A Healthcare Face-Off: Apollo vs. Narayana

15 Kas

◉ Abstract
India's hospital industry is growing rapidly, valued at ₹8.35 lakh cr. ($98.98 B) in 2023, with a projected CAGR of 5.8-8.0% from 2024 to 2032. Apollo Hospitals and Narayana Hrudayalaya are two leading players, with Apollo being the largest private hospital network and Narayana Hrudayalaya known for cost-effective cardiac care. Narayana Hrudayalaya appears undervalued with a P/E ratio of 33.5 and more profitable (ROCE: 27%), making it an attractive investment option. Apollo Hospitals seems overvalued with a P/E ratio of 83.4 but remains viable for strategic entry points. Both companies are poised for growth driven by increasing healthcare demands and infrastructure expansion.

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◉ Introduction
The hospital industry in India is experiencing significant growth, with the market valued at approximately ₹8.35 lakh cr. ($98.98 B) in 2023. Projections indicate a robust compound annual growth rate (CAGR) of 5.8% to 8.0% from 2024 to 2032, potentially reaching between 13.87 lakh cr. and 16.33 lakh cr. ($164.4 B - $193.6 B) by 2032, depending on various market analyses.

◉ Growth Drivers of the Indian Hospital Industry

● Increased Healthcare Expenditure:
➖ Rising public and private spending on healthcare, with government health expenditure aiming for 2.5% of GDP by 2025.
➖ Expanding middle class with higher disposable incomes and greater access to health insurance.

● Technological Advancements:
➖ Adoption of healthcare technologies such as telemedicine and robotic automation, improving service delivery.
➖ National Digital Health Blueprint promoting innovations in e-health.

● Policy Support and Foreign Investment:
➖ Favourable government policies allowing 100% FDI in healthcare, attracting significant investments.
➖ Public-private partnerships enhancing healthcare access, especially in underserved areas.

● Demand for Specialized Services:
➖ Increasing incidence of lifestyle diseases driving demand for specialized healthcare.
➖ Growth in medical tourism as India becomes a preferred destination for cost-effective treatments.

These factors are collectively propelling the growth of the hospital industry in India, positioning it for a promising future.

◉ Key players in the Indian hospital sector
1. Apollo Hospitals leads the sector with a market capitalization of approximately ₹98,646 Cr, establishing itself as the largest private hospital network in India.
2. Max Healthcare closely follows, boasting a market capitalization of around ₹97,820 Cr.
3. Fortis Healthcare is another key participant in the market, with a market capitalization of ₹48,249 Cr.
4. Global Health also ranks among the premier healthcare institutions, holding a market capitalization of ₹28,786 Cr.
5. Narayana Hrudayalaya is recognized for its cost-effective cardiac care services and maintains a notable market share with a market capitalization of ₹26,086 Cr.

In this report, we will conduct an in-depth analysis and comparison between two of India's leading healthcare providers, Apollo Hospitals and Narayana Hrudayalaya. This comprehensive evaluation will assess their technical and fundamental aspects,

◉ Company Overviews

● Apollo Hospital APOLLOHOSP
Apollo Hospitals was founded in 1983 by Dr. Prathap C Reddy, a visionary in the evolution of modern healthcare in India. As the first corporate hospital in the country, Apollo Hospitals is celebrated for leading the charge in the private healthcare transformation.

Today, Apollo Hospitals stands as Asia's leading integrated healthcare services provider, boasting a strong footprint throughout the healthcare landscape. This includes a diverse range of services such as hospitals, pharmacies, primary care and diagnostic clinics, as well as various retail health models.

● Narayana Hrudalaya NH
Narayana Hrudayalaya Limited is involved in providing medical and healthcare services both in India and abroad. It functions through two main divisions: Medical and Healthcare Related Services, and Others. The organization is responsible for acquiring, owning, and managing a variety of healthcare facilities, including hospitals, clinics, health centres, diagnostic centres, and nursing homes, among other related operations. Its range of services encompasses cardiology, cardiac surgery, nephrology, urology, neurology, neurosurgery, endocrinology, orthopaedics, internal medicine, obstetrics, gynaecology, pediatrics, neonatology, gastroenterology, and oncology. Additionally, the company is active in the health insurance sector. Established in 2000, its headquarters is located in Bengaluru, India.

◉ Technical Analysis

● Apollo Hospitals
➖ The stock faced a significant obstacle near the 5,800 level, resulted in a steep drop.
➖ It later found support around 3,500 and rebounded.
➖ Following an extended period of consolidation, the price developed a Rounding Bottom pattern.
➖ A breakout ensued, leading to a price increase, but it encountered resistance close to 6,800, which triggered a pullback to the breakout point.
➖ Following a successful retest, the price surged past the previous high, reaching a new peak at 7,545.
➖ However, due to prevailing negative market sentiments, the price has since retraced and is currently trading just above its immediate support zone.

● Narayana Hrudalaya
➖ The stock price is overall in an uptrend.
➖ After reaching an all-time high close to the 1,445 level, the price experienced a decline and has since entered a consolidation phase.
➖ A Symmetrical Triangle pattern has formed on the chart.
➖ We expect an upward breakout from this pattern, which could lead to a significant price rally.

◉ Relative Strength

➖ The chart reveals that both Apollo and Narayana Hrudayalaya have underperformed the Nifty Healthcare index. Although Apollo has given a descent 31% return, Narayana lagged significantly, yielding a modest 17% return. In contrast, the Nifty Healthcare index delivered an impressive 41% return.

