Good day, and thank you for standing by. Welcome to the fourth quarter 2022 results presentation call. At this time, all participants are in listen-only mode. After the speaker's presentation, there'll be the question and answer session. To ask a question during the session, you need to press star one one on your telephone keypad. You will then hear an automatic message advising your hand is raised. To withdraw your question, please press star one one again. Alternatively, you can submit your questions via the webcast. Please be advised that today's conference is being recorded. I would now like to hand the conference over to a speaker today, Fredrik Rågmark. Please go ahead.
Thank you. Good morning, everyone. Welcome to our Q4 2022 results presentation. We start with summary of the fourth quarter. I would add a headline here calling it a challenging quarter with strong delivery. Clearly, there are factors in the environment that we have seen for most throughout 2022 that continued in the fourth quarter that makes it challenging. You know, inflation remains at historically high levels. COVID is really pretty much behind us in terms of testing, and the war in Ukraine continues. Despite that, I think we have continued on a strong path of delivery. We've seen a very strong member growth in the core Polish member business.
We have continued on a very strong expansion phase in India with several new hospitals opening in the quarter. We have made an entry and two dental acquisitions in Germany and several new openings in Poland. We have been busy acquiring gyms and gym networks to support the sports and fitness business in Poland. Although overall the diagnostic segment is impacted quite significantly by COVID reducing and obviously the situation in Ukraine, but despite that, quite a few of the other core markets in diagnostics have performed very well during the quarter. Although it's visible in the lab test volumes going down in terms of both the COVID reducing and Ukraine, that the comparative quarter last year was completely normal, of course.
We then go and have a look at the revenue, just short of EUR 400 million of revenue, that was 6% up with a reduction organically of 2.5%. Again, you know, we have quite a big chunk of COVID revenue dropping out relative to the comparative quarter. As we have done over the recent period, we give you as well a number, what we call Business as Usual, when we neutralize for the COVID element as well as the Ukraine situation. Business as Usual, ex-COVID and ex-Ukraine, we've had a good, robust underlying growth of 17.5%, which is pretty much what you have seen or what we have seen over the past couple of years. That is continuing that trend.
Overall revenue from COVID in the quarter, EUR 11.6 million. You see quite a sharp reduction to say the least from what we had the last quarter last year. We brought in just short of EUR 40 million revenue in terms of acquired revenue. Fee-for-service, which is our consumer direct pay business, is now up to just short of 60% of revenue. Looking at the pie charts and the two bars there, what may be noticeable, you know, Poland was where we started, has always been the largest geography. In fact, this quarter it is actually growing quite significantly as a proportion. You see Poland is up 26%. Revenue-wise, it's climbing back up to 45% of our overall group revenue as a geography.
Now that's partly driven by obviously reshifting, where you see Ukraine, being this small pie to the left is down 61%, so down to 3% of group revenues. Of course, there's a, you know, there's a few things going on in the overall scheme of things here. Perhaps worthwhile to notice as well is India is now representing a double-digit share of our overall group revenue at 11%, up 36% for the year. In terms of the bar chart to the right, you see the underlying strong growth and in the light blue, the COVID element basically shifting out, as well as Ukraine significantly dropping and then the added revenue from acquisitions at the top. Overall, strong growth, but in quite adverse conditions. We go to the expansion.
We have continued investing significantly. Joe will talk about that much more later on today. That clearly is short-term impacting our margins as well as the COVID situation. EBITDA, we came up to EUR 53 million, a reduction from EUR 75 million last time, around 13.3% EBITDA margin. adjusted EBITDA, which is then our public financial target at EUR 57.7 million, so 14.5% for the quarter. I remind you we talk about that later on. The three year behind us, we closed where we had the financial targets 15.5%-16.5%. You know, we're pleased that we hit the target for the full year. We're obviously a bit short for the final quarter of the year.
Adjusted EBITDAaL, which is basically the cash flow proxy that we use in today's financial accounting standards, of EUR 34.6 million or 8.7% margin and operating profit EUR 8.6 million. You see the bar illustration to the right, and it's always just note or worthwhile to remind ourselves of Q4 2019 at the very left of this chart was the last quarter on this illustration that was completely not impacted by any COVID. You can see that being compared to the last quarter 2022, where there is still a little bit impact, but rather negligible as I just mentioned to you. Quite a significant still impact obviously from the Ukraine situation.
