Global Health Ltd (NSE: MEDANTA) Q3 2026 Earnings Call dated Feb. 05, 2026
Corporate Participants:
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Priyansh Jain
Yogesh Gupta — Group Chief Financial Officer
Analysts:
Amit Valk — Analyst
Tushar Manudhane — Analyst
Devansh Shah — Analyst
Bansi Desai — Analyst
Manish Poddar — Analyst
Damayanti Kerai — Analyst
Ashutosh Nemani — Analyst
Rahul Jiwani — Analyst
Nitin Agarwal — Analyst
Naman Bagrecha — Analyst
Ebin Benny — Analyst
Chirag Gupta — Analyst
Presentation:
operator
Ladies and gentlemen, you are connected to Global Health Limited conference call. Please stay connected. The call will begin shortly. Ladies and gentlemen, good day and welcome to Global Health Limited Q3FY26 earnings conference call hosted by GM Financial Institutional securities Limited. As a reminder, all participants line will be in listen only mode and there will be an opportunity for you to ask question after the presentation concludes. Should you need assistance during this conference call, please signal an operator by pressing star then zero on your touchstone phone. I now hand over the conference to Mr. Amit Valk from JM Financial Institution securities Limited. Thank you. And over to you sir.
Amit Valk — Analyst
Thank you Pari. Good afternoon and warm welcome to all the participants on Global Health Limited 3QFY26 earnings call hosted by GM Financial. Today on this call we have with us from the management Dr. Naresh Trehan, Chairman and Managing Director, Mr. Pankaj Sahni, Group CEO and Director, Mr. Yogesh Kumar Gupta, Chief Financial Officer and Mr. David Goatwal, Head of Investor Relations. I will now hand over the call to Dr. Priyan for his opening remark. Thank you. And over to you doctor.
Priyansh Jain
Thank you. Good afternoon to everyone and welcome to Vedanta’s Q3FY26 earnings conference call. I hope all of you have had the opportunity to review the results and presentations that were released yesterday. At Medanta, our primary focus continues to be on delivering high quality patient centric care across our network supported by strong clinical governance, robust processes and continuous investment in medical expertise and infrastructure. During the quarter, the company remained firmly committed to strengthening its clinical program, expanding across tertiary and quaternary care and ensuring consistent clinical outcomes across its hospital network. As doctors, we remain deeply concerned about the rising cancer burden in India where early detection continues to be the most effective intervention.
In this context, we launched a large scale cancer awareness program during the last six months focusing on breast and prostate cancers. The initiatives were aimed at dispelling prevalent myths, promoting self examination and encouraging timely medical interventions. To meet the growing demand for advanced oncology care, our Gurugram facility commissioned its first fifth radiation oncology machine, significantly enhancing treatment capacity and adding some of the latest technology to this field. I would like to acknowledge the dedication of our doctors, clinical teams and support staff whose collective expertise and commitment remain the central to maintaining the highest standards of care while delivering personalized patient centric outcomes across our hospitals.
Our recently commissioned Noida Hospital completed its first full quarter of operations. During this period, the hospital made encouraging progress across clinical onboarding, outreach initiatives and infrastructure activation, thereby laying a strong foundation for the ramp up of business operations and the delivery of high quality healthcare services not only to Noida City but also across Western Uttar Pradesh. I am also pleased to share that Mehdanta Lucknow has received the prestigious Joint Commission International Short Form JCI Quality Accreditation in January 2026. Medanta Lucknow is the first hospital in the region to be accredited by JCI. This certification reaffirms our commitment to deliver the highest global standards of clinical quality and patient safety in the region where we operate.
With that, I will now hand over the call to Mr. Pankaj Sani, our Group CEO who will take you through the financials and operational performance in detail. Thank you.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Thank you Dr. Jain. Good afternoon everyone and thank you for joining us today for our Q3 FY26 earnings call. Let me begin with the financial performance for Q3FY26. Total income for the quarter stood at Rupees 11,428 Million, delivering a robust 19% year on year growth driven by sustained momentum across all our hospitals and continued improvements in operating metrics. EBITDA excluding Noida grew by 11% year on year to rupees 2,814 million with healthy margins of 25.4%, underscoring the resilience and operating leverage of our balanced portfolio. EBITDA including Noida stood at rupees 2,494 million with margins of 21.8% reflecting the expected impact of early stage operating losses from our newest hospital, Medanta.
Noida, which commenced operations in September 2025, completed its first full quarter of operations during Q3 and the hospital generated rupees 343 million in revenue and reported an EBITDA loss of rupees 320 million in line with the investment required to operationalize a facility of this scale and high standard. At Noida, we accelerated the ramp up with addition of 102 beds taking total bed count to 328 beds with nine new operating theaters added this quarter taking the total count to 14 operation theaters. This is also supported by significant strengthening of our clinical teams. We remain confident of steady improvement in utilization and financial performance over the coming quarters.
Consolidated profit after tax stood at rupees 950 million, impacted by higher depreciation and finance costs related to Noida, initial operating losses and a one time statutory impact of Rupees 366 million arising from the implementation of new labor codes classified as an exceptional item. Adjusting for labor codes impact, profit after tax was rupees 1224 million. We also saw encouraging momentum in international business. International Patient revenue grew by 30% year on year to rupees 703 million driven by higher volumes while our OPD pharmacy business grew 30% to rupees 465 million. Operationally, the quarter demonstrated strong traction across the Network.
