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Sectorometer: Healthcare In Focus: Hospital

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Table of Contents
Executive Summary Suggested Sector Strategy Sector Outlook Key Performance Metrics Revenue Structure Cost Structure Capex Investments in the Sector Analysis of Stalled Projects Projected Bed Additions (Prime Cities) Financial Summary of the Industry Trend Indicators External Credit Ratings Migration Key Takeaways from Delinquent Account Player Profiling Apollo Hospitals CARE Group Pulikkal Medical Foundation Kovai Medical Center Dr Agarwals Eye Hospital Annexures: Classification of Hospitals Role of Government Regulatory Framework List of Licenses & Registrations List of Accredited Hospitals

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Executive Summary
Healthcare industry is expected to grow at a CAGR of 12% to reach Rs 4.2 trillion in 2015-16 (from Rs 2.3 trillion in 2010-11). Hospitals contribute ~50% of healthcare industry Investments of over Rs 5.6 trillion is required in India over the next 5 yrs to meet global meridian of 24 beds/10,000 population (WHO statistics) Drivers Increasing population Changing demographic structure Shortage in no. of hospital beds Increasing disposable income Growing lifestyle related health issues Thrust in medical tourism Health insurance penetration Govt. initiatives; focus on PPP models
Healthcare Sector - As on May 2012 #Clients POS (Rs Cr)* % of Commercial Finance Portfolio 42 86.35 1.2%

Market

Challenges Shortage of medical professionals Lack of investment in IT infrastructure Shortage of FDI flows in Indian hospitals

Drivers & Challenges

CFD Exposure Summary


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*Includes exposure of Vasan Healthcare (in Infra book) of Rs 40 Cr We have recently sanctioned a LAS Exposure of Rs 60 Cr to PCR Investments against shares of Apollo Hospitals, which is yet to be disbursed. Including the same exposure would stand at 2.1%.

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Suggested Sector Strategy


-Healthcare contributes ~1% of commercial finance portfolio; and hence there is room to explore further opportunities in the sector. The near term outlook remains stable for the sector. -Overall performance of the sector has remained satisfactory in India, reflective from the fact that till Mar 2012 total amount approved by Corporate Debt Restructuring cell constitutes relatively low amount ~0.07% of total proposals approved. * -Given large number of unorganized players in the segment, and few rated or listed players in the sector data availability in public domain may be a challenge. Further, relatively long gestation periods, high reputation risks, availability of manpower and enforceability of security are issues that needs mitigation. -To begin with we may focus on corporate hospitals; preferably present in multiple segments and/or multiple locations to reduce concentration risk and/or manpower availability risk. In case of single location/single specialty hospital stress should be given on proven track record and established brand in the region. -Given, large scale expansion plans we may explore relationships with established promoter group(s) (having acceptable brand recognition) towards supporting their capex plans. It is expected that some consolidations may take place in the sector which may also offer us lending opportunities. -Some of the hospitals may offer us equipment leasing and equipment financing opportunities. Some of the major manufacturers offer organizations schemes like pay per use (especially for expensive equipments like MRIs etc.); we may explore tie ups with such manufacturers in supporting such schemes.
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*Source: www.cdrindia.org

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Near Term Outlook: Stable (Growth likely to continue; slower pace)


Higher revenues; stressed margins -Capacity additions seen over the past few years funded by both debt & equity. -More beds likely to become operational in 2012 resulting in increased revenues. -Operational costs likely to increase: manpower costs due to shortage of doctors & medical staff. Could affect profitability margins; thereby affecting credit profiles of some players. -Rise in interest rates may lead to slowdown in investments in 2012 & may affect the credit profiles of small players, especially the ones which have carried out debt led expansion in the past one/two years & are yet to reach meaningful occupancy levels. -Small players looking for capacity additions may have to rely on PE investments. -High competition & expensive real estate in big cities will drive expansion plans of the players in Tier II & III cities where lack of healthcare services, cheaper real estate & lesser competition will be the main growth drivers. -Hub & spoke model & PPP will guide investments in smaller towns. -Likely to offer investment opportunities in increasing bed capacity, ancillary industries like medical technologies & diagnostics in Tier II & III cities while specialty services (cardiology, neurology etc) are likely to attract most of the investments in bigger cities.

