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Indian healthcare market
The overall economic development and rising population of the country has led the Healthcare sector to become amongst the largest sectors of the Indian economy, both in terms of revenue and employment. Healthcare comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services, and increasing expenditure by public as well private players. In recent years, medical tourism has also emerged as a promising prospect for the industry.
Indias healthcare delivery system is categorised into two major components - public and private. The government, i.e., public healthcare system, comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of Primary Healthcare Centers (PHCs) in rural areas. The private sector provides majority of secondary, tertiary, and quaternary care institutions with major concentration in metros, tier-I, and tier-II cities. Industry is dominated by private sector which contributes ~ 67% of the total hospital facilities.
Industry dominated by private hospitals
Private hospitals growth bounces back, will continue to outpace government hospitals
• Share of private hospitals to increase to nearly 70% by next fiscal on the back of higher growth
• In fiscal 2021, during the first wave of Covid-19share dropped to 58%; however, recovered to 65% thereafter
• Private hospitals to grow at a faster 11-12% between the current and next fiscals vis-?-vis 7-8% for government hospitals
• IPD (in-patient department) share to rise to 72-73% by fiscal 2027 from ~66% in fiscal 2017 Indias competitive advantage lies in its large pool of well-trained medical professionals. India is also cost competitive compared to its peers in Asia and western countries. The cost of surgery in India is about one-tenth of that in the US or Western Europe. The low cost of medical services has resulted in a rise in the countrys medical tourism, attracting patients from across the world. Moreover, India has emerged as a hub for R&D activities for international players due to its relatively low cost of clinical research.
The healthcare market in India has drawn attention more than ever both from public and private service providers post Covid-19 pandemic. It continues to advance at a rapid pace owing to increased coverage, better facilities and greater participation by public and private players.
The growing prevalence of lifestyle diseases, demand for affordable healthcare delivery services and technical advances continue to drive this segment. Moreover, with the advent of telemedicine, accelerated penetration of health insurance and government measures such as e-health, healthcare has become easily accessible for a large majority of the Indian population. Over the past few decades, India witnessed a systematic shift in the healthcare industry as it continued to create more diagnostic centres, nursing homes, hospitals, health clubs, 24*7 pharmacies and blood banks.
With rapid advancements in the medical industry, the quality of clinical care has improved significantly. It has also ensured cost efficiency and made India an attractive medical tourism destination. Many hospitals in India, today, meets international standards and deliver the expertise of highly qualified and trained medical professionals. It continues to boost the countrys reputation as a favoured destination for patients from around the world.
The healthcare industry in India is expected to touch $372 Bn in 20221. Out of the total size of the Healthcare Sector, the Hospital segment carve out an important share i.e.~ 35% contributing ~US$ 130 Bn.
Major Industry Developments
• New medical device policy will be a game changer for industry: The Union Cabinet recently approved the new Medical Device Policy, 2023. This is anticipated to help the medical devices industry to increase from its current $11Bn to $5Bn by 2030. Experts believe that this new policy will reduce the countries reliance on importing high-end medical equipment and can potentially optimize innovations and boost the manufacturing of medical devices within the country. Currently India has about 70 to 80% import dependency on medical devices.
• India emerging as favourable destination to conduct global clinical trials: India has the potential to increase the global clinical trial in the country by 5 times in the coming years. There are significant opportunities for biopharma companies to leverage Indias rich diversity and robust healthcare infrastructure to develop innovative treatments. The total number of investigators have more than doubled in the last three years, with the majority of the increase occurring in the internal medicine and oncology specialisations.
• World bank to support India with $1Bn to boost public health infra: The Government of India and the World Bank have signed two complementary loans of $500Mn each to support and enhance Indias healthcare sector development. This amount will directly support Indias flagship Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), launched in October 2021, to improve the public healthcare infrastructure across the country.
• Center should regulate manufacturing of drugs instead of state bodies, new bill moots: During the ongoing consultations on the draft Medical Devices and Cosmetics Bill, 2023, the think tank of the government, NITI Aayog, endorsed the newly-introduced provision of giving the powers to the CDSCO to issue manufacturing licenses for drugs and cosmetics instead of the state regulators, saying it will ensure uniform and effective implementation of the law and it implies a huge change towards resting all manufacturing duties with a central licensing authority. This new bill seeks to replace the existing Drugs and Cosmetics Act of 1940.
Government policies and initiatives
The Indian government plays a significant role in healthcare funding through effective mobilization of resources. Some of the major initiatives taken by the Government of India to promote the Indian healthcare industry are as follows:
(i) In the Union Budget 2023-24:
(a) the Ministry of Health and Family Welfare has been allocated INR 89,155 crore (US$10.76Bn), an increase of 3.43% compared to INR 86,200.65 crore (US$10.4Bn) in 2021-22.
(b) Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was allocated INR 3,365 crore (US$ 0.41 Bn)
(c) Human Resources for Health and Medical Education was allotted INR 6,500 crore (US$ 780 Mn).
(d) National Health Mission was allotted INR 29,085 crore (US$ 3.51 Bn).
(e) Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was allotted INR 7,200 crore (US$ 870 Mn).
(ii) In July 2022, the World Bank approved a US$ 1 Bn loan towards Indias Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission.
(iii) To promote medical tourism in the country, the government of India is extending the e-medical visa facility to the citizens of 156 countries.
(iv) In May 2022, the Union Government approved grants for five new medical colleges in Gujarat with a grant of INR 190 crore (US$ 23.78 Mn) each. These colleges will come up in Navsari, Porbandar, Rajpipla, Godhra and Morbi.
India has one of the highest shares of out-of-pocket expenditure in healthcare; however, the government aims to increase public healthcare expenditure to 2.5-3% of GDP by 2025 from the current ~2%, as per the National Health Policy.
Expenditure on health by center and state government as % of GDP in India (2017 onwards)
Digital Transformation of Healthcare Sector
Digital transformation has pervaded all facets of society and it has also changed the way healthcare is delivered to a large majority of the population. The governments National Digital Health Mission is expected to augur the digital transformation of the countrys healthcare sector and encourage the development of an interconnected environment that promotes universal healthcare coverage. Artificial Intelligence, Telemedicine, the use of remote technologies and many more systems are being constantly used in the healthcare arena since 2019 and it is expected to increase phenomenally over the next few years.
After the Covid-19 pandemic, telemedicine has emerged as an effective method for consultation. The Indian telemedicine market stood at US$1.3Bn in 2021 which is further forecasted to reach US$7.1Bn in 2026. GOI has promoted various initiatives to boost technology adoption in healthcare system; launched Ayushman Bharat Digital Mission (ABDM) and eSanjeevini, as per the Economic Survey 2020-21, eSanjeevani OPD (a patient-to-doctor teleconsultation system) has registered nearly a Mn consultations since its launch in April 2020. The COVID-19 pandemic has highlighted the importance of technology-enabled networks as a digital delivery mechanism for healthcare services. Given Indias complex struggles to reach out to patients in different parts of the country, technology enabled services can provide a new dimension to the healthcare delivery system in India.
Outlook
Indian healthcare delivery market poised for robust growth in the medium term.
India is a land full of opportunities for players in the medical devices industry. The country has also become one of the leading destinations for high-end diagnostic services with tremendous capital investment for advanced diagnostic facilities, thus catering to a greater proportion of the population. Besides, Indian medical service consumers have become more conscious towards their healthcare upkeep. Rising income levels, an ageing population, growing health awareness and a changing attitude towards preventive healthcare is expected to boost healthcare services demand in the future. Greater penetration of health insurance aided the rise in healthcare spending, a trend likely to intensify in the coming decade.
Breaching pre-covid level in FY22, CRISIL MI&A Research estimates the Indian healthcare delivery industry to post healthy 10-12% compound annual growth rate between fiscals 2022 and 2027, driven by long term structural factors, strong fundamentals, increasing affordability and potential of the Ayushman Bharat scheme.
Healthcare delivery industry to grow 10-12% from FY22 to FY27
With long term structural factors supporting growth, renewed impetus from PMJAY and government focus shifting onto healthcare sector, the healthcare delivery market in India is expected to grow at 10-12% compound annual growth rate (CAGR) and reach INR 8.6 trillion in fiscal 2027.
From fiscal 2018 to fiscal 2022, major hospital chains have added supply (~2-3% of their incremental supply during the period). The supply was largely affected during the covid period as from fiscal 2020 to fiscal 2022, major hospital chains supply was declined by ~1-2%. The government is also expected to augment this via the Ayushman Bharat scheme which aims to create 1,50,000 Health and Wellness centers (~1,54,338 HWCs created till Dec 2022) for strengthening primary & secondary infrastructure in the country. The other contributors to the demand are more structural in nature, like, increase in lifestyle-related ailments, increasing medical tourism, rising incomes and changing demography.
In India, healthcare services are provided by the government and private players, and these entities provide both IPD and OPD services. However, the provision of healthcare services in India is skewed towards the private players (both for IPD and OPD). This is mainly due to the lack of healthcare spending by the government and high burden on the existing state health infrastructure. The share of treatments (in value terms) by the private players is expected to increase from 60% in fiscal 2018 to nearly 70% in fiscal 2027, the share only witnessing a slight dip in fiscal 2021. The skew is more towards the private players owing to the expansion plans of private players being centered on it, further buttressed by increasing reliance on private facilities till government infrastructure is properly put in place.
Oncology
Global Overview
According to World Health Organization (WHO), cancer is growing at an unprecedented rate worldwide and stronger prevention measures are necessary for combating the disease. Cancer is the second major cause of deaths worldwide, accounting for almost 10 Mn deaths per year. The disease is responsible for almost 1 in every 6 deaths around the world2. These recent estimates send a clear message that urgent action is required to prevent its occurrence and improve treatment methods for better cure and care.
The growing rate of population, increasing consumption of tobacco and alcohol, unhealthy eating habits and sedentary lifestyles are some of the major factors contributing to growing incidences of cancer around the world. These factors are also the shared risk factors for various other non-communicable diseases. In many cases, risks of certain cancers increase with age and an ageing population can be a cause of concern for the medical fraternity.
Since 2015, the worldwide oncology/cancer medicines industry has grown at a compound annual growth rate (CAGR) of 9.8 percent, reaching about $167.9Bn in 20193. The oncology drugs industry is projected to shrink by 11 percent in 2020, from $167.9Bn in 2019 to $149.9Bn in 2020. The downturn is mostly attributed to the recent global economic crisis caused by the COVID-19 pandemic.
Patients with cancer are more vulnerable to serious infections, particularly after chemotherapy, stem cell transplants and surgeries. Oncology services have experienced severe implications after the pandemic in 2020. COVID-19 also delayed clinical trials for oncology drugs, production had been suspended in many parts of the world due to the lockdown and this has triggered supply chain issues of massive proportions. However, post successful vaccination drive across the globe, the oncology industry has returned to normalcy.