We added 144 beds including 42 beds in Patna and 102 beds in Noida. Inpatient volumes grew by 14% while outpatient volumes increased by 20% year on year. Our average length of stay reduced to 3.02 days, a 7% year on year improvement while occupied bed days increased by 7% translating into an occupancy of approximately 59% on expanded bed base. RPOP increased by 10% to Rupees67361 supported by improvements in ALOS and case mix. Moving on to Matured and Developing Performance Update Our mature hospital consisting of Menantha, Gurugram, Indore and Ranchi delivered steady performance with revenue of Rupees 7020 million up 9% year on year and EBITDA of Rupees 1675 million up 7% with margins of 23.9%.
Matured margins during the period were impacted due to increase in employee costs and other operating expenses including repairs and maintenance. Our developing hospitals excluding Noida continue to outperform recording 22% revenue growth to Rupees 3651 million and EBITDA of Rupees 1156 million growth of 13% with strong margins of 31.7% in Q3FY26. If you look at nine month performance, both Lucknow and Patna facility continues to deliver double digit growth in revenue and EBITDA with Lucknow margins registering over 150 basis points improvements year on year while Patna margins remain stable. Developing hospital including Noida stood at rupees 3994 million up 33% year on year while EBITDA stood at rupees 836 million with margins of 20.9% reflecting the expected drag from early stage operations in Noida.
Inpatient volumes across developing hospitals increased by 27% year on year with overall occupancy at 62% and RPOP rising 8% to rupees fifty six thousand eight hundred and fifty three. Project update during the first nine months of FY26, bed capacity increased by 18% year on year with addition of 537 beds comprising 99 beds at Patna, 110 beds at Ranchi and 328 beds at Medanthan Noida. We continue to have meaningful headroom for growth within Our existing network with the potential to add 496 beds through brownfield expansions including 193 beds at Lucknow, 81 beds at Patna and 222 beds at Noida.
These additions are expected to drive near to medium term growth with minimal incremental capex. On the expansion front, our pipeline continues to progress well. In Guwahati, barricading is complete and drawings have been submitted for approvals. In Mumbai, land acquisition is complete. Additional FSI approvals have been received and drawings submitted for approval. In South Delhi, construction activities are underway following the completion of site surveys and soil testing. Pitambara project is going through the regulatory approvals phase. Overall, nine months of FY26 reflect disciplined execution across the organization. Our core hospitals remain stable. Developing hospitals continue to scale efficiently.
And Medanta Noida is progressing in line with expectations during its ramp up phase. We remain confident that these investments will create sustainable value for all stakeholders. With this I would now request the operator to open the line for questions. Thank you.
operator
Thank you very much. We will now begin the question and answer session. Anyone who wishes to ask a question may press star and one on their touchstone telephone. If you wish to remove yourself from the question queue, you may press star and two participants are requested to use handsets while asking a question. Ladies and gentlemen, we will wait for a moment while the question queue assembles. The first question is from the line of Tushar from Motilal Oswal Financial Services. Please go ahead.
Tushar Manudhane — Analyst
Thanks for the opportunity. Opportunity. Sir, firstly on the clarification like in your opening remarks you highlighted about Lucknow and Patna margins. If you could just spell out again.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Yeah, should I go ahead or do. You have another question?
Tushar Manudhane — Analyst
Yeah, first if you could address this and then I’ll take the second. I’ll have the second question.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Yeah. So if you look at our developing hospitals performance. If you look at the presentation on the investor presentation, I think it is on slide. You will see that we have seen an income growth of 28% from the nine month period. This is excluding Noida where the revenue has grown from 812 crores to 1040 crores. And if you look at the margins that has also increased. In fact the margins have increased from 30% to 31.1% excluding Noida. And then if you factor in Noida that is because of Noida loss. So that is coming to 25%. So I hope that is the question you are asking.
Tushar Manudhane — Analyst
Sir, on Lucknow particularly how has been the margin scale up?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
On Lucknow we have done very well. Over the Course of the last nine months or so, as I mentioned in the opening remarks, we have seen a margin expansion of over 150 basis points when you look at it on a nine months to nine month basis.
Tushar Manudhane — Analyst
And secondly now with respect to Noida, we’ve almost onboarded 220 doctors. What is the like moral are we more or less now done with in terms of onboarding doctors or what is the sort of target as far as doctors are concerned and how has it has been like maybe the initial feelers with respect to Noida Kappa?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Yeah. So you know, as you are aware, we don’t stop hiring doctors even after several years. But of course the hiring to be able to start the services is more or less underway. There are some departments which are still not active in Noida. So some of the departments which are not active in noida as at December 31 would be the pediatrics department, the obstetrics department, liver transplant department, some of the departments in some of the more niche specialties like vascular surgery. So we are still continuing to look at these departments and hiring, but I would say that the majority of the hiring has been undertaken, including adding in some of the talent to support the the key teams.
So we now expect that, you know. Most of that hiring is finished. But like I said, if we do find that we need to bring in more talent, we will not stop that hiring. That will continue. And wherever the departments are not there, as I mentioned, that hiring will take place. I don’t know whether it will happen. Immediately in the next few months or whether that will happen subsequent to March 31, but that will be as per. Our availability of beds and our availability of talent and our, you know, plans as we move forward.
Tushar Manudhane — Analyst
Got it. And just lastly, now that it’s like three, four months into operation, so broadly, what kind of RPAP is like as a starting point, so to say. Of course this will further improve with the change in case mix, pair mix. But currently, if you could share what kind of RPOP we are having at Maida Hospital.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
So RPOps are in Noida Hospital are coming currently much higher than golda. But I would not necessarily use this as a proxy for extending out into many months into the future because we have just started, so we have now signed up about four or five major insurance contracts. Other insurance contracts are coming on board. We have not yet taken any of the panels in Noida that may come on as we move forward in line with our broader philosophy of serving every strata of society and every category of patients. So I don’t I mean right now the RPOps are, you know, similar to Delhi rpops.
