Over the past year, the global economy has continued to bear the burden of several macroeconomic pressures, impacting various sectors including the healthcare industry. In addition to the impact of the war between Russia and Ukraine, the countries around the world have been affected by supply chain disruptions and rising inflationary pressures. The resurgence of Covid-19 in China has also slowed down growth prospects, while the global economy has witnessed an inflation of 8.7% in CY22. Furthermore, it is expected that inflation will slow down to 7% in CY23 before slowing down to 4.9% in CY24.1 This has put an additional strain on healthcare budgets and affordability, necessitating careful financial management within the industry. A recessionary environment prevailed in Europe and United States too. On the back of rising commodity prices, consumer demand continued to be muted. Alongside, the fragility of the US financial system has come to the fore with the banking crisis in the country and this may have potential ripple effects on the healthcare industry, resulting in changes of funding mechanisms and regulations.
The global economy is expected to grow by 2.8% in 2023 and 3% in 2024. Efforts by the Central banks to tighten monetary policy are also anticipated to ease global inflation.2 This is likely to reduce the price of essential commodities and in turn, reduce the burden on the common man. Overcoming Covid woes, China has ramped up production and is expected to rebound in the near term which is likely to contribute to the recovery of global healthcare supply chains. Besides, emerging and developing economies are anticipated to play an integral role in shaping the way forward for the global economy.
A strong economic recovery has been witnessed across the oil exporting Gulf Cooperation Council (GCC) countries, mostly buoyed by high oil prices. This recovery is expected to have positive implications for the healthcare sector, as increased economic stability and revenue streams can potentially lead to higher healthcare investments and improved access to quality healthcare services. Supporting new supply-demand dynamics, policymakers remain focused on securing energy supplies from this region. As a result, growth prospects for the GCC remain upbeat. Additionally, countries in the GCC are also looking to diversify revenue streams, away from oil exports, to sustain its growth momentum. This provides expansion opportunities for the healthcare sector too. Moreover, the GCC countries are also planning to increase the utilization of renewable energy for electricity generation. They are also aiming to minimise the role of the public sector and enhance private participation in the energy sector to explore growth prospects. The transition towards green energy is expected to lead the transformation towards a low-carbon economy and in turn, enhance GDP growth.3
The economic outlook for the GCC countries remains positive as the countries in this region grew by 2.5% in 2023 and are expected to grow by 3.2% in 2024. The GDP of the GCC would increase to an anticipated US$ 6 trillion by 2050, if they retain the growth momentum. However, the GDP of the GCC nations might increase to approximately US$ 13 trillion by 2050 if they adopt a green growth plan that would aid and speed up their economic diversification. The transition towards sustainable and low-carbon healthcare practices, along with increased investments and private sector participation, can contribute to the growth and development of the healthcare industry, ultimately benefiting the population by providing improved healthcare services and advancing medical innovation. For this, private sector investment would play a leading role in job creation and the adoption of green energy.4
Despite economic weakness witnessed all over the world, the Indian economy remained remarkably resilient and has become one of the fastest growing major economies in the world. According to the second advanced estimate of NSO, the GDP growth for the financial year 2022-2023 has been 7.2%5. Amidst robust domestic demand and improved investor sentiment, the Indian economy is well on track to rebound growth. Formal sector employment rates have improved and business performance of the private sector continue to be encouraging. Besides, the governments concerted efforts to increase capital expenditure has added impetus to economic activity.
In the recently released Union Budget, the government announced a capex of around 10 lakh crore rupees, which amounts to 3.3% of GDP.6 It is expected to crowd-in private investment, increase job opportunities and demand, which will help in enhancing Indias growth. The recent pandemic has also shifted focus on the healthcare industry and investments for improving medical facilities continue to be prioritised. Healthy collection of goods and services tax (GST) and direct tax receipts indicate a positive momentum and it is anticipated to cushion the Indian economy against concerns of a global downturn.
In FY 2023-2024, Indias economic growth is projected at 6.5 percent and effective monetary policies are expected to curb inflation considerably. On the back of rising domestic demand, declining inflation, rising employment rates and strong fiscal policies, the Indian economy is expected to withstand the combined pressures of a tough macroeconomic environment7. Figure 1 depicts the GDP growth of India as compared to the BRIC Nations for the period 1990-2023. In the last eight years (2015-2023), India has been growing at a rate greater than the other nations, making it the most attractive business market for the investors.
Global Healthcare Industry Post-COVID-19
Global healthcare has been irrevocably altered by the COVID-19 pandemic, which has accelerated the adoption of new technology and service delivery methods. At the same time, it has also shown the way in which healthcare systems need to be modified to provide people services in an effective manner. After the pandemic, virtual healthcare has gained momentum. A huge potential awaits the virtual healthcare sector due to the use of advanced technology and growing awareness about the need to avail quality healthcare services. It will allow people to easily connect with experienced doctors and help in better management of various health issues. Emerging technologies like Artificial Intelligence, Blockchain, telehealth and monitoring devices provide continuous update on health and wellbeing. By 2024, nearly 440 million consumer health and wellness wearable devices are expected to be shipped worldwide as medical professionals continue to be more comfortable in using them8. Applications of Artificial Intelligence (AI) are increasingly focusing on numerous aspects of healthcare such as assistance for clinical decisions, prevention, treatment and monitoring of diseases. It is also aiding diagnosis and treatment of various health issues. Besides, the use of advanced technology and innovative methods of doing work have helped healthcare personnel to effectively overcome challenges. The Covid-19 pandemic tested the resilience of healthcare systems around the world. It allowed medical professionals to undertake innovative methods to deliver quality care. In many instances, lack of information affected peoples well-being. These issues were also addressed with online campaigns and virtual sessions. To tackle the requirements of the healthcare sector, the demand for trained and experienced medical specialists is expected to increase manifold in the coming years. However, there will be an estimated shortage of 10 million healthcare workers worldwide by 20309. Climate change has also been one of the biggest health threats for the human race. Whether it is the availability of safe drinking water, fresh air or adequate food supply, people have been impacted due to changes in climatic conditions.