Strategic partnerships in the oncology drugs industry continues to produce better results. Companies are designing new products and exchanging skills and knowledge to stay afloat in a highly competitive environment. New developments and technological advances in cancer care are also gaining traction. The use of artificial intelligence in research and development and in 3D printing systems to simulate the human body for drug trials and testing have proved to be extreme.
India overview
Cancer is on the rise in India, a pattern that is coinciding with the overall rise in non-communicable diseases (NCDs). Cancer cases are estimated to touch 20 lakhs by 2040, up from about 11.6 lakh in 2018. In 2018, it was reported that Indias cancer prevalence has more than doubled in comparison to the previous 26 years.
While incidences of cancer in India are lower than most Western countries, the sheer size of its population becomes a significant public health burden. In India, cancer is the second leading cause of death. Breast cancer, prostate cancer, oral cancer, gastric cancer, and cervical cancer are the most prevalent cancers affecting the countrys population.
According to the National Cancer Registry Programme (NCRP) Report 2020, published by the ICMR and the National Centre for Disease Informatics and Research in Bengaluru, the number of cancer cases in 2020 was estimated to be 13.9 lakhs and it is projected to increase to 15.7 lakhs by 2025. The report also suggested that females are more prone to cancer than males, with 712,758 cases of cancer reported in females in 2020 and 679,421 in men. Moreover, the results indicate that one in 68 males (lung cancer), one in 29 females (breast cancer), and one in 9 Indians will grow cancer between the ages of 0-74.
While lung, throat, stomach, and esophageal cancers are most common among men, breast and cervix uteri cancers are on the rise among women in India. Incidences of breast cancer have also touched alarming proportions. It continues to affect a larger proportion of women in metropolitan cities such as Hyderabad, Chennai, Bengaluru and Delhi, than in other parts of the country.
In 2022, around 19-20 lakh new cancer cases were estimated to be reported in India. However, real incidence of cancer is conservatively estimated to be 1.5-3 times higher than the reported incidence from cancer registries.
Incidence across countries
India faces a grave challenge of high cancer incidence which is growing at a faster pace as compared to other developing countries.
According to the 2020 WHO ranking on cancer burden, India ranks at the 3rd position after China & USA, respectively, in terms of new yearly cancer incidence being reported.
Based on the historical growth in reported cancer incidence (CAGR of 5% between 2012-16), Indias cancer incidence crude rate is estimated to be 122 per lakh population and age specific incidence (ASR-W*) rate is estimated to be 116 per lakh population in 2020. While the estimated age-specific incidence rate (ASR rate) for India is lower compared to other geographies, Indias real ASR rate is expected to be higher than Thailand and Indonesia, and comparable with China and Brazil (refer Chart below)
Despite the crude rate of incidence not being amongst the highest in India compared to other geographies, the total incidence burden is high due to the large population size of the country. Considering growth in population and crude rate, Indias cancer incidence is estimated to be growing at a CAGR of 6.8% (2015 to 2020) which is significantly higher than other developing countries such as China (1.3%) (which has a comparable population size), Brazil (4.5%) and Indonesia (4.8%) as well as developed countries such as UK (4.4%).
In 2022, around 19 to 20 lakh new cancer cases were estimated to be reported in India. However, the real incidence of cancer is conservatively estimated to be 1.5 to 3 times higher than the reported incidence from cancer registries.
Source: NCRP 2020 Annual report, Global cancer observatory for Brazil, Thailand, US, UK, China and Indonesia
#Estimated incidence considering only population growth and crude rate CACR, without considering impact of changes in risk factors and improvement in diagnosis *ASR-W is a weighted mean of the age-specific incidence rates. The weights are taken from the population distribution of the "world Standard Population defined by WHO, and the estimated incidence rate is expressed per lakh population for comparisons between different geographies.
*CAGR: Compound annual growth rate, measures the annual growth over multiple years by compounding over the time period.
Head and Neck, Gastrointestinal and Lung contributes to 50% incidences in males and Breast, Cervix uteri and Gastrointestinal organs in case of females. Head and Neck, Prostate and Ovarian cancer are growing at a faster pace than other cancers.
• Out of ~14 lakhs Cancer cases in 2016 based on published estimates from national cancer registries, males contributed to 49% (47% in 2012) and females contributed to 51% (53% in 2012).
• Cancers of the Head and Neck and Gastro-intestinal organs constitute 21% and 18% respectively for males and 6% and 11% respectively for females out of the total incidence across the respective genders.
• Cancers of the Head and Neck are growing at highest overall CAGR (12-16) of 23% (CAGR of 25% in males, vs 16% in females). In males, it is followed by Prostate cancer at 19% while in females by ovarian and lung cancer at ~11%.
• Breast cancer is the highest contributor (29%) to total incidence among females in India in 2016 and the incidence has been rising among women at high CAGR of 8% between 2012-16.
• Cervix Uteri, which was one of the top contributing cancers in female (23% in 2012 compared to 11% in 2016) has seen a significant reduction with negative CAGR of 13% (2012-16) driven by screening, awareness programs and preventive measure.
The issue of high disease burden is compounded with late stage detection caused mainly due to lack of awareness and poor screening programs
India has a poor detection rate across major cancer sites with only 29% & 15% of breast and lung cancers being diagnosed in stages 1 & 2, respectively, which is significantly lesser than that in China, UK and US.
Within India, out of the 17 states covered by population-based cancer registries (PBCRs), 13 states exhibit a rising cancer burden
Among all states and UTs covered by population-based cancer registries (PBCRs), Kerala, Mizoram, Tamil Nadu, Karnataka, Punjab, and Assam report the highest overall crude incidence rates of cancers (above 130 cases per lakh population) and have 23% share of the total cancer burden of the country. Tamil Nadu, Karnataka, Punjab, and Maharashtra are the states where the crude incidence rate among females is significantly higher than male cancer incidence. Conversely, for Assam, Meghalaya & Nagaland, the crude incidence among males is much higher than female cancer incidence.
Key state wise projected crude incidence per lakh population (2020) and CAGR trend
| State/UT (No. of Registries) | Crude rate per lakh population | ||
| Overall | Male | Female | |
| Kerala (2) | 181.6 | 188.7 | 175.4 |
| Karnataka (1) | 151.7 | 132.3 | 172.6 |
| Tamil Nadu (1) | 148.6 | 135.4 | 161.5 |
| Punjab (1) | 144.0 | 126.4 | 163.7 |
| Mizoram (1) | 141.7 | 143.5 | 139.9 |
| Assam (3) | 138.6 | 151.6 | 125.8 |
| Delhi (1) | 113.5 | 111.7 | 115.5 |
| Maharashtra (6) | 97.2 | 88.8 | 106.2 |
| Arunachal Pradesh (2) | 94.1 | 91.0 | 97.1 |
| West Bengal (1) | 87.9 | 94.1 | 81.4 |
| Madhya Pradesh (1) | 87.8 | 85.3 | 90.4 |
| Gujarat (1) | 85.8 | 92.6 | 78.2 |
| Meghalaya (1) | 79.5 | 100.7 | 58.4 |
| Sikkim (1) | 70.5 | 67.8 | 73.5 |
| Tripura (1) | 68.5 | 76.7 | 60.0 |
| Nagaland (1) | 68.2 | 74.1 | 61.9 |
| Manipur (1) | 56.2 | 50.8 | 61.6 |
The challenge of rising disease burden is further compounded by poor outcomes compared to global counterparts across all major organ types
While at one hand incidence is rising, the mortality to incidence ratio for different cancer types in India is among the poorest compared to global counterparts. India has sub-optimal mortality to incidence ratio across almost all organ types compared to China, US and UK. Late-stage detection is one of the key factors impacting quality of outcomes in India compared to other countries.
Mortality to Incidence ratio comparison across countries
Advancements in cancer treatment in India
With the rising incidence of cancer in recent years, India has significantly improved the processes for cancer diagnosis and treatment. Recent advancements have also transformed cancer care and has given hope to Mns of people.
• Genomic guided Immunotherapy: Immunotherapy, also known as biologic therapy, is widely used for cancer care and cure. It boosts the bodys natural defence to help combat the disease. The treatment promises much better outcome for the cancer patients.
• Liquid biopsy: The sampling and examination of non-solid biological tissue, usually blood, is known as liquid biopsy or fluid phase biopsy. Its a ground-breaking method for detecting cancer at an early stage and determining the effectiveness of chemotherapy.
• Artificial Intelligence (AI): Recent advancements in artificial intelligence have largely enhanced the efficacy of various treatment methods. AI has helped medical practitioners to predict the effectiveness of cancer immunotherapy and is extremely useful for the diagnosis of different types of cancer.
• Adaptive Radiation Therapy: Through this new technology the treatment is adapted to account for internal anatomical changes as some organs in the body that require radiation therapy can change in size and shape over the days and weeks that a course of treatment can take.
• Multiparametric-magnetic resonance imaging (mp-MRI) and Fluorescence lifetime imaging (FLI): These imaging techniques aid in breast cancer detection. The scan shows signs of proteins that aid the growth of cancer cells and allows doctors to quickly diagnose and decide a clear path for treatment.
India, therefore, stands at the cusp of offering remarkable cancer care through numerous innovative and patient centric treatments. The country has achieved important breakthroughs in cancer research that help better care and treatment of cancer patients. Besides, the use of advanced technology has enabled caregivers to rely on innovative pathways for cancer detection
Fertility
India is the second-most populous country in the world accounting for 17.7% of the worlds population. However, over the past few years, fertility rates have severely declined in India. The fertility rate in 2019 was 2.22 births per woman, a 0.89% fall from 2018. In 2020, the fertility rate further reduced to 2.2 births per woman, a fall of 0.9% from 20194.
Infertility is among the most prominent health issues faced by many young couples around the world. In India too, it has become a grave problem in recent years. Sedentary lives with little or no physical exercise, increasing stress levels, erratic sleep patterns and unhealthy lifestyle choices are some of the major factors causing infertility. As a result, artificial methods of conception have become quite popular in large metros as well as small towns.
Risk factors leading to high prevalence of infertility
PCOS |
PCOS incidence in India reported to range between -4% to 23% |
| Mean global prevalence rate of 5% to 10% | |
Endometrial |
Endometrial TB causes endometrial and tubal damage resulting in infertility |
Tuberculosis |
Prevalence is estimated to be ~18% among infertile women in reproductive age in India vis-?-vis 1% in the USA |
| Prevalence of obesity in men has increased from 17% (2010) to 20% (2014) | |
Obesity |
Increased from 11% (1998) to 25% (2014) in women |
| Tobacco | Tobacco prevalence in India estimated at 17% |
| Approaching the levels of use in the UK (21%) and the US (19%) | |
Alcohol |
Overall alcohol consumption per capita increased from 3.6 liters in 2005 to 4.3 liters in 2010 |
STD |
High prevalence of STDs |
| Estimated to range between 10-34% |
The growing prominence of advanced research has opened up new avenues for infertility treatment in India. It has provided patients with safe and secure solutions including IUI (intrauterine insemination), IVF (in vitro fertilisation), and ICSI (Intracytoplasmic sperm injection). In India, the most common method of treatment is in-vitro fertilization and IVF clinics continue to report a very high number of successful conceptions.
