Let's see. Hopefully you can all hear me, and very welcome to this very actual inaugural Capital Marke ts Day, something we have not done before. Hopefully it will go well. First of all, I hope you like the headline. You may have seen that we released our new financial targets last night, and we will speak quite a bit about that, I'm sure. One headline number it's easy to remember is that we will do at least organic revenue in 2025 of EUR 2.2 billion, wh ich is quite significantly above, we just closed on EUR 1.5 billion ten. Basically 50% up almost organically over the coming three years, which we're very comf ortable with.
I think a large part of today here is about giving you as well some comfort how all of that will be achieved. Now this is what the agenda looks like. I will spend some 30 minutes. More importantly, I think, most of you have heard me and Joe talking quite a few times over the years. You have not heard in this context our Chief Operating Officers, Staffan Ternström for our Diagnostic side and John Stubbington of our healthcare side will spend 1 hour each basically trying to educate and give you much more insights into what actually is going on within our divisions and what is driving growth forward and historically.
Joe, that you all have met and heard many times before, will have a financial block, and I do a very quick wrap-up, and we have a Q&A session at the end. I'm also very pleased, happy that Kristofer Liljeberg, who is somewhere in the room. There you are. Who follows us from Carnegie, has kindly agreed to moderate the Q&A sessions. You will see Kristofer up here after Staffan's bit when we do the first Q&A session. There is also then a little lunch break in the middle. Already now I make the point that sort of timekeeping is sometimes difficult and particularly when people move out and in of a room.
If you would kindly agree to try and be back in your seats by 1:45 P.M., that would be very good. For those of you that have not met me before, basically, Medicover has been my career. I did first stint with Oriflame, when all of that happened in Eastern Europe with Robert's brother, Jonas, that sadly passed away a few years ago. Basically ever since, I have spent my life with Medicover. Going straight into it, headline-wise here was a high cash generation enabling reinvestment for persistent organic growth. I think that is something you're gonna hear throughout today. We have grown strongly historically. We keep growing strongly organically, and we think we will continue to grow strongly organically going forward.
We use throughout this presentation 2016 as a base year. You remember we listed in May 2017 on the back of full year 2016 numbers. The full year revenue that we released this morning, you see we have tripled revenue over these six years. 2/3 of that has been organic growth. 1/3 has been acquired growth. You see here over the six years since IPO, we have effectively generated organic growth equal to 137% of the size of the company when we listed. I think that sort of brings home the message very strongly in terms of the underlying demand and our ability to drive organic growth.
We've had two periods of three-year financial targets. Of that organic growth, two-thirds of that has happened in the second three-year period, which you sort of would expect because obviously the company is grossing up. 70% of the M&A-driven growth has happened in the second three-year period. Very strong growth. Now, also what is really, really important is to realize that all of this growth is really internally funded. Not the M&A side, then we use our balance sheet, but the organic growth we drive from our own cash flow. This is a simplified view of cash flow. This is EBITA IFRS 16 that everyone is using nowadays. Anyway, you see basically this is operating cash flow. After tax payments, you see I put on maintenance CapEx because we basically need to maintain our assets, obviously.
The bars, the rest of the bars is basically cash available. We need to pay a little bit of interest, obviously, but otherwise it's cash that we can recirculate to drive growth, and that's obviously what we have done historically. You see, obviously, 20 and 21 was a little bit inflated from COVID work. COVID came and COVID has gone. I think it's important, one point to make is if we look at 2019, no one had heard the word COVID. And 2010, where there's a tiny little bit of COVID left, but not very much. Sorry, 2022 when there's not very much COVID left. Here, no one had heard about Russia invading Ukraine, and you know the situation.
Despite that, you see we have basically doubled from 2019-2 022, we have doubled the absolute amount of free cash flow in this definition. Really, really important. Joe will speak much more about that later on. Some operational milestones. We could make that list very, very long, but I just sort of took some things. India is a very important piece of what we do nowadays. John will go into that in quite some detail. We entered 2017. 2019, at the end of the year, we started to consolidate 23 hospitals, 4,500 operational beds now. That's significant. Close to 10 million outpatient services, etc. We'll speak much more about that later on. A very significant presence, and importantly, something which will drive growth going forward significantly.
We started a dental market consolidation in Poland some 5, 6 years ago. We'll speak about that as well, where we do organic growth through our own, you know, organic investments, and we complement that with acquiring clinics wherever it makes sense. We made big steps, John will spend time on that, into the sport and wellness market in Poland 4 or 5 years ago. Staffan will spend quite some time on describing to you what we do in the genetics field. Plus, there is a lot more, but I thought, you know, those were just some relevant points to mention. Revenue-wise, I've already made the point, strong organic growth. You recognize 16 - 20.
If we look at total revenue growth, so organic plus acquired, we've compounded above 20% since we listed, which I think is a really good record. Very happy and proud over that. You see we noted at the bottom of the bars, you see for both periods, we have been significantly above the publicly stated target for revenue growth. Here, on the profit measure, the first period, you need to remind yourself that then it was different accounting stuff, so we had IAS 17 EBITA at that time. Our target was to grow 18%-20% per annum. We came out over the period growing 20.2%.
The period that we just now closed, actually then when we released the results this morning for 2022, we reached an adjusted EBITA margin, adjusted EBITA IFRS 16 of 15.5%. Just at the bottom end of the target, but I see that as a very strong outcome considering all the headwinds that we've had against us in the world in 2022. Likewise, as on the other graph I showed, if you look at 2019 undisturbed, 2022, there's a tiny bit of COVID in there, but not very much.
Basically, you can look at the EBITA generation to 19-22 on pretty much a like for like basis, and you see that is, it's not fully double, but it's 90% up. I think a really strong development over 3 years, which arguably has been the worst since World War II with how COVID affected the world and now Ukraine. I think strong delivery. We've had pretty much the same leverage when we went into the period as when we come out of the 3-year period. Clearly, there has been a lot of change in between. We went in at 2.8, I think, exactly, and we came down pretty much to no debt at all.
We have now been busy over a couple of years to invest, so we're back up now as we announced today morning at 3.2. I'm not gonna go very much into this. This will Staffan and John talk very much about. The only point I'm gonna make on this slide is geography. I will use Poland in a number of examples in here. They are largely applicable on the other geographies as well. You can say as Poland is 43% of the entire group, I think it's relevant to use Poland as a proxy for some of the examples we will show. You see Germany, 21%, and Romania, India, and Ukraine now, obvious having reduced quite significantly on the back of what has happened.
The ambition here is to be able to really try and explain a very clear, strategic roadmap for you, and also explain, illustrate for you the position we have in these different market segments, why we very strongly believe that we can continue on this rather superior growth journey. Now I will show you three slides, which sort of wanna bring home to you a super important element of this overall message, which is we are operating in markets that grow, most of them, with one exception, Germany, which is mature. All our other markets grow double digit.
That's when people, "How long can you keep on growing double digit?" It's a big difference if you operate in a market growing 3% per annum or if you're operating in a market growing 12% or whatever percent per annum. These three slides are aimed to try and sort of bring home that message to you. This, you probably or most of you have seen many times before. The further to the right. The less rich the country is, the less GDP per capita, we obviously are predominantly over at this end. The good thing with that is that if you are less rich, you're growing faster than the richer countries, so the eco-economic growth is above average. That's the first thing to remember. Secondly is the richer an economy is, the more it tends to spend percentage-wise on healthcare.
A rich country, in absolute terms, has much more money to spend, but in addition, a higher % is being spent on healthcare. Thirdly, you see the difference between light and dark blue is public and private money. We operate in markets where you tend to have, often have a more significant element of private pay because public budgets are often put under more constraints than what we are used to in the richer Western Europe. The private spend of healthcare tends to grow faster because there are less budgetary restrictions, et c. You have above-average economic growth, you have GDP, or sorry, healthcare as a % growing in total, and thirdly, the private piece of this tends to grow faster. Those are the markets we operate in.
Here, this is the same graph, just displayed in a slightly different way where you have per capita on the one hand, pure GDP per capita and then healthcare expenditure per capita on this one. This is in purchasing power money, so purchasing power is equal here. What I'm gonna try and do here now, you're gonna see some bubbles moving, and this is to illustrate where I took two countries, Poland and India, and you will see what happens here now. Remember, this a rather low spend place. This is where most of us are here now. The U.S. is a big outlier, so no one really wants to be there. Switzerland is also a European outlier.
This is sort of the space where most, I shouldn't say civilized, but most of the countries you recognize are there. Here, Poland, 2012, India, 2012, India, 20, Poland, 20, Poland, 2030. This, I think is actually quite nice to see how it moves. The point I'm trying to make with this little show is this is a given. This, you know, this is gonna happen. You can argue it may be one year faster, it may be one year later, depending on economic growth and some local factors, but inevitably, it's gonna happen. Our core geography in terms of Poland 7 years down the road will be in this sort of sweet spot area where you have Australia, UK, all the countries that we would typically relate to as high-spending countries.
This is the third big picture on market size. I have taken out only Poland, and that's the point I made before. We use Poland as a proxy. It would equally be true in Romania. The numbers would vary obviously a little bit, but the message would be the same. You look at GDP per capita. 10 year may feel like a long time, but in history, it sort of is an eye blink. We had been going for a long time in 2012, it is not such a long time in history. Here you have 77% uptick in GDP per capita. You have a little bit, not a tremendous amount, but you have a little bit higher percentage spend. This is important when we look at the private spend.
I discount that. I don't look at public money here. I only look at private spend. You see the 10 years we've gone from EUR 3.7 billion-EUR 6.7 billion of private spend in the Polish healthcare market. This is also important. This is structured versus fee-for-service. You will hear those terms very much later on here today. That is when someone pays directly out-of-pocket as a customer's fee-for-service. When a corporate is paying us insurance premiums or subscriptions premiums, it's a structured pay. You see more and more of the market gets to be structured of the private pay. It obviously is an urban market, unsurprisingly. You see here the two highest income quintiles represent 55%-60% of spend. Needless to say, that's our target market, as John will be spending a lot of time talking about before.
If you look about our overall market share in this, about 9%. You take 9% times that, you come pretty much to our Polish revenue. As that fundamental size of the market, for all the reasons I've just been through, will keep growing. Will our revenue, and we certainly have an ambition to grow these 9% more. How is that gonna happen? John will explain that in detail. I think the fundamental argument is that in the structured market, that's where we started back in 95, selling to corporates. As you've heard many times before, we have probably a high-teen market share. In the much larger consumer pay segment, where we really have only been going for perhaps 10 years, we have a single-digit, probably mid-single-digit market share.
There's plenty of room for us to grow in that market. Those are the three sort of slides why we're very comfortable that we will be able to keep growing. I will speed up here a little bit. Basically, strategic focus. This will go through the different presentations. Retain and grow the customer base, expand service offering, pursue operational excellence, do selective M&A, and very importantly, digitalization that cuts through all of this. Now I will simplify this a little bit. Basically, retain and grow the customer base, that is largely around extending our network. Now, when we make new facilities available, we tend to fill them up. As we grow our network, we grow our customer base, we grow our reach, we grow our revenue.
I think one good way of illustrating this too, in a phenomenal way, I think is, it's in the report today. We're saying in 2022, the best proxy for this is how many sq m of medical space do we operate, clinics, hospitals, etc . In 2022 alone, we expanded that network 200,000 sq m, which is 34% up on the network we started with. If you look at the year before, we grew it almost as much, 182,000. Basically, over the two years behind us, we are actually, basically doubling the, if not doubling, but significantly more than 50% up on the entire network that we operate. Obviously, that is a lot of sq m to fill with customers over the time.
In fact, it's actually about 60 football pitches. If you can imagine a football field in front of you, take 60 of them, and that's the amount of medical space we put on over the past couple of years. Expand service offering. It's rather obvious what that means. As we expand our customer base, we extend our network, we do more things to service our customers. Lots of examples that you will hear. John will talk about the entry to sports and fitness stuff, and we'll talk about genetic testing. We do a big push in our Indian business to bring big oncology radiotherapy centers, big demand in India. I can say, unfortunately, but cancer is big time on the rise, so big demand for oncology services. Lots of such examples. Pursue operational excellence.
You know, it's really important to always become much more efficient in how care is delivered. One such example may be we call it a hub-and-spoke model, how we organize our hospital delivery in India or how we operate our lab structures here in Europe to have central labs and then bigger hospitals with feeder hospitals or feeder labs around it, to become more efficient. Digital differentiation, both divisions will speak big time about that. It's big in healthcare. We have had that on our agenda for a long time. I think we have a lot of really innovative solutions that are driving both, you know, customer-related growth as well as service delivery efficiency. Clearly, you know, we've been quite active on the M&A front. Here, take two examples just to illustrate how we think about M&A.
This is a dental roll-up example in Poland. Now, if you look at that Polish private pay market, I think I said EUR 6.7 billion, if my memory is right. The largest single individual component of that market is dental. Dental in Poland, I think John will know the exact number, but I think it's EUR 1.5 billion, EUR 1.6, somewhere like that. We, we have organically grown our dental business over a long time. We complemented that since, whatever, 5, 6 years ago with also acquiring selected clinics. We have really strict investment criteria, so minimum number of chairs, importantly how much revenue is generated per chair, the growth rates and margins, the strong local brand with leaders, a high level of specialization in our revenue mix, and the level of technology.
We have bought, we made 17 acquisitions over 6 years here. That has included 36 clinics, you see, and 186 chairs. That's a little bit less than half of our Polish dental business today. You see, some EUR 35 million of revenue coming through from these acquisitions in 2022, and an EBITDA impact of some EUR 5 million. Important to say, we are, with quite a long shot, the largest dental operator in Poland, but we still have a probably single-mid-digit market share. It's an extremely fragmented market. You can keep growing in this market for decades without getting, you know, terribly big, I mean, relationship-wise. I also put on India. John will speak much more about that. 23 hospitals, I said. This is quite interesting.
I don't know how many of you, perhaps some of the analysts, you would follow some other hospital groups. 10 million outpatient visits, 180,000 inpatient admissions, and they sort of stay three and a half, four days. 700,000-800,000 bed nights per annum. It's significant. Over 30,000 coronary procedures. For any European hospital, these are big numbers. 35,000 radiation therapies, 73,000 CT scans, and 37,000 MRA scans. They are 24/7 operated seven days a week, you know, demand is really high. We're among the top 10 private hospital networks in India. Today, we're in three states across India, west to east on the sort of south side. Revenue-wise, we started investing in 2017. We consolidated from end of 2019. Three years as consolidated, you see the revenue development and the profit margins.
These profit margins are significantly depressed because of the very high-paced rollout we have underway. You would know, or some of you would know, if you look at our listed peer group of hospital groups in India, they all trade significantly above 20 x the EBITDA on that stock exchange. I said that's a depressed number. Take that times 20x and compare with the amount of money we have so far committed to India, and I think that's a good indication on the sort of value creation that we have, and we're still early days. One point to make here on digitalization, super important, customer reach, operational efficiency, care quality, and very importantly, last one, monetize our accumulated information base. You know, we have so much customer interaction and so much customer data to work with.
You will hear a lot about that later on. Sustainability is really at the heart of what we do. Medicover has always been and actually, I think one of the most sustainable companies. At the heart of what we do, you can really say is our mission to improve and sustain health and well-being. That's really the mission, our mission. If you look at the, you know, the UN SDG, the Sustainable Development Goals that the UN formulated some years back. We're incredibly aligned with the SDG number 3, good health and well-being for all. We did a stakeholder materiality assessment some years back, which sort of led to this, which is our sustainability framework, extend access to care and early diagnosis. If you don't get access to care, it's not gonna help you very much.
Accessibility of care is extremely important. The workforce to fill that infrastructure, extremely important. To develop a healthcare worker, train and equip with the right tools at the right time, prevention and early detection of disease. All of these things may sound obvious when I say them, this is built into how we run our business, it's built into how we measure, and it's built into what we do as a business. Obviously minimize the negative impact on the planet and maintain and uphold a culture of ambition that is open, inclusive, and ethical, which is sort of wrapped around this. In our annual report, which will be published, I guess, in about a month or so, I really invite you to take part of the new sustainability report in there, which we're really very proud over.
I think it's a big, big step up on the prior year. This is really interesting. I don't know if anyone in the room has heard of the so-called Upright platform. This is an independent initiative that several other large cap businesses here on Nasdaq Stockholm are using and publishing. It's an artificial intelligence algorithm that is scanning through all publicly available information on companies and then basically do an overall holistic rating in terms of what they call, they measure what comes out as a net impact ratio, which is basically, they're looking at, well, what are the good things you do for the world and what are the negative impacts of what you do, largely pollution. We actually have an extraordinary outcome here.