A quarter million more deaths are expected to be caused by malnutrition, malaria, diarrhoea and heat stress between the year 2030 and 2050, in the absence of sustainable and resilient healthcare ecosystems.10 Attributing to the above factors, the average global expenditure on medicine is expected to increase from USD1000 billion in 2023 to USD 2000 billion by the end of 2027 (Figure 2). This surge in spending reflects the increasing demand for healthcare services, advancements in medical research, and the need for innovative therapies and treatments. The evolving healthcare landscape, coupled with the rising burden of chronic diseases and aging populations, is driving the need for greater investment in pharmaceuticals and medical technologies. As countries strive to enhance healthcare access and quality, the expenditure on medicine is poised to play a pivotal role in shaping the future of global healthcare systems. It is imperative for policymakers, healthcare providers, and industry stakeholders to collaborate and develop sustainable strategies that ensure affordability, accessibility, and efficacy in the delivery of medical services and medications. By proactively addressing these challenges, we can pave the way for a healthier and more prosperous future for individuals and communities worldwide.
The health sector demonstrated phenomenal resilience in the face of crisis. From overcoming the Covid-19 pandemic to dealing with novel infections and diseases in different parts of the world, its impact on well-being continues to evolve. Governments and nations have taken stock of healthcare requirements and are heavily investing in upgrading medical facilities. In the years ahead, private as well as public healthcare expenditure is expected to rise. With a proper plan to handle crisis and enhance patient care, the healthcare sector needs to focus on upgrading facilities and improving its care portfolio with technologically advanced methods of treatment and diagnosis.
GCC Healthcare Industry
The GCC healthcare industry has completely evolved after the pandemic. Accelerated digitalization, increased use of data analytics, proactive wellness regulations and increased health awareness has completely changed the dynamics of healthcare and wellness industry. The technology, telecommunications, and consumer industries have seen a flood of investments as a result of disruption and a multidisciplinary approach to innovation. Looking ahead, the healthcare industry is expected to grow at a 6.4% CAGR from 2021 to 2027, reaching US$ 23.6 billion in 2027.11 Currently, the GCC healthcare industry is in transformative phase, transitioning from cure to prevention, due to the growing awareness about health and well-being. Digital transformations have also taken place and governments are focused on investing in smart technologies to transform the healthcare sector. Organizations are developing strategic plans to implement data integration and make use of cross-functional capabilities that will increase their competitive advantage and promote the development of integrated healthcare networks. However, numerous challenges such as shortage of healthcare personnel prevail in the healthcare industry. Moreover, the region is highly reliant on imports. Disruptions in the supply chain may increase global prices. The cost of healthcare services in the GCC region continues to rise because of lack of specialized treatment, dependence on imports and the demand for complex treatments.
To overcome these challenges, the regulatory authorities are encouraging investments from private players through the PPP model. They are also prioritizing investments in technology and is moving towards a value-based care model that places patient care at the centre of their growth strategy.
United Arab Emirates (UAE) Healthcare Industry
UAE, one of the Middle Easts most economically developed and diverse marketplaces, has an excellent healthcare system driven by innovative technologies. The digital healthcare commitment by the countrys government is accelerating the growth of the healthcare industry. For the federal budget 2022-26, the UAE government has allocated Dh4.9 billion (8.4 per cent of the total budget) for healthcare and community protection10. The adoption of smart technologies including Artificial Intelligence and Machine Learning continues to rise. Healthcare service providers are also committed to use new and advanced technologies to ensure service excellence and better treatment for patients. Furthermore, the quick expansion of infrastructure, increasing emphasis on precautionary care and robust policies by the government has played a key role in boosting the sector. The countrys reputation and the liberalising policies by the government is also attracting foreign direct investments from private companies to invest in sectors like home nursing, tele-health, virtual care and many more.
Saudi Arabia Healthcare Industry
In the past few years, technology has become an important part of the kingdoms healthcare system. The power of Artificial Intelligence, metaverse, blockchain and virtual reality is being harnessed to increase the healthcare capabilities as well as quality of operations and medical care in the country. It has made great progress in enhancing its healthcare infrastructure, which is one of the key pillars of its economy.
In 2022, Saudi Arabia established a Health Sector Transformation Programme which aims to ensure continuous development of healthcare services and aims to offer 88% of the population inclusive medical facilities by 2025. The regulatory authorities also plan to invest in the healthcare sector to build resilient and sustainable healthcare models. According to a report published by Mashreq and Frost & Sullivan, a total of US$66.67 billion is planned to be invested in healthcare infrastructure and it is anticipated to increase from the current 40% to 65% by 2030. It aims to privatize 290 hospitals and 2300 primary health centres13.
Qatar Healthcare Industry
Qatar has one of the best healthcare sectors in the world and in the coming years this sector is expected to gain prominence as medical tourism continues to drive the countrys economic diversification strategy. The healthcare industry has experienced tremendous growth and is expected to reach $12 billion by 2024.14 Additionally, investments in the sector is consistent with Qatars desire to create a population that is both physically and psychologically fit, as expressed by the Qatar National Vision 2030s human development pillar. The country, therefore, plans to shore up investments in cutting-edge healthcare infrastructures, facilities and technologies as well as the development and improvement of the current healthcare services.
Oman Healthcare Industry
The Sultanate of Oman has made many attempts to create a robust healthcare ecosystem that is inclusive, sustainable, and extremely flexible to community needs. With a keen focus on the well-being of its people, Omans health vision 2050 aims at creating a well-organised, just, effective, and responsive health system that is based on society principles of social justice and equity. To reduce the public sector healthcare burden, the government is also focused on regulating the private sector to address the healthcare needs of the people. However, there are many challenges in Oman and with significant government policies, the healthcare sector in the country is poised for tremendous growth.
Bahrain Healthcare Industry
Bahrains hospitals and clinics are growing on account of rising demand for specialty treatments. The countrys healthcare system has seen great prospects for more investments due to the growth of general and specialty medicine as well as the development of medical facilities in hospitals. Bahrains healthcare sector is also influencing the healthcare in the Gulf because it has strong foundations, attractive development potential, a strategic position, and promising talent. The governments economic vision for 2030 aims to provide all residents access to quality medical facilities. They are also investing in new technologies and encouraging the private sector to build a sustainable healthcare system.
