw in the past. There is some quarterly volatility in Cayman numbers. Is it the same, and do you expect patient numbers to return back in this quarter, or has there been anything structural that happened in the last quarter?
I think you're right. As you recall, since we commissioned a new hospital in the Q4 of last year and Q1 of this year being the first two quarters of the new hospital, and if you recollect even in the early days of Cayman when the hospital was new, when we're starting a new building with low base, low volumes, you're going to see this volatility up and down, but these are just standard blips quarter to quarter because the structure is new, and the next quarter, as we proceed, maybe two or three quarters, things should stabilize, but your intuition is right. These are things that happen in the early days, and they will settle in as we progress. On the ground, we have no reason to have any concerns around the growth trajectory with the new building.
Got it. And if you have to look at the absolute EBITDA number for Cayman business side on a sequential basis, and the decline seems to be around INR 20 crores-INR 25 crores, I understand there is a INR 9 crore number coming from the Integrated Care. What explains the remaining difference in the EBITDA numbers on a sequential basis?
If you account for the slight decrease quarter- on- quarter in hospital business, aside from that, maybe I'll just say that hospital business as such, the economics have not changed, whether it's comparing Q4 to Q1 or a few quarters later. It's just that right now we have broken up, and we are starting to see the Integrated Care business ramp up significantly in revenue terms, which is obviously at a very different margin profile, A, given it's a new business, and B, it is Integrated Care insurance, which is very different on a margin profile from hospital business. so hospital business itself, the economics remain unchanged. We did have a slight revenue decrease quarter- on- quarter. You are again going to see some early volatility in case mix.
In the previous quarter, we had some small, sorry, few in volume, but high value cases, which you generally tend to have higher margins. This time, that was not the case. You saw that reflected in the volumes as well. But over the next few quarters, we think on the hospital business, things will continue to be similar to what we've seen previously.
On the hospital side, earlier before commissioning the new hospital, you were making $120 million revenue and a 45% margin. I understand new hospitals focus more towards OP, where it can be a bit of margin value too. So can we expect or can we look at the hospital business as $200 million revenue and a 40%-42% kind of EBITDA margin business on a sustainable basis?
Yeah, I think it is difficult to give exact guidance to that extent. Having said that, we think that the margin profile of hospital business, you will not see too much variation from what we've been used to. Obviously, your first comment is partly right that in the new hospital, you are more focused towards quicker short-stay daycare sort of procedures, which are obviously lower margin than the long-complicated cases. So there will be to that extent that change. But the underlying profitability of hospital business itself will not see any big swings. Having said that, like we've said before as well, for the entire bucket of the geography, whether it's the hospital alone, the hospital combined with the Integrated Care, whichever way we want to look at it, the intention very much is in absolute terms to continue to see healthy growth in earnings.
Because of the new Integrated Care on a much larger revenue base, but absolute growth in earnings is definitely the intention.
So one final question on the Integrated Care. Can you throw some light on how exactly you're looking at this business, what kind of opportunity, and how does it translate to investments and the break-even number?
Sure, sure. So this is always, this is the first time we're sort of adding small detail to break it up because it's starting to get significant. It was always subsumed in the financials that everybody's used to seeing. So it's not a new outflow of any kind. Having said that, we started formally selling to the external market in the first of January. Obviously, it takes time to ramp up, but in just a quick five to six months, we've been very, very happy with the response we've seen. We have some of the most prominent and largest employers and organizations on board. So the trajectory has obviously been very, very positive for us. It's going much better than we planned.
Having said that, this business is not going to have even at steady state, and it was never intended to have the same margin profile as the services, hospital business, which we all understand and know. Right now, yes, it is loss-making. It's the first quarter, first one to two quarters of the business. Longer term, we expect this to be a break-even to plus or minus slightly positive, hopefully by the end of the year or first quarter next year. But this is going to be a very different margin profile from the services business. The reason we're doing it is to aid in our entire ecosystem of services to have a very safe lock-in with all our customers to create this multi-touchpoint experience for patients so that longer term, we have a very safe, non-volatile earnings stream from this geography.
But you see any sizable revenue coming from this particular segment?
Yes, it's starting to happen, and we do think that it is on that trajectory. It is something that even on a standalone basis is attractive. Having said that, its real goal is being part of the ecosystem. In fact, I would say the reason why we find it difficult to give an exact prediction on EBITDA as a percentage term is because it's going to be challenging to predict the relative revenue between the Integrated Care business and the hospital going forward, especially because the Integrated Care is going to see good revenue growth since it's starting from a low base.
So just to squeeze in one final question, so we can assume this quarter losses are the peak for the Integrated Care, and it will start coming down in the next couple of quarters?
I think that's hard to say as a percentage of revenue, that maybe it's going to be a narrow band. You're not going to see wild swings, but in absolute terms, it would depend on where the revenue lines up the next quarter. This is just the first quarter we are disclosing it, so maybe in a couple of quarters, we'll get more clarity on what that could look like. Having said that, we don't expect to see wild swings unlike hospital business. i would also point that maybe quarter on quarter is perhaps not the best way to look at it because it depends on when large claims come in, etc., and these kinds of factors. Let's give it a couple of quarters to play out, and we'll have much more clarity there.
Thanks. That's all from my side.
Thanks, Prithvi.
Thanks, Prithvi. Damayanti, c an you please have a question?
Yeah, hi. Thank you for the opportunity. My question is again on patient operation. So just want to understand, in the newer unit, the services which you intend to offer, are all those now in place, or you have some more to offer which can help the volumes to pick up from here on? So just want to understand on that part.
Yeah, so all the new services have been activated, to your question. Having said that, we don't see the entire potential of them kick in immediately. It does take some time for these, depending on the service line, for them to grow to their potential. But yes, as of the quarter we are talking about, which is Q1, all services were commissioned, but just recently commissioned. But yes, all have been commissioned.
How long do you expect the things to reach steady state in terms of operations being in place and volumes, etc., also reaching up to some steady state?
I mean, it's difficult that we don't know how these things take to ramp up with an exact quarterly number or prediction of that sort. It depends. Some will obviously be quicker than others. Some are dependent on some other changes with payer relationships, etc., happening. That would be very difficult to answer.
Sure.
I mean, what could help? Yeah, what could help is that you did see from, say, Q4 to Q1, a very big step up in revenue. And that is almost exclusively because of the hospital, almost all of it, because the Integrated Care had just started or was negligible. So you did see that big jump, which is bigger than we expected, but sort of what one would predict because you've started a new facility with new services. Going forward, the increase quarter on quarter will obviously not take that big leap up. It will be more linear as the existing services grow in and mature, and there's more awareness and marketing and sales about them. So we're not going to see that kind of jump that you saw from Q3 to Q4, but we do expect to see a linear growth going forward.
