Yes. Good morning, everyone, and welcome to Medicover quarter four and year-end report for 2020. We are very happy today, as I think you all can imagine. We have had an absolutely fantastic quarter behind us with historically strong growth rates, expanding margins, and super strong cash flow. Before we go into that, I would, though, like to start, as I've done, I think each quarter this year, to pay tribute to all our fantastic staff across the group, who tirelessly and relentlessly work day in and day out to support all our customers with their health concerns and, of course, big worries about COVID-19 virus. I really would like to recognize and appreciate that upfront before going into the quarter and the year.
Revenue was extraordinarily strong, just short of EUR 300 million with some change, EUR 297.7 million, up 30% versus prior year, of which organic 27%. Obviously, that's very strong. I remind you, last time around, third quarter three months ago we celebrated the milestone that we were first time on a run rate basis above EUR 1 billion revenue. You see now we're almost 20% up. We're almost EUR 1.2 billion run rate. Although for the year, we're just a tad below, but very strong growth indeed. That's something to celebrate.
In terms of fee for service, our cash paying customers, and I remind you, that's where we took the biggest hit in the second quarter when elective services were largely shut down due to the lockdowns. Our fee for service segment, which is now 58% of revenue, was up a full 40% for the quarter. I don't think you've seen that number for a long time. For the quarter, we account just over EUR 50 million from COVID-19 revenues.
We assess the net positive revenue impact, i.e., the revenue of a bit more than SEK 50 million and deduct the negative impact from still a lower demand in other areas. For the quarter, we see a net positive revenue impact of range SEK 25 million-SEK 35 million from COVID-19. On the pie charts at the bottom right noteworthy there is you see Germany our second-largest geography, plus 50%. That is, of course, an incredible number, reflecting the very high demand for diagnostics in Germany, of course. That's something to remind ourselves of. Left pie chart, you see the payor mix and, of course, the funded business or employer-paid business in the same way as back in the second quarter.
We pointed out how important the stability of that revenue payor segment is for us. You can see that the growth there, of course, is much, much lower now when demand has returned in the fee for service segment. You see plus three in the funded business, whereas we're in 40% in the fee for service segment and even 36% up in our public pay business, which again, then, of course, is a reflection of the demand for largely diagnostic services in Germany as well as the other countries. Strong growth in profits, obviously, as this is flowing through to the results.
Although EBIT is not on this chart, but operating profit almost tripling for the quarter. EBITDA also up a strong 59%, with margins expanding some 330 basis points. EBITDA contribution from the COVID-related services, we assess at about two percentage points. That leaves still 130 basis points of margin expansion, excluding the COVID-19 contribution. I remind you that's despite having a EUR 17 million- EUR 27 million estimated lost revenue due to COVID-19. Although we have that lost revenue, we still have been able to expand margins with quite a significant amount, which I think it's a strong and good reflection of all the hard work underlying.
Of course, operating cash flow, Joe will talk more about that later on, very strong, up more than 60% versus the prior year. Again, the graphic illustration to the right there, both in terms of the absolute amount, you can see the dip we had in the second quarter, and then the very strong second half of the year 2020. If we flip over to the commentary on the full year. Again, I don't think any business, perhaps, certainly not ours, have seen a year like 2020 in terms of such a roller coaster with a sort of cliff drop in the second quarter and an extremely strong bounce back second half. Revenue for the year up 18% and just a tad off EUR 1 billion.
You see there, SEK 997.8 m illion of revenue o rganic growth of that being just above 11% v ery strong indeed. I think it's nice anecdote to remind you that now here in May, in a few months, it will be four years since we listed the company, we have now more than doubled revenue over that period. We have been compounding growth at just short of 20% over these four years as a public company, which I think is noteworthy.
I think it's worthwhile to remind you, memory short, back the second quarter this year, 2020, our revenue effectively decreased year-on-year. We had a revenue decrease in the second quarter of a couple of percent, and organic was even 8% down for the quarter. Despite a contraction in a quarter out of four, we have seen these growth rates. If you look at the second half alone, so the third and the fourth quarter, we're up 27% year-on-year, of which 20% is organic. We can express that rebound in many different ways, but it's clear in terms of the nature of our services and the essential nature of our services, how customers have strongly returned to our business across geographies.