We have a 75% positive impact ratio, which means this is not us doing this. This is an independent company doing this, that we're actually, you know, we're bringing 4 x as much good things to the world as we actually bring negative things to the world. Believe it or not, we actually rank among all these 20,000 companies globally they have assessed we are a top 3%, which I think is something we're very proud over and that we will continue to communicate in terms of the way we impact the world. We are our people. Medicover has a big workforce you see here. Over the years, we have basically tripled our overall employment group since we listed. We are as good as our people.
Our growth is really driven by our ability to attract and retain skilled, motivated, and caring professional staff. Nothing is more important than that. We have our mission, I talked about that, a strong sense of purpose. We have a strong culture in Medicover. It's very much a culture and value-driven business. People largely, I would say, come and work and stay working for us because of our culture. You can imagine in a business that is growing like this, there's lots of growth opportunities. What do you want as an ambitious young man or woman? You want to have a chance of developing your skill, developing your career, and we really have an opportunity to offer that. You have a snapshot of some KPIs. At the bottom, you see John is employing about three quarters.
obviously the service business is more staff intense than diagnostics. About two-thirds of all our people are medical, 72% are women, and very importantly, 73%, so three quarters of everyone working for us have at least one university degree. Imagine that. Out of 45,000 people, three quarters of them have at least one university degree. Average age is 39, so a relatively young, super well-educated, very female dominated, highly motivated workforce. That is really a fundament that we use for going forward. This I'm not gonna go into, only saying, you know, we have since a long time had technology as a core topic. And we have developed a lot of proprietary internal systems to manage our business models, and that is giving us a lot of advantages today.
I know John will cover quite a bit of that, as will Staffan. I will spare you this now. This, I think, is my last slide for the morning. Yes. These are then the financial targets that we released last night. I would have made the point go from EUR 1.5 billion-EUR 2.2 billion organic revenue over the coming three years and move the EBITDA adjusted line up to EUR 350 million. That also then implies a slight margin increase, but the absolute amount, very importantly, we keep the same leverage and dividend payout ratio.
You can see the amount of organic growth that we say we as a minimum will generate over the coming 3 years is basically 60% higher than what we did the prior 3 years. With that, I think I conclude my opening session, not too late, and then I hand over to Staffan.
Thank you, Fredrik. I think we say both good morning and good afternoon. Potentially we have some listeners in other regions as well, whether it's further east or further west. My name is Staffan Ternström. I joined Medicover in the midst of the pandemic, so in summer 2021. I'm probably the junior in the leadership group surrounded by people who spent most their career here. I had a slightly different track. I've been in medical devices since I more or less graduated from university, with some prominent places like Johnson & Johnson and some big companies like Mölnlycke Health Care as well. This is my first opportunity to be in the service business. I must say it's a great pleasure to be part of this journey.
My plan for today was to try to mix a little bit educational on what we're doing and what the business is about, so you understand the drivers of the business, and then put that into context to our strategy and what we intend to do over the next year or the next 3-5 years and beyond. If we look at what do we have here, we have this term of blood drawing points, which is where we, through our own outlets, collect blood or from which we then send to our labs. We either get it from our own blood drawing points or we get it from external senders. Then we process this in some of our 100 labs.
We are present in Germany, which is our biggest market, throughout Central Eastern Europe, all the way to Georgia. We have had an impressive compound annual growth of 15% over the horizon we talk here about, and a margin which has been around 20%. If you then look, what has happened over the last years, as in any other lab company who decided to embark on servicing the pandemic and the COVID testing, you can see we had some tremendous growth to some extent in 2020, definitely in 2021, in 2022, in the beginning of the year, that has then since faded. I think we are now, in whatever market we operate in, are coming to an end.
I think the market that has been staying with us longest in COVID testing is the one where I live in Germany, where they still have certain measures going on in hospitals. We still do some testing there, but that's also coming to an end, most probably during the first half of this year. We also had some pressure on our business. Not only are we losing the very nice leverage that we got from the COVID testing, we also had a challenge in Ukraine, which I must say also has been an experience to lead a team in Ukraine during this time. We lost roughly 46% of our top line that we had in 2021 in Ukraine, we lost more or less 90% of our profits, that used to be our market.
On top of that, we have been kind of going a transition to live with all the inflationary effects that we've seen over the last couple of years. Our sales is consisting of fee-for-service and public payment or government-funded. You could almost think in this government-funded public pay, Germany and private pay or fee-for-service in the more east, Central Eastern European countries. I come back to that. When you then look at we're relatively well diversified across our markets, obviously with a smaller impact from Ukraine as it used to be. We believe we are well-positioned to tap into all the positive drivers that we see in this business.
On the right-hand side, very much is to try to get from where we do the classical lab tests and create more of an advanced portfolio. We do that in 2 areas. One is the genetic space, which I will get back to later on. We also invest and enjoy a very nice growth in a place we call special immunology, which some people relate to as functional medicine. It's somewhere between the classical medicine and more towards the functional medicine performance, how you perform and so on. Not only is the advanced testing portfolio providing some nice revenues and nice profits and growth and some innovation into it's also creating some stickiness with our customers and senders as they can work with us as a one-stop shop.
Before you can see that this is taking a relatively small level of our volume, but still relatively high in revenue. You can see during the horizon, I have a slightly different number here, 2017 - 2022, a nice growth. This is cleaned for COVID and Ukraine, here you see also a little bit flattening out during COVID times because there was just a different focus. This is what we see in most of our curves. We operate where we are two different go-to market models, and this is a little bit educational here.
We are in what we call the reimbursement or the government-funded or the public pay model, the one on the left-hand side here, where the patient, as they do or as we normally do in Sweden, we go to a doctor. We have something that we wanna get diagnosed. We talk about the disease. They may take our blood, and that blood then goes to one of our labs. The report go back to the doctor, and then ultimately either you get a letter or you get another discussion and then discuss your treatment. That's, I would say, a classical reimbursed model, and that's the one we operate mainly in Germany. It is a very stable demand. The public funding is there in Germany.
It is also a fixed pricing, and if the government decides to change their reimbursement, we can benefit from that, which you could say most of the governments may have a challenge over the next couple of years since they spend quite a lot of money on COVID. We expect not to see some bigger reimbursement moves. The referring clinicians or the mid segment here, the physicians and specialists, are really the ones that we need to serve well to be able to get their business or their senders into us. If we then look to the other model, which is the fee-for-service model, yes, it still exists, the similar thing. You as a patient go to the doctor.
They say, "You should do this and this test." They even take your blood sometimes or a nurse do and send it to our labs. That's not the most predominant model. We then move to the right-hand side of this slide, you go to the doctor and they say, "Walk down the street here to Synevo and get that and that test, and then you come back to me." As many patients do, and if we take Romania, which is our biggest fee-for-service market, roughly 60% of those patients actually come into one of our blood drawing points directly and say, "I wanna take this blood taken," and then they get the report back.
This is the two different models, meaning that we are much more in a B2B model where we need to work with the doctors and have a sales force that address that. In the others, we have a combination of a B2B and a B2C model. Very important. When we interact with that consumer or that patient directly, we have an opportunity to complement the tests that they have chosen that they would do. You could call that upselling, but at least give them the full panel, maybe that what they need. The demand is very much driven by consumers coming into us, and we can obviously impact that to some extent.
Then customer centricity, being there, talking to the patients is very, very important, as well as providing a network where they can find our blood drawing points. I come back to this as being one of the key components in our business. Those are two go-to market models that we talk about. What is then a lab about, and what are the core processes? I'm still a little bit on the educational topics, but I think it's important for the context. You see here three different blocks. To the left, you see the pre-analytics phase. That's about either a blood drawing point. As I say here, collection point, how the blood then goes from those into one of our labs. Then you have the analytics lab, analytics phase that's in the lab.
That's where the whole biology, chemistry happens, and it's in the laboratory. It's about the medical staff and the reagents we put into it. Then we have the post-analytic phase. That's when we store the sample afterward for a period of time, but more importantly, to report the results either to a patient or to a clinician. What we saw from the beginning or in the past was that analytics phase and providing good quality analytics was critical. What we do see as a value driver, what we do see is that many, especially in a country like Germany, takes good quality for granted. It's a little bit like flight security when we are flying, if we are still staying in Europe.
What we see are being more and more important is the pre-analytics phase and post-analytics in our ability to create value. It's about how do we integrate with our customers, from the beginning, either D2C or B2C through digital solutions, etc., etc., so they can easily connect with us. Also on the post-analytics, how can we help our doctors to interpret the results, deliver what we call patient-friendly or customer-friendly reports? How can we help them to do some further analytics on the report they got and to learn even more than necessarily what that specific test says or what the combination of test says?
This is the two areas where we see the differentiation going forward, but rather in the analytics, it's about us to keep the quality we do and drive that as a very efficient machine, and then we invest in the two other areas. That's a little bit the fundamentals of being in the lab industry and doing what we're doing. If you look at the market where we are, and we stayed out with numbers from Healthcare Business International throughout this presentation, try to be consistent on that. Probably could be debates. You can see it's a very, very big market, the European market.
You also see here, 2021, it follows the pattern we can see in our number, the market really went up to EUR 34 billion in 2021, and then it's coming down to more normalized levels, you could say. If we go down there to the middle chart and the different colors of blue here, you see the IVD spendings and how that's been increasing over the years. 2017- 2023, so there is a prediction into 2023. You can see, and no surprise, I think, Germany, relatively low growth. Poland, a little bit higher, coming back to what Fredrik talked about before. Romania growing 8% year-over-year and 13% for Ukraine.
That's obviously very good that we can see that our markets have been growing, and we predict them to continue to grow. Maybe not so much Germany, which is slightly different dynamics than to the Eastern European markets. If we then look a little bit to the right, to the right-hand corner, you can see how much do they spend in different countries per capita in vitro diagnostics. Germany is probably the leading market in Europe. Maybe if we take out Switzerland, 140 EUR per capita. Romania, 21. Poland and Ukraine, smaller numbers. Means that there is a huge room for growth going forward. To put in another market where we are not in, Spain is roughly 79 on this scale.
There is a lot of room for us to grow in the Eastern European market, Central Eastern European markets where we act. I picked some of them here. If we then move to the left-hand side, what is driving this, whether you are in Western Europe, and it's obviously slightly different than if we are in some of our markets. It's the increased focus on prevention and early detection. If we can prevent the disease by manage it very well, or if we can find it very early, there is much better chance that patient can get a better outcome. There is also a much better chance that the society where this patient is can get a lower cost for treating or controlling that patient.
Good example of this is Pap smear tests that in some of the markets that you're doing that every third year to check if there, you have cervical cancer, for instance. That's kind of a screening in our lab business, which serves us well. Obviously understand those trends, very important for us and to be there. Rising health awareness and potentially wellness needs, and that's probably two different things here. I just wanna say that I think the whole community in all of the markets we are have a totally different appreciation on what lab work is. I would almost bet with you here that more or less every one of you over the last couple of years has been a lab technician.
You've been taking a sample from your nose or your mouth, you've been putting it into a little bit of reagent, and then you've been putting that into an analytical, call it, yeah, analyzer, and then you've been reading the result and finding out on an antigen test if I'm positive COVID or not. I think most of us been doing that. There is an understanding of lab tests and going and doing tests in a different way is what we see when we, when we, research the different populations. There is also a trend in the more affluent communities and where you can afford getting into gyms, focusing on health. There is a number of different health tests, not necessarily to prevent or do a diagnosis or monitor a disease, but actually checking out, am I still okay?
Am I performing at my maximum? Do I have the vitamins I need to have, et c, et c. That is another important trend that we will tap into. There is also the digitalization of consumers and patients, where more or less everyone is doing everything on their mobile. Very important for us to be there with mobile-friendly solutions. Then we have the health providers, and yes, if we are in Sweden, where at least I started, we are relatively savvy in digitalization. I think most of us have been picking out an electronic e-prescription. That's something that in Germany we are just piloting. Obviously the societies are on slightly different level, but it starts to move.
Especially since the pandemic, I think what we say and when I read certain different reports from the McKinseys and the BCGs of this world is that we've been making 10 years progress over the last 2 years in terms of being digitally interactive or communicate through digital, between either a business like us and a healthcare provider, or potentially between healthcare providers as well. Personalized or precision medicine in most of the oncology field going forward or in orphan diseases, there is a big trend of that not only will I get this very, very expensive medicine or drug, but I also need to make sure, since it is expensive and since it may have certain side effects, that it actually fits me. I need to do a diagnostics before to see if that medicine works up.
2018, 2017, 2018, there was roughly 20 drugs approved by FDA. Obviously, very important trend, not only to develop those drugs where we can help, and I come back to this, but also when they are in commercial use, you need to have lab work being done. Given it's relatively expensive medicines, our customers can also spend some money on working that up. Then, the last one is the growing prevalence of chronic diseases and just take heart diseases or take diabetics, which is 2 good examples of that. Since we are living longer, we're also living, many of us more unhealthy, which means that, some of those diseases becomes more prevalent, and there's a higher incidence of them.
That means that we sometimes need to get in there to find out if we have those diseases and then monitor it for lifelong. We have a number of patients that we serve that are in those spaces. A few very, very good underlying trends coupled with the ones for some of our markets, which Fredrik talked about, which I believe provides growth for the future. If we move over to our strategy, this is just a similar picture to what Fredrik showed before. It's about retaining and growing the customer base where we are. It is about expanding the service offerings we have and obviously pursuing operational excellence in all what we do, not only in how we serve our customers, but also how we run our operations behind. You will see this later on.
In my division, have not done so much M&A lately. One of the first things I've done since I started was to start to build a team around M&A, so I have a new leader. We also brought in some refreshment to our digitalization offers and are investing in that. If you then step back and look at what we are about, we look at the core, as we call it, which is Germany and our Central Eastern European markets. Germany, we intend to grow faster than the market or double the market as we have been doing, a little bit depending on how you view that market, and I'm coming back to that. That would mean somewhere high single-digit growth, almost double-digit growth.
If we look at Central Eastern Europe, where we have had a high market growth over the year, and we've been able to outperform that, we will continue to do that. Then I will talk to you about two, what I would say for us in relative terms, new areas which we have been investing in, both organically but also inorganically over the last year, and are exciting, you could say growth opportunities, going forward. Our genetics business, but also our Medicover Integrated Clinical Services businesses, which really doesn't serve patients directly. It serves the pharma industry and also as CROs, clinical research organizations. In those two businesses, we intend to grow faster, than what we grow the core and also to do that to accretive profit. Those businesses comes relatively profitable for us.
If we then move over to Germany, we are number 5 in that market. We are, as I said, not the leader in the full market, but if we look at northeast, so from Berlin and up in the northeast corner, we are enjoying a market share of 25%. We're very strong there, you could say, in that region. It's not one of the richest regions, but we have a good share there. Since a couple of years, we're starting to get a stronger position in the south around Munich, where we made an acquisition, 2017, 2018, which was then also our genetics business, where we bought some classical lab. There, we started to strengthen ourselves. In Germany, you can see the market growth has been relatively modest here.
We have COVID into those numbers. We've been able to grow with COVID 70% over the horizon. If we take out the COVID part and look at what we define as business as usual, meaning we take out COVID, then the growth over this horizon has been around 10% or just short, around 10%, which is still good. That business has mainly been grown by driving our advanced portfolio. And that has really been driving the over market growth. We've taken a big step forward there, which is then genetics and what I talked about before, special immunology. What is important for us, Germany being relatively limited in ability to increase price and still an opportunity to take market share, and what do we intend to do there?
There's really three things that we will focus on. We will drive efficiency and integration, we will gain national market share out there, and also with our advanced portfolio, get a bigger share of wallet, you could say, from the customers that sends to us. Then we will leverage this fantastic portfolio, which we already do today, and serve some of the other Medicover markets and beyond. If we start with integration of systems, our labs today are relatively independent units on different systems and so on. We wanna put them on one platform. We wanna put them on one digitalized system towards our customers. That we are almost done with.
We are now investing in one lab information system which connects all the labs, which means that we can leverage them, we can deploy capacity where we want in those labs, and by so both serve our customers better, but also drive a much more efficient business. Lab information system, a common master database, meaning we call our labs and define lab tests the same way, and then also a digitalized order entry system is what we are in the works of deploying right now. We are also investing into automation, which is very, very important, and we're not doing that only because it's very costly to have people to run the machines that could then be robotized and where you could see the sample moving relatively automatically.
Many of those individuals who are lab technicians, they're a relatively scarce resource as well, and by doing automation, we can actually take out part of the human factor and even provide better quality. We just equipped our biggest lab in Berlin with a full-track solution from Abbott, which is a fully automated lab. If you have the chance to come by, please come by and I'll show you around. That's kind of in the classical biochemistry and immunochemistry, and that's the normal classical lab tests. If we take microbiology, which some of us have done, where you put some reagents, and then you put this culture to grow, and then you look at that test, that's also now coming in an automated fashion.
