Narayana Hrudayalaya Limited (NSE: NH) Q1 2026 Earnings Call dated Aug. 04, 2025
Corporate Participants:
Unidentified Speaker
Nishant Singh — Investor Relations
Emmanuel Rupert — Managing Director & Group Chief Executive Officer
Sandhya Jayaraman — Chief Financial Officer
Analysts:
Unidentified Participant
Presentation:
Nishant Singh — Investor Relations
Sam it. Sam it. Foreign this meeting is being recorded. Hello everyone. My name is Nishant Singh. And I welcome you all to the quarter one FY26 earnings call of Narayana Hidala Limited to discuss our performance and address all your queries. Today we also have with us Mr. Viren Shetty, our Vice Chairman, Dr. Cooper, our CEO and MD, Mrs. Sandhya Jaraman, our Group CFO. Mr. Venkatesh, our Group CEO, Dr. Nisheti. Also like to remind you. Was I audible people investors? No, it was not. So I’ll just, you know, repeat the introduction. So. My name is Dishan Singh and I welcome you all to the quarter one FY26 earnings call of the company.
Is it better now? Oh yes.
Unidentified Speaker
Yes, yes. Yeah.
Nishant Singh — Investor Relations
So, yeah. So to discuss our performance we have with us Mr. Viren Shetty, Dr. Emmanuel, Rupert, Mr. Santha Jayaraman, Mr. Venkatesh, Dr. Anish, Ravi and Vivek. Before we proceed with this call, we would like to remind everyone that the call is being recorded and the transcript of the same shall be made available on our website as well as on the stock exchange later. We would also like to remind you that everything that is being said on this call that reflects any outlook for the future or. Or which can be construed as a forward looking statement must be viewed in conjunction with the uncertainties and the risk that they face with that now we would like to start the Q and A.
Questions and Answers:
Nishant Singh
I request everyone to now use the raise hand features to start asking the questions. Thank you. Yes, please start.
Unidentified Participant
Thanks, Nishan. I just have few questions on Cayman. If you have to look at the discharges and op patients number, it has come down on a sequential basis and the decline seems to be quite high. Just we wanted to understand, you know, this is something we saw in the past. There is some quarterly volatility in Cayman numbers. Is it the same and you expect patient numbers to return back in this quarter or has there been anything structural that happened in the last quarter?
Unidentified Speaker
I think you’re right.
Unidentified Speaker
As you recall, since we commissioned a new hospital in the you had the Q4 of last year and Q1 of this year being the first two quarters of the new hospital. And if you recollect, even in the early days of Cayman when the hospital was new, when we’re starting a new building with low base, low volumes, you’re going to see this volatility up and down. But these are just, you know, standard blips quarter to quarter because the structure is new. And the next quarter, as we proceed, maybe Two or three quarters, things should stabilize. But you know, your intuition is right.
These are things that happen in the early days and they will settle in.
Unidentified Speaker
As we progress on the ground.
Unidentified Speaker
We have no reason to have any concerns around the growth trajectory with the new building.
Unidentified Participant
And if you have to look at the absolute EBITDA number for Cayman business, right, on a sequential basis, the decline seems to be around 20, 25 crores. I understand there is a 9 crore number coming from the integrated care. What explains the remaining difference in the EBITDA numbers on a sequential basis?
Unidentified Speaker
So if you account for the slight.
Unidentified Speaker
Decrease quarter on quarter in the hospital business, aside from that, maybe I’ll just say that the hospital business as such, the economics have not changed, whether it’s comparing Q4 to Q1 or a few quarters later. It’s just that right now we have broken up and we are starting to see the integrated care business ramp up significantly in revenue terms, which is obviously at a very different margin profile, A, given it’s a new business and B, it is, you know, integrated care insurance, which is very different on a margin profile from the hospital business. So the hospital business itself, the economics remain unchanged.
We did have a slight revenue decrease quarter on quarter. You are again going to see some early volatility in case mix. In the previous quarter we had some small, sorry, few in volume, but high value cases, which you generally tend to have higher margins. This time that was not the case. You saw that reflected in the volumes as well. But over the next few quarters, we think on the core hospital business, things will continue to be similar to what we’ve seen previously.
Unidentified Participant
And on the hospital side earlier, before commissioning the new hospital, you were making $120 million revenue and a 45% margin. And New Hospital is focused more towards OP where it can be a bit of margin value too. So can we expect, or can we look at the Cayman hospital business as $200 million revenue under 40 to 42 percentage kind of EBITDA margin business on a sustainable basis?
Unidentified Speaker
Yeah, I think it’s, it is difficult to, you know, give exact guidance to that extent.
Unidentified Speaker
Having.
Unidentified Speaker
Having said that, we think that, you know, the margin profile of the hospital business, you will not see too much variation, you know, from what we’ve been used to. Obviously your first comment is partly right that, you know, in the new hospital you are more focused towards quicker, short stay daycare sort of procedures, which are obviously lower margin than the long complicated cases. So there will be to that extent that change. But you know, the underlying profitability of the Hospital business itself will not see any big swings. Having said that, like we’ve said before as well, for the entire bucket of the geography, whether it’s the hospital alone, the hospital combined with the integrated, integrated care, whichever way we want to look at it, the intention very much is in absolute terms to continue to see healthy growth in earnings and you know, because of the new integrated care on a much larger revenue base.
But absolute growth in earnings is, is definitely the, the intention.
Unidentified Participant
The one final question on the integrated care. Can you throw us some light on, you know, how exactly you’re looking at this business, what kind of opportunity and how does it translate to investments and you know, the break even number? Sure, sure.
Unidentified Speaker
So this is always, you know, this is the first time we’re sort of adding small detail to break it up because it’s starting to get significant. It was always subsumed in the financials that were, that everybody’s used to seeing. So it’s not a new outflow of any kind. Having said that, we started formally, you know, selling to the external market in the 1st of January. Obviously it takes time to ramp up, but in just a quick five to six months we’ve been very, very happy with the response we’ve seen. We have some of the most prominent and largest employers and organizations on board.
So the trajectory is obviously been very, very positive for us. It’s going much better than we planned. Having said that, you know, this business is not going to have even at steady state and it was never intended to have the same margin profile as the services, the hospital business, which, you know, we all understand and know right now. Yes, it is loss, making it the first quarter, first one to two quarters of the business. Longer term we expect this to be, you know, a break even to plus or minus, slightly positive hopefully by the end of the year or first quarter next year.
But this is going to be a very different margin profile from the services business. The reason we’re doing it is to aid in our entire ecosystem of services to have a very safe lock in with all our customers to create this, you know, multi touchpoint experience for patients. So that longer term we have a very safe, non volatile, you know, earning stream from this geography.
Unidentified Participant
But you see any sizable revenue coming from this particular segment?
Unidentified Speaker
I see, yes, it’s starting to happen and we do think that it is on that, it is on that trajectory. It is something that even on a, you know, on a standalone basis is attractive. Having said that, its real goal is being part of the ecosystem. In fact, I would say you Know the reason why we find it difficult to give an exact prediction on EBITDA as a percentage terms because it’s going to be challenging to predict the relative revenue between the integrated care business and the hospital going forward. Especially because the integrated care is going to see good revenue growth since it’s starting from a low base.
Unidentified Participant
So just to squeeze in one final question so we can assume this quarter losses at the peak for the integrated care and it will start coming down in the next couple of quarters.
Unidentified Speaker
I think that’s hard to say as a percentage of revenue. You know, that maybe, you know, it’s going to be a narrow band, you’re not going to see wild swings. But in absolute terms it would depend on, you know, where the revenue lands up the next quarter. And this is just the first quarter. We, you know, we are disclosing it. So maybe in a couple of quarters we’ll get more, more clarity on what.