For the year fee for service being 54% of revenue, and that was up 24%, and revenue from COVID-19 for the year, we estimate at just short of SEK 95 million. However, you see the net overall COVID-19 revenue impact, i.e., the positive amount and deducting the losses in revenue we estimate is still negative. Although I've mentioned just recently here that for the quarter, we have a net positive impact, however, for the year, we still have a net negative impact, which also is important to remember. Going to the profit side of the full year EBITDA was up also strongly, 31% to just short of SEK 158 million, and margins expanding 150 basis points to 15.8%. We're saying that we assume about 170 basis points from the extra COVID work and COVID contribution.
You see underlying, including grants, et cetera, received from governments, we say we have a 40 basis points contraction in EBITDA for the full year underlying. I consider that being a very strong number, considering that we have lost an estimated SEK 117 million-SEK 136 million revenue for the year from COVID-19 I think that's a very strong number indeed. We have talked quite a bit about how the pandemic has impacted our people, our business, and all of us, and clearly one thing that we or our colleagues have managed very well has been to service our customers digitally and through virtual remote care. For the full year, our virtual care provision is up some 4.5 times the prior year level.
If you look at the last few months of the year, 2020, we were even up six and a half times versus the prior year period. A very significant shift in consumer behavior and consumer demand. We have some very strong NPS scores cl early our customers like that. Also for the full year operating cash flow, very strong, up almost 80% at SEK 156 million. We successfully placed the share issue back in the late spring to support the balance sheets. The new financial targets that we set a year ago pretty much now, or exactly a year ago to run for the coming three years, we are now already trading at the top end of that range, which of course we are very happy and proud of. As we write in the report, we're not obviously revising the financial targets.
Clearly, we're confident that we will achieve or perhaps even exceed those financial targets. Last but not least, you remember last year we canceled the inaugural dividend due to the pandemic, and this year around, we're happy to suggest to the annual meeting a new inaugural dividend at this time of EUR 0.07 per share. Look quickly at our two trading divisions. Healthcare services as a portal statement, of course, healthcare services has mainly the negative impact from COVID-19, and still some restrictions in societies, whereas diagnostic services has most of the positive impact in terms of the divisional effects. You see the revenue for healthcare services just short of SEK 150 million, 19.4% growth versus prior year with 10.9% being organic.
I think that's a very good number. For the full year, up 21% to EUR 540 million, of which 5.2% being organic. Again, remind all of us again of the severe drop in the second quarter, which of course impacts the full year number. Again, perhaps more an anecdote than anything else, but back when we listed four years ago, the whole group revenue 2016 was EUR 497 million. You see the healthcare services side alone in 2020 is larger from a revenue point of view than the entire group when we listed four years ago. Fee for service here, just short of half of the division grew by a strong 38% in the quarter. You see the payer split here a lready commented before in terms of the funded business.
Obviously, it still is much lower than our historic growth, although we're confident that's going to return over time. Fee for service growing very strongly. You see also the public business is up 21% in this division. Indeed, a strong number. From a profit point of view, healthcare services EBITDA a margin of 14.4% for the quarter at SEK 21.5 million. Margin expansion for the quarter. For the full year an even more noticeable 200 basis points margin expansion growing 38% to EUR 84 million for the year.
You recall second quarter we had negative member growth and back then we commented that we're confident that we will return to growth second half of the year. We had good third quarter member growth, and we also have good fourth quarter member growth you see bringing in 36,000 members in the fourth quarter. Although of course year-on-year it's much lower than previous. That's 4% due to the drop of course, in the second quarter. We've been active on the M&A front in this division in the fourth quarter where we acquired a reasonably significant gym chain to support our Sport Card business in Poland.
We also closed three dental acquisitions to further support our dental business and dental rollout. You can see there again the graphic illustration to the right showing both the revenue and then EBITDA margin growth. Shifting to diagnostic services. Of course, one comment on this in any other way than this is sort of an epic growth quarter to have a 42% revenue growth and even stronger organic. Of course, this is the FX effect w e've had quite significant FX headwinds in the quarter.
Almost 46% organic growth I think is something to carry with us, something to remember. Revenue for the full year at SEK 473 million up 16% and organic 18%. You remember in this division, fee for service is a larger proportion at 68% of divisional revenue and up 43% for the quarter. Again, just very, very strong indeed. Again, you see the split at the bottom. I already commented before Germany is basically half of this division and you see as a geography is up 50%, which of course is quite remarkable. You see the other geographies all growing strongly and growth being from a percentage point of view, equally strong you see in our private pay and publicly funded business.