Switching on to Healthcare Services, had a super strong quarter, revenue up to EUR 259 million, 35% revenue growth with organic growth of 19%. Indeed a very significant growth trajectory. I think that is very visible in the bar chart to the right. Full year revenue was equally up strongly at just short of 29% at EUR 917 million, of which organic growth was just short of 16%. Again, it's worthwhile to remind ourselves that when we listed 6 years ago, the entire group was basically EUR 500 million, and Healthcare Services is rapidly approaching twice the size of the entire group at listing. Here, revenue from COVID is gone as you see, EUR 200,000.
It was EUR 8 million last time around, it's pretty much behind us in terms of this division. Been quite active on the acquisition front in Healthcare Services, EUR 35 million in the quarter and over EUR 100 million for the full year brought in as acquired revenue. That's particularly then represented as you know since before in the Fee-for-service segment. That keeps on growing strongly. It is now up to 55% of revenue in this division and was up 39% for the quarter.
Very pleasing, is to see the strong trend, in our member, co- corporate paid business in Poland, where we brought in, had another good strong quarter with 24,000 new members, 177,000, for the full year, really confirming the trend that we have seen, for a number of years now, not the least driven by employers, definitely even more recognizing the value of importance of quality healthcare in a, in a post-pandemic world. You see Poland being up now to 64% of, the revenue split, in this, division, and India, actually climbing quite quickly up to position number two in terms of Healthcare Services, with 17% of divisional revenue.
Looking at profitability in Healthcare Services, EBITDA for the quarter at EUR 38.2 million, same margin as last year, 14.8%. For the full year, EBITDA of EUR 125.9 million or a 13.7% margin. When you look at the EBITDAaL profit measure, you will see a bigger deviation versus prior year, which obviously is a reflection of the fact that we have put on a lot of new facilities, particularly in this division, which we will fill with new customers in the coming periods while we still carry the lease costs in the current period. Obviously, you know, we're carrying, as the point we have made before, quite a bit of higher costs in terms of the early stage greenfield rollouts.
Shifting to Diagnostic Services, a slightly different picture here, with the unwinding of COVID-19 revenue, and the impact of Ukraine. The revenue for the quarter at just short EUR 144 million, down 24% since the prior year. Full year revenue down 12.7% at EUR 612 million. COVID revenue in the quarter, EUR 11.4 million, so it's not completely gone. You know, you see 20-odd percent of what it was prior year, full year, EUR 106 million versus EUR 179 million. The point we make in the written report that largely COVID-19, as a pandemic, as a testing, commercial testing topic is largely behind us, although obviously the virus will still circulate in society.
Revenue from Ukraine, I would argue was surprisingly strong, EUR 11.6 million, obviously a big, big, big drop since prior year, but nevertheless EUR 48.4 million for the full year. I have said in every earnings call since February of last year that I think it is incredibly impressive to see how our Ukrainian leadership team is handling a very, very difficult situation. Our business is profitable, and you have more profit details in the full report in terms of Ukraine. In this business, Fee-for-service or direct pay from our private pay customers represents 67%, so a broader base. As you know, largely everything outside Germany is pretty much full Fee-for-service.
We had quite significant reduction in the number of lab tests on the back of COVID unwinding, as well as Ukraine. Perhaps the one point to make on the geographic chart, you see actually all geographies are shrinking here, which is COVID unwinding. Of course, particularly stands out here is Ukraine, which is down, I mentioned before 64% and as the division is down to 8% of diagnostic revenue. Not surprisingly, as you know, the drop in volume feeds through to lower profitability. EBITDA was up to EUR 23 million for the quarter, 15.9%. For the full year, EUR 118.7 million, 19.4% margin. Likewise, the EBITDAaL profit measure has dropped in a similar level.
I don't need to further remind you in terms of the impacts that we have seen during the years. We've continued to invest in BDP openings, not in Ukraine obviously, but in the other markets that we're pushing distribution forward. If I quickly also cover 2022, as this is also a book slots communique for the full year. I think I'm very proud, pleased, and happy to say that we've delivered on the three-year financial targets. We concluded the second period of three years since we listed. The first three years, we also exceeded our targets, and we're pleased that we could do that as well this time around equally. What I think is important to point out when you...
As you know, our revenue target in the public financial target is about organic revenue growth. When you look at the numbers, we've actually put on over the three-year period here now an organic annual revenue, additional EUR 428 million, which is basically 85% of the entire company that we listed soon to be six years ago. I think that's a number which should sink in. I think it's a very strong outcome in terms of how we're able in the environment we have and have had over the past couple of years to see that organic revenue generation. That is despite all of these factors that we have talked about extensively. Over the three-year period, we delivered adjusted EBITDA quite a bit above the target.