Okay, and for the combined operations, you mentioned 40%-45% margin looks sustainable. And so it's a case of.
Yeah, we didn't say a number, but sorry, please go ahead. Yeah.
No, I'm saying, say compared to the, because on Q1 numbers, we saw IP, OP volume seeing some decline quarter on quarter, but you grew on the top line, right? So I assume the mix would have been much better. So just wanted to understand, compared to last quarter's EBITDA profile for the patient operations, the current quarter, the Q1 EBITDA margin profile, were those very different, or how should we think?
Yeah, so maybe I'll try and help with that. hospital business will not see any significant change in the profitability or the margin profile. You are going to see certain variations quarter on quarter, but on the whole, that remains unchanged, the core economics of that business. The challenge to give you a percentage prediction or guidance for the consolidated picture is because it depends on the relative revenue contribution of the Integrated Care business, which as of now is yet to break even. And even when it does, it'll be a significantly lower margin business than hospital business. so we don't know whether that will, it's too early to tell how significant in the total revenue consol that will be to give you a guidance on what we expect the consol Cayman EBITDA percentage to be.
Predicting a percentage is tricky, but predicting what it could be in absolute terms or the trend in absolute terms is easier. I hope that was helpful.
Yeah, that's helpful. Thank you. My another question is on your India operations. So just want to understand the kind of scale-up or progress you have seen in your insurance offering. So I see in presentation it has been rolled out to other segments as well, but how do you see this piece picking up?
Sure, hi. This is Ravi. Happy to.
Hi, Ravi.
I think the insurance business overall has picked up quite well. As you saw in the presentation also, we've added on some new markets and new products as well. The Arya scheme has started encouragingly well. We have great feedback from our customers. We've got about 6,000 lives at the moment, and we are now seeing acceleration at that pace as well. Over the quarter, we started expanding to Kolkata, to Shimoga, and Raipur. We also launched an upgraded version of our first plan is Aditi, called Aditi Plus for the Kolkata market. We've also developed and taken to market a group omnibus product for non-employer employee plans, which is something we're actually quite excited about because it opens up new opportunities for us to partner with external parties potentially that have got roster of customers. We are building the business steadily.
The focus is on risk management and underwriting and making sure that we are building a business that will be sustainable over the long term.
Sure. So the current quarter loss from new initiative, can we assume mostly it's coming from your spend, which is happening on the I nsurance part?
Sandhya, do you want to answer that?
It is a combined number between both Insurance and the NHIC, which is the clinic business.
Okay, that's helpful. Thank you. I'll get back in the queue.
Thanks, Damayanti. Ronak hi, can we please have your question?
Yeah, thank you for the opportunity, sir. So as we know that we are going to start the new hospitals in 2028, 2027. So I mean, what would be the break-even cycle we are expecting? Because these hospitals are in the existing region. So first of all, are we expecting the break-even to happen or the ramp-up to happen very fast? And second, are we or would we be able to charge the similar, I mean, revenue per bed comparable to the existing revenue per bed in the same region?
Ronak, the break-even characteristics of the hospital we're starting up will be in line with market. The realizations that are possible in these hospitals will be at a discount to the current market prices in the geographies where we are setting up hospitals.
Okay, got your point, sir. Sir, and I mean, coming on the specialty profile, so in the past few years, we have seen the oncologists increase very much. So can we expect the oncology, let's say, in upcoming five years to it may become, let's say, 20% or, I mean, 25% as a percentage of revenue?
The oncology has been growing very well for the last couple of years, and that's the same trajectory which we have been observing and working towards with the clinical team and the kind of investments that we are making. And our aim is to get towards that number which you mentioned, and we will be seeing a good healthy growth year- on- year on that.
Thank you, sir. I'm done with my questions.
Thank you. Bhavi, can we have your question, please?
Hello, thanks for the opportunity. So I would like to ask that there are the 400 beds currently in the pipeline. So when this will be operationalized, and what CapEx is expected for these 400 beds?
Where have you picked up the 400 beds from? That is the.
Oh, in.
The pipeline, yeah. So at all possible time, we keep exploring for the new opportunities. So the moment we close something, we'll be able to announce then. But right now, we are looking at multiple opportunities. So that pipeline is not confirmed yet.
These are M&A sort of transactions that we're in discussion with various bankers with, and we're not exactly sure when they can conclude.
Okay, thank you for that. And another, the hospitals are getting commissioned in FY 2027 and FY 2028. So, will the margins be impacted due to the commissioning of new hospitals? And if they are impacted, the impact will be similar to the dilution in the past, or it will be less due to the brownfield?
It will be a margin impact. We will do our best to minimize the impact. Whether it will be less than the past, that's hard to say. Just because in the past, the cost structure was very different. The manpower cost and a lot of the startup costs are much higher these days than it was when we had done in the past. But again, we will try and keep margin dilution, break-even period more in line with what the peers have been able to achieve.
Okay, and another, I have seen that ALOS fell from 4.5 to 4.3. So can we expect this to fall for the year, or it is just for the quarter basis?
We are working towards this. Whether this particular drop, I mean, we want to bring it down to closer towards four. And we are working towards this. Hopefully, this will keep coming down in the future as well.
But the quarterly variances will show this slight fluctuation because of a lot of seasonality. But the long-term trend is towards lesser ALOS.
Okay, thank you. I am done with my questions.
Thank you. Rehan, can we have a question, please?
Yeah, good evening to the team, and thank you for giving me the opportunity. So I want just more clarification regarding the Integrated Care and insurance business. So with the Integrated Care program now scaled to multiple cities, so what's the next frontier? Are you considering disease management or wellness-led models under NHIL? Or on the other insurance side, how is Aditi Plus being received in Kolkata? And what are your plans to build distribution or partnership for this vertical?
Sure, I'll try and answer most of those questions, so in terms of clinic business, just to clarify, clinic business itself is focused on Bangalore at the moment, and in fact, we are increasing our footprint in Bangalore. There's a new clinic that's opening tomorrow. There's another one that's under construction. Over the coming quarters, we'll be focusing on offering a wide range of services to our customers. Now, these will include, I wouldn't call it wellness, but these are basically services that we'll be offering to help our customers get well and stay healthy, and that's kind of our focus. In terms of geographical expansion, we continue to evaluate opportunities to grow the C linic footprint, both in Bangalore and beyond, and we'll try and share updates on that as and when it's appropriate. In terms of Aditi and Kolkata, I think that's gone well.
In fact, we also did launch the new product, which is Aditi Plus, in that market. That's the whole we've only been selling in Kolkata for about six weeks, but the initial response to this has been very good. We're very excited about how we think the Kolkata market will react to Aditi.