The future of infertility treatment in India relies largely on the adoption of digital methods of treatment. With growing importance of artificial intelligence and machine learning in the field of medicine, infertility treatments are also expected to be remodelled in the coming years. The incorporation of AI in therapeutic Anti-retroviral therapy (ART) opens up promising possibilities in this field. It is not only expected to offer high efficacy rates, but is also anticipated to reduce treatment costs considerably. By processing and analysing more data accurately and in greater detail, AI is anticipated to distinguish high-quality embryos from chromosomally defective ones, a method that is intended to save healthcare practitioners enormous time and effort.
India is witnessing a high burden of infertility, with an estimated 32 to 34 Mn couples in the reproductive age suffering from lifetime infertility in 2021
In 2020, an increase in the proportion of women in the reproductive age (20-44 years), coupled with a skew towards those aged between 30-44 years has resulted in an increase in infertility prevalence
• In 2018, ~70% of live births occurred among married women in the age-group between 20-29 vis-?-vis 83% in 2012
• Fertility rates in women aged 30-49 are significantly lower than that of women aged 20-29 years
• Demographic changes in the population are forecast to increase the percentage of women in the reproductive age (20-44 years) by ~14% between 2010 to 2020
• The increase in the proportion of women is skewed towards those aged 30-44 years, and is forecast to increase by ~20% between 2010 to 2020. This shift is likely to increase the burden of infertility in India by 2020.
• Assuming the marital rate in 2021 is similar to the decadal growth rate observed between 2001 and 2011, the number of couples in reproductive age group (20-44 years) has increased from 193 Mn in 2011 to 231 Mn by 2021 (Source: Census data)
Potential IVF market in 2027: With more infertile couples coming forward for treatment, the IVF market is estimated to grow by ~10-15% to 5-6 lac cycles by 2027. Between FY15 to FY22, share of organized players (corporate IVF chains and large doctor setups) has grown from 25% to ~45-50%; shift in share from un-organized to organized players expected to continue largely driven by increased regularisation of the sector with implementation of ART bill as well as shift in patient preference towards organised players post COVID
Our business
Oncology
The Company is the largest provider of cancer care in India under the "HCG" brand. It owns and operates comprehensive cancer diagnosis and treatment services (through radiation therapy, medical oncology and surgery). As of March 31, 2023, our HCG network consisted of 22 comprehensive cancer centres, including 1 centre in Africa. Each of our comprehensive cancer centres offers, at a single location, comprehensive cancer diagnosis and treatment services (including radiation, medical oncology and surgical treatments). Our freestanding diagnostic centres and our day care chemotherapy centre offer diagnosis and medical oncology services, respectively.
We follow a multidisciplinary approach to cancer care across our HCG network, wherein specialist physicians from various disciplines collaborate to provide the best course of treatment for each patient. This allows us to share and develop best practices, build clinical expertise and adopt standardized protocols for diagnosis and treatment, thereby improving the quality of our cancer care services. We believe that as a result, we are able to better serve our patients and ensure consistent clinical outcomes.
In our HCG network, our specialist physicians adopt a technology- focused approach to diagnosis and treatment. For instance, we use advanced technologies, including molecular pathology and molecular imaging for accurate diagnosis and staging of cancer, which enable us to decide upon the appropriate course of treatment for each patient. We believe that owing to the relationships we enjoy with such medical technology vendors and pharmaceutical and biotechnology companies and our involvement with them in the areas of research and development, we have been able to introduce in India and adopt across our HCG network the latest advances in technology relatively early.
Each of our comprehensive cancer centres offers, at a single location, comprehensive cancer diagnosis and treatment services including radiation, medical oncology and Multidisciplinary approach to cancer care across our HCG network, wherein specialist physicians from various disciplines collaborate to provide the best course of treatment for each patient.
For instance, we were among the first healthcare providers in India to standardize molecular diagnostics technologies, including genomic testing and molecular imaging, including 128 slice PET-CT scans in the diagnosis and staging of cancer, as well as to introduce high intensity flattening filter free mode radiotherapy, stereotactic and radiosurgery and robotic radiosurgery, in the treatment of cancer in India. We were also the first healthcare provider in India to perform computer assisted tumour navigation surgery. We believe this gives us a distinct advantage relative to our competitors in delivering high quality and standardized cancer care to our patients. We also utilize targeted nuclear medicine therapies as well as advanced radiation treatments to minimize side effects and improve the outcome of treatments. By ensuring that we adopt these diagnostic and treatment technologies throughout our HCG network, we are able to provide consistent quality of care to all patients.
Given the large number of patient cases treated across our HCG network, we believe that we are able to efficiently utilize our equipment, technologies and human resources, thereby deriving economies of scale. Furthermore, efficiently utilise our equipment, technologies and human resources, thereby deriving economies of scale.
Through the adoption of a centralised drug and consumables formulary, we are able to lower the overall cost of drugs and consumables. We believe that our business model is scalable and when combined with efficient utilisation of resources, it enables us to operate within a competitive cost structure.
HCG key differentiators :
1) Clinical outcomes a major driver in selecting doctor/ hospital; survival rate a lead indicator of clinical outcome:
A Patient chooses a hospital based on clinical outcomes which are different in different hospitals based on the in-depth practice (specialization, sub-specialisation), research, machines, technology, tools, knowledge sharing, domain expertise and various such factors. One does not decide hospital on basis of multi-speciality or single speciality.
HCG is the largest oncology focused hospital which does extensive research on cancer care which allows it to stay one step ahead compared to other hospitals. Based on the sheer volume that HCG caters our belief is that the clinical outcomes at HCG should be far superior compared to other hospitals when it comes to oncology and has higher success ratio/survival rate matters in case of oncology which is one of the major driving force when it comes to selecting HCG.
2) Sub-specialization is need of the hour: With ever increasing complexity of cancer and need for accurate treatment there are various sub-specializations which have emerged. There are close to 53 different types of cancer each requiring unique treatment & know-how. HCG has highest number of oncologists (400+) in the country with various sub-specialist oncologists which is a determining factor to choose hospital.
3) Largest tumor-board in India: Tumor board is a unique approach whereby group of oncologists meet every week to discuss critical case and decide what treatment needs to be given to a particular patient taking into account various factors. This helps in enhancing the accuracy level and outcome levels are far better. HCG has the largest tumor board in India which is a key differentiating factor in itself.
4) Pioneers of research in India: Very few institutes like HCG and Tata memorial in India are focused on R&D and academics. HCG has been at the forefront of Research and Development when it comes to cancer research. HCG till date has published close to 837 research papers.
5) All modalities under one roof: Most of the multi-speciality hospitals have one department for oncology but they lack comprehensive cancer care centres. HCG has dedicated 21 comprehensive cancer care centres in India which provides all modalities (diagnostics, radiotherapy, medical, surgical oncology) under one roof.
6) Largest gene sequencing in the country (Genomics Lab): HCG has taken a leadership role in genomics-driven tumor boards and gene-profiling. HCG is First in Asia to complete ~105 Clinical runs (1000+patients) of Comprehensive Genomic Profiling (CGP). This has given insights into patient-centric approach, particularly for advanced and recurring tumors, not only from India, but from Africa and Middle East, making HCG a destination for cancer care. This approach helps in better outcome and indirect more patient referrals.
Fertility
BACC Healthcare Private Limited, our wholly owned subsidiary, is the leading provider of fertility treatment under the brand "Milann". It owns and operates comprehensive reproductive medicine services including assisted reproduction, gynaecological endoscopy and fertility preservation. Milann has been Ranked No. 1 in India and first in the South India region continuously for 3 years in the fertility segment in the Times Health All India Critical Care Hospital Ranking Survey 2018. (Source: All India Critical Care Hospital Ranking Survey 2017, All India Critical Care Hospital Ranking Survey 2017, published on Times Health, Times of India on December 16, 2016).
Milann is led by a team of qualified and experienced fertility specialists with successful track record of providing fertility treatments. Our Milann fertility centres provide comprehensive reproductive medicine services, including assisted reproduction, gynaecological endoscopy and fertility preservation; and follow a multidisciplinary and technology focused approach to diagnosis
149 and treatment. Our Milann network also operates on a model similar to our HCG network, wherein the various Milann fertility centres aim to provide medical services following established protocols with a focus on quality medical care across diagnosis and treatment.
This World Cancer Day, Milann and HCG have come together for the digital campaign #PledgeToPreserveFertility to #CloseTheCareGap to raise awareness amongst people diagnosed with cancer. The purpose of the campaign is to educate people so that they can make informed choices to preserve their fertility before they begin cancer treatments.
Precision Diagnostics
Triesta Sciences is an integrated speciality diagnostics vertical of HCG with end to end capabilities in precision medicine through proprietary analytics, clinical research, genomic technologies, assay development and validation and a network of laboratories offering a broad menu of tests.
Triesta Sciences is a one- stop solution for oncology diagnostics, Genomics (Next Generation sequencing based diagnostics), biomarker and translational research, laboratory services, and clinical research services for several hospitals across India with a focus on innovation, quality and accuracy for better diagnosis and prognosis of Cancer.
Triesta offers proprietary data analytical engines for research and clinical applications for genomic testing, and also offers hospital laboratory management services by way of establishing and operating laboratory within the hospital premises. It also provides clinical reference laboratory services in India with specialization in oncology, rare diseases and reproductive health and its offerings include molecular diagnostic services and genomic testing. Triesta central reference laboratory is located in Bengaluru and is accredited by NABL in India, as well as by CAP for quality assurance of laboratory tests performed. Additionally, Triesta offers research and development services to pharmaceutical and biotechnology companies in the areas of clinical trial management and biomarker discovery and validation and is led by a team of specialist onychopathologies, molecular biologists and clinical researchers.
As part of clinical diagnostics, Triesta offers precision tests like Inherited Cancer Risk Analysis, Tumour Mutation Analysis for Precision Treatment, Liquid Biopsy Analysis for Precision Treatment, Response Monitoring, and Early Detection of Relapse, in addition to an entire gambit of traditional tests.
Multispecialty
HCG operates three multi-speciality hospitals, under "HCG" brand in Ahmedabad, and Rajkot, in the state of Gujarat and one in Hubli in the state of Karnataka.
HCG Multispecialty in Ahmedabad, Rajkot and Hubli are tertiary care hospitals with 103, 60 and 118 beds respectively, as of 31 March 2023. These hospitals provide comprehensive inpatient and outpatient treatments. Their key specialties include cardiology, neurology, orthopaedics, gastroenterology, urology, internal medicine and pulmonary and critical care. Suchirayu Health Care Solutions Limited, in Hubli, is a multi-speciality quarternary hospital. With 118 operational beds and capacity to go to 250 beds, the hospital offers state of the art facilities and infrastructure in the region.