If you look at single-handedly 2022, we came in at the bottom end of the range at 15.5%, which again, I consider very strong considered environment we've been operating in in 2022. I mentioned on the Healthcare Services already the strong member intake over the years, so 177,000 members for the new year. The big theme throughout the year has been our very, very high pace of investment. In fact, as a company, as a group, we've never invested money at the pace we've done over the past couple of years. If you look at 2022 alone, we put EUR 370 million at work, and that splits some EUR 140 million in organic and EUR 229 million in acquisition investments.
Joe will talk about that before. I think one KPI, one proxy, which I think gives you a flavor of what's going on here quite nicely, is to look at the amount of medical delivery space we have. That I think is the best proxy we can get for, for, you know, sort of future revenue growth. Over 2022, we have added more than 200,000 square meters of medical delivery space. That's a 34% growth on the opening balance. It's sort of sometimes perhaps a little bit hard to fathom that, but it's, you know, we spent 27 years developing a medical infrastructure network over a number of countries.
In this year alone, we have expanded that medical footprint some 34%, which obviously will drive growth for many years to come as we fill that with private ca-pay customers going forward. We look at the full year revenue, just above EUR 1.5 billion, so 9% up for the year, organic growth of 1.9%. That you see, with basically EUR 120 million, EUR 130 million odd of COVID revenue disappearing. We've been able to fill up, and a little bit more in fact, the revenue that disappeared from reduced COVID services. I think a very strong achievement. You see a four-year compounding revenue graph to the right, so 22.5%.
That's obviously total growth, so adding up organic growth and acquisition growth over that period. You will see a picture very similar to what I have described on both divisions below on the full year level. Last picture on 2022. Earnings wise, EBITDA of EUR 217 million for the year, 14.4% margin. As already mentioned, adjusted EBITDA margin just at the bottom end of our target range at 15.5%. Operating profit EUR fifty-five and a half million, 3.7%, and earnings per share at EUR 0.08 per share. Again, you will by now be very aware of the various factors that have impacted trading.
The board, is also recommending a dividend the same as last year of EUR 0.12 per share. I think with that, I hand over to Joe to give a little bit more financial, details in the financial review.
Thank you, Fredrik. In terms of our interest costs, we've expanded, so as you'd expect, our lease liabilities have increased, and therefore, the cost of that has increased as well. We have about EUR 6.1 million charged in terms of lease liability interest, EUR 4.3 million of, you can call it sort of real interest costs, and that includes discounting and obviously what we pay for our external debt. Total just over EUR 10 million. If you look at that in terms of what sort of rates that implies, then in terms of the lease liabilities, that implies a rate of about 5.8%.
Obviously, we've expanded our footprint quite significantly, as Fredrik referred to, range of different markets, but particularly also then in India as well. That has a higher implied interest rate, and interest rates in general are higher as you know. Our gross debt has increased to EUR 515 million from EUR 418 million. Not as not so significantly as the amount of money we've deployed as we raised a lot of the debt back in 2021. But obviously we're paying for that fully now, so that's the 3.3% effective interest rate all in for that gross debt level. Our maturity is really good. we've got an average maturity of about 4.7 years on our external debt.
We're in a strong position also with undrawn facilities. Got about EUR 260 million undrawn credit facilities at the moment. If you look at our indebtedness level, that is up now. If you look at our loans payable net of our cash and short-term investments, we're at EUR 466, up very heavily from EUR 143 million at the end of last year, as we've deployed and utilized the debt that we raised and the money we had sitting on the balance sheet. In terms of our ratio of indebtedness, that's up. As reported, that's 3.2.
It's lower in terms of our covenant basis with our finance partners, with our banks, and investors, on a covenant basis, it's about 2.85. We've got quite a large variance this year-end because that's adjusted for M&A, full L-LTM, looking backward view. As we've done quite a lot of M&A during the year, that adjustment factor is bigger. If we look at our working capital, it's pretty benign. Our net operating cash flow after working capital, EUR 41 million for the Q4 and full year, EUR 170 million. Stock has been one of the drivers in managing that in the Q4.
We're pretty flat on receivables days over the last few quarters, nothing particularly unusual there. Our effective tax rate is up, we're looking at about 29.3% for the full year. Last time around, last year, it was 25.8%. As you'd expect with the level of pace of investments that we have been doing and the rollout in greenfield and brownfield sites, the drag that that causes in terms of the results doesn't get reflected in the deferred tax fully. The rate has moved up. We expect that to come down, it probably will be a higher level in 2023. Look at then in terms of some of the balance sheet measures.