EBITDA profit reflecting that super strong revenue growth. EBITDA doubling up to EUR 37.4 million for the quarter and a strong margin of 24.2%. You see massively up from last year, o f course very much supported by COVID-19 testing. Again underlying demand for diagnostics is also picking up. We have sort of two tailwinds here supporting us. Full year EBITDA just short of SEK 90 million and margin growing for the full year. Again, although we were so severely impacted from a profit point of view, particularly in diagnostic services in the second quarter. Impressive to see this kind of performance coming through.
Laboratory tests up 8% for the quarter although for the full year in fact they decreased by 3% due to the second quarter. We keep on building our BDP network. We've reached 733 at the end of the quarter and the year. Just a few comments specifically on the COVID-19 situation in the two divisions. I already made the point that most of the benefits from COVID-19 sits in diagnostic services, whereas most of the headwinds we see in healthcare services. You remember back in the third quarter, so last time we reported, we spoke quite a bit about the high level of hospital admissions in our Indian hospital business.
You can say luckily from a health perspective, the virus spread in India is significantly down. We are very happy about that. That is of course reflected in lower number of admissions for COVID in our Indian hospital business. As you can see, we're down to just short of 2,000 for the quarter, whereas I think we were around 5,000 in the third quarter. Otherwise, in terms of healthcare services, you see negative impact for quarter four and a quite significant net negative impact for the full year.
Fitness business as an example, is the single individual business we have across the group that is still mostly negatively impacted where in fact the gyms are still closed in Poland. We have some expectation that they will be able to reopen quite soon, but for the time being, they are still closed. On the diagnostic services side, you see a very significantly positive impact, so SEK 34 million-SEK 38 million for the quarter, and much less, SEK 11 million-SEK 19 million, but still positive for the full year. Significant additional contribution, of course, from the COVID-19 work.
We spoke quite significantly last time around about the investments we were doing in terms of scaling up capacity for dealing with the demand for COVID-19 testing. Clearly, you can see that here we performed 1.2 million tests in the fourth quarter alone and 1.9 million for the full year. That clearly, I think, visualizes the sort of upscaling that's been going on in the fourth quarter. We could have done even more. We, as well as, I guess most, if not all other people in this industry, had quite severe supply chain issues experienced, which had a negative impact in the quarter. Had that not been the case, we would have done even more.
Now, the COVID-19 testing is, of course, a reflection on how society view the virus. You know how that has continued into 2021, and we're slightly down from the peak levels we saw in quarter four, but we clearly still run that engine on a very high level. Also to note is that, with these new mutations arriving, the demand for ability to sequence the positive tests, so where someone tests positively.
In Germany, for example, the ambition is to take 10% of all positive tests across the country and get them sequenced to verify the virus mutations, that is just starting, we see that as also a significant demand driver going forward into 2021. The last point to make is that, clearly for us to be able to safely provide care to all our customers, a very important element is to be able to have our staff being vaccinated, it's good to be able to report to you that we are well underway with achieving that across the Group. With that, I hand over to Joe.
Thank you, Fredrik. Just looking at slide 13 with a summary of financial numbers there. Yeah, it was unfortunate with the supply chain limitations, but I think that was a feature we saw. We came in just short of EUR 300 million of revenue recognized for Q4 and just short of SEK 1 billion for the full year. SEK 997.8, SEK 2.2 million short. For sure, if we had not quite the scale of supply chain limitations, then we would have been over that SEK 300 million mark and over the SEK 1 billion mark. Unfortunately for us, we need to wait another year before we are solidly past that milestone.
In terms of the figures, the only one here I really pull out is in terms of the EBITDA number, the adjusted one. This, for the quarter, we came in at SEK 43.8 and SEK 115.1 million. That number is akin to the old IAS 17 EBITDA number and represents a fair reflection of our ability to generate cash. The adjustments there we put through are IFRS 2 share-based payments, which was SEK 5.1 million for the year, and M&A expenditures, direct M&A expenditures, which was SEK 1.1 million.
Down a little bit as we put, for the first part of the year, our M&A agenda on hold. Overall, SEK 6.6 million of adjustments for the year. 14.7% margin, up 4.6% for the quarter and up 1.4% even reflecting the cliff fall that we had in Q2. Really encouraging numbers across the board in all respects in terms of our financial report for this quarter and the year. Just moving on to slide 14. Net interest cost. This reflects the IFRS 16 lease-based interest allocation, SEK 2.7 million.