We just have full new equipment into one of our big regional labs just outside Berlin for that as well. By doing things like that, to just give you an example of the microbiology automation investment we've just been completing, you can actually do 1,700 tests per day, compared to maybe 500-600 before, and you can do it with one third of people. That's an obviously a very important activity to do. In Germany, and I maybe missed this on my previous slide, we also run 25 clinics with key opinion leaders focused on endocrinology, on rheumatology, and very much on infectiology. Those patients require quite a lot of blood tests. In those clinics, it's all about productivity.
What we're doing there is that we're digitalizing those clinics. We're doing that in terms also putting in a clinical information system, so we can measure what we do much better. We also put in what we say speech to text solutions. So when you sit and talk, it actually becomes out whatever it may be, a recipe, digital, whatever it may be, or the write up on the patient and some other digital booking systems, all to drive productivity for that investment in the doctor's time. When we look at some of those clinics, we look at portfolio optimization to be and strengthen our networks where we really are good and potentially get out on some therapeutic fields, which is a little bit of a smaller, you could say, presence in the network.
When it comes to gain national market share, one of the things from our acquisition point of side, where we're looking to, we look at to the west of the country and the north of Germany, where you normally have more, higher share of private insured patients, and by that, also getting some higher reimbursement. We wanna get into that side of Germany. The other thing where we're looking into is to the area of pathology, which is a field where we are. That's pathology, for the ones who don't know, is about looking at tumors and cancer and making an assessment if it's malignant or benign and so on. We're looking into that space to be able to complement our portfolio and our offering in Germany. That's a very important exercise for us.
If we look into getting after and getting after more share, we've just been investing in new leaders. We have a new lab leader. He comes from competition, with a very proven model for acquiring customers. He just started with us, and we look forward to see the benefits of that. I also brought in new leadership into both, our Munich site, and the lab there, and also to our clinic network. I would say there is a little bit of a generation shift, where we move from people only being doctors here into people who are passionated about delivering customer value and by the same time, very much driving a business and drive efficiencies in what we do, which I think is very important. In a country like Germany, we have 40 people in our sales force.
They're fully equipped on Salesforce.com, and they are practicing the best practice in terms of good salesforce effectiveness as well. We are focused on the advanced testing and the integrated portfolio. We're building together as you can go into one portal and find all our different, classical lab, but also genetics and or special immunology or any other specialized lab test, which we normally do out of our Berlin site. That's what we're doing in Germany. We're also taking that integrated or advanced portfolio and exporting it out from Germany. We have roughly 8,000 specialized tests that we can do. When we do that, you can see here is a map of Germany on the left-hand side, and then there is our internal markets, or it's a partner lab somewhere else.
What we do is that we actually enable our own lab structure in Central Eastern European countries with more advanced tests, so they can be a better end customer to their clinics. We also work with some external labs that goes beyond from what we call the normal Medicover markets. Those tests are very nice because they come to a much better profit than the normal ones and are very accretive to what we do in terms of that. We wanna drive and put effort into that business. We have invested into certain sales forces, so we are into Finland, which you say, "Oh, what are we doing in Finland?" There we sell now advanced test and genetic test, and we are also growing this business very nicely within our Medicover markets.
That's what we're doing in Germany. That's Germany in a nutshell. If we move into the markets which is central Eastern European, and what I talk, they're obviously very, very different, and they are different stage of evolution. 1 thing what we are driving, which is very, very similar, is we're driving the FFS model or the private BDP model, as we call it as well. We are in many of those markets. We are in Poland, we are in Ukraine, we are in Moldova, we are in Romania, Serbia, Bosnia, Bulgaria, Georgia, and Turkey. I think that's the markets which we define here. We have a few new markets for genetics as well, which I come back to a little bit later.
We've been able to get to a leadership position in most of those markets. Not all, but most of them. If you then look at the right-hand side of this picture, you can see what the market has been growing. In the case of Poland and the Polish flag here, we are a EUR 66 million business. That market, over the last year, since in 2016, has been growing with 5%, and we've been able to enjoy a 13% growth. Very nicely outperformed the market. We believe there is an opportunity for us to continue to take share, especially in the fee-for-service segment and therefore, we are investing in very aggressive BDP expansion in that country. Ukraine is slightly different.
It's kind of in a wait and see position here. I actually did take out 2022 here because it distorts the full picture. Just for you to understand the underlying performance on what we've been doing and what the market has been growing, we been growing very nicely in a market which has been growing less so. Then you have Romania, then you have the remaining countries where it's a little bit hard to find some kind of good benchmark number. Why have we been growing and outperforming the market so well? I think it comes back down to very much. It's a number of different things, but one is on what you see on the left-hand side model here, where you see our investment in blood drawing points, and obviously, we've been investing in labs as well.
You can see we more or less double this over the horizon here, and we continue to invest into those markets. They are growing. We get into new locations and by so, we can grow. In this market, it's as we talked about before, an opportunity because the markets are growing themself in terms of GDP development. More is being spent on health care in them, and we can see that they have an underlying growth. We have proven that we actually can grow faster in that market, and we will intend to do that. There is a few more. When we refine this model, what are we really trying to do to take it one level deeper? This is not only about the BDPs.
First of all, we work very much on trying to push brand awareness, and in those markets, we operate them not under the brand name Medicover. We're actually under brand name Synevo in those markets. So brand awareness is very, very important for us. Beyond having commercials, digitalization program, and so on, and being on the web, we also use a number of additional channels. If you take Poland, for instance, or if you take Romania, where we are one-to-one with our healthcare partners or John's business, they provide labs. We provide lab services to all the clinics there, so it's a very nice synergy. We also use telehealth partners which are not physical and wants to send someone to a lab work. We partner with a number of those.
In many cases, where we work really on the top level of the market, we provide at home services and can so charge a higher price and then get a very nice service to people who wants to have their blood drawn at their home. If you look at that physician or doctor layer, which is the next one, they are, to some extent, sometimes taking the blood, as I talked about before, or referring the patient into one of our sites. It's very important to get their endorsement for what we do. We have a full sales force who details them, and I'm gonna give you an example from Romania. We also provide a lot of education to those people. We try to take a very educational stance towards them.
Doctors needs continuous medical education or CME, as it's called, and we try to label our courses so we can provide that and then, obviously, bring in our messages or our innovation into that package when we educate them. I was just before Christmas in Romania on what we call the Synevo Days. After a few years of pandemic break, you could say, we had 800 doctors for 2 days in Bucharest, where we gave them the latest and the best about new testing or standard testing for different therapeutic areas like gynecology or endocrinology or whatever it was. If we then take that one step further, it's the BDP, and they need to be well-located, where people normally move, easy to find.
Once we find this location, we make sure that they are clean, standardized in their branding, patient-friendly, modern, et c, etc . We even adapt some of them to fit with kids as well. The last step of it is how we then provide our lab network to be able to economically disperse those labs across the country, but then also to make sure that we cannot wait too long until a lab test comes to it. We process it and then deliver the results. If you take the same picture here and then look at it from a numbers point of view, a few facts, this is just to give you an impression. This is Romania. There is similarities to some of the others. I picked that. It's our biggest market.
We have a net and externally validated, actually an external agency called Medibus, who is doing both our Net Promoter Score, and they also do our customer satisfaction measurement in the BDPS. We have a Net Promoter Score of almost 87, which is just a fantastic number. You normally say that beyond 30, it's very good. Beyond 50, it's the customers loves you. We enjoy a very good Net Promoter Score, meaning that we are recommended to a number of other new customers. If you ask someone on the street, more than 40%, top of mind comes out and say, "When you think lab test, what do you think then?" They would say, "Synevo," which is obviously good from an awareness point of view as well.
We still have a good Net Promoter Score with the doctors that we work with. We have roughly 25,000 doctors in Romania who refer to us, that's out of 40,000 doctors. That's obviously very, very nice number for us. Those doctors, either individually but very often in group, get about 6,000 visits. When we come into a BDP, it's very important to understand what do our customers think about it, how do they rate us, and important is the reception staff that you come in and meet, is that an efficient process? Is the nursing staff that ultimately cares for you and take the blood another important factor? How long time is all of this taking? One of my leaders said it's a little bit like McDonald's.
We may have a different connection to that, all of us, but it's relatively standardized in what you can and what you expect, and you normally get what you expect. We're trying to standardize what we do. We train people very well in our BDPs. We also select them carefully, and we also incentivize them, both in time and in terms of Net Promoter Scores. Our ambassadors meeting face-to-face our customers are, I think, very good face to the customer. Ultimately, the sample lands into one of our Medicover labs, and this is just an example of our Bucharest lab, the main lab, and I'll come to this later on when I talk about the hub-and-spoke model. That lab is making roughly 25,000 tests a day.
It's less patients because you normally do more tests, and the normal turnaround time is around a day. Relatively quick, report back on the results. Throughout this journey, we continue. We have a number of, I would say, digital solutions, and we continue to invest in that throughout the journey. Here is a couple of examples. We have. In all countries, we have web shops with full functionality. You can book slots, you can pay, you can select tests you wanna have, and then you just walk in there and do that. In some of the. You can see there is a child in the middle of this slide which sits with some kind of a virtual reality camera.
It's maybe not the most biggest thing we do, but it's a very important thing because the mother in the family, she's normally the target group for all our advertising and interaction, and obviously they care for their kids. Here in this case, we've been relatively early on mimicking the movements you need to do when you're supposed to take your blood. The kid is doing that by giving energy to some kind of out of space creature, and by that, hardly recognize when the blood is taken. The mother is happy, the kid is happy, et c, etc . Then also one of the things to see if we can further drive efficiencies, are moving to digital, or I would say reception-free, blood drawing points.
That is to take out people, but also to expedite the journey, which means that you can book everything, you can pay, you can book an appointment, then you go to the reception, you have your QR code, out comes the nurse on that specific time, take your QR code to identify you go in, do the blood, and then go out, and then get your report back on, on that. That's something that we're also trying. One thing we can't get away from is taking the blood. That's still an important one for most of the tests, even if they are self-service options for the future as well. The last one I just wanna talk about is our Synevo app, and that's a full app where you have all the functionalities, where you connect the patient, the doctor.
You can do all of your lab orderings, you can get all your history, you could share that with a reference doctor, and so on, and the full flow goes electronically in the discussion. That's something we've just been launching. So that's very much in the consumer-customer interface. I talked about the hub-and-spoke model, and that's what I try to explain on the right-hand side here. There may be a BDP network, which is our network. There may be other clients or hospitals and so on. We try to deploy certain labs, sometimes even in hospitals we serve or in clinics we serve, but that's relatively simple tests. As we get higher volumes and more advanced tests, we build centralized labs.
In all the countries, we have a central lab, that's in Lodz in Poland, it's in Kiev in Ukraine, it's in Bucharest, it's in the main cities of the smaller markets where we are, and it's in Berlin for Germany. We have some very highly specialized labs on the top of this pyramid, and that's the one I referred to, either in Cyprus, which is a new acquisition, or in Munich, where we do genetics, or in Berlin, where we do special immunology and some other very specialized tests that then you can send into. Driving an efficient lab network is important in the FFS market. It's also important and critical in Germany.
We leverage our procurement strength across the markets, meaning that we have with the Roche and Abbott and Sysmex and DiaSorin and whatever the names are of the big volume players. We have framework contracts which fix pricing over a number of years. That's a good thing to have today. It's also very good to have those framework contracts when you are in one of the smaller markets, because you actually have a cost advantage to some of your competitors because you buy reagents to a much lower price point, and that's normally somewhere around 25%-30% of your overall cost in a lab is the reagent spend. We try to centralize when we can.
For instance, we have a big financial center in Eastern Germany, where they're doing all the finance functions and so on for Germany in Frankfurt (Oder) for all the different businesses we operate there, including our new dental business that we just talked about before. We drive automation, as I talked about before. Very, very important practice process excellence methodologies, in this case, lean quite a lot. When we build our labs, we normally equip them and sometimes we put full automation, and sometimes we, depending on the economics of it, we do them semi-automated. What we do is those labs operate to somewhere around 70% capacity. It obviously differs, but just to give you an understanding roughly where it is, so we have room to fill those labs further.
What we do when we need to fill with some further capacity, we then extend with one machine that we connect to the track we have or put in one new machine. That is some... Normally, it's the dynamics that we may not invest in that machine. One of the big providers place it there, and then we pay per reagents. That's a model we have in many, many of our cases. We can relatively easy scale up and then get another 10% plus, minus in terms of capacity. It obviously depends on what the test is, but just so you understand the model for how we operate this. I can't go on through those markets without saying a few words on Ukraine.
We look at back at this market with great success in the past, and we think we are well-positioned to continue the high growth after the war, because I think we've, we have that hope of believing that there will be some time after the war period. We were the number one player. We today operate six labs. We don't think it's safe to be in Kharkiv. We also have a lab in Kherson, which was just liberated by the Ukrainian, which we haven't reopened. We have a big number of blood drawing points in this country because it's probably the most fee-for-service business, if you can gradually say it, was in Ukraine. We operate today 317 of 340-350 available we had before the war.
You can then imagine in the east, we do less of it. That's where we're not. What we focus on currently or have been focusing over the last period of time is to returning to stable profits. We have been able to dimensionalize our workforce to the number of tests we do. We've been coming down from somewhere 3,000 employees to a little bit less than 2,000 employees in terms of numbers. We've been stabilizing the profits relatively well. It is a little bit of a special dynamics because if there is no Russian shelling, then we normally deliver what we say we will do that month. It's an awkward situation. We are further reopening blood drawing points and labs where it's safe and possible and intend to do so.
Because the critical thing is even if there is war, there is people who needs good diagnosis, who needs to monitor their chronic disease and need or in need of lab tests. I'm very proud. Maybe the most thing that I'm most proud of is to be able to say that during last year, we were able to serve 2 million patients, unique patients in Ukraine, and providing 15 million lab tests in 2022. That helped us to become profitable, but more so we were able to support the country in deep need of it. If and when the war comes to an end, we are well-positioned to get back in there. Currently, this is 4% of the group's total turnover, so relatively limited exposure to that business.
That takes us into my last section, which is a little bit around genetics and Medicover Integrated Clinical Services. I suggest we start with genetics, and that's a journey that started for us around 2017 when we bought a small genetic lab in Berlin. I think the turnover around that time was roughly EUR 2 million at the time. Today, after our latest acquisition in Cyprus and growing this business organically very nicely, we are around a EUR 50 million euro business. Very nice growth over the years. We were relatively limited when we started in Germany, and today we serve 50 countries across the world. You also see something here which talks about tech transfers, which I will talk about in a minute. This is a relatively new market.
It's growing. There is a few different drivers behind that. There is an increasing demand, and I would also say reimbursement in many of the countries for predictive testing, very often for prenatal conditions. If you are pregnant or a pregnant mother, I would say, you wanna test together with the father if there may be some diseases this child carries, and then you can do a prenatal testing, as we say. That's becoming more prevalent. I talked about pharmacogenomics, the genetic profile together with certain drugs, how that works. That's becoming more and more important and is a driver behind this business. The rising awareness and wellness tests.
Many of those wellness tests that are out there or that we intend to launch in the future, are on a genetic swab. Relatively cheap genetic testing, but they are genetics-based, and can give you a lot of data. This is a business which is in evolution, so there's a lot of technical advancements, and there's big hope to what genetic testing can help us to understand either self-standing or combined with a classical lab profile, in terms of, providing the best diagnosis to the patient. That means that Also sequencing cost is coming down, which means that it will be open for many, many more individuals or customer groups, but there will also be some interesting technical advances.
When we first came into this, we worked in this business in the classical way where you do lab as a service, meaning once someone sends their samples to us, we process it and send it back to an external customer. That's lab as a service or a send-out model as it's called. If we look at this picture here with the wheels, you can see physician prescribes that to a patient. That's the classical one. I'm not talking about the wellness tests here. I'm talking about the more medical tests. Normally blood, urine sample, swab, or some other body liquid could be used to do that genetic testing. The most common one is blood or a swab still, but we can sequence anything.
That goes to one of our two production sites or sequencing sites, which is either in Cyprus or in Munich, one a little bit with a cost advantage and the other one with a very, very good hub, you could say. The good thing with genetic testing is that it doesn't need to be as it is for other lab services, because the turnaround times, the sample can actually travel a bit for a week without providing less quality, you normally generate the report. You don't need to be so close to the patient all the time, which is a benefit. We sequence those results, we look at them and filter them.
We then partner deeply with geneticists, if it's more advanced, because interpreting those results and what it could mean is very complicated. Geneticists, we employ a number of them ourselves, or we sometimes partner with them in other markets where we distribute the results. We then give the report either to the doctor or the patient through a geneticist. That's the kind of model what we're doing. This is where we get from 50 places all over the world, into those different markets. We bought, and that was, one of the first acquisitions I was involved in when I came on board, we bought the majority of the NIPD business in Cyprus, which could act as a hub, and is a hub and has some other benefits as well.