Our lease liabilities have increased as we've increased that footprint, from EUR 345 -E UR 424. We've got acquisitions in there and new leases, indexation. The indexation has not been a significant part. It's been in that EUR 82.5 million. It's been more about new leases that we put in place and extensions of existing ones. It's not such a significant part, indexation. I'm sure we will get more as we go through in 2023, if I look, for instance, in the Indian portfolio, a lot of that, the indexation is already half-baked into the leases. It's not actually based on an index. It's planned increases over time.
You don't see that coming through fully in the lease liabilities, as you might expect. Equity, we've gone from EUR 517 at the beginning of the year to EUR 474. The obvious things that you will see in there, but we have also then bought out some minorities that have impacted that. We have also then the put obligations to non-controlling interests. That's gone up, particularly on the back of the value of the Indian business, in terms of the valuation models going up as well. That then pushes up the amount that we reflect for a future potential buyout of the Indian minority.
Capital investment and deployment, very strong, EUR 40.8 million, and for the quarter, EUR 140 million, EUR 1 million for the full year. Very much more heavily weighted to the growth investments than we have in prior years. Hospitals, dental clinics. We've effectively launched new facilities, whether brownfield or new sites. We've effectively launched 136 new locations, not looking at acquisitions, just looking at new greenfield sites. We're looking at 136 over the 12-month period. In total, if you look at that, it's a substantial amount of money. That's EUR 200 and...
Just short of EUR 230 million that we've invested in cash flow wise in inorganic and EUR 141 million in organic investments. We've been pretty busy. You see on the table on the right here at the bottom, we've got about EUR 282 million of enterprise value for the acquisitions that we've done this year. EUR 59 million just in the fourth quarter. We've got those two dental clinics that we announced in Germany. We went into a new market in dental, plus we got another one in Poland that we acquired in the fourth quarter.
We got a few gyms that we acquired also in Poland, a couple of gym chains in Poland in Q4 as well, building out our gym network for the wellness and sports fitness area of the Polish business. If we look in terms of a summary, looking back at where we are in terms of our overall targets we set back in February 2020. We've effectively carried on our previous guidance of 9%-12% for organic growth. We had, as the base year for that, we had EUR 844 million. We've now come in, as you see, you have just over EUR 1.5 billion in terms of revenues.
If I knock off the first 24 months for acquisitions that we've done in that period, and also acquisitions that we did in 2019, but the full year impact, then that would come down to EUR 1.39 billion in terms of revenues. That compounds out as a 14.6% organic compound annual growth rate. That's EUR numbers. We haven't adjusted for FX constant currency. If I looked on that on a constant currency basis, it's a little bit difficult with the acquisitions. If we do it in as fair way as possible, we would be looking at about probably another 2.8% on top of that in terms of compounding rate.
As you see, when we report every year, we have a higher organic constant currency basis when we report in terms of the growth. Pretty, pretty strong and growth well above our targets. The pace that we've invested in terms of our organic capital deployment, it's really what we've been trying and aiming to do, is to be consistent, very strong high growth. Profit-wise, we had a target we set back in February 20 of 15.5% to 16.5% adjusted EBITDA margin. We had in 2019, EUR 125 million adjusted EBITDA, and a 14.8% margin. And now we come out at EUR 234 million, 15.5%.
That is a compound annual growth rate of 23.3%. If I go back to the prior three year one, we're not far different from that. We have a very similar compound annual growth rate. Our capital structure, we had 2.8 x in terms of our leverage metric. We now come out at 3.2. Obviously between 2.8 and 3.2, there's been a lot of change. We've been, we went up to 2.8, then we came down, and now we're back up again.
I'm very happy that we've been able to use the balance sheet in organic investment and actually use that strength and money that we had on the balance sheet to boost our growth. Back to you, Fredrik.
Sure. Thank you, Joe. We will finish today with commenting on the new financial targets that we released last evening, after the close of the exchange. You know, we're very pleased with these new financial targets that I think signal a strong confidence in our ability to keep up the organic growth rate. In fact, after 6 years as a listed company then, and 3 x the size when we listed, we're actually increasing percentage-wise, the organic growth ambition. We also do it slightly different this time around to state this as an absolute number in both revenue and adjusted EBITDA as a number that we will exceed.
we say in terms of 2025, from a base of EUR 1.51 billion, we will exceed EUR 2.2 billion of organic revenue, and we will exceed EUR 350 million of adjusted EBITDA for 2025.
We also say that we will, in addition, complement that with inorganic activity, but we point out that that will be weighted towards the second half of that three-year period, as we have signaled that in terms of 2023, we will normalize our investment activity and focus on execution on the fast agenda that we have had behind us. We maintain the balance sheet and dividend policy targets with a leverage up to 3.5 times, which we can exceed for shorter periods of time, but that's the same guidance, and then 50% payout ratio of net profit. I think that's a, you know, strong outlook, strong targets.