Our underlying external debt side of SEK 1.1 million of interest cost, reflecting our lower debt levels. For the full year, those numbers being SEK 17.2 million, SEK 10.2 million for interest for operating leases for real estate, and SEK 7.7 million of external debt. Our debt coming down in terms of our total cost there reflecting our reduction in indebtedness. FX losses were high for the quarter, SEK 2.2 million. One of the things when we introduced IFRS 16 was it reflected that we were going to have higher volatility in this line in the P&L account, and that's what we see. Half of that amount, SEK 1.1 million, coming from our euro-denominated contracts, mainly in Poland for this quarter.
If we get the currency moving the other way, as it could well do, over 2022, then you'll see some unwinding of that through the P&L account as well. Those figures, SEK 8.4 million for the year, of which SEK 5.5 million being lease related, with Belarus and Poland being the substantial parts of there. Our Q4 cash flows extremely strong. Operating cash flows before tax, SEK 56.4 million. A really good number there. If you look at the working capital side we had some unwinding as we went through the year of working capital.
That's come back a little bit now in the fourth quarter to SEK 12.6 million increase in working capital over the quarter. For the full year, that figure is SEK 0.7. We had a very benign situation, even though we've expanded the business and done some smaller acquisitions over the year in terms of working capital. Our full year cash flow before tax payments, just short of EUR 168 million. Our tax level has been in line with where we were last year, so our effective tax rate 26.7% versus 25.9% last time around for the full year, so a tax charge of SEK 10 million. Tax paid, in cash, a little bit ahead of that, SEK 11 million, SEK 13.5 previous year.
Mixture in terms of we've reduced profitability in some units and other units obviously doing well, particularly with the German units in respect of the laboratories for testing and our average tax charge being slightly higher in Germany than some of the other markets. Cash and cash equivalents, as you can imagine, has followed then the operating side. We have excluded some liquid short-term investments from our definition of cash versus our previous quarters of this year, just to make it clear. This increased SEK 46.7 from SEK 34.8 last year around for 2019. Strong operating cash flows.
The capital increase we did and then the repayment of the debt and also then our strong organic investment in fixed capital has also impacted that. Our loans payable net of cash and short-term liquid investments, SEK 81.1 million, down from SEK 240 million at the end of 2019. A quite substantial reduction in terms of our indebtedness and increase in our balance sheet ability. Our lease liabilities, this has increased.
We increased this by SEK 23.3 million net with the FX movements gross, that comes up to about EUR 33 million, and that's a reflection of the expansion of our footprint in terms of continued expansion over the year, particularly in India, where we've added quite a few facilities, and then also some of the expansions that we've done in some of the acquisitions. With that strong balance sheet, we have over SEK 300 million in liquidity available in terms of our facilities and the cash that we have on hand. We're strongly placed for both organic and inorganic growth.
Reflecting that ability for organic growth, we've done capital investments now of EUR 31.4 million for the quarter. As we've picked up and as we went through that shock of the second quarter, when we resumed in the second half in terms of our capital programs and our investments, we've got that moving again and caught up some of that delay that we had that we put in place in the second quarter. Full year, SEK 72.5 million, and if you look at the split between that, 61% growth, 39% maintenance. You can see our clear focus on there.
In terms of where we've been putting that money to work then for the quarter SEK 13.6 million of that went into our Medicover Hospitals India business unit, as we had increased the number of facilities there. Now we're operating something like about 20 facilities. I'm glad to say also, we just commissioned our first LINAC accelerator for treating cancer patients in Hyderabad for the group. That is now fully commissioned, fully operational, fully permitted, and seeing patients in our completed state-of-the-art cancer treatment center there in a fantastic location. Really happy.
Our second one will be coming on in a matter of short months or even weeks. Our non-cash impairment charge, we've adjusted this SEK 5.2 million. This was some smaller units earlier on in the year, where COVID-19 really crystallized some decisions, and we wrote those down and move out of those small activities. Really strong balance sheet, SEK 483 million in terms of our IFRS equity. Impacted by currency movements. You look at the FX movement between the EUR and the USD, some 8% movement there for the full year 2020.