Unidentified Speaker
That could look like.
Unidentified Speaker
Said that you know, we don’t expect to see W swings unlike the hospital business. I would also point that maybe, you know, quarter on quarter is perhaps not the best way to look at it because you know, it depends on when large claims come in etc and, and these kinds of factors. So let’s give it a couple of quarters to play out and, and we’ll have much more clarity there.
Unidentified Participant
Thanks. That’s all from my side.
Unidentified Speaker
Thanks. Prithvi.
Nishant Singh
Hi, can you, can you please have your question? Yeah.
Unidentified Participant
Hi. Thank you for the opportunity. My question is again on Cayman operation. So just want to understand in the newer unit the services which you intend to offer are all those now in place or you have some more to offer which can help the volumes to pick up from here on. So just want to understand on that part.
Emmanuel Rupert
Yes, all the new services have been activated if you know to your question. Having said that, we don’t see the entire potential of them kick in immediately. It does take some time for these depending on the service line for them to grow to their potential. But yes, as of the quarter we are talking about, which is Q1, all services were commissioned, albeit, but just recently commissioned. But yes, all have been commissioned.
Unidentified Participant
Okay, so how long do you expect the things to reach steady state in terms of operations being in place and volumes etc, also reaching up to some steady state.
Emmanuel Rupert
I mean it’s difficult that, you know, that we don’t know how these things take to ramp up, you know, with an exact quarterly number or prediction of that sort. It depends. Some will obviously be quicker than others. Some are dependent on some other changes. With payer relationships, et cetera happening. That would be very, you know, difficult to answer.
Unidentified Participant
Sure.
Emmanuel Rupert
I mean what could help? Yeah, what could help is that you did see from say Q4 to Q1 a very big step up in revenue and that is almost exclusively because of the hospital, almost all of it because the integrated care had just started or was negligible. So you did see that big jump which is, you know, bigger than we expected, but sort of what one would predict because you’ve started a new facility with new services. Going forward, the increase quarter on quarter will obviously not take that big leap up. It will be more, more linear as the existing services grow in and mature and you know, there’s more awareness and you know, marketing and sales about them.
So we’re not going to see that kind of jump that you saw from Q Q3 to Q4. But you, we, we do expect to see a, you know, a linear growth going forward.
Unidentified Participant
Yeah. Okay.
Unidentified Participant
And for the combined operations you mentioned 40 to 45% margin looks sustainable and so is the case.
Emmanuel Rupert
Yeah, we didn’t say a number but sorry, please go ahead.
Unidentified Participant
Yeah, no, I’m saying say compared to the. Because on 1Q numbers we saw IPOP volume seeing some decline quarter on quarter. But you grew on the top line. Right. So I assume the mix would have been much better. So just wanted to understand compared to last quarter’s EBITDA profile for the Cayman operations, the Current quarter, the 1Q EBITDA margin profile where were like those very different or how should we think?
Emmanuel Rupert
Yeah, so maybe I’ll try and help with that. The hospital business will not see any significant change in the profitability or the margin profile. You know you are going to see certain variations quarter on quarter but on the whole that remains unchanged. The core economics of that business. The challenge to give you a percentage prediction or guidance for the console picture is because it depends on the relative revenue contribution of the integrated care business which as of now is yet to break even. And even when it does, it will be a significantly lower margin business than the hospital business.
So you know, we don’t know whether that will. It’s too early to tell how significant in the total revenue console that will be. To give you a guidance on what we expect the console came in EBITDA percentage to be. So predicting a percentage is tricky but predicting it what it could be in absolute terms or the trend in absolute terms is easier. I hope that was helpful.
Unidentified Participant
Yeah, that’s helpful. Thank you. My another question is on your India operations, so just want to understand the kind of scale up or progress you have seen in your insurance offering. So I see in presentation it has been rolled out to other segments as well. But how do you see this piece picking up?
Unidentified Speaker
Sure. Hi, this is Ravi. So I think the insurance business overall has picked up quite well as you saw in the presentation. Also we’ve added on some new markets and new products as well. The ARIA scheme has started encouragingly. Well, we have great feedback from our customers. We’ve got about 6,000 lives at the moment and we are now seeing acceleration in that pace as well. Over the quarter we started in expanding to Kolkata and to Shimoga and Raipur. We also launched an upgraded version of our first plan is Aditi called Aditi plus for the Kolkata market.
We’ve also developed and taken to Market group omnibus product for non employer employee plans. Which is something we’re actually quite excited about because it opens up new opportunities for us to partner with external parties potentially that have got pools of customers. We are building the business steadily focus is on risk management and underwriting and making sure that we are building a business that will be sustainable over the long term.
Unidentified Participant
Sure.
Unidentified Participant
So the current quarter loss from new initiative. Can we assume mostly it’s coming from your spend which is happening on the insurance part?
Unidentified Speaker
Sandhya, do you want to answer that?
Sandhya Jayaraman
It is a combined number between both insurance and the NHIC which is the clinic business clinics. Okay, okay, that’s helpful, thank you.
Unidentified Participant
I’ll get back in the queue. Can you please have a question? Yeah. Thank you for the opportunity sir.
Unidentified Speaker
So as you know that we are.
Unidentified Speaker
Going to start the new hospitals in 2028, 2027. So I mean what would be the breakeven cycle we are expecting? Because these hospitals are in the existing region. So first of all are we expecting the breakeven to happen or the ramp up to happen very fast. And second, like are we or would we be able to charge the similar, I mean revenue per bed comparable to the existing revenue per bed in the same region?
Unidentified Participant
Ronan, the break even characteristics of the hospital we’re starting up will be in line with market. The realizations that are possible in these hospitals will be at a discount to the current market prices in the geographies where we are setting up hospitals growth to.
Unidentified Speaker
Okay, got your point sir. And I mean coming on the specialty profile. So in the past few years you have seen the oncologist increased very much. So can we expect the oncology let’s say in upcoming five years to like it may become let’s say 20 or I mean 25 percentage as a percentage of revenue. The oncology has been growing very well for the last couple of years and that’s the same trajectory which we have been observing and and working towards with the clinical team and the kind of investments that we are making. And our aim is to get towards that number which you mentioned and we will be seeing a good healthy growth year on year on that.
Thank you. Thanks Babi, can we have a question please?
Unidentified Participant
Hello, thanks for the opportunity. So I would like to ask that There are the 400 beds currently in the pipeline when this will be operationalized and what, what capex is expected for this? 400 bits.
Unidentified Speaker
Where have we picked up the 400 bits from? That is the pipeline. Yeah. So at all points in time we keep exploring for the new opportunities. So the moment we close something we’ll be able to announce then. But right now we are looking at multiple opportunities. So that pipeline is not confirmed yet.
Unidentified Speaker
These are MNA sort of transactions that were in discussion various bankers with and we’re not exactly sure when they can conclude.
Unidentified Participant
Okay, thank you for that. And another like the hospital are getting commissioned in FY27 and FY28. So will the margins will be impacted due to the commissioning of new hospital and if they are impacted the impact will be similar to what dilution in past or it will be less due to the brown fill.
Unidentified Speaker
There will be a margin impact. We will do our best to minimize the impact. Whether it will be less than the past, that’s hard to say just because in the past the cost structure was very different. The manpower cost and a lot of the startup costs are much higher in these days than it was when we had done in the past. But again we will try and keep margin dilution break even period more in line with what the peers have been able to achieve.
Unidentified Participant
Okay. And the another I have seen that alos fall on from 4.5 to 4.3. So can we expect this to fall for the year or it is just for the quarter basis?