Hospital Network
Existing HCG cancer centres in India
As of March 31, 2023, we operate a network of 22 comprehensive cancer centres across nine states in India and 1 centre in Nairobi, Kenya. All of these centres are owned and operated by the Company, with some of the centres in joint-venture with oncologists or healthcare groups where majority ownership is with the Company. The following table sets out our existing comprehensive cancer centres as on the date of this report and their facilities and service offerings:
| Facilities and services | ||||||
Location of the comprehensive cancer centre |
Commencement of operation (calendar year) | Number of beds3 | Number of RT- LINACs | Number of operation theatres7 | Number of PET-CT scanners | Laboratory |
Karnataka Cluster |
||||||
| Bengaluru – double road | 1989 | 48 | 1 | 3 | - | Yes |
| Shimoga1 | 2003 | 47 | 2 | 3 | - | Yes8 |
| Bengaluru- Kalinga Rao road2 | 2006 | 202 | 36 | 5 | 2 | Yes |
| Bengaluru- MS Ramaiah Nagar | 2007 | 33 | 1 | 2 | - | Yes |
| Hubli | 2008 | 32 | 1 | 2 | 1 | Yes8 |
| Gulbarga | 2016 | 42 | 1 | 2 | - | Yes8 |
Gujrat cluster |
||||||
| Ahmedabad 1 | 2012 | 90 | 2 | 5 | 1 | Yes |
| Baroda1 | 2016 | 63 | 1 | 3 | 1 | Yes |
| Bhavnagar | 2018 | 87 | 1 | 3 | - | Yes |
East India cluster |
||||||
| Ranchi | 2008 | 74 | 1 | 3 | 1 | Yes |
| Cuttack | 2008 | 116 | 2 | 3 | 1 | Yes |
| Kolkata 1 | 2019 | 49 | 1 | 2 | 14 | Yes |
Maharashtra cluster |
||||||
| Nashik1 | 2007 | 95 | 1 | 4 | 1 | Yes |
| Borivali1 | 2017 | 63 | 1 | 5 | 1 | Yes |
| Nagpur1 | 2017 | 63 | 1 | 4 | 1 | Yes |
| South Mumbai | 2019 | 25 | 26 | 2 | 1 | Yes |
| Nashik Phase II1 | 2018 | 75 | 2 | 5 | 1 | Yes |
Andhra Pradesh cluster |
||||||
| Vijayawada | 2009 | 875 | 2 | 4 | - | Yes |
| Ongole | 2012 | 325 | 1 | 2 | - | Yes |
| Vishakhapatnam | 2016 | 735 | 1 | 3 | 1 | Yes |
Others |
||||||
| Chennai | 2012 | 5 | 1 | - | - | Yes8 |
| Jaipur | 2018 | 100 | 2 | 2 | - | Yes |
Notes
1. Operated through our Subsidiary.
2. Our comprehensive cancer centre located at Kalinga Rao Road in Bengaluru is our centre of excellence.
3. Number of beds includes ICU beds (as applicable).
4. We utilize PET-CT of our partner.
5. In addition, we have self-care beds of 83, 45 and 28 at our centres in Vijayawada, Ongole and Vizag respectively.
6. Includes a WBRRS system and Cyber Knife.
7. Includes major and minor operation theatres. Major operation theatres are used to perform complex surgeries and minor operation theatres are used to perform minor surgical procedures.
8. Lab services by Partner
As of March 31, 2023, we also had two freestanding diagnostic centres, of which one is located in Chennai and another in Vijayawada. Our freestanding diagnostic centres are equipped with PET-CT scanners and provide radiology and diagnostic services. We established some of these centres under partnership arrangements.
HCG cancer centres under development in India
New Centres
As on the date of this report we are in the process of establishing 1 new cancer Centre in Bangalore which is an extension to our Centre of Excellence and would primarily cater to cancer diagnostics, day-care radiation and chemotherapy services with limited surgical services. In addition, we are expanding our Centre in Ahmedabad with additional beds, OTs and associated facilities.
The table below sets out details of our cancer Centre under development in India as on the date of this report and their facilities and service offerings:
Location of new cancer care centres under development |
Facilities and services | ||||
| Number of beds | Number of RT- LINACs | Number of operation theatres | Number of PET-CT scanners | Laboratory | |
| Bangalore (Whitefield) | 20 | 1 | 2 | 1 | Yes |
| Ahmedabad | 200 | - | 7 | - | - |
Milann centres
The following table sets out our existing Milann fertility centres as of March 31, 2023 and their facilities and service offerings:
Loactions |
Year | Number of Beds | IVF | Endoscopy Operation Theatre | Embryology Labortory | Neonatal ICU |
| Shivananda Circle, Bengaluru | 1989 | 38 | ? | ? | ? | ? |
| Jayanagar, Bengaluru | 2010 | 26 | ? | ? | ? | ? |
| Indiranagar, Bengaluru | 2012 | 6 | ? | ? | ? | - |
| MSR Nagar, Bengaluru | 2015 | 6 | ? | ? | ? | - |
| Delhi | 2016 | 4 | ? | ? | ? | - |
| Chandigarh | 2016 | 3 | ? | ? | ? | - |
| Whitefield, Bengaluru | 2018 | 6 | ? | ? | ? | - |
Milann new centre in Whitefield was launched to strengthen presence and market share in Bengaluru region and has achieved break-even and continued to ramp-up.
Risks and concerns
Risks are integral part of any enterprise. Efficient management of business risks is a key factor that determines growth, profitability and at times, even survival. In the last few years, the healthcare industry in India has been witnessing increased consolidation even among the larger players. Further, Government intervention, by way of an active regulatory regime, be it in terms of price control or capping of margins on medicines has been stepped up. State and Central Healthcare coverage schemes are also impacting industry margins. The risks that might impact our business, prospects, financial condition and results of operations, inter-alia includes:
(a) Our results of operations in any given period can be influenced by a number of factors, many of which are outside of our control and may be difficult to predict, including political and economic conditions, the timing of opening and the number of new centres, changes in the competitive landscape in which we operate, government policies which may affect the pricing of our medical services, the operation of medical equipments, the licensing and operation of our centres and hospitals and the licensing of our medical staff, delays in executing our growth strategies due to a number of factors, delays in project execution resulting in significant time and cost overruns, delays or failure in receiving government approvals, unavailability of human and capital resources, or any other risks that we may or may not have foreseen etc.
(b) The success of our business is dependent on our ability to maintain our relationships with our partners, to identify suitable partners and acquisitions targets and to undertake new partnership arrangements and acquisitions. We may be unable to continue to operate our centres and hospitals if there are any conflicts or disputes with our partners or if our partnership arrangements are not renewed at the end of their respective terms.
(c) Our patients include patients who pay for their medical expenses themselves and patients who are beneficiaries of third-party payer agreements. If we do not receive payments on time from our payers, our financial condition, cash flows and results of operations may be materially and adversely affected. We make provisions for disallowances and doubtful trade receivables in our financial statements on account of the probability of not being able to collect the amounts billed to third party payers, based on our actual experience of disallowances and collection from each category of payers. Provisions for disallowances reduce our revenue from operations and provisions for doubtful trade receivables increase our expenses and thus reduce our profitability.
(d) We face intense competition from other healthcare facilities. If we are unable to compete effectively, our business and results of operations may be materially and adversely affected.
Our ability to effectively compete with our competitors is dependent on our ability to achieve high success rates in diagnosis and treatment and reduce risks and side effects in providing cancer care and fertility treatment, enhance the brand image and marketability of our "HCG" and "Milann" brands, increase new patient registrations across our HCG network, attract and retain specialist physicians, physicians and other skilled persons etc.
(e) We are highly dependent on our promoters, key clinicians, partners and the members of our senior management team, including some who have been with us since the establishment of the first cancer centre in our HCG network, to manage our current operations and to meet future business challenges. The loss of the services of our senior management or key management personnel, including our senior specialist physicians and physicians, or if we are unable to find a suitable replacement for them, could seriously impair our ability to continue to manage and expand our business.
(f) We may not realise the value of our goodwill or other intangible assets. We expect to engage in additional transactions that will result in our recognition of additional goodwill or other intangible assets. We evaluate on a regular basis whether events and circumstances have occurred that indicate that all or a portion of the carrying amount of goodwill or other intangible assets may no longer be recoverable and is therefore impaired. Under the current accounting rules, any determination that impairment has occurred, would require us to write off the impaired portion of our goodwill or the unamortised portion of our intangible assets, resulting in a charge to our earnings. We have written off goodwill in the past, and any future write off could have a material adverse effect on our financial condition and results of operations.
(g) Currently, our Company conducts a portion of its operations through its subsidiaries. Further, a portion of our Companys assets is held by, and a part of its earnings and cash flows is attributable to, our subsidiaries. If earnings from our subsidiaries were to decline, our Companys earnings and cash flows would be materially and adversely affected. We cannot assure you that our subsidiaries will generate sufficient earnings and cash flows to pay dividends or otherwise distribute sufficient funds to enable our Company to meet its obligations, pay interest and expenses or declare dividends.
(h) We rely on the financing arrangements with various banks and financial institutions to bridge the gap between cash flow from operating activities and investing activities (including put options of the partners). We cannot assure that the banks and financial institutions would fund us as per the planned timelines, and this could adversely affect our results of operations and financial condition.
The above risks can be considered as potential threats to the business of the Company. For information on opportunities, please refer to Industry section of the Management Discussion and Analysis Report.
We have revitalised our Risk Management framework with a detailed exercise aimed at a better and updated understanding of all our operational, financial, regulatory and strategic risks. Please refer to the section on Enterprise Risk Management forming part of the Management Discussion and Analysis Report to read more on the Risk Management framework.
Financial and operating highlights
Overview
HCG (the Company) stepped into the Financial Year 2022-23 ("Fiscal Year" or "FY"), after completing some key acquisitions in FY 2021-22. HCG continued to achieve newer heights in FY 2022-23 with highest ever revenue and EBITDA for 9 and 8 quarters consecutively. Along with continued efforts to improve operational efficiency and drive better margins, increased occupancy levels and better capacity utilisation, revenue for FY 2023 grew at 21% over FY 2022 and the adjusted EBITDA margin grew by 139 bps from 17.6% to 18.9%
Overview of key regions
Karnataka cluster
Karnataka cluster had 7 HCG centres during the year, including multispecialty hospital in Hubli. Revenue from Karnataka cluster increased to INR 5,692 Mn in FY 2023 from INR 4,748 Mn in FY 2022 with a 20% YoY growth. Oncology centres registered a growth of 23%, with centre of excellence growing at 27%. Multispecialty centre registered a growth of 5%. Share of Karnataka region as a percentage of total revenues for HCG Centres (excluding Fertility) was at 35% in FY 2023 with only a marginal reduction by 1% from FY 2022.
Revenue growth in FY 2023 is led by surgeries and better case mix which has also helped improve ARPOB. Post COVID recovery, this cluster witnessed a big jump in international revenue.