Interest rate impact

Focus on smaller cities

Capacity additions

Sensitivity factors Factor Consolidation High debt led expansion Details Some level of consolidation in the highly fragmented industry along with improved occupancy rates & avg. revenues per operating bed. Debt led brownfield/greenfield expansion in bed capacity, in light of high interest rate environment & stressed profitability due to higher manpower costs & low occupancy, could hurt the credit metrics of healthcare providers. Likely impact POSITIVE NEGATIVE

Source: FITCH
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Key Performance Metrics


Size & Level of Integration Reliance on external agencies for its support functions Extent of presence in primary/secondary/tertiary care Dependency on external referrals.

Competition

Hospitals in the vicinity effect on margins or higher investments to increase service offerings Standalone Hospital Single location. Multispecialty eg. Lilavati Hospital, Mumbai; Single Specialty eg. Tata Memorial, Mumbai Hospital Chains Catering to only one ailment, but present in all levels: eg. Sankara Nethralaya/Catering to single as well as multiple ailments & present in all levels: eg. Fortis Healthcare Integrated service providers Presence in diagnostic/pathology/pharmacy centers/hospital consulting Synergistic revenue streams Lowers dependency on one revenue stream, also act as feeders to the main hospital business. (eg. diagnostic centers, pharmacies etc). Focus on medical tourism No. of in-patients = Ratio of beds occupied per year to average length of stay Bed Occupancy Rate(BOR) = Ratio of no. of beds occupied to no. of beds available. Hospitals strive to achieve high BORs and minimize ALOS. Ailment/Case mix Mix of various ailments treated. Surgery/Medical mix Higher surgery patients denote higher avg. billing per inpatient.
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Business Strategy

Operating Efficiency
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Revenue Structure
-Occupancy levels: Given high fixed cost component; hospital needs high occupancy levels; most well managed hospitals have ~65-70% occupancy levels. Key factors for high occupancy levels: Good brand recognition; reputed doctors & strong referral network -Average length of stay (ALOS): Successful hospitals couple high levels of occupancy with short ALOS, ensuring facilities are utilized to their max. potential & highest possible no. of patients are treated. -Medical patients vs. Surgical patients: Having higher no. of surgical patients strengthens revenues since these patients use the facilities more extensively as compared to medical patients. ~30% of OPD patients get converted to IPD. In initial stages of operation of a hospital; dependence on IPD is higher on OPD. Diagnostics, pathology, surgeries & investigation usually contribute ~50% of total revenues for a hospital.
Avg. realizatio n /patient 2,00,000 2,25,000 22,000 85,000 N/A

Surgery , investigations /diagnostics constitute ~80% of the in-patient revenue

Ailment-wise ALOS
ALOS (# days) Remarks Complex cases: 8-10 days Angiography: 1 day; Cardiac 5 Angioplasty: 2-4 days. Knee replacement: 8-10 Orthopaedics 3-4 days Chemotherapy: day care Oncology 4-5 bed Neurosurgery 10 Depends on complexity Opthalmology 1 Day-care Ailment
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Source: CRISIL Research Commercial Finance Risk Initiative

Operating Ailment Margins (%) Cardiac 25-30 Orthopaedics 25-30 Opthalmolog y 22-25 Oncology 30-45 Neurosurgery 16-18

Ailment wise margins & avg. realizations

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Cost Structure
Components of cost