You see that reflected in some of our markets. Poland is almost exactly the same movement against the EUR and some other ones. I think it's as much the weakness in the COVID story and developing markets as it is with the movements between the EUR and the USD. Really strong balance sheet, really strong position, and we continue to invest in growing our business. Just moving on in terms of the financial targets overview. Fredrik has talked extensively earlier on in terms of our growth. If you look at that, this is fantastic numbers.
Our organic growth, 26.6% for the quarter, 11.3% for the full year. Even with the COVID impact in there, our underlying businesses have done very well indeed. The adjusted EBITDA margin, 18.7% there for the quarter. Really outstanding performance with the aid from the additional COVID revenues and contributions. Also in terms of for the full year, including that cliff fall that we had in the second quarter, 16.4% and at the upper end of our three-year targets as well. If you look in terms of our balance sheet side, our liquidity are very good and our indebtedness are pretty low, it's 0.7. We have lots of ability in terms of to continuing our organic investment side, as you see that picking up in Q4, also to be able to look at inorganic expansion over 2021 and further.
Very good. Thank you, Joe. I think that summarizes the report from our side. We are happy to take any questions that the audience may have.
Your first question comes from the line of Kristofer Liljeberg. Please ask your question.
Yeah. Hi, good morning. Great quarter, of course. Three questions from me. First, the diagnostic business. I think you said that volumes now are a bit below the peak in Q4, but still strong. Maybe you could give some more view on how you expect the diagnostic business to play out in 2021. Also for the group, when do you expect the pent-up demand for the healthcare business to start helping you?
Y ou think it's fair to assume for the group that organic growth will be above sort of a normal level also in 2021, and then maybe below in 2022 due to a difficult comparison? That's sort of the first question. Then just wondering if you can explain, I think you said lab test was up 8%, and how that relates to revenue in diagnostic being up as much as 45%. The final question is if you also have an EBITA figure adjusted for leases. That's something you have provided before. Thank you.
Okay, Kristofer. I kick off. I do the first one. I think Joe will give you answer two and three there. Starting out, from a DX perspective, I think the outlook for 2021 is Obviously, the uncertainty is will there be another wave coming? Will there be new mutations arriving? We will see demand for that core PCR testing starting to drop at some stage.
If that is mid-year, quarter three, four, who knows? No one really knows, Kristofer. I think the only thing, it's going to last much longer than everyone expected six months ago. That's my view. We see a slight reduction, that's the point we made, but still a very strong underlying demand. We're still scaling up capacity, so we're still investing in increasing capacity, and I guess that's an indication as good as any that we see that sort of level still riding for a while.
Sorry, could I ask.
Yeah
because you talked about the supply problem. Is it so that even if demand has come down a little bit from the peak, the revenues, the run rate now for revenues is actually higher than what you had in Q4?
I don't want to give a specific what the run rate of revenue is there, Kristofer. I think the supply chain issues are better now, but there's still some of that there. The comment I was going to make though is that I think even with the virus at some stage sort of starting to drop a little bit, you're going to have other types of COVID relating testing coming into play. We talked before about this thing we do at the airport in Munich, just as one example.
As people start to travel again on the back of perhaps lower restrictions, you're going to have a large degree of testing that wasn't there before related to anyone that want to move around Europe and flying or anything. You have this sequencing stuff that I talked about that's going to start. The last one wishing that we have more mutations would be us. If you have more mutations arriving, you're going to have even more demand for sequencing.
The point I'm making with that is that you're going to have an over demand of diagnostic testing for the foreseeable future. It may not be at the peak levels we saw in quarter four for forever, obviously. In the service division, normalization of demand there is very much sort of an inverted reflection of what I just talked about. Somehow, I think we will see lower than normalized demand levels as long as you have sort of significant virus spreads in society. Now, that's going to normalize as well, but when that will be back at fully at normal level, that is as difficult to say as when will the DX demand be back to normal.
I guess the important thing, which I've said many times, is that those two things sort of take out each other in our combined situation. Slightly weaker outlook, not than we have today, but I think the run rate we see in healthcare service probably will run like that, perhaps slightly stronger, but not massively back to normal, whereas the sort of unusually high situation, again, in diagnostics will probably run like that for the foreseeable future.
I guess because of the diagnostic being so strong, the net effect is still going to be positive for 2021.
As long as the situation remains as it is now, Kristofer.
Yeah
you're going to have certainly a net positive impact on the group. Yes.
Yeah. Thanks.