But I just caution that we should not assume that that will maintain as we move forward. Once we have a more balanced, you know, revenue mix then you will see a slightly more balanced RPOP as we move forward.
Tushar Manudhane — Analyst
Got it sir. Thank you. That’s it from my side.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Thank you.
operator
Thank you. The next question is from the line of Devash Shah from Suri D securities. Please go ahead.
Devansh Shah — Analyst
Yeah. Hello sir. Thank you for the opportunity. So I wanted to understand like could you typically state the employee to wed ratio for the hospital? Because as per my understanding the employee to bed ratio varies for the different specialty. So on the overall basis what would it be for your hospital?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
So we don’t look at. I mean I’m not very sure where you are getting these baselines from. We don’t normally look at employee to bed ratios in any one area because. It varies very drastically depending on the nature of the specialty. So neither have we ever published it, nor do we. Nor can I tell you that this. Is a standard number for a hospital. Just to give you a sense. A liver transplant department may have fewer. Beds but very high number of clinical talent whereas an internal medicine department may. Have high number of beds and very. Few number of doctors. So it is not a very meaningful metric for us to look at in terms of any of the operational parameters. So unfortunately we don’t have anything which. We report out which I can share with you. I’m not sure if you have something deeper in mind in the question. I can try to assist. But this metric as such we don’t report.
Devansh Shah — Analyst
Okay. Okay sir. And the second question was like could you tell the total census beds for the each unit?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
The total census beds in each unit. Yeah. I think that was in the investor deck. Let me see if I can find it. So Noida census beds right now is 187. Right. Let me just pull out the census beds for our total is about 2,427. And maybe I can get this shape. Sorry 2665 as at December. And maybe I can get this sent. Across to you from our investor relations team so we don’t waste everybody else’s time on the call. Each of the units will get the bed sent you.
Devansh Shah — Analyst
Awesome.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Gurgaon is about 1220. I remember that number. And I think Lucknow currently is operating at around 600.
Devansh Shah — Analyst
Okay.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Sir is 569. Sorry. 386 is the census. But we will get this sent to you. I think it’s in the deck also.
Devansh Shah — Analyst
Yeah. Okay.
operator
Thank you. To ask a question, please press star and one now. Participants who wish to ask a question may press star and one this time. The next question is from the line of Bansi Desai from JP Morgan. Please go ahead.
Bansi Desai — Analyst
Yeah, hi, thanks for taking my question. So firstly on Noida, how should we think about the losses from here on? I’m assuming these would be the peak kind of losses that we report in the quarter given, you know, we’ve added, you know, doctors and you know, large part of commissioning expenses would be sitting in this quarter and therefore as the unit ramps up, you know, should we see losses coming down and also, you know, given the fact that we are expected to add another 200 plus beds here over the next one year, how should we see the loss trajectory?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Yeah, so you know, I mean, I hope so that we’ve seen the peak of the losses. You are right. If you look at our scale up of clinicians, we added in a whole bunch of clinicians from September to November and even within this quarter, if I was to really see the performance really. Was more in terms of volumes growth. More started towards the second half of this quarter. So you don’t even see complete three. Months of run rate. So we are seeing now especially December. And as we move into January, a better run rate trajectory on the revenue. So of course that will help with the loss containment. I don’t know exactly when it will be fully concluded. One thing I just want to clarify. For one of the earlier questions I had mentioned on the specialties, one thing which I forgot to mention is our radiation oncology and our nuclear medicine department which is on board in terms of the talent in the machines that hasn’t started yet. So that is another thing I forgot to mention that the department which is currently missing, but you’re right, as we scale up, we should see now the business coming in, our insurance contracts coming on board, our corporate impanelements coming on board and really now the question is getting down and actually ensuring that we are able to service the people of Noida and Western up.
So much of the initial work is done, although some of the project work is still undergoing. But the hospital is fully functional now subject to the departments that I mentioned. And when we think of adding 200 beds here, I would assume those would largely get absorbed with these 300 beds ramping up by that time. Yes. So the additional beds would largely get. Absorbed with the teams which we have, plus some element of the teams which we are adding. So I can tell you for Example that we are already underway of creating. Our dedicated transplant unit. So although it was not completed and commissioned by December 31, that is one. Area which we will be having. Some of these additional beds will come into that. So with the exception of really transplant, which has dedicated infrastructure and maybe obstetrics or pediatrics, the rest of the infrastructure will more or less just scale up as and when the need is there. And will be part of the existing clinical team. So we don’t see that there’s any real need to hire new departments for filling those beds.
