Ladies and gentlemen, thank you for standing by, and welcome to the fourth quarter 2018 results presentation. At this time, all participants are in a listen-only mode. If you wish to ask a question at the end of the presentation, please press 1 on your telephone keypad. This is being recorded on Friday the 15th of February 2019. I shall now hand over to your speaker for today, Fredrik Rågmark. Please go ahead.
Hello. Good morning, everyone, and welcome to our fourth quarter year-end announcement that we do here from our office in Stockholm. Overall, we are very pleased, very happy with the fourth quarter and how the year came out. We had revenue growth accelerating. We had good revenues before, but it further accelerated in the fourth quarter, just short of 19%, EUR 182 million, of which organic growth was 13.6%. As importantly, our adjusted EBITDA measure bounced back to grow just short of 19% to EUR 17.6 million. As you will hear later, largely on the back of a pronounced normalization in German lab trading, which is very important. Our healthcare services division had an outsized growth of just short of 28%, partly driven by acquisitions, but also strong underlying organic growth.
Of course, as you've heard, since we listed, the main driver of this is our integrated model with a continued very strong member intake as well in the fourth quarter. Likewise, the private pay fee for service markets in our different specialties keep on growing well. Of course, fueled by an ongoing strong employment market, principally in Poland, but as well in Romania. Also, our diagnostic service business grew well, albeit slightly less than healthcare services, 9.6%. We had some currency headwinds in our main markets outside Germany. You see organic, we grew short of 12%. Very strong growth in Ukraine and Romania. Lab tests grew about 6.5%. You see we've had a good mix of test and price development in our portfolio.
We continue to grow our BDP footprint as the main principal source of distribution outside Germany, and very importantly, as we have talked about for now the third quarter round, in the fourth quarter, we came around and really could see as evidenced in the numbers, good normalization trends in Germany. Overall, as mentioned, growth accelerated. If you look at the final quarter, 18.7% growth, that's EUR 30 million of added business since last year around. Annualize that, and it's EUR 120 million. You see for the year, we put on EUR 90 million of new business. Indeed, an accelerating trend in growth towards the end of the year from be it an already strong position. I think one really needs to emphasize the underlying dynamic growth we see in the business.
Adjusted EBITDA, as mentioned, came back growing 18.9% with a margin of 9.7%, just in line with last year. I remind you that last year, our issues in Germany this quarter had yet not started. We're very pleased to see that. Strong growth really across all key markets, with of course still some headwinds remaining in Germany, but a strong bouncing back from where we were in the second and third quarter. Again, healthcare particularly strong, driven by that strong top-line growth that comes through quite well in our contribution and EBITDA lines. We're expanding margins 60 basis points vis-à-vis last year. Some 37% EBITDA growth versus last year, of which 22% being organic and the rest coming through acquisition. Indeed, very strong indeed.
Likewise, perhaps even more importantly, relatively vis-à-vis our two prior quarters, the diagnostic services business actually grew margins relative to last year, fourth quarter. I remind you again that last year, fourth quarter, Germany was not yet into the reform territory. That's a very important way to illustrate that Germany is coming back for us. Overall, 12.2% EBITDA growth, 15% organic, very happy with that number. If you look for the full year, already mentioned, we put on EUR 90 million of more revenue versus prior years of 15.8% growth, of which 30.5% organic. We keep up our organic growth trend. Adjusted EBITDA up 9.5%. The result measure that we have communicated or do communicate publicly where we talk about organic EBITDA growth and excluding the Indian fertility startup.
I make the note here for your record that for comparative purposes, last year, fourth quarter, that was the first quarter we had India fertility in. To keep the comparison, we only really need to exclude it for the nine months period because fourth quarter on fourth quarter, it's fully comparable. Excluding the nine months of India fertility, we grew that result measure 12.2%, which is good. You recall that end of July we set the range of 8%-12% on the back of the German deterioration. We're pleased to be able to come out at the top end of that range for the year. Member growth, absolutely fantastic. 18% up, 1.2 million members, 185,000 people joined us as Medicover members in the integrated model over the year. That's a lot of people, to say the least. We're very happy about that member growth.