Growth opportunities in the GCC healthcare industry
Aster DM Healthcare is a leading integrated healthcare services provider operating in multiple countries across the Middle East. The presence of the following factors facilitates growth of our company in the GCC healthcare segment:
• Partnerships and adoption of technology
To address the challenge of low awareness about digital health technology and the high cost of acquiring customers directly, Asters focus is shifting towards B2B2C partnerships. These partnerships between health solution developers and healthcare professionals aim to make specialist medical treatments more accessible and affordable. Effective collaborations with healthcare providers can help raise awareness about the benefits of digital healthcare technologies and improve their adoption among patients.
• Expansion of digital therapeutics
Digital therapeutics is a field that makes use of evidence-based treatments to treat or manage a disease or condition by supplementing or substituting current treatment methods. Chronic illnesses that are commonplace, like diabetes and hypertension, cause considerable pain in people, rob them of years of healthy life, and place a significant financial load on healthcare systems. Expansion of digital therapeutics in the KSA and the UAE could help patients and lessen the strain on healthcare staff by integrating digital therapeutics technologies into patient care, for example to monitor blood sugar levels and dispense insulin. The digital-therapeutics market in KSA and UAE has far from reached its full potential and new service providers can explore opportunities in this segment. There is also less usage of apps in these countries because limited number of solutions are available for patients.
• Medical tourism
Medical tourism has impacted the growth of the healthcare sector in the region but, there remains ample scope for improvement. UAE is one of the fastest growing medical tourism hub in the GCC. There is a huge opportunity for private players to offer quality services as the UAE government continues to extend its support for delivering excellent medical care.
Indian Healthcare Industry
Indias healthcare market has been expanding at a compound annual growth rate (CAGR) of 22% due to factors such as population demographics, a growing middle class, higher earnings, increased health awareness, and an increase in lifestyle disorders. The Indian healthcare market is expected to reach US$ 638 billion by 202515. The rapid expansion in the industry is facilitated by advancements in healthcare coverage and services, as well as rising investments from both public and private entities. Following the Covid-19 pandemic, there has been a heightened emphasis on self-sufficiency within the Indian healthcare system, with a shift in focus towards innovation and research, the manufacturing of pharmaceuticals and medical equipment, the digitalization of health services, equitable access to healthcare solutions, and the promotion of mental health and well-being.
The Indian healthcare industry, with its remarkable diversity, presents numerous opportunities across various sectors of medical care. Stakeholders within the healthcare service provision sector are earnestly scrutinizing novel dynamics and market trends to fuel further growth within the industry. The medical device manufacturing sector, in particular, has identified promising growth potential within India.
Key segments of Indian Healthcare sector Hospitals and Infrastructure
The hospital business in India is rapidly growing sector, fuelled by increasing demand for quality healthcare services and advancements in medical technology. With a large population and rising middle-class, the demand for healthcare facilities has surged, leading to significant investments in the hospital industry. Presence of world-class hospitals and skilled medical professionals has strengthened Indias position as a preferred destination for medical tourism. Superior quality healthcare coupled with low treatment costs in comparison to other countries is benefitting Indian medical tourism, and in turn, has enhanced prospects for the Indian healthcare market. Indian medical tourism market was valued at US$ 2.89 billion in 2020 and is expected to reach US$ 13.42 billion by 202613.
Synergy Between Health Insurance Market Growth and Hospital Expansion in India"
The percentage of the Indian population covered under health insurance has been relatively insignificant. However, there has been a noticeable increase in the number of individuals opting for health insurance over time, indicating a growing demand for health insurance in India. The India health insurance market is expected to grow at a compound annual growth rate of 11.55% from 2023 to 2030 to reach USD 30 billion by 2030 The growth of the health insurance market in India is expected to have a positive impact on hospitals as well. As more individuals opt for health insurance coverage, it will increase their ability to access healthcare service bills, including hospital care. This, in turn, can lead to higher patient footfall and increased revenue for hospitals. With a larger customer base and the assurance of insurance coverage, hospitals may also have more financial stability to invest in advanced medical technologies and infrastructure, further enhancing the quality of healthcare services provided. Overall, the growth of the insurance market presents an opportunity for hospitals to expand their reach and cater to a larger population in need of medical care.
India currently has a $41 billion pharmaceutical market, and by 2030, the market is projected to grow to $130 billion. According to World Trade Organization (WTO), India is the third-largest pharmaceutical market in the world where production costs are around 33 percent lower than in the US. It is believed that pharmaceuticals industry in the country will continue to grow and India is expected to become a pharmaceutical hub16.
In FY 2020, the industry was valued at 21.56 USD bn and is projected to grow at a 12.02% CAGR over the next five years. Because of a rise in internet users and technical improvements, online pharmacy retail channels are predicted to grow at a CAGR of 44.34% between 2022 and 2026. The pharmacy retail market is also divided into generic, over-the-counter, and patented pharmaceuticals based on drug type. Generic medications have the same chemical composition, dose effects, side effects, and administration routes as patented originals17.
Diagnostic service market
The India diagnostic services market achieved a valuation of approximately US$ 14.57 billion in FY22. Further, it is projected that the market will grow at a compound annual growth rate (CAGR) of 11.6% from 2023 to 2032.18 This growth can be attributed to several factors, including the rise in healthcare expenditure, the expanding elderly population, and the mounting prevalence of chronic ailments. In addition to that, advancements in medical technology are expected to contribute to a surge in the demand for diagnostic services.
It provides a range of medical and supportive services to patients in the comfort of their homes. It is a cost effective and efficient way to deliver care to patients who do not require hospitalization. These types of services include skilled nursing, physical therapy and occupational therapy. Home healthcare is currently in a nascent stage in India.
This specialized form of care is designed to cater to individuals who may have chronic conditions, disabilities, or require post-operative care. The home healthcare business is influenced by various factors, such as the size and scale of the company, its geographic presence, the range of services offered, patient demographics, and the overall demand for home healthcare in the market. With the aging population and increasing preference for home-based care, the demand for home healthcare services is on the rise, making it an attractive investment opportunity.