Gujarat cluster
During the year, Gujarat cluster had 5 operational centres. At a cluster level, revenue grew by 18% from INR 3,518 Mn in FY 2022 to INR 4,163 Mn in FY 2023. Oncology centres grew at 21% and multispecialty centres grew at 12%. Share of Gujarat region as a percentage of total revenues for HCG Centres (excluding Fertility) remains at 26%.
East India cluster
East India cluster had 3 operational centres during the year and revenue increased by 44% in FY 2023 to INR 1,688 Mn from INR 1,168 Mn in FY 2022, with Kolkata growing at 56% driven by medical oncology and Ranchi growing at 64%.
Andhra Pradesh cluster
During the year under review, Andhra Pradesh cluster had 3 operational centres. The revenues of the cluster have shown an increase of 15% to INR 1,204 Mn in FY 2023 from INR 1,047 Mn in FY 2022. We continue to strengthen our position in state of Andhra Pradesh, with continuing focus on improving revenue mix.
Milann Centres
During the year, Milann achieved 13.6% increase in new registrations (from 4,633 in FY 2022 to 5,265 in FY 2023) and 10.8% increase in IVF cycles (from 1,747 cycles in FY 22 to 1,936 cycles in FY 23) resulting in a revenue growth of 7% from INR 621
Mn as of FY 2022 to INR 663 Mn as of FY 2023. Milann continues to be one of the leading IVF brands in India with strong focus on clinical excellence, training and education as well. Lower volume growth during the year is attributed to regulations around surrogacy which has eased out in Karnataka and the volumes are expected to pick up.
Maharashtra
Our centres in Borivali in Mumbai and in Nagpur, both amongst the largest new centres launched in the last few years, are continuing to ramp up in volumes and revenues. South Mumbai centre was fully operationalised in FY 2021 and is one of the most advanced new cancer centres with substantial investment in radiation technology.
Overall Maharashtra cluster clocked revenue of INR 2,408 Mn during FY 2023 as against revenue of INR 2,275 Mn in FY 2022 registering a year-on-year growth of 6%. Excluding vaccination revenue for FY 2022, revenue growth at the cluster level is 15.3%. We continue to strengthen our position and scale, remain extremely positive about this region.
North India
Our new centre in Jaipur registered a revenue growth of 121% by clocking a revenue of INR 757 Mn for FY 2023 as against INR 343 Mn in FY 2022 in-spite of decrease in revenue in the last quarter of FY 2023 due to clinicians statewide protest against the state health bill. Revenue growth in this centre is driven by medical oncology.
Financial Performance
The financial statements of HealthCare Global Enterprises Limited and its subsidiaries (collectively referred to as "HCG" or the Group) and its joint venture are prepared in compliance with the Indian Accounting Standards ("Ind AS") as prescribed under section 133 of the Companies Act, 2013 read with the Companies (Indian Accounting Standards) Rules as amended from time to time.
The discussions herein below relate to consolidated statement of profit and loss for the year ended March 31, 2023, consolidated balance sheet as at March 31, 2023 and the consolidated cash flow statement for the year ended March 31, 2023. The consolidated results are more relevant for understanding the performance of HCG.
In accordance with the Companies (Indian Accounting Standards), Rules, 2015 of the Companies Act, 2013, HCG adopted Indian Accounting Standards (Ind AS) for preparation of its financial statements from April 1, 2016.
Significant accounting policies used for the preparation of the financial statements are disclosed in the notes to the consolidated financial statements for the year ended 31 March 2023.
Particulars |
For the fiscal year ended March 31, 2023 |
Growth vis- a- vis FY 2022 | For the fiscal year ended March 31, 2022 |
||
| (INR In Mn) | % of Revenue. | In % | (INR In Mn) | % of Revenue | |
REVENUE |
|||||
Revenue from operations |
|||||
| Income from medical services | 15,920.81 | 93.23% | 22.25% | 13,022.63 | 92.33% |
| Income from sale of medical and non-medical items | 839.66 | 4.92% | 3.82% | 808.75 | 5.73% |
Other operating revenue including income from government grant |
184.00 | 1.08% | 25.64% | 146.45 | 1.04% |
Total Revenue from Operations including income from government grant |
16,944.37 | 99.23% | 21.22% | 13,977.83 | 99.10% |
| Other income | 131.84 | 0.77% | 4.08% | 126.67 | 0.90% |
Total Revenue |
17,076.31 | 100.00% | 21.07% | 14,104.50 | 100.00% |
EXPENSES |
|||||
| Purchases of stock in trade | 4,323.75 | 25.32% | 19.78% | 3,609.75 | 25.59% |
| (Increase)/ decrease in stock-in-trade | (83.14) | -0.49% | 36.88% | (60.74) | -0.43% |
| Employee benefits expense | 2,751.24 | 16.11% | 17.75% | 2,336.49 | 16.57% |
| Finance costs | 1,035.02 | 6.06% | 5.87% | 977.65 | 6.93% |
| Depreciation and amortization expense | 1,634.73 | 9.57% | 3.28% | 1,582.84 | 11.22% |
| Other expenses | 6,965.73 | 40.79% | 21.94% | 5,712.64 | 40.50% |
Total Expenses |
16,627.33 | 97.37% | 17.44% | 14,158.63 | 100.38% |
Profit/ (loss) before tax and exceptional items and share of loss of an associate/ joint venture |
448.98 | 2.63% | (929.26%) | (54.13) | (0.38%) |
| Exceptional Items | - | 0.00% | 946.1 | 6.71% | |
| Share of (loss) of equity accounted investees | (0.18) | 0.00% | (14.25) | -0.10% | |
| Profit/ (loss) before tax | 448.80 | 2.63% | 877.72 | 6.22% | |
TAX EXPENSE |
|||||
| (1) Current tax | 153.79 | 0.90% | 237.09 | 1.68% | |
| (2) Deferred tax | 118.71 | 0.70% | 251.38 | 1.78% | |
| Net tax expense I (credit) | 272.50 | 1.60% | 488.47 | 3.46% | |
| Profit I (loss) for the year | 176.30 | 1.03% | 389.25 | 2.76% | |
| Share of loss of minority interest | (117.19) | (0.69%) | (148.08) | (1.05%) | |
Net Profit/ (loss) for the year |
293.49 | 1.72% | 537.33 | 3.81% | |
Revenue
Revenue from operations
The revenue from operations (other than other operating revenues) increased by INR 2,929.09 Mn, or by 21.18%, from INR 13,831.38 Mn in Fiscal Year 2022 to INR 16,760.37 Mn in Fiscal Year 2023. The increase is primarily attributable to increased patient footfalls and occupancy in Fiscal Year 2023.
During the Fiscal Year 2023, Our, Karnataka, Gujarat, Maharashtra East India and Andhra Pradesh clusters contributed to a revenue of : (a) Karnataka: INR 5,693 Mn, (b) Gujarat: INR 4,163 Mn, (c) MH: INR 2,408 Mn, (d) East India: INR 1,688 Mn; and (e) Andhra Pradesh: INR 1,204 Mn, respectively. All the centres registered year on year growth in revenues.
Existing centres registered a year-on-year growth of 19%, new centres registered a year-on-year growth of 29%.
Other operating revenues
Our other operating revenues including Govt. grants was INR 184.00 Mn during fiscal year 2022 as compared to INR 146.45 Mn in Fiscal Year 2022. Other operating income primarily consists of income from training, other operational arrangements and the government grant.
Other income
Our other income increased by INR 5.17 Mn, from INR 126.67 Mn to INR 131.84 Mn in Fiscal Year 2023. Increase in other income was primarily on account of Gain on termination of lease and Payables no longer required written-back aggregating to INR 6 Mn.
Expenses
Our total expenses increased by INR 2,468.70 Mn, or by 17.44%, from INR 14,158.63 Mn in Fiscal Year 2022 to INR 16,627.33 Mn in Fiscal Year 2023. Increase in cost of consumption, employment cost and other operating expenses is in line with increase in revenue and operations.
Cost of consumption
Cost of consumption comprises of our expenses related to purchases of medical and non-medical items and changes in inventories of medical and non-medical items. Cost of consumption related to usage of drugs, medical and nonmedical consumable items increased by INR 691.60 Mn, from INR 3,549.01 Mn in Fiscal Year 2022 to INR 4,240.61 Mn in Fiscal Year 2023.
Cost of consumption as a percentage of our total revenue including government grant & other income is 25% for Fiscal Year 2023 and Fiscal Year 2022.
Employee benefits expense
Our employee benefits expense increased by INR 414.75 Mn, or by 17.75%, from INR 2,336.49 Mn in Fiscal Year 2022 to INR 2,751.24 Mn in Fiscal Year 2023. This increase in Fiscal Year 2023 is attributed to increase in head count due to increase in volume of operations, increments during the year and higher performance payouts. Further, the diagnostic and clinical research management business acquired from Strand Life Sciences and acquisition of majority stake in Suchirayu Health Care Solutions Limited impacted primarily in the second half of Fiscal year 2022.
Finance costs
Our finance costs increased by INR 57.37 Mn, or by 5.87%, from INR 977.65 Mn in Fiscal Year 2022 to INR 1,035.02 Mn in Fiscal Year 2023. This marginal increase is primarily due to increased rate of interest as compared to previous year.
Depreciation and amortisation expense
Our depreciation and amortisation expense increased by INR 51.89 Mn, or by 3.28%, from INR 1,582.84 Mn in Fiscal Year 2022 to INR 1,634.73 Mn in Fiscal Year 2023. Such an increase is after factoring the impact of reduction in the expense in Fiscal Year 2023 by INR 56.6 Mn pursuant to revision in the estimated useful life for certain category of its Property, Plant and Equipment with effect from April 1, 2022 based on its technical evaluation.
Increase in expenditure during the Fiscal Year 2023 is due to impact of additions during the current year as well as additions (including assets acquired through business combinations) which primarily impacted later part of the previous year.
Other expenses
Our other expenses increased by INR 1,253.09 Mn, or by 21.94%, from INR 5,712.64 Mn in Fiscal Year 2022 to INR 6,965.73 Mn in Fiscal Year 2023. Increase in other expenses is mainly on account of increased medical consultancy charges in line with increase in revenue and operations, increase in legal and professional fees mainly due to spending towards advisory services for Value Creation Program, repairs and maintenance expenses of medical equipments and IT infrastructure and increase in sales and marketing activity. Overall, the other expenses for 41% of total revenue for both the Fiscal Years.
Profit / (loss) before tax and exceptional items and share of loss of associate/joint venture
Our profit before tax and exceptional items was INR 448.98 Mn in Fiscal Year 2023 as compared to a loss before tax amounting to INR 54.13 Mn in Fiscal Year 2022, as a result of significant revenue growth during the current year.