To put it in some perspective, I made the point early in this call that we have put on over the last three years, I think an impressive EUR 428 million of organic annual revenue growth. You do your math quickly, and you see, as a minimum, we say we will put on EUR 690 million of organic revenue growth over the coming three years, which is then some 60% higher than the prior three -year period, which clearly we're comfortable with because of the underlying strong demand, as well as the very strong investment agenda that we have had behind us and now we are executing on. In addition, you know, Joe made the point when he talked to the balance sheet.
When we deliver on these targets over the period and looking at the sort of leverage levels we can take it up to, when we start again with more inorganic activity over the period, we can deploy should the opportunities arise, some to up towards EUR 300 million of inorganic activity as well during the period. That's the end of the presentation. We're happy to take any questions that you may have.
Thank you. Dear participants, as a reminder, to ask a question, you need to press star one one on your telephone keypad and wait for your name to be announced. To withdraw your question, please press star one one again. Alternatively, you can submit your questions via the webcast. Please stand by while we compile the Q&A roster. This will take a few moments. Now we're going to take our first question. The question comes from line of Kristofer Liljeberg from Carnegie. Your line is open. Please ask your question.
Yeah, thank you. Can you hear me?
Yeah.
Hi, good morning. I have three questions. First, on depreciation that has come up naturally here, of course, from 4% a few years. Now it's about 5% with all investments you have done. Is it possible to maybe give some color what that level should be in 2025, if you're reaching your target? Also, to reach that target, what type of organic CapEx is needed? My final question relates to the new medical delivery space that you have talked about. How much of the new space has been filled during the year? What could you say about the timing for rest of it? Thank you.
Thank you.
Yes, sure. Hi, Christopher. So depreciation, that's up, which I think is a reflection of the pace of the expansion that we've done. We've got two years of quite heavy expansion. If you look back to over the last 24 months, we've put on 91% from the beginning of 2021 in terms of medical space. That rollout we've done at a slower pace historically because we haven't had so much capital to be able to deploy. Also as we've grown the business, we've grown the ability to the sort of like the employee base and the capabilities in terms of rolling that out as well, because we expanded our footprint.
Historically, we've also been able to grow and deploy more space. That space, as you see in terms of the margins, and if you look also at the Return on Invested Capital, that space is not full. We've done the investment, we've got the space and we're depreciating the asset base. We've got a higher depreciation level. As we move that space to being full, that depreciation level will come down to levels that you've seen historically. We've not changed dramatically in terms of how we deploy capital. We use operating leases for the real estate. We're investing in the fit out, in the machinery, in the equipment, et cetera, which is on our balance sheet. That's what's getting depreciated.
I'm talking here excluding Right-of-Use Asset Depreciation, so real depreciation if you like. That will come down as the margin and that fills up. You asked then about organic CapEx, what's the sort of level? Well, we're gonna come down to a more normalized level of organic capital deployment. If you look back historically, that's been up around about sort of 4% of revenues. That's the sort of level to that we expect that we're gonna be running at in the next couple of years and still achieve that EUR 2.2 billion organic target. How long does it take us to fill that sort of space up?
sort of like a reasonable sort of like a reasonable sort of historical level in terms of where we start to get to. Pretty reasonable, pretty okay levels of occupancy is sort of 18 months. Sometimes we've done that quicker, sometimes it's been longer, depending on the particular one itself. As we've increased scale, it's got a little bit easier in some of the business units as well. If I look at the Polish employer paid one, then we're starting to get to good utilization levels well before 18 months. In some of the new hospital standalone sites, it can be a longer period. I hope that gives you some sort of flavor. Yeah, very helpful. Thanks a lot.
Thank you. Now we're going to take our next question. The next question comes from the line of Claus-
Hello. This is Clas Tolfén, Erik Penser Bank. Can you hear me?
Yeah, we hear you, Claus.
Yeah. Great. Thank you for taking my question. I have a couple if I may. My first question would be when it comes to India, you reported a nice growth year-over-year, but a little bit of a slowdown compared to the third quarter. Is this just due to seasonality or any other things?
Yeah, it is. There's definitely not a slowdown, but you do have a seasonality and depending on how festivals and holidays fall, et cetera.
Mm-hmm.
There's definitely not slowdown in the Indian rollout. Yeah. In Northern Hemisphere we see hospital occupancy go up in the winter.
Mm-hmm
In India, it's the sort of reverse that people don't go to the hospital so much when it's the winter. When they have their winter, it's just a different dynamic. You have a whole ton of festivals in the fourth quarter. Maybe you've heard of Diwali. That's a big festival.