We now bring our Munich and Cyprus offering together and brand them as Medicover Genetics, build some new communication material, both in terms of marketing and education, and intend to go bigger around genetics. We also try to integrate this, what I talked about, with the classical lab work, where it makes sense to be able to create that holistic picture around the patient for some of our customers. We invested in some sales force in Nordics and in Adriatics for this business, and we actually start to see the first contracts coming through. You really don't need to have a lab in the Adriatics or in Finland, in this case, where we started, but you need to have a geneticist, and you need to have someone who can serve that local partner.
Then we can send the samples to Munich and then send the results back as it is in the case of Finland. Then we work with these research projects and so on because this is an evolving field. We started this business in the prenatal space or with our proprietary NIPT solution, which is called VERACITY or VERAgene, very important prenatal tests. That is important here to say proprietary, because normally in all our lab business, we buy a reagent from Roche, Abbott or anything else.
We may put together different assays by combining them and say, "This is the test you're buying." In this case, we actually have our own solution, which suddenly takes us into becoming an IVD kits provider, so we suddenly sell a product. Besides, and what excites us, only being able to add another sender when we're out selling globally, we actually now have a product which we can enable other labs with, either through our branding or white label, and sell to them. That's what we call when we're doing tech transfers. What we're doing is that we take our proprietary technology in terms of sequencing, extracting DNA, and so on, and the bioinformatics about it, and we provide that to a third party in another country.
In this case, we are in India, we're just in the process of doing this in Japan, South Africa, and a few others. We can even do this in Germany to compete with ourselves in a way. We enable other lab chains to do this with our technology. A big part of that are the reagents that goes into this, which is our proprietary kit with patented and so on and so on, which we also put into this and can sell off the shelf. By so, we can scale this business much, much more. That's what the Cypress acquisition enabled us to do, which makes this business very, very exciting going forward. The other thing, based on the NIPD technology that we got from Cypress, which in this case was the NIPT, there's a lot of NI here.
On that technology, and it's really, if I simplify it, how you extract the DNA, and we have our way of doing that. We're getting into the field of liquid biopsy and cancer, or some people relate to it to the Holy Grail, when each and every one of us can go once a year, take a blood test, because it's blood in this case, sequence it, and see if there is some kind of emerging cancer somewhere in our body. We're not there today. We are at the first step. You have a cancer, and you need to define which therapy you should have. We are in therapy selection, which is the first product we are. We are commercial with one called NeoThetys.
The second step for us is to get into something which is called minimal residual disease. If I am treated, I had a cancer, it's treated, I'm fully declared to be okay, but I still will go for a 5-year follow-up. Normally, today, you do ultrasound or MR or CT scans, different types of scans to see if it has regrown. Here, there is a chance actually to look at if it's been relapsing by testing this one. We are just in that development stage, step. If we go beyond that, there is a chance for us to potentially find a screening product. That's a little bit how our R&D program. That excites us.
We besides doing lab as a service in our genetics business, I think we differentiate ourselves a little bit by providing tech transfer and CE-IVD kits, and then have a bet on or one race, a horse in the race, you could say, for potentially screening for cancer in the future. That's one exciting area. The other one is in our Medicover Integrated Clinical Services businesses. We have grown this business in 2018 fourfold, still relatively small, about half the size of our genetics business, but still some very exciting area to be in because we can leverage the network we have. We last year got ourselves into patient recruiting. We are in precision medicine. I come back to those two.
We are in central lab services, meaning that when someone is providing or doing a clinical trial, they need to very often do lab testing. What we are doing, we're providing that lab testing for them. We are in biospecimens. Sometimes you wanna buy some predefined type of blood to test your new drug on or something like that, and that's what we relate to as biospecimen. I'm not gonna talk about the two lower businesses, but I wanna talk about patient recruiting. A critical market, if you are in pharmaceutical or if you are a CRO, that's what you live about, is to conduct clinical trials. Today, roughly, 80% of all trials are not on time, and that's very costly to extend trials in pharmaceutical, and 30% of the trials are under-enrolled.
We've got ourselves into this business in Poland, in Toruń, Warsaw, and Bydgoszcz, where there was a network we could buy and that are specialized on rheumatology and trials around rheumatology. They do roughly 1,000 patients that they have enrolled in studies as per today. We are dealing with roughly 50 companies and a number of trials. They've been very, very good at enrolling trials on time and with quality, which means that we have a very good pipeline of trials to come in to our sites here. Did we buy this just because we were excited about that? No. We see actually a very, very nice fit with our healthcare clinics, which we can leverage and do trials in that. I'm partnering with John, and we're driving trials in the healthcare clinics.
We're also doing trials on the German side. If you are in clinical trials, it's a great combination to get a German key opinion leader who do some patients, and then maybe you get the volume in Poland or in one of the other countries. We are expanding this business and building it out. It comes to almost double the size of the normal diagnostics revenue in terms of profitability. It's a nice business to build on going forward. The other one, which is very exciting, is the one I talked about, precision medicine. We're probably a little bit earlier in that. Currently, as I said, 200 FDA-approved drugs that requires companion diagnostics. We have an opportunity to provide that diagnostics in Germany.
We also have an opportunity to provide it to a slightly lower cost point in one of our Eastern European markets when you go into commercial use. You talk here about oncology, or you talk about rare or orphan diseases very often. We don't talk a lot about a lot of patients, but those are relatively high-value patients. Normally you have one or two sites in Europe which you partner with for your companion diagnostics in commercial use. We have the network. We also have the ability to partner with those companies in the early stage when they are finding out what is that, the early trial work to find out the companion diagnostic assay.
When you do the bigger development of that assay, or ultimately in the later part when it goes into commercial use. When you look at those drugs, they normally have a relatively long lifespan, which means if you partner up with them, you have some nice business coming, and then you add something on top of that. We currently do some work in this in Germany, we do some work in Serbia, and we do some work in Romania in this business today. It's very exciting going forward as precision medicine continues to grow. That kind of takes me to my last slide, where just wanna reiterate, we wanna make sure that we continue to grow Germany high single digit and sustain profits in Germany by working on what I talked about.
Central Eastern Europe is more growth. I would park that somewhere around an expectation of solid double-digit growth, and then look at mix and genetics from lower bases, to be both accretive to profits and grow faster, than the core. With that, thanks a lot, and I hope we can then open for questions. Thank you.
We're 20 minutes behind schedule here, but let's do some Q&A. Just a reminder. Over here.
Yes. Fredrik was talking about the transformation of the market in Poland and how it's growing, talking about GDP, and it's a private payer market. What if in, let's say, 10 years, they would like to switch to a reimbursement model? What kind of adaptation would be needed from you? Is that a risk?
I think it's a little bit hard to predict. I think what we see now is that actually the fee-for-service market has grown faster and faster and faster, as Fredrik showed. As we are in a market like Poland, compared to if you take Ukraine, or at least before the war, which is probably the least public pay market or with the most underserved community in terms of public health care, we have a bigger mix of what I would say, to some extent, reimbursement or working with the referring doctors, which is partly on fee-for-service, but some of them also do some government business. I would say we have a foot more there, and obviously we'll see how this evolves. Currently, we see the fee-for-service market growing nicely, and the hence we are there. Yeah.
Could I ask you about the situation in Germany? It's a reimbursed market, as you described. How difficult etc .
I think the other thing to add to that is that you're coming out from a highly intense COVID market as well, which we're providing a number of tests as well.
I think it's critical for us to automate what we can. That's one of the things we are doing to take out cost over time. Not only the specific labs, but also tie them together because in some parts you have different reimbursement caps to different regions or Länder, as it's called in Germany. In many cases, we have an opportunity to shift lab work to other areas. Even if it's not the price increase, it's a reimbursement improvement for us to manage this as well.
The third thing is to drive that special immunology business that I talked about or some other more, what should I say, privately insured tests and drive slightly the mix of our portfolio and get up into a more profitable one, and then further drive the high-value tests into the marketplace, which is either privately reimbursed or potentially private paid for, which is still very, very few. The good thing is that we just saw last year the German government decided in the midst of the year to reimburse NIPTs.
We saw our volumes of that business. That happened 1st of July. We saw our volumes almost 3-fold after that. We provided a network. We have a very, very good product in VERACITY, VERAgene, and we saw that growing. That obviously helps our mix. I can't increase price per se.
On automation, how far have you come? Go through that a little bit, to begin with.
We're relatively early out on the German reimbursement, if I start on that. The Eastern European genetics consumption that we supply to today is more or less only private pay. We have been making efforts in our three main markets, Ukraine, Romania and Poland, to deploy specialized sales force that complement our classical one, because it's a little bit of slightly different depth sometimes to sell those tests. That's more or less a pure private play. An anecdote on that is that we actually still do NIPTs that comes by train over the Polish border from Kyiv and then goes to Munich and still gets back. That's still working in a war zone, you could say, some of those, and people are ready to pay for them.
Second question, please remind me.
It was about the sort of natural price erosion that cost per test is decreasing within this area in general.
Yeah. I think the interesting thing is that we had looked. If you take the NIPT test, and the way it works in Germany is that I think it was reimbursed on EUR 185. We were charging slightly more than that before. We didn't want to be too far because we wanted to gain customers. Obviously, very hard to say where it will be parked. The interesting thing is that you can do what you can't do for all other healthcare services, but you could actually co-pay. There is a basic offering that comes reimbursed, but what we see is that people add to that. I think our average is maybe 25% more than the current reimbursed rate.
The other thing, obviously, when you go to the private pay, that's where you can put the price to what you want. We've seen some of our competition that provides those tests, Centogene, there are some other bigger ones that actually been operating with huge losses, but on the way of getting out the markets. We think there will be a little bit of self-sanitation to the market, if I can use a term like that. We don't see that necessarily. We've been able to increase prices and increase volumes in our FFS markets.
Great. Maybe the final question here, if we gonna try stick on time.
Yeah. I had a couple of questions, or one at least. In terms of your plans to expand into the northern and western parts of Germany, which clearly is a part of your growth plan, could you give us a sense of how many acquisition opportunities there are? I imagine these markets are pretty well consolidated.
You... There's obviously a couple of big players in Germany. One is Limbach, one is Sonic, SYNLAB is there, Kramer is there, and we are probably number 5 around that. There are some speculations in the German market, or there are, you could say, different suggestions on the government table where they want to limit, I would say, corporations to hold medical business. This is something that started in the dental business, has been a big discussions, owners in that. We've been in that space for quite some time. For us, we will navigate this. We will fulfill the regulatory requirements to continue to acquire is our scenario today based on what we understand. We're participating in some of those central lobbying groups as well, obviously to work...
we stay very close to the topic. What this has triggered is that some of the unconsolidated parts of the market actually has come to market. Whether there's been a relatively dry pipeline for the last 4 years, and obviously with COVID, very little activity was happening because it was hard to evaluate the assets. We start to see a number of those coming out. The question is obviously what multiples, what's the value with or without COVID sales and some of those. We see a much richer pipeline today than what we've done just a couple of years ago. I hope that answers your question now.
Okay. I think...
No?
Yes. A quick question on how are you working with IVDR regulation, and does that affect your business?
It doesn't really do directly for most of our business, you could say, because this is what Roche take care of and all others. We're obviously regulated in the lab work we do. We are accredited, ISO and all kind of different accreditations in the different countries. What we are doing is in the IVDR is for our genetic space, where we now provide a kit. That's where we are getting into the regulatory processes, and that's a competency they have in Cyprus because they were already working with that. That has its challenges, as we know, with the regulatory bodies and delays in that. We are getting there. When we need to be there, we can market and sell our kits, so that's okay.
Okay, thank you very much, Staffan.
Thank you.
We will have a short lunch break. Still planning to start in 10 minutes. 1:35. Sorry? 1:35. 1:35. Yeah. Okay, great.
The IPO, which is a position I'm particularly proud of. We operate with 6 subdivisions. I'll talk you through most of those today. We're in 8 countries. Most of the attention today will be in 3 countries, mainly because that's 93% of the revenue. We've got 1.7 million members, which is really important because our membership is a big part of the way that we grow the business, and I'll demonstrate that with the model today. Those members, plus other patients, are looked after, you know, by the 34,000 people that we have in the division. I'm sorry. As you can see, in terms of our revenue growth, to me, it's quite impressive.
It's really pleasing to see that we're much, much bigger than we were going back in time. COVID kind of affected us kind of negatively really, in terms of our operations and our development. What's pleasing to see is that, you know, since the COVID times, we've kind of accelerated our development. From a bottom line perspective, as you can see, it's quite good, but at the same time, we really are investing heavily. As a consequence of that, you've got a drag in the bottom line. This is the revenue breakdown. As I said, we operate with a number of different subdivisions.
If you go back in time, business services, which is where our Polish membership business is and where our sports business is, was much, much bigger, 55%. Over the period of the last few years, we've managed to hedge that with the development of other services in terms of hospitals in Poland, obviously bringing on India. Romania's tended to keep pace, then obviously dental's been quite impressive. Our revenue breakdown mix has changed quite a bit over the years. When we, when we came to market, you know, 32% of what we did was fee-for-service. As you can see now, it's 55% of what we do. Our funded business has carried on being strong and still is a good percentage of what we do.
Of course, public pay is a small percentage. Our revenue breakdown by country, Poland is very, very strong. If you see in history, it used to be 82%, now gone down to 65%. Obviously, what's helped that is the development of India, and as I say, Romania's held its own. If you look at the 3 main countries, obviously Poland is most developed, where we've got our sports and our healthcare business. We've got our hospital business, and we've got our dental business and fertility. In terms of the size of the market. Sorry, I've got problems here. In terms of the size of the market, you know, we've got a very big market opportunity for us in Poland.
In terms of our market share, you can see it's 7%. There's lots of room for us to grow and for us to move forward. If you look at India, whenever you put India side by side with any European number, it just seems, you know, incredible. An addressable market of EUR 338 billion, which is massive. Obviously, in terms of our development, although we're proud of what we've done, you know, we're really just 0.1% market share. In Romania, we've got very similar business to Poland in terms of the top two segments here. The market's a bit smaller, but again, we've got a decent market share. Our growth opportunities are strong, are big.
You know, we've got a position where healthcare is more important than ever, that more and more people are thinking about healthcare. More and more people obviously want those services. You've got a change in the way that consumers act in terms of a mix of physical, delivery, the historic kind of style, and a move towards more remote. We've got a challenged public system. No matter what country you go to, every country struggles with its public provision. That can only drive more growth for us. We've got a growing importance of the funded healthcare business, with us, benefiting from that with, driving more growth. We've got doctor shortages, and if there's a doctor shortage, people look for more private healthcare, which is good for us.
Obviously, there's a digital kind of revolution going on, which helps us grow. You know, in terms of the spend per capita, in all our markets, it's got pretty strong growth. It's good prospects. Our model, in terms of the way that we work, is that we basically do three things. We raise money for funding, and we do that in many different ways. We do that through our medical cards. We do that through our sports cards. We do it through plans for individuals. Obviously we have a different mix. We have our service management, which is the facilitation of people's care. Making sure that they get to the right service at the right time.
We have our care provision in terms of the networks that we provide. In terms of, you know, our focus areas, nothing's really changed here. We obviously want to retain and grow the customer base, which we've done successfully for a number of years. We want to expand our services. Again, which we've done over the last few years and developed into space. Operational excellence is really, really important in healthcare. You know, to be able to offer fantastic healthcare, you've gotta generate efficiency. Over the years, we've been very, very good at doing that. This, obviously we do selective M&As, and we grow through digitalization. Later on today, I'll sort of show some of the developments that we've done in those areas. This is Poland.
This is the Polish healthcare market. You can see the structured market has grown going from EUR 1 billion to EUR 1.5 billion. You can see that the out-of-pocket market has also grown at a greater pace. The market growth at 6.1%. There you can see that we've grown at a rate in business services at 15.2%. In terms of our pace of growth, we're growing outside the market. We're a large player in Poland, either number one or number two. There's an aging population, which is gonna drive more need. There's a growing importance for healthcare since the pandemic. Employers are looking for more solutions, that's really good news for us.
There's a lacking of infrastructure, so as we build new capability, we tend to fill that capability up. As I said before, there's a challenge public public provision position. In terms of our ability to grow, we will do that through our B2B customers. We know individuals will spend more if they join us on a B2B basis and spend on an individual basis. We've got more development that we can do in the regions, and of course, we can develop through digital channels. This is business services growth since 2006. As you can see, same kind of story that I said before, which was that, you know, COVID came.
We had a period of being flat. Now you can see that we've accelerated in terms of our business performance. We're the second largest healthcare player in Poland. It'd be good to see the figures for the end of 2022. We've got a lot of medical centers in the key cities. A lot of specialists out there, 1.2 million members in Poland. We've entered the sports segment. We're the second biggest player. I'll talk a little bit about the sports market a little bit in the future. Got a good proposition. It's developing really, really well. I'm quite excited about the prospects there. Obviously, to grow the sports market, we need to have a network of gyms.