Exceptional items
There are no exceptional items in the Fiscal Year 2023 at the consolidated level. Exceptional items for the previous Fiscal Year 2022 are explained below:
(a) During the previous year, in accordance with the terms of Share Purchase Agreement dated 3 September 2021, the Company sold its investment in Strand Life Sciences Private Limited (Strand) for a total consideration at fair value of INR 1,577.76 Mn, resulting in a gain of INR 1,419.36 Mn (net of expenses relating to the disposal amounting INR 5.62 Mn and amounts set aside for various contingencies INR 50 Mn).
(b) During the previous year, the company had been engaged in construction of greenfield project at leased premises in Gurugram ("project") since 2017. While the project was initially scheduled to be operational as of 2020, it was delayed due to changes in managements plan on account of operational priorities followed by the outbreak of COVID-19 pandemic. During the budgeting process in the previous year, the Management decided to focus on increasing marketing activities and driving operational efficiencies and further invest in the upgrading and consolidating the existing footprint. As a result, the management decided not to pursue the project. The Company then had about two years of non-cancellable lease of the said premise. Accordingly, the Company recognized impairment charge aggregating to INR 472.45 Mn of assets relating to this project (comprising impairment of CWIP INR 456.46 Mn, right of use asset INR 10.94 Mn and security deposit INR 5.05 Mn) during the previous year ended March 31, 2022, after considering minimum lease payable and other committed costs of the project. Additionally, during the year ended March 31, 2021, the Company had recognised impairment charge of INR 363.01 Mn of assets relating to this project (comprising impairment of CWIP INR 304.02 Mn and capital advances of INR 58.99 Mn).
(c) During the previous year, the group invested INR 330 Mn in the equity shares of Suchirayu Health Care Solutions Limited (Suchirayu) through primary funding, which resulted in increase in the Groups stake in Suchirayu from 17.7% to 78.6%. Suchirayu became subsidiary of the Group with effect from November 18, 2021, considering the Groups voting rights and its majority representation in the Board of Directors which gives it the current ability to unilaterally direct relevant activities of Suchirayu. The Group remeasured its previously held interest in Suchirayu at fair value on the date of acquisition of additional stake and recognised the resultant gain of INR 17.4 Mn, net as an exceptional item in accordance with the applicable Indian Accounting Standard.
(d) During the previous year, the Group refinanced its certain borrowings from banks and financial institutions. On account of this, the Group incurred one-time expenses of INR 75.04 Mn towards foreclosure charges and accelerated amortization of loan processing fees related to earlier borrowings.
(e) During the previous year, the Group settled put option of CDC for US$ 554,600 (INR 41.13 Mn) and acquired its investments in HCG Africa on September 30, 2021. The Group remeasured its previously held equity interest in HCG Africa at its fair valuation on acquisition of the additional stake and recognized the resultant gain of INR 69.84 Mn. Further, the Group reclassified unrealised foreign currency loss previously recognised in OCI to profit or loss amounting INR 7.51 Mn in accordance with the applicable Indian Accounting Standards.
(f) During the previous year, the Group incurred INR 5.5 Mn towards legal and professional fees in respect of acquisition of businesses.
Share of (loss) of equity accounted investees
Our investments in HealthCare Global (Africa) Private Limited, held by HCG (Mauritius) Private Limited was accounted under equity method as per Ind AS 28 ‘Investment in Associates and
Joint Ventures till it was acquired on September 30, 2021, post which it has become a wholly owned subsidiary. Post acquisition of HCG Africa, its investments in Advanced Molecular Imaging Limited, Kenya, through its subsidiary Healthcare Global (Kenya) Private Limited, Kenya is accounted under the equity method as per Ind AS 28 ‘Investment in Associates and Joint Ventures.
Our investments in Strand Life Sciences was accounted under equity method as per Ind AS 28 ‘Investment in Associates and Joint Ventures till it was sold on September 03, 2021.
Accounting of the above investments under equity method till such dates have resulted in loss of INR 14.25 Mn in the previous fiscal year and INR 0.18 Mn during the current fiscal year.
Tax expense
We recorded current tax of INR 153.79 Mn and deferred tax of INR 118.71 Mn in Fiscal Year 2023 as a result of which total tax expense for FY 2023 was INR 272.50 Mn. We recorded current tax of 237.09 Mn and deferred tax of INR 251.38 Mn in Fiscal Year 2022 as a result of which total tax expenses for FY 2022 was INR 488.47 Mn.
Profit / Loss for the year
Our profit after tax before share of loss of non-controlling interest was INR 176.30 Mn in Fiscal Year 2023 as compared to a profit of INR 389.25 Mn in Fiscal Year 2022.
Share of profit/ (loss) of non-controlling interest
Non-controlling interests share of loss was INR (117.19) Mn in Fiscal year 2023 as compared to a loss of INR (148.08) Mn in fiscal year 2022.
Profit/loss for the year attributable to owners of the Company
As a result of the foregoing, our net profit for the year attributable to owners of the Company was INR 293.39 Mn in Fiscal year 2023 as compared to a net profit attributable to owners of the Company amounting to INR 537.33 Mn in Fiscal Year 2022.
Assets
(INR in Mn)
Particulars |
As at 31 March | |
| 2023 | 2022 | |
Non-current assets |
||
| Property, plant, and equipment | 9,718.25 | 9,315.25 |
| Capital work in progress | 181.78 | 217.25 |
| Right-of-use assets | 3,812.71 | 4,045.40 |
| Goodwill | 1,812.34 | 1,812.68 |
| Other intangible assets | 186.73 | 298.03 |
| Investments inequity accounted investees | 28.51 | 30.13 |
Financial assets |
||
| - Investments | 68.38 | 58.03 |
| - Other financial assets | 542.55 | 545.61 |
| Deferred tax assets (net) | 52.74 | 59.57 |
| Income Tax assets (net) | 574.40 | 458.80 |
| Other non-current assets | 378.43 | 331.12 |
Total non-current asset |
17,356.82 | 17,171.87 |
Current Assets |
||
| Inventories | 382.86 | 299.72 |
Financial Assets |
||
| - Trade receivables | 3,025.11 | 2,174.45 |
| - Cash and cash equivalents | 1,746.19 | 1,975.08 |
| - Bank balance other than cash and cash equivalents above | 220.20 | - |
| - Loans receivable | 17.69 | 16.08 |
| - Other financial assets | 72.08 | 341.25 |
| Other current assets | 339.22 | 216.78 |
Total current assets |
5,803.35 | 5,023.36 |
Total assets |
23,160.17 | 22,195.23 |
We had property, plant and equipment amounting to INR 9,718.25 Mn as of March 31, 2023, and INR 9,315.25 Mn as of March 31, 2022. Our property, plant and equipment assets primarily consist of medical equipment, buildings, land, leasehold improvements, furniture and fixtures and vehicles.
Increase in our property, plant and equipment assets is on account of net additions of INR 1,359.19 Mn which is offset by depreciation charge of INR 993.57 Mn during the fiscal year 2023.
Our Capital Work-in-progress, which was INR 217.25 Mn as of March 31, 2022, has decreased to INR 181.78 Mn as of 31 March 2023. There were no projects that were overdue or had exceeded its cost compared to its original plan as at 31 March 2023 and March 31, 2022.
The Right-of use assets increased by INR 109.66 Mn on account of new leases during the year ended March 31, 2023 and further increased by INR 214.20 Mn due to remeasurement of lease liabilities pursuant to change in lease rentals for certain lease premises. The Right-of use assets decreased by INR 530.29 Mn on account of depreciation and further decreased by INR 26.16 Mn due to termination of lease and foreign currency translation adjustments.
We had goodwill amounting to INR 1,812.34 Mn as of March 31, 2023 and INR 1,812.68 Mn as of March 31, 2022. Our goodwill mainly relates to our acquisition of Milann fertility centres, City Cancer Centre in Vijayawada and HCG Medi-Surge Hospitals, Diagnostic business acquired from Strand Life Sciences and our acquisition of controlling interest in Suchirayu Health Care Solutions Limited.
Decrease in our other intangible assets from INR 298.03 Mn as of March 31, 2022 to INR 186.73 Mn as of March 31, 2023 was mainly on account of amortization during the year.
Investments in equity accounted investee relate to investment made in Joint Venture - Advanced Molecular Imaging Limited, Kenya. We had non-current investments of INR 68.38 Mn as of March 31, 2023, and INR 58.03 Mn as of March 31, 2022.
We had other non-current financial assets of INR 542.55 Mn as of March 31, 2023, and INR 545.61 Mn as of March 31, 2022. This primarily comprises of Term Deposits and security deposits.
Our Deferred Tax Assets decreased from INR 59.57 Mn as of March 31, 2022, to INR 52.74 Mn as of March 31, 2023. Our income tax assets increased from INR 458.80 Mn as of March 31, 2022 to INR 574.40 Mn as of March 31, 2023 which is primarily on account of Advance tax and Tax Deducted at Source by our customers, net of tax provisions pending assessments and refunds in our holding company and our subsidiaries.
We had other non-current assets amounting to INR 378.43 Mn and INR 331.12 Mn as at 31 March 2023 and 2022 respectively. The increase is mainly on account of increase in our capital advances by INR 19.40 Mn and INR 20 Mn of advance paid to Radiant Hospital Services Private Limited for the acquisition of its radiation therapy centre, along with its assets located at Sambalpur, Odisha on a slump sale basis.
We had inventories of INR 382.86 Mn and INR 299.72 Mn as of March 31, 2023 and 2022 respectively. Our net trade receivables increased from INR 2,174.45 Mn as of March 31, 2022 to INR 3,025.11 Mn March 31, 2023. Our trade receivables comprise receivables from government payors, corporate bodies, insurers, and patients who pay directly to us.
We had other current financial assets (including Bank balance other than cash and cash equivalents) of INR 292.28 Mn as of March 31, 2023 and INR 341.25 Mn as of March 31, 2022.
We had other current assets of INR 339.22 Mn as of March 31, 2023, and INR 216.78 Mn as of March 31, 2022, which primarily comprised of prepaid expenses, advances to vendors, taxes paid under protest and receivable from revenue authorities.
Liabilities and Indebtedness
Liabilities
The following table sets forth the principal components of our liabilities as at March 31, 2023 and 2022:
Liabilities
(INR in Mn)
Particulars |
As at 31 March | |
| 2023 | 2022 | |
Non-current liabilities |
||
Financial Liabilities: |
||
| - Borrowings | 3,617.41 | 3,628.74 |
| - Lease Liabilities | 4,530.61 | 4,659.04 |
| Provisions | 131.86 | 105.11 |
| Deferred tax liabilities (net) | 123.66 | 12.79 |
| Other non-current liabilities | 359.27 | 254.97 |
Total non-current liabilities |
8,762.81 | 8,660.65 |
Current liabilities |
||
Financial Liabilities: |
||
| - Borrowings | 375.94 | 447.58 |
| - Lease Liabilities | 488.02 | 411.40 |
| - Trade payables | ||
| Total outstanding dues of micro enterprises and small enterprises | 48.94 | 20.23 |
| Total outstanding dues of creditors other than micro enterprises and small enterprises | 2,435.60 | 1,919.18 |
| - Other financial liabilities | 1,403.81 | 935.94 |
| Other Current liabilities | 755.07 | 784.98 |
| Provisions | 171.14 | 172.82 |
| Income tax liabilities (net) | 24.68 | 5.31 |
Total current liabilities |
5,703.20 | 4,697.44 |
Total liabilities |
14,466.01 | 13,358.09 |
A significant portion of our liabilities comprise of non-current borrowings and lease labilities. We had non-current borrowings amounting to INR 3,617.41 Mn and INR 3,628.74 Mn as of March 31, 2023, and 2022 respectively. Non-current lease liabilities amounted to INR 4,530.61 Mn and INR 4,659.04 Mn as of March 31, 2023, and 2022 respectively.