Unidentified Speaker
We are working towards this. Whether this particular drop, I mean we want to bring it down to closer towards four and we are working towards this. Hopefully this will keep coming down in the future as well.
Unidentified Speaker
But the quarterly variances will show this slight fluctuation because a lot of seasonality but the long term trend is towards lesser a loss.
Unidentified Participant
Okay, thank you.
Unidentified Participant
I am done with my questions.
Emmanuel Rupert
Thank you.
Unidentified Participant
Rehan, can we have a question please? Yeah. Good evening. Productive and thank you for giving me the opportunity. So I have, I want just more clarification regarding the integrated care and insurance business. So with the integrated care program now scale to multiple cities. So what’s the next fronter? Are you considering disease management or wellness level wellness led models under NHIL or, or on the other insurance side, how is Aditi plus being received in Kolkata and what are your plans to build distribution or partnership for this particular.
Unidentified Speaker
Sure, I’ll try and answer most of those questions. So in terms of the clinic business, just to clarify, the clinic business itself is focused on Bangalore at the moment. And in fact we are opening, we’re increasing our footprint in Bangalore. There’s a new clinic that’s opening tomorrow. There’s another one that’s under construction. Over the coming quarters, we’ll be focusing on offering a wide range of services to our customers. Now these will include, I wouldn’t call it wellness, but these are basically services that we’ll be offering to help our customers get well and stay healthy. And that’s kind of our focus.
In terms of geographical expansion, we will, we continue to evaluate opportunities to grow the clinic footprint both in Bangalore and beyond and we’ll try and you know, share updates on that as and when it’s appropriate. In terms of Aditi and Kolkata, I think that’s gone. That’s gone well. And in fact we also did launch the new product which is Aditi plus in that market. But that’s, you know, the whole, the, the. We’ve only been selling in Kolkata for about six weeks. But the initial response to this has been very good and we’re very excited about how we think the Kolkata market will react to.
Unidentified Participant
Okay, so thank you for clarification, sir. My second and last question is on the digital and technology investment side. You have mentioned digitalization of 85% patient documents. How are these initiatives translating into measurable oper efficiencies like reduced turnaround time or improved clinical outcomes? And just follow up in this. Can you elaborate on the roadmap of your doctor APP and ICU master initiatives? Are there early signs of improved compliance or star productivity? Just can just, can you please more light on this?
Unidentified Speaker
Yeah. So we have rolled out our just like RD which is a doctor application, we have rolled out our nurse application called NAMA and also the digital for the inpatient services, the medication card and various other modules.
And it’s getting stabilized and we hope that it will get stabilized somewhere by October and all these things will speed up the discharges and other things because we are working along with our Meda, which is the analytical division, to work towards multiple improvements in the operational efficiencies so that we’ll be able to streamline the processes and make documentation, both clinical and operational documentation, much more streamlined and enable things to happen in a much quicker way. So these are some of the things which I’ve been doing, and this will continuously keep happening and improve the overall efficiencies and it will make the manpower, clinical as well as operation, operational manpower, to be very effective in what we are doing.
Unidentified Speaker
It’s hard for us to accurately gauge out how much of the improvements that we see in both in realization, discharge time and the patient experience can be attributed solely to the digital investments. Just because the nature of technology today is that it is so diffuse and we have parallel projects running at the nursing team, at the clinician team, with our technicians, with our senior doctors, with the administrators, supply chain people who are embedding this into everything that they do. So our hospitals are fully paperless. Our patient experience can be done in such a way that no patient has to visit a counter for anything.
Most of the transactions in our hospitals can be done either on their phone, with the app or going to a kiosk. Now, it is far from perfect. There’s still a lot of bugs that come from time to time. But this is the experience that we’re investing in so that it is a fully seamless experience in all our hospitals.
Unidentified Participant
Okay, sure. For a clarification. Thank you for clarification and okay, I’ll jump back in the queue. Thanks. Rihan. Yes, Binu. Can we have a question please? Hi. Hope you can hear me. Yes, we can hear you. Yeah, thanks. Got a little bit of confusion around this integrated care. So you have these two entities, NHIC and nhil. May I know what each of them does?
Unidentified Speaker
NHIC is a company that runs clinics. So these are brick and mortar clinics in Bangalore and they run care plans where people can buy subscription packages for loyalty, access to the clinics for doctor follow ups, medicine, home delivery and lab collection. Home collection of lab samples that is part of nhic, NH Integrated Care. NHIL is the IRDA regulated health insurance company. This is the entity that has the license for being a standalone health insurer. And this is the entity that issues policies called Aditi, Aria, ARIA plus and so on. So this is our insurance entity.
The insurance entity sells through NHIC as a channel as well as through multiple other arrangements.
Unidentified Participant
Got it. And those who have policy from nhil, are they, as of today, free to go to other facilities as well, or do they have to come to nudge facilities?
Unidentified Speaker
Ravi, you want to answer that?
Unidentified Participant
One. Sure.
Unidentified Speaker
So for the moment, so the way that we look at this is that we can provide the best experience to our customers when they come to our hospital. One of the biggest pain points is the entire pre authorization discharge, something not paid, something else covered, etc. Confusions this you want to avoid. So we would prefer for customers to come to our hospital for treatment. Having said that, there are such way. There are situations where if somebody needs to go outside, they are, they are able to go to any hospital in the country. There are four specific situations.
If somebody has an emergency, they can go any, to any place they want. If the treatment is not available in our network, they can go any place they want. If they happen to be traveling and require assistance, they can go any place they want. And if they buy the policy here and then they move somewhere else within India, they can go wherever they want. So with those, you know, in those situations, people can go to any accredited hospital in the country. Otherwise we do prefer that they come to our hospital and you know, because the whole point of this is that.
So that we can give them the best possible experience at the time of discharge and remove the trust deficit that typically exists between an insurance company and a hospital. In this case, it’s not there. And that allows us to give a much superior experience to our customers.
Unidentified Participant
Understood. So now this is, this was all India. Now is there any integrated care model like this in Cayman as well?
Emmanuel Rupert
Yeah, it is. You know, the local dynamics are such that you can use the, you can use it anywhere in any hospital in the US Anywhere in the world, any other provider. In Cayman, we don’t restrict anybody because the local market conditions and dynamics are different.
Nishant Singh
I’m sorry, I’m not quite, I haven’t quite understood that. The reason I asked was earlier when there was a discussion about the margins in, in Cayman island, it came up that there was some integrated care model which has come up there. I was not sure if I heard it right or sure that’s why it asked.
Emmanuel Rupert
Yeah, no, that you are correct. So we do have, we do have that. It’s just that to your question on whether the holder of this plan or policy is restricted to you is restricted as to where they can use it. It’s not like in, in India. In India you predominantly have to use it in NH with certain exceptions that Ravi mentioned. In Cayman, with these plans that we sell, you know, you can use it anywhere you want.
Nishant Singh
Understood. But that is a completely different operation. Right. Or does it come under.
Emmanuel Rupert
It’s a separate entity. Completely separate. Yeah. Completely differently regulated. Different. Everything is different.
Nishant Singh
Yeah, got it. So I was wondering, you know, your Cayman operation is pretty big now in your ppt. It would be great if you give the Cayman EBITDA separately as a number. That would be great. You give the revenue, but I don’t think you give the EBITDA number.
Emmanuel Rupert
So there are ways to, you know, to get a rough sense of what that is with the information that’s there. Maybe, you know, Nishant, we can connect with Bino offline to help walk him through that.
Nishant Singh
Sure. Yes. Yeah. Yeah, yeah, sure. Thank you very much.
Unidentified Speaker
Thanks. Vino.
