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Initiating coverage
Assessment
Excellent fundamentals Superior fundamentals Good fundamentals Moderate fundamentals Poor fundamentals
Assessment
Strong upside (>25% from CMP) Upside (10-25% from CMP) Align (+-10% from CMP) Downside (negative 10-25% from CMP) Strong downside (<-25% from CMP)
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Each member of the team involved in the preparation of the grading report, hereby affirms that there exists no conflict of interest that can bias the grading recommendation of the company.
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Polaris Software Limited Fortismomentum remains (India) Ltd Business Healthcare intact
Forging ahead
Fundamental Grade Valuation Grade Industry 4/5 (Strong fundamentals) (Superior fundamentals) 5/5 (CMP has strong upside) 4/5 upside) Information technologyServices Healthcare Providers &
CFV MATRIX
Excellent Fundamentals
Fortis Healthcare (India) Ltd (Fortis), one of the leading healthcare service providers in India, is suitably placed to benefit from strong growth in the healthcare industry. While aggressive bed additions via the inorganic route led to strong growth in the past, greenfield projects and asset-light model will ensure future growth with enhanced return ratios. Synergy benefits from the recent acquisition of a diagnostic business and outstanding litigations are key monitorables. We assign Fortis a fundamental grade of 4/5, indicating that its fundamentals are superior relative to other listed securities in India. Journey through the inorganic route ensured growth in the past Fortis has aggressively followed the inorganic route to increase the bed count from 300 in FY01 to 4,800 installed beds now; 60% through acquisitions. Given the timeline of about three years to set up a hospital, we believe acquisitions have enabled Fortis get a head start on others and register faster growth. Greenfield path with focus on asset-light model to aid future growth Fortis plans to add ~1,400 beds over the next two-three years through greenfield projects. Considering rising real estate costs, particularly in metros/ tier I cities, Fortis has adopted the asset-light model for expansion. Of the eight upcoming hospitals, seven are on a lease basis; this will help Fortis grow at a rapid pace and enhance return ratios. Key monitorables: SRL acquisition and pending litigations 1) Fortis recently acquired 71.4% stake in Super Religare Laboratories (SRL) for Rs 8,030 mn. Since 60-70% of treatment decisions are based on diagnostic results, we expect Fortis to derive synergy benefits in the long term. 2) One of the Fortis hospitals in Delhi Escorts - has pending litigations related to right on leasehold land and tax demand of Rs 969 mn. Since the outcome of litigations is pending, this remains a key monitorable. Revenues to grow at a two-year CAGR of 46%, RoCE to increase We expect revenues to register a two-year CAGR of 46% to Rs 31.4 bn in FY13 driven by addition of new beds and contribution from the diagnostics business. EBITDA margin is expected to remain stable at 14.9% in FY13. RoCE is expected to improve to 6.2% in FY13 from 2.1% in FY11. Valuations the current market price has upside CRISIL Research has used the discounted cash flow method to value Fortis and arrived at a fair value of Rs 185 per share. While the hospital services business is valued at Rs 156 per share, the 71.4% stake in SRL has been valued at Rs 29 per share. We initiate coverage on Fortis with a valuation grade of 4/5.
Fundamental Grade
5 4 3 2 1
Poor Fundamentals
Valuation Grade
Strong Downside Strong Upside
SHAREHOLDING PATTERN
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Jun-10 Promoter Sep-10 FII Dec-10 DII Mar-11 Others 76.5% 81.5% 81.5% 81.5% 17.0% 1.3% 5.2% 10.3% 2.7% 5.5% 10.2% 2.0% 6.3% 9.4% 1.7% 7.4%
KEY FORECAST
(Rs mn) Operating income EBITDA Adj PAT Adj EPS-Rs EPS growth (%) Dividend yield (%) RoCE (%) RoE (%) PE (x) P/BV (x) EV/EBITDA (x) FY09 6,354 825 87 0.8 NA 2.2 0.9 138.7 1.3 22.1 FY10 9,487 1,352 564 1.4 83.6 9.8 1.7 4.1 77.7 2.4 62.7 FY11# 14,672 2,148 1,091 3.0 117.6 2.1 4.2 62.2 2.1 29.8 FY12E 25,488 3,662 1,653 4.0 32.8 4.8 4.3 41.4 1.5 19.8 FY13E 31,429 4,674 1,907 4.7 15.3 6.2 4.2 35.9 1.5 15.4
ANALYTICAL CONTACT
Sudhir Nair (Head) Ravi Dodhia Bhaskar Bukrediwala Client servicing desk +91 22 3342 3561 clientservicing@crisil.com snair@crisil.com rdodhia@crisil.com bsbukrediwala@crisil.com
NM: Not meaningful; CMP: Current Market Price #FY11 numbers based on abridged financials Source: Company, CRISIL Research estimate CRISIL Limited. All Rights Reserved.
