Good morning and welcome back to ABG's Investor Days. My name is Philip Ekengren. I'm an equity research analyst here at ABG, covering healthcare stocks. Today I have the pleasure of introducing Medicover, an international provider of healthcare services and diagnostic services. With me today, I have the new CEO, Mr. John Stubbington. John.
Good morning.
Take it away. You'll have a presentation for 15 to 20 minutes, and then do a Q&A.
Okay. Good morning, everybody. Let me introduce myself because I am new. My name is John Stubbington. I've been in healthcare for 40 years. I'm English, obviously, as you can tell from the accent. Although I'm new to Medicover as a CEO, I'm not new to Medicover. I've been with Medicover for 15 years. Historically, I ran the healthcare services division, which I'll talk you through in a second. I'll give you an overview of the business, and then I'll talk you through our Q1 results. If you look at our business, it's split into two sides. We have healthcare services on the left-hand side here, which is historically the side of the business I ran, 70% of the revenues. We have diagnostic services on the right-hand side. They're highly synergistic between each other. Basically, on the left-hand side, we deliver healthcare.
We have a number of different healthcare assets that allow us to service customers. We have hospitals, we have clinics, we have different specialist clinics, etc., etc. Every couple of seconds, we're treating a patient. That gives you an idea of our scale. That is about 13 million-14 million consultations that we do every single year. As we do those consultations, of course, people will need lab tests. They will need to be able to get help with diagnostics. Of course, that goes across to the right-hand side of our business, which is our diagnostic services, which has a number of different labs and blood drawing points to be able to serve patients. We tend to specialize and focus in countries where the health system is a little bit more stretched.
In those countries, we have the opportunity to provide private services in the main to an ever-growing middle class. As the middle classes grow, they get more choice. As they get more choice, they look for more opportunity. As they look for more opportunity, we become a provider of choice. We started in Poland. That is why Poland is very dominant. We have a strong position in Germany, mainly to do with our lab business. We are in other kind of countries, as I say, where the healthcare system is developing and developing at quite a fast pace, being Romania and India. Why do we believe that we can have high growth, or why have we maintained our high growth? We have an ever-expanding expenditure in healthcare. If you look at healthcare expenditure versus GDP, it is much, much higher.
People are more health aware, so people are looking to access more health services. There are more health services, so there's more options for people. There are more tests available than there has been in history. There's more access, there's more machines, there's more availability. There is more awareness through Dr. Google. As a consequence of that, there is a high level of demand. We have strong brands, strong capabilities, which means that a lot of people recognize us, and we are a provider of choice. Why do we think we can maintain our high level of profitability? Mainly because currently, if you look at our assets and look at our position, we have put a lot of capacity onto our network over the last two, three years. A little bit later on, I'll quote the numbers, but it is a tremendous amount of square footage that we have put on extra.
That means we're actually quite immature. A lot of our assets are quite immature. We put the assets out there. Because they're out there, we can go and get more customers. We go and get more customers, then we grow, and as we grow, we become more profitable. We also have a higher focus on our more profitable lines, and we've got technology helping us in terms of our ratios. We're in a strong position. We gave guidance a few years back for targets that we thought we would meet in 2025. We're currently well on track for those targets in terms of EUR 2.2 billion in terms of revenue, EUR 350 million in terms of EBITDA, and our leverage at 3.5. We've got a very strong payer base. It's well hedged. We've got a lot of customers that pay us in advance, so our funded business.
This is where employers in the main pay us to cover their employees. We've got a lot of customers that pay as they go, which is the fee-for-service arrangements. We've got a decent amount, but not overcooked, amount of money coming from governmental funds. We kind of manage the governmental funds in the main because we don't want too much because they can change very quickly. We don't want too much because they can control price. Whereas on the funded and the self-pay, we've got more control over price. Healthcare has high inflation. As a consequence of that, price is important. Our first quarter results, you can see, are strong. We've grown 15.9%. Organic growth in that 14.9%. We've got robust margin expansion. Healthcare services, very strong, very strong in all of our segments.
India, a little bit weak in the first quarter, but we've seen that recovering in the second. Our revenue from our diagnostic services and our model there is strong, so that's been good. If you look at our mix here, we've got strong revenues in the first quarter. We've got a decent mix across the countries. You can see there's growth across all of those countries. We're doing strong, and our payer mix is doing strong. If you look at the growth, again, it's strong for us. From a profitability point of view, if you focus on the orange bars, you can see each of the orange bars increases, which means that quarter on quarter, we're doing really well. Our EBITDA is up, our EBITDA is up, our EBIT is up. Everything going in the right direction. Healthcare services, very, very strong.
As you can see, again, on the orange side here, quarter by quarter, we have gone up very strong in terms of growth. Very pleasing about that. In terms of our split by country, it is very dominant in terms of Poland, but we have got a decent mix and a very decent mix in terms of payer. In terms of profitability, EBITDA grew by 36.8%, so very, very pleasing. You can see we are filling up our capacity. The EBITDA went up very strongly, EBIT as well. We have got immaturity here in terms of some of our hospitals. We opened six hospitals in recent times. In the first quarter, their profitability dropped a little bit, but that is a cycle thing. That is a first quarter cycle thing that will get stronger. You can see that our medical cost ratio is improving.