Okay, sir, thank you for the clarifications. My second and last question is on the digital and technology investment side. You have mentioned digitalization of 85% patient documents. How are these initiatives translating into measurable operational efficiencies like reduced turnaround time or improved clinical outcomes? And just follow up in this, can you elaborate on the roadmap of your doctor and ICU master sheet initiatives? Are there early signs of improved compliance or staff productivity? Just, can you please shed more light on this?
Yeah, so we have rolled out our just like Aadi, which is a doctor application. We have rolled out our nurse application called Aha, and also the digital for the inpatient services, the medication card, and various other modules. It's getting stabilized, and we hope that it'll get stabilized somewhere by October. All these things will speed up the discharges and other things because we are working along with our Medha, which is the analytical division, to work towards multiple improvements in the operational efficiencies so that we'll be able to streamline the processes and make documentation, both clinical and operational documentation, much more streamlined and enable things to happen in a much quicker way.
So these are some of the things which have been doing, and this will continuously keep happening and improve the overall efficiencies, and it will make the manpower clinical as well as operational manpower to be very effective in what we are doing.
It's hard for us to accurately gauge out how much of the improvements that we've seen, both in realization, discharge time, and the patient experience, can be attributed solely to the digital investments just because the nature of technology today is that it is so diffuse, and we have parallel projects running at the nursing team, at the clinician team, with our technicians, with our senior doctors, with the administrators, supply chain people who are embedding this into everything that they do, so our hospitals are fully paperless. Our patient experience can be done in such a way that no patient has to visit a counter for anything. Most of the transactions in our hospitals can be done either on their phone with the app or going to a kiosk. Now, it is far from perfect.
There's still a lot of bugs that come from time to time, but this is the experience that we're investing in so that it is a fully seamless experience in all our hospitals.
Okay. Thank you for your clarification, and okay, I'll jump back in the queue.
Thanks, Rehan. Yes, Bino, can we have your question, please?
Hi, I hope you can hear me.
Yes, we can hear you.
Yeah. Thanks. Got a little bit of confusion around this Integrated Care. So you have these two entities, NHIC and NHIL. May I know what each of them does?
NHIC is a company that runs clinics, so these are brick & mortar clinics in Bangalore, and they run care plans where people can buy subscription packages for loyalty access to the clinics for doctor follow-ups, medicine, home delivery, and lab collection, home collection of lab samples. That is part of NHIC, NH Integrated Care. NHIL is the IRDAI-regulated health insurance company. This is the entity that has the license for being a standalone health insurer, and this is the entity that issues policies called Aditi, Arya, Arya Plus, and so on, so this is our insurance entity. The insurance entity sells through NHIC as a channel as well as through multiple other arrangements.
Got it. And those who have policy from NHIL, are they as of today free to go to other facilities as well, or do they have to come to NH facilities?
Ravi, you want to answer that one?
Sure. So for the moment, the way that we look at this is that we can provide the best experience to our customers when they come to our hospital. One of the biggest pain points is the entire pre-authorization, discharge, something not paid, something else covered, etc., confusions. This we want to avoid. So we would prefer for customers to come to our hospital for treatment. Having said that, there are situations where if somebody needs to go outside, they are able to go to any hospital in the country. There are four specific situations. If somebody has an emergency, they can go to any place they want. If the treatment is not available in our network, they can go any place they want. If they happen to be traveling and require assistance, they can go any place they want.
If they buy the policy here and then they move somewhere else within India, they can go wherever they want. So in those situations, people can go to any accredited hospital in the country. Otherwise, we do prefer that they come to our hospital. And because the whole point of this is so that we can give them the best possible experience at the time of discharge and remove the trust deficit that typically exists between an insurance company and a hospital. In this case, it's not there, and that allows us to give a much superior experience to our customers.
Understood. So now this was all India. Now, is there any Integrated Care model like this in Cayman as well?
Yeah. It is the local dynamics are such that you can use it anywhere, in any hospital in the U.S., anywhere in the world, any other provider in Cayman. We don't restrict anybody because the local market conditions and dynamics are different.
I'm sorry, I'm not quite I haven't quite understood that. The reason I asked was earlier when there was a discussion about the margins in Cayman Islands, it came up that there was some Integrated Care model which has come up there. I was not sure if I heard it right or not sure. That's why I asked.
No, you are correct. So we do have that. It's just up to your question on whether the holder of this plan or policy is restricted as to where they can use it. It's not like in India. In India, you predominantly have to use it in NH, with certain exceptions that Ravi mentioned. In Cayman, with these plans that we sell, you can use it anywhere you want.
Understood. But that is a completely different operation, right? Or does it come under NHIC?
It's a separate entity. Completely separate. Yeah. Completely differently regulated. Everything is different, yeah.
Got it. So I was wondering, your Cayman operation is pretty big now. In your PPT, it would be great if you give the Cayman EBITDA separately as a number. That would be great. You give the revenue, but I don't think you give the EBITDA number.
So there are ways to get a rough sense of what that is with the information that's there. Maybe Nishant, we can connect with Bino offline to help walk him through that.
Sure. Yeah.
Yeah. Yeah, yeah. Sure. Thank you very much.
Thanks, Bino. Rajit, can we have your question, please?
Yeah, hi. The Southwest Bangalore expansion, given that the civil and structural works are in final stage, do we have a sense of exactly when this will be operational, whether it'll be Q1 or Q2 or FY 2027 or later?
Not with that much accuracy. It will take about a year. The building shell has already come up. We are working on the interiors and outfitting the medical equipment.
So a year from now?
Yeah, at least, right?
Okay. All right. So in the last call, there was a discussion on chemotherapy centers coming up in Gurgaon, where you had mentioned there'll be a soft launch and then a formal launch. Any update on that and what kind of footfalls you might be seeing there? And if you can share some kind of numbers on it as to revenue per patient or something like that, so that gives us a better sense of where that is going to.
This is an investment we've made in a startup which will be doing this. It's called Everhope Oncology. Their first infusion center is in Gurgaon, in Emaar Business Park. The center is up and running. They've had the soft launch already. They've not gone for the official launch yet, and they are seeing patients. As far as it comes to reporting of the numbers, it will, for the near future, be a very small contributor. And being a startup, have significant setup costs and losses and so on. And our involvement in this is as an investor. We are providing a lot of the backend services, like referrals for radiation oncology and surgery, as well as providing them supply chain and software help. But we're not managing these units, and it won't count as any of our subsidiaries.
Okay. Understood. And they're obviously free to see patients referred from other hospitals also.
Yes.