Our other non-current liabilities primarily comprise of Deferred Government grant of INR 359.27 Mn as of 31 March 2023.
We had outstanding trade payables amounting to INR 2,484.54 Mn and INR 1,939.41 Mn as of March 31, 2023, and 2022 respectively. This primarily comprised of payables towards purchase of drugs, consumables, various services including medical consultancy charges, legal and professional fees, housekeeping charges and security charges.
We had other current financial liabilities amounting to INR 1,403.81 Mn and INR 935.94 Mn as of March 31, 2023, and 2022 respectively. These primarily comprised of liability on put options amounting to INR 970.00 Mn and accrued salaries and benefits amounting INR 343.18 Mn.
Our other current liabilities amounted to INR 755.07 Mn and INR 784.98 Mn as of March 31, 2023, and 2022 respectively. This primarily comprised of advance from customers amounting to INR 241.50 Mn and 294.49 Mn and statutory dues amounting to INR 109.78 Mn and INR 104.28 Mn as at March 31, 2023 and 2022 respectively. We also had a contingency provision for custom duty amounting to INR 374.87 as on March 31, 2023 as against INR 357.70 Mn as on March 31, 2022.
Liabilities – borrowings
(INR in Mn)
Particulars |
As at 31 March | |
| 2023 | 2022 | |
Secured loans |
||
| - Term loans from banks | 3,728.17 | 3,660.55 |
| - Term loans from other parties | - | 2.28 |
| - Vehicle Loans | - | 0.70 |
| - Working capital loans (bank overdraft) | 34.37 | 48.18 |
Total secured loans |
3,762.54 | 3,711.71 |
Unsecured loans |
||
| - Deferred payment liabilities | 222.53 | 332.5 |
| - From Other parties | 8.28 | 32.11 |
Total unsecured loans |
230.81 | 364.61 |
Total borrowings |
3,993.35 | 4,076.32 |
To fund our working capital and capital expenditure requirements, we have entered into various loans and facility agreements with various financial institutions. All of our indebtedness outstanding as of March 31, 2023 was denominated in Indian Rupees except for INR 222.53 Mn (US$ and Euro denominated loans) outstanding loans taken from various equipment vendors.
Summary of cash flow statement:
(INR in Mn)
Particulars |
For the fiscal year ended | |
| 31 March 2023 | 31 March 2022 | |
| Net cash generated from operating activities | 2,515.91 | 2,201.24 |
| Net cash generated from / (used in) investing activities | (1,330.32) | 1,245.86 |
| Net cash (used in) financing activities | (1,400.67) | (1,548.85) |
| Net cash flows generated for the year | (215.08) | 1,898.25 |
Cash flow generated from operating activities
For the fiscal year ended March 31, 2023, we had profit before tax of INR 448.80 Mn and our operating profit before working capital changes was INR 3,201.74 Mn. Our cash generated from operations after adjusting for changes in working capital was INR 2,743.06 Mn.
After adjusting for changes in working capital and net income taxes paid amounting to INR 227.15 Mn, our net cashflow generated from operating activities was INR 2,515.91 Mn for the fiscal year ended in March 2023.
Cash flow used in investing activities
For the fiscal year ended March 31, 2023, our net cash outflow in investing activities was INR 1,330.32 Mn, mainly relating to acquisition of property, plant and equipment aggregating INR 1,332.37 Mn. Substantial additions to these relate to plant and medical equipments.
Cash flow used in financing activities
For the fiscal year ended March 31, 2023, our net cash outflow in financing activities was INR 1,400.67 Mn. This includes repayment of lease liabilities and interest thereon aggregating to INR 857.37 Mn and net repayment of loan and interest aggregating to INR 552.16 Mn.
Particulars |
For the fiscal year ended March 31 | |
| 2023 | 2022 | |
Ratio Leverage |
||
| Debt/Equity | 0.46 | 0.46 |
| EBIDT/interest * | 3.01 | 2.56 |
| Ratio Profitability | ||
Operating Profit Margin % ** |
18.26% | 17.76% |
| Net Profit Margin% | 1.74% | 3.90% |
| Return on equity % | 3.39% | 6.90% |
| RoCE % | 8.36% | 10.39% |
Ratios Operations |
||
| Inventory Turnover Ratio | 12.43 | 13.90 |
| Current Ratio | 1.01 | 1.06 |
Ratio - Per Share |
||
| EPS (Diluted) | 2.10 | 3.97 |
| P/E | 124.98 | 67.99 |
| Market Capitalisation/Total Revenue *** | 2.14 | 2.66 |
*EBITDA includes other income
**Operating profits includes other income and income from govt. grants
***Based on closing share price as on 31 March 2023 on NSE
Notes to key ratio:
(i) Return on Equity: PAT/Average Shareholders Equity
(ii) RoCE: EBIT/Capital Employed
(iii) Inventory Turnover Ratio: COGS/ Average Inventory of FY 23 and FY 22
(iv) Current Ratio: Current Assets/ Current Liabilities
(v) EPS: PAT post minority interest/ Nos. of diluted shares outstanding
(vi) P/E: Closing share price as on 31 March 2023, on NSE/EPS
(vii) EBIDTA/Interest: Interest includes Interests on lease liability.
(viii) Net profit margin: Profit / (loss) for the year/ Revenue from operations
Please refer to Note 49 of standalone financial statements for other relevant ratios and explanatory notes.
Credit Rating:
The long-term credit rating of HCG for FY 22 has been upgraded to A (+) by ICRA. (Associate of Moodys Investors services) ‘A Rating for Instruments signifies adequate degree of safety regarding timely servicing of financial obligations. The outlook on the long term rating is Stable.
Internal Control System and Their Adequacy
At HCG, management has the overall responsibility to design, implement and monitor an effective process and control environment that is aligned to the inherent risk profile of the organization. Management is responsible for the identification, evaluation and management of significant risks. The Company has institutionalized a framework to focus on key risks that might impact achievement of business objectives. The framework entails a structured process to identify, assess and monitor the risks and initiate suitable mitigation strategies for effective risk management. The Board monitors exposure to these risks with the assistance of various committees and senior management.
The internal control framework is designed to manage and mitigate the risks faced by the Company. The company has designed and Implemented an entity level control framework setting the control philosophy and principles which guide the organization policy and operating process framework.
The organizational role, responsibility and accountability structures with appropriate performance oversight processes are defined and aligned to provide an enabling environment to the business units and functions to operate as per the design control environment. Review and oversight procedures are designed to monitor effective adherence as per design.
The internal control system commensurate with the nature of business, size and complexity of operations and has been designed to provide reasonable assurance on the achievement of objectives in effectiveness and efficiency of operations, reliability of financial reporting and compliance with applicable laws and regulations.
As a part of overall governance mechanism around financial reporting and as stipulated under the Companies Act, 2013,
Internal Controls over Financial Reporting (ICoFR) framework have been institutionalized. The adequacy and operating effectiveness of the internal controls affecting financial reporting is assessed by the management.
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 Internal Audit function with direct reporting to the Audit and Risk Management Committee of the Board.
The scope and authority of the Internal Audit Function is derived from the Audit Charter approved by the Audit Committee of the Board. 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 and management that a system of internal control is designed and deployed to manage key business risks and is operating effectively
Management provides action plans to address the observations noted from the internal audit reviews and action plans are monitored towards resolution under the supervision and guidance of the Audit Committee.
The Audit Committee reviews the adequacy and effectiveness of the Companys internal control environment and monitors the implementation of internal audit observations
Enterprise Risk Management
HCG operates in a business environment that is characterized by increasing competition and market uncertainties. It is exposed to a number of risks in ordinary course of business. This is inevitable, as there can be no entrepreneurial activity without the acceptance of risks and associated profit opportunities.
Accordingly, risk management activities at HCG are not aimed at eliminating all risks in their entirety, but rather at helping to identify and assess the risks the company encounters in its daily business. This allows the company to manage the risks in an efficient manner to take informed decisions, to exploit the opportunities available and thereby enhance the value of the company and its stake holders.
Risk Management Framework:
The Risk Management framework has been developed and approved by senior management in accordance with the business strategy.
The key elements of the framework include Risk Strategy, Risk Structure, Risk Portfolio, Risk Measuring & Monitoring and Risk Optimizing. The implementation of the framework is supported through criteria for risk assessment and categorization, risk escalation matrix, Risk forms & MIS.
The overall objective of risk management process is to optimize the risk-reward relationship.
Risk Categorization:
Risk Categorization into different buckets help to prioritize risks, within an entity. It assists management in ensuring that they have captured all categories of organizational risks, not just traditional, financial hazards.
The Risk Management Committee of the Board considers a number of factors for risk categorization during risk identification and assessment.
Risk Measuring and Monitoring
A risk review involves the re- examination of all risks recorded on the risk assessment repository to ensure that the current assessments remain valid and review the progress of risk reduction actions.
Risk Communication and Escalation need to be embedded in the culture of an organization to make it effective. At HCG, the Board of Directors drive the Risk Management Process through its Risk Management Committee by adopting the following communication and escalation procedure: Employees continuously identify needs to update / modify the risks and escalate them to their respective Unit / Functional Head.
The respective Unit/ Functional Head or designated personnel collate the identified risks/ modifications and forward the same to the respective Risk Coordinator for collation and escalation to Risk Management Committee. Standard forms for identification/ modification/ deletion of risks are used for this purpose.
The Risk Coordinator collates the risks and forwards the same to the Risk Management Committee on a periodic basis. The Risk Management and Steering Committee (RMSC) is responsible for reviewing and validating the risks/ modifications for all departments. The RMSC categorizes and rates the risks (using the risk appetite). Risk Owners for each risk are identified and approved by RMSC.
Risk Owners may be at any level in the organization depending on the nature and categorization (e.g. strategic, operational, compliance or reporting) of the risk.
Designated Risk Coordinator updates the Risk Assessment Repository on the basis of the approvals obtained from the RMSC.
RSMC, through the Chief Risk Officer, provides half yearly updates to the Chairman & Board of Directors for key risks, their assessment and status of action plans for mitigating these risks.
The escalation of key risk information will assist in ensuring that significant risks identified at the line level are available for consideration in the context of the overall operations of the business.