Bansi Desai — Analyst
All right, that’s clear. And my second question is on the mature units, we’ve seen significant decline In Alos there 2.9 days. Is it of quarter phenomena or do we expect, you know, structurally ADOs, you know, you know, coming off there. And you know, so that’s one. And the second is you mentioned on margins, you know, we had higher employee cost and certain maintenance related expenses. So with those behind, should we expect, you know, the, the overall unit to see improvement in margins, you know, from the upcoming quarter, you know, from the next quarters, as you see your revenues growing?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Yeah, so let me take that in two parts. First, you know, when you look at the ALOs, I think just picking up one or two quarters may not be. Appropriate because there is some effects of how the seasons play out, how the Diwali holidays play out, how the, you know, certain seasonal diseases like Degu, etc. Play out. Sometimes it’s more in September, sometimes it’s more in October. So I would, I would, you know, suggest we look more at an annual. Or a nine month basis at a minimum, rather than quarter on quarter, just to get the numbers correct. That being said, the ALOS reductions are. Also driven a lot by, you know, the increasing work for cancer. And given the growth which you see. On the, on the sales mix and I think it’s phenomenon across the country. Where cancer treatment and cancer detection is increasing. So a lot of the cancer work is in the nature of radiation oncology. Or medical oncology, which has a daycare component to it. So there is an increase in daycare. There is also some amount of difference. This year versus last year with respect. To patients who are more in the dengue and some of the other respiratory. Diseases which tend to have a slightly longer length of stay vis a vis some of the shorter procedural departments. Other than that, I don’t see any very significant structural change. I mean, we already have a very aggressive length of stay. That being said, we continue to work especially in some of the units like Patna and maybe even in Gurgaon to. Actually ensure that we are optimizing our length of stay. And we will continue to try to see if we can convert a lot of the work from nightstage to daycare. So we want to work on how. We also do things like improving discharge processes, streamlining the discharges for patients who are credit patients. So I mean there is still some operational efficiencies I think we can bring in. But I think a three days length of stay for an ecosystem as complex as ours is very, very robust.
Bansi Desai — Analyst
Understood. And just on margin, are we done with our investments into May adding employees and maintenance expenses or we expect that to recur?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Yeah, so I don’t think that there. Is any kind of. I mean obviously the employee costs are recurring costs they incur every month. But I think if you go back to last three, four quarters, I had been mentioning that there is some amount of war for talent that is coming. Is likely to come. We are also aggressively hiring across the unit. So there will be some amount of optimization and balancing out of this as we stabilize our hiring as well as. How other hospitals look at hiring in the market. We will also look at operational efficiencies where we can bring about as much as possible both on the manpower cost as well as on some of the other expenses. Some of these are cyclical in nature. So for example, we do notice in. Our P and L that repairs and maintenance costs, whenever we have annual maintenance contracts coming up, which is out of. Warranty, new equipment comes out of WARranty. After maybe three, four years of procurement. Those come in and then they balance out over time. So depending on which horizon you’re looking. At the more or less balance out, I don’t see any very significant structural issues on the margins. I do believe there are efficiencies, especially. In some of the older units that we can eke out and we will work towards that. You will see some of those efficiencies. Are already playing out on some cost items. So material costs have been are currently in the process of being optimized as we move and we seen some of that captured in the numbers so far. We hope that will continue. So you know there’ll be some up and down across cost items. But overall I think that we’ll be looking at trying to see whether we can get couple of hundred basis points. Of efficiency out of the system as well.
Bansi Desai — Analyst
All right, I have more questions. I’ll join back to Q.
operator
Sure. Thank you. The next question is from the line of Manish Podar from invesco amc, please go ahead.
Manish Poddar — Analyst
So just one question. So either that, you know, you said, I hope so, for the peak losses to be behind for Noida, how are you thinking actually of the ramp up the other way around, you know, let’s say, versus the initial expectation, you know, versus what you would have seen in the last few months. How are you thinking about getting to utilization? Let’s say 40, 50, 60%. And is the journey faster than earlier expectation? Just any color on that will be helpful. Thanks.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
So I think, Manish, the journey is very much as per our expectations. I think that as we look at getting everything settled, not only operationally, but. Also some of the project teams moving out of the system. You know, we started out this hospital while it was currently being constructed as well. So some of these things will stabilize. You know, like I mentioned, just as an example, our radiation oncology doctor is on board, but the machine is not yet live because we are waiting for the approvals from aerb. So there will be some teething issues around this next couple of weeks, maybe months. But I think that, you know, for the most part, we are now ready. To fire on full cylinders. What that time frame exactly will be, I’m not sure. But I don’t think that we have seen anything happen in Noida which is. Totally counter to what our expectations was. Either on the hugely negative side or. On the hugely positive side, more or. Less moving in line with what we expected.
Manish Poddar — Analyst
Okay, thank you.
operator
Thank you. The next question is from the line of Damianti KD from hsbc. Please go ahead.
Damayanti Kerai — Analyst
Hi, good afternoon and thank you for the opportunity. My first question is again on Noida, where you mentioned it’s ramping up Hqari expectation. So just to clarify, the additional bed addition plan which you have, that will only be done once you have achieved cost breakeven at the existing bed set, right?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Or no, no, I don’t think that’s the right way to think about it. So, you know, again, without getting into too much specifics, our Noida facility is a single tower facility, as opposed to Gurgaon, Lucknow and Patna, where we had two towers, where we were able to build one tower, then wait, then fill it, then operationalize the second tower. Because of the structure of this building, we intend to complete the project work as and when we move, as and when the project teams are able to do it. So we will not actually demobilize and start again.
Once the occupancy increases, we will continue to build out throughout. It just ends up being more efficient that way. And while it May be beds coming in, you know, a few months before we need it. We feel it’s the most efficient way. So we would not stop the build out is the answer to the question that you had.
