Global Health Limited

A Business Analysis

About The Company

Global Health Limited is one of the largest private multi-speciality tertiary care providers operating in the North and East regions of India. The company has key specialities in cardiology and cardiac science, neurosciences, oncology, digestive and hepatobiliary sciences, orthopaedics, liver transplant, and kidney and urology.

Global Health Limited have a network of four hospitals currently in operation (Gurugram, Indore, Ranchi and Lucknow) under the "Medanta" brand. The company established "The Medanta Institutional Tissue Repository" in 2017 to promote biomarker and other tissue-based research.

In Fiscals 2020, 2021 and 2022 and the three months ended June 30, 2021 and 2022, the company generated income from healthcare services of Rs. 14,805.71 million, Rs. 14,178.41 million, Rs. 21,003.95 million, Rs. 4,732.10 million and Rs. 5,960.89 226 million, respectively, and had EBITDA of Rs. 2,304.54 million, Rs. 2,228.52 million, Rs. 4,897.57 million, Rs. 1,057.69 million and Rs. 1,416.46 million, respectively.

As of June 30, 2022, the company provide healthcare services in over 30 medical specialities and engage over 1,300 doctors led by experienced department heads, spanning an area of 4.7 million sq. ft., the operational hospitals have 2,467 installed beds.

Global Health Limited's hospital at Gurugram was ranked as the best private hospital in India for three consecutive years in 2020, 2021 and 2022, and was the only Indian private hospital to be featured in the list of top 200 global hospitals in 2021 and was featured in the list of top 250 global hospitals in 2022 by Newsweek.

Business Overview

The company is one of the largest private multi-speciality tertiary care providers operating in the North and East regions of India in terms of bed capacity (as detailed on pages 212 and 221) and operating revenues amongst the players that operate in the North and East regions of India, as of and for the financial year ended March 31, 2022, with key specialties of cardiology and cardiac science, neurosciences, oncology, digestive and hepatobiliary sciences, orthopaedics, liver transplant, and kidney and urology, according to CRISIL Report. Under the “Medanta” brand, they have a network of five hospitals currently in operation (Gurugram, Indore, Ranchi, Lucknow and Patna) and one hospital (Noida), which is under construction. As at June 30, 2022, the company provide healthcare services in over 30 medical specialties and engage over 1,300 doctors led by experienced department heads and, spanning an area of 4.7 million sq. ft., our operational hospitals have 2,467 install beds.

The company were founded by Dr. Naresh Trehan, a world-renowned cardiovascular and cardiothoracic surgeon. He has been awarded the prestigious Padma Bhushan and the Padma Shri, the third and fourth-highest civilian awards in India, and the BC Roy award, in recognition of his distinguished contribution to medicine as well as a special award for outstanding contributions as ‘Indian Father of Cardiac Surgery’ by the American Association of Cardiologists of Indian Origin. Dr. Trehan is the driving force behind their hospitals. The company strive to deliver advanced healthcare by establishing institutes of excellence that integrate medical care, teaching and research all while providing affordable medical services to patients. The company hospital at Gurugram was ranked as the best private hospital in India for three consecutive years in 2020, 2021 and 2022, and was the only Indian private hospital to be featured in the list of top 200 global hospitals in 2021 and was featured in the list of top 250 global hospitals in 2022 by Newsweek. Company's hospital at Gurugram was also featured in the list of world’s best specialized hospitals for cardiology and neurology in 2022 and the list of world’s best specialized hospitals for cardiology in 2021 by Newsweek and was awarded the ‘Best MultiSpeciality Hospital – National’ at the ‘Economic Times Healthcare Awards 2021’ and ranked as the best multispecialty private hospital in North India by ‘The Week’ in 2021. In addition, their hospital at Gurugram ranked as the best multispeciality private hospital in North India and the second best private hospital in India as per “Best All India Multi Speciality Hospital Ranking 2022” by Outlook and NEB Research. 