We've been working quite extensively in recent times to be able to develop that. We've got a good base network. We've got areas that we further need to develop, but that base network is driving a degree of growth for us. We're seeing success in terms of not only medical members joining us in this sector, but also gym members as well. This is our business model. It's fairly simple. We try to get members, and the members join us. Obviously, to get members to join us, we need clinics, so we need hospitals to build our base proposition for medical. There's some public funding that comes into that system as a consequence of having those assets. Because we've got those assets, we also get fee-for-service.
Every time we bring a member in, of course, that member has wider needs, wider healthcare needs. As a consequence of that, you know, they look for wider solutions and a much more complete solution. We have a holistic position. We basically look at things from prevention, so before people are ill. We obviously treat people if they are ill. We have a proposition for physical activity, which helps prevent people from becoming ill. We look into their healthy nutrition side and have solutions related to supplements and food. We like to make people feel good and improve their image, which is where our dental proposition and our optical proposition comes in. There's a growing need and demand for mental health.
As a consequence of people needing mental health, we've developed a national network to be able to help people with that need. We're obviously very strong when it comes to maternity and looking after families in terms of their health as well. We've got a complete holistic kind of view in terms of the way that we look at people's care. To support that, we've got a very good, strong proposition in terms of our network in delivering these services. A large dental network in Poland, and of course, we've moved to Germany. We've got our gym network, which is very good. Eye care is really important for people because a big percentage of... Excuse me.
A big percentage of people certainly over the age of 40, you know, at that kind of age, more and more people, 50%, 60%, 70% of people have developed eye problems. It's a big part of our proposition. We've developed hospitals. I'll talk through the development we've done on the hospital side. Ambulatory care is where it all started, we obviously we've got a good network there. We have fertility solutions, and we have a few selected pharmacies. A strong proposition. This is our network around the country. You know, at the heart of what we do is our services to business.
The services to business also is a holistic view, where we're looking at not only medical care, which is where we started, but customers want services for prevention and occupational health. Again, the businesses want the sports proposition. We've got our sales force that deals with health, also deals with sport. There's the health heating proposition, and we have a full benefit service in terms of employee benefits and employee platform. If you look at the map of Poland, you know, our clinics are in nearly all of the voivodeships. We've obviously got a network of fee-for-service clinics as well, which supports this proposition. The optic shops which I talked about, dental, hospitals, etc . This is the sports market.
People say, "Well, why have we got into the sports market?" First and foremost, we've got into the sports market because our customers wanted it. You know, the number 1 benefit that people ask about in Poland is medical usually, but the number 2 is sport. In terms of the customers that are buying medical, they're the same customers that are buying sport. There's a synergistic nature to this, and it sort of supports our proposition in terms of being holistic. The market's also very attractive. You know, 1 billion market in terms of opportunity. Hit very much by COVID. As you can see, the COVID impact was big.
That gave us an opportunity in terms of building the network because there was a lot of distressed gyms out there, and we've taken full advantage of that to start developing what we do. The market's flat. Yeah, the market's really flat, driven by the COVID issues. There wasn't an opportunity to develop. The underlying trends at the moment is there's good signs of growth. You know, we've grown 79.77%, which is pretty good. We feel that there's a big, a big opportunity here to be able to develop this market further. It's quite synergistic for us because obviously it's the same sales force. It's very, very similar to managing medical in terms of the administration and the risk management. We see this as a very exciting space.
This is the hospital market in Poland. As you can see, it's growing 5.6%. If you look at it from an inpatient perspective, there's a stable kind of market. We're seeing quite tremendous growth, 26.6% growth. Again, there's a big pent-up demand for services in hospital that has been driven from the backlog of COVID that we see. The public, the public proposition is very, very good in places, but is fragmented and is always challenged. We see lots of opportunity here. There is no real national chain of hospitals in Poland. Of course, we were looking to develop the first one. You know, what will we do?
We will get new customers with the reach that we've got. We'll use our ecosystem to be able to develop, of course, we'll make selective acquisitions. This is the track record of hospitals. You can see in 2016, really quite small. Similar scenario, you know, COVID came along, we've developed and gone much faster, both organically and through acquisitions. As you can see that we've developed the network much further with the acquisitions that we've made in recent times. Our model for hospitals, pretty straightforward. We use our membership base again. Some of those members have got insurance, some of those members haven't got insurance, so they pay out-of-pocket.
You then have referrals from some of our other activities that come into the hospitals, and then we have the general fee-for-service traffic. We have a range of services, as you can see in different specialisms, and we have a good network around the country. This is the dental market. As Fredrik talked about before, big opportunity for us here. If you look at the mix from public to out-of-pocket, there's a lot of out-of-pocket opportunity. The growth, 4.9%. Our growth in Poland, 104.7%, which is very, very good. We've hardly started in terms of penetration, so there's much more opportunity for us to grow. You know, again, similar dynamics that there's a big difference between Poland and Western Europe.
There's limited public provision, which is driving people to pay out of pocket. We have a very, very good proposition, which we'll talk about in a minute. We see again good opportunity to grow. This is our track record for dental services. You can see when we, when we came to market, it was fairly insignificant. Very small amount of revenue, and that we've successfully grown the services over the years. We've done that through acquisition. We've done that through greenfield. You know, 17 acquisitions in Poland, 2 in Germany, which we're excited about and can see good opportunities as we go forward. This is our model. Again, looks similar, but probably has different dynamics.
We've got a membership base which has dental cover, which has no dental cover, which obviously means that there's a good opportunity for us to give dental services. We have some members that have a rich coverage for dental, and obviously, we're providing services for them. We have a large part of our membership base that don't really have cover but have some kind of incentive to be able to use our services. At the other side, we've obviously got the fee-for-service customers coming to us. We have a strong proposition, which is aimed at people to go through transformation.
Then we have a technology-enabled kind of platform, which means that we can service these people well, so that when they say they wanna go through the transition, we move them through the transition very, very quickly and very, very efficiently. This is our network in Poland. As you can see, we're in most of the voivodeships. You can see it's been a journey of acquisition and a journey of greenfield. Then our new development in Germany, where we bought 2 dental networks, Mein Zahnarzt and DDent. Obviously, we've been working with those for a few months. We think there's good synergies to be had in terms of our business. We've got a good proposition, and that proposition, we believe we can roll into Germany.
Our back office will be similar, so we can get some efficiency from that. We've got good technology that we can work together with and obviously purchasing. We're excited about our developments in Poland and Germany. This is just some examples of digitalization, some of the work that we do in Poland. You've got the sales side of it in terms of having the online store, where 270,000 products were sold through last year. We've got our telemedicine platform, which again is strong, and we did 2 million telemedicine consultations in 2022.
We've been using electronic medical records for a long period of time, so we've got a tremendous amount of data, structured data in terms of our customers, which helps us in terms of the treatment journey. Our customers want to be able to do more things themselves. As a consequence of that, we've built mobile solutions, 610,000 users on the mobile. Not everybody wants to use the mobile. Some people still wanna work off the PC, and obviously, we've got those solutions as well. We're very efficient in terms of allowing customers to do things themselves, so 30.5 million bookings take place every year. You know, again, we use our data very well.
In terms of our back office, we wanna remove paper as much as possible. 94% of our of our membership comes through self-activation, which is great, and 89% of our invoices are electronic, which is fantastic. In Poland, we've got good opportunity to grow. It's an attractive market. You know, it's the high, high quality, premium and digitally supported services, which is great. Our B2B, healthcare and sport is very strong and growing very fast. Our hospital and fee-for-service segment again is strong and growing fast. Our dental services again are very strong and growing super fast. Our supportive fee-for-service lines are there and doing very well. Romania. Romania is very similar. You know, you can see the growth in Romania.
You can see the growth in the out-of-pocket development in the country, with the funded not being as strong. Whilst Romania is a smaller country, it's managed to keep pace with 26.9% growth, which again I think is pretty good. Similar kind of trends, growing importance of healthcare, people wanting employee solutions more. The public sector certainly challenged. People used to paying out-of-pocket, used to searching for their own services, which is very good. Competition quite fragmented nationally. Obviously, there's some key players that we compete with, and again, a lack of national hospital chain. Similar kind of thing.
We will look for the B2B members to be able to drive our services, offer a wide range of solutions for individuals, and expand into the regions and build our hospital network. This is how Romania's progressed, as you can see, over the period. Really strong growth. You know, it's our second market that we entered in going back years, and we've made selective acquisitions along the way, which has been very, very good for us. This is our network throughout the country. As you can see, it's quite comprehensive in the major cities, but there's lots of room for us to be able to expand. We'll be looking to develop the network, develop our business over that time.
40 clinics, 5 hospitals, 1 hospital in delivery, which is quite big and in Bucharest. Looking forward to opening that later on in the year. Similar model. You know, it's got the membership model, the fee-for-service, the store, and the funding mix, and we'll be looking to develop a wider proposition in terms of our holistic approach once we've built more membership. So, you know, good opportunity for us to grow through spend with our existing customers. Good opportunity for us to, you know, capture more through extra members. You know, leverage our proposition, and grow further. Romania should do well. Finally, India, which I'll tell you more about.
Obviously, our relationship with India started back in 2017. We fully consolidated in 2000 and... Sorry. Sorry. This is the Indian healthcare market. As you can see, in terms of private hospitals, the amount of spend is accelerating and growing very, very fast. The market growth since we consolidated, 25.7%, which is good and strong. Of course, our growth is much higher at that, 43.5%. Good opportunity to grow 'cause there's, you know, insufficient funds in the marketplace in terms of public provision. Large and growing number of affluent customers, which I'll show you. You know, strong underlying economics for India. This is our growth since we consolidated.
As you can see, that we've managed to double the size of the business, and we've done that through the development of the network. Started with the 7 hospitals. Started to expand. COVID hit us, then we've gone into a super expansion mode, and as a consequence of the super expansion, there's quite a drag in terms of the bottom line. In terms of the maturity of existing hospitals and profitability, that's good. In terms of the development of the new hospitals that we've done, that's progressing really, really well, so it should be good. This is the growing customer base or growing target market. As you can see, more and more people moving into this middle class element for India. Lots of young people.
Lots of people going to the major cities. There's a place where, you know, everybody's got a mobile phone. Everybody's got a smartphone. Everybody's digitally aware. Everybody online. You know, lots of new customers for us to tap into. New affluent customers. This is kind of like our model and how we operate. The historical model kind of in India is that most of the development happened in the large cities. People would travel to those large cities. They would look to get their healthcare in kind of like some of the bigger cities. There would be some hospitals in the region, but they'd be very fragmented.
What we see is a great opportunity because the large city growth continues as more and more people move in. Also there's opportunity to develop more hospitals in the regions, which is what we've done. We have a very clear focus in how we approach it, which is we search for either underperforming assets. Somebody entrepreneurial has built a hospital and maybe it hasn't ran very well, or somebody's building a hospital, and they want an operator to run it. We've become turnaround experts, where, you know, hospitals that have been stressed and are struggling to be able to operate, we've come in and actually turned it around. We look for a certain size of hospital nowadays. Much, much bigger than we started off a few years ago, 300, 400 bed.
We look to do an asset deal where basically release the building, buy the equipment, and just come in and operate. We're in 3 states. We've got lots of opportunity to develop in those 3 states. We'll move to a fourth when ready. We're quality-based. We look for high cash payment, and try and reduce our legacy liability for some of the governmental schemes, where payment terms are slow. We look to develop much more in the tier 1, tier 2 cities, rather than the historic tier 3 that the business has been in. This is our footprint. As you can see, it's quite comprehensive. It looks like we've covered all of our states, but of course it's India.
You could put lots of new hospitals in the states that we're in and still grow. 23 hospitals with some more commissioned that will come online this year. 378 operational beds. You know, if you take one of our hospitals in India, the amount of beds that we have in one hospital is the total beds we've got in Poland, which then gives you a kind of, like, sense of the scale of some of these, some of these places. We do a very broad scope of service. You know, we're doing a lot of intensive care. We do a lot of transplants. We, we're very good in cardiology, et c.
We've entered the top 10 when it comes to private hospitals in India. Don't be fooled. India, our India business is very digitalized. It's probably more advanced than some of our Western businesses in terms of its digitalization. You know, we do all of the online services that we do here in Europe in terms of capturing the traffic from consumers, offering them the services to be able to book and look at the doctors to choose from. We also have 500 people on the ground that are our marketing team. They're out there visiting doctors. All of that in terms of tracking the activities is done online. It's a really digitalized business.
This is really interesting, probably sums up our journey of where we are with India, which is that this is a comparison of us versus some other listed companies. What you can see is that, you know, our bed size is significant, which is really good. If you look at our occupancy rate, it's very low. It's very low due to the expansion. It's not low because we're not attracting customers, because if you look at the number of inpatient customers, it's quite strong versus our competition. What is, you know, driving our dynamics is our occupancy rate is low because we've expanded and our average revenue is low. Our average revenue is low for 2 reasons, really.
One is that historically we were based in tier-three cities. By being based in tier-three cities, the premium per bed bed day goes down. Historically, we had quite a high percentage of governmental schemes. The amount of money you get per procedure is a lot lower. In recent times, we've changed our approach. Our approach is much more tier-one cities, which will drive, you know, a higher premium level per person. Of course, we're much more into cash insurance. As a consequence of that will grow.
Even though, even though we've got 4,378 beds, that low occupancy will really drive a big move in our profitability as we fill those beds up and as we harden our position in terms of the average revenue per person. In India, we've got, again, a good opportunity to grow. We've got mature hospitals. Some of those hospitals have got space. We'll continue to increase our bed size. We've got new hospitals that are gonna come online, which will again strengthen us in terms of our ability to grow. We've got other areas that we can look at to add on, and we can continue our digitalization, which makes us very, very efficient.
In summary, in terms of the division, we've got good opportunity to grow, good opportunity to grow, good opportunity to grow, and a good opportunity to grow. You know, we start with Poland and business services. They have a good opportunity to grow the membership. If we grow that membership, we will grow our other services, and at the same time, we've got a strong fee-for-service proposition. In Romania, very, very similar, putting on new capability, which will drive growth again. In India, we've got our hub-and-spoke strategy and expansion, which will give us good opportunity to grow and will continue to digitalize. Thank you.
Again, remind you that you can ask questions also on the webcast, and they will show up here. Do we have any questions in the room? Should I start maybe? If we start with India and you show that picture comparing with other listed companies. For Medicover, what's required for you to reach a similar type of profitability, so 20% plus EBITDA margin?
I think it's just maturity. You know, we've gone from a historic position of being in the regions. We've gone from a historic position where, you know, our mix of business was very much focused on having Aarogyasri and some of the governmental schemes. We've now kind of got alignment and direction together for us to develop the business in a different way than it's been done historically. We've had successes, so we're starting to see that happen come through, which always builds belief. People, once they get the belief, you tend to, you know, go faster. You know, our figures in India are hindered really by the growth that we've done.
If, I went through a little bit quickly, but if you go back to the slide which shows the hospital development, you know, we've put on quite a number of hospitals in the last 2 years. Hospitals take time to build. Hospitals take time to, you know, get traction in terms of customers. In Europe, we've had some hospitals that have taken, you know, quite a long time to get to a very successful state. In India, we tend to go faster. I just think it's maturity.
What do you think is the reason for your ability to go faster?
Equipment, where people invest in it. You wanna be paid. You know, you wanna make sure you're paid regularly and on time. You want patients. You know, we give them all those things. We the team in India do very, very well in terms of bonding the doctors, and the doctors are working well as clinical groups, yeah. I'm not saying we don't do that in Europe, 'cause we do. It's just on a different scale.
I think you also said that, so, is that increasing the risk in?
No, I don't.
In the opening pace here or?
No, I don't think so. I don't think so. I mean, you know, we've gone through a journey as a team where you're going into scarier kind of territory. I mean, our biggest hospital is 650 beds. When the guys kind of said, you know, we've got an opportunity for 650 beds to begin with, it's like, "Oh, hang on, guys." Actually, because they're doing such a good job in terms of looking after doctors, in terms of giving them the ability to do their job well, getting them the patients, we've obviously got a reputation that that's what we do. As a consequence of that, doctors know doctors, so you know, we're hiring really good high-quality clinicians. As a consequence of that, we get some patient traffic anyway.
We can top it up. You know, the way that we look at it is maturity, really. The mature hospitals, what we opened in that year. If you break the maturity down, then, in India, everything looks very, very positive indeed. Very similar with dental.
Okay. What about competition?
It's kind of like the history of what we do as Medicover. The competition are definitely aware of us. Again, you know, a lot of this is about doctor loyalty. If you can get the doctor loyalty right, because the competition for them to open a hospital, they've got to have doctors.
At the moment, you know, with the way that we've built the system, and the way that all those things that I described is kind of working for us, we have more of a positive position in terms of doctors wanting to come and work for us. It's a good position to be in. We've got a good model. We've got good people. We've got good traction.
I have a few questions here, but maybe start in the back and then one here.