Emerging trends in the healthcare industry Tele-medicine
By bridging the gap between patients and their doctors or carers, telemedicine has profoundly transformed the healthcare sector, and its use will only increase over time. Consequently, it will play a big role in the growth of home healthcare. With the use of healthcare apps, patients and doctors can communicate in real-time and prevent medical emergencies.
Digital Prescription and Health Records
The usage of digital prescriptions are expected to increase significantly due to an emphasis on reducing the use of paper and creating a digital database. The global digital health market was estimated to be worth $96.5 billion in 2020, and by 2028, it is anticipated to rise at a CAGR of 15.1%. Only 14% of doctors were available for virtual consultations in 2016 but, this number increased to 80% in 2022. Unprecedented rates of digital adoption and change is expected to revolutionise the healthcare ecosystem like never before.19
Remote Patient Monitoring and Wearables
Remote patient monitoring helps to increase the effectiveness of healthcare services. By keeping an eye on patients outside the hospital or clinic, doctors are able to monitor patients more effectively and expand the reach of the healthcare system. It is now quite convenient to treat chronic illnesses like heart disease or diabetes with remote monitoring devices. To ensure preventive care, real-time access to data via connected wearable devices can be extremely useful. Access to such data might also encourage changes in unhealthy habits, which can aid in the management of chronic illnesses.
Personalized Medicine and Genomics
Medicines are typically developed on ‘one-size-fits-all basis. The study of DNA, digital twins, and AI have enabled carers to adopt a far more personalized approach, leading to the development of treatments that are tailored to individual needs. Drug companies need to collaborate with hospitals, clinics, and medical specialists to develop specialized medical devices and medications. Based on blood sugar measurements and other specific characteristics, personalized treatment offers recommendations for exercise, diet, and illness management that are customised for each patient.
As major retailers have begun to offer medical services including immunisations, blood testing, and medical checks, retail healthcare is rapidly evolving. Traditionally, only trained professionals, doctors, and other medical staff provided these services in hospitals, clinics, and other healthcare facilities. Compared to traditional healthcare providers, retail healthcare services are much more easily accessible and do not require prior appointments and hence, these services have a huge growth potential in the future.
Government Initiatives in FY23
In the Union Budget 2023-24 the Government of India allocated budgets for various segments of healthcare.
• The Ministry of Health and Family Welfare has been allocated INR 89,155 crores (US$ 10.76 billion)in FY23, an increase of 3.43% compared to INR 86,200.65 crores (US$ 10.4 billion) in 2021-22.
• Allocation of INR 3,365 crores (US$ 0.41 billion) for Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)
• Human Resources for Health and Medical Education was allotted INR 6,500 crores (US$ 780 million).
• Allocation of INR 29,085 crores (US$ 3.51 billion) for National Health Mission
• Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was allotted INR 7,200 crores (US$ 870 million).
• INR 5,156 crores (US$ 675.72 million) was allocated to the newly announced PM-ABHIM to strengthen Indias health infrastructure and improve the countrys primary, secondary and tertiary care services.
In July 2022, the World Bank approved a US$ 1 billion loan towards Indias Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission. Indias government is also making the e-medical visa option available to nationals of 156 countries to encourage medical tourism in the nation. The Union Government authorised funding in May 2022, of INR 190 crores (US$23.78 million), for five new medical colleges that are going to come up in Navsari, Porbandar, Rajpipla, Godhra, and Morbi in Gujarat .20
Challenges for the Indian healthcare industry Lack of infrastructure
For a long time, India has struggled with a lack of well-equipped medical facilities as a result of inadequate infrastructure. Moreover, compared to the current need, the rate of construction for such medical teaching or training facilities is still lower.
Shortage of efficient and trained manpower
The lack of qualified personnel in the medical field, including doctors, nurses, paramedics and primary healthcare workers, continues to be one of the most serious concerns of the domestic healthcare sector.
High out-of-pocket expenditure remains a stress factor
Nearly 30% of Indians, or 42 crore people, do not have a health insurance, according to NITI Aayog, though true estimates are likely to be higher. The majority of Indians must pay out-of-pocket (OOP) in order to receive healthcare services. Numerous expenses, such as those for medical exams, prescription drugs and post-operative care, are mostly not covered by government programmes and commercial health insurance policies.
Rural health infrastructure
Most pharmacies and hospitals are located in urban areas, leaving rural areas underserved. In India, there is little to no emphasis placed on preventative healthcare.
Aster DM Healthcare Limited is one of the largest private healthcare service providers operating in GCC and in India. Established in 1987 by Dr. Azad Moopen, it has grown into an integrated healthcare service provider that offers people the full spectrum of quality care through its network of hospitals, clinics, labs, and pharmacies, providing primary, secondary, tertiary, and quaternary care to all segments of the population. The organization has consistently upheld its 35-year-old mission of delivering high-quality and affordable healthcare, pushing the boundaries of healthcare excellence and creating international standards for patient care.
The Company is headquartered in Dubai, United Arab Emirates and has grown from a single clinic to a healthcare enterprise spread across 885 establishments in 7 countries. Aster has strengthened its reputation as a quality care provider and continues to earn the trust of patients from different parts of the world. Asters portfolio is diverse, including 32 hospitals, 127 clinics, 521 pharmacies, 16 labs and 189 patient experience centres in 7 countries, as of 31st March, 2023. It has over 26,156 dedicated staff including 3,863 doctors and 8,975 nurses committed to ensure service excellence.
• Driving synergies through global networks
Aster provides services through a wide network of hospitals, clinics, and pharmacies throughout the GCC, focusing largely on primary, secondary, and tertiary/quaternary care. Its team of qualified medical professionals also help to sustain its operations in India and the GCC. It has a robust global network in 7 countries and strives to make a positive impact on millions of lives through its top-notch healthcare services.
• Medical Excellence
In order to provide high-quality healthcare to millions of people, Aster DM Healthcare strives for excellence and perfection. It aims to offer affordable healthcare and emphasize on advanced healthcare solutions to deliver patient-centric care. Additionally, it uses innovative technology to further upgrade its care portfolio and has received numerous industry accolades that attest to its constant commitment to quality healthcare.