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Currently, it has a dominant presence in the North with more than 50% beds. Acquisition of Malar and Wockhardt hospitals ensure a presence in the South and West as well. Market position One of the leading private healthcare service Diagnostic service industry is highly
providers in the country with a network of ~3,600 owned beds and ~1,200 managed beds
fragmented with organised players having ~10% market share. SRL has the largest share, 48%, in the organised diagnostic services market in India
Healthcare delivery services industry to grow at a five-year CAGR of 12% to Rs 3,500 bn by FY15 Lack of government and for spending care players especially to who in are
Diagnostic service industry is expected to grow at a five-year CAGR of more than 25% by FY15
secondary opportunity
tertiary private
provide
increasingly looking to expand in this space Sales growth (FY08-FY11 3-yr CAGR) Sales forecast (FY11-FY13 2-yr CAGR) Key competitors Apollo Hospitals, Max India, Manipal Group Dr. Lal Pathlabs, Metropolis, Thyrocare, Medinova and Quest Diagnostics Demand drivers Low penetration of beds and doctors leads to huge opportunity for private players. India has only nine beds and six doctors per 10,000 people, far below the global average of 27 and 14 respectively Growing medical tourism industry and increasing insurance penetration to enhance growth prospects of leading hospital chains in India Rising lifestyle diseases, increasing health Growing healthcare industry will have a direct results impact as 60-70% treatment decisions are based on diagnostic test 26.0% 27.2%# 40.9% NA*
awareness and preference for healthy lifestyle with preventive care Margin drivers A newly commissioned hospital takes ~two years to break-even at EBITDA level. However margins improve as it matures We expect ~500 beds to be commissioned in next two years, which will moderate margins *Fortis acquired diagnostic business (Super Religare Laboratories) in May 2011 #Considering full-year numbers of FY11 for Piramal, which was acquired in August 2010 Source: Company, CRISIL Research Margins to improve once the recently opened laboratories mature. New laboratories take ~two years to breakeven at PBT level
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Fortis expanded from 300 beds in FY01 to the current 4,833 installed beds
Upcoming hospitals Existing hospitals Kangra (100 beds) Noida > Fortis Hospital (350 beds) Gurgaon > FIIBMS (1,000 beds)
Amritsar > Fortis Escorts Hospital (166 beds) Ludhina 1 (200 beds) Ludhina 2 (75 beds) Mohali > Fortis Hospital (300 beds) Faridabad > Fortis Escorts Hospital (250 beds)
> Flt. Lt. Rajan Dhall (200 beds) >Jessa Ram (150 beds)
> Shalimar Bagh (350 beds) Kolkata >Anandpur (414 beds)
Mumbai >S L Raheja Hospital (280 beds) >Mulund (567 beds) Bengaluru >Fortis Hospital (100 beds) >BG Road (451 beds) >Cunningham Road (128 beds)
Source: Company, CRISIL Research Though Fortis has a dominant presence in North India with more than 50% of the beds, acquisitions of Wockhardt and Malar hospitals have helped it make inroads in western and southern regions. With an aim to further expand and tap opportunities in central India, Fortis plans to add ~1,400 beds over the next two-three years.
CRISIL RESEARCH | 3
8,000 2,875 6,000 2,220 4,000 2,785 1,276 50% 40% 30% 20% 2,000 3,622 3,557 4,313 10% 0% Apollo Owned Fortis Subs/JV/associates Manipal Managed 14%
16% 8%
17%
20% 11%
North Apollo
South
West Fortis
Over the years, Fortis has shown consistent improvement in operating parameters. While the occupancy rate increased from 63% in FY08 to 72% in FY11 (marginal y-o-y decline of 200 bps as ~350 beds were operational in 2HFY11), average length of stay (ALOS) declined from 4.3 days to 3.7 days during the same period. Average revenue per occupied bed (ARPOB) increased from Rs 7.7 mn in FY08 to Rs 8.1 mn in FY11.
64%
63%
60%
56%
CRISIL RESEARCH | 4
Indias per capita spend on healthcare is mere US$109 (adjusted for PPP)
international benchmarks set by WHO for healthcare infrastructure, India will require an investment of over Rs 6 tn over the next five years.