Basically, as we're putting more assets on, more customers are coming in, that drops our medical cost ratio. In terms of diagnostic services, we've got stronger and stronger here. The COVID times have dropped out, but the growth is still coming through for the business. Again, you look at all markets, on the right-hand side, sales by country, it's very strong across the board. Germany is a little bit more mature, so that grows at a lower rate. Our number of lab tests are growing strongly. Again, all doing very, very well. In terms of our profitability, our EBITDA each quarter, if you look at the orange bars, in diagnostic services going very, very strong. EBITDA very strong and EBIT very strong. In terms of the number of blood drawing points to our capacity, it's increased. We've done two acquisitions recently.
We've bought some assets from SYNLAB. This is highly synergistic for us in terms of existing volume going on to existing assets. Also synergies in terms of the purchasing capability that we can do. That will make our performance stronger as we go through the year. We've also added to our fitness business that we have in Poland, where we bought our biggest supplier of fitness entries, a company called CityFit. CityFit, we used to obviously pay them for our members to go into gyms. Now, as we make the payments, we're making the payments internally because we own the assets. That's a really important thing for us. Finally, in terms of our financials, in terms of our investment, it's at similar levels that we've had before. Our ROIC is increasing. Our CapEx is at similar levels.
As I said before, we've put a tremendous amount of extra capacity on. If you look at the square meters, you've got 900,000 sq m that we currently have in terms of space. Since 2022, we've put 300,000 sq m of space on. That is the extra capacity that we put on before we gained the members, before we gained the customers. That capacity is now starting to fill, which is driving the growth and driving the profitability. We gave guidance a few years ago in terms of where we would be in terms of growth, profitability by 2025. We said we'd be at $2.2 billion. Currently, our run rate is at the $2.2 billion. If you take our first quarter's results and annualize that, we're tracking ahead of that particular measure.
Our profitability, as you've seen through the ratios, is improving quarter by quarter. We are confident that we will reach and surpass this guidance. We stated that our leverage would be 3.5 or below 3.5. What you are going to see in the second quarter is that 3.5 will increase. As a consequence of that, that increasing is just related to the acquisitions that we have done. As we go through the course of the year, that will start to drop. As that drops, it will come back into line with guidance. Our EBITDA will be in excess of EUR 235 million and EBIT EUR 140 million. All going very, very well for us. Thank you very much.
Thank you, John. Medicover has managed to deliver double-digit organic growth now for quite some time, many quarters. Why should we expect this to continue going forward? What is your strength?
We have got unmet capacity. As I have said, we have got a lot of assets out there where we have got the ability to take on more members. We have got the ability to take on more fee-for-service customers. We have got a strong brand. When people think of healthcare in the countries that we operate or the sectors that we operate, we are our go-to brand. We have got strong distribution in terms of our relationships with employers, which helps us grow our membership base, which helps the funded business. We have a model that is really good in terms of taking the relationships that we have and making them deeper. As an employer puts on an employee, we have got the opportunity to have a relationship with that employee. That employee buys more healthcare than their employer offers.
That is why the fee-for-service line in our books is so strong.
Makes sense. Could you describe the differences between the markets that you operate? What are the key differences that an investor needs to understand to understand the potential and the difference, say, between Poland, India, and Germany?
Poland is where we are really strong. We have a very holistic model in Poland, which means that we offer a full range of services from pre-birth in terms of fertility all the way through to we have actually got a small care home for the older population, hospitals in between, and full-service capability. Governmental facilities are strained, rising middle classes, middle classes wanting to have more choice. We provide that choice. They have a long history with us. We have been going 30 years. We are very, very well established.
Romania, similar in terms of stretched governmental system, probably more so, a lot more cutting and capping the public funds, which then means at certain times of the month, people come to us more, especially in our lab business. We are very strong in our lab business down in Romania. Our healthcare and hospital side also has very strong assets, really good growth. We built a new hospital down there in Romania recently. That has been very, very popular. We built another one a year before in Cluj. Again, that has been very, very popular. Those have matured very, very fast. There is a lot of demand for private services. In Romania, they allow you to blend the government funds that you are entitled to and pay some money on top, which means that they look to use private services more than public services.
India, India is a location where there isn't enough capacity. If you look at the number of beds per population, per thousand population, there's just undersupply. We're historically in tier one, tier two, and sometimes tier three cities. Our strategy very much now is to stay in Tier One, which means that we will go for bigger facilities. We will go for higher payments per bed. Our model will strengthen. There's no problem for going for bigger cities in terms of population. If you look at somewhere like Hyderabad, which is our main base, Hyderabad will grow 5 million people over the course of the next few years. When you put 5 million people into an existing location, the infrastructure has to follow. Germany, the government currently are suppressing some of the payments in the lab services where we operate. That's disrupting.