Damayanti Kerai — Analyst
Okay, so both will happen simultaneously, right? The ramp up on the existing bed.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Yeah, yeah, correct. So we’ll ramp up the adjacent beds. We will build out. Now you may not hire every department, you may not hire the nurses for running one ward if the ward doesn’t have patients. But the infrastructure and capex and the fit outs and all we will conclude and then we will see as and when we move out. We may also have some things in the back pocket for maybe one floor or so depending on whether we need. More ICUs or more OTs. You may need to optimize there. We are now seeing this after about 4 years performance in Patna. We are actually realizing that we may have a demand for additional procedure rooms as opposed to beds. So we may actually redeploy some of the spaces which are allocated for beds to procedure rooms. So today I believe patna is about 560 beds. So from the remaining 8,000 beds I. May choose to redeploy some beds to procedure areas or we are trying to find if we can optimize there. So barring this small adjustments, we will continue to build out. Noida.
Damayanti Kerai — Analyst
Got it. My second question is on the update which we heard on the CJS rate division sometime back. So anything you are picking up on that part in terms of your operations.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
So CGHS rate revision has of course been beneficial for the industry. It has been a long demand after many many years. There has been positive movement across the group on that in terms of tariff increases. We have captured some of that in the nine month numbers that you see. I think high single digit in terms of crores is the impact on that and hopefully some of that will fall to the bottom line also as we roll out. Because these increases I think came middle or late Q2 so it’s not even a full 12 months of impact yet.
So if I remember correctly it was maybe sometime around October. And then also what happens is some of the other institutional companies that follow CJHS rates, they then follow up with their own orders like the railways will follow up saying we also will activate these rates and so on and so forth. And also we are working with our partners in Bihar that those rates are where we have ppp. Those rates also get adjusted. So the full year impact of this I think is not yet played out. But so far it’s been positive.
Damayanti Kerai — Analyst
And did you mention some high single digit impact or.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
That’s right. I think Yogesh will correct me if I’m wrong. I think it’s somewhere in the range of 7 to 10 crores of impact in nine months.
Damayanti Kerai — Analyst
Oh, 7 to 10 crores. Okay, okay, that’s helpful. And my last question is on your plan for price increase which is obviously not your focus but as you focus more on the volume growth. But in terms of taking price hike for some of your units where you haven’t taken price hike, are those done?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
So if I remember correctly from our last call in September till December, I think no real price increases have been taken. Except maybe in Patna. Patna we haven’t taken. Gurgaon and Lucknow we have taken. But I think more important than that is that some of the insurance contracts which were not renewed for almost two to three years, they are now getting renewed across the group. So there will be some potential benefit for those price renegotiations as we move forward. So I think, you know, probably when we come to maybe June or September of next year you will see more of a realistic picture of a full year of pricing impact across cghs, our increases and insurance negotiations.
Damayanti Kerai — Analyst
Just a clarification on these rates which you renegotiated with your insurance partner. What kind of, you know, hike you might have got? Just some indication they compared to the last contract when you signed the new contract. What is the difference?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
So let me put it this way. When we, when we sign up the contracts with the insurance companies, they were on a, on a tariff list which I think was somewhere around two years or three years ago. 2024 tariffs I think or 2023 tariffs. So now when insurance companies negotiate, they negotiate it with our 2025 tariffs which was what we had done last year. So depending on how those tariffs increase we kind of renegotiate basis tax. So it would be different in different units depending on when the insurance company signed up. But typically insurance companies will sign up.
For a two year time and now. It’S already been little over two years so you can say about two years plus of increases. And then insurance companies ask for different levels of support in terms of discounting, etc. But on the whole I think it will be a positive benefit for us from a talent point of view.
Damayanti Kerai — Analyst
Sure. Panka. Thank you. I’ll get back in the queue.
operator
Thank you. Before we take the next question, we would like to remind participants that you may press Star and one to ask a question. The next question is from the line of Ashutosh Nimani from GM Financial office. Please go ahead.
Ashutosh Nemani — Analyst
Thanks for the opportunity, sir. My question is on the earlier answer, you told that war of talent coming up in the next three to four years. So I wanted to understand more about it. Like particularly what locations do we see this doctor supply, nurse supply, more severe as compared to other on a national level. If you could just take a highlight on that.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
I mean, I’m not fully an expert. To tell you at a national level in which city there will be more or less war for talent. I think this is a phenomenon the industry is facing to the best of my knowledge, across the board. I can tell you in the regions where we operate, which is more on the northern side, there are two ways in which we look at it. One way is where there are existing. Facilities, where there are lots of doctors and there’s lots of demand for talent there. It is a little bit driven by some forms of competitive intensity. Doctors are trying to get poached by other hospitals. Obviously we would be also looking at hiring doctors from other institutions, some amount of retention. Also we have been very lucky. We’ve been able to retain most of. Our senior doctors, if not all, even. After 15 years in Gurgaon. Then when you come to units which are in cities where there may be a slightly shorter, you know, tale of talent in terms of super specialists, we’ve. Been able to get in doctors from other cities. Sometimes you have to pay for getting doctors to move into certain locations or. You’Re actually looking at building up a. Talent base over there vis a vis taking time to build that specialty. So just to give you an example, if I bring in a very talented, say robotic surgeon from one part of the country, they may not have a patient base, say in a Bihar or in a upgrade. They build up that. So that takes little time to build up. So these are the kinds of things. That we have seen. From my conversations with colleagues in the industry, I think this is a phenomenon everybody’s facing. Obviously there’s a lot of talk about hospitals, so everybody getting very excited. One thing though we have seen is. That I think clinical talent understands the. Value of strong brands and strong institutions. Medanta has been very lucky to be a kind of what we believe is a preferred employer for clinicians. So we’ve been lucky on this front. But I do believe that given the talent is scarce, this is something that the industry and the country will face for, you know, some years to come. I don’t think this is something going to get solved in the next quarter.