109
UK
US
Malaysia
Singapore
Russia
Germany
Australia
China
Brazil
India
Population growth in 30+ age group will be higher at 2.7% in the next 20 years
CRISIL RESEARCH | 5
Cost advantage: Complicated procedures in India cost ~one-tenth of that in the developed countries. Limited waiting period: Unlike a waiting period of ~15 days to one month in developed countries, India has minimal or virtually nil waiting period. International quality standards: Some of the well-established hospitals in India are Joints Commission International (JCI) accredited, depicting international quality services at comparatively lower costs.
% of population covered
Medical tourists
Unlike other established players, Fortis has taken the inorganic route for expansion
CRISIL RESEARCH | 6
951
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644
600
200
140
15% 3,112
2,832
10%
10% 5%
0%
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Asset-light model helps the company grow faster and enhance return ratios
CRISIL RESEARCH | 9
-10% Year 1
Operating Costs
CRISIL RESEARCH | 10
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Revenue growth of 46% supported by new bed additions and diagnostic business
35,000 30,000 25,000 20,000 15,000 10,000 5,000 6,354 0 FY09 FY10 Revenue FY11 9,487 14,672 20% 55% 49%
74%
25,488 FY12E
31,429 0% FY13E
29%
20%
Hospital services
CRISIL RESEARCH | 14
4,000
EBITDA margins(RHS)
PAT to grow at a two-year CAGR of ~24%, EPS to increase from Rs 3.0 in FY11 to Rs 4.7 in FY13
Fortis consolidated PAT is expected to grow at a two-year CAGR of 24.2% to Rs 1.9 bn in FY13. Revenue growth will be offset by moderation in margins and higher depreciation expenses. We expect EPS to increase from Rs 3.0 in FY11 to Rs 4.7 in FY13.
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RoCE (RHS)
CRISIL RESEARCH | 16
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composition, typical board processes, disclosure standards and related-party transactions. Any qualifications by regulators or auditors also serve as useful inputs while assessing a companys corporate governance. Overall, corporate governance at Fortis reflects good practices supported by a strong and fairly independent board, good and relevant experience, and board processes and structures broadly conforming to minimum standards.
Board composition
Fortis board consists of 10 members, of whom six are independent directors, which exceeds the requirements under Clause 49 of SEBIs listing guidelines. The board brings sector expertise relevant to Fortis as well as diversified technical and business experience.
Boards processes
The board's processes appear to be well structured, with all the committees audit, remuneration and investor grievance - in place, supporting good corporate governance practices and decision-making framework. The audit committee is chaired by an independent director, Mr Balinder Singh Dhillon. The committee meets at timely and regular intervals. The board also includes other well-known names like Mr Gurucharan Das, who has held positions of CEO in Procter and Gamble India and CMD in Richardson Hindustan Limited. He is an operating advisor and investor in Chrys Capital LLC. Lt. Gen. T. S Shergill is also an independent director; he was chairman of the Punjab Public Service Commission and is currently a member of the board of governors of the University of Petroleum and Energy Studies.
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We have used the discounted cash flow (DCF) method to value Fortis and arrived at a fair value of Rs 185 per share. While the hospital business has been valued at Rs 156 per share based on DCF, its 71.4% stake in SRL is valued at Rs 29 per share based on its DCF value of Rs 13,974 mn. The stock is currently trading at Rs 167 per share. Consequently, we initiate coverage on Fortis with a valuation grade of 4/5, indicating that the current market price has upside from the current levels.