Your question number 3 was 8% up for tests and 45% up in terms of revenue. We have 1.2 million tests in Q4 related to COVID, so take that out of the 29.1 million total, that comes to 27.9 million versus 26.8 million last time around. That's 4.1% up. We had SEK 41.2 million in revenues for the division of SEK 154.6 million total. Take that out, you come to SEK 113.2 million for non-COVID versus SEK 108.6 million last time around, so that's +4.2%. Those two numbers are roughly what you would expect to see.
Okay. I missed that you were leaving out the COVID test. That's okay.
EBITDA. For adjusted EBITDA for leases, 11% for Q4 versus 5.6 last time around. In our spreadsheet, which we publish on our website with the APMs, you have that reconciled last year. For the full year, that was 7.3% versus 6% in 2019.
It's not in the report, right?
Not in the report, no.
If possible, I would appreciate if you could include it again in the future.
Okay. Yeah, sure. No problem. If that's useful, we will be happy to accommodate that.
Okay. Thank you very much.
Your next question comes from the line of James Vane-Tempest from Jefferies.
Hi, thanks for taking my questions. Just a couple, if I may. Just curious in terms of the underlying population in Poland. I understand that, I guess, the rate of decline had increased in 2020 versus 2019. That sort of continued so far in 2021. The business is clearly doing very well. I'm just conscious how do you view the broader macro dynamic in terms of what the prospects are?
The second question is thinking about the organic growth in healthcare services, just curious how much India contributed to that, or was it all a consolidation effect? Then the third question, it's a bit of a follow-up to one we've had already, but just thinking about what you're currently benefiting from in diagnostics in terms of testing how we should think about the phase of the business as we move to a vaccination level and then a new world beyond COVID. Thank you.
James, on your first question, you said something about decline in Poland. What were you referring to in terms of decline?
Population.
Oh, population.
The population. Yes.
Okay. Yeah, I think Poland has been at the bottom of the birth rates in the EU for quite some time. I think it's a top-of-mind issue for the government. They're doing a lot of stuff to try and get people to have more babies, and I think so far not very successfully so. I think that's an issue for Poland to address, making sure they get their birth rates up. I don't think there's anything visible so far in data or statistics that that's happening.
We see quite a bit of that in our hospitals, of course, and not the least down in Neomedic in the south part of the country. I think we had some 7,000 births or so in the Neomedic group in 2020. We see quite a bit of that. That's an issue, James. It's been there for quite a while, and it so far has not gone away. I think from that broader perspective on Poland, knock that on to the economy, I think we're quite positive. I think you heard me say pretty much every quarter before the pandemic hit that the main issue for the Polish economy was lack of labor. It was basically zero unemployment.
Now obviously, there's been quite a bit of unemployment, but I think that sort of reabsorption rate is going to go much quicker in Poland because there's still a lot of demand for qualified labor. Which is why if you look at our employer paid business, that second half growth, if I remember correct from memory, the member intake the second half of 2020 was some two and a half times the member intake second half of 2019.
Not only were we back growing, but relatively speaking, we were back growing much quite robustly, which again, is a reflection of that economy. I take your last question as well, which I think is sort of quite similar to the answer I gave to Kristofer here, that from a DX perspective and demand outlook, we will see when I mean for the foreseeable future, quite a bit into 2021, we will see very elevated COVID-19 related testing.
You're going to have different kind of testing, as I talked about, depend as the sort of disease evolves or the virus evolves. Whether it's gene sequencing, virus sequencing, or if it's the regular PCR testing, or it's more onto rapid testing for traveling, et cetera, but it's going to be elevated. Then in terms of when that knocks on to underlying demand returning to normal, we will just see. I reiterate that the good thing for Medicover is that we have this sort of natural hedge that somehow we're suffering a little bit on one side, but we gain significantly more on the other side. Somehow when it normalizes again, the timing of that is just very difficult to predict for us as for everyone else in the world, really. Joe, you had the second one.
Yeah. In terms of the organic growth question, we acquired and consolidated the Medicover Hospitals India business the end of November. We have one month of revenue recognized December in the prior comparative numbers. If you look at the inorganic element in terms of acquisitions, we had an adjustment of SEK 15.8 million for this quarter, which was almost exclusively the two months of revenue. October and November for the Medicover Hospitals India, and the one month of December was considered organic.
That's great. Thanks very much, all.