CRISIL Report notes that India’s bed density (bed count per 10,000 population) of 15 beds (as estimated by CRISIL Research for 2021) not only falls far behind the global median of 29 beds (for 2017) but also lags behind other developing countries such as Brazil (21 beds for 2017) and Malaysia (19 beds for 2017). It states that with its population growing at almost 1% annually, India is expected to have more than 1.4 billion people by 2026, stressing the need for increased number of hospital bed capacity. This need was accentuated during the Covid-19 pandemic. To serve Indian and international patients, we have gradually grown the number of our beds to 2,467 installed beds as at June 30, 2022. Subsequent to the opening of our flagship hospital in November 2009 in Gurugram (1,391 installed beds as at June 30, 2022), we expanded to Indore (175 installed beds as at June 30, 2022), Ranchi (200 installed beds as at June 30, 2022), Lucknow (473 installed beds as at June 30, 2022, with capacity to accommodate over 900 beds) in 2014, 2015 and 2019, respectively. Further, the outpatient department facility of our Patna hospital was launched in 2020 and the inpatient department facility of their Patna hospital was inaugurated in October 2021 and commenced operations during Fiscal 2022. As at June 30, 2022, our Patna hospital had 228 installed beds and is designed to accommodate over 500 beds. Additionally, the company have a hospital in Noida, which is under construction and intended to commence operation during Fiscal 2025 with an expected installed capacity of 300 beds. They also operate six multispeciality clinics at DLF Cybercity Gurugram, Delhi Airport, south Delhi, Darbhanga, Patna and Subhash Chowk Gurugram. 

As at March 31, 2020, the company had 2,141 installed beds, which grew to 2,467 installed beds as at June 30, 2022, representing a growth of 15.23%. Upon operation of their Noida hospital in Fiscal 2025, the company expect the number of total installed beds to exceed 3,500 at the end of Fiscal 2025, which will cater to domestic and international patients as part of their strategy to capitalize on medical tourism. The company facilities have received national and international accreditations, such as from the Joint Commission International (“JCI”) in the case of their Gurugram hospital, the National Accreditation Board for Hospitals and Healthcare Providers (“NABH”) in the case of their Gurugram, Lucknow, Indore (such accreditation expires on November 9, 2022 and our renewal application is currently pending) and Ranchi hospitals, and the National Accreditation Board for Testing and Calibration Laboratories (“NABL”) in the case of the lab at their Gurugram hospital. The company blood bank facility at their Gurugram hospital is also NABH accredited.  

In Fiscal 2021, they took the outpatient department pharmacies in-house at their Gurugram, Lucknow, Indore and Ranchi hospitals, and launched outpatient department pharmacy at south Delhi clinic and home care services in Gurugram and New Delhi. In Fiscal 2022, company launched the outpatient department pharmacy at our Patna hospital. The company pharmacies provide convenient access to necessary pharmaceuticals for patients.  For their home-care services, we have scaled up their telemedicine and remote delivery of healthcare services, and the monthly average consultation via video and telephone in Gurugram increased by 1,419.33% from 419 in Fiscal 2020 to 6,366 in Fiscal 2021 and by 33.60% to 8,505 in Fiscal 2022 and was 5,070 in the three months ended June 30, 2022. Company's home-care sample collection services (“Home Care Services”) provide sample collection, delivery of medicine, preventive health checks, paediatric vaccinations, and nursing services (by transaction), all at the convenience of the patient’s home. 

