Hospitals rarely featured in discussions on economic development through much of independent India’s history. Roads, ports, power plants, airports and, more recently, digital infrastructure dominated policy debates, while healthcare remained largely viewed as a social responsibility rather than an economic imperative. The Covid-19 pandemic changed that perception forever. As the country grappled with an unprecedented health emergency, the scramble for hospital beds, oxygen, ventilators and trained medical personnel exposed both the strengths and the limitations of India’s healthcare system. More importantly, it underscored a truth that policymakers, investors and corporate India could no longer ignore: a modern economy cannot be built without resilient healthcare infrastructure.
The pandemic accelerated trends that had been gathering momentum for years. Longer life expectancy, rapid urbanisation, changing disease patterns and the growing burden of chronic diseases were steadily reshaping healthcare demand. The subsequent economic recovery, expanding health insurance coverage and greater awareness of preventive healthcare further reinforced the shift towards organised healthcare.
Patients were seeking not merely treatment but access to sophisticated tertiary and quaternary care, supported by advanced diagnostics, specialised clinicians and world-class technology. Simultaneously, expanding health insurance coverage, government-backed healthcare programmes and greater awareness of preventive medicine began bringing organised healthcare within the reach of millions of Indians.
Scale, once considered desirable, has become essential. Modern hospitals require sustained investments in advanced medical equipment, electronic health records, specialist manpower and research capabilities: investments that increasingly favour integrated healthcare networks over isolated facilities.
Few companies illustrate this transformation better than Manipal Health Enterprises. Manipal has pursued this opportunity by building a network that combines organic expansion with strategic acquisitions. As of 31 March 2026, the company operated 49 multispecialty hospitals with 13,037 licensed beds across 14 states and Union Territories, making it the largest pan-India multispecialty hospital network by bed capacity and the second largest by number of hospitals. It also reported the second-highest revenue from operations among private hospital chains during Fiscal 2026. For Fiscal 2026, the company reported revenue from operations of Rs10,329.75 crore (Rs10,933.63 crore on a pro forma basis), the second highest among private hospital chains in India, according to a CRISIL Report.
Regional leadership
The network has been built around regional leadership rather than a dispersed national presence. Karnataka remains its largest market with 6,404 licensed beds, followed by Maharashtra and Goa with 2,188 beds, and eastern India, comprising West Bengal, Odisha, Jharkhand and Sikkim, with 2,887 beds. In each of these regions, the company occupies a leadership position among private hospital chains.
The metropolitan strategy is equally distinctive. Manipal is the only private hospital chain to lead simultaneously in Bengaluru, Kolkata and Pune by bed capacity. As of 31 March 2026, it operated 12 hospitals in Bengaluru, five in Kolkata and nine in Pune, together accounting for 5,376 licensed beds. “This concentration enables the company to serve wider referral catchments while providing patients access to specialised care closer to home,” says Dilip Jose, Managing Director and CEO of Manipal Health Enterprises Limited.
At the same time, the network has consciously maintained a balanced presence beyond metropolitan markets. “Of its total licensed bed capacity, 46.78 per cent is located in metros and 53.22 per cent in non-metro locations, reflecting its strategy of expanding access to organised healthcare across diverse geographies,” Jose explains.
The scale of operations is reflected in patient volumes. During Fiscal 2026, the network served 7.63 million patients across its hospitals, including hospitals managed under operating and management arrangements. The company’s services span the entire continuum of care, from outpatient consultations and diagnostics to tertiary and quaternary interventions across multiple specialities.
Growth has been driven not merely by adding hospitals but by strengthening the quality and reach of the network. Over the past several years, the company has expanded through acquisitions, including Columbia Asia Hospitals in India, Medica Synergie, AMRI Hospitals and Sahyadri Hospitals. “These transactions have broadened its geographic footprint, strengthened its presence in key regional markets and added significant clinical capacity to the network,” according to Jose, who has over 36 years of experience across sectors and functions, including 22 years in healthcare. Before joining Manipal Health, Jose served as Group CEO of CARE Hospitals, where he managed a network of tertiary care facilities. Earlier, as Regional Director at Fortis Healthcare, he headed the group’s operations in South India.