Nishant Singh
Rajat, can we have a question, please? Yeah. Hi. The South West Bangalore expansion, given that the civil and structural works are in final stage, do we have a sense of exactly when this will be operational? Whether it’ll be Q1 or Q2 or FY27 or later?
Unidentified Speaker
Not that much accuracy to take about a year. The building shell has already come up. We are doing on the interiors and outing the medical equipment.
Nishant Singh
So year from now. Yeah, at least. Right. Okay. Yeah. All right. So in the last call, there was a discussion on chemotherapy centers coming up in Gurgaon, where you had mentioned there’ll be a soft launch and then a formal launch. Any update on that and what kind of footfalls you might be seeing there and if you can share some kind of numbers on it. Yeah, as to revenue per patient or something like that. So that gives us a better sense of where that is going to.
Unidentified Speaker
This is an investment we’ve made in a startup which will be doing this. It’s called Everhope on Collagen. Their first infusion center is in Gurgaon in Emaar Business Park. The center is up and running. They’ve had the soft launch already. They’ve not gone for the official launch yet. And they are seeing patients. As far as it comes to reporting of the numbers, it will, for the near future be a very small contributor. And being a startup, have significant setup cost and losses and so on. And our involvement in this is as an investor. We are providing a lot of the backend services like referrals for radiation, oncology and surgery, as well as providing them supply chain and software help.
But we’re not managing these units and it won’t count as any of our subsidiaries.
Nishant Singh
Okay, understood. And they’re obviously free to see patients referred from other hospitals also.
Unidentified Speaker
Yes.
Nishant Singh
All right, one last question. The gross written premium of the insurance segment has marginally come down during this quarter compared to the last quarter. So, I mean, given it’s not Even one year since we launched it. And we are actually being very bullish on it and it’s growing. What could be the reason for that?
Unidentified Speaker
It was borderless flat. And as you know, you know, the bulk of the buying behavior in the country is that the large majority of sales actually happen in the Jan. Feb. March quarter for tax and other reasons. And so there is a bit of a seasonality effect. You know, we are seeing much improved momentum, you know, in the later half of, of the quarter of last quarter and into this quarter as well. So we continue to be bullish about that. But largely, you know, if you look at insurance anywhere, typically the first quarter, there is obviously there’s always a large drop off from the JFM quarter across industry.
Nishant Singh
No, but these would be annual policies, right?
Unidentified Speaker
It doesn’t, it doesn’t matter because what’s booked is the, what’s booked is the gwp, the gross written premium, which is a full year’s premium. So when somebody buys, you know, if, if 100 people buy, buy the policies in JFF, the, the premium is counted in that quarter. It’s not split out over the year.
Unidentified Speaker
It’s just to.
Unidentified Speaker
The GWP is accounted in the same quarter.
Unidentified Participant
One second, just to add to what Ravi mentioned, also the numbers that you are comparing is ytd because last year was a small year for insurance. So we were reporting YTD numbers. Now we are reporting quarter on quarter. So they’re not exactly comparable also.
Nishant Singh
But it says YTD Q1FY26. Right. So it’s only for this financial year.
Unidentified Participant
Yes.
Nishant Singh
Oh, these are not cumulative.
Unidentified Speaker
No, no, it’s not. It’s not cumulative. On a cumulative basis we’ve had.
Unidentified Speaker
But your larger point is taken. Ravi needs to work harder and make it grow more.
Nishant Singh
All right, thank you, sir. Good luck with that. Thanks. Thank you, Rajit. Nancy, can we have a question, please?
Unidentified Participant
Hi, team.
Unidentified Participant
Thank you for the opportunity. I also wanted to discuss the Cayman numbers. It seems that the EBITDA has fallen. So like I, firstly, if possible, I wanted to confirm the number and if it has fallen according to the calculate, according to what I’m able to calculate, then I wanted to know the reason and if possible, I also wanted to get the India’s adjustment number for Cayman.
Emmanuel Rupert
Yeah. Hi, Nancy, thank you for your question. So, as we explained in, in the beginning of the call, we have now, we’re now seeing a significant ramp up in our integrated care business. So the economics and the margin profile of the hospital business remain largely unchanged from what you would have seen previously. But on a console picture you will see a diluted EBITDA percentage and that is because of the new integrated care business which is starting, which was not a significant contributor to the console earlier and now is starting to become so. And secondly it is yet to break even given that it’s just been it’s the first or second quarter that that we’ve started it.
So you are going to see that drag effect of that. We expect this to settle down over the next few quarters. On your second question, I’ll pass it on to Sandhya. On The India’s verification.
Unidentified Participant
658K is India’s for the quarter. Is the India’s impact for the quarter 658K? Yes, USD. USD. USD. All right, sure. And also I just wanted to confirm. So basically could you tell is it possible for the team to tell the drag number from the integrated care business on the Cayman? It is there.
Emmanuel Rupert
That will be the slide. Sorry, go ahead Sandhya. Yeah, go ahead.
Unidentified Speaker
That’s 3.3 negative number, right? Yes. Actually there is a revenue as well as a EBITDA number that has been given there. So for you to derive you have to adjust both the numbers. Understood, Understood. Thank you so much team.
Nishant Singh
Super helpful. Thanks. Nancy, can we have a question please? Yeah. Thank you for the opportunity. Sir, my question is regarding the oncology division. In addition to the previously asked question regarding the ever change which we established in the last quarter. You mentioned that we have we’re yet to start on the chains. Do we, you know, do we have any expectation on the number of centers which are currently in operations and the pipeline for this year?
Unidentified Speaker
As mentioned earlier, the investment we make is in a startup that is still in the ramp up phase. They are not a publicly listed company and they will be making their investment as per their own strategic business plan. Our investment we disclosed earlier which they will use to build a business with. They have some very aggressive projections and as and when these things come up and are clear for us to disclose publicly, we will do so.
Nishant Singh
Understood.
Unidentified Speaker
Thanks.
Nishant Singh
Can we have the question please? Thank you for the opportunity. I think this question has been asked earlier but I wasn’t able to hear it properly on the slide 13 of the PPT where the operational review of Cayman Islands has been given. In the bottom left corner the revenue and EBITDA of CIHL for Q1FY26 is there. Would you please elaborate on that?
Emmanuel Rupert
Yeah, that’s the integrated care we were talking about. It stands for Cayman in Cayman Integrated Healthcare Limited or something like that.
Nishant Singh
So does that include only the insurance business?
Emmanuel Rupert
Yeah, integrated care, you know that. That is it. That’s the only activity of that.
Nishant Singh
Yeah.
Unidentified Speaker
Just for Cayman. Just to clarify.
Emmanuel Rupert
Just for Cayman. Yeah, sorry, just for Cayman. I think there’s a confusion because the currency is in rupees. Sorry about that mistake. Yeah, it’s just for Cayman.
Nishant Singh
But the. So the amount is in rupees only. There is no mistake there, right? 9.3 crore.
Emmanuel Rupert
No, the amount is correct. But we should have represented it in dollars. I. I think we represented it in inr. But the absolute, whichever way you converted the absolute number is accurate.
Nishant Singh
And if we adjust this with the overall ebitda, I think then we’ll able to find out only the hospital business. Ebitda. Right.
Emmanuel Rupert
More or less. There are. Yeah, more or less. But Sunday, any comments there?
Unidentified Speaker
Yeah, you have to adjust both on the revenue and on the EBITDA side, but correct.
Nishant Singh
Okay, thank you. You have any other questions because you’ve been raising hands for a while. Yeah. So we’ll go to Prithvi. Thanks for taking the question again, Anish, again, on Cayman, given that now you have two hospitals and you are also coming to insurance. So how do we look at the opportunity size here? I mean, you’re already at $45 million revenue in Cayman and the population rate is quite less. So could you throw some light on, you know, I mean, for how many years you think you can grow in Cayman before reaching a growth of population growth number?