WACC computation
FY13-23 Cost of equity Cost of debt (post tax) WACC Terminal growth rate 15.7% 8.0% 10.0% Terminal value 15.7% 8.0% 11.5% 5.0%
WACC computation
FY13-23 Cost of equity Cost of debt (post tax) WACC Terminal growth rate 17.5% 8.0% 12.6% Terminal value 17.5% 8.0% 13.2% 5.0%
Source: CRISIL Research estimates CRISIL Limited. All Rights Reserved. CRISIL RESEARCH | 19
Downside
Feb-11
Feb-10
Feb-10
Dec-10
Dec-09
Dec-09
Aug-09
Dec-10
Feb-11
Jun-09
Jun-11
Jun-09
Jun-10
Jun-10
Aug-09
Aug-10
Aug-10
Fortis
32x
40x
48x
56x
64x
EV
12x
22x
32x
P/E movement
80 70 60
1000%
+1 std dev
800%
50 -1 std dev 40 30 20
600%
400%
200%
Jun-09
Jun-10
Feb-10
Dec-09
Aug-09
Aug-10
Dec-10
Feb-11
Jun-09
Jun-10
Feb-10
Dec-09
Dec-10
Feb-11
Aug-09
Aug-10
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Apr-09
Apr-11
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Oct-10
Premium/Discount to NIFTY
Median PE
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Jun-11
Apr-09
Apr-10
Apr-11
Oct-09
Oct-10
Jun-11
42x
Oct-10
Oct-09
Oct-09
Oct-10
Apr-09
Apr-11
Apr-10
Apr-10
Apr-11
Apr-09
EPS
CY10 CY11E CY12E
P/E
CY10 CY11E CY12E
P/BV
CY10 CY11E CY12E
EV/EBITDA
CY10 CY11E CY12E
4.2 10.5
4.3 11.3
4.2 11.8
3.0 14.7
4.0 17.1
4.7 19.4
62.2 33.6
41.4 29.0
35.9 25.6
2.1 3.4
1.5 3.1
1.5 2.9
29.8 16.3
19.8 14.0
15.4 12.4
Note: *For FY11, FY12E and FY13E Source: CRISIL Research, industry sources
CRISIL RESEARCH | 21
Company Overview
Incorporated in 1996, Fortis Healthcare (India) Ltd is a leading chain of hospitals, providing quality and modern healthcare services. The company is managed by the erstwhile promoters of the Ranbaxy group. It started its first 300-bed hospital in Mohali in 2001 and over the years has expanded to ~4,800 beds. Its key areas of specialisation include cardiology, neuro sciences, oncology and orthopedics.
Milestones
2001 2003-04 2005 2007 2008 2009 2010 Inaugurated the first hospital at Mohali with 300 beds Commenced operations in Noida Acquired 90% in Escorts chain of hospitals for Rs 5,850 mn Got listed on the BSE and the NSE Opened a new hospital in Jaipur Acquired Malar Hospitals (178 beds), Chennai for Rs 550 mn Rights issue of Rs 10 each at a premium of Rs 100 per share Acquired 10 hospitals of Wockhardt group at Rs 9,090 mn Acquired 25% stake in Parkway Holdings and sold to Khazanah for a net profit of Rs 180 mn Commenced two greenfield facilities in Delhi and Kolkata Launched an oncology block in Mulund, Mumbai 2011 Signed 5 O&M projects Acquired strategic stake in Super Religare Laboratories (SRL) Source: Company, CRISIL Research
CRISIL RESEARCH | 22
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7,290
3,588
6,000 3,261 2,992 1,643 799 797 604 233 109 4,000 2,522 2,000 951
4,833
US
Malaysia
Germany
Russia
China
Brazil
UK
Singapore
Australia
India
4,000 11% 12% 1% 17% 29% 29% 9% 6% 13% 19% 30% 9% 6% 13% 18% 1,000 13.0% 825 0 FY09 FY10 EBITDA 1,352
EBITDA margins(RHS)
12,500
11,870 9.9
10,000
9,381 7.2
8.4 6.2
7,500 4.8 5,000 2.2 2,500 1,032 2.1 FY09 FY10 1.7 2,639
1,627
Capex
CRISIL RESEARCH | 24
Analytical Contacts
Tarun Bhatia Prasad Koparkar Chetan Majithia Sudhir Nair Jiju Vidyadharan Ajay D'Souza Ajay Srinivasan Sridhar C Manoj Mohta Director, Capital Markets Head, Industry & Customised Research Head, Equities Head, Equities Head, Funds & Fixed Income Research Head, Industry Research Head, Industry Research Head, Industry Research Head, Customised Research +91 (22) 3342 3226 +91 (22) 3342 3137 +91 (22) 3342 4148 +91 (22) 3342 3526 +91 (22) 3342 8091 +91 (22) 3342 3567 +91 (22) 3342 3530 +91 (22) 3342 3546 +91 (22) 3342 3554 tbhatia@crisil.com pkoparkar@crisil.com chetanmajithia@crisil.com snair@crisil.com jvidyadharan@crisil.com adsouza@crisil.com ajsrinivasan@crisil.com sridharc@crisil.com mmohta@crisil.com
Business Development
Vinaya Dongre Ashish Sethi Head, Industry & Customised Research Head, Capital Markets +91 (22) 33428025 +91 (22) 33428023 vdongre@crisil.com asethi@crisil.com
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