:Capital Costs: -Overall capital costs: ~Rs 2 - 5 mn per bed. For imported equipments costs are higher. Land & building development: ~40-60% of project cost depending on location. When Govt. provides land @ concessional rates, a particular percentage of patients are required to be treated free of charge & a particular percentage at subsidized rates every year. Area required: On an avg. floor space occupied by a bed is ~700-800 sq.ft. Equipment cost: ~30-40% of project cost. MRI & cardiology equipments are most expensive & costs ~Rs 60-100 mn and ~Rs 50 mn respectively. Maintenance costs of high end equipments are in the range of ~5% of capital costs.
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:Operating Costs: Wages & Salaries: ~15-20% of sales. Salaries are fixed costs; however, consultants fees can be variable linked to operations. Bed to staff ratio varies from 1:3 to 1:5 depending on the nature of services being offered. Consultancy/professional fees: 2 models Doctor on roll fixed salary Fee for service usually consultants take ~75-85% of procedure fee; rest remain with hospitals Operational overheads: ~5-7% of sales; highest contributed by power~2-3% of sales. Raw material/consumables: ~30-40% of sales.

Source: CRISIL Research

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Capex investments
FY2011-12: 111 new projects were announced entailing an investment of ~Rs 7265 Cr. Expected bed addition of 21,305 in future. 69 projects were commissioned at a cost of ~Rs 4583 Cr. Bed capacity increased by 6,708. Bed capacity expected to increase by 21,564 & 12,728 beds in FY13 & FY14. Increase in expenses like wages, depreciation & interest may be expected. In the event new capacities become operational by the beginning of FY2012-13, pressure on margins may ease and profits may return to growth. It is expected that PAT margins may revert back to growth from FY13-14, as full benefit of revenue growth from new capacities may be visible by then.

List of major projects scheduled till Mar 2013


Company/Project/Locations Global Hospitals Ltd. Mumbai Hospital Project, Mumbai Ministry of Labor, Rajajinagar ESIC Hospital Upgradation Project, Bangalore Wockhardt Hospital Ltd, Adams Wylie Hospital Project, Mumbai Govt. of Tamil Nadu, Omandurar Secretariat Hospital & Medical College Project, Chennai Mandi ESI Medical College & Hospital Project, Himachal Pradesh Columbia Asia Hospital, Multilocation Community Hospital Project, Ahmedabad BMC, KEM Hospital Modernization Project, Mumbai
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Capacity 250.0 200.0 350.0 800.0 740.0

Unit Beds Beds Beds Beds Beds

Cost (Rs Cr) 300.00 700.00 400.00 575.00 1000.00 800.00 700.00

Completion date May 12 Jun 12 Jun 12 Jul 12 Oct 12 Dec 12 Dec 12

Source: CMIE IAS

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Summary of Capital Expansion (since CY 2011)


-Total 190 projects were announced since 2011; out of which pvt. sector announcements comprised ~86%; remaining from the public sector. Total involved cost of ~Rs 18,500 Cr.

-~97% of the pvt. sector investments (~Rs 15650 Cr) pertain to new capacity additions; rest pertain to expansion of existing units/renovations/modifications.
Top 10 States in terms of investments
Project cost - status summary since May 11

Top 3 States constitute ~40% of the total project investments

Source: CMIE, Commercial Finance Risk

Analysis of Stalled Projects click here

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Analysis of Stalled Projects

The prime cause for projects getting stalled was funding issues or reputation issues which affected the promoter companies; preventing them to implement the projects as per planned schedule.
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Projected bed additions prime cities FY2011-13


Mumbai Bed supply in 2011 Upcoming supply 2013 Bed/ 1000 population National Capital Region Bed supply in 2011 Upcoming supply 2013 Bed/ 1000 population Bengaluru Bed supply in 2011 Upcoming supply 2013 Bed/ 1000 population Bed capacity (# beds) 29,528 5,579 3.5 47,748 8,606 4.2 43,900 6,837 3.5 Pune Bed supply in 2011 Upcoming supply 2013 Bed/ 1000 population Kolkata Bed supply in 2011 Upcoming supply 2013 Bed/ 1000 population Chennai Bed supply in 2011 Upcoming supply 2013 Bed/ 1000 population 28,731 4,530 6.1 24,959 11,985 5.6 17,930 1,343 5.8 Ahmedabad Bed supply in 2011 Upcoming supply 2013 Bed/ 1000 population Hyderabad Bed supply in 2011 Upcoming supply 2013 Bed/ 1000 population 28,287 2,301 4.2 15,586 3,060 2.8