◉ Service Wise Revenue Breakdown

● Apollo Hospitals

The company operates through three primary segments, each contributing significantly to its revenue.
➖ Healthcare services account for approximately 52% of total revenue, forming the largest share.
➖ The retail pharmacy business generates nearly 41% of total sales, while the retail health and diagnostics segment contributes the remaining 7%.

● Narayana Hrudalaya

➖ The company operates exclusively in the healthcare services sector, deriving all its revenue from this single segment.

◉ Revenue & Profit Analysis

● Apollo Hospitals

Year-over-Year

➖ The company's fiscal year 2024 performance was marked by strong growth, with revenue reaching ₹19,059 crore, a 15% increase from ₹16,612 crore in FY23.
➖ EBITDA surged to ₹2,394 crore, up from ₹2,065 crore in FY23, while the EBITDA margin improved to 13% from 12%.

Quarter-over-Quarter

➖ In the latest quarter ending September 2024, the company achieved its highest-ever sales of ₹5,589 crore, significantly up from ₹5,086 crore in June 2024. This quarter-on-quarter growth has been consistent since March 2022.
➖ EBITDA for the quarter was an impressive ₹816 crore, a 21% increase from ₹675 crore in June 2024.
➖ Diluted EPS (LTM) rose substantially to ₹83.31 from ₹72.13 in June 2024.

● Narayana Hrudalaya

Year-over-Year

➖ In FY24, our company achieved remarkable sales growth, surging 11% to ₹5,018 crore from ₹4,525 crore in FY23.
➖ EBITDA soared to ₹1,173 crore, up from ₹987 crore in the same period, with an impressive EBITDA margin of 23%.

Quarter-over-Quarter

➖ Our quarterly sales reached an all-time high of ₹1,400 crore in September, representing a 4% increase from ₹1,341 crore in June.
➖ Although EBITDA growth was modest, it still improved to ₹308 crore in September from ₹304 crore in June 2024.
➖ However, Diluted EPS experienced a decline, dropping to ₹38.85 from ₹39.72.

◉ Valuation

● P/E Ratio
➖ Apollo Hospitals' current P/E ratio stands at 83.4, down from its 1-year median of 107.7. However, this remains significantly above the industry average of 56.9, indicating overvaluation.
➖ In contrast, Narayana Hrudalaya's P/E ratio of 33.5 is slightly above its 1-year median of 32.8 and substantially below the industry average, suggesting undervaluation.

● P/B Ratio
➖ Apollo's P/B ratio of 13.15 indicates considerable overvaluation compared to the industry average of 7.18.
➖ Narayana Hrudalaya's P/B ratio of 8.14 also suggests overvaluation, albeit to a lesser extent.

● PEG Ratio
➖ Narayana's PEG ratio of 0.49 positions it as an attractive investment opportunity, especially when compared to Apollo's considerably higher PEG of 2.43.

◉ Profitability Analysis
➖ Apollo Hospitals ROCE - 15% in FY24
➖ Narayana Hrudalaya ROCE - 27% in FY24

The significant difference in ROCE between the two healthcare giants underscores Narayana Hrudalaya's superior profitability. Narayana's impressive ROCE of 27% demonstrates its ability to efficiently utilize its total capital, comprising both equity and debt, to generate substantially higher returns.

◉ Cash Flow Analysis
➖ Apollo Hospitals has demonstrated impressive growth in its operating cash flow, surging 39% to ₹1,920 crore in FY24 from ₹1,377 crore in FY23. This robust growth underscores the company's efficiency in converting profits into cash, highlighting its strong financial health and liquidity position.
➖ In contrast, Narayana Hrudalaya has shown sluggishness in turning profits into cash, with its operating cash flow declining 2% to ₹1,067 crore in FY24 from ₹1,085 crore in FY23.

◉ Debt Analysis
➖ Apollo Hospitals' debt stands at ₹7,371 crore, resulting in a debt-to-equity ratio of 0.98, which, although relatively high, is not alarming. However, the company's low interest coverage ratio of 4.69 raises concerns about its ability to service its debt. This vulnerability may complicate repayment of borrowed loans, potentially straining Apollo's financial stability.

➖ In contrast, Narayana Hrudalaya's debt of ₹1,703 crore and debt-to-equity ratio of 0.53 indicate robust financial health. Furthermore, its impressive interest coverage ratio of 8.34 suggests the company is well-positioned to manage its debt obligations, ensuring greater financial flexibility and stability.

◉ Shareholding Pattern

● Apollo Hospitals

➖ In the September quarter, Foreign Institutional Investors (FIIs) increased their stake in Apollo Hospitals to 45.37%, up from the previous quarter.
➖ Conversely, Domestic Institutional Investors (DIIs) reduced their holdings to 19.94%, a significant decrease from 24.77% in the last quarter.

● Narayana Hrudalaya

➖ In contrast, Narayana Hrudalaya witnessed a decline in institutional investor holdings. FIIs reduced their stake to 9.69%, down from 10% in the previous quarter.
➖ Domestic Institutional Investors (DIIs) also decreased their holdings to 7.9%, down from 8.22% in the June quarter.

◉ Conclusion
Following a comprehensive analysis of both technical and fundamental aspects, we conclude that Narayana Hrudalaya appears to be favorably positioned from a valuation perspective, presenting an attractive investment opportunity.

However, this does not diminish Apollo Hospitals' potential. Although the stock currently appears overvalued, investors can consider accumulating shares during dips, making it a viable option for those seeking strategic entry points.

The healthcare sector's promising growth trajectory, fueled by rising healthcare demands and infrastructure expansion, positions both companies for potentially excellent returns in the near future.