• Robust and expansive healthcare ecosystem
The company offers holistic healthcare solutions including primary, secondary, tertiary and quaternary care. It follows a de-risked business model to diversify revenues from operations in different countries.
• Experienced team
Over the years, Aster has expanded its range of healthcare services with a group of skilled and experienced medical professionals, effectively led by its top management to provide each patient the finest care possible.
In the GCC region, we are mainly present in the United Arab Emirates, Oman, Qatar, Saudi Arabia, Bahrain and Jordan. We are currently planning the restructuring of our GCC Business.
The Company operates 15 hospitals across the GCC, through two renowned brands - Medcare and Aster. Table 1 provides the details of these facilities in terms of their location, year of acquisition, capacity beds and operational beds.
Table 1: GCC Hospitals Overviewr>
|Commencement or Acquisition year
|Operational Beds (Census)
|Al Raffah Hospital
|Al Raffah Hospital
|Medcare Orthopaedics and Spine Hospital
|Aster Hospital Mankhool
|Medcare Women and Child Hospital
|Aster Hospital Qusais
|Sonapur Dubai, UAE
|Aster Royal Hospital
Aster has the largest clinic network in the UAE, abiding by the highest standards of medical excellence. With affordable services, it aims to improve the quality of life of patients. The Company operates 101clinics in the United Arab Emirates, 6 clinics in Oman, 6 clinics in Qatar, and 2 clinics in Bahrain.
GCC Retail Pharmacies
Aster has a huge pharmacy network of 264 stores, offering customers a wide range of products including nutritional supplements, baby care, personal care, medical devices, rehabilitation products and others.
In India, the company operates mostly in Kerala, Karnataka, Maharashtra, Andhra Pradesh and Telangana and provides medical facilities through hospitals, clinics, pharmacies, labs and patient experience centres.
The companys focus on evidence-based medicine ensures that medical treatments and procedures are supported by the most recent scientific research and best practices, resulting in better patient results. The Centres of Excellence of Aster hospitals are staffed with highly skilled medical personnel who are experts in their respective fields. This comprehensive approach guarantees that patients receive personalized and specialized care. Continuous training and professional development programmes for healthcare professionals guarantee that they are up to date with the newest medical developments and technologies, hence improving overall quality of care. The companys emphasis on patient safety, quality assurance, and adherence to international standards develops a culture of excellence in patient care. Adoption of digital health technologies and platforms improves patient engagement, accessibility, and convenience, resulting in improved healthcare experiences.
The Company operates 17 hospitals in India with an installed bed capacity of 4317 beds, as of March, 2023 and the same has been detailed in Table 2. These hospitals offer a wide range of services including Cardiac, Orthopaedic, Neurology, Oncology and others.
Table 2: India Hospitals Overview
|Commencement or Acquisition year
|Operational Beds (Census)
|Aster MIMS Kozhikode
|Aster MIMS Kottakkal
|Dr. Ramesh Hospital
|Guntur, Andhra Pradesh
|Dr. Ramesh Hospital
|Main Centre, Vijayawada, Andhra Pradesh
|Dr. Ramesh Hospital
|Labbipet, Vijayawada, Andhra Pradesh
|Dr. Ramesh Sanghamitra Hospital
|Ongole, Andhra Pradesh
|Aster MIMS Kannur
|Aster Whitefield Women and Children
|Aster Mother Hospital
|Tirupati, Andhra Pradesh
|Vijayawada, Andhra Pradesh
With the introduction of Aster Lab, Aster DM Healthcare gained more control over diagnostic services, resulting in faster turnaround times and precise test findings. A more simplified and effective patient experience was the result of this integration. In addition to having a sizable presence in Kerala and Karnataka, Aster Labs have made headway in regions like Andhra Pradesh and Maharashtra. The Company shall consider broadening the scope of its diagnostic offerings in order to meet the changing needs of the healthcare industry and accommodate a wider range of medical specializations. The Companys operational performance, which included 189 Patient Experience Centres (PEC), 15 Satellite Labs, and 1 Reference Lab, was successful. Through this network, it was made sure that patients could easily receive diagnostic services in various locations.
Aster DM Healthcare established the Aster Pharmacy business to provide the southern states of India with pharmaceutical and wellness products. The pharmacy division aims to provide accessibility to healthcare products and services by providing items across a variety of markets, including nutrition, baby care, skincare, and home healthcare.
Aster Pharmacy increased the size of its network in FY23, opening 106 locations in Karnataka, 85 in Kerala, 61 in Telangana, and 5 in Andhra Pradesh. The expansion of stores gave the business the ability to serve a bigger client base and offer a variety of services, which helped to improve operational performance.
Omni-channel presence of Aster pharmacy
The Aster Pharmacys omni-channel refers to its thorough strategy for offering services through a variety of channels, including internet platforms, mobile apps, and in-person visits to medical institutions.
The omni-channel allows patients to communicate with Aster DM Healthcare through their preferred channels, improving accessibility and convenience of healthcare services.
The omni-channel approach has contributed to improved revenue generation by:
• Expanding the customer reach: The availability of online appointments, teleconsultations, and health monitoring apps attracts a broader customer base, resulting in increased revenue opportunities.
• Improving patient engagement: The convenience and ease of using digital channels lead to higher patient engagement and satisfaction, increasing loyalty and repeat visits.
• Cost-effective operations: Digital solutions can streamline processes, reduce overhead costs, and optimize resource utilization, contributing to improved efficiency.
The total bed capacity increased from 5,065 beds to 5,756 beds by the end of FY2023. In GCC, the number of beds increased from 1,160 to 1,439. In India, the total number of beds increased from 3,905 to 4,317. The total number of operational beds have increased from 3,822 to 4,418. In India, the total number of operational beds increased YOY from 2,899 to 3,304 and in the GCC, it increased from 923 to 1,114.
On capacity management, we prioritize allocating the appropriate space to each bed based on qualitative operational key metrics. Our focus lies in ensuring that the allocation is optimized to enhance overall operational efficiency and patient experience. By carefully considering the specific needs and requirements of each bed, we strive to provide a conducive environment for quality care delivery. This approach allows us to maximize resource utilization and maintain a high standard of service throughout our facilities.