Mm-hmm.
They've got a whole load of other ones as well.
Okay. Perfect. Great. Also if you just could repeat what you told about the tax rate going forward. If you expect this to come down somewhat in the near term.
Yeah. We were last year around, we were just above 25%. I expect to see it coming down. It's going to be linked into getting the occupancy levels and getting the facilities that we've expanded on producing. We've got a number of different units where the new facilities sit within separate legal entities. We're not getting the tax tax offset for the operating deficits we generate on those new units. Those will come in to being profitable, contributing, we'll get then the recognition in deferred tax, and that will come down. Our cash tax has not that significantly changed, our recorded tax level will come down.
If you look at what we do in terms of our Return on Invested Capital calculations, when we're looking at that, we use a normalized tax rate of around 25%. That's where I expect to trend back to. I don't expect it will be next year, but certainly the next year afterwards, I'd expect to be trending down to that sort of tax rate.
Okay. Great. Perfect. My last question is about your German dental business, and if the integration has progressed well, and if how much revenue contribution it gave in Q4. If it's possible to split up?
Yes, we do. It's in the disclosure on the back on the... Sorry, no. It's not in the disclosure there in terms of the back, but if you look at for Q4 our which has been probably the best guide for you. We bid both acquisitions in the from the beginning of Q4. Just to give you an idea of the sort of size of the scale.
Okay.
Our Q4 revenue was just short of EUR 11 million for Q4. Annualize that out at EUR 44 million. This all gives you an idea of the scale.
Okay. Perfect. Thank you so much.
Thank you. Now we're going to take our next question. The next question comes from line of Mattias Vadsten from SEB. Your line is open. Please ask your question.
Hi there. I have three questions today to start with. We have more on the CMD. You know, on the revenue target, is the difference versus the prior target of 9%-12% organic, mainly the elevated price increase is expected through 2025 versus the level that you had in the past in terms of price increases? Of course, you added a lot of capacity lately, like 2021, 2022, that you fill up going forward, but it sounds like sort of the future organic CapEx should be fairly the same as you've had in the past. Just some thoughts from you on this topic would be helpful.
Just so I get it, you're asking basically if the difference in the revenue growth target is sort of price driven or if there's a volume difference as well. Is that your question?
Exactly. The 13.5% per year versus the 9%-12% historically, or in terms of your target. If that's incremental-More bullish on volumes or if it's higher price increase?
I think, Mattias, you should interpret that we're sort of more bullish on growth than what we have been, and we have not been un-bullish historically. You know, right now we're in a higher inflation environment. That's gonna drop. When it drops, you know, who knows? You will have more volume growth than what we have seen historically, and there will be some obviously price growth, as you see in this report, much higher than what we have seen historically. That will add up to a higher growth, and that's why we're basically putting up a higher absolute number as a number we intend to exceed. There is a growth in volume element in there, and there is an unspecified price component in there.
Then you asked us-
Just wanted to make that clear.
Yeah.
Thanks.
You asked us about CapEx. I think I answered that with Kristofer's question. We'll bring that down to a level which is more, more in line with what we've done historically, so around about towards 4% of revenues, that sort of level for our reinvestment in growth. For our maintenance levels, that will come, which is this year and will be in line with previous years. Around about somewhere around about the 2.5%-3% level, but not more than 3%. Good. Do you expect this, you know, you're talking about 4% until 2025, but should you-
Well, you know, whenever we grow.
Like in over 2023 or?
Matthias, whenever we grow, we invest for growth. We're not investing for this year's growth. We're actually, we're investing for the next year and the year afterwards and the year afterwards. So that sort of growth is just to keep the engine going. And just by growing the business to EUR 2.2 billion, you know, multiply that out by 4%, you're on to effectively what we've invested total this year, EUR 140 million just on the growth side.
It gives you an idea of sort of like that we not only increase our cash generation to fund our growth, but we also increase our ability to grow as well, because the markets we're in have got such a fundamental demand and fundamental need for the infrastructure that we're putting in place and then servicing the clients through.
Agreed. Good. My next one, you know, I know I've been asking like three quarters in a row now about Diagnostic Services. I will try to frame it a little bit differently. I mean, if you look on the lab test growth, you know, in 2021 over 2020, excluding the COVID testing, it was up like a splendid 24% or something, up 2.3% this year, excluding COVID and Ukraine. If you look over a three-year period, it still looks, you know, quite good. Is there a difficulty to exactly know the moving parts that make the difference in 2022 versus what you achieved in 2021? And, you know, what do you expect going into 2023 and beyond in terms of diagnostic tests?