Emmanuel Rupert
Yeah. So you know, Prithvi, as you recollect from previous discussions, yes, the population is. Is small, but our market is a broader Caribbean. Having said that, both the new businesses, which is the new hospital as well as the new integrated care, we are still only in quarter two. And these especially the new hospital, is a very substantial investment we’ve made. So we continue to absolutely expect and be confident of growth for several, at least for the foreseeable future, given we’re still just in Q2 of where we’ve started. The only caveat I would add is it’s not possible to predict there’ll be some lumpiness in this growth.
But on the whole, we are confident for a healthy Runway still to follow, given both the untapped demand domestically as well as the larger market we can to internationally in the region going on.
Nishant Singh
Tell me if you have to just understand this a bit better, you know, how much of growth is coming from Cayman and how much is from other Caribbean islands. I mean, I’m not talking about exact numbers, but incrementally. Can we Assume half of the growth is coming from other Caribbean islands and this is where there is still significant scope for you.
Emmanuel Rupert
Before that B. Sorry, could you just go on mute? I think you have accident. Thank you so much. Yeah Prithi, back to your question. It is, you know it is difficult to give a split between domestic and international. I will say that for both whether it’s domestic as well as international we still have you know an untapped opportunity. Of course much, much more in international but more challenges to access it. Domestically is much more known and you know we understand what we need to do but we continue to see good growth both from domestic and international.
We do predict eventually, not now. Eventually the bulk of our growth will come from non Cayman markets. Obviously we will saturate this, this market but we are not yet there.
Nishant Singh
One final question on India business. In the last con call it was mentioned that this year will be the peak losses for insurance and a clinic business. Are we still retaining it and can we expect losses to come down from next year onwards?
Unidentified Speaker
So we haven’t given a peak loss kind of guidance but more so we said that we are investing and we have set aside a certain amount of money and we are thinking that a lot of the investment will happen in the initial period. So from that perspective I think you have inferred that. So we, our first cohort of clinic have broken even. So we are able to see that model that we built saying each clinic will break even in 18 months time. We are able to see that there are still corporate costs to recover and there are growth ambitions.
So as new clinics come online we will have losses in the initial period. We are still sticking to our overall cash burn number that we have indicated for both the businesses put together. And as you can see the absolute cash burn in the business in the current quarter is lower than what, what it was in the previous quarter. So we are projecting in the right trajectory.
Nishant Singh
If I remember the number it’s almost 450 to 500 crores of investments is something that you have guided right?
Unidentified Speaker
454. Yeah. 450 crores.
Nishant Singh
May know how much of that has been invested till now.
Unidentified Speaker
So 100 crores we’ve invested as capital and 150 crores has been invested for clinics. The clinics and the cash burn relating to that including some capex.
Nishant Singh
Thanks. Thanks. Thank you. Aryan, can you, can you please have a question? First of all thanks for the opportunity sir.
Emmanuel Rupert
I’m sorry if I, if it is already answered.
Nishant Singh
I just wanted to know that what growth we are expecting in Indian business till new facility commission because as we all know that there are capacity concern in Bangalore and Kolkata cluster. Right. So for time being, what we are doing to deal with that.
Unidentified Speaker
Yeah we will try and maintain the growth trajectory we’ve had for the past two to three years. What we are doing is still more of the same. More digitization, more automation, more work on the patient mix, more work on improving our efficiencies over here, more investment in robotics, in oncology. Looking at the case mix, there are enough and more things that can be done in a hospital to generate the hard fought and hard won revenue and margin growth. While the new hospitals take time to come, there’s plenty of work for us to manage but it will not be in the high double digit growth numbers that would otherwise come from adding new beds in new parts of the cities.
Nishant Singh
Thanks sir. Yes. So yes, thank you very much for the opportunity. So I have a couple of questions. So first of all I can see that there is a good growth in every peripheral for arpp. So what were the factors that led to the growth and is this trend going to continue?
Unidentified Speaker
So there were few factors like we always do. We’ve taken a small price increase on 1st of January, low single digits. Some of the effect of that has come through also in the current quarter. The second is that there is a payer mix change. As you can see from last year to this year we’ve had almost a percentage improvement in the payer mix. So that’s also helped. And thirdly we’ve had almost a 50% drop in the Bangladesh revenue from last year to this year, same quarter and Bangladesh was coming in at the lower realization. So that having been substituted by domestic revenue, domestic revenue has grown by 12% this quarter.
So that’s also contributing to the ARBP. Finally we are also doing a lot of high end procedures. For example, we’ve done the largest number of cardiac robotic surgeries in the country in the last quarter and so on and so forth. So there are a lot of high end work that is also coming through which is also improving our ARP ipp.
Nishant Singh
Okay, so is this trend going to continue forward, the growth in ARP to.
Unidentified Speaker
The extent of the one time benefit we’ve got from the Bangladesh mix change? I think that that kind of increase will not come but the rest of it, yes, we can look at it as a. And again a price increase will next happen only in the first of January. So that benefit will also come next next year. But the regular improvement in payer mix that we drive as well as higher value procedures that we will continue to push.
Nishant Singh
So second question was regarding the expansion. So what I have seen in the presentation was the expansion generally in the higher ARBP regions, right. In Bangalore and Bangalore I think and Kolkata and third is in Raipur. So going forward in the longer term, say after when the expansion is completed. So can we see a margin increase from the current levels?
Unidentified Speaker
Absolute basis? Yes, because MUHAs, once they are broken even an absolute basis, the EBITDA numbers will be higher on a margin basis. That will depend a lot more on the cost structure as it looks. Because as much as Bangalore, Calcutta, Delhi, Raipur places a high realization, they’re also very high cost markets. And the cost drivers of this industry are relentless. Meanwhile the pricing pressures what we face from various payers, both insurer and the government are also equally relentless. So question of, you know, will things look better? One will balance out the other.
Nishant Singh
Okay, so last question was I can see that the owned hospital revenue mix has increased from 7, 23% right. To 73% and the management part has little bit come down. So has the, has this any impact on the margins that makes up owned and managed hospitals?
Unidentified Speaker
I think this may have been the removal of Jammu which is a managed hospital that we were managing on behalf of the Shrine Board. We’ve moved to handover of the hospital to the Shrine Board trust and we are just there to manage the operations at no fee. So I think that may be explaining the difference over there.
Nishant Singh
So going forward it is going to look the same. Right? Okay. Thank you very much. Can you have a question please? Yeah. Thank you for taking my question. Sir, I have question regarding this insurance. Sir, I was going through this Aditi insurance plan. It is very competitive. So I have question regarding. Do we put. Do we add any loading on the insurance premium if the customer has any pre existing element or any surgeries undergone in the past before underwriting the client.
Unidentified Speaker
So Neeraj, our goal is that we want to give people a policy with no waiting periods and either for pre existing conditions etc. But obviously as you know we’re also in the business of taking risk. So what we ask is we ask our customers to undergo a health checkup. It’s a comprehensive health checkup. It’s part of the service we offer. It’s a comprehensive health checkup that they can do actually every year. It’s built into the plan that there’s no, there is no fee for it. It’s completely free checkup that they do. The majority of customers who complete that health checkup they go through the plan on a standard basis.
In some cases we may ask for some slight additional loading in premium or depending on again on the underwriting results you may ask for a waiting period. But that is not the, not the, that’s not the rule. That’s the, those are the exceptions. And of course in some cases we may not be able to offer cover as well. For example, if somebody is, you know, immediately scheduled for surgery, for example, then it’s not really insurance. But the point is that we ask every customer to go through a health checkup and you know, we decide on the basis of that.