Competitive Strengths  

Tertiary and quaternary care provider in India, recognised for clinical expertise in particular in dealing with complicated cases

For the last three years (2022, 2021 and 2020), hospital in Gurugram has been rated as the best private hospital in India by Newsweek. It is also the only private hospital in India to feature in Newsweek’s list of the top 200 global hospitals in 2021 and was featured in the list of top 250 global hospitals in 2022 by Newsweek. The company believe that they achieved this leadership position by the focusing of their experienced doctors on treating complicated cases and also ensuring at the same time the best quality of care. The same philosophy of clinical excellence is embedded in their culture across our hospitals. Their hospital in Gurugram has been honoured with numerous awards including being featured in the list of world’s best specialized hospitals for cardiology and neurology in 2022 by Newsweek, the list of world’s best specialized hospitals for cardiology in 2021 by Newsweek and was ranked first for emergency/trauma, neurology, gynaecology, and ranked second for cardiology, gastroenterology, nephrology, oncology and urology by ‘The Times of India’s Critical Care Study 2021’. Additionally, hospital at Gurugram was awarded the ‘Best MultiSpeciality Hospital – National’ at the ‘Economic Times Healthcare Awards 2021’ and ranked as the best multispecialty private hospital in North India by ‘The Week’ in 2021. Their hospital at Gurugram also ranked as the best multispeciality private hospital in North India and the second best private hospital in India as per “Best All India Multi Speciality Hospital Ranking 2022” by Outlook and NEB Research. 

 Focus on Clinical Research and Academics 

The company also focused on clinical research and academics. Established in 2009, clinical research facility is another driving force behind their high standard of care. Company established “The Medanta Institutional Tissue Repository” in 2017 to promote biomarker and other tissue-based research. Doctors associated with their hospitals have published 451 peer reviewed indexed journal publications between January 2021 and June 2022. The company have on-going research studies and are currently working with Qure.ai to develop artificial intelligence algorithms with the aim of increasing productivity and improving the accuracy and speed of medical diagnoses, particularly in radiology scans. The company cover 37 specialties under the Diplomate of National Board (“DNB”) and Fellowship in National Board programs with over 100 approved seats (number of students that we can accept to train at our facilities). Since the inception of their academic program, they have successfully graduated 325 students across 36 specialties for the DNB and, as at June 30, 2022, we had 184 students undergoing training at their hospitals. 

‘Doctor-led’ hospitals driven by skilled and experienced doctors in the healthcare space

Company were founded by Dr. Naresh Trehan, a world-renowned cardiovascular and cardiothoracic surgeon. He has been awarded the highly prestigious Padma Bhushan and the Padma Shri by the Government of India and the BC Roy award as well as a special award for outstanding contributions as ‘Indian Father of Cardiac Surgery’ by the American Association of Cardiologists of Indian Origin. Dr. Trehan is the driving force behind their hospitals. Under his leadership, company have managed to successfully recruit and retain skilled and experienced healthcare professionals. As at June 30, 2022, had a team of more than 6,000 medical professionals, including over 1,300 doctors and over 3,700 nurses and over 1,000 paramedical personnel.  

Company have adopted a ‘doctor-led’ model of management. Dr. Trehan leads the entire organization. The day-to-day operational governance of their hospitals is overseen by a committee comprising the heads of the major clinical specialties, the Medical Director/CEO/CMD. Each speciality operates on a departmental concept with all doctors in the department working together as a team, thus enabling sub-specialisation, a joint rewards system and a combined team-based approach to patient care. A large amount of autonomy is given to each departmental head to drive their clinical practice to ensure the focus is on delivering the highest standard of healthcare. The majority of our doctors (less than 10% of whom are visiting consultants) work full-time and exclusively at our hospitals.   

Track record of operational and financial performance 

The company have grown to hospitals with 2,467 installed beds across five cities as at June 30, 2022. Company believe that compnay have consistently delivered high operational and financial performance through high patient volumes, cost efficiency and diversified revenue streams across medical specialities. Over the years of service to patients,  dedication has helped us in enhancing the “Medanta” brand and believe that their patients have placed a high degree of trust in them. Patient volume in Fiscals 2020, 2021 and 2022 and the three months ended June 30, 2021 and 2022 was 1,389,460, 1,178,230, 2,073,619, 440,766 and 590,476, respectively. Company newer hospitals have benefited from the established image and credibility of the “Medanta” brand, able to tap into their potential for growth.  