All right. One last question. The gross written premium of the insurance segment has marginally come down during this quarter compared to the last quarter. So I mean, given it's not even one year since we launched it, and we are actually being very bullish on it, and it's growing, what could be the reason for that?
It was more or less flat, and as you know, the bulk of the buying behavior in the country is that the large majority of sales actually happen in the Jan-Feb-March quarter for tax and other reasons, and so there is a bit of a seasonality effect. We are seeing much improved momentum in the later half of the quarter of last quarter and into this quarter as well, so we continue to be bullish about that, but largely, if you look at insurance anywhere, typically the first quarter, there is obviously a large drop-off from the JFM quarter across industry.
But these would be annual policies, right?
It doesn't matter. What's booked is the GWP, the Gross Written P remium, which is the full year's premium. So when somebody buys, if 100 people buy the policies in JFM, the premium is counted in that quarter. It's not split out over the year. The GWPs are counted in the same quarter.
One second. Just to add to what Ravi mentioned, also the numbers that you are comparing is YTD, because last year was a small year for insurance, so we were reporting YTD numbers. Now we are reporting quarter- on- quarter. So they're not exactly comparable also.
But it says YTD Q1 FY 2026, right? So it's only for this financial year.
Yes.
Or these are not cumulative?
No, it's not cumulative. On a cumulative basis, we've had.
But your larger point is taken. Ravi needs to work harder and make it grow more.
All right. Thank you, sir. Good luck with that.
Thanks.
Thank you, Rajit. Nancy, can we have your question, please?
Hi, team. Thank you for the opportunity. I also wanted to discuss the Cayman numbers. It seems that the EBITDA has fallen. So, like, firstly, if possible, I wanted to confirm the number. And if it has fallen according to what I'm able to calculate, then I wanted to know the reason. And if possible, I also wanted to get the Ind AS adjustment number for Cayman.
Yeah. Hi, Nancy. Thank you for your question. So as we explained in the beginning of the call, we're now seeing a significant ramp-up in our Integrated Care business. So the economics and the margin profile of hospital business remain largely unchanged from what you would have seen previously. But on a consolidated picture, you will see a diluted EBITDA percentage, and that is because of the new Integrated Care business, which was not a significant contributor to the consolidated earlier and now is starting to become so. And secondly, it is yet to break even, given that it's the first or second quarter that we've started it. So you are going to see that drag effect of that. We expect this to settle down over the next few quarters. On your second question, I'll pass it on to Sandhya on the Ind AS verification.
$658,000 Is the i mpact for the quarter.
All right. Sure. And also, I just wanted to confirm. So basically, could you tell me, is it possible for the team to tell the drag number from the Integrated Care business on the Cayman? It is there.
That will be the slide. Sorry, go ahead, Sandhya. Yeah, go ahead.
That's INR 9.3 crore negative number, right?
Yes. Actually, there is a revenue as well as an EBITDA number that has been given there. So for you to derive, you have to adjust both the numbers.
Understood. Understood. Thank you so much, team. Super helpful.
Thanks, Nancy. Archit, can we have your question, please?
Sure. Thank you for the opportunity, sir. My question is regarding the oncology division. In addition to the previously asked question regarding the EverHope chain which we established in the last quarter, you mentioned that we are yet to start on the chain. Do we have any expectation on the number of centers which are currently in operations and the pipeline for this year?
So as mentioned earlier, the investment we make is in a startup that is still in the ramp-up phase. They are not a publicly listed company, and they will be making their investments as per their own strategic business plan. Our investment we disclosed earlier, which they will use to build a business with. They have some very aggressive projections. And as and when these things come up and are clear for us to disclose publicly, we will do so.
Understood.
All right. Thanks, Archit. Vedant, can we have your question, please?
Thank you for the opportunity. I think this question has been asked earlier, but I wasn't able to hear it properly. On the slide 13 of the PPT, where the operational review of Cayman Islands has been given, in the bottom left corner, the revenue and EBITDA of CIHL for Q1 FY 2026 is there. Could you please elaborate on that?
Yeah. That's the Integrated Care we were talking about. It stands for Cayman Integrated Healthcare Limited or something like that.
So does that include only the insurance business?
Yeah. Integrated Care, that's the only activity of that, yeah.
Just for Cayman, just to clarify.
Yes, for Cayman. Yeah. Sorry. Just for Cayman. I think there's a confusion because the currency is in rupees. Sorry about that mistake. Yeah. It's just for Cayman.
But so the amount is in rupees only. There is no mistake there, right? INR 9.3 crores.
No, the amount is correct, but we should have represented it in dollars. I think we represented it in INR, but whichever way you convert it, the absolute number is accurate.
If we adjust this with the overall EBITDA, I think then we'll be able to find out only hospital business ebitda, right?
More or less, there are. Yeah, more or less. But Sandhya, any comments there?
Yeah. You have to adjust both on the revenue and on the EBITDA side.
Right, right, right. Okay. Thank you.
Rehan, you have any other questions because you've been raising hands for a while now? Rehan? Yeah. So we'll go to Prithvi.
Thanks for taking the question again. Anesh, again on Cayman, given that now you have two hospitals and you're also coming to insurance. So how do we look at the opportunity size here? I mean, you're already at $45 million revenue in Cayman. And the population there is quite less. So could you throw some light on, I mean, for how many years do you think you can grow in Cayman before reaching a population growth number?
Yeah. So Prithvi, as you recollect from previous discussions, yes, the population is small, but our market is a broader Caribbean. Having said that, both the new businesses, which is the new hospital as well as the new Integrated Care, we are still only in quarter two. And especially the new hospital is a very substantial investment we've made.
So we continue to absolutely expect and be confident of growth for several, at least for the foreseeable future, given we're still just in Q2 of where we've started. The only caveat I would add is it's not possible to predict. There'll be some lumpiness in this growth, but on the whole, we are confident for a healthy runway still to follow, given both the untapped demand domestically as well as the larger market we cater to internationally in the region.
If we have to just understand this a bit better, how much of growth is coming from Cayman and how much is from other Caribbean islands? I mean, I'm not talking about exact numbers, but incrementally, can we assume half of the growth is coming from other Caribbean islands? This is where there is still significant scope for you to grow.
Before that, Bino, sorry, could you just go on mute? I think you've accidentally. Thank you so much. Yeah, Prithvi, back to your question. It is difficult to give a split between domestic and international. I will say that for both, whether it's domestic as well as international, we still have an untapped opportunity. Of course, much, much more in international, but more challenges to access it. Domestically, it's much more known, and we understand what we need to do. But we continue to see good growth both from domestic and international. We do predict eventually, not now, eventually, the bulk of our growth will come from non-Cayman markets, obviously. We will saturate this market, but we are not yet there.