Thank you very much. It sounds like the long-term return on investment will be higher in India for you in this segment, you are filling up capacity there very fast as I see it. Could you put us in any direction towards share of investments that will be directed to sort of India in the next, let's say, five years?
I'll go back to what Fredrik said earlier today, which is, you know, usually our level of investment follows with the size of the positions that we've got. India obviously is a smaller market for us currently. As a consequence of it being smaller with a good opportunity to expand, I think there will be slightly heavier weighting towards it. Don't underestimate our model, which is that, you know, when you look at the subdivisions that I've got, all of them are pretty strong. You know? All of them are growing very, very fast. All of them have got good management teams. You know? All of those good management teams are gonna want, you know, money to be able to develop the businesses.
India is slightly different. You can see that from the market, the market sizes, that if you've got a market size that big, you know, EUR 338 billion or whatever it was, and we've got 0.1% of that market with a model that's really working well, we'd be crazy not to, you know, give it some time, attention, and let it develop. I think you will see slightly more going in there. You know, I have this thing with my team all the time, which is my Indian team tell me that they're gonna outgrow, you know, gonna make a serious indent into the, into the revenues in terms of their percentage, and then my other teams start to fight back. Long may the competition continue.
Another one here in the middle here.
Yeah. I just wonder if you could mention something about the challenge you meet to grow your business in India and why we don't see that many other foreign companies operating in India?
India is a graveyard, really, when you look at it historically. I mean, you all know that. That's probably why at the beginning of our journey, lots of people looked at it and thought, "This is gonna be interesting. What are they doing? Should we put it in our model? Should we not put it in our model?" I think we've got a really good team, you know. If I look at my division, it's all about leadership. If I've got good leaders, I can do more. If I've got positions where I haven't got such good leadership, then it holds me back. You know, India, the challenges of India, you know, are gonna be there. The competition are gonna fight us.
I've got a really good team that are really hardworking, and I don't just mean the team right at the top. I mean the team at multiple levels. It's really reflective of what it's like working at Medicover. You know, good leadership, really, really good teams, really focused, wanting to make a difference. We'll adapt. It's, you know, the Indian team will do well.
changing topic, so one of the.
Able to develop. We've taken advantage of the COVID situation to be able to build our network. Our network is not complete. There's areas that they've got strong elements of their network. We've got strong elements of our network. They've got a long history. They've got 90, you know, 80 odd% of the market. If you went back, I don't know, probably 18 months or so ago, that percentage would be in the 90s. Of course, as we start to develop, they as an organization will do things, and we'll have to do things. Am I worried about it? Not particularly. I've got strong relationships with customers that are long-standing relationships, that have been there for a long period of time.
I've got a good sales team that are out there being very active with the network that we've got. You know, we've got a holistic proposition that we're talking about, not just an individual component. So far it's working. I've also got a good leadership team there, you know, at multiple levels. Some really good assets. I think it's one of those things where, again, if I was looking at your models, it's like, "What the hell are you doing, guys? Why are you in this kind of business?" I think there's been doubters inside Medicover too, you know? I'm quite happy to have those doubters, 'cause I'm quite happy to prove them wrong.
I think that you'll see, hopefully through the course of this year that we develop quite well and this becomes a little bit more noticeable.
Is this business profitable today or...
Yeah.
It is. Okay. The way you market this, is it together with the healthcare membership business who's selling this to the same customers and add on combining them?
Sorry. I promise with this mic. We, our proposition now is a healthy company proposition.
Okay.
When we go to see a company, it's not... We don't go to say, "Hi, we're in medical." We go to say, "We, we deliver a healthy company proposition. You can choose the elements of the healthy company that suits you." And of course, by doing that, what you're also finding, and I didn't say it in the presentation, is that, you know, we're getting customers through both our benefit platform, which is the electronic means of communicating with the, with the customer to manage healthcare, fitness, whatever. We're getting customers that are buying from us that don't buy medical. You know? They're buying sport or they're buying benefits, but they're not buying medical. We're getting much more reach in terms of to new customer streams, new opportunities to sell the wider proposition.
We would not have grown our fee-for-service volumes in the way that we've grown our fee-for-service volumes if it hadn't have been for us developing a much wider proposition.
It's, it can be individual. You know? If you just want a bit of it, you can have a bit of it. It can be holistic, and different businesses want different things. People do notice that we're, you know, we're positioned differently from our competition because it's about a healthy company, it's about a healthy life.
Given the fact that you have those synergies in Poland, does this mean for the sport business, that's gonna be Poland, or is there an idea for you to expand that into other countries as well?
Never, never say never. Poland currently, this is a new area of our business. It would be stupid of us to go crazy and suddenly say, "Right, we'll do Poland, we'll do Romania, we'll do whatever.
I've obviously got plans to do more holistic things in Romania because that was stated on the charts. You know, at the moment, we'll focus very much on Poland. We're getting traction. I'm very pleased with the performance of the business. One thing I didn't say, and I should have said before, take this sports market with this context, which is, you know, May 2021, sorry, April 2021, you wouldn't have found a gym open. You know, if you, if you put that context in place, if you're selling a B2B proposition, you've got no proposition in April 2021. Big companies don't make purchasing decisions overnight.
If they've got an existing scheme, they do it at their kind of renewal or their annual kind of cycle. We've had one and a half opportunities, if you like, to be able to pitch our proposition to some of these big companies in sport. We're making a bit of traction. you know, we're ahead of our own personal expectation for where we thought we would be. There's a long way to go, but it's gonna be okay.
Okay. Other question? Yeah, here in the front.
Just following on from that point, how do you make the assessment of the increasing complexity of your business in Poland, for instance, versus the upsell opportunities? I suppose there must be an element of trade-off.
In what context? Give me a little bit more context.
Well, in that you are adding more and more services. Clearly, these are not necessarily the same type of business that you have historically been in. I'm just wondering whether that is a consideration at all, how you're expanding the business.
It is. I'll go back to the statement that I said before, which is it's all about leadership. You know, I've got a really, really good, strong leadership team, especially in Poland, that have been with me for a long period of time. When I first joined the business, obviously, that's I'm based in Poland. When I first joined the business, you know, a lot of these people have been with me for a long period of time. They understand the system, they understand what we're trying to achieve. They're very well-organized. They execute very, very fast. There is complexity. Yeah. There are challenges and things that we've got to sort in our business to do with the, you know, with the system side of life. Yeah.
From a front-end perspective and from a margin perspective, to me, that would just be upside. Yeah. We haven't really reached a point where we're starting to worry about any of the subdivisions or the complexity, 'cause things are only complex if you let them be complex. If you can break it down and make it not so complex, it's not so complex. From the outside, it looks super complex. From the inside, there is a lot of complexity. If you're experienced and you're knowledgeable, you can navigate that complexity. I've got an experienced and knowledgeable team, so I'm very, very lucky, very loyal.
One more in the back.
I just wondered about inorganic opportunities. I would guess dental would be one of the areas here. To the gym side, if you have reached sort of required density or if you need more gyms?
I need more gyms. You know, I've reached a stage where I've got a good network, yeah, in lots of different places, but I'll need more gyms. I mean, Benefit Systems will not stop developing their chain. We can't stop developing our chain. I'm very strong in certain places, and other places I need to do some development work. Dental, we'll continue with dental. You know, the dental team are great, and the activities that they've done is good. You know, Germany is a new market for us, so we need to, you know, bed that down, understand that, understand the detail of that a little bit more.
Encouraging signs so far in terms of the information that we're picking up, and our confidence is quite high. You know, India is going to be India. I'm not short of opportunity. I'm really not, you know? We're growing as fast as we're growing because we've got lots of opportunity and because we've got a system and a bunch of leaders in lots of different places, including the hospital side as well, which are, you know, really, really focused, and they can execute. Though we've deployed a lot of capital recently, you're not seeing anything in terms of the real benefits of that at this current moment in time. My job, yeah, and my team's job is now that we've deployed that, is to fill everything up.
We've got, you know, all the signs are that we'll do that, and we'll do that well. We're not short of opportunities, but, you know, so all those areas we will look to develop, yeah.
Good. I have one more, if I may. Switching focus a little bit to the sort of services online, in terms of risks, I guess, you know, less capacity utilizations in your various sites, physically maybe, more remote services, higher amount of staff needed. You know, just help us understand how this is affecting Medicover as more patients use your services online?
Yeah. I mean, it's okay. I mean, it does change the mix, yeah? I mean, it means that we don't have to open as many centers as we used to open at the same kind of pace. You can't do everything online. You know, again, you have to break this down by specialism. Some specialisms are much more suited to it than others. You know, our online stuff isn't always doctor-related because quite often people are asking, you know, we can take out some of the physical visits that used to happen by some of the remote stuff.
It, it will change our mix, but that probably, you know, probably in a positive kind of way for everybody, which is we probably won't need as much capital for the, for the physical clinics. We will need them in new locations and things like that. It's positive for the customer because, you know, the customer wants to solve their problem as fast as they can. Certain things they'll wait for, and certain things they won't wait for. It just gives us flexibility, to be honest. The mix has changed, but as it's changed, we're kind of just evolving to it. It's not causing us any great hassle.
Thanks.
No problem.
One here.
Instead they announced quite aggressive price hikes since this year, 20, up to like over 20%. What's your strategy, here? would you like to become more price competitive or would you to grab new clients, new customers-
You know.
Would you go with price hikes as well?
Let's go with the first thing, which is the headline says that they're putting aggressive pricing through. I think in your report you quoted 20%-40%, something along those lines, I think. That's probably a soundbite. That's probably a soundbite of somebody in public, probably Anna in public, saying, you know, "We've got to do this," whatever. All the soundbites that you'll get from the whole industry in Poland will, about price will be true, which is that, you know, our prices due to market conditions have been suppressed for quite a long period of time. There has been price increases that go through, and there has been inflation that's gone through over that time.
As the inflation over that time has gone through, you know, industry players have either done 1 of 2 things. They've either got more efficient, and as a consequence of getting more efficient, they are managing those, you know, those price issues, or they've cut their access, you know, so people get less. We haven't done that. You know, we've focused on the efficiency side. On the pricing things, we've hardened price. The thing about the market, though, that you need to understand, especially on the business-to-business side, is it's individual pricing. You know? When it comes to it, the price is driven by the risk, and the risk then dictates the price.
We will have individual customers where we have put through price increases similar to what you've talked about, and we'll have other customers where we've put a general price increase through. We're just dealing with it by customer. In terms of, you know, whether this 20%-40% is true, I've got some customers where, you know, we've taken on new customers, and we've let some of our customers go. Some of those customers that have been let go, you know, LUX MED have given them very, very, very attractive prices. I don't know whether the soundbite versus the reality on the ground really balances, but what I do know is that inflation's in the system. You know, the inflation's always been in our system.
What caught us out last year is it was mega inflation, and it was mega inflation just after we'd done our main price increase. We had to wait until we could address it. We've addressed it. Our margins are, you know, okay, doing well in that particular area. The game's not over, and quite a lot of it will be driven by governments 'cause really what's driving a lot of the inflation is wage inflation, from the medical community because governments have, Polish government has put more into the system, and that drives everything going through. We're just going through a cycle. These cycles, they come, they go, they whatever.
Our job as a competent provider of healthcare services to our customers is to manage these challenges and these cycles in a very professional way, where we're being fair to the customer, but at the same time being fair on price, but also being fair on delivery of service. I think we've done that really well.
Second question, if I may, about dental business also in Poland, and the wave of market consolidation that I think started just several years ago.
I think my mic's going again. It's not really a wave. It's like two or three players, isn't it, really? You know. The funded players like us, LUX MED, we're always gonna be involved in things like dental consolidation. There's one or two funds that are looking to do dental consolidation. You know, if you look at the percentage penetration of the players, if you like, that are looking to get a network together, it's really, really low. There's lots of opportunity for us still to be able to grow. We have a, you know, like we always do, we have a different kind of proposition to these people, which is you're coming into a business that's incredibly stable. You're coming into a business that's incredibly long term.
You know, some of the other players, they're gonna turn their business, and they don't know who's gonna own them. Of course, we're developing a system for dental in terms of the proposition for a customer which is really, really good. If you go into our centers, they're really beautiful places. And the technology that we deploy as well makes the customer experience really, really positive. Of course, if you're a dentist, you want similar things that I talked about in India, which is good place to work, you have modern equipment, patients that can come through, which we can provide.
You want colleagues that you work with that you feel are professional, that are knowledgeable, that you can learn from, that you can have strong relationships with, and that will last over the long term. We've got all of that, you know. The dental team offer a really good proposition to prospects. If there's people out there that wanna join a good organization, then I would bet on us.
Maybe just one extra, follow-up on timing of this strategy from even those three or four players that started to consolidate.
Well, the funds will sell, won't they? The funds, of course. The usual cycle that you see with any fund is that they'll come in and they'll, you know, they'll get a collection of assets, and they'll tend to probably pay more than we would, you know, more than we could look at at times. They'll do that because they know that later on, they're gonna turn it, and they're gonna, you know, get a margin from that, whereas we're in a different place. We're talking about long-term relationships, building businesses together. Because we're in it for the long term, our interests are the same as the dentist's interests, which is they wanna expand, they wanna get bigger.
If they want to help us grow, they, you know, they wanna be a good partner and work with somebody, we're there. Again, I think it cycles. I mean, I've worked in Poland and these markets now for, you know, 13 years. I've never, I'd never even been to Poland before I joined Medicover. It's one of the reasons I joined. It was kind of like somewhere new, somewhere fresh, something different to learn, you know, to be inquisitive about. You kind of see these patterns happen.
You know, in my early years, it would be like, "Oh, my God, what's gonna happen?" Actually, most of the time, because we're good at what we do, because we're very professional, because we're long term, because we've got great people, because we're consistent, we just work through these issues and come out the other end. My confidence in my division is really, really strong. You know, you can see the growth. You can see the growth in terms of the percentages. They're good percentages, you know, really good percentages for our industry, versus our competition, versus what we do.
I've got a good team, and I think that most of these challenges you described, they'll come along, but, you know, we're very good at kind of like very quickly understanding it, very quickly deciding what to do, and then very quickly executing it, versus some of the people in that we compete against, you know? We've got frustrations, we've got challenges, but we're still very good at what we do.
Okay, thanks so much.
No problem.
We have a few more minutes to go. One thing I wanted to ask you is, coming back to this membership growth in Poland.
Yeah.
We've seen it accelerating, this year or in 2022. Is that just market growing, or have you been able to gain some market share? How would you describe that?
I think we've gained market share. I'm really interested to see the annual reports at the end of 2022 in terms of what the main source is PMR. I'm really interested to see what the PMR report suggests. I would say that we've taken market share, but I can't be 100% certain of that at this moment in time.
Okay. And again, I think that in
Still got a long way to go. Still got a long way to go. You know, it goes through, again, cycles, in terms of there's been some years when the growth has been relatively small.
Yeah.
There's been some years when the growth has been really quite strong. Obviously, in last year, the growth was strong, very strong. Part of that is price because of the difficulties that we're facing. I still think we've got quite a long way to go in terms of the membership growth, so.
Okay. in Romania.
Yeah. As you can see from the model that we've created in Poland, I, you know, from a personal perspective, I'd rather we accelerated our membership growth, which we haven't done as well as I would've wanted. You know, signs in current times look quite positive.
How many members do you have there approximately?
From memory, I think it's about EUR 240,000, something like that.
Okay. Final from my side, planning to open a new large hospital also in Bucharest now?
Yes. Yes.
That's more for the fee-for-service, or is that something you need to grow this membership business further?
It'll be both. I mean.
Okay
... the, we have an attitude when it comes to hospitals, which is, I'll go to Poland first and come back to your question.
... you know, nearly... if you speak to anybody in Poland about a private hospital, nearly everybody will say it's gotta be NFZ funded.
If you look at the statistics that I put up, you know, the statistics say it should be NFZ funded. We don't have that attitude. I won't allow that attitude to come into our business. We're about looking for all types of revenue streams, and fee-for-service is a big part of what we do. It'll be the same in Bucharest. That hospital will go up. Hopefully will be open in a few months. The progress on the hospital is fantastic. Really complex, a really complex build in terms of change that's been managed really, really well. Again, down to good leadership. It will be open on time, and then we'll go through the course of...
Obviously, our membership business will drive some volumes into it, and we'll get fee-for-service coming through. We'll probably repurpose the existing hospital that we've got in Bucharest to be more focused on woman and child and maternity.
Okay.
The bigger hospital goes on multi-specialty. It'll be a mix.
Okay. If there's no other question.
Fredrik said to me, "Oh, yeah, we've got these people coming on Wednesday from Poland." This was a guy who was running the business then. "There's a company called Medicover. Do you think you could join the meeting and just have a look at the finance side for it?" That was as far as he ever sort of formal involvement I formally had of being invited to work on the finance side for Medicover. Now in my 26th year afterwards, with that year where we had in 1996, $1 million of revenue, 'cause we counted in dollars in that day. Now we're EUR 1.5 billion. It's certainly been a journey.