# of major hospitals Existing hospital supply Mumbai Pune Ahmedabad NCR Kolkata Hyderabad

Ahmedabad, Mumbai and Bengaluru likely to have higher demand support in case of capacity addition in these cities have lower bed/population ratio as compared to other locations. Bengaluru Chennai

>=1000
500 999 300 499 200 299 100 199
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17 19 18 43

3
6 4 9 19

3
2 8 3 11

7
21 18 24 57

6
7 9 14 21

5
6 9 10 35

5
11 12 15 32

5
13 4 16 27 Return to Top
Source: CRISIL Research

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Financial Summary of the Industry


-At operating levels EBIDTA% is seen at ~15.5% for the industry over the last 7 yrs. PAT% seen at ~3% for the same period. -While debt/NCA remains high at~8x for the industry on a/c of relatively longer gestation projects as well as expansions undertaken, however, the players remain significantly capitalized with healthy D/E of ~1x -Interest cover remains satisfactory for the industry at ~2.4x. -For FY2011-12, topline grew by ~16.5%; however, PAT de-grew by ~22.9% (detailed financials yet to be made available.
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Source: CMIE Prowess

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Trend indicators

Income continued to grow, although pace subdued in FY2011-12. EBIDTA of the companies remained flat in FY2011-12, after a peaking in FY2010-11. PAT showed a de-growth in FY2011-12 due to significant interest cost effect.

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CMIE IAS; Commercial Finance Risk

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External Credit Rating Migration

-Sample size relatively small of 23 cases. -Weighted average rating of the companies in the sector is BBB; highest available rating pertains to Apollo Group of AA-; and lowest being B+. -Ratings were found to have been reaffirmed in most of the cases studied

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Study of Delinquent Case: Key Takeaways


Name of the Company: Innova Childrens Heart Hospital Pvt Ltd. Sanctioned Amount: Rs 0.80 Cr (Equipment Finance); POS: Rs 0.44 Cr; OD: Rs 0.16 Cr (DPD: 3160) Sanctioned Tenor: 5 Yrs; Residual Tenor: ~2.5Yrs Cheque bounce history: Consistent cheque bounces noticed in the account cheque bounces for all the consecutive months since Oct 2011; regularized with an avg. delay of ~10-12 days. Cheque bounces for May 2012 and Jun 2012 are yet to be fully regularized. Brief on the borrower: Incorporated in 2006; Hyderabad based; specializes in pediatric cardiology. Set up by group of doctors led by Dr K S Murthy to provide dedicated care for children suffering from heart diseases. External Credit Rating: B+ by ICRA as on Oct 2011. Concerns at the time of original sanction: -Relatively low vintage of ~2 yrs of operation; single location hospital -Cheque bounces in bank statement of existing lender. Credit challenges currently faced: -Moderate scale of operations -High attrition of consultants/doctors on account of competition in the industry -High gearing & stretched liquidity profile given ongoing capex (being undertaken to set up multispecialty unit)
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Player Profiling

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Few Key Players in the Segment


Sr No. 1 2 Name Apollo Hospitals Enterprises Ltd. Fortis Healthcare Ltd. Sales (Rs Cr) 2827.92 592.75 N/Worth (Rs Cr) 2352.27 3204.61 External Credit Rating CRISIL AA/A1+ (May 12) CRISIL A-/A2+ (Mar 12) Recently downgraded A+/A1+ from Remarks

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Quality Care India Ltd. Kovai Medical Center & Hospital Ltd. AMRI Hospitals Ltd.