Again, I just remind you, we have 98% retention rate. We only account, of course, for the first month, every month. We have already sold, as I'm sure Joe will comment later on, we have already sold a vast proportion of the growth going into 2019 because of our member retention levels. Very strong number. We keep on growing the BDP footprint as mentioned, added a net 69 BDPs over the prior year. We reiterated back in the second quarter, and I reiterate it again for your memory, that our midterm 2016 through 2019, EBITDA growth target or organic EBITDA growth target, excuse me, 18%-20% remains intact. Looking specifically at healthcare services. Revenue just short of EUR 100 million, 27.7% growth, 15.4% organic. Again, you remember that about two-thirds of revenue in this division comes from our integrated model.
It's natural that the integrated model and the member-funded business is the main driver of growth. Of course, the other one-third being predominantly our private pay fee for services businesses, which also have grown well throughout the year. 185,000 members came in through the year, already commented on that. That's the strongest member growth year Medicover have ever recorded. I think that's a nice milestone for us to pass. We have put on a lot of new clinical infrastructure capacity throughout the year to accommodate all of our new business, which is great news. Again, remind you the fact that we are growing the way we are is that we offer the best service, the best quality, and I would argue the best accessibility in the market.
Clearly, we have to stay ahead of the curve when it comes to expanding our infrastructure footprint to meet this nice demand that we see. EBITDA up at 37%, margin expanded here up to 9.5% vis-à-vis 8.9% the prior year, and organic growth was 22%. Now private funding, as you recall, is the vast majority of business here, 97% in healthcare services, and that grew a strong 22% in 2018, evidencing the points I made. If we go over to diagnostic services. The headline we put there, you see normalization in Germany. That is clearly very important. I can't stress that enough. Germany is half of our business in diagnostic services. Of course, we are hugely impacted by how our German business is trading. We have also seen continued and accelerated growth in Romania and Ukraine as the main explanation drivers of growth here.
Revenue up just short of 10%, organic 11.7%, and with a 6.5% lab test volume increase. I made the point, the difference in between the two is largely explained by selling a better or a richer mix of tests, as well as seeing if not for the first time, but for quite some time a price effect as well coming through in our numbers. EBITDA up 12.2% to EUR 11 million for the year. Importantly, that's a margin expansion vis-à-vis last year, fourth quarter. 30 basis point margin expansion and the underlying organic EBITDA growth in that being 15%. Normalization trend in Germany.
In the second quarter, we talked about this the first time when we sat here for the third quarter, we said that we started to see a bit of light at the end of the tunnel towards the end of the quarter, i.e., in September. Throughout the fourth quarter, particularly in the main urban areas, that has indeed come back quite significantly. Romania, Ukraine, just fantastic growth. Nothing else to comment on that. Our Medicover clinics business in Germany has grown very well, 17% up, which is a very strong number in Germany, no doubt about that. Just short of EUR 15 million of revenue. EBITDA added 120 basis points on margin up to 6.7, up 43% versus prior year. We're happy with that number. This is really increasing productivity in the existing infrastructure. It's an important sign of our business model developing and working well.
Ending the year with 570 BDP locations in our diagnostic business, all of that outside Germany, as you know. With a focus on all markets with, I think, most of the BDPs in numerical terms we have in Ukraine, but we're growing the numbers across all of our locations. Private funding, if you have had time yet to look through the full report, you will see we have inserted a new table in the report, which I think is very illustrative, where you see the split of public and private funding in the two divisions, and you see the geographic split where growth is coming from. As you see, therefore, diagnostic business, 61% of our overall revenue in diagnostics is private pay, and that grew in 2018, 14%.
Considering the currency headwinds, particularly out of Romania and Ukraine lately, on a constant currency basis, that grew 18%, which is a very strong number. I just want to remind you that we do have a strong growth in our private pay diagnostic business. Also to mention, which is not on this slide, if you look at our diagnostic business excluding Germany, and you know Germany is pretty much exactly 50% of diagnostics. The other 50%, Romania, Ukraine, Poland, et cetera, recorded revenue growth overall for the year between 14%-15%, so underlying robust growth.
That part of the division, so the non-German part of diagnostics, expanded their margins both for the final quarter of the year, as well as for the full year with 110 basis points, which I think is a very good illustration of the fact how scale is coming through in both growing the business, but then flowing through to growing our profits in diagnostics. For those of you that were up early this morning, you could see a very other exciting announcement that we sent out this morning regarding an acquisition we signed during the night in south part of Poland called Neomedic. You see some nice pictures on slide eight illustrating some of the elements of Neomedic. This is an obstetrics and neonatology hospital group in the so-called Malopolska region, where Kraków is the main urban location. Malopolska and Kraków has about 3.6 million people.