Hospital Patient Visits
The number of in-patient visits increased from 273,350+ in FY2022 to 326,300+ in FY2023. In GCC, in-patient visits jumped from 90,900+ in FY2022 to 100,600+ in FY2023 and in India it rose from 182,400+ in FY2022 to 225,650+ in FY23. The number of out-patient visits increased from ~4.09 mn in FY2022 to ~4.70 mn in FY2023. In India, the out-patient count increased from ~2.03 mn in FY2022 to ~2.70 mn in FY2023 and in GCC from ~2.06 mn in FY2022 to ~2.01 mn in FY2023.
ALOS (Days) and ARPOB (INR.)
The average length of stay reduced from 3.1 days in FY2022 to 2.9 days in FY2023. Although, for the GCC hospitals, this number stood constant at 1.9 in FY2022 and FY2023, it reduced for the India business from 3.7 in FY2022 to 3.4 in FY2023. The average revenue per occupied bed grew from INR 66,000+ in FY22 to INR 69,550+ in FY2023 for the consolidated business. The numbers showed an increasing trend for both GCC and India Business segment. For GCC, it grew from INR 192,600+ in FY2022 to INR 200,650+ in FY2023 and for India, it increased from INR 33,500+ in FY2022 to INR 36,500+ in the year ended March, 2023.
On the financial performance of Aster for the year 2023, while there has been significant revenue and profit growth in India, the EBITDA growth and percentage was muted. The margins were muted in GCC due to the major expansions leading to early EBITDA loss. At a consolidated level in financial year 2023, we posted a revenue of INR 11,933 crores, an increase of 16% as compared with the last financial year. EBITDA stood at INR 1,565 crores when compared to INR 1,483 crores in financial year 2022, an increase of 6%. The EBITDA growth was impacted due to losses from new hospitals. Adjusted for this loss, EBITDA was INR 1,655 crore, an increase of 11% over the last year. Profit after tax post-NCI stands at INR 425 crores when compared to INR 526 crores in financial year 2022. The impact of new hospitals, including the depreciation and interest costs on account of the capital allocation towards these investments was visible. Profit after tax post-NCI excluding losses from new hospitals and post adjusting for onetime other income is INR 581 crore, a growth of 7%. Figure 3 tabulates the change in key financials from FY2022 to FY2023. Table 3 details the changes in key financials and Table 4 depicts the YOY changes in the financial ratios.
In FY2023, Aster Indias revenue from operations increased from INR 2,384 crores in FY22 to INR 2,983 crores, reflecting a notable growth of 25%. The EBITDA for the India segment also showed a positive trend, increasing from INR 353 crores in FY22 to INR 453 crores, representing a growth of 28%. The profit after tax (post-NCI) improved significantly from INR 60 crores in FY22 to INR 147 crores in FY23, indicating a substantial growth of 146%.
Table 3: Change in Key Financials
|Revenue from Operation (INR Cr.)
|Table 4: Changes in Financial Ratios
|Debtor Turnover Ratio (times)
|Inventory Turnover Ratio (times)
|Interest Coverage Ratio (times)
|Net Debt Equity Ratio
|PAT (Post-NCI) Margin (%)
|Return on Net Worth (%)
GCC Market Expansion
The Company launched the 179 bed Aster Royal Hospital in Muscat, Oman and the 101 bed Aster Hospital in Sharjah in 2022. In Qusais, it plans to open a 126 bed hospital called ‘Aster Royal Hospital by Q4 FY 24. In Qatar, a 60 bed hospital is being planned to be launched at the end of FY 25. In Saudi, we plan to launch a 59 bed Annex Building in the first quarter of FY 24. Aster DM Healthcare is expanding its footprint in Saudi Arabia with the Aster Pharmacy division tie-up with Al Hokair Holding Group. The division, through this partnership, aims to provide pharmaceutical and wellness products across segments such as nutrition, baby care, skincare and home healthcare to the communities in Saud Arabia. The joint venture plans to open and operate pharmacies in high streets, communities and shopping malls, beginning with Riyadh. Our foray into digital health with MyAster has seen significant traction in FY23. We are ranked the #1 free medical app in the UAE, across both App Store and Play Store. We are currently at about 4,00,000+ net downloads in Q4 FY2023, double from what it was in Q3 FY223. Both Consultation and e-Pharmacy services that are live on the platform saw significant growth during this time. This is owing to the improvements that we rolled out on the platform across - smoother appointment booking flows, quicker search, conversion focused product listing and product detail pages - all of which were done based on consumer research and feedback we obtained in our pilot days.
In FY23, about 69,000+ appointments were booked through MyAster. This number has continued to scale since the e-Pharmacy orders, including non-prescription orders, have increased significantly. We are working on improving efficiencies of our rider base using state of the art technology which shall help us to scale the digital orders further without major increase to our cost base.
Aster Pharmacy has entered a strategic partnership with UAEs largest online food delivery and q-commerce platform Talabat to bring prescription medicines directly to the front door of patients in Dubai. Under the strategic pact, Aster Pharmacy customers can upload their medical prescriptions securely and easily through the Talabat app to make prescription medicine purchases, beginning February 1st, 2023. The partnership is designed to save consumers time and money in line with Dubais vision to provide the highest quality of specialized and accessible health care to its community members by pursuing efficiency, appropriate allocation and utilization of resources. It aims to create a complete ecosystem of care that fully utilizes the latest technologies to enhance patient-centred care and help ensure medication adherence compliance in line with Aster DM Healthcares mission to continue to improve accessibility to healthcare.
India Market expansion
• The number of hospital patient visits increased from 182,400+ in FY22 to 225,650+ in FY23, reflecting the growing demand for Asters healthcare services.
• In India, the total number of beds increased from 3,905 to 4,317 operational beds increased YOY from 2,899 to 3,304.
• The average length of stay (ALOS) for patients reduced from 3.7 days in FY22 to 3.4 days in FY23, indicating improved efficiency in patient care.
• Aster India expanded its pharmacy network, reaching a milestone of 106 stores in Karnataka, 85 stores in Kerala, 61 stores in Telangana, and 5 stores in Andhra Pradesh by the end of FY23.