Understood. One final question on the India business. In the last con call, it was mentioned that this year will be the peak losses for Insurance and clinic business. are we still retaining it, and can we expect losses to come down from next year onwards?
So we haven't given a peak loss kind of guidance, but more so, we said that we are investing, and we have set aside a certain amount of money, and we are thinking that a lot of the investment will happen in the initial period. From that perspective, I think you have inferred that. Our first cohort of clinics have broken even. We are able to see that model that we built saying each clinic will break even in 18 months' time. We are able to see that. There are still corporate costs to recover, and there are growth ambitions. As new clinics come online, we will have losses in the initial period. We are still sticking to our overall cash burn number that we have indicated for both the businesses put together.
And as you can see, the absolute cash burn in the business in the current quarter is lower than what it was in the previous quarter. So we are projecting in the right trajectory.
If I remember the number, it's almost INR 450 crores- INR 500 crores of investments. It's something that you have guided, right?
INR 450 crores, yeah, INR 450 crores we have.
May I know how much of that has been invested till now?
INR 100 crores we've invested as capital, and INR 150 crores has been invested for the c linics and the cash burn relating to that, including some CapEx.
That's it. Thanks. Thanks a lot.
Thank you, Prithvi. Aryan, can you please have your question?
First of all, thanks for the opportunity, sir. I'm sorry if it is already answered. I just wanted to know what growth we are expecting in Indian business till new facility commission because, as we all know, there are capacity concerns in Bangalore and Kolkata cluster, right? So, for the time being, what we are doing to deal with that?
Yeah. We will try and maintain the growth trajectory we've had for the past two to three years. What we are doing is still more of the same: more digitization, more automation, more work on the patient mix, more work on improving our efficiencies over here, more investment in robotics, in oncology, looking at the case mix. There are enough and more things that can be done in a hospital to generate the hard-fought and hard-won revenue and margin growth while the new hospitals take time to come. There's plenty of work for us to manage, but it will not be in the high double-digit growth numbers that would otherwise come from adding new beds in new parts of the cities.
Thanks, sir. I'm done.
Thanks, Aryan. Yes, Ajay?
So yes. Thank you very much for the opportunity. So I have a couple of questions. So first of all, I can see that there is good growth in every parameter for ARPP. So what were the factors that led to the growth, and is this trend going to continue?
So there were a few factors. Like we always do, we've taken a small price increase on 1st of January, low single digits. Some of the effect of that has come through also in the current quarter. The second is that there is a payor mix change. As you can see, from last year to this year, we've had almost a percentage improvement in the payor mix. So that's also helped. And thirdly, we've had almost a 50% drop in the Bangladesh revenue from last year to this year, same quarter. And Bangladesh was coming in at a lower realization. So that having been substituted by domestic revenue, domestic revenue has grown by 12% this quarter. So that's also contributing to the ARPP. Finally, we are also doing a lot of high-end procedures.
For example, we've done the largest number of cardiac robotic surgeries in the country in the last quarter, and so on and so forth, so there are a lot of high-end work that is also coming through, which is also improving our ARPP.
Okay. So is this trend going to continue forward, the growth in ARPP?
To the extent of the one-time benefit we've got from the Bangladesh mix change, I think that kind of increase will not come. But the rest of it, yes, we can look at it as a. And again, the price increase will next happen only in 1st January. So that benefit will also come next year. But the regular improvement in payor mix that we drive, as well as higher value procedures, that we will continue to push.
So the second question was regarding the expansion. So what I have seen in the presentation was the expansion generally in the higher ARPP regions, right? In Bangalore, I think, and Kolkata, and third is in Raipur. So going forward in the longer term, say after when the expansion is completed, so can we see a margin increase from the current levels?
Absolute basis, yes, because once they have broken even, on absolute basis, the EBITDA numbers will be higher. On a margin basis, that will depend a lot more on the cost structure as it looks because as much as Bangalore, Kolkata, Delhi, Raipur places a high realization, they're also very high-cost markets, and the cost drivers of this industry are relentless. While the pricing pressures, what we face from various payers, both insurer and the government, are also equally relentless, so the question of will things look better? One will balance out the other.
Okay. So last question was, I can see that the owned hospital revenue mix has increased to 73%, right, to 73%. And the management part has a little bit come down. So has this any impact on the margins that makes up owned and managed hospitals?
I think this may have been the removal of Jammu, which is a managed hospital that we were managing on behalf of the Shrine Board. We've moved to handover of the hospital to the Shrine Board Trust, and we are just there to manage the operations at no fee. So I think that may be explaining the difference over there.
Okay. So going forward, it is going to look the same, right?
Yeah.
Owned and managed hospital.
Yeah. Right. Right.
Okay. Thank you very much.
Thanks, Ajay. Neeraj, can you have your question, please?
Yeah. Thank you for taking my question. Sir, I have a question regarding this insurance. Sir, I was going through this Aditi insurance plan. It is very competitive. So I have a question regarding, do we add any loading on the insurance premium if the customer has any pre-existing element or any surgeries undergone in the past before underwriting the claim?
Neeraj, our goal is that we want to give people a policy with no waiting periods and either pre-existing conditions, etc. But obviously, we're also in the business of taking risks. So what we ask is we ask our customers to undergo a health checkup. It's a comprehensive health checkup. It's part of the service we offer. It's a comprehensive health checkup that they can do actually every year. It's built into the plan. There is no fee for it. It's a completely free checkup that they do. The majority of customers who complete that health checkup, they go through the plan on a standard basis. In some cases, we may ask for some slight additional loading in premium or, depending on, again, on the underwriting results, we may ask for a waiting period. But that is not the rule. Those are the exceptions.
Of course, in some cases, we may not be able to offer cover as well. For example, if somebody is immediately scheduled for surgery, for example, then it's not really insurance. But the point is that we ask every customer to go through a health checkup, and we decide on the basis of that.
And, sir, the second question is, for selling this for growing the GWP, are we looking to tie up with some national distributors in India, or is it just through the NH network?
So we're always looking at the balance of this. As you know, some of those national distributors come at a very high cost. And our focus, especially with Aditi, is to make sure that we're offering something that is affordable for the people that otherwise cannot afford insurance. So it's always a balance between the cost of distribution, which can be very high, and passing on those benefits to the customer. What we are focusing on at the moment is offering our plans directly to the customers and giving them the benefit of both lower premium and better service by going direct. But again, this is something that we do evaluate all the time. And we are looking for partners that are kind of like-minded where we can offer this through certain partners.
But the focus has always been on the customer and making sure the customers get the product at a good price, great value, and we're able to provide good service.