Company business has demonstrated sturdy financial performance over the last three Fiscals and weathered the challenges of Covid-19. Since Fiscal 2020 we have focused on managing their operational efficiency and cost base and have been able to secure reductions in their operating costs by reducing employee benefit expense to revenue ratios from 35.91% in Fiscal 2020 to 32.23% in Fiscal 2021 and 26.21% in Fiscal 2022, and from 27.37% in the three months ended June 30, 2021 to 25.20% in the three months ended June 30, 2022. 

Company Lucknow hospital was able to meet EBITDA break-even in their first full year of operations and ended Fiscals 2021 and 2022 and the three months ended June 30, 2021 and 2022 with an EBITDA of ₹341.04 million, ₹1,073.53 million, ₹177.97 million and ₹352.68 million, respectively. All this was achieved despite the Covid-19 restrictions and challenges.  The company were able to achieve revenue of over ₹500 million in nine specialities indicating the diversified revenue streams across multiple specialities in Fiscals 2020, 2021 and 2022. In Fiscals 2020, 2021 and 2022 and the three months ended June 30, 2021 and 2022, their debt to EBITDA ratio was 2.70, 2.89, 1.71, 1.71 and 1.40, respectively, and as at March 31, 2020, 2021 and 2022, and June 30, 2021, 2022, our gearing ratio (Debt to Equity) was 46.09%, 46.63%, 51.85%, 50.87% and 47.41%, respectively. For a more detailed discussion on our financial performance, please see “Management’s Discussion and Analysis of Financial Condition and Results of Operations—Selected Historical Financial Information".

Company Strategy

Continue to invest in bed capacity expansion in existing facilities and develop further super-specialities, employ new technology and focus on preventive healthcare.

Continue to attract, engage and train prominent, skilled doctors and other healthcare professionals.

Enhance clinical capabilities and improve operating efficiencies.

Extend clinical services outside the hospital and across the lifetime of the patient.

Leverage technology to improve patient experience and grow our digital health services.

Build on our thought leadership through increased focus on academics and research.

Company's Facilities

Medanta – The Medicity, Gurugram  

Our flagship hospital is located in Gurugram. Established in 2009, our Gurugram hospital has a gross area size of over 2 million sq. ft. and had 40 operating theatres and 285 ICU beds, as at June 30, 2022. As at June 30, 2022, it had an installed bed capacity of 1,391 beds and employed over 800 doctors.  

Medanta Lucknow Hospital  

Our Lucknow hospital opened in 2019 to cater to the demand for quality healthcare in central and eastern Uttar Pradesh as well as parts of Bihar and Nepal. It has a gross area size of over 1.3 million sq. ft. and had 12 operating theatres and 93 ICU beds, as at June 30, 2022. As at June 30, 2022, it had 473 installed beds with capacity to accommodate over 900 beds and employed over 200 doctors.  

Medanta Super Speciality Hospital, Indore  

Our Indore hospital commenced operations under the “Medanta” brand in 2014 with a gross area size of approximately 73,727 sq. ft. and had five operating theatres and 53 ICU beds, as at June 30, 2022. As at June 30, 2022, it had 175 installed beds and employed over 50 doctors. It provides high quality medical services to central India.

Medanta Abdur Razzaque Ansari Memorial Weavers’ Hospital, Ranchi

Our Ranchi hospital commenced operations under the “Medanta” brand in 2015 and operates a facility with a gross area size of approximately 187,000 sq. ft. and had eight operating theatres and 64 ICU beds, as at June 30, 2022. It is a multi-speciality hospital and serves large catchment areas in Jharkhand. As at June 30, 2022, it had 200 installed beds and employed over 50 doctors across key specialties such as neuroscience and cardiac sciences.  

Management

Dr. Naresh Trehan - Chairman and MD

Financial Performance

Profit and Loss

Balance Sheet

Cash Flow

Margin

Shareholding Pattern

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