Yeah. You know, the, I know you've asked that question two, three quarters in a row, and it is, it's sort of difficult to put the finger exactly on it because you have quite a few moving parts, as you put it. You have an element of. I think, you know, the main thing I have answered the last couple of quarters on this question, Mattias, is that, you know, there is an element of this sort of transition from sort of COVID prescription into normal prescription of tests, which is delayed, for the lack of a better word, somehow.
you know, in a completely different part of our business, we have talked before about when we transitioned in the Indian hospital network from, you know, only serving COVID in the hospital, and then it took two, three months, you know, coming back to normal, treatments in the hospital. It, you know, it's something like that, but not identical. Somehow as, you know, COVID revenues unwind, in some places, we see it takes a bit longer to build back, if I call it the normal testing volume. The observation is correct. If you exclude, you neutralize Ukraine and COVID, you have a benign underlying test growth. you know, we expect that to improve, no doubt.
You know, we can't be sort of scientific with you about what is actually driving that at this very moment in time.
Good. A last question, if I may. You know, recently, you have invested quite forward leaning in Healthcare Services, and we know, of course, you know, going forward that India will grow quite sharply. If we look to your, you know, budget and your organic investments in the next three to five years, let's say. Will you be more forward leaning on Healthcare Services over Diagnostic Services, or, you know, how should we interpret this? I assume you will talk about it on the CMD, but anyways.
I mean, I think you will hear quite a bit about that in a couple of hours. I mean, I think one question. Sorry, sorry. One way we have answered this question historically is to say, well, you know, we will invest our capital pretty much in relationship to where we have our business and assets today. And whether that is geography, you know, historically Poland, Germany being the largest and Romania runner-up. And, you know, that is largely still true with. And I said, you know, there's one exception to that rule which we have articulated as India over the past couple of years because it came from a very low base. Proportionally, it has received much more growth capital than what its, call it, its geographical base and our revenue warranted.
Now it's up to 11 odd %. I think if you look at the Going forward, I think India as a, as a geography will probably still re-receive slightly more than its sort of, geographic revenue share. Otherwise, I think that rule still applies. You know, the fact that we have seen less, capital deployed in diagnostics is not because we haven't wanted to, if I put it that way. You know, with, with what has happened in... Well, you know, Ukraine speaks for itself.
But also not to be forgotten is that, you know, we say COVID may be just behind us, but over the three years that we have lived with COVID very intensively, a large part of the, call it, development agenda and everything beyond actually just running the daily business in Diagnostic Services has been about servicing an a COVID agenda. That's also part of, if you wish, putting COVID behind us and moving into to a regular development phase.
That makes sense. Look forward to the CMD later on. Thanks.
Thank you. Now we're going to take our next question. The next question comes from line of David Adlington from Jefferies. Your line is open. Please ask your question.
Hi. Thank you for taking my question. Could I ask three questions, please? First on India, could you just comment on the profitability performance in Q4 that you've achieved so that we get the idea of sort of exit rate on this? Thanks.
Why don't you just give us all your questions there, David Adlington , and we'll come back to you, come back to you.
Yes. Second question is about expansion KPIs that you've mentioned earlier. You mentioned about medical delivery space, but also there is, I think, disclosure around the EBITDA after lease. Can you remind us how much of your facilities are hospital expansions, in particularly India, they are sort of leasing versus ownership so that we can think about squaring that to what that means to EBITDA in terms of lease cost aspect of things? That's my second question. Third question quickly on sort of net interest expectation for 2023 and leverage impact. Thank you.
Sorry, I didn't catch that last one, Grace.
Your expectation for net interest for 2023 and room for your leverage given is quite high at 3.2. Can you remind us covenant as well, please? Thank you.
Yeah, sure. Okay. India profitability, Grace. For full year, we run around about 14.6% EBITDA margin for India. If we look at just the quarter, we were running around about 17%. That's an EBITDA margin. Obviously then, EBITDA is lower than that. EBITDA margin for Q4 was around about 7%, just above 7%. That's with that heavy expansion coming through and pre-opening costs and everything else. We still got our expansion agenda for 2023 for India as well, which we're working on within that.
Plenty of room for that to move up, is I think, what you need to think about. The question was on leasing versus ownership, yeah? Specific to India.
Yes. Yes, please.