Sir, one last question. Sir, do we have any internal guideline in terms of underwriting that since we have just started this insurance business? Because in terms of age, say, for example, if we underwrite 100 claims, so if the ratio of people who are above 60, whether claims can be higher in future? So say only 40% or 30% of the customers should be above a certain age, and then if it crosses above a certain age, then we slow down on the underwriting part.
No, it's not that way. There is no automatic loading if somebody is above a certain age or anything like that. And by the way, this is one of the great strengths that you get when a hospital that really deeply understands healthcare and health risks does insurance and looks at evaluating these risks. And that's where the health checkup comes in. So it's a detailed health checkup. And we have a very, very extensive underwriting process in terms of guidelines and rules. And it's completely based on that. There's no automatic if somebody is above 60, they get a loading of this, or somebody's got diabetes, they get a loading of that. It's not that way at all. It's a very holistic review and really takes advantage of our understanding of healthcare.
I think it's one of the key differentiators to help us manage the risk in the book over a long-term basis.
Thank you. Thank you so much, Ravi.
Sure.
Thank you, Neeraj. Rajit, please, can we have your question?
Yeah. Given the current projects in hand, what is the peak debt that you are aiming for? And if you can share the Q1 numbers of borrowings and leases as well.
We'll answer this question in terms of the leverage ratios. For us, we are looking at a maximum leverage ratio at the consolidated level of around 2.5-3, and same for the respective entities as well. Maybe India also same number and Cayman also same number. So the leverage is on the net debt to EBITDA. So that's maximum around 2.5-3.
It may fluctuate up to plus or minus depending on in case any acquisition were to come temporarily, but on a sustainable basis, that's the range we would look. The upper bound of the range we would look at.
Right. Much appreciated. So actually, where I am coming from is because of the ongoing expansions, while your EBITDA has in absolute terms gone up YoY, the earnings per share has actually gone down, and that is because of higher depreciation and interest cost. So all I'm trying to do is forecast the earnings growth over the next few quarters or a couple of years. And if I could get a sense of the interest cost, then that helps.
We've announced projects so far for about INR 3,000 crores . Roughly 80% of that we will borrow, and we will repay over a 10- to 15-year time period, so that can help you forecast the interest costs.
Right. So we are already at INR 2,100 crores if I do not count the lease liabilities. Right. I mean, that is as of March 2025, which is a combination of long-term and short-term debt. So you're saying over the next three years, it'll only go up by INR 300 crores. And I'm assuming you said INR 2,400 crores excluding lease liabilities. I mean, I'm a little unclear on this. Can you just help me?
This is due to a CapEx slide, which we have given our expansion number. So we've announced almost INR 3,000 crores of incremental CapEx.
Right. So INR 2,400 crores will be over and above the number I have as of March 2025.
Yes. But we will also be repaying some of the existing loans .
Exactly. So that's why I asked if you have a sense of where the .
INR 2,400 crores will come on the books in the next three years, not eight years, because they'll all come to p lus a bit of regular CapEx of around INR 300 crore-INR 350 crore every year. So there'll be an addition of around INR 800,000 crore of gross debt every year, minus the repayment which is on the existing loan.
Understood. Thank you, sir.
Thank you. Shreyas, yes, can we have your question, please?
Yeah. Hi. So I see on the CapEx slide that our FY 2026 projection for greenfield projects is about INR 420 crores. And we have only done about INR 5 crores for that in this quarter. So are we on track for this year for the projection? I mean, because the difference is so huge, so that's why I'm asking .
Yeah. We are running a little behind because of the rainy season. A lot of the contractors and a lot of the work has not been able to start on time. But a lot of them have geared up, and they should catch up over the next three quarters.
Okay, so still seems on track for the INR 420 crore target, right? Yeah.
There may be a slight overrun, as usually is the case with construction projects. Our expertise is in the patient care. Construction is very, very difficult for us to understand. But we're hopeful.
Understand. Thank you very much.
Thank you. Ravi, can you have a question, please? Ravikiran, can you have a question, please? Okay, so we'll move to Deekshant.
Hello, sir. Congratulations on the results. First question is, is this margin, a slight contraction margin that we have seen, is this seasonality only, or is there any other sort of impact that has given us these margins?
You are talking about India, or you're talking about consol?
Consol, ma'am.
Okay. So consol , I think, was explained. The dilution is coming from Cayman. And as far as India is concerned, actually, we have expanded margins. And even in Cayman, hospital business is stable on margins. The dilution has come from Integrated Care, which Anesh explained a couple of times during the call.
Thank you. Secondly, we have started to expand our insurance business right now. So I know that we have talked about a direct distribution thought process. But since we are ramping up right now, and also, there has been now word of mouth going around with people. So what's the further expansion idea on distribution strategy that we are working with right now?
So look, I mean, I think our focus right now is still pretty early days, right? And as you know, direct distribution takes time to build. So that's our focus. And there are multiple avenues to distribute directly. So our focus right now is on doing that. Having said that, we are open and always talking to and considering various other options that can help us in our growth. But as I said to an earlier question, our focus is on doing this in a way that the value remains with the customer in the form of lower prices and better service. And also, a key part of our entire program is that we want to be actively involved with the customer and in helping the customer manage their health, etc. So making sure we have that direct relationship with our customer is very, very important.
So as long as we're able to do those things, we would be open to partner with people. But our focus is on building direct distribution through multiple avenues.
So historically, insurance, I'm sure you have been asked this question a lot of times. But historically, insurance is a business of gathering enough of a pool in order to manage the risk correctly. And of course, our expertise being a hospital provider, we are able to manage risk better. But at what number, or is there any metric that you can share at this metric we would be breaking even, and we would be doing much better so that we can push the absolute a little harder?
Yeah. I mean, surely, I mean, obviously, internally, we have those metrics that we track very regularly. But I think it's a little bit early to start talking about that publicly. One thing that is worth noting is that our business model is substantially different from the traditional players. And what that means also is that while we can give customers better value and hopefully better service and partner with them on their healthcare, it also does mean that we need fewer lives to break even than a traditional very distributor-led type of model, right? So it's really about balancing those things back, balancing both things, and making sure that where we do partner, that distribution cost is acceptable to us.
And because, as I said, our goal is to save it, pass it back to the customer in the form of lower premiums, better service, and also be really proactively managing their health. So that's our focus. And our model is very, very different from the traditional models. You can't really compare the two.
Can you share the number of policyholders as of quarter-ended?
About 6,000.
About 6,000?
Yeah.
Okay. Perfect. Lastly, on Cayman Islands, so we already are now operational, and we are getting better sort of demand than we had expected as was told on the call. So what's the next hospital that we are looking in the Mediterranean Islands? What's the sort of goal of expansion? Because cash flow will start pouring in pretty soon now in a couple of quarters, right?
Yeah. So we're in the Caribbean. Yeah. So we've made.