Once again, if you wish to ask a question, please press star and one. Your next question comes from the line of Karl Norén from Danske Bank.
Yes, good morning. Congratulations on a very strong quarter once again. I just have two questions here, if I may. The first one is on your employer-based model in Poland, where you once again had a very strong quarter, as you already mentioned. I just wonder if you could say anything, how you see the long-term prospects in growing this business even more, and could you please elaborate on how large you see this market to be, and what is your anticipated market share as of now?
Also, on the second question, I wonder if you could comment anything about the digitalization we've seen during this pandemic. I think you mentioned that in December you saw 6.5 times more virtual visits than last year. What do you really expect to be the long-term effects of this into your business? There clearly is a lot of opportunities to this, and it would be interesting to hear what you see how this will impact you in the longer run, both financially and also operationally. Thank you.
Yeah, sure. The employer-paid business, that's how we started 25 years ago. It still is the largest individual business we have. It's not only Poland, as you know. It's also Romania, and we also have a risk-carrying business in Hungary, although we sold off the provider side in Hungary a number of years ago. The nice thing with that business, and we have pointed that out numerous times, is the stability and the predictability.
As I said, over 25 years of history, we had two quarters where we had negative member growth, and the second time it happened was second quarter last year. I think that gives you that sort of proof of that stability. Growth rates typically have been a low double digit. Now, as we're lower than that because we're carrying with us second quarter last year. We're confident to represent that growth is going to tick up. I'm not going to give a percentage, clearly from a run rate wise, growth is going to pick up from where we are in the current quarter, just as the model works.
If you see the member intake I just mentioned on the second half of last year, that's going to give us obviously new revenue in 2021. We don't see anything on the horizon that would lead us to have a different outlook on that business than we've had for the past 10 odd years or so, or perhaps even more. The largest competitor we have in Poland being our main market is a company called LUX MED that is owned by Bupa out of the U.K. We're sort of in the employer-paid side, more or less the same size.
Then there are other competitors, also listed companies that are smaller than us, but a very solid business that is, if you wish, in many ways the anchor of our business historically and certainly continue to be so. The sort of virtual care, the digital care provision, yeah, it's just really important. I think one can give a lot of credit and appreciation to our colleagues in terms of when the crisis hit there in March. If my memory is correct, I think we shifted over the sort of course of 10 days, two weeks. I think we moved about 2,000 clinicians over to digital remote care away from a clinic setting, which is significant. I think we comment in the report that we did about 1.5 million virtual visits, I believe, for the year 2020.
Run rate wise, we're sort of trending around 2 million visits currently. We made a comment before that when all of this is over, when we think back what the pandemic was and when life is back to normal, whenever that will be, we expect that particular feature will remain. Perhaps not at the level we are right now, but at levels significantly elevated to where they were before.
The reason why we're quite confident to make such a statement is that if you look at the consumer response, what our customers are telling us in terms of that service, it's just really positive. I think that's going to be one of the lasting effects of this, that the consumer behavior have changed, and that's not going to go back. It's going to stay like that to a certain degree, which is obviously very positive for us and for the industry.
Yeah. Thank you. That answers my questions.
Okay. There are currently no further questions. Once again, to ask a question, please press star and one on your telephone keypad.
We have one question or two questions in our chat room. First one is, could you please discuss a little bit what you see in your M&A pipeline, and do you expect more deals in diagnostic service business?
Yeah. We have a super strong balance sheet. Our balance sheet is really posed in terms of being able to support the continuing organic and certainly a substantial amount of inorganic expansion as well. We put that obviously on hold, our processes in Q2 when that hit and subsequently have put that back in the agenda in terms of moving ahead with that. I think you start to see us picking up, okay, on a smaller scale. We did three acquisitions in the dental field in Poland in our sort of roll-up processes there for dental practices.
We also then bought one gym company, which fits within our expansion in the non-medical wellness area in Poland and fits really well in terms of supporting that strategy. We have put that back on the agenda. We are actively pursuing acquisitions, and we will continue to do so. That's not to say that we have anything large which is in the pipeline imminently.
Certainly, if you look at the size of the balance sheet that we have, we certainly have the ability to do quite a substantial amount over the next couple of years. That has expanded quite substantially with the business, with the capital raise we did in June last year. You will see inorganic expansion coming through in the next couple of years in a quite substantial way.