The catchment area for Neomedic is about 4 million people, so about 10% of the Polish population. Neomedic has three hospitals in this part of the country with a set of ambulatory care clinics around. They do, or rather did in 2018, some 7,600 births with around EUR 28 million of revenue and have recorded very strong organic growth over the past years. The Malopolska region around Kraków is a very fast-growing industrial and business service hub of Poland. If you look at the population in this part of the country, very well fits the Medicover member base, if you wish, in terms of demography as well as age. Medicover has somewhere between 50,000 and 75,000 members in this part of the country, depending on where you cut it. We see a lot of synergies between Medicover and the Neomedic business.
Overall, including Neomedic, Medicover now will have around 10,500 births in our group on an annual basis. Each hour of the day, 24 hours a day, 365 days a year, there's actually a baby born somewhere in the Medicover network, obviously with quite a big weight towards the Neomedic group in the south part of Poland. We have signed a contract to acquire 100% of this business. It's subject to regulatory clearance, which we expect and hope to happen so we can close it sometime during the second quarter. EUR 70.5 million will be paid in cash on closing, and we have the credit facilities committed to pay for this. Joe will comment on this later on.
Profitability-wise, including synergies that we are very certain will be realized within 6 to 12 months, this implies a high single-digit EBITDA margin, which we think is a good price for this particular asset. If you look at an accretive measure, we will I'm sorry, did I say not multiple? I mean a high single-digit EBITDA multiple. If you look on an earnings per share basis, once this is consolidated on a full year basis, we expect this to add somewhere between 12%-14% to our bottom line on an EPS basis. We're very happy about this. It's a really good fit in terms of what these guys do with what we do. Not to get too technical, but this is a so-called level 3 hospital. There's only three so-called level 3 hospitals in this part of Poland.
A level 3 hospital is designed, that's the most medically advanced facility you can have. Where the most complex deliveries, the most complex cases are referred to them. They do about 20% of all deliveries in this part of Poland, and they do around two-thirds of all complex or risk pregnancies. It's really a critical component of the healthcare system in this part of Poland. It has an excellent reputation, and the fact that they are growing the way they do is, of course, a reflection of the fact that this is where you want to come to deliver your child, and particularly if you have any kind of risk pregnancy. As mentioned, there's a big fit with Medicover.
This is the specialty that we do pretty much in every country where we operate, and not the least in our Wilanów hospital, I think, where we deliver 1,000, 1,200 babies per annum. Of course, there's an interesting fit to our fertility business, and there's a lot of other synergies that we see we will exploit between Neomedic and Medicover. Overall, we're very happy with this. It's a fantastic group of people that is running this company, and of course, they will stay and work with us going forward. Perhaps also to say as a last point, you probably have heard me historically not necessarily being overly positive on public healthcare reforms. In Poland, actually, the reforms in this area have been rather insightful, and that's the reason why we're even more optimistic to get involved with Neomedic.
The reforms, Poland has actually the second lowest fertility rate in the entire European Union. There is a lot of policies being adopted since years back to grow the fertility rate, to actually grow the Polish population, needless to say. On top of that, from a funding perspective, they have put in reforms which are outcome-based. Actually, you get paid for what you produce, the outcomes you produce. Which a lot of reform systems are talking about that, but necessarily, you haven't really seen it in many places. That is also a key driver for Neomedic, and I think they're excellent placed both in that reform environment and as a vital player in this part of Poland. Moving on to India. MaxCure, we have not changed our ownership in MaxCure during the quarter. As last quarter around, we operate 11 hospitals.
Now you have a slightly different picture than last time there on our hospital in Nashik, which has now been trading for some three months, doing really very well. We recorded a net loss in the associate line for the final quarter of the year relating to this, and this is really on the back of MaxCure taking on a much stronger investment phase than what we saw before. Not only the Nashik hospital on the picture there has been funded, started, and operated over the second half of the year. We have also gone in to develop two quite significant new oncology centers where some of you may be shareholders in our fellow Elekta company out of Stockholm, so you will be happy to hear that we have bought two Elekta accelerators to put into those, or at least one of the two oncology centers.