No problem.
Yeah, no problem. We did make a small investment in a large health system in the Bahamas. That was a couple of quarters ago. We continue to evaluate that opportunity. Nothing to announce as of now. It's tough to find similar geographies. We continue to do so and explore all options, both in the Caribbean and elsewhere. But there's nothing to talk about now.
If I can just expand a little bit here on the question, sir. A lot of opportunity there is people flying from nearby countries to get better healthcare. And we have built that reputation in Caymans over time. So do you think that the opportunity with the cash flow that we would be getting, we are at that right moment right now that we can start pushing for new facilities this year, next year, or is it too open-ended right now?
We definitely want to. It's just a question of when a suitable opportunity arises, because for us, the first port of call is essentially our home, the world's most attractive healthcare market, which is India. But we already have plans there. They're already on their trajectory. So for us to allocate capital anywhere else, it has to pass a very, very high bar, which is the opportunities in India. So it's not easy. We've said no to all of them. There have been many potential opportunities. But let's see what happens. We definitely would like to do something, but let's see.
Okay. Just one last follow-up. How are things looking in our Mumbai facility? We were looking to ramp it up from a pediatric scale to a full-fledged hospital.
We're in discussion with the trustees. There's been a lot of positive momentum, and we're confident it should happen soon, but it's not in a position where we can publicly state that it definitely happened in Q2, Q3, Q4, but it is something we know should happen sometime this year.
So since the last two quarters, this has been the conversation. So that's why I was asking you again because of that.
It's a fair point. Even once we do get permission, it will take time to ramp up as well. We need to hire a lot more doctors and build up the marketing plan to run this as an adult multi-specialty. So we are quite disappointed with the progress that has happened, but it is something we're working very hard to try and rectify.
Yes, sir. I'm sure you'd be doing amazing at it. It's a great market, and you are great people to run it.
Thank you, Deekshant.
Thank you.
I think Ravikiran figured out his hand raise thing. Ravikiran, if you can answer your question, ask your question.
Yes, sir, so this is regarding the oncology initiative. Now, just thinking about it from a patient perspective, right? What does it mean coming to Narayana Hrudayalaya as against, let's say, approaching a dedicated specialized treatment provider such as Healthcare Global or whatever? I mean, I imagine lower cost would be one of the factors. But apart from that, in terms of the treatment, specifically, what does it mean for them? How do we compare?
If comparing us to HCG, HCG is a dedicated oncology provider versus us. For a pure oncology patient, there would be no difference in terms of maybe our facilities will be larger. Maybe our infrastructure may be slightly better for some hospitals. But other than that, in terms of the treatment being offered, because we are multi-specialty and we offer the entire range, we are able to afford much more advanced equipment. As well as cancer being multi-site, it would be useful in the early detection of a lot of cancerous tumors. We also have huge amounts of investment in bone marrow treatment, in CAR T-cell therapy, and a lot of advanced genetic screening. Dedicated cancer setup can do all of these things. It's just that our DNA is in being multi-specialty.
And so for patients, they get to have a much more comprehensive view of their health.
Okay. But in terms of the level of treatment, etc., you would say it's on par or better than even a specialized cancer? Okay.
Yeah. I mean, we are closely working with them on the protocols, but they're on par with what we are doing.
Okay. Thank you. That's helpful.
Thanks, Ravikiran.
Vedant, your question, please.
Yeah. Hi. Thank you so much for taking my question. So there's been news around private hospitals not receiving Ayushman Bharat's payment on time. How are things looking for us? It also seems that our contribution from schemes has been going down. It's around 18%. So will it be same going forward, or is it just a quarter-on-quarter change?
Yeah. So there are challenges with respect to Ayushman Bharat payments. For some hospitals, some quarters are a challenge. In some other hospitals, other states, maybe different quarters. So it's not across the country at the same time, but at different points in time, there are cash crunches with the government, and therefore, we do have payment challenges. Our aspiration is definitely to continuously improve the payer mix, but it has to be set in the context that we also want to be accessible, available to our patients. So we will try to continue to improve payer mix, at the same time not compromising on the fact that we want to make high-quality care accessible to everyone.
Okay. Got it. And also, if it is possible, how much percentage Ayushman Bharat contributes to our scheme patient mix?
Overall, our scheme patient mix is 19%.
No, no. How much does Ayushman Bharat contribute?
Roughly less than half.
Okay. It's not major.
It is major because it is still a big number for us. But yes, roughly half, less than half, we can say.
Of the scheme patients? Of the 19%?
Yes, yes.
Okay. Got it. Got it. Thank you so much.
Thank you. Ravi and Deekshant, do you have still any further questions, or should we move to the chat, questions on the chat?
Yeah. Just last one here. You have mentioned the 6,000 number for our insurance, and you have mentioned this in passing on a couple of things about insurance. But still, do you think that there is a number where we can see break-even? Because I don't think so we'd be break-even right now at all, right?
No, we won't be. 6,000 is the current number of policyholders, but we wouldn't get into the forward projections of how much it would take. Suffice to say, we still have a couple of years' worth of work to figure out the right model. You raised a fairly good point about the distributor-led model. There are pluses and minuses on that, as well as the slow ramp-up because we're getting a lot of our systems in place. But we do intend to reach that operational break-even soon. The model will evolve to be able to achieve that.
So there is a huge market of people who are over the 50, 60 age limit. And is that the market that we are focusing on? Because they are a very high-risk market, but we want to cover all people. So is that the market that we are looking at at all?
We are looking at it. It's just that the pricing would not be able to meet the requirements because the older cohort, as you're aware, will have very high healthcare utilization, and to be able to price products just for them means that they would find it very unaffordable, so we'd have to create a mix of products that cater to both younger cohorts as well as older ones.
So there would be mixed policies to adjust our risk premiums?
Yeah.
Okay. Got it. Thank you, sir.
Thanks. I'll just talk through the chat questions, and I'll ask the people to answer them. So the first one, how much burn we can expect from health insurance business? We haven't called out any specifics, but we've indicated earlier about how much we intend to invest in both the clinic and the insurance business. There was a question of any new branch name which has been started last quarter. We haven't started any new branches. I think they may have been referring to the Cayman New Hospital, which is Health City in Camana Bay, as well as the Cayman Integrated Care, which is our insurance plan. There's a question from Suruchi about price capping from the government, similar to the drug price control. What are our thoughts on the possibility of price capping for services in the hospitals?
To this, I think it's come up several times in the past as well. The probability of such a thing happening is not zero, but it is not 100% either. This is a highly regulated industry, and a lot of advanced Western countries, the realizations depend a lot on the large payers. So Ayushman prices, for example, have been capped from the day of launch. The CGHS, ESI, ECHS have also. The prices have not changed in the past nearly 15 years. And the large private insurers also have a body that allows them to negotiate as a group. So body by body, the large payers are working out ways to control the prices, and hospitals are at the receiving end of that.