Nishant Singh
And so second question is for selling this, for growing the jwp, are we looking to tie up with some national distributors, Pan India or it is just through NH Network?
Unidentified Speaker
So we’re always looking at, we’re always looking at the balance of this. You know, as you know some of those national distributors come at a very high cost. And our focus especially with Aditi is to make sure that we’re offering something that is affordable for the people that cannot, you know, otherwise cannot afford insurance. So it’s always a balance between the cost of distribution which can be very high and you know, passing on those benefits to the customer. What we are focusing on at the moment is offering our plans directly to the customers and giving them the benefit of both lower premium and better service by going direct.
But again this is something that we do evaluate all the time and we are looking for partners that are kind of like minded where we can offer this through certain partners. But the focus has always been on the customer and making sure the customers get the product at a good price, great value and we’ll be able to provide good service.
Nishant Singh
Correct, sir. One last question, sir. Do we have any internal guideline in terms of underwriting that since we have just started this insurance business because any in terms of age, say for example if we under 800 clients, so if the ratio of people who are above 60 where the claims can be higher in future, so say only 40 or 30% of the customer should be about certain age and then certain, if it crosses above certain age then we slow down on the underwriting part.
Unidentified Speaker
No, it’s not that, it’s not, it’s not that way. There is no automatic loading if somebody is above a certain age or anything like that. And by the way this is one of the, one of the great strengths that you get when a hospital that really deeply understands healthcare and health risks, you know, does insurance and looks at, you know, evaluating these risks and that’s where the health checkup comes in. So it’s a detailed health checkup and you know we have a very, very extensive underwriting process in terms of guidelines and rules and it’s completely based on that.
It is not. There’s no automatic, you know, somebody’s above 60, they get a loading of this or somebody’s got diabetes, you get a loading of that. It’s not that way at all. It’s a very holistic review and really takes advantage of our understanding of healthcare and I think it’s one of the key differentiators to help us manage the risk in the book over a long term basis.
Nishant Singh
Thank you. Thank you so much. Please can we have a question? Yeah. Given the current projects in hand, what is the peak debt that you are aiming for? And if you can share the Q1 numbers of borrowings and lease as well, we’ll answer this question. In terms of the leverage ratios for us we are looking at the maximum leverage ratio at the console level of around two and a half, three and same for the respective entities as well. Maybe India also same number and came up with the same number. So the leverage is on the net debt to beta.
So that’s maximum around two and a half three.
Unidentified Speaker
Plus or minus depending on in case any acquisition were to come temporarily but on a sustainable basis that’s the range we would look the upper bound of the range we would look at.
Nishant Singh
Right. Much appreciated sir. My, my. Actually where I am coming from is because of the ongoing expansions your while your EBITDA has in absolute terms gone up yoyo the earning per share has actually gone down and that is because of higher depreciation and interest cost. So all I’m trying to do is forecast the earnings growth over the next few quarters or a couple of years and if I could get a sense of the interest cost then that helps.
Unidentified Speaker
We’ve announced projects so far for about 3,000 crores, roughly 80% of that we will borrow so and we will repay over a 15, 10 to 15 year time period. So that can help you forecast the interest costs.
Nishant Singh
Right. So we are already at 2100 crores if we, if I do not count the lease liabilities, right. I mean that is as of March 25, which is a combination of long term and short term debt. So you’re saying over the next three years it’ll only go up by 300 crores and I’m assuming you said 2400 crores excluding lease liabilities. I mean I’m a little unclear on this. You can just Help me.
Unidentified Speaker
This is incremental Capex slide which we have given our expansion number. So we announced almost 3000 crores of incremental capex.
Nishant Singh
Right. So 2400 crores will be over and above the number I have as on March 25th.
Unidentified Speaker
Yes, but we will also be repaying some of the existing.
Nishant Singh
Exactly. So that’s why I asked if you have a sense of whether 2400 crores will come on the books in the next three years, not eight years, because they’ll all come to. Yeah. Plus. Plus a bit of regular capacity of around say 300 crores every year. So there’ll be addition of around 800,000 crores of. Of gross debt every year and manage the repayment which on the existing loan. Understood. Thank you. Sir, can we have a question please? Yeah.
Unidentified Speaker
Hi.
Nishant Singh
So I see on the Capex slide that our FY26 projection for greenfield projects is about 420 crores and we have only done about 5 crores for that in this quarter. So are we on track for this year for the projection? I mean, because the difference is so huge.
Unidentified Speaker
So that’s why we are running a little behind. Because of the rainy season, a lot of the contractors and a lot of the work has not been able to start on time. But a lot of them have geared up and they should catch up over the next three quarters.
Nishant Singh
Okay, so still seems on track for the 420 crore target, right?
Unidentified Speaker
Yeah, there may be a slight overrun. As usually is the case with construction projects, our expertise is in the patient care. Construction is very, very difficult for us to understand. But we’re hopeful.
Nishant Singh
Understand. Thank you very much. Ravi, can we have a question please? Ravikaran, can we have a question? Okay, so we’ll move to Dikshank. Hello, sir. Congratulations on the results. First question is, is this margin a slight contraction margin that we have seen? Is this seasonality only or is there any other sort of impact that has given us these margins?
Unidentified Speaker
You are talking about India or you’re talking about Consol? Okay, so Consol, I think was explained. The dilution is coming from Cayman. And as far as India is concerned, actually we have expanded margins. And even in Cayman, the hospital business is stable on margins. The dilution has come from integrated care, which Anish explained a couple of times during the call.
Nishant Singh
Thank you. Secondly is we have started to expand our insurance business right now. So I know that we have talked about a direct distribution thought process. But since we are ramping up right now, could you. And also there has been now word of mouth going around with people. So what’s the further expansion idea on distribution strategy that we are working with right now?
Unidentified Speaker
So look, I mean, I think our focus right now is still pretty early days, right? And as you know, direct distribution takes time to build, so that’s our focus. And there are multiple avenues to distribute directly. So our focus right now is on doing that. Having said that, we would be, we are open and always talking to and considering various other options that can help us in our growth. But as I said to an earlier question, our focus is on doing this in a way that the value remains with the customer in the form of lower prices and better service.
And also a key part of our entire program is that we want to be actively involved with the customer and in helping the customer manage their health, etc. So making sure we have that direct relationship with our customer is very, very important. So you know, as long as we’re able to do those things, we would be open to partner with people. But our focus is on building direct distribution through multiple avenues.
Nishant Singh
So historically, insurance, I’m sure you have been asked this question a lot of times, but historically insurance is a business of gather enough of pool in order to manage the risk correctly. And of course our expertise, being a hospital provider, we are able to manage risk better. But at what, what number? Or is there any metric that you can share? At this metric we would be breaking even and we would be doing much better so that we can push the accelerator a little harder.
Unidentified Speaker
Yeah, I mean, surely, I mean obviously internally we have those metrics that we track very regularly. But I think it’s a little bit early to start talking about that know, you know, publicly. One thing that is worth noting is that our business model is substantially different from the traditional players. And what that means also is that while we can give customers better value and hopefully better service and partner with them on their healthcare, it also does mean that we need fewer lives to break even than a traditional very distributor LED type of model.
Emmanuel Rupert
Right.
Unidentified Speaker
So it’s really about balancing those things back, you know, balancing both things and you know, making sure that where we do partner with that distribution cost is acceptable to us. And because I said our goal is to save it, pass it back to the customer in the form of lower premiums, better service and also be really proactively managing their health. So that’s our focus and our model is very, very different from the traditional models. You can’t really compare the two.