Risk Management Organization
A robust organizational structure for managing and reporting risks is a prerequisite for an effective risk management process. The organization structure needs to be supported by clearly defined non - overlapping roles and responsibilities which are communicated and understood.
In order to ensure that this policy is followed in letter and spirit, a Risk Management and Steering Committee (RMSC) is constituted comprising of Key personnel nominated from the following departments:
• Operations
• Finance
• Compliance
• Legal
• Procurement & Pharmacy
• IT
• HR
Quality Control and Audit
Monitoring the quality of our patient care is one of our prominent focus. We take action to identify and eliminate the recurrence of any expected or adverse incidents. As part of that, we embrace patient feedback, self-examination and peer review. We use these benchmarks to help us deliver high quality patient care in a safe environment and look at ways to continually improve our patient experience.
We review and publish our inpatient services performance against a number of important measures including hygiene, infection rate and patient satisfaction. We use these benchmarks to help us deliver high quality patient care in a safe environment and look at ways to continually improve our patient experience.
We are subject to various internal and external audits, incident reporting and feedback monitoring processes. Internal audits are carried out by members of our staff at each cancer centre on a half-yearly basis. Our internal audits are based on standard requirements set out by NABH and may impose corrective and preventive actions, as necessary, for any non-compliance with such requirements. The quality department of each cancer centre reviews all feedback received from patients daily and takes measures to appropriately address such feedback. Incident reports are collected and analysed by the quality departments weekly and appropriate remedial measures are undertaken.
External audits are carried out by NABH at our centre of excellence in Bengaluru and at HMS. External audits by NABL and CAP had been carried out at Triesta central reference laboratory. External audits by NABH, NABL and CAP are based on the standards set out by these bodies and are voluntary. The external accrediting bodies also set out certain quality standards, which are monitored by our internal quality departments and a monthly report of quality indicators is presented to our corporate quality team, which oversees the quality functions of our Company. Further, our internal quality teams document the policies and procedures mandated by the accrediting bodies. The accrediting bodies verify these policies and procedures. Our corporate quality team also develops specific quality indicators to monitor clinical outcomes based on documented clinical procedures.
In addition to the above, HCG has also developed case specific clinical protocols for the majority of the oncology cases that we see in the HCG Network. This standardization has helped us in achieving optimum level of care in all units without having to compromise.
Each cancer centre also has other committees which are responsible for quality control, such as hospital infection control committees, pharmacy and therapeutics committees, employee grievances committees and ethics committees.
From time to time, AERB also conducts audits at our cancer centres relating to quality assurance of radiation equipment, radiation safety measures taken by our cancer centres, any changes in the representations made by our cancer centres while obtaining the AERB approval and the adequacy of the skills and number of manpower and resources at each cancer centre.
We also have a quality management system structured as per the ISO9001:2008 guidelines for quality management systems across our Milann fertility centres. The key quality assurance practices at our Milann fertility centres include standardised treatment and management protocols, service delivery by experts in reproductive medicine, globally accepted medical equipment, regular calibration and maintenance of key equipment, quality control processes such as standardised processes for tests and audits.
Our Milann fertility centres undertake weekly clinical audits aimed at enhancing clinical outcomes, patient safety and care. The clinical audit process reviews and evaluates medical management in line with clinical and scientific best practice standards, clinical success rates, possible causes and courses of action for unsuccessful outcomes, quality metrics for clinical, embryology and laboratory outcomes and policies and action plans for continuous quality improvement.
Employee surveys are carried out twice a year by the human resource departments of each cancer centre and the results of such surveys are shared with the quality departments and the management team of each cancer centre for remedial measures.
Clinical Excellence
Clinical excellence is the core premise around which our healthcare operations are structured. Our Group continues to deliver the highest standards of clinical outcomes across all our business verticals. Our standardised clinical protocols for diagnosis and treatment of cancer patients have allowed us to manage the large volume of patient cases across our HCG network with successful clinical outcomes. The five-year survival rate for breast cancer patients at our HCG network is comparable to U.S. benchmarks. We believe that we are able to attract and retain highly skilled specialist physicians due to our reputation for clinical excellence, our technology-focused approach, the exposure and experience we provide in relation to clinical best practices and the training programmes we offer for their ongoing development. We believe that the abilities and expertise of our team of specialist physicians differentiate us relative to our competitors.
Department of Clinical excellence at HCG has been instrumental in synergizing the clinical functions at all HCG hospitals. This department under quality and strategy aims to improve the quality of clinical care and usher in uniform standards of care across all HCG centres. This has been facilitated through a systematic change in people, process, and function. Credentialing and privileging have been synergized with the functions and quality indicators of each department thereby ushering a sense of accountability. Identifying training needs and skill development has ensured improvement at the people level. At the process level upgradation of medical record departments, registry, implementation of uniform documentation practices across centres, clinical audits and deficiency monitoring has helped set high standards of clinical practice. Mapping our own clinical outcomes and constantly evolving HCG treatment guidelines has paved way for standardization of clinical pathways and improvement in the functioning of the departments. Research leveraged with genomics has ushered in an era of precision medicine at HCG. Biorepository specimens and the accompanying clinical repository is a treasure trove for novel drug targets and discovery. The department of clinical excellence strives towards an improvement in clinical care and health of the patients transcending beyond oncology. The vision is to make peoples lives better than what they had before a cancer diagnosis using caring hands, clinical expertise, and high-end technology.
The Department of Clinical Excellence facilitates:
• Implementation of Uniform documentation standards
• Implementation of Uniform treatment protocols and clinical pathways
• Centralized Cancer registry
• Centralized Biorepository
• R&D activities and Investigator
• Centralized Clinical repository
• Initiated Trials
• Documentation of outcomes
• Development of clinical audit standards across departments
• Developments of clinical forms
Human Resources
The Human Resources (HR) department at HCG is driven by the mission to help HCGians realize their potential – to develop, grow and achieve their purpose, build the right culture and capabilities to enable us to serve our patients and to make HCG the best place to work for passionate, innovative people who want to make a difference.
We believe that we are able to attract and retain highly skilled specialist physicians due to our reputation for clinical excellence, our technology - focused approach, the exposure and experience we provide in relation to clinical best practices and the training programmes we offer for their ongoing development. We believe that the abilities and expertise of our team of specialist physicians differentiate us relative to our competitors. Several of our specialist physicians have received accolades and awards in recognition of their contribution to their respective fields of medicine.
Our senior management team has extensive experience in the management of healthcare businesses. We believe the experience, depth and diversity of our management team, complemented by the clinical expertise and relationship base of our physician Promoter, is a distinct competitive advantage in the complex and rapidly evolving healthcare industry in which we operate.
In order to maintain the quality of care we offer to our patients; our physicians and other medical staff must pursue a rigorous programme of continuing education. We offer a wide range of health education sessions and seminars on-site at our centres and hospitals to our physicians and medical staff, as well as to healthcare professionals outside our network of centres and hospitals. The sessions are led by expert physicians and other healthcare professionals from our network of centres and hospitals, who have first- hand knowledge of the latest clinical developments and research. We believe that these sessions provide an important forum to discuss recent developments to improve patient care and teach our physicians and medical staff new skills. In addition, we believe that they also provide an important opportunity for us to showcase the capabilities of our centres, hospitals and physicians and allow our physicians to grow their referral networks.
We also offer physicians the opportunity to consult with each other on challenging cases and treatments. For example, at our weekly tumour board discussions, we discuss selected complex cases from across our HCG network. This allows knowledge sharing and enables us to develop best practices and protocols which are implemented across our HCG network. We also evaluate the clinical activities of each centre and hospital as part of our annual evaluations to ensure that high quality treatments or services are provided to patients.
Furthermore, we have a dedicated learning and development department, which continuously monitors the learning and development activities and ensures that a high quality of service is provided to our patients, thereby improving patient satisfaction. Our learning and development department provides continuing education for quality improvement to our employees. It identifies areas in which training is required, and develops an employee development plan for each employee, pursuant to which employees are provided various skill enhancement trainings.
At our centre of excellence in Bengaluru, we offer a Diplomate of National Board medical residency programme for radiation oncology, medical oncology and pathology, in affiliation with the National Board of Examination.
In addition, we offer various certificate medical and nursing courses on oncology, a paramedical course on advanced radiotherapy technology, a laboratory research course and various other medical and non-medical courses for our employees.
Our Milann fertility centres also offer a post-graduate fellowship programme in reproductive medicine services to fertility specialists, in affiliation with the National Board of Examination. Additionally, our Milann fertility centres offer training programmes in IVF for fertility specialists and embryologists. We believe that these education and training programmes are critical capabilities that we have and these enable us to develop an in house trained team of specialist physicians.
Forward Looking Statement
Except for the historical information contained herein, statements in this discussion contain contains certain "forward-looking statements". These forward-looking statements generally can be identified by words or phrases such as "aim", "anticipate", "believe", "expect", "estimate", "intend", "objective", "plan", "project", "will", "will continue", "will pursue" or other words or phrases of similar import. Similarly, statements that describe our Companys strategies, objectives, plans or goals are also forward-looking statements. These forward-looking statements involve a number of risks, uncertainties and other factors that could cause actual results to differ materially from those suggested by the forward-looking statements. These risks and uncertainties include, but are not limited to, our ability to successfully implement our strategy, future business plans, our growth and expansion in business, the impact of any acquisitions, our financial capabilities, technological implementation and changes, the actual growth in demand for our services, cash flow projections, our exposure to market risks as well as other general risks applicable to the business or industry.
The Company undertakes no obligation to update forward looking statements to reflect events or circumstances after the date thereof. These discussions and analysis should be read in conjunction with the Companys financial Statements included herein and the notes thereto.
2024, IIFL Securities Ltd. All Rights Reserved
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- No need to issue cheques by investors while subscribing to IPO. Just write the bank account number and sign in the application form to authorise your bank to make payment in case of allotment. No worries for refund as the money remains in investor's account."
www.indiainfoline.com is part of the IIFL Group, a leading financial services player and a diversified NBFC. The site provides comprehensive and real time information on Indian corporates, sectors, financial markets and economy. On the site we feature industry and political leaders, entrepreneurs, and trend setters. The research, personal finance and market tutorial sections are widely followed by students, academia, corporates and investors among others.
Risk Disclosure on Derivatives
- 9 out of 10 individual traders in equity Futures and Options Segment, incurred net losses.
- On an average, loss makers registered net trading loss close to Rs. 50,000.
- Over and above the net trading losses incurred, loss makers expended an additional 28% of net trading losses as transaction costs.
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Copyright © IIFL Securities Ltd. All rights Reserved.
Stock Broker SEBI Regn. No: INZ000164132, PMS SEBI Regn. No: INP000002213, IA SEBI Regn. No: INA000000623, SEBI RA Regn. No: INH000000248
We are ISO 27001:2013 Certified.
This certificate demonstrates that IIFL as an organization has defined and put in place best-practice information security processes.