• Aster Labs increased its foot prints to 189 Patient Experience Centres (PEC), 15 Satellite Labs, and 1 Reference Lab.
Key Strategies that contributed to the Success of Aster India during FY23:
• Expansion Strategy: Aster India focused on expanding its hospital, clinic, and pharmacy network in key states like Kerala, Karnataka, Maharashtra, Andhra Pradesh, and Telangana. This strategy allowed the company to reach a broader patient base and serve more communities.
• Patient-Centric Care: The emphasis on evidence-based medicine, multidisciplinary collaboration, and personalized treatment plans ensured that patients received high-quality healthcare services, leading to positive patient experiences and loyalty.
• Digital Innovation: The introduction of digital platform, allowed patients to access healthcare services through various digital channels, improving accessibility and convenience for patients.
• Quality Assurance: Aster India prioritized patient safety and quality assurance, adhering to international standards and implementing rigorous protocols and continuous monitoring in its healthcare facilities.
• Talent Development: Investments in the professional development of employees, including doctors, nurses, and other healthcare workers, ensured a skilled and competent workforce capable of delivering clinical excellence.
The company priorities its human resources and aims to strengthen its people policies. In order to maintain a competitive edge, it continually makes investments in the professional development of employees. Aster consistently offers its staff high-quality training to make them future-ready and equipped to handle advanced medical procedures. As of March 31, 2023, the Company has a workforce of 30,330 including 3,863 doctors, 8,975 nurses, 13,318 other healthcare workers and 4,174 outsourced staff.
Risk management is the set of methods by which companies evaluate potential losses and take action to reduce or eliminate such threats. Risks are inevitable to any business activity. Risks and controls are key components of our Companys Enterprise Risk Management (ERM) protocol. Our Risk Management framework is robust that helps us proactively identify potential risks, analyze them, and take measures to reduce/mitigate the risk. This facilitates us to set up procedures to avoid the risk, minimize its impact, or at the very least help cope with its impact. Essentially, the goal of risk management is to identify potential problems before they occur and have a plan for addressing them. Our Risk Management includes internal and external risks that could negatively impact our organization and we have a strong regulatory framework for timely identification and mitigation of such risks.
Since the inception of the ERM team, there were several risk initiatives driven across the organization, thereby adding value to the business. These include: -
Risk Identification and Assessment Process
• Carrying out Board Risk identification workshop to gain insights into risks and opportunities from a top-down approach.
• Surveying top 100 employees of the organization to discuss and challenge critical thinking around risks developing a more nuanced understanding of risks at the organization and helping eradicate siloed thinking.
• Preparation and drafting of the Risk registers for the business along with assessment of each risk and review of controls for Hospitals, Clinics, Retail and Homecare businesses.
• Discussing the top risks with the Business leaders, challenging where appropriate and updating these for reporting to the Risk Committee
• Discussing risks and controls monthly with the Executive Directors, CEOs, and COOs across various business verticals to identify emerging risks, optimize assurance efforts and report risk interconnectivity.
Scenario workshop Sessions- Crisis Management
Conducted multiple Crisis Simulation scenario workshop sessions with Business Leaders and Department Heads focused on the unique executive-level decision-making and communication strategies that are critical to any crisis response.
Risk Awareness Sessions
Imparting risk and compliance awareness sessions across various teams to increase understanding of risks and familiarizing teams with risk assessments and control activity via new joinee induction and Biweekly newsletter named ‘Risky Times.
• Implementation of ESG Risk framework and policy to monitor and mitigate any ESG risks.
• Detailed SOPs and templates drafted and approved for ESG reporting across Energy, Water, Emissions, Environmental Compliance, and Employment.
• Carrying out a stakeholder engagement process (both internal and external) via a survey to ascertain ESG Material topics to guide our ESG reporting and disclosures and to ensure transparency into ESG issues of greatest importance to the organization. The results of the survey are used for our ESG Materiality Assessment.
Embedding of a Risk acceptance process with monthly reporting to the Chairman and Deputy Managing Director.
Embedding of a Risk events process with an escalation matrix for all High, Medium and Low events with appropriate reporting to the Chairman and Deputy Managing Director.
Implementation and successful certification of the ‘Abu Dhabi Health Information and Cyber Security (ADHICS) regulatory compliance which Healthcare facilities are required to meet the standard requirements to integrate within the new Malaffi system. The standard is mandatory for licensing healthcare practitioners and facilities.
• Implementation and successful certification of the ISO 9001-2015 Quality Management Systems standard for Aster Retail demonstrating our ability to consistently provide services that meet customer and regulatory requirements.
Enclosed below, in Table 5, is a summary of the top risks for Aster DM Healthcare as agreed and approved at the Executive Risk Committee along with the potential impact, appetite, and our mitigation strategies.
|Information and Data Security Risks
|At Aster, we maintain a low-risk appetite when it comes to security breach involving the compromise of confidential data that could impact our patients, customers, employees, or shareholders, as well as proprietary information. We recognize that such breach can lead to regulatory notifications, financial penalties, legal liabilities, and damage to our reputation.
|The organisation remains committed to its IT transformation strategy to ensure the robustness of systems across the landscape. Several IT controls are in place to ensure that patient data isnt compromised. Engaged with third party agencies for enhancement of overall security posture of the organization. Ongoing vendor due diligence in place to review data security and privacy risks before onboarding suppliers.
|The growth of the Company is highly dependent on its ability to acquire a talented workforce. The expertise and engagement of employees drives organisational success. Inability to acquire such talent can significantly impact the companys operations. As our largest area of expenditure, we have a medium risk appetite for pursuing outcomes that lead to more efficient and economic people outcomes.
|The Company continuously works to improve its work environment to retain a pool of trained medical and non-medical professionals with a low- risk appetite for any deviation from the Aster Code of Conduct and ethical Governance standards.
|Legal and Compliance Risks
|With its vast network in seven countries, the Company provides services within highly regulated environments and must meet high level of compliance and legal expectations from regulatory bodies. Failure to comply with regulations could lead to legal consequences and/or regulatory censure and we have a low-risk appetite for the same.