Ashutosh Nemani — Analyst
Understood. Then my second Question is in the next two to three years what should be the like RPOB growth that we could assume for Vedanta.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
So you know, again next two to. Three years I don’t know how things will play out but we have always. Maintained that RPOps grow 5 to 7% a year as opposed to what we have seen maybe you know, in the last three, four years where we’ve seen much higher growth. Again, RPOP is little bit dependent on length of say and case mix but we don’t project anything more than 5% to if you are very enthusiastic maybe a 7% growth in RPOP on an annual basis. In fact typically projects much lower. 3 to 5% is what we try to think about. But again that’s more for us on tariff or realization side. Rpop again if you optimize length of stay then RPOP will grow.
But I think that days of 10, 15% RPOP growth or realization growth which we were seeing maybe a year and a half that has already stabilized. You can already see it in the results of all companies Last maybe to 18 months we’ll see a significant slowing down of the R Corp growth that was there two, three years ago. So I think five to seven is a reasonable number to project out if you’re thinking about building a model. I would not go more aggressive than that. Definitely not single digits. I would keep it to not double digits. I would keep it to single digits.
Ashutosh Nemani — Analyst
Thank you, this was very helpful.
operator
Thank you. The next question is from the line of Rahul Jeevani from IIFL Securities Ltd. Please go ahead.
Rahul Jiwani — Analyst
Thanks for taking my question sir. On the Noida Hospital for let’s say these 300 odd beds which we have operationalized, what kind of an exit occupancy we would have seen either for the December month or the Jan month. And if you can also talk about the occupancy which you, which you need to achieve to let’s say hit EBITDA breakeven on these 300 bids.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
So you know we don’t normally look at occupancy from a breakeven point of. View because of the fact that we. Believe much more in the volumes in. The procedures rather than the midnight occupancy. So at least Medanta doesn’t necessarily look at that. That being said, I think normally what we find is in a big system somewhere in the range of 40 to 50% or maybe 40% plus occupancy typically breaks even on a long run basis. For the kind of fixed cost model that meantha employs. It May be very different in other industries. Our goal is very simple. In Noida, our goal is that we have put everything that is required to deliver the highest standard of care. That is investment in infrastructure, the technology, the clinical talent, the processes, the IT systems, et cetera. Our goal is to drive this occupancy through and through. So sorry, to drive this volumes and. This business through and through. Once we do that, whatever occupancy falls out of that, it falls out of that. Our focus is that we must be ensuring that we invest to deliver the highest end of care. We have done that. And basis the trajectory we see in. The last few months, including post December, we are pretty happy with how things are moving and pretty confident of the. Success of this institution. So whether this occupancy will break even at 30% or 40% or 50%, I don’t know. It’s also not a percentage number which we are chasing. Our goal is to ensure that we are able to drive as much patient volumes into the system. And we are pretty confident, given our track record, these things will then work out well.
Rahul Jiwani — Analyst
Sure, sir. And for let’s say these another 200 beds which you would commission at Noida, how many incremental doctor hirings would we need to do given that obviously for the initial phase of 300 beds we have already onboarded 200 odd doctors.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
So. Not many as I mentioned, I think in response to an earlier question, we have some departments which we may add. So they of course are not linked to beds. They would have additional. So obs peds is an example of that, which is a totally new department. The rest of the departments, all the. Seniors or most of the senior talent is already there. So when you add in beds, it’s really more of the junior staff who need to do more of the maintenance, management and taking care of the care. Nurses of course will get added and. Other stuff, but the senior doctors I don’t think are necessarily linked to the two bed addition.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Okay, so the incremental opex for these another 200 beds obviously would then be lower.
Rahul Jiwani — Analyst
Yes, correct answer. Last question from my end. In terms of the mature hospitals where we have seen some sort of a margin pressure this year, while you alluded to higher employee and maintenance cost is the Ranchi O and M hospital also led to some sort of a margin drag for the mature units.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
I mean definitely the new Ranchi hospital also has a little bit of impact. I’m not sure it will play out in the numbers which you are seeing because very small, it’s only about 100 beds on you know, 2,000, 3,000 bed overall base. So I don’t think it has an. Impact as to what you see. Of course it is a drag but I don’t think it’s significant or material on the financial, on the absolute rupee amount.
Rahul Jiwani — Analyst
Okay, sure sir, thank you. That’s it.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
From, I mean just to let you. Know, obviously Ranchi indoor margins are of course lower than you know, Gurgaon and Lucknow, so. And Gurgaon, sorry, Lucknow is coming and developing still. But other than that I don’t think it’s a very significant drag.
Rahul Jiwani — Analyst
Okay, sure sir, thank you.
operator
Thank you. The next question is from the line of Nitina Grwal from Dam Capital. Please go ahead.
Nitin Agarwal — Analyst
Thanks for taking my question on the, you know, over the last few months and quarters we’ve had multiple sort of media items, news flow around, you know, increased between hospitals and insurers. A, I mean two questions here. One is A, is there a change in relationship between insurers and corporate hospitals in the sense as insurers become larger in cloud? And two, what kind of implications does it have for rates and business as we go along?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Yeah, so I think maybe I’ll give three, four specific points on this. I think first of all, as with many things, the media likes to sensationalize things much more than they are in reality. So I wouldn’t always necessarily go with either the substance or the tone of. What we hear in the media. That’s point number one. Point number two, just again at a higher level, see every player in this industry, whether it is a provider like us, whether it is an insurance company or whether it is even the government authorities, including at every level of government, they all understand that our collective responsibility is first and foremost towards the patient. Neither can we survive without the insurance companies. Neither can the insurance company survive without the providers. And by the way, the same logic applies to the pharmaceutical and medical device companies which are also part of this ecosystem and also part of some of these conversations that you’re alluding to.