Another question was, one of the past constraints problem was the rise in employment cost and availability, hiring of qualified staff, especially nurses. Given the constraints of COVID-19 over the last month, how do you see the staff attraction going forward, and will that put any limitations on business?
Well, I think the fair answer to give on that one is, well, it certainly has not become easier. I think that's the answer to give. That was a constraint before, and it is not less of a constraint today. We are in a situation where we, I think for the year 2020, when probably most businesses reduced staff to meet lower demand, we increased our staff levels by 13% over the year. I think we net hired about 3,500 people for the year in a COVID-19 environment.
The fact that our HR colleagues and HR processes were able to do that in 2020 certainly gives me a lot of confidence that we will manage that situation 2021 as well going forward. The underlying cost inflation for medical staff and everything to deal with medical will remain above general inflation. When I say forever, nothing in life is perhaps forever, but for a very long time. The only way you can compensate for that is by becoming more efficient, which we do. Again, staff costs will continue to rise faster than inflation. That's just law of nature. We're just going to have to remain becoming more efficient day by day.
I think it's also fair to make the comment, Fredrik, that in some respects, some of the positive longer term impacts of the COVID crisis will be the focus of public health authorities in terms of making sure there is adequate supply in the provision of medical staff. Part of the problems we faced in terms of recruitment are because of the lack of focus in terms of training and development from public authorities. We've done our own part in terms of trying to provide training and developing our own staff resources. I think that focus will also help the industry overall in general in our markets.
We have got a new question as well. You mentioned about COVID testing outlook for 2021. Could you provide potential contribution upside from vaccination for 2021?
No, we cannot because that outlook is very uncertain. We do get cost coverage in some locations for the work we do with vaccinations. It's not going to be material in terms of the overall group. We look upon our work in that vaccination field more as a service we do to society to help vaccinate customers and staff. It's not going to be a revenue generator that's going to be noticeable.
Do we have any further questions?
Yes, we have one question, and it's from the line of Gerhard Armfelt from Redeye.
Hello. I have a question about the wellness segment. Do you see this as becoming a third division in the company, or could you elaborate on the plan there with the gyms?
Hello, Gerhard. No, it's not going to be a third division. We see the wellness segment as very closely connected to our corporate employee paid business. That is because this is obviously in Poland for the benefit of everyone, where we grow our Sport Card business, as we call it, where alongside our healthcare benefit, employers are increasingly as well spending money on buying a sports cards benefit that allows access to gyms.
Now, that's very synergistic with our employer-paid healthcare business at the very basic level, of course, because we do this to try and keep our customers as healthy as possible. That's the mission of the business, and that's what we're working every day to do. If people start to do a little bit more sports and spend more time in the gym, you sort of feel better. You build a better health. That's certainly good for our healthcare business. It's good for everyone. That's why it's very synergistic and very closely connected to that corporate paid business.
Okay, another question about the German operation. Do you plan expanding and buy more labs there as the largest market?
Yeah, we would love to do that. We're always up for expansion. Germany is our largest geography for labs. Absolutely. There's nothing imminent. Joe made a point. We're very acquisitive when we can. We have a strong balance sheet. Germany is a big focus for us. When the right opportunity arrives, absolutely.
Okay. Thank you. A new question in the chat. Can we have some more insights in what the plan is for the business to expand in India?
Yeah, we've taken quite an aggressive expansion given the COVID-19 backdrop in India. We now have up and running 20 facilities, including diagnostic-only centers in India. Our two dedicated cancer centers, one is now completely operational. Second one is partially operational, with its LINAC being commissioned in, as I said, in a few months, even a matter of weeks. This is part of our expansion in terms of the super specialty profile that we have for our business there. We moved up from originally when we started off that business unit in 2017 with nine facilities to 20 now.
That's been quite an aggressive expansion over the second half of 2020, where we'll probably reduce that expansion pace a little bit in terms of making sure we can digest those new facilities and get them to the performance levels we want to see before we have another big expansion step. Definitely we will continue to dedicate organic capital expenditure in India. If you look at the amount of money we've invested there so far, it's still one of our, I think it's the fourth largest market in terms of capital that we put in after Poland, Romania, and Germany. Not quite to 10% of revenues yet, but it's an important market for us, and one we will continue to expand there.
Thank you. Any further questions?
We have no further questions from the phone lines.
Thank you everyone for listening in on this call, and look forward to meet you all for the first quarter in about a month and a half or something like that. Thank you. Bye.