But as far as it comes to one uniform price for heart surgery across a country for everyone, depending on how much they can pay, doesn't seem likely. But again, the chance of that happening is non-zero. Next question is asked about the maintenance CapEx there in Cayman. Sandhya could answer.
That's in the slide 14. Sandhya, sorry. Go ahead.
Yeah. It is given in our expansion slide, slide 14 of our investor deck. We have budgeted INR 457 million for Cayman maintenance CapEx. And so far, we have incurred INR 158 million.
The next one is CapEx plan and bed additions for the next five years. We've projected out the CapEx budget that's in the investor deck. There's a question asked two times about other administrative expenses increasing. Sandhya can give the explanation on that.
Yes. Roughly half of that increase is coming because of our insurance business. Because the way consolidation happens for insurance businesses, all the costs and the claims that are paid out from the insurance business, it gets consolidated as other expenses. So roughly half of that INR 100 crore increase that you're seeing is the insurance business P&L, essentially, all the costs of the insurance business. The other half are genuine increases in costs that we have seen. A big chunk is because of the minimum wages revision across states. Now, that has an impact on our cost lines like housekeeping, security, etc. So that's one chunk of costs. The second chunk of cost is that we've had an increase in our hospital equipment R&M. And also, the costs relating to the robotic investments we have made. There is an increased cost of the robotic investment.
That also is coming in as the second big chunk. A third chunk is a more reversible chunk, which is coming from PDD, which is provision for doubtful debts. That's an accounting entry that the auditors take based on the receivables. Q1 is generally a slow quarter in terms of collection. So therefore, our PDD provisions go up, but then they reverse. We've hardly taken any write-off in our books for doubtful debts. So we will recover this money, but there is a timing issue there. And that's adding another about INR 10 crore on the provisions. Other than that, there are small, small increases across different expense lines, including CSR, our average profit, because CSR runs on a three-year average profit basis. And we had the effect of the COVID year on the base till last year. So that's gone.
So therefore, our average profit, three-year average profit has gone up. And therefore, our CSR commitments have also gone up. So that's another item which is increasing.
Last two questions on the chat are on Cayman. First question is on the CIHL. Did the impact come from Q1 FY 2026? And can you share the previous quarter numbers if applicable? Anesh, I don't believe we break that up.
Yeah. It's not material. Yeah, we don't break it. It wasn't material up anytime. Yeah.
Yeah, and the last question has been asked in several forms multiple times in the past. How much would the cannibalization happen between the new block in Camana Bay versus the old hospital?
Yeah. There's no cannibalization because it's a single P&L. The teams are common. The cost structure is the same. Patients freely move between one to the other. So they are not two separate businesses.
So that answers all the chat questions. Did anyone?
I think we still have some questions from Ravikiran, Deekshant, and Ravindra.
Do you have questions?
Yeah. I think Ravindra has not asked any question before.
Yes, yes. I want to ask one question, sir.
Go ahead, please.
Am I audible?
Yeah, yeah.
Yeah. I'm looking at the slide of the presentation, slide number nine. So I just want to get some clarification of insights. The inpatient average revenue, in particular to Bangalore, is INR 231,000. And rest all, I think it's more or less an average, around INR 120,000. So if I average that out, it's around INR 120,000. So what should I infer from this? Are we doing some kind of a specialized treatment, particularly in Bangalore, so that the revenue is INR 231,000 only in Bangalore?
Yeah. I can answer that.
Because you're showing us an average. So how there can be a huge divergence in the average revenue per patient? That's my question.
It's specifically for Bangalore. Bangalore consists of the Health City, which is our flagship center.
I'm from Bangalore. I'm from Bangalore, so that's fine, but I want to know the huge divergence because 231 average, when you're taking an average, so hospital, you see there's a Southern Peripheral, Kolkata, East, Western. There is some kind of an evenness over there, right, so only in Bangalore, when you're averaging out, how we can get such a huge divergence, which is almost 100% divergence?
When you take averages into consideration, then things start to happen. The other hospital we have across the country, so in Eastern India, the average realizations are less. The GDP per capita is less. Most of the hospitals we offer are in tier two towns, with the exception of our hospitals in Delhi. So even if you compare Delhi against Bangalore, Bangalore is a 25-year-old center of excellence with multiple surgical robots, very advanced oncotherapies, with a massive bone marrow transplant unit that does very cutting-edge work, which the other hospitals don't have. So the case mix is disproportionately in favor of long-stay, very high realization procedures.
So what I can infer from this, that we are doing some kind of a specialized treatment, particularly in Bangalore, correct?
To a much larger extent than we are able to do simply because of the size. The Bangalore hospital is also close to 1,800 beds.
See, if I compare Kolkata, the capacity of beds is 1453. Bangalore is 1503. There's not much difference.
Kolkata, as I said, is a city where the realizations are lower. The patient payer mix is also lower. And the patient profile and payer base in Kolkata is much different from Bangalore.
Yeah. But I don't know. I'm not that satisfied from your answer that the average can be increased in other hospitals. That's what if I go with Bangalore as a case study, there's a huge scope to increase the revenue in other places as such, if you can implement the same kind of treatment available in other places as well.
That's a fair point. And that's something we will work on over the coming years.
Because we have the capacity in Kolkata, for example. The capacity is there. So only maybe we are not doing a particular advanced treatment over there maybe. So it may require some fixed treatments as such. So there's a huge scope because we are already having the inventory of beds there. But we are not utilizing in a better way if I compare to Bangalore.
Yes.
So rather than expanding in a newer hospital, why can't we use the hospitals which are available there where there is a capacity? Why can't we do the same advanced treatments in other hospitals?
Buildings aren't fit for purpose, but it is a fair point and something we'll take into consideration.
Okay. Thanks. And I have the other question on other expenses as well. So I think it's more or less answered, but not to the satisfaction of my.
Okay.
Okay. Thanks.
Thank you, Ravindra.
Neeraj. Yeah. Yes, yes, Neeraj. Please go on.
Anesh, just your last clarification on what you gave. So I have stayed both in Bangalore and Kolkata . So I very well agree with your point that the customer profile in Bangalore and Calcutta is totally different. So just that clarification because I have stayed in both the places. So you are right, actually. That's it.
Thanks, Neeraj.
So, Ravindra, do you still have any more questions, or?
That's it. Thanks.
Thank you.
So I think with that, we've got no more questions. Thank you, everyone. With that, we will conclude our session. Thanks, everyone, for your active participation as well.