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Aster DM Healthcare Ltd>
  • CMP : 369.0 Chg : -14.40 (-3.76%)
  • Target : 270.0 (39.90%)
  • Target Period : 12-18 Month

25 May 2022

GCC normalises; expanding India presence…

About The Stock

Aster operates in segments like hospitals, clinics, retail pharmacies and provides healthcare services to patients across economic segments in several GCC states through various brands such as Aster, Medcare and Access.

  • Its network consists of 13 hospitals, 109 clinics and 240 retail pharmacies in GCC states;14 hospitals, 11 clinics, 131 pharmacies and 114 labs in India; total bed capacity: GCC: 1160, India: 3905
  • Revenue break-up FY22: hospitals: 56%, pharmacies: 21%, clinics: 23% with GCC & India contributing 77% & 23% of revenues, respectively
Q4FY22

Aster DM reported in line numbers driven by GCC - hospitals, pharmacies and clinics (up 12% YoY) and India operations (up 26% YoY).

  • Sales were up 14% YoY to ₹ 2728 crore
  • EBITDA was at ₹ 463 crore, up 44% YoY with margins at 17%
  • Consequent PAT was at ₹ 226 crore (up 115% YoY)
What should Investors do?

Aster’s share price has grown by ~1.1x over the past four years (from ~₹ 180 in May 2018 to ~₹ 193 levels in May 2022).

  • Maintain BUY for a unique blend of GCC healthcare network and a quest to expand in India with a calibrated capex approach
Target Price Valuation

We value Aster DM at an SOTP of ₹ 270.

Key Triggers for future price performance
  • Expansion via asset light model (1000 beds through O&M) in India, keeping an eye on leverage
  • Strong RoCE in GCC due to assets light model, integrated business model, faster occupancy & strong brand equity, healthy ARPOB & targeted strategy
  • Increased focus on asset light retail models like diagnostics, pharmacy distribution, homecare along with push towards integrated virtual platform
  • It is pursuing aggressive expansion in both GCC and India via assets light model but remains on firm footing due to FCF generation from GCC
New Stock Ideas

Apart from Aster, in our hospital coverage we like Narayana.

  • Narayana operates a duel model, which perfectly blends established ‘’Asset-right’’ India business (more focus towards oncology, transplants, etc, besides cardiac pedigree) with a hospital in Cayman Islands

 

  • BUY with a target price of ₹ 750

Key Financial Summary

Particulars FY19 FY20 FY21 FY22E 5 Year CAGR(FY17-FY22) FY23E FY24E 2 Year CAGR (FY22-FY24E)
Revenues 7,962.7 8,717.1 8,608.4 10,253.3 11.6 10,838.9 12,040.6 8.4
EBITDA 862.8 1,265.6 1,062.8 1,483.3 34.9 1,822.8 2,087.9 18.6
EBITDA margins (%) 10.8 14.5 12.3 14.5 - 16.8 17.3 -
Net Profit 333.1 284.9 147.7 526.0 38.9 718.5 919.2 32.2
EPS (|) 6.7 5.7 3.0 10.5 - 14.4 18.4 -
PE (x) 28.9 33.8 65.1 18.3 - 13.4 10.5 -
M.Cap/ Revenues (x) 1.2 1.1 0.9 0.9 - 0.9 0.8 -
EV to EBITDA (x) 14.0 11.9 13.3 9.5 - 7.3 5.9 -
RoCE (%) 8.3 7.2 5.4 9.0 - 11.4 12.9 -
ROE 10.4 8.7 4.4 13.3 - 15.4 16.4 -
Source: Company, ICICI Direct Research

Key takeaways of recent quarter & conference call highlights

Q4FY22 Results: Robust performance continues

  • Revenues grew 14% YoY to | 2728 crore driven by 26% YoY growth in the India business to | 607 crore and 12% YoY growth in GCC business to
    | 2214 crore. In GCC, hospitals grew 14% YoY to | 944 crore, Clinics grew 13% YoY to 661 crore and pharmacy grew 9% YoY to 609 crore. EBITDA margins improved 353 bps YoY to 17% while EBITDA grew 44% YoY to
    | 463 crore. Subsequently, net profit increased 115% YoY to | 226 crore. Delta vis-à-vis EBITDA was mainly due to lower interest and tax expenditure
  • Aster DM posted a good set of numbers with both revenues and margins coming in line with I-direct estimates. At a blended level, occupancy improved to 63% in FY22 from 55% last year and ARPOBD improved to
    | 66,000 in FY22 from 65,500 last years. Aster owns a unique business model among Indian healthcare services providers with strong established presence in GCC and India. We are positive on Aster’s integrated business model and Aster’s growth strategy for India to add brownfield facilities with low capex investment but high potential opportunity. We expect gradual margins and RoCE improvement on the back of higher occupancy and capacity optimisation in newer assets