265.68* 223.93 213.23

160.17* 61.11 212.14

CRISIL A+/A1 (Jun 12) CARE BBB (Nov 11) CARE BBB- (Apr 12) Affected by fire in one of the hospitals

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Dr Agarwals Eye Hospital Pulikkal Foundation Medical

105.68* 89.89*

13.12* 68.93*

CARE BBB- (Oct 11) CARE A-/A2+ (Apr 12)

Peerless Hospitex Hospital & Research Center Ltd.

57.22*

23.77*

FITCH B- (Jan 12)

EBIDTA level losses

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*As on Mar 11

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Apollo Hospitals Enterprises Ltd.

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Brief Background
-Started operations in 1983 with Apollo Chennai; first Indian corporate hospitals -As on Dec 2011: 51 hospitals; 8276 beds. 37 hospitals are owned including subsidiaries, JVs & associates with bed capacity of 5888, remaining hospitals are managed or franchised. -Also operates retail pharmacy chains of 1290 stores. It holds 39.38% in a healthcare BPO services and 11% in Apollo Munich.

Source: CMIE
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As on Mar 12 50.41% of the promoters shares were pledged; which had reduced from 58.96% as on Mar 11.

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Financials Summary

Source: CMIE
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Strengths Risks - Recommendations


Mitigants -Established & leading position in the industry market Risks -Project risk embedded Greenfield projects in Sensitivity Factors -Higher than estimated capex & funding plan -Acquisitions & their funding plans -Operational viability of new projects -Performance companies of Group

-Healthy operating profitability -Healthy financial risk profile

-Sizeable exposure to Apollo Health Services Ltd. (BPO; Investment Rs 180 Cr)

-Significant increase in support to associate & JV cos.


Source: CRISIL

Recommendations: Commercial Finance had sanctioned an exposure of Rs 60 Cr in the form of LAS to promoter company PCR Investments with underlying scrip of Apollo Hospitals which stands undisbursed as on date. In the event the same stands undisbursed we may look at exploring entry into the Company, as there are capex plans which may require support.

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Quality Care India Ltd. (CARE Group)

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Brief Background
-Group was set up in 1997 by cardiologists, Dr B Soma Raju & Dr N Krishna Reddy in Hyderabad -Presence across various locations in India; combined bed capacity of 1577 beds. -Provides tertiary healthcare services in multi-specialty areas; focus on cardiac. -Has presence in Vishakhapatnam, Surat, Nagpur, Pune, Raipur, Bhubaneshwar and Hyderabad.

Advent became as majority shareholder in May 12 through a combination of fresh equity infusions and acquisitions from erstwhile investors incl. Mr Rakesh Jhunjhunwala

Source: CMIE
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Financials Summary

Remarks: Detailed financials of the Group for FY2010-11 and FY2011-12 are not available. -FY2010-11: Sales: Rs 430 Cr; PAT: Rs 21.15 Cr -FY2011-12: Sales: Rs 490 Cr; PAT: Rs 20.97 Cr.
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Strengths Risks - Recommendations


Mitigants -Established market position in the tertiary healthcare segment -Healthy operating efficiencies -Groups profile healthy financial risk Risks -Competition in the healthcare industry -Sub-par performance of few of the Groups recently added hospitals -Exposure to risks related to stabilization of operations after completion of its large proposed capex. Sensitivity Factors -Capex & acquisition plans; and their funding mix -Operational stability of new projects -Performance of loss making hospitals

-Expected benefit from equity infusions by Advent International; it has majority shareholding in the Group. Source: CRISIL

Group: Ganga Care Hospitals; Visakha Hospitals & Diagnostics; Ramakrishna Care Medical Sciences; Care Instt. of Medical Sciences; Galaxy Care Laparoscopy; Quality Care Medical Excellence Center Pvt Ltd and Quality Care Health Services