The acquisition strategy has also helped diversify the company’s presence across different healthcare markets while creating opportunities to integrate clinical practices, operational systems and support functions. “Rather than operating as standalone institutions, the hospitals function within a common organisational framework designed to improve efficiency and standardise quality across the network,” says Karthik Rajagopal, Group Chief Operating Officer of Manipal Health Enterprises Limited, who has more than 22 years of management experience across healthcare, media and advertising.
The network’s scale is supported by clinical depth. As of 31 March 2026, Manipal had 11,064 doctors across its hospitals and served 7.63 million patients during the year. Forty-one of its 49 hospitals were accredited by the National Accreditation Board for Hospitals (NABH), while 24 laboratories had National Accreditation Board for Testing and Calibration Laboratories (NABL) accreditation.
The company’s clinical strategy is centred on six high-acuity specialities that it collectively refers to as CONGO-R: cardiac sciences, oncology, neurosciences, gastro sciences, orthopaedics and renal sciences. These disciplines account for the bulk of complex tertiary and quaternary procedures and have become increasingly important to the business. “Their contribution to gross inpatient revenue rose from 61.55 per cent in Fiscal 2024 to 64.30 per cent in Fiscal 2026, reflecting a steady shift towards higher-value clinical services,” says Rajagopal, who has spent the past 17 years in senior healthcare roles across India, Sri Lanka, Mauritius and the Gulf Cooperation Council (GCC) region, focusing on operations and P&L management, marketing and brand management, integrated healthcare communications, patient engagement and clinical relations management.
Growing patient volumes
Within these specialities, the network has developed capabilities across advanced procedures and technologies. The company reports one of the highest volumes of robotic-assisted spine surgeries in India, with about 1,750 procedures completed by 31 March 2026. “Its Dwarka hospital in Delhi also achieved what it describes as Asia’s first post-mortem organ revival using extracorporeal membrane oxygenation, enabling successful multi-organ retrieval and transplantation,” says Rajagopal. Growing patient volumes have accompanied this expansion in clinical capability. Inpatient volumes increased from 0.33 million in Fiscal 2024 to 0.53 million in Fiscal 2026, representing a compound annual growth rate of 26.26 per cent.
“Clinical capability is backed by investments in talent development,” says Sameer Agarwal, the company’s Chief Financial Officer. As of 31 March 2026, the network employed 11,064 doctors, 11,048 nurses and 6,362 paramedics. The company operates Diplomate of National Board (DNB), Doctorate of National Board (DrNB) and Fellowship of National Board (FNB) programmes spanning 343 seats across 25 hospitals and 42 specialities, with 785 students enrolled. It also collaborates with the Manipal Academy of Higher Education for medical education, research and specialist training.
Research has become an integral part of the clinical model. Over the past 5 years, the network has supported 209 research and clinical trials and produced more than 1,163 publications in indexed journals, complementing its emphasis on tertiary and quaternary care.
“The company’s expansion has combined acquisitions with organic growth. It also commissioned new hospitals at Kanakapura Road and Yelahanka in Bengaluru during 2025, expanding capacity in one of its strongest markets,” says Jose.
Building a large hospital network also requires maintaining a consistent patient experience across multiple locations. Jose says: “We follow a patient-centric model built around protocol-driven care, clinical safety frameworks and standardised processes. We have invested in digital tools for appointment scheduling, reducing turnaround times and providing multilingual support, with the objective of delivering a more seamless patient experience across our network.”
The strength of the organisation also lies in its ability to attract and retain medical talent. The company believes its broad speciality portfolio, academic programmes and integrated hospital network make it an attractive destination for healthcare professionals. “Doctors have opportunities to work across hospitals within the network, participate in multidisciplinary collaborations and access advanced medical technologies, while regular conferences and training programmes facilitate knowledge sharing across specialities,” Rajagopal explains.