One is in a city called Nellore on the east coast of India, where we have a significant hospital presence. The other one is adjacent to the core hospital in Hyderabad. Again, both of these oncology centers will become operational during the year, but it's of course, draining quite a bit of money as we set them up. Overall, very happy with the MaxCure development, the team there. As prior expressed, we expect and hope to be able to take control of MaxCure during the calendar year 2019. Joe will comment later on a little bit in terms of the guidance on MaxCure profitability for 2019, which of course becomes more important as eventually it will become a consolidated part of Medicover. Fertility, a good development.
If you go back and look at our records, I think you heard us say that we expected to see 20 clinics by the end of the year. We turned the year with 15 clinics up and running. Two aspects to that. One is that we actually have slowed down a little bit our pace of expansion to make sure that we see the performance metrics coming out of the clinics we have in the way we want it, and for those clinics to generate enough of cash to keep paying part of the development that we will keep on doing. Second is that it's not necessarily always easy to find the locations we want and getting the licenses and permits we want. We've had a little bit of delay vis-à-vis the original plan on achieving that.
So that's the reason why we now see 15 operational by end of the year as opposed to 20. That's not necessarily a bad thing. You can even say, I think it's a good thing because then we will be able to track the development in the existing clinics as they mature. A reflection of that is the EBITDA loss for the year was quite a bit less than what we originally told you, expected we did about EUR 2.5 million negative vis-à-vis an expectation of EUR 4 million. Final quarter of the year, we had an EBITDA loss of EUR 400,000 relative to just short of EUR 1 million last year. The Delhi cluster we have previously communicated have been profitable for quite some time. Punjab, northwest of Delhi, that is yet to come.
We opened, I think we had just opened when we spoke to you last time, a large new facility in Hyderabad, which has developed really, really well. We're pleased with what we see in India. That is, I think, end of my part, I'll hand over to Joe.
Thank you, Fredrik. Just having a look at some of the key financial data here. It really is a good number. We've got EUR 181.2 million revenues to report. If you look at that and then in comparison in terms of our business model, where our revenue really ratchets up, what we sell is recurring and repeating business. If you look at that in comparison to what we did for the whole year, if you look at that in terms of a growth perspective for 2019, we're a large way to meeting our growth targets already, even at the beginning of the year, the 1st of January for 2019. A very rough, an easy way of sort of looking at that is to actually just multiply that number by four, because of the recurring nature.
That's your sort of starting off point in terms of where our growth is. If you do that exercise, you've already done 8% growth for 2019. In actual fact, what we're concentrating now on is our growth for 2020. We're investing over this year to actually drive the growth figures that we'll actually be realizing in 2020. If we look at the adjusted EBITDA margin, just to remind you there in terms of the adjusted EBITDA margin, that is excluding M&A costs, but we expense direct M&A costs. That's gone up a little bit in this quarter. As you can see, we've been a little bit more active. Also then taking out the non-cash IFRS 2 share-based payments cost. On that basis, we did a very nice development.
We are up for the quarter, just under 19%, and the margin is around about 9.7%, which is the same as we booked in 2017 for the quarter. We also put on there the EBITDA. Earnings before interest and amortization related to acquisitions. We put that number on there as well, which is 8.9 versus 8.5, a 5% increase. We don't actually report an adjusted EBITDA number for that. If we were to do that would be up in a similar sort of level as the adjusted EBITDA number. That would be up some 18%. The margin on that would actually be consistent for this quarter versus last year, around about 5.7%. Just to make that point there, as I know some people do follow that number and use that as a metric in looking at the business.
The growth is really strong, 1.2 members is a fantastic number, and to come in on our record growth in actual absolute number of members is fantastic. Within that means that we put 43,000 new members on in the quarter. You see that in our figures in terms of our capital spend. We need facilities to be able to service those members. We are continuing to expand our base in terms of being able to service and look after our customers. Great development. Strong growth already in there now. We have already started off the year with a very good strong growth rate. As I said on that, if you look at it as 8%, it is already done.
In terms of when we did the IPO, we had an acquisition agenda that was part of the reason of going out, strengthening the balance sheet, and paying down our debt to give us the capacity to go out and do inorganic growth on top of our organic growth. If you look at here, I have just listed off a few of the transactions which we have either closed or now announced and expect to close them coming up shortly. Pelican Hospital, really nice business in the west of Romania. OK System, employee benefit systems. It is quite synergistic with our Polish Medicover business. Dr. Klein, the genetics business out of Bavaria, that is now closed in the beginning of January. We already funded it last year, and it was already in our debt figures.
