Manipal Hospitals' ₹9,275 crore IPO to strengthen balance sheet for growth

India’s largest hospital chain is eyeing a cleaner balance sheet to fuel its expansion plans after a public listing. Manipal Health Enterprises Ltd plans to use a large chunk of the fresh proceeds from its ₹9,275 crore IPO to settle outstanding debt, which in turn will unlock further opportunities for growth, managing director and chief executive officer Dilip Jose told Mint.

The Temasek-backed hospital chain, which opens its initial public offering on Wednesday, plans to raise up to ₹8,000 crore through a fresh issue. It has ₹7,500 crore in net debt, ₹10,000 crore in gross debt, and ₹2,500 crore in cash. A large chunk of the fresh proceeds will be used to clear the debt, said Jose.

“It gives us the opportunity that, as the years go by, and operating cash flows come in, we have the ability to raise debt if we want. As a listed company, we can also access the equity markets again. I don't think capital will ever be in short supply for growth,” said Jose.

He added that the firm would likely retain some cash on its balance sheet after the IPO while maintaining moderate leverage to fund inorganic growth. "We don't have to be net-zero. A reasonable level of leverage is what the market would expect.”

Apart from the fresh issue, the listing involves an offer-for-sale of up to 21,613,834 equity shares by promoters—Temasek's arm Imperius Healthcare Investments Pte Ltd, and Manipal Education and Medical Group India Pvt. Ltd, amounting to 1,275.22 crore on the upper price band.

Investors selling shares include TPG SG Magazine Pte Ltd, Seventy Second Investment Co. LLC—an arm of Abu Dhabi sovereign wealth fund Mubadala Investment Co., Ammar Sdn Bhd, Novo Holdings Invest Asia A/S and Phoenix Bear Investments, LLC.

It has fixed a price band of ₹560 to ₹590 per equity share, with a face value of ₹2/- each.

Over the past five years, Manipal has invested around ₹12,000 crore in acquisitions, with only about ₹2,000 crore funded through equity, while the rest came from debt and internal accruals. “That’s the way we would continue to grow,” said Jose.

Manipal’s big-ticket acquisitions, including the Maharashtra-based chain Sahyadri Hospitals in 2025 and Amri Hospitals in 2023, made it the largest hospital chain by bed capacity.

While it currently has over 13,000 beds across its network, the company has committed around ₹4,000 crore towards organic expansion through greenfield and brownfield projects, which are expected to add roughly 2,800-3,000 beds over the next three to four years.

On the inorganic front, Manipal expects acquisitions to continue playing a key role, although the nature of deals is changing. The company is evaluating opportunities in markets like Kerala and the National Capital Region (NCR), however, target assets may be smaller than earlier.

"Assets like Sahyadri are no longer available in the near future," he said. "We'll have to look at individual hospitals rather than large networks.”

Despite an aggressive expansion race among listed hospital operators, Jose dismissed concerns that competition would become a zero-sum game. "Being number one in terms of capacity is not a goal in itself," he said. "India remains severely underserved in terms of quality hospital beds. Whatever capacity everyone is putting in is only a fraction of what the country needs."

The listing will also prompt a shift in the firm’s approach. While the company has focused on long-term growth as a privately owned business, Jose acknowledged that public markets would bring greater scrutiny of quarterly performance, return on capital employed and shareholder expectations.

Jessica has been tracking the pharmaceutical, life sciences and healthcare sector for Mint since November 2024. Based in the country's financial capital, she reports on everything to do with health and medicines. This includes corporate action, patent wars, deals, startup activity and consumer trends. She also keeps a keen eye on the ever-evolving world wellness a...