Recommendations: The Group has planned capex of ~Rs 360 Cr (to be implemented b/w FY12-13 and FY14-15); equity tied up with PE investor Advent ~Rs 50 Cr infused in Mar 12 and ~Rs 25 Cr each is committed to be infused in each of the years FY13 and FY14. Group has requirement to raise ~Rs 250 Cr of debt in future. However some of the Groups recently added hospitals (Raipur, Nagpur and Musheerabad units) have shown moderate profitability. Groups operating lease model of operations have pulled down the profitability to ~13% as compared to ~15% for other multi-location hospitals. Losses are expected in some of the Greenfield projects and margin is likely to be under pressure. 26
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Pulikkal Medical Foundation

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Brief Background
-Kochi based company; runs a 750 bed hospital in the name of Medical Trust Hospital (MTH) & a related education and research instt. in the name of Medical Trust Instt. of Medical Science. -Initially established as a partnership firm in 1972 as Pulikkal Corporation and subsequently in 1976 was incorporated and took over MTH from Pulikkal Corporation. -It is a multi-specialty tertiary care referral hospital. -Presently accredited by National Board of Examination in 16 specialties. -It also conducts graduate & post-graduate nursing courses and diploma courses in radiology and ophthalmic assistance, among others.

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Financials Summary

Remarks: Financials of FY2011-12 not available. Till H1FY12 the Company has achieved topline of Rs 49.20 Cr.
Source: CMIE
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Strengths Risks - Recommendations


Mitigants -Established region presence in Kochi Risks -Single location hospital -Dependence on scarcely available medical professionals -Growing industry competition in the Sensitivity Factors -Ability to diversify its income by establishing hospitals in new locations -Maintain levels higher occupancy

-Vast experience of promoters in healthcare industry -Long & stable operational track record with relatively high occupational levels -Stable financial position marked by consistent revenue & surplus growth. Healthy cash accruals available for further development & low leverage ratios

-Retain its current pool of medical professionals

-Qualified & experienced team of doctors; advanced medical equipments. Source: CARE Recommendations: We may explore supporting the Company in the event it decides to diversify to other locations based on internal due diligence. We may also seek entry by way of equipment finance etc. in the Group.
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Kovai Medical Center & Hospital Ltd.

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Brief Background
-Coimbatore based company engaged in providing healthcare services. -Promoted by Dr Nalla Palaniswami and his wife Dr Thavamani Devi Palaniswami in 1985. -Owns a multi-disciplinary hospital with 481 beds providing advanced health care facilities. -Has 2 satellite centers at Ramnagar, Coimbatore (10 beds) and Erode (65 beds) -Has a subsidiary in Erode Idhayam Hospitals Ltd. which operates another specialty hospital (58 beds)

As on Mar 12 none of the promoters shares were pledged.


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CMIE

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Financials Summary

33 Source:

CMIE

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Strengths Risks - Recommendations


Mitigants -Experience of promoters; supported by qualified & experienced team of doctors Risks -High leverage -Dependence on scarcely available medical professionals -Growing industry competition in the Sensitivity Factors -Ability to grow its patient registration -Successfully achieve & maintain higher occupancy levels

-Hospitals presence

established

brand

-Long & stable operational track record

-Major expansion program is nearing completion; though minor delays in commissioning of the cancer block
Source: CARE

Recommendations: The Company had comfortable liquidity position (WC utilization of ~3% as on Nov 11). It had undertaken expansion with a project cost of ~Rs 267 Cr (D:Rs 226 Cr; E: Rs 41 Cr); where there were minor delays in completion from Jun 11 to Nov 11. The overall gearing & debt/NCA ratios remain significantly high; hence we may explore secured funding to the Company; subject to satisfactory internal due diligences.

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Dr Agarwals Eye Hospital Ltd.

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Brief Background
-Super specialty eye hospital set up in 1994 to offer eye care services. -Family has been in the profession of providing total eye care services for ~5 decades. -It has a network of 29 branches, predominantly in Tamil Nadu and one each in Andhra Pradesh & Rajasthan.