Nishant Singh
Can you share the number of policyholders as of quarter ended, about 6,000. About 6,000 okay, perfect. Lastly on Cayman Islands. So we already are now operational and we are getting better sort of demand, demand input that we had expected as was float on the call. So what’s the next hospital that we’re looking in the Mediterranean Islands? What’s the sort of goal of expansion? Because cash flow will start pouring in pretty soon now in a couple of quarters. Right?
Emmanuel Rupert
Yeah. So we’re in the Caribbean. Yeah. So we’ve, we’ve made a. Yeah, no problem. We, you know, we did make a small investment in a large health system in the Bahamas. That was a couple of quarters ago. We continue to evaluate that opportunity. You know, nothing to, nothing to announce as of, as of now. It’s, it’s tough to find, you know, similar geographies. We continue to, to do so and explore all options both in the Caribbean and elsewhere. But there’s nothing to, to talk about now.
Nishant Singh
If I can just expand a little bit here on the question, sir. A lot of opportunity there is, people flying from nearby countries to get a better health care and we have built that reputation in Cayman’s over time. So do you think that the opportunity, with the cash flow that we would be getting, we are at that right moment, right now that we can start pushing for new facilities this year, next year, or is it too open ended right now?
Emmanuel Rupert
We definitely want to, it’s just a question of when a suitable opportunity arises. Because for us, you know, the first port of call is essentially our home is the world’s most attractive healthcare market, which is India.
Unidentified Speaker
So.
Emmanuel Rupert
But we already have plans there. They’re already on their trajectory. So for us to allocate capital anywhere else, it has to, you know, pass a very, very high bar, which is the opportunities in India. So it’s not easy. We say no to, we’ve said no to all of them. There have been many potential opportunities, but let’s see what happens. We definitely would like to do something, but let’s see.
Nishant Singh
Okay, just one last follow up. How is, how are things looking in our Mumbai facility? We were looking to ramp it up from a pediatric scare to a full fledged hospital.
Unidentified Speaker
We’re in discussion with the trustees. There’s been a lot of positive momentum and we’re confident it should happen soon. But it’s not in a position where we can publicly state that it definitely happened in Q2, Q3, Q4, but it is something we know should happen sometime this year.
Nishant Singh
So since the last two quarters this has been the conversation. So that’s why I was asking you again.
Unidentified Speaker
It’s a fair point. Even once we do get permission, it will take time to ramp up as well. We need to hire a lot more doctors and build up the marketing plan to run this as an adult multi specialty. So we are quite disappointed with the progress that has happened. But it is something we’re working very hard to try and rectify.
Nishant Singh
Yes, I’m sure you’d be doing amazing at it. It’s a great market and you are great people to run it.
Unidentified Speaker
Thank you, Dikshan.
Nishant Singh
Thank you.
Unidentified Speaker
I think Ravikiran figured out his hand raise thing. Could you. Ravikan, if you can answer your question, ask your question.
Nishant Singh
Yeah. Hi. So this is regarding the oncology initiatives. Now just thinking about it from a patient perspective. Right. What does it mean coming to Narayan as against, let’s say approaching a dedicated specialized treatment provider such as, you know, Healthcare Global or whatever. I mean I imagine lower costs would be one of the factors. But. But apart from that, in terms of the treatment especially, what does it mean for them? How do we compare?
Unidentified Speaker
So comparing us to hcg. HCG is a dedicated oncology provider versus us for a pure oncology patient. There would be no difference in terms of maybe our facilities will be larger, maybe our infrastructure may be slightly better for some hospitals. But other than that, in terms of the treatment being offered, we have. Because we are multi specialty and we offer the entire range, we are able to afford much more advanced equipment as well as cancer. Being multi site, it would be useful in the early detection of a lot of cancerous tumors. So we also have huge amounts of investment in bone marrow treatment, in car T cell therapy and a lot of advanced genetic screening.
So dedicated cancer setup can do all of these things. It’s just that our DNA isn’t being multi specialty. And so for patients, they get to have a much more comprehensive view of their health.
Nishant Singh
Okay, but in terms of the level of treatment etc, you would say it’s on par or better than even a specialized cancer. Okay. Yeah. I mean we are closely working with them on the protocols but they’re on par with what we are doing. Okay, thank you, that’s helpful. Thanks Ravi.
Unidentified Speaker
Thanks.
Nishant Singh
Ravi Vedant, New question please. Yeah. Hi. Thank you so much for taking my question. So there’s been news around private hospitals not receiving Ayushman Bharat’s payment on time. How are things looking for us? I also see it also seems that our contribution from schemes has been going down. It’s around 18%. So will it be same going forward or is it just a cotton quarter change?
Unidentified Speaker
Yeah. So there are challenges with Respect to Ayushman Bharat payments, it’s for some hospitals, some quarters are a challenge in some other hospitals, other states, maybe different quarters. So it’s not across the country at the same time, but at different points in time. There are cash crunches with the government and therefore we do have payment challenges. Our aspiration is definitely to continuously improve the payer mix. But it has to be set in the context that we also want to be accessible, available to our patients. So we will try to continue to improve payer mix at the same time, not compromising on the fact that we want to make high care, high quality care accessible to everyone.
Nishant Singh
Okay, got it. And also if it is possible that how much percentage Ayushaman bar contributes to our scheme patient mix overall?
Unidentified Speaker
Our scheme patient mix is 19%.
Nishant Singh
No, no. So how much does Ayusha 1 Bharat contributes?
Unidentified Speaker
Roughly less than half.
Nishant Singh
Okay. It’s not major.
Unidentified Speaker
It is major because it is still a big number for us. But yes, roughly half. Less than half we can say of.
Nishant Singh
The scheme patients of the 19%.
Unidentified Speaker
Yes, yes.
Nishant Singh
Okay, got it. Thank you so much. Ravi and Dikshan, do you have still any further questions or should we move to the chat? Questions in the chat? Yeah, just last one here. You have mentioned the 6,000 number for our insurance and you have mentioned this in passing on a couple of things about insurance. But still, do you think that there is a number where we can see break even? Because I don’t think so. We’d be break even right now at all, right?
Unidentified Speaker
No, we won’t be 6,000 the current number of policyholders, but we wouldn’t get into the forward projections of how much it would take. Suffice to say we still have a couple of years worth of work to figure out the right model. You raised a fairly good point about the distributor LED model. There are pluses and minuses on that as well as the slow ramp up because we’re getting a lot of our systems in place. But we do intend to reach that operational break even soon. The model will evolve to be able to achieve that.
Nishant Singh
So there is a huge market of people who are over the 50, 60 age limit. And is that the market that we are focusing on? Because they are very high risk market, but we want to cover all people. So is that the market that we are looking at at all?
Unidentified Speaker
We are looking at it. It’s just that the pricing would not be able to meet the requirements because the older, the older cohort, as you’re aware, will have very high healthcare utilization and to be able to price products just for them means that they would find it very unaffordable. So we’d have to create a mix of products that cater to both younger cohorts as well as older ones.
Nishant Singh
So there would be mixed policies to adjust our risk premiums.
Unidentified Speaker
Yeah.
Nishant Singh
Okay, got it. Thank you sir. Thanks.
Unidentified Speaker
I’ll just talk through the chat questions and I’ll ask the people to answer them. So the first one, how much burn we can expect from health insurance business? We haven’t called out any specifics but we’ve indicated earlier about how much we intend to invest in both the clinic and the insurance business. There was a question of any new branch name which has been started last quarter. We haven’t started any new branches. I think they may have been referring to the Cayman New Hospital which is Health City in Caymana Bay as well as the Cayman Integrated Care which which is our insurance plan.