Ukraine, in terms of the lab, which is still unfortunately winding its way through slow approval processes in Ukraine. The one we just announced with Neomedic in the south of Poland. We look at all of those and add to the amount of money we are talking about, that is about EUR 130 million. When we were doing the roadshow and the IPO, we were talking about a sort of EUR 200 million-EUR 300 million figure of investment. We now get underway and actually start to get that money being invested and put that to work. We had a quite an important figure in the numbers we reported for the full year. We have EUR 8.6 million in other income. We split that out from the operating income to make a clear distinction of the recurring business versus the non-recurring business.
Within that, quite a large part of that is related to revaluation of our rights, position, and ability to increase the share of MaxCure versus the price that we pay, so the options revaluation, which is non-cash in nature. We also then picked up a EUR 2 million net loss for our share of the associate in MaxCure for the year, which was recognized in the fourth quarter. If you understand a little bit about what we're doing with MaxCure, we're expanding that quite significantly, putting along new assets. We brought on quite a bit of debt onto the balance sheet of MaxCure as well. We funded that in Indian rupees. That's relatively expensive, so we're paying somewhere about 11%-12% cost of funds for that. That means that we've managed completely our balance sheet exposure, so we have no foreign currency exposure on that business.
Given the volatility you've had in the Indian rupee over the last year, I think that was quite wise and that should pay us back on there. That hits us in terms of the net profit in there, also with the expansion phase they're going through. It's a different type of expansion that we've done before in the past. Before we came in, they had pretty much expanded with a very low capital investment process because they had taken over at relatively good price non-performing assets, as they're very good hospital operators, they turned those around very quickly. Now we've actually gone into a different type of expansion where we're actually creating new assets. We have the Nashik Hospital, which is a 300-plus bed hospital, fully equipped, which is now operating for three months.
We have the two cancer care centers, which are in the process of being constructed now, will open in the year. We're also working on some new greenfield hospital development projects as well, which will come on in 2020. Busy expanding that business. If you look at the net interest cost, EUR 2.6 net for the year. A little bit slow to get cash out of Ukraine, given that they have quite strong controls in terms of foreign currency. It takes a little bit of time. As we generate quite a bit of cash on a monthly basis there, we've been investing those in T-bills, that's managed our currency risk in terms of the exposure to try and offset that. That's worked quite well.
That's about 35% of the income, 35% of our interest costs for the year. We've been reasonably fortunate that we haven't actually had any devaluations on that. Net operating cash flow has been strong, EUR 63.9 million, it's up some 12% for the year. We've expanded the working capital. It's mainly been in receivables balances. On a net basis, that's gone up EUR 7.6 million with the strong growth of the business. The effective tax rate has been quite low, 23%. A part of that has been driven by the other income with the options revaluations. Given the nature of those non-cash, there isn't a taxation on those. Equity has developed quite well. The increase there, some EUR 20-odd million, has been around the net profit for the year after the comprehensive income which has gone through. Other items have pretty much balanced each other out.
Net debt has gone up for the year now, we are EUR 93.4 million. Included in that is then the pre-funding for the acquisition which closed in January in Germany. Excluding that pre-funding, net debt would have been around EUR 69 million. We have now increased that at the year-end including. If I look at the Neomedic acquisition and funding for that, and then also for assuming that we get shortly approvals for the Ukrainian acquisition, this would bring our net debt up to around EUR 170 million. This would then increase our leverage to somewhere towards the sort of 2.5 levels from where it is now, around 1.6. We have increased the debt facilities that we have. We had at the year-end EUR 200 million revolving credit facility with our four main banks.
We have increased that now to EUR 300 million, same banks, same terms, and conditions. That then means that we have still got flexibility to further acquisitions and to continue our agenda. We have continued to invest since the IPO. Now we are coming up shortly in a few months, in a quarter or so, to two years. We have done just short of EUR 50 million in terms of acquisitions. Now that will step up with the German one and with Neomedic, and that will put on another EUR 100 million onto that number. The genetics business is doing very nicely. We now see that being consolidated into our figures, you will see that acquisition in the Q1 numbers. We are bringing in new products and launching them in Germany.