As on Mar 12 none of the promoters shares were pledged; which was at 51.52% as on Mar 11.
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CMIE

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Financials Summary

Source: CMIE
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Strengths Risks - Recommendations


Mitigants -Experience of promoters; supported by qualified & experienced team of doctors -Established brand presence across Tamil Nadu -Availability of latest technology & medical equipment providing comprehensive eye care services -Benefits out of enhanced reach through newly established branches
Source: CARE

Risks -Small size of operations -Dependence on scarcely available medical professionals -Growing industry competition in the

Sensitivity Factors -Ability to grow its patient registration -Improve profitability margins -Ability to retain its team of doctors

Recommendations: The Company has long vintage in the field of eye care and enjoys good brand presence in the local market. However, given the size of operations we may look at an entry opportunity with a small exposure (by way of equipment finance; leasing opportunities etc.)

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Annexures

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Classification of Hospitals
Run by Central Govt., State Govt, and local bodies eg. BMC Hospital, KEM Hospital, Cooper Hospital, Mumbai

Public

Voluntary Ownership Basis

Functions with public/private funds on a non-commercial basis

Private

Owned & operated by individual or group of people as business for profit earning eg. CARE Group

Corporate

Public ltd. cos. formed under Companies Act run commercially & is likely to operate chain of hospitals eg. Apollo, Fortis etc.

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Classification of Hospitals
Staffed by atleast 2 medical officers; provides in-patient accommodation &medical care for more than one category of medical discipline Located in rural areas; provides inpatient accommodation & medical care for more than one category of medical discipline

General

Rural

Specialized Clinical Basis Teaching

Caters to one discipline eg. Dr Agarwals Eye Hospital

A hospital to which a college is attached for medical/dental education eg. AIIMS Delhi

Isolation

Hospitals for care of persons suffering from infectious diseases

Tertiary

Govt. established in their state capitals

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Role of Government
Govt. spending on healthcare has been amongst the lowest in India when compared to similar economies. An increasing contribution is being witnessed in the recent times, though not at the required pace. Important steps taken by the Govt. in the past few years are: efforts to deepen the healthcare reach through insurance schemes, encouraging PPP & fiscal incentives to channel investments into the sector Govt. intends to increase its focus in the next 5 yr plan (2012-17) by increasing healthcare spending from current 1.3% of GDP to ~2.0%-2.5%. These benefits could subsidize part capex & consequently reduce funding requirements.

Lowest spending as compared to BRIC nations and far lower as compared to Global standards
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Source: CRISIL Research

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Regulatory Framework
Union Ministry of Health & Family Welfare: Apex authority for various Central Govt. programs. Also assists State Govt. in healthcare through technical assistance. Ministry also formulates & implements various World Bank assisted projects. State health projects, though implemented through State Govts., the Department of Health assists the States. FDI in India 100% foreign equity participation is permitted Approval is automatic. Examples: Pacific Hospitals, Hyderabad and Columbia Asia Hospital, Bangalore. Accreditation of hospitals

Voluntary process Aids in building community confidence; helps in getting credible & authentic information on services. National Accreditation Board for Hospitals & Healthcare Providers (NABH) has been set up for the purpose. [For complete list of NABH accredited hospitals, click here ] NABH accreditation is compulsory for empanelment under Central Govt. Health Scheme (CGHS) Examples of Hospitals accredited: P D Hinduja Hospital (Mumbai), Max Super Specialty Hospital (New Delhi), Apollo Specialty Hospital (Chennai), Narayana Hrudalaya (Bangalore), Medwin Hospital (Hyderabad)
SECTOR FACTS Cumulative FDI inflow in hospital and diagnostic centers was US$ 1.3 billion during April 2000 to March 2012, according to the latest Department of Industrial Policy & 43Promotion (DIPP) data
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Licenses, Registrations & Approvals

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Source: CRISIL Research

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List of NABH Accredited Hospitals

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Source: NABH

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Source: NABH

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Source: NABH

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Source: NABH

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Source: NABH

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