Right. So I think we all get it and everybody is reasonably mature in that. That being said, there is always a commercial negotiation and a commercial discussion that happens between any two parties engaged in a commercial conversation. Now we have so far been very, very clear on our approach that we are open and ready to talk to anybody. And we have, we have been successful with those activities and all conversations in good faith between two parties in a professional and in a non collusive manner are something that we stand for and we have been successful in moving that forward, of course, if I would like to pay 10 rupees and you would.
Like to pay 5 rupees or I would like to charge 10 rupees, you would like to charge 5 rupees, of. Course we will negotiate on that price. Nothing wrong in that. And we’ve been successful in closing out many of these contracts and many of these negotiations. I think that we could have been faster and more efficient. I think that some of the players in the industry who are maybe trying to project that, you know, we’ll only. Talk as one body or that we. That, you know, only. It’s only the hospitals that are making money and the insurance companies are not making any money. I think these are facts which are. Being a little bit manipulated one way or the other. I think the truth is obviously somewhere in the middle. As with most cases, we do realize that the insurance companies have challenges, but many of those challenges are also linked to their operating model and some of the issues in the industry. Similarly, I think they understand that while you look at EBITDA many times, but the real money at the bottom line coming on the profit after tax, which is the money that has to go into capex refresh and investing in all of these areas is required for hospitals to be able to grow and for frankly speaking, people like us to invest in places like Patna and Bihar and Ranchi and Northeast.
And the government also understands that it’s very important that they encourage private investment in all these areas because that’s how. The care will get delivered. So I frankly speaking, see that there is no long term relationship impact between the two parties. We have been very comfortable interacting with everybody. But of course we will negotiate on price. I don’t see that stopping this year, next year or anytime in the future as any entity has feels they have more power, they would like to be stronger in a negotiation position. It is exactly the same thing that I would do with my suppliers. So it’s normal. I think some of it is blown out of proportion and some of it has few stakeholders in the ecosystem on both sides probably, you know, mischaracterizing, misusing one party or another party on their side of the industry for their own personal benefits, which is also not correct.
Nitin Agarwal — Analyst
Thanks, this is very helpful. And secondly, sorry if I missed it. Did we guide to a time period when we expect Noida to break even on ebitda?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
No, we don’t guide on future earnings as a policy. All I did allude to was the fact that we are pretty hopeful that we are now in a position to See strong positive momentum into the system. I do not know when that break even will happen, but we are not worried that it is all slipping south or something like that very much as per our expectations on how the ramp up of these units will do. But it’s fair to say that this quarter EBITDA loss is kind of close to the PK bitter loss will do on the asset. And that is the question which I said I hope so. I don’t want to commit to you one thing or the other but I leave that to you guys to figure out. But yes, we are feeling confident that things are moving in the right direction.
Nitin Agarwal — Analyst
Thank you so much.
operator
Thank you. The next question is from the line of naman Bhagrecha from IIFL Capital Service Ltd. Please go ahead.
Naman Bagrecha — Analyst
Hello?
operator
Hi, we can hear you.
Naman Bagrecha — Analyst
Thanks. Thanks for the opportunity. Sorry to press on the mature hospital margins again. So if you look earlier, we used to make almost around 24 and a half kind of margins. But is it because of now the incremental costs or war on talent is. One should look at let’s say lower margins Structurally, let’s say 100bps lower versus what was the trajectory earlier?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
No, you know, I think that, I mean, so I wouldn’t necessarily agree with that. Right. I mean if you look at the margin profile which we have in the. Nine month period and the mature facilities. It’S just under 24% we have maintained for a long time and I have maintained for a long time that, you know, anything in the range of 22. To 25 is very strong performance for a system like this, especially such a. Big system like the ones which we have, I think that, you know, 190, 80 basis points swing here and there, especially in one period over the other, is fairly insignificant. I mean our industry, you have to look over this over, you know, three to four years, not nine months or even one year. And even within the nine months the swing to me doesn’t seem very significant. So I don’t think there is a structural difference. There was a structural reset post Covid which we have talked a lot about on various calls. I think we are now in a fairly balanced way around that.
I also had always maintained that I don’t see this margin profile jumping up every year 30% or 300 basis points to head towards the 30% margin. I had always said that those were expectations that were being incorrectly set in the market. This is a fairly balanced range, you know, 22, 23, 24, 25, this number is a very balanced range. You do A little bit better, it could go up. But I don’t think there’s any big structural issue between one period or the other. You try to eke out as much efficiencies as you can, we will see this, you know, stabilize in these ranges only.
I don’t, I don’t think they’re going to change significantly. The only thing in Medanta’s case in this, how we report out is, which is a little different, just so that you’re aware is all our corporate costs are loaded in our Gurgaon unit. So what you see as the margin of the individual units is a little. Bit deflated because of the corporate costs. Probably if you took out those corporate costs and you allocated them across, you would see a slightly more balanced margin profile between all of the bigger units, at least in our group. Fair, fair, fair.
Naman Bagrecha — Analyst
Thanks. And just one, what would be our net cash position as of December 27th?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Net cash as in December? 600 crores. About 600 crores. Go ahead, Yogesh.
Yogesh Gupta — Group Chief Financial Officer
We have a loans of about 600. Crore rupees and the cash position of about 500 crores. So net cash is about 600 crores.