I just wanted to look to start by having a look at the numbers for the 2022... 2020, 2022, the last three-year period. back in 2019, before COVID, that was our sort of base level of where we were started. 844 million EUR of revenue, 125 million EUR Adjusted EBITDA. We just have applied the new IFRS 16 standard in that year. we set in February the targets for 9%-12%, or we renewed the targets for 9%-12% in terms of organic growth. we set targets of a margin target, 15.5%-16.5%, in terms of Adjusted EBITDA.
If you apply that to the base year and roll that forward, that would be like EUR 1.1 billion-EUR 1.2 billion of sales and EUR 170 million-EUR 195 million in terms of Adjusted EBITDA. What have we done? We did a bit of work on that, but we also bought some things, did some inorganic activity in between. What we've done is taken out the revenues for the first 12 months of what we've bought or what's in the period for that we're looking at, if it's done this year and not quite 12 months yet. Also the related EBITDA. Add that on to what our targets would have implied, and you can see the numbers there. This is what we've done, EUR 1.5 billion, EUR 234 million.
We've got an excess of EUR 85 million and EUR 3 million in terms of the EBITDA side. That translates then into 14.6% annual compound rate for the organic growth and 16.7% for the Adjusted EBITDA. We moved from 14.8% margin to 15.5% this year. If you look at the full reported numbers, then you're on 21% and 23%. It's worth noting that that 14.6% is not adjusted for currency, so it's not constant currency figure. As you see, when we report our figures, our numbers are a little bit higher than that when we report those in terms of the organic constant currency figures on an annual basis.
If we did adjust for currency, and it's a little bit difficult because you've got acquisitions in there and the weightings change, but if we did adjust for currency, you're probably about 2.8 percentage points higher on that figure. You compare and look back then to 2017, 2019, what we did, 14.8%, again, non-currency adjusted, and 23.4% reported compound annual growth in the EBITDA figure. That's the old EBITDA figure. That's what we reported when we last reported on our three-year targets. Pretty good numbers. We are a persistent high-growth company. We have done high growth all the time. In fact, actually, we're not really just a persistent high growth company, we're a persistent very high growth company.
We have consistently, over time, delivered in terms of this. It's not just going back in terms of since we did the IPO in 2016. You can go back further in time, you can go back all the way. As I said, when we started off, we had $1 million of sales in the first year of our activity. I just wanted to show you here, go back to 2014. That was the first year in this time series, just to give you some sort of scale understanding. That's when we had our first war in Ukraine. 2015, despite that war, we continued to grow. We put onto just short of 14%.
2016, we continued to grow, just short of 20%. That's the numbers that we backed the IPO out of, we raised EUR 200 million in terms of new capital into the company then. At that time, when we went into the IPO, our equity was around about EUR 80 million. We moved up in terms of the amount of equity in the assets that we had to be able to deploy. In that year, after the year of our listing, we did 16.7% growth. We carry on growing in 2018. We did just short of 16% again. 2019, the end of our first three-year period, we did 14.8% organic over that period, unadjusted for currency.
We grew that year 25.7%. This is with one month of the Medicover Hospitals business being consolidated. We consolidated them in December 2019. We had February 2020, we had COVID coming in. Despite that, organic sort of baseline growth hit that we had in the second quarter, we still grew 18.2% with COVID helping us in that growth story. We went out to the market and raised just short of SEK 142 million of new capital. We had just short of SEK 200 million. We had another SEK 142 million. People paid 100 krona a share cash at that time to buy those shares.
We carry on growing again, obviously with 2021 being boosted by COVID as well, 38% growth. That growth was particularly strong because the business as usual was suppressed in 2020. This year we've done just over EUR 1.5 billion, and a 9.6% sales, with that big swing in COVID as well being compensated for. We've had certainly a big journey on that. If you look then in terms of how the business has changed in terms of the segments that we report, we were pretty much running as, you know, growth was about the same in weighting in both divisions, pretty much all the way through to 2019.
2019, we only had one month of Medicover Hospitals India being in there. Before this it was an associate from 2017. Come 2020, obviously COVID changed all of that, and we had COVID coming in. And we had a bigger hit in the diagnostic side of the business, very much more exposed to people walking around on the streets and going to our blood drawing points, versus the employer paid business, which was a lot more stable in terms of its revenue persistency. Anyway, 2020, we had that there. 2021, again, we had that big COVID side.
Now in 2019, we had the 1 month of India, but then we have that coming in in 2020 and 21 and 22, and being a bigger part of the business. That's really a large factor in terms of that weighting change. Likewise, when you see in 2022, when we had the war outbreaking in the second war outbreaking in Ukraine as well. That's been a large driver for that reweighting of the splits between the business. Just wanna spend a little bit, talk to you a little bit about the organic growth, but talk a little bit about the inorganic growth as well, which has boosted us over these periods.
What I've charted here is our full year of revenue for the acquisitions we've done. It's not necessarily what we've booked as revenue for that year, but it's an adjusted number with the full year for the re- acquisitions we've done versus the money we paid out, the cash. The cash also includes associates. You got there in terms of also you can see a sort of multiple of what we paid versus the revenues that we acquired for that, for that money. If you average that out over the whole period there, you'd be around 1.3x we paid for acquired acquired revenues. Now, we've done a fair amount of inorganic.
We've done cash flow-wise, just short of EUR 500 million in terms of inorganic deployment over that period, 2017-2022. If you look at the enterprise value, EUR 680 million. A large part of that then is obviously the minorities that we picked up as well, because particularly in India, we've got quite a large minority in our business there. It's been across the board in terms of what we bought, and also then across different markets as well in terms of what we've acquired since 2017-2022. Now, if you look at that, you can see there's a pretty big number of acquisitions. We've done 66 transactions since 2017, since the IPO.
You can see there a very large weighting to the healthcare services versus the diagnostic services. That also makes sense in terms of where you see the weighting in terms of the divisions. We've allocated more capital to the healthcare services. Why we've done that? Well, it's the opportunity. We've had more opportunity, particularly in the markets where we are, Poland, and India, and Romania, where we've had better opportunity in terms of acquisitions. Also the pricing has been more interesting. The pricing versus the potential for the future growth, we've had more interesting opportunities on the healthcare services side. Diagnostic assets tend to be much more pricey in terms of the transaction multiples expected on those.
If you look then in terms of how that's split, that goes back to what we've been asked serially since we did our IPOs. Where are you gonna invest money? Well, we're gonna invest money where we've got our business, which is sort of like, you know, pretty logical if you think about it. This is where we have the capacity to execute, and this is where we've got the synergies, and this is where we know best in terms of the opportunities and the right ones to pick and the ones to avoid. If you look there, you can see there a sort of, a quite similar sort of weighting in terms of where we've got our business. One which is maybe a little bit different is India.
Although we have India in here as enterprise value, it's really when we took control of the Indian Medicover Hospitals India business, we did have it as an associate for 2017, 2018, and most of 2019, and we accounted it for as an acquisition then in the end of 2019. EUR 682 million in terms of the total enterprise value of those businesses is what we've invested in. I wanna move on in terms of organic CapEx. It's a really important part of our model. It drives our growth. Our growth doesn't come for free. We've got an amount of growth which comes pretty much for free because we're in the markets, and the markets are growing on their own.
Even that isn't really for free because we are a healthcare business. We're not providing. Only a small part of our services are virtual in terms of digital. A large part of our services throughout that 2017 to 2022 are physical. You've gotta go and see a doctor, you've gotta get a scan, you've gotta have your blood drawn. You know, it's a physical service, so we need a physical footprint to be able to deliver that, and we need to invest in that. These are long-term assets. The assets that we're investing in have a very long duration and persistency. I've got machines that we put in place back in the 90s. Diagnostic machines. We're still using them today in our clinics.
We've invested, upgraded them, serviced, and they're still running today. An MRI will have something like probably a 15-year life in terms of the MRI. We'll get rid of it probably about 9, 10 years, but we will sell it and get a reasonable price for it and replace it with a more modern machine. It still will have a life of some 15 years. We depreciate it over 6, 7, 8 years, depending on the market where we're using it. We need to reinvest. What I've done here is I've plotted our business as usual, so excluding COVID, revenue growth, organic revenue growth versus our growth capital spend. It should really be shifted in time.
Obviously, I can't shift it in time for the future because the money that we're investing this year isn't for the growth of this year. That is coming from what we've invested in previous years. When we invest, it's sort of like next year's growth, the year after, the year after that. That's sort of like the timeline's 18, 24 months before you can sort of get that capacity filled up. That's really what's driving our growth. The great thing about these growth investments is, you know, you've got that recurring cash flow. If I ratio, put the ratio for this in terms of our growth on this and plot this out over this 5-year period, that ratio is... I've just gotta remember what it is.
That ratio is a half. If you look 17-22, the growth revenues versus the growth CapEx, that's a ratio of half. Just go back up to the slide I had earlier on, 1.3. You can see that this is a way more effective proposition in terms of growing the business than going out and inorganically buying buying things. Remember, this is suppressed because we had that dip in our business as usual in the 1st and 2nd quarter in 2020. This is actually a suppressed number, but still that's our ratio at half. It's best thing we can do is deploying our growth CapEx in terms of creating shareholder value.
Where does that money come from for us to be able to do that? Here I've put up EBIT, EBITDA, Adjusted EBITDA. We use that measure because that's the measure which is more akin to the cash that we generate than just straight EBITDA. We use a lot of operational leases with our property. Those are recurring cash flows. We take that out in terms of being able to come down to a number that's nearer the old EBITDA number, cash generation. And that's been pretty good. That's been quite close to the old EBITDA number all the way through. 2022, we've got quite a big divergence on that.
We've got about EUR 9.2 million divergence on that. That's because of the acceleration in the deployment of new leases, new operating spaces. We're really seeing that front-loading impact. Anyway, looking at the EBITDA number and our margin, we've had that's sort of like the number there in terms of, you can see in terms of the raw cash generation ability for the business. If we look in terms of what we've done with that cash, if I take out COVID-19, you can look back at the EBITDA for the business, which is just ex COVID. Sort of you can call it our underlying business, if you like, and the margins. That's grown, but obviously at a lower level.
What it means is COVID-19 has generated quite a chunk of cash for us. What we've done is we've used that cash to reinvest in accelerating our growth CapEx. If you look at here in terms of that raw cash there, on the right-hand side, you can see in terms of the maintenance CapEx, the darker colored one at the block bottom and the growth CapEx. We really stepped up in terms of 2022 in terms of deploying that growth CapEx. That's the sort of COVID bonus, if you like, in terms of the extra cash flows that we've got. We've redeployed that back into the business, and it's been quite substantial. We put 138 new greenfield units on and over that 24-month period, we've deployed.
From the start of that, we've increased our medical space footprint by 91%. We've really, really accelerated. No way have we ever done that sort of acceleration before. You can see that then in terms of return on invested capital. This is plotting our return on invested capital over that same time series. I've presented it with goodwill and without goodwill because we've done acquisitions inorganic, to try and sort of give you a performance indicator with and without goodwill, you can get an idea of our efficiency for the raw assets themselves versus the efficiency, including the premium that we pay to buy those assets. Now we've had that big peak, we've had COVID-19 come in, which has pushed those numbers up.
We've had that extra marginal contribution coming through. Now what we're seeing is that return coming down as the pace of the deployment of the capital has accelerated and depressed our margins and in 2022 as we deploy and put that extra capital in place. What's gonna happen in the future? Well, if I take this time series back further prior to when we were when we were listed as well, we grew at a much slower pace 'cause we had less access to capital. There we always were running around somewhere between 14 and 15, even up to around about 16% in terms of where we were historically.
We will trend that back up, that will come up towards that 15%, excluding goodwill in terms of the assets. Why will it do that? Because that's the sort of historical level we know that we get in terms of when we've got those assets in there and how we operate in there. Maybe with inflation, nominally, it may actually increase a little bit, but that's the sort of level that we will be looking for in terms of trending back up. The pace of it is always determined to a certain extent with the pace of our rollout of new investments. That is an important feature and you see that in, now in 2022. We've got a very strong capital base.
We have always said since we did the listing, we were gonna use the balance sheet strength to be able to bring debt onto the balance sheet. We sort of were getting there in 2019, using that. We went out with the COVID situation and brought in another just short of EUR 142 million of additional cash in which pretty much took out all of our debt. We were in a situation at the start of the COVID side cycle with a very strong balance sheet indeed. You can see that step up in terms of our capital. Remember, as you go back to 2016, we started off with EUR 80 million of capital, so brought in that EUR 200 million.
That's what we've done pretty much in 2022 now. We've used that balance sheet to invest in both our inorganic expansion with some EUR 228 million of cash flows out in terms of inorganic. We raised the debt in 2021. At the end of there, we've got a really good debt profile. Our average tenor is 4.7 years in terms of our debt profile. Around about half of our interest-bearing debt is in fixed rates. We're sort of hedged in terms of where we go in terms of the duration of interest rates.
We've got around about EUR 260 million of untapped facilities. We're reasonably comfortable now in terms of our debt levels. We are now at 3.2 on our reported level in terms of net debt to EBITDA, Adjusted EBITDA. On our covenant basis, we're at 2.85. With the covenants with the banks, we look back in terms of the acquisitions we do and take into account the profit streams that we've bought in those calculations. Normally, you got a little bit of divergence on there, but because we've been so deploying so much inorganic in this last 12 months, that's got a larger spread in terms of those two measures.
We have the capabilities in terms of supporting our growth. We've got a target of EUR 2.2 billion in terms of where we're gonna go in terms of our organic revenues. We've got the cash generation from our business to be able to fund an aggressive growth strategy in terms of putting money into growing our asset base. It's been very high in 2022 as we've used that COVID bonus and deployed that in our growth. We will come down to a lower level. You can see here we're above some 6% in terms of our growth CapEx versus our revenues. That will come down to something more like around about the 4% level where we've historically been running, more normali zed.
Our maintenance will run in the same sort of level at between 2.5 and 3% of revenues in terms of maintenance CapEx. We have the cash generation to support our growth. We've had a very nice inorganic boost. We will, in, as we support our growth, we will still also work in the inorganic area, but it won't be now. This 2023, we will still do some inorganic, but it will be on a much, much smaller level. We're 3.2 now in terms of our reported levels. That will tick up into Q1 because we've got very strong comparatives that will drop out.
We will come back to looking at the inorganic in the second half of our 3-year period. If we look at our meters squared, that's a really strong scale increase, so +91% for 24 months, +34% for 12 months. Obviously weighted towards the Healthcare Services side. We've got that scale to fill up. That also is gonna be a big factor in terms of us being able to achieve our targets. If you look at those targets just to refresh on there, EUR 1.5 billion where we are today, more than 13% growth, an absolute target of EUR 2.2 billion.
We expect to be as a minimum, EUR 2.2 billion for 2025. Adjusted EBITDA, EUR 234 million this year. We're looking at an absolute target of EUR 350 million. Again, minimum of EUR 350 million. We expect to be at least at that level. If you look at where we are in terms of our loans, we're around about EUR 467 million for the end of this year. A 3.2 reported level. We still will be keeping that target in terms of 3.0 at or thereabouts. We wanna continue to use the balance sheet. I estimate we'll probably have something around EUR 200 million-EUR 300 million in this three hundred...
three-year period to be able to deploy in, inorganic investments. As I said, that won't be at the first part of the period. We will be probably tipping up now because of those technical features in terms of the comparatives numbers falling out for the first half of 2023, and then we'll see that coming down over the second half of 2023. We have our ability to generate cash. We've got a set of assets which are a fantastic set of assets. They're long-lived assets. If you think about it in terms of, you know, an inflationary environment, the assets are there. We bought them historically and financed them historically with historical loans. The ability of those assets actually increases in value.
The cash generation ability of those assets increases actually over time in nominal terms. We've got a great set of assets. They're becoming more valuable. Our capital structure is strong. We've got a really good arrangement in terms of our debt structure. We've got really good recurring cash flows, we've got really good relationships with our bankers and with the people who have trusted their money to us to loan us money. I think we're in a really strong position in terms of being able to continue to use the balance sheet over that 3-year period.
Our return on invested capital, and this is, a, you know, an important feature of what we look at in terms of how we, how we assess our performance against those assets, that will trend up. We've been here before in terms of when we've rolled out assets before historically, and, you can see that in terms of the impact on our numbers. We've got a long history in terms of filling up those assets and getting them working. We're very confident in terms of being able to get those assets, to good occupancy levels. You know, John was quite. Gave you a sort of, a really good flavor, I think, in terms of understanding, the business.