The emphasis on education extends beyond practising clinicians. Manipal supports postgraduate and super-speciality training across multiple disciplines, encourages publications and conference presentations, and facilitates investigator-initiated and multi-centre clinical research through collaborations with the Manipal Academy of Higher Education and other recognised academic institutions. The company also sponsors participation at national and international medical conferences, reinforcing its focus on continuous professional development.
Nursing, too, is treated as a long-term institutional capability. The company has established structured preceptorship programmes for newly inducted nurses and continuing education initiatives designed to strengthen clinical skills and improve retention. Career progression opportunities within the network, together with recognition programmes, form part of its effort to build a stable nursing workforce in an industry where skilled manpower remains a critical differentiator.
A pipeline of specialists
The network’s academic orientation distinguishes it from many hospital operators. Its association with the Manipal Academy of Higher Education provides access to one of India’s largest alumni networks of medical professionals, while its DNB, DrNB and FNB programmes help create a pipeline of specialists familiar with the company’s clinical systems and standards. “This integration of education, research and healthcare delivery has remained part of the Manipal model since its early years,” Jose points out.
The company’s progress has also been reflected in industry recognition. It has received awards including Healthcare Company of the Year 2023 from the VCCircle Awards, Best Hospital Chain – National at the Economic Times Healthcare Awards, and Excellence in Healthcare Industry Leadership in 2026. Manipal Hospital Old Airport Road, Bengaluru, has been ranked the city’s leading hospital by The Week-Hansa Survey for 20 years between 2005 and 2025, except for one year, when it ranked second.
Key business highlights
The company’s expansion has combined acquisitions with organic growth. It also commissioned new hospitals at Kanakapura Road and Yelahanka in Bengaluru during 2025, expanding capacity in one of its strongest markets
Three decades after opening its first hospital in Bengaluru, Manipal today represents the evolution of organised healthcare in India. What began as a regional healthcare institution has expanded into a national network through a combination of organic growth, carefully selected acquisitions, investments in clinical capability and a sustained commitment to medical education and research. “That journey mirrors the broader transformation of India’s hospital sector – from standalone institutions serving local communities to integrated healthcare networks capable of delivering advanced tertiary and quaternary care across multiple regions,” Rajagopal explains.
The company’s strategy now extends beyond increasing the number of hospitals. It is equally focused on deepening its presence within existing markets through brownfield expansion, selective entry into adjacent micro-markets and increasing the share of complex tertiary and quaternary care. “The objective is to improve capacity utilisation while leveraging established clinical teams, infrastructure and brand recognition across markets where it already enjoys a strong presence,” says Jose.
Research and innovation are expected to play a larger role in this next phase of growth. The company plans to strengthen its in-house research initiatives, building on the 209 research and clinical trials it has supported over the past 5 years and the more than 1,163 publications produced by clinicians across the network during the same period. “These initiatives are intended to reinforce clinical capability while contributing to evidence-based medical practice and specialist education,” says Jose.
The business has also evolved alongside changing payment patterns in Indian healthcare. Insurance and third-party administrators accounted for nearly half of healthcare service revenue in Fiscal 2026, while government healthcare programmes contributed a further 14 per cent. “Direct payments by domestic patients represented about 30 per cent of revenue, illustrating the increasingly diversified mix of healthcare funding in the country,” says Agarwal, who has more than two decades of experience across strategic and operational finance, treasury, mergers and acquisitions, and business and finance transformation.
Manipal Health’s diversification reflects one of the most significant structural changes in India’s healthcare landscape. The expansion of health insurance, government-sponsored healthcare schemes and organised reimbursement mechanisms has broadened access to specialised treatment while reducing dependence on out-of-pocket spending. For large integrated hospital networks, this has created a more stable and diversified revenue base than was possible a decade ago.
Operational efficiency
Managing a network of this scale also requires balancing investments in people with operational efficiency. Professional fees paid to doctors accounted for 22.72 per cent of revenue from operations in Fiscal 2026, while employee benefits represented 14.42 per cent. The company expects these costs to increase as it expands its network and patient volumes, although it views investment in medical professionals as fundamental to sustaining clinical quality and supporting future growth.