There’s a question from Suruchi about price capping from the government similar to the drug price control. What are our thoughts on the possibility of price capping for services in the hospitals? We would to this. I think it’s come up several times in the past as well. The probability of such a thing happening is not zero but it is not 100% either. This is a highly regulated industry and a lot of advanced western countries. The realizations depend a lot on the large payers. So Ayushman prices for example have been capped from the day of launch. The CDHs, ESI, ECHs have also the price have not changed in the past nearly 15 years and the large private insurers also have a body that allows them to negotiate as a group.
So body by body the large payers are working out ways to control the prices and hospitals are at the receiving end of that. But as far as it comes to one uniform price for heart surgery across the country for everyone depending on how much they can pay doesn’t seem likely but again the chance of that happening are non zero. Next question is asked about the maintenance capex there in Cayman. Sandhya could answer that’s in.
Emmanuel Rupert
It’s in the slide 14 Sunday. Sorry, go ahead.
Unidentified Participant
Yeah, it is given in our expansion slide slide 14 of our investor day we have budgeted 457 million for Cayman maintenance Capex and so far we have incurred 158 million.
Unidentified Speaker
The next one is capex plan and bed additions for the next five years. We’ve projected out the capex budget that’s in the investor deck. There’s a question asked two times about Other administrative expenses increasing. Sandhya can give the explanation on that.
Unidentified Participant
Yes, roughly half of that increase is coming because of our insurance business. Because, because the way consolidation happens for insurance businesses, all the costs and the claims that are paid out from the insurance business, it gets consolidated as other expenses. So roughly half of that 100 crore increase that you’re seeing is the insurance business. P and L essentially all the costs of the insurance business. The other half are genuine increases in costs that we have seen. A big chunk is because of the minimum wages revision across states. Now that has impact on our cost lines like housekeeping, security etc so that’s one chunk of costs.
The second chunk of cost is that we’ve had increase in our hospital equipment, R and M and also the costs relating to the robotic investments we have made. There is a increased cost of the robotic investment so that that also is coming in as the second big chunk. A third chunk is a more reversible chunk which is coming from PDD which is provision for doubtful debts. That’s an accounting entry that the auditors take based on the receivables. Q1 is generally a slow quarter in terms of collection so therefore our PDD provisions go up but then they reverse.
We’ve hardly taken any write off in our books for doubtful debt so we will recover this money. But there is a timing issue there and that’s adding another about 10 crore on the provisions. Other than that there are small, small increases across different expense lines including csr, our average profit because CSR runs on a three year average profit basis and we had the effect of the COVID year on the base still last year so that’s gone. So therefore Our average profit, 3 year average profit has gone up and therefore our CSR commitments have also gone up.
So that’s another item which is increasing.
Unidentified Participant
The last two questions on the chat from Cayman. First question is on the Cihl did the impact come from Q1FY26 and can you share the previous quarter numbers if applicable? Anish I don’t believe we break that.
Emmanuel Rupert
Yeah, it’s not material. Yeah, we don’t break it. It wasn’t material of any kind of.
Unidentified Speaker
Yeah and the last question has been asked in several forms multiple times in the past. How much would the cannibalization happen between the new block in health in Kemana Bay versus the old hospital?
Emmanuel Rupert
Yeah, there’s no, no cannibalization because it’s a single P and L. The teams are common. The cost structures are same. Patients freely move between one to the other so they are not two separate businesses.
Unidentified Speaker
So that answers all the chat questions. Anyone?
Nishant Singh
I think we still have some questions from Ravikir and Dikshant and Ravindra.
Unidentified Speaker
Do you have questions or.
Nishant Singh
Yeah, I think Ravindra has not asked any question before. Yes, Yes, I want to ask one question.
Unidentified Speaker
Sir, go ahead please.
Nishant Singh
Am I audible? Yeah, yeah. I. I’m looking at the slide of the presentation, slide number nine. So I just want to get some clarification or insights. The inpatient average revenue in particular to Bangalore is 231,000 and Restal, I think it’s more or less an average around 120 around. So if I average that out it’s around 120. So what should I infer from this lab? Are we doing some kind of a specialized treatment particularly in Bangalore, so that the revenue is 231,000 in only in Bangalore? Yeah, I can answer that because you’re showing us an average.
So the how there can be in a huge divergence in the average revenue per patient. That’s my question.
Unidentified Speaker
It’s specifically about Bangalore. Bangalore consists of the health city which is our flagship.
Nishant Singh
I’m from Bangalore, so that’s fine. But I, I want to know the huge divergence because 231 average when you’re taking average. So rest all you see there is a southern peripheral, Kolkata east western. There is some kind of an evenness over there. Right. So only in Bangalore when you are averaging out how we can get in such a huge divergence which is almost 100% divergence.
Unidentified Speaker
When you take averages into consideration, then things start to happen. The other hospital we have across the country. So in eastern India the average realizations are less, the GDP per capita is less. Most of the hospital we offer are in tier 2 towns with the exception of our hospitals in Delhi. So even if you compare Delhi against Bangalore, Bangalore is a 25 year old center of excellence with multiple surgical robots, very advanced oncotherapies with the massive bone marrow transplant unit that does very cutting edge work which the other hospitals don’t have. So the case mix is disproportionately in favor of long stay, very high realization procedures.
Nishant Singh
So what I can infer from this, that we are doing some kind of a specialized treatment particularly in Bangalore. Correct.
Unidentified Speaker
To a much larger extent than we are able to do simply because of the size. The Bangalore hospital is also close to 1800 beds.
Nishant Singh
See if I compare Kolkata, the capacity of beds is 1453. Bangalore is 1503. It’s. There’s not much difference.
Unidentified Speaker
Calcutta as I said is a city where the realizations are lower, the patient payer mix is also lower. And the economy, the patient profile and payer base in Calcutta is much different from Bangalore.
Nishant Singh
Yeah, but I. I don’t know. I’m not that satisfied from your answer that the average can be increased in other, you know, hospitals. That’s. What if I go with a Bangalore as in case study. There’s a huge scope to increase the revenue in other, you know, places. As such, if we can implement the same kind of treatment available in other places as well.
Unidentified Speaker
That’s a fair point. And that’s something we will work on over the coming years.
Nishant Singh
We have the capacity in Kolkata for example. The capacity is there. So only maybe we are not doing a particular advanced treatment over there. Maybe so it may require some fix it, you know, equipment as such. So there’s a huge scope. Because we are already having the inventory of beds there. But we are not utilizing in a better way. If I compare to Bangalore.
Unidentified Speaker
Yes.
Nishant Singh
So rather than expanding in a newer hospital, why can’t we use the hospital which are available there? Where there is a capacity, why can’t we do the same advanced treatments in other hospitals?
Unidentified Speaker
Buildings aren’t fit for purpose. But it is a fair point and something we’ll take into consideration.
Nishant Singh
Okay, thanks. And I had the other question on, you know, other expenses as well. So I think it’s more or less answered but not to the satisfaction of mine.
Unidentified Speaker
Okay.
Nishant Singh
Okay. Thanks.
Unidentified Speaker
Thank you.
Nishant Singh
Yeah. Yes. Yes. Please go on. An just your last clarification what you gave. So I have stayed both in Bangalore and Calcutta. So I very well agree with your point that the customer profile in Bangalore and Calcutta is totally different. So just that because I stayed in both the places. So you are right. Actually that’s.
Unidentified Speaker
Thanks.
Nishant Singh
So Ravindra, do you still have any more questions or. That’s it. Thanks.
Unidentified Speaker
Thank you.
Nishant Singh
So I think with that we’ve got no more questions. Thank you everyone. With that we will conclude our session. Thanks everyone for your active participation. As you as always.