We only own one facility in India. All the other facilities that we operate and all the stuff that we're doing expansion wise now is where we're leasing with the real estate. The leases are long leases. We're looking at normally sort of 20-25 years in terms of the leasing. As I mentioned earlier on, the indexation is actually hard baked into those leases, so that's actually reflected upfront in the leases. We've got quite a large divergence between IAS 17, so the older EBITDA, and EBITDA this year, which we haven't had previously. About EUR 9.2 million, if I think, remember off the top of my head.
where the IAS 17 EBITDA would be 9.28, that's the front loading of the lease charges that you get through IFRS 16. On a cash flow basis, we are in a strong position than we would be just on a sort of EBITDA number. You asked, I think, a question, that's our strategy going forward, Grace. We often have a right to buy out the leases from the landlord if they wanna sell it or in some other areas. We can if we ever find we get spare capital lying around, which I don't think we will, but we can always buy out the real estate if that's the sort of what we thought was a good idea.
We don't think that's a good idea at the moment. We'd much rather use our scarce capital to be able to leverage up with having other people financing the real estate. On 2023 in terms of net interest and room for organic, I'll talk more about that at the Capital Markets Day. Basically, as our COVID comps will now drop out in Q1, so the really nice COVID numbers that we had back in Q1 2022, that will drop out in Q1 now this year. So expect our leverage to go up in terms of the reported number in Q1. Probably also then maybe a small increase or staying stable in Q2.
Then we'd expect it to start coming down as we slow our as we slow our inorganic and growth CapEx deployment in the second half of the year, and we'll get better contribution coming through from our early-stage investments.
Great. Thank you. Could I just squeeze in one question about that leasing ownership side of things? Obviously this has impact in terms of cost, construction, and you mentioned indexation not so much, but there is often cost to it. Does that impact how you think about the pace of expansion or speed, sort of? Is there other consideration that impacts, if you can just highlight here? Thanks.
I think we're gonna run out of time here, Grace, do feel free to ask the question at the Capital Markets Day.
Yes, that's true. Bye. Thanks.
Thank you.
Okay.
Now we're going to take our last question. The last question comes from the line of Danny Sarimpa from Pacific Asset Management. Your line is open. Please ask your question.
Hi, Danny.
Hi, guys. How are you? Just a couple of questions, if I may. On India, how many beds did you have in operation at the end of the year? What is the expected number of new bed openings either in 2023 or over the next couple of years, if you're able to comment on that? Definitely as it relates to your organic growth target to exceed EUR 2.2 billion, is there a cadence there that we should think about in the context of, you know, you talked about capital deployment being more levered towards the end of the period. Should we expect an acceleration in organic growth towards the end of the period as well, or is it fairly evenly balanced?
I guess the ultimate question here is, when you think about M&A and capital deployment, you've historically been able to acquire hospital operations in India at particularly low multiples versus if you look at what multiples of the publicly traded Indian hospital operators are. I'm just curious how you're thinking about the market environment to add additional assets through M&A rather than through greenfield or organic investment.
Thanks, Danny. We've got operational beds, and this is not our full capacity because we've got actually in the facilities we've invested in, we've got capacity to add more beds as we get occupancy going up. We've got 4,300 operational beds now at the end of the year. That will increase as we launch more hospitals over 2023, 2024, 2025. We have a clear ambition to increase our hospital, number of hospitals and operating beds, so we will see strong growth over this three-year period and over the next 5 years in, and probably over the next decade in India.
In terms of M&A deployment and will that mean that we see sort of an acceleration at the end of the period? No. The targets we've given is EUR 2.2 billion or at least EUR 2.2 billion, so in excess of EUR 2.2 billion in terms of revenues from organic for 2025. As I mentioned, when we do the investment for growth, our organic investment, it's not for this year's growth, it's for next year's growth and for the year subsequently and the year after that. We've done quite a bit of the deployment that we need to in terms of capital and facilities to actually achieve that EUR 2.2 billion target. Not all of it, but a long way there.
We will do that with reducing our rate of organic investment from the highs that we've had this year. We'll bring that down in terms of percentage of revenues. As I mentioned, whenever we're doing organic investment, it's not for this year's growth, it's for next year and the year afterwards and the year afterwards. You really need to sort of look backwards to the investment we did historically to compare to the growth we're getting in the current year. M&A work on will be incremental and above the 2.2 target. That M&A work will be towards the end of the three-year period, so we will be doing a lot less inorganic this coming year, 2023.
We probably expect that it'll be the second half of the period before we accelerate. I think that's pretty much all the time we've got for Danny. If we haven't answered that adequately, please ask again at the capital event later on today.
Thank you.
Thank you. There are no further questions at this time, and I would like now to hand the conference over to our speaker, Fredrik Rågmark for closing remarks.
Thank you everyone for attending, and I hope as many as possible of you will have a chance to join us for our inaugural Capital Markets Day, just starting in an hour. Thank you and goodbye.
That does conclude our conference for today. Thank you for participating. You may now all disconnect.