We don't sort of come from it saying, "Oh, you've gotta get this filled, you've gotta do this." We come from it from a point of view of, well, what do we do? We provide a good place for doctors to work. We have an environment where people feel comfortable working. We give access to our customers where it's a convenient place for them to get the service. They can get trusted. With their brand, and with their history, and with our approach of how we run the business, we fill those assets. We've done it time and time and time again over the last 26 years that I've been involved in the 25 years that I've been involved in the business. We see that happening.
you know, you can't predict exactly the timescale of it, so it's gonna happen, but we're well on the way in terms of getting those assets to a good level of performance. That then feeds through into your return on an invested capital on that return on your margins and your growth. We are a persistent, very high growth company. just to block that out for you, we start at EUR 1.5 billion this year. COVID during this period is pretty much gonna go away. We'll probably have some small recurring revenues from COVID, but nothing that will be particularly special. We have disposed of our sold our Belarusian business, so that had about EUR 20 million of sales in 2022.
That will be gone from our numbers here in our target. We've got businesses that we've acquired as well. When you annualize those out in terms of the annual revenues, you sort of more or less equal out in terms of your starting point. That implies then we've got to put EUR 700 million of organic growth on over that 2023 - 2025 period. We're very confident that we will do that. To do that then, our organic CapEx, we will normalize that. That will come down from the levels that it's been in 2022. It will still be, you know, fairly aggressive deployment of capital. We've got the ability to do that.
We've got the demand in the markets. We will have lower inorganic activity in 2023, and it will probably be the second half of the period before you see that picking up again. I reckon probably around EUR 200 million-EUR 300 million of inorganic capacity that we'll have over this period that we'll be looking to deploy. If you look then in terms of the Adjusted EBITDA level, we start off at EUR 234. Target is EUR 350. If you block out those numbers, COVID-19 being significant, Belarus and the M&A annualization, it implies that we've got to put EUR 160 absolute amount of additional EBITDA on.
With our historical execution, with the historical focus in terms of understanding for the assets what sort of level that we get, with that, we again feel pretty confident that we can execute in terms of bringing that on, and bringing that into the, to the business. Just to summarize before we go to Q&A. Persistent very high growth company, and it's not since listing, it's all the way through our whole history, and it's a factor of how we approach the business and the markets we're in and the opportunities we have. There's a structural deficit in the healthcare needs and the infrastructure. When we're bringing in those, the infrastructure, there's a hole. It doesn't exist, but people are looking for it, and we're helping to fill that need.
We've got a proven track record and to be able to execute on this, existing markets, both organic and inorganic. We've got great teams of people that we've built up that have got a lot of history and experience with the company. We've got our playbooks in terms of what we do, where we go, how we do it. We've got that developed and built up over time. I think you've got a little bit of flavor of that from hearing directly from John Stubbington and Staffan Ternström. We've got a really good capital structure in terms of being able to fund that. I'm really happy that we've actually finally been able to use our balance sheet and get to a year where we've actually got a good utilization of our balance sheet and the inorganic.
Obviously, that means we've used a little bit of the power that we have, but as we generate and build those profit metrics, with the investments, we'll have more of that coming back in as well. Thank you.
Thank you, Joe, and John and Staffan. You haven't heard already, if I do a 2-minute recap, what sort of we want you to walk away with from here is that you've heard this high growth, high organic growth enough of times today, I think. You're not gonna forget that. I think you will continue to see that going forward. That's really, again, a reminder. I talked quite a bit in my opening session about why our markets will continue to grow double digits, certainly outside Germany, and mid-single digits in Germany, all the reasons. Don't forget that sort of moving bubble chart.
The thing that may differ is it may take one or two or three years longer, or it may go one or two years faster, but that is an inevitable movement. If you have a strong position, network, people, brand, customer relations in that market, you will grow with that bubble. There's a million problems and challenges along the way, but I promise you, they are certainly much less than if we look historically, the kind of challenges and problems that we have had to overcome. On Staffan's side, not to repeat what Staffan went through, and I'm sure you will have some further questions on it, but fundamentally in growth market in Central and Eastern Europe, strong position in Germany, and then some really interesting growth engines for the future, particularly in the genetic space.
I think Staffan was clear on advocating why in genetics you're actually a global business. It is not a business where you're limited by the sort of territory you're in because you can ship long distances if you have something really good to sell. I think John took you through in terms of a number of businesses that are growing. There's a lot of interest around India for obvious reasons. John made the point, I repeat that somehow, you know, the Indian team, that is a super good team, they think they will outgrow the European business. So far, they've sort of been surprised percentage-wise, the European business has been able to almost keep up. I'm sure that they will keep on growing very strongly going forward.
Joe talked you through, you know, the financial side of things where, you know, cash generation and a healthy balance sheet is essential. You know, we have that. We understand that. I think we have been disciplined historically in terms of how we use our balance sheet, use our cash flow. What hasn't been touched upon at all in this presentation because it, you know, obviously is not in the business, is the ownership structure. You know, it is, healthcare is a long-term business. It is a little bit up, a little bit down every now and then. A war breaks out on a major market, a lot of people get nervous, things happen.
Particularly, I think it is super important today, but over the first 10, 15 years of the journey of Medicover, everyone was not convinced this was such a success. I think a large part of why we are where we are today is the af Jochnick family and then Jonas, obviously, who passed away. Nowadays his family and Celox and the family foundation as the main shareholder has been a very, I think a very important steward and continues to be so to allow us to really take the long-term perspective required to sort of drive this business forward.
Again, I think you've heard enough of time today why we're then confident enough to put down our foot to say a minimum of EUR 2.2 billion and a minimum of EUR 350 million. I think Joe's second last, or third last slide was to show, you know, the absolute amount of money that we need to put on, which is not insignificant. It's not just gonna happen by walk and park. You know, we're very confident we're gonna get there based on what largely Staffan and John talked to you about or described to you. I think that's the material we intended to go through. Kristofer, if you wanna try and moderate questions for all of us, we see what comes, and we take it from there.
Perhaps it's good if we come up here, all of us.
We have around 15 or 20 minutes for questions. Anyone would like to start? Maybe here in the front.
Yes, hello. I have a question about the dividend. I haven't seen or read your Q4 report, but maybe you have commented the level of the dividend. It's unchanged from the year before.
Correct.
Could you comment on that?
Well, I think the short comment is that we have a strong financial position, and it has no impact on terms of the growth agenda. We felt it's a good thing to maintain the dividend at the level we paid last year.
Regarding your new financial targets, 50% up on the revenue and on the income side, can we expect a similar trend for the dividend, or is that too much or too little?
Say that again.
Your new financial targets.
Yep.
-up almost 50% for, to 2025.
You mean the profits?
Yeah.
The dividend, yeah.
No, no, not the dividend. You have explained that you, for your revenues and for your profit, you have raised your estimates for 2025.
Well, I don't think that I am in a position, Torbjörn, to predict what the dividend will be. You know, that's up to the AGM to decide and the board to recommend. I would assume if we grow our profits, it sort of seems reasonable that dividend will also grow. I think that's not for me to speculate in the future.
Okay, thank you. Finally, your share is listed on the Swedish stock market in Stockholm. You don't have any business in Sweden, and that could of course raise some positive or negative questions. My question is really, have you any plans to list your share on another market as well?
No. You know that I think one of the historic issues with our share has been too little liquidity. The liquidity has actually picked up over the years, which is good. I don't think you should do the mistake to list it in more places where we are now. You actually reduce liquidity. There's no plan to do that.
To raise the 10 million EUR.
Torbjörn, we actually are in Sweden because we have a regulated insurance arm, and that is actually a Swedish regulated insurance entity. A little bit of business in Sweden.
Thank you.
Other questions? Shall we start in the back and then here?
Yeah. My question would be if you could describe a little bit on what you think about a potential entry into diagnostics in India, what that would require, if that would be attractive, and if you could just... Oh, no. Now it's working. My question was around diagnostics in India, if that would be attractive and if, you know, Medicover's model could be applied there to create value.
I think it's a bit unfair to ask Staffan to do it because it's John and me really who's spent the time in India. Maybe I'll have an attempt on that, and maybe then you want to add something, Fredrik, Staffan.
You know, we've deployed a fair amount of capital, EUR 119 million in India, in the hospitals business. As I mentioned before, the asset prices for diagnostics are pretty expensive. If Indian hospital companies are expensive, then diagnostic companies are on sort of another level of expensive. To get in in terms of sufficient scale has always been the issue. We would like to be in Indian diagnostics. I expect at some point in time we will be in Indian diagnostics. Sort of we are already, because we run quite big central labs in our hospitals, and these are big hospitals, so obviously the labs are quite big as well. We've got that sort of capacity.
We're sort of a little bit there already. I expect we will a little bit. If you look at Max Healthcare group in India, they have a diagnostics activity alongside their hospitals. I suspect it will be some sort of extension like that where we use the synergies we have and go into the diagnostics. I can't really say anything more than that, really.
Maybe I can just add, obviously it was pretty natural to look into India when I came on board, Optik. We have some small activity through our mixed business. Very, very limited. And we also have looked at a number of targets. When you look at the multiples there in the midst of COVID, it's just been, let's wait and see and come back to it.
Thank you. The next question was on within genetics, as you spoke about... Sorry if I have a bad understanding here, but you're selling it widely, like it was highlighted, markets in North America, also further east or-
We can say we have customers who send into either Munich or to Cyprus from 50 countries, not North America. We are in the process of doing freedom to operate. It's a little bit more of a litigious environment there, so we wanna make sure that we are fully sure. We are clearing the rest of the world. That's potentially something we're looking into to get into the U.S. market over the years to come.
Thank you.
We have one in the front there.
This is perhaps more a comment than a question. Your strategy has obviously served you well through the years. For an outside observer, it's astonishing that a small company like yours can cover such a wide space of services. There's almost no facet of wellbeing or healthcare that you are not engaged in, not in every market, but still somewhere. It has been touched upon before, but it's, it is really amazing. On a lighter note, I just want, since you are so deeply engaged in Poland, I wonder if you in your spare time might encourage the Poles to carry through a spelling reform.
Other questions? Maybe I could ask you, many of you have been with the company for, you know, since the start, more or less. How would you describe the growth opportunities now? There seems to be a lot of them, if you compare with the past.
Growth opportunities.
Growth opportunities. Is this a normal situation, or I would guess maybe it's more opportunities than before with this new leg in India, but what would you say?
I mean, if I take it, I think it's much more, Kristofer. I think there's two things. One is now if you're a EUR 1.5 billion company growing 15% organically or whatever, you know, that's a lot of money relative to if you're a EUR 100 million company growing 15%. I think the fact that we keep up pretty much our percent. Actually, in these recent financial targets, we jack up the percentage growth expectation. Apply that on a much larger base, so clearly, you know, it's many multiples more absolute money, which is really driven by what I think John and Staffan talked through, that, you know, we have multiple businesses, multiple teams, multiple opportunities, and when you gross them up, it just becomes much more.
We have much, much more opportunity today than we had 5 or 10 years ago. Definitely.
At the same time, of course, you have a lot of capacity now to fill, but at the same time, you're talking about that you will slow down investments a little bit now versus what we have seen in the past two years.
We come back to sort of the rate that we were doing it before.
Okay.
Actually, absolute amount of monies, it actually increases. You take 4%, apply it to EUR 2.2 billion, yeah, and you're on, you know, you're on, sort of not far off what we invested already this year in terms of with this accelerated COVID bonus that we deployed for this year. It's still chunky amounts of money.
given the opportunities out there, did you consider, you know, continue to be this aggressive?
Maybe that would have required new equity or something like that.
I don't think that topic is a financial issue, Kristofer.
Okay.
I think it's much more a basic, you know, management or a leadership ability to actually handle that, you know, there's some limit to what you can do. I think even if we had had 50% more capital to deploy, we probably would not have done more than what we had. I think we've sort of touched the limit what you where you wanna be organizationally to expand, and that's why I think we make quite a significant point. Obviously, financial is one thing you don't wanna get too leveraged up, but I think it's an important thing to state that now, you know, we wanna make sure that we fill up capacity that we have put on.
It's a sort of risk approach as well.
Yeah.
We've leveraged the balance sheet. We're using other people's money as well, we've gotta make sure we've got all of those things actually executing. We wanna go out and raise on good terms more money, which we will in this period. With our debt lenders , we need to visibly demonstrate to them, "Look, everything's fine, guys. This works. We deployed the capital, it works. Look, this is the money." It's also about risk on execution as well.
You have, of course, you have managed a lot of challenges in the past few years here, but how would you describe the risks now in this period until 2025 and the risk for not reaching this target? Anything that you would like to highlight?
Unthinkable.
Okay.
Just unthinkable to me.
Sounds good.
Yeah. The target's been set and whatever comes along, comes along.
Could you speak in terms of.
The target's been set. We've got good capability. We've got good people. We've got good leadership. We've got good opportunity. There'll be challenges along the way. There'll be the odd thing that goes completely wrong, I'm sure, because of whatever reason at that particular time. You know, we'll find a way through. It's what we do, it's what we've been doing for years. You know, we can't be arrogant about it, but we've got a really good momentum, you know, and momentum means a lot. Yeah, it's looking okay.
Kristofer.
War doesn't stop us.
Well, I know.
Pandemic doesn't stop us.
No. Nothing's gonna stop you. Did you have something?
No. I just wanna add that I think I'm exactly where you are on our core business, where I think we know what to do in Germany. We have redeployed or brought in some new capabilities, maybe a little bit later in the journey than what John and his team is. I think we are all set there to continue to capture the opportunities and deliver on it. I think for us, we have a little bit of an unknown around where genetics is going, because obviously it could open up totally new things-
for us as well.
That's still to be seen.
Okay.
One thing which I think it has been said indirectly a few times today, but I don't think it's been said very specifically. You know this, but I'm just making that point here now that, you know, one other aspect of a private pay healthcare service business is that if you do your job well, you know, you satisfy the customer, you're accessible. You know, the business that you bring with you tends to stay with you.
Yeah.
You know, you can just think, you don't wanna change your doctor if you don't have to. You don't wanna change your dentist. Whatever, you don't wanna change your lab provider if you're not forced to, if you don't have to. You have this beautiful stickiness, unless something external happens, like what Joe just talked about.
Otherwise, that's a really important thing. You know, you sell a lot more every year, you tend... Many other businesses, you sort of start from 0 January of every year and sell your first product. I exaggerate a little bit now, that's a really important aspect. When I say private pay healthcare, if you don't remember or don't forget, sorry, that in the public pay healthcare, then you get much less customer loyalty because then sometimes you know, the public payer-
You know, will, you know, buy service somewhere else and redirect. We have some of that obviously, but predominantly private pay, and then that is a very important element.
Mm-hmm. Did we... Yeah. Please.
Thank you. You know, you won't probably like this question. We will probably not end up here anyways. I mean, you constantly keep investing for growth and that constantly also dilutes profitability given, you know, you constantly ramp up capacity. Could you just try to shed some lights on, you know, where the profitability is if we just, you know, fill up the capacity and utilize what we have?
I think-
Just.
I think we gave you a pretty good indicator there in terms of with Steel when I talked about the return on invested capital. I think that gives you a pretty good level. We're coming off on that calculation on EBITDA. Sorry, EBITDA. Just EBITDA after amortization-adjusted leases. Our operating profit take out the amortization charges for acquisitions and lease costs with a 25% tax rate factored in there. That's what we've seen in the past. That's what we delivered on the assets we've had before. It's the same type of assets, same type of financing structure, same way of operating and very much similar markets in terms of price points and everything else and profitability levels we get to.
That's where we're gonna come back up to. It's really just about the pace of growth that we do in terms of, you know, the overall reported margins, but we'll get that coming up and that would drive the profits, cash flows and everything else.
Thanks.
Okay, final question from me today. You have this very good platform now, are you at all spending time on looking into new geographies? Is that a topic at all for you to expand into new geographies?
No. I mean, we've had that question come in quite a few times. Not really, and when I say not really, I mean, you know, the one exception to that we have said, which I think is still the case, is that, you know, we in some of our niche specialty businesses.
you may wanna bring that to new markets. That's a very sort of narrow element of what we do. If you look at the, you know, the broader platforms or businesses we have, in fact, that's one of the main stated reasons to go to India because, you know, you can grow in India for 50 years. Somehow, actually, you know, concentrating the resources in the geographies, some people say it's a risk, to focus on some countries which, you know, I'm not saying that it's not so if something goes really bad in that particular geography. The other side of that coin is that you have strong management systems, brand, all that kind of things, where obviously Poland is our-
You know, biggest example of that. I think, actually, if John may not be, quite a few of us are actually surprised year-on-year how strongly that Polish franchise is growing. You know, the last thing you wanna do is, you know, not capitalize on that.
I know that was not your question, I think, you know, we have no immediate plans to go to any new big geography, but rather. If you so remind, I showed 9% market share in private pay Poland. Seven of that was in John's division, Two in Staffan's, and that business is compounding or market compounding, whatever, 6%, 7%, 8% per annum. There's a lot of growth still for us to come, even in that one particular original geography.
Yeah, I think we stop there. Thank you very much.
Thank you.
All right.
Thank you.
We say thank you for attending this, first capital market.