Investments in growth CapEx, we, as I mentioned, have got all those members on, plus also expanding our footprint in terms of our diagnostics side. We have been busy putting on new capability and investing in that. We have around EUR 41 million we have invested for the full year. The maintenance CapEx has been a little bit higher as we have invested in terms of replacing some machinery and also to deal with the expansion we have moved some clinics as well. Part of that investment in renewal of the clinics then we count as maintenance. The two main investments in India. To date, we have invested about EUR 41 million cash into those businesses. If we look at the business in India with MaxCure, where we are looking out for the 2019 calendar year, then the existing business is doing well. Very happy with that. That is trading very well.
We expect that to continue in the mid-teens level in terms of the EBITDA margin. We have the new businesses that we are adding on, and as you can expect that those would be loss-generating in the first year of operations. That would then take down on the overall EBITDA margin, we can expect that to come down for MaxCure to the low teens, low double digit figures for the full year, taking into account that impact as well. We expect to take our share ownership through the 50% level and consolidate the business during this year. That will not be in the first half of the year, that will come in the second half of the year, probably likely in the third quarter sometime.
If we come onto our financial targets, we have with the growth level, you can see we have lots of that, and we've kept that up, and we've maintained that all the way through, even with the headwinds we had in Germany. The profit levels, you can see that coming back in terms of the fourth quarter and for the full year. You have the 12.2% margin there, 12.2% increase there you see, which is what we were forecasting when we discussed the first problems that we had in Germany and after the second quarter results. We start to put on some debt, 1.6 times.
As I mentioned, that would go up on a full year basis towards the 2.5 level with the Neomedic acquisition. We expect that then to come down towards nearer the 2 level towards the full year as we grow the business over 2019. Just to mention that we will not have any dividend. That's in line with the stated guidance that we gave at the time of the IPO.
Thank you all. We are ready for questions. Please go ahead with your questions.
Thank you very much. Ladies and gentlemen, we will now begin the Q&A session. If you wish to ask a question, please press star one on your telephone keypad. If you find your question has been answered or you wish to remove your question, please press star two. Again, that's star one for any questions. Thank you. Our first is from Kristofer Liljeberg-Svensson today from Carnegie. Please go ahead.
Yeah, hi. Good morning. It's Kristofer from Carnegie. Could I follow up on MaxCure a little bit about the financials? First on the EBITDA margin, did you say, including all the investments they are doing, we should expect still a low teen type of EBITDA margin for 2019 on a reported basis?
Yeah. Low teens down into the double digits, low double digit figures. Yeah. Somewhere around about there.
Okay. Then there's nothing excluded then, that's the reported type of margin.
Yes.
First, what type of, maybe that's in the report, but I missed it. The sales level now for 2018.
In EUR figures, you're around about EUR 55 million for the full year. If we look at for local currency figures, it's about 11.3% increase for the full year. If you look at the Q4 numbers, we had last year, a really strong October and November on the sales. That was a really very strong numbers. It's probably better to have a look at more normalized one, which was December. There, if you look at the December numbers, local currency, which then has the startup operations within it, then we were up some 14% local currency numbers.
Given the expansion you're doing now, how much sales could they potentially add, both in 2019 and then when fully up and running, the new hospital and the two cancer centers?
There's a lot depends on when you get the approvals and when you can get the licenses. We expected originally to get the hospital up and running in July. We didn't really get it up and running until October because it took us longer with licenses and things like that. It's just a really difficult number for us to give you guidance on.
When fully up and running, that will probably take some years.
No, it goes pretty quickly. Yeah. I expect, for instance, us this first quarter on a monthly basis to be through half a million EUR sales per month on the Nashik hospital, for instance. We expect to go through that level sometime in this first quarter. It grows very quickly. We'll get to a position for this new hospital where it's a positive EBITDA number for sure during 2019. It will be, for sure that will be contributing sometime during 2019.
Is it so that the dilution effect from these expenses will be larger or smaller in 2020 than in 2019?
No, these will be very supportive for 2020.
Okay. Good. You said you're taking on more debt in local currency. How much debt do you have in India?
I have around about EUR 22 million today. We're still bringing on more debt.
Okay. What will that be end of this year, you think?
Again, I can't give you a detailed projection, Kristoff.
Okay. You have a lot of investments to do in the projects you have talked about.
Yeah. It will increase, but it won't be EUR 30 million. Yeah.
Okay, good. My final question, extremely impressive membership growth, 18%. Would you say, is that a good indication for growth in the healthcare business in 2019, or is there a mix effect here that we need to consider as well?