Q4FY22 Earnings Conference Call highlights

  • GCC Hospitals: The management indicated at a change in case mix to offset pressure from insurance companies in GCC. Also, FY23 is expected to be normal year. However, Q1FY23 can see ~50 bps of margin decline
  • GCC Pharmacy: Uptick in margins for Q4FY22 was on account of purchase benefits. Aster will pursue franchise models and geographical expansion. Pharmacy volumes are likely to grow, going ahead. Sales mix: medicine: 70% and non-pharma:30%
  • GCC clinics: About 33% of revenues were from RTPCR in FY22. Some downturn is likely in H1FY23 due to high base of RTPCR revenues
  • India Hospitals: Aster DM has taken ~ 5-10% price hike. ARPOBD growth in India will continue in FY23
  • Capex: Guidance for | 580 crore every year for the next two to three years, with ~ | 300 crore being allocated to India for expansion.
  • Capital employed for GCC: | 6,500 crore and India: | 2,500 crore
  • In-patient visits: GCC: 22,300 in Q4FY22 and India: 46,600 in Q4FY22
  • Occupancy in Q4FY22: 58%; GCC: 53%, India: 60%
  • ARPOBD in Q4FY22: | 73,700; GCC: | 2,05,800, India: | 36,700
  • Pipeline Projects:
  • GCC:
    • Aster Hospital, Oman greenfield project (planned beds: 145) to be completed by Q1FY23
    • Aster Hospital, Qatar expansion project (planned beds: 60) to be completed by Q4FY24
  • India:
    • Aster Whitefield (Phase 2), Bengaluru brownfield project (planned beds: 275) to be completed by Q2FY23
    • Aster MIMS Kasargod (Phase-I) with 200 planned beds to be completed by FY25
    • Aster Hospital, Trivandrum and Aster KLE, Bengaluru greenfield project (planned beds: 350 and 500, respectively) by FY26
Variance Analysis

  Q4FY22 Q4FY22E Q4FY21 Q3FY22 YoY (%) QoQ (%)   Comments
Revenue 2,727.8 2,671.4 2,390.9 2,649.6 14.1 3.0   QoQ improvement mainly driven by GCC Hospitals and Clinics
Raw Material Expenses 703.4 752.1 665.1 746.0 5.8 -5.7    
Employee Expenses 872.3 839.7 702.5 832.8 24.2 4.7    
Other Expenditure 689.5 630.2 702.2 673.7 -1.8 2.3    
Operating Profit (EBITDA) 462.5 449.4 321.1 397.1 44.1 16.5    
EBITDA (%) 17.0 16.8 13.4 15.0 353 bps 197 bps   QoQ increase in margins mainly due to lower raw material cost and change in case mix
Interest 62.2 66.9 76.7 66.9 -18.9 -7.0    
Depreciation 170.4 160.9 152.6 160.9 11.6 5.9    
Other Income 22.0 11.6 29.8 11.5 -26.3 90.6    
PBT before EO & Forex 251.9 233.2 121.5 180.8 107.3 39.3    
Forex & EO 0.0 0.0 0.0 0.0 0.0 0.0    
PBT after Exceptional Items 251.9 233.2 121.5 180.8 107.3 39.3    
Tax  4.2 17.0 5.3 13.1 -20.2 -68.1    
PAT before MI 247.7 216.3 116.3 167.6 113.0 47.8    
MI 19.4 25.6 11.3 19.9 70.9 -2.5    
Net Profit 226.3 191.2 105.4 148.3 114.7 52.5   QoQ delta vis-à-vis EBITDA mainly due to higher other income, lower interest, depreciation and tax expense
Key Metrics                
India 607.0 586.2 481.0 618.0 26.2 -1.8   YoY improved mainly due to normalisation in hospital activity
GCC 2,214.0 2,147.3 1,972.0 2,113.0 12.3 4.8   YoY improved mainly due to normalisation in footfalls across hospitals, pharmacy and clinics
  GCC - Hospital 944.0 886.7 826.0 868.0 14.3 8.8    
  GCC - Clinincs 661.0 645.7 587.0 637.0 12.6 3.8    
  GCC - Pharmacy 609.0 614.9 559.0 608.0 8.9 0.2    

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