|Aster constantly keeps track of regulatory frameworks in different countries and implements them within the stipulated timelines within the business. All permits are renewed in countries where it operates. The Company abides by all laws and regulations set by various Governments, ensuring smooth and seamless operations across geographies.
|With its widespread operations the company expects strong internal controls to be maintained which ensures compliance with governance and accounting principles in line with the credit risk policy. We have no tolerance for risks that may lead to fraud or financial misconduct leading to brand and reputational damage, decreased revenue and/ or market share.
|The company has created a Centre of Excellence for Revenue Cycle Management (RCM) aiming for better payer relationship and uniformity. There is an increased focus on Medical Value travel, rejection control, digitalization, consolidation, offshoring, and other cost controlling initiatives. All deviations from our code of conduct and ethical governance standards are investigated and mitigated accordingly.
|Disaster management plan and emergency response plans as per the emergency codes available for all our facilities. The company is taking adequate measures to backup business applications and systems thereby reducing instances of data losses.
|Business Continuity and Resilience Risk
|Healthcare providers need to ensure that patients/ customers can always avail their services. The Company has Business continuity strategy ensuring that even during incidents we continue to operate critical businesses with a predetermined recovery time. Failure to do so would cause an impact on our business operations adversely affecting our patients, resulting in loss, or declined revenue and/or brand and reputation damage.
|Crisis Simulation scenario workshop sessions with Business Leaders and Department Heads conducted focussing on the unique executive-level decision-making and communication strategies that are critical to any crisis response.
|Clinical and Patient Health and Safety Risks
|Healthcare providers must follow stipulated norms for meeting quality and safety standards. Failure to do so could cause patient harm and may have an impact on patient care and impact the future of the Company.
|Aster DM continuously strives to deliver quality care to achieve desired results by following evidence based clinical practise guidelines. Patient safety and advanced medical care are, therefore, a priority for the Company.
|The Company accepts that some level of reputational risk is inherent in all our activities which include the effect of factors such as regulatory intervention, employee conduct, human resource practices, information security and patient experience. Negative perceptions by patients, staff or other stakeholders may jeopardize the Groups credibility and impede the achievement of delivering our strategic objectives.
|Aster operates within three brands namely, Aster Medcare and Access. The brand value and reputation of the organization has grown tremendous in the last 30 years since it began operations. Several brand and marketing strategies are in place and social media listening tools and ORM practices have been deployed to monitor events both internal and external that could pose a reputational risk.
|Strategic, Transformation and Innovation Risks
|Technology is changing every day and it is critical for the Company to stay up to date with new and updated innovations in the industry. Insufficient embrace of digital capabilities may not meet performance expectations related to quality, cost, and innovation as well as our new digitally born competitors with hyper scalable business model and low cost of operations.
|Aster adopts new and emerging technology regularly to provide superior quality patient- centric care. The organisation has state-of-the-art equipment to aid complex treatments and deliver excellent care to each one of its patients.
|Competition and Market Share Risks
|The healthcare sector is dynamic and growing demand for healthcare continues to attract more players to the industry. As a result, inadequate competitive strategies may deteriorate the companys value proposition which can result in reduced brand value and loss of customers and patients.
|With over 30 years of industry experience, the Company has a vigorous business model that lends it a competitive edge over its peers. To leverage industry trends and prevailing technology stack, an external partner has been engaged as the implementation partners with a clear governance mechanism established reporting into the Steering Committee.
|Vendor and Supply Chain Management Risks
|The company works with numerous suppliers who provide services to ensure we have a smooth business operation. We recognize that optimizing our supply chain and enhancing its sustainability as a key element in achieving our strategic aims. Failure to do so could have an impact on clinical quality and lead to inability in delivering quality services to our patients/customers.
|The company has obtained a CIPS certification for Procurement Ethics Compliance for the Group Supply Chain Management. ERP rollout for verticals in a phased manner is underway. Also, introduction of an E-capex platform would further strengthen the overall Vendor and Supply Chain management process.
Internal Control System and their adequacy
The Management has laid down internal financial controls to be followed by the Company. The Company has adopted policies and procedures for ensuring orderly and efficient conduct of the business, including adherence to the Companys policies, the safeguarding of its assets, the prevention and detection of frauds and errors, the accuracy and completeness of the accounting records, and the timely preparationofreliablefinancialdisclosures
.Theinternalcontrolsystem is commensurate with the nature of business, size and complexity of operations and has been designed to provide reasonable assurance on the achievement of objectives, effectiveness and efficiency of operations, reliability of financial reporting and compliance with applicable laws and regulations. As part of the Corporate Governance Report, CFO certification is provided, for assurance on the existence of effective internal control systems and procedures in the Company. The internal control framework is supplemented with an internal audit program that provides an independent view of the efficacy and effectiveness of the process and control environment and supports a continuous improvement program.
The internal audit program is managed by an in-house internal audit function and by Grant Thornton Bharat LLP, external firm. The Audit Committee of the Board oversees the internal audit function. The Audit Committee is regularly apprised by the internal auditors through various reports and presentations. The scope and authority of the internal audit function is derived from the audit charter approved by the Audit Committee. The internal audit function develops an internal audit plan to assess control design and operating effectiveness, as per the risk assessment methodology. The internal audit function provides assurance to the Board that a system of internal control is designed and deployed to manage key business risks and is operating effectively.
Certain statements in the Management Discussion and Analysis section concerning future prospects may be forward-looking statements which involve several underlying identified / non identified risks and uncertainties that could cause actual results to differ materially. Besides the foregoing changes in the macro environment, some unprecedented challenges may pose an unforeseen, unprecedented, unascertainable and constantly evolving risk(s), inter alia, to the Company and the environment in which it operates. The results of these assumptions made, relying on available internal and external information, are the basis for determining certain facts and figures stated in the report. Since the factors underlying these assumptions are subject to change over time, the estimates on which they are based are also subject to change accordingly. These forward-looking statements represent only the Companys current intentions, beliefs or expectations, and any forward-looking statement speaks only as of the date on which it was made. The Company assumes no obligation to revise or update any forward-looking statements, whether because of new information, future events, or otherwise.