A lot of people will say to us, can you cope with that? We're used to coping with that kind of thing. I think we'll ride that quite well. When that disruption comes, it disrupts competition and it changes consumer behavior. The early signs for us is all of that will be strong. Yeah.
Yeah.
Yeah. We've got opportunity there.
I can follow up a bit on Germany because despite this kind of the headwinds that you face there with this change to the public pricing model, you've managed to grow quite a lot in recent quarters.
Yeah. I mean, I had a conversation recently with the chairman about this where he was saying Germany will not grow at a certain rate that we were talking about that I wanted us to. In recent times, it has done that. That is very encouraging for us.
Where we have our lab base, which is mainly Berlin, we are very, very strong. This is a disruptive position currently created by the government in terms of the payment model. It takes a while for it to settle down. That disruption for us could be as big an opportunity as it is a challenge.
Could you describe how you mitigate and how you work with this operationally? Do you have an example of it?
We have a lab capacity. In the German model, it is mainly to do with labs. It is not to do with the blood drawing points. In some markets, the blood drawing points are important because that is where the consumer goes. In the main here, it is more lab-driven. It is about getting your lab network structured appropriately and for us to get efficiency out of those labs.
We focus very much on getting efficiency because we know the price isn't going to change much. If we get that efficiency, at some stage, the price will have to change. When the price does change, the efficiency base is there and we'll benefit from it.
Sounds good. Could you describe how Medicover differentiates itself from other competitors in the market? What do you do differently and what's your competitive advantage?
I'll take Poland as the best example there because it's the biggest part of the business, which is that we very much are about giving a full service to the people that interact with us. It's not just about all aspects of care. It's all about wellness as well and fitness.
We're a unique provider in Poland because we're the only people that do a fitness proposition for employers as well as a health proposition for employers. That's important because health and fitness tend to be number two, number three on the benefit list for employees. We're able to blend our pricing a little bit with that. We're able to penetrate into employers at a much greater rate because the older population tend to want the healthcare, the younger population tend to want the sport. We're creating relationships with people at an early stage that we're now starting to deepen from one line to another line. Our healthcare proposition allowed us to go to certain segments of companies. Our sports proposition is allowing us to go to others. Therefore, it's creating a bigger ecosystem for us.
With you guys, India tends to be a hot topic.
Always.
Always. You're planning a separate listing of that business?
Yeah.
Announced that late last year, if I'm not mistaken.
Yeah. I mean, IPOs in India take longer. There's a lot more pre-work that needs to be done. We announced in December last year that we would explore listing our Indian business. We're currently doing that work. The reasons why we're doing it, which is the natural question to ask next, is that it's easier for us to raise capital in India for our Indian expansion. To stay relevant in India, you've got to get a size and scale. Now, we've come from nowhere. In 2017, we entered the market. In terms of number of beds, we've got 5,500-6,500, depending upon how you define it. We're in the top 10 when it comes to beds.
The top five will really accelerate their growth. We need to follow. The listing is aimed to try and accelerate that.
A question that I love to ask companies is, what's the biggest misconception about Medicover?
Probably in history that Medicover is only available to members. When we first started, we were a membership-based business. If you recall from the payer mix, our payer mix now is much more fee-for-service than it was funded. A lot of people think Medicover is a closed system because an element of what we do is a closed system. We have certain healthcare delivery points that are only available to people that pay us in advance to dedicate the fact that they've paid in advance. They need access. The availability needs to be there.
Around that, we've built a subsequent network of facilities for people to come and use as they wish and for people to buy extra services. The misconception really is that we're only available to people that pay in advance.
Great answer. You just entered the role as CEO. I know you've been here for long. What's your main operational focus over the coming, say, 12 months?
Probably two. I mean, they're the basic things, which is we want to continue our growth rate, yeah, because we're a growth business. We've got opportunities to grow. We've got immaturity in the system. We want to push up our margins and our profitability and produce cash. Yeah. All those things that we want to do, why do we want to produce the cash?
We want to produce the cash to be able to look at our dividend payments and also to look at the development of the business. We've got a lot of markets where the appetite for our services is there. We've got a lot of places that we've never been to in our existing countries to develop that, so profitability and growth.
Nice. Maybe a final question then. Where do you see Medicover in 5 to 10 years?
Currently, I don't see us particularly going to lots of new countries. We're in 20 countries, which is quite a lot. We're in four that really, really count in terms of scale. Within those four countries, we have got a tremendous opportunity to be able to penetrate more. Why take the risk of going to a new country, new system, new politics, new things to learn?
We've got a lot of different services that we can offer in the countries that we currently operate in. I can just see us penetrating more in the locations that we serve and going wider. We've got some things I haven't talked about today, such as genetics, etc., that we do, which currently, versus our current scale, is quite small. In the future, that's growing quite nicely. You never know.
Yeah. Sounds great. Thank you very much, John.
Thank you.