No, that's a good indication, Kristofer.
We put 43,000 members on in Q4, which you've got almost no revenue impact from in Q4. That's all going to be felt in the future.
I see there's a question someone else has asked regarding this specific topic. I remind you of that again, because someone just asked this particular question, that from a retention perspective, I think you are going to look far and few to find a business with the kind of retention that we have. We keep 98% of our corporate business year on year, and those corporates, they still compound more than 10% organic member growth with us. What explains the accelerating member growth in 2018 is that we are significantly growing the share of new business sold in our total growth. Why is that important? It's really important for two reasons. One is, of course, a new member is a new member that's going to stay with us.
Even more important, when you sell a new membership, a new company with 98% retention, it not only gives you membership for the coming month and coming 12 months, but it's not forever. There may be nothing forever in the world, but for a long time going forward. You really build, you broaden your base from which you're going to grow for many years to come. That's why we're really confident to be so specific on your question, Kristoff.
That's why I keep banging on about that. It's really important for us to invest, to be able to service those members, because we retain those members because we do what they are actually buying the service for. That's the challenge for us, actually, is to build infrastructure so we can keep those satisfaction levels and keep the membership. We had strong growth periods plenty of times in our past, we know from experience that we need to work, the team out in the countries are working very hard in terms of doing that.
Just before I go back to the queue. Historically, when you have had a significant economic slowdown, what has happened with the growth in the membership level?
What typically happens, Kristofer, you remember, I think we said in the roadshow there that we have never, ever in Medicover's history had a year of declining revenue in that business, and that is true. I think the worst economic crisis to my recollection was 1999 or 2000 in Poland, when it was just really bad. I think we sort of grew, I think it was 4% or 5%. This was before EUR times, so I think we grew about 4% or 5% in PLN. What happens, which is not intuitive, it's sort of actually a bit counterintuitive. What happens in bad times is that this is from experience, so this is not theoretical. The organic growth basically dies off and even went negative, i.e., existing companies don't hire more people, so that may not be so strange. Our new sales has always kept up.
I say, in the middle of an economic cycle, our growth is sort of split 50/50 in organic as opposed to new sales. When it gets really poor economic cycle, overall growth of course goes down. That's obvious. That's driven by the half, which is organic growth, basically just goes away. Of course your new sales also will go down. That's not the point I'm making. Even in the worst kind of climates, we've kept on selling new business. Then you're going to ask me, why is that? I think that is probably a reflection of the fact that this is such a sought-after benefit to be an attractive employer. Even in bad times, certain industries, certain companies still need to recruit staff.
As a sort of portfolio of businesses, that demand from some companies is always there to bring this into the benefit portfolios. I think that was a long answer to your question.
Great. Thank you very much.
Ladies and gentlemen, as a reminder, it's star one for any questions. We've had another come through from James Vane-Tempest from Jefferies. Please go ahead.
Yes. Hi, good morning. Thanks for taking my question. Apologies if I missed it, but I was just wondering if you could give any guidance for 2019 and how we should think about expectations for the group. Thank you.
Yeah. When we were giving our guidance when we did the IPO, a midterm guidance in terms of 18%-20% EBITDA growth. We expect through to 2019, from that period 2016 to 2019, to be able to fulfill that. Even though we had a bit of a holdback this year, we still expect over that period to be able to maintain that level of growth.
Okay. I guess I could do the math myself, but are you able to at least give us what you expect then for this one year? Just for the benefit of everybody, at least in terms of top line and EBITDA growth for the business, I imagine by the end of this year, you may update some midterm expectations. Is that the right way to think about it?
Yeah. If you look at last year, we were a little bit of ahead, and now we're a little bit behind. If you look at the two, then we've sort of come out towards in line with where we would've been on a compound basis from using 2016 as your base year, looking at the adjusted EBITDA numbers. You can expect a level of 18%-20% increase over-
For this year
for the 2019 full year, yeah.
Great. 18%-20% for 2019. Thank you.
Currently, there are no further questions at this time.
All right. Well, I'm glad that we were so clear in our message delivery. Round up, just repeating, I'm very happy with this quarter, very happy about the numbers, and I think we have a super solid platform for delivering on our expectations and plans for 2019. Look forward to speaking to you next time around. Thank you.
Thank you very much, sir. Ladies and gentlemen, that does conclude the call for today. Thank you all for participating. You may now disconnect your lines.