As newer hospitals mature and recently acquired facilities are integrated, operating efficiencies are expected to improve over time. Agarwal notes: “Staffing levels are typically higher during the initial stabilisation period following commissioning or acquisition, reflecting the need to maintain service standards even before patient occupancy reaches optimal levels. This gestation period is an inherent feature of hospital expansion and forms part of our long-term capacity-building strategy.”
Healthcare, unlike most other businesses, measures performance in more than financial terms. Revenue growth and expansion remain important, but so do clinical outcomes, patient safety, medical ethics and institutional credibility. Hospitals build their reputations over decades, one patient at a time, making consistency of care as valuable as scale itself.
As India’s healthcare sector enters its next phase of growth, demand is likely to be shaped less by the availability of hospital beds alone than by the ability to deliver complex care consistently, efficiently and at scale.
Last week, the company launched its public issue, which also attracted healthy investor interest. The initial public offering was subscribed 4.92 times, receiving bids for 44.31 crore equity shares against the 9.01 crore shares on offer. Qualified Institutional Buyers led the response, with their portion subscribed 8.25 times, while the non-institutional investor segment was subscribed 1.02 times, the retail portion 0.93 times and the employee reservation 2.19 times.
Clinical capability is backed by investments in talent development
The IPO was a fresh issue of equity shares aggregating up to Rs8,000 crore and an offer for sale of up to 21.61 million equity shares by promoters Imperius Healthcare Investments Pte Ltd. and Manipal Education and Medical Group India Private Limited, along with certain existing shareholders, including TPG SG Magazine Pte Ltd, Seventy Second Investment Company LLC, Ammar Sdn Bhd, Novo Holdings Invest Asia A/S and Phoenix Bear Investments LLC.
Manipal Health’s market debut also drew strong institutional endorsement. Ahead of the public issue, the company raised R4,167 crore from anchor investors by allotting 70.63 million equity shares at R590 apiece. The anchor book attracted 133 investors spanning sovereign wealth funds, global asset managers, domestic mutual funds, insurance companies and alternative investment platforms, reflecting broad-based confidence in the company’s business model and the long-term growth prospects of India’s organised healthcare sector.
Key investors
Prominent participants included Abu Dhabi Investment Authority, Norway’s Government Pension Fund Global, Templeton Emerging Markets Fund, Allianz Global Investors and Fidelity, while domestic participation came from 21 mutual funds investing through 55 schemes, including those managed by ICICI Prudential, Kotak, Aditya Birla Sun Life and UTI.
Brokerages were broadly positive on the issue. Anand Rathi described Manipal as the largest pan-India multispecialty hospital network by bed capacity and the second-largest hospital chain by number of hospitals as of 31 March 2026. At the upper end of the price band, it valued the company at a price-to-earnings multiple of 85.4 times FY26 earnings and assigned a Subscribe rating, citing its long-term growth prospects. SBI Securities, too, maintained a Subscribe recommendation, noting the company’s comprehensive healthcare platform spanning outpatient services to complex tertiary and quaternary interventions. It valued the issue at an enterprise value-to-EBITDA multiple of 29.4 times FY26 pro forma earnings on a post-issue basis, describing the valuation as fair relative to listed peers.
Doctors have opportunities to work across hospitals within the network, participate in multidisciplinary collaborations and access advanced medical technologies, while regular conferences and training programmes facilitate knowledge sharing across specialities
The healthcare major proposes to utilise Rs5,552.7 crore from the fresh issue to repay or prepay borrowings, together with accrued interest, of its material subsidiary, Manipal Hospitals Private Limited. Another Rs574 crore has been earmarked for acquiring the minority stake in its step-down subsidiary, Sahyadri Hospitals Private Limited, with the balance allocated for general corporate purposes.
The company’s revenue profile also reflects the evolution of healthcare financing in India. Nearly half of healthcare service revenue is generated through insurance companies and third-party administrators, while government healthcare programmes account for another meaningful share. Individual patient payments continue to remain significant, illustrating the coexistence of private insurance, public healthcare schemes and self-funded treatment within India’s healthcare ecosystem.
While acquisitions