India Ratings & Research (Ind-Ra) has a stable outlook on the
health care sector and all its rated sector companies for FY15. The
agency believes growth in the sector will continue to be driven by the
wide gap between demand and supply in health care services. Key drivers
for demand are increasing lifestyle-related health problems, the
sector's immunity to economic cycles, improving health insurance
penetration, increasing awareness and disposable income. The sector's
growth is also likely to be boosted by continuing government initiatives
and increasing medical tourism in the country.
The industry is attracting investments towards health services (hospital
beds) and the allied industries such as medical technologies,
diagnostics, etc. Ind-Ra believes a majority of the investments in FY15
will continue to come from the private sector. Revenue of most health
care players will grow 10%-15% yoy in FY15 due to continuous expansion
in the bed capacity. However, the overall profitability of the sector
might be affected due to long break-even period of new capex and high
manpower costs. Ind-Ra believes credit profiles, especially of the
standalone hospitals with recent bed additions, are likely to be
stressed in FY15. However, larger players with multiple hospitals
leading to higher economies of scale would be better placed.
The government has made important contribution to incentivise the
investments in the sector through its insurance schemes, encouraging
investments in public private partnership and also qualifying hospitals
(including medical colleges, paramedical training institutes and
diagnostics centers) for infrastructure lending. These initiatives are
likely to positively impact the occupancy levels and could also mean
better lending terms in the form of concessional interest rates, longer
moratorium and maturity aiding in the capex plans of health care
players. The initiatives could also enhance the credit profiles of
entities, especially in the initial years of the capex when optimum
utilisation is yet to be achieved.
Increasing competitive intensity and high real estate costs involved in
the Tier I cities have shifted the investors' focus towards relatively
lower cost, under-penetrated Tier II and Tier III cities and also towards
asset-light, less capital intensive business models. Ind-Ra believes
certain business models such as single specialty, hub-and-spoke, health
mall and day care/ambulatory services centres will attract investors in
FY15.
What Could Change The Outlook
Consolidation of Operations: Continuous capex in the last few years has
led to a rise in borrowings for many players, impacting their credit
profiles. Consolidation of operations leading to improved credit profile
will be a positive for the sector Timely completion of the planned
expansion along with attaining optimum occupancy rates will also lead to
a positive outlook revision for both the sector and companies.
Reducing the gap between the demand and supply of doctors and medical staff will also be a long-term positive for the sector.
Debt-led Expansions, Commissioning Delays: Continuous debt-led capex,
coupled with delays in commissioning of facilities and stressed
profitability due to low occupancy could affect the outlook negatively.