Naman Bagrecha — Analyst
Thanks.
operator
Thank you. The next question is from the line of Eben Benny from JM Financial Institution securities. Please go ahead.
Ebin Benny — Analyst
Hi sir, thanks for the opportunity. I’m audible.
operator
Yes.
Ebin Benny — Analyst
Hi sir. Yeah. So sir, while you did allude to the kind of IPOB growth that we can be expecting, but in the new my was regarding the newer clusters, while we add more complex specialties, while we add on to the new ones, what kind of dynamics do you see regarding the kind of RFOC that can change in these specifically and if you can give some color on that dynamics.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
So I mean, I don’t have a number for you, but let me just give you a little bit of perspective. Right? So one of the things the industry has been commenting on for the last. Couple of years, or maybe you know, six quarters, is this entire shift to say robotics. Now robotics means a higher realization but also potentially a lower length of stay. Because the patient gets to go home faster. So obviously that has a disproportionate increase. On R pop because your alos will. Fall and your realization will increase both. So it’s one example of something that may boost up when you look at it at a RPOP level rather than a ARPP level. The second thing, as I said earlier. Was that when you get into increasing work in cancer, especially if it is. Cancer work in the daycare nature, like. Radiation, oncology, where you may not admit the patient or medical oncology where the patient just stays for one day for treatment. You will find a disproportionate growth to RPOP because the occupancy is not that. Long as opposed to say somebody coming. In for cardiac surgery. So I think that these things are. Actually in favor of RPOP growth because RPOP is a derived metric. I think if you look at it and step back towards realization which is. What the patient bill actually is. I think as I mentioned earlier you will see a more balanced realization growth. There will be some growth towards realization because of complex work, some amount of. Increase in complex work across our newer. Units in Patna and even in Noida. As that gets ramped up to some of the services including transplant and things like that. We are also starting to see some of this complex work coming into places. Like Indore with robotic surgery happening there now reasonably well. So you will see some of this. And then some of the changes of. The CGHS rates as I mentioned earlier. Which happened in October and the tariff increases will play out over maybe the course of the next six to 12 months. So you will see some positive trajectory towards this. But I think again it will be measured. I would not assume you would see 10%. I would say single digits is a. Fair number to be looking at.
Ebin Benny — Analyst
Got it, thank you. And so if possible can you give us the kind of expectations on capex outlay for next year or given given that majority of the expansion will be there?
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Yeah, I think there was a slide correct me if I’m wrong on the. CAPEX plan In the presentation slide 23 I think lays out the CapEx. We have been somewhere around the thousand crore range I think on next year capex. So this is. 3,000 over the next five years. Next year maybe a bit less actually now that a lot of the cost. Was Noida is already. So last year we had I think. Announced about a thousand crore capex in the year out of which almost 600, 700 was Noida if I’m not mistaken. Yogesh, am I right? And I don’t see that this year’s this FY27 CapEx will be of that range. It will be much lower than thousand crores. Maybe some maintenance capex in the new in the older units, some capex on the margin in Noida there will be. Not much capex on the other units because they are still in the digging and construction phase. So a lot of the CAPEX in the new project is back ended towards. Maybe two, three years from now. So next year capex is probably, I don’t know, maybe below 500 crores. I would say below 500 crores would be our estimate.
Ebin Benny — Analyst
Sure. Thank you. Thank you.
operator
Thank you. The next question is from the line of Chirag Gupta from Allegro Capital. Please go ahead.
Chirag Gupta — Analyst
Yeah, thanks for taking my questions. I just wanted to understand why the margins in your developing facilities are higher than your mature facilities. So I mentioned, I think to one of the earlier speakers, one reason of course is that our corporate costs are fully loaded in Gurgaon which is part of the mature facility. Right. The second question if you look at. Our historical performance is that our Lucknow unit and our Patna units have been doing a exceptionally good performance right through. And through, barring one or two quarters in Lucknow. So what we’ve actually seen is a good amount of growth, a good amount of operating leverage come in. So just to contextualize for you, Lucknow.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Is about a six year old asset, Patna is about four years old now and we’ve continually been adding beds to these facilities. So what you’re seeing in these facilities, in addition to the strong growth in these regions, you’re also seeing improvements in newer specialties getting added. Just to give you an example, we have added three or four robots including orthopedic robots in Lucknow. So you’re getting more complex work. We’re adding more complex work into our facility in Patna. And you are also seeing the benefits. Of operating leverage kick in. Depending on which year you are looking at, after a couple of years would have kicked in plus we would have added, I think last maybe year or 18 months ago, we added almost 200 additional beds taking Lucknow from about 400, 500 to about 700 census beds. So those beds operating leverage also kicks in after some months. So I think these are the three, four reasons why there’s a difference between the developing and mature. And then the last reason, although it may not be very significant in absolute terms, is that our mature units also include Indore and Ranchi which are significantly smaller scale and have a significantly lower margin profile.
Chirag Gupta — Analyst
Okay, thanks a lot.
operator
Thank you. Ladies and gentlemen. Due to time constraints, that was last question for today. I now hand over the call to management for closing comments over to you.
Pankaj Prakash Sahni — Group Chief Executive Officer and Director
Thank you. Thank you everyone for your questions and for joining us today. Please feel free to reach out to our investor relations team in case you have any questions that remain unanswered. I know there’s one question on census beds. We’ll get that information out to you. But if you have any other questions. Please feel free to reach out to the team. Thank you once again, and we look forward to speaking with you all soon.
operator
Thank you. On behalf of GM Financial Institution securities limited that concludes this conference. Thank you for joining us. And you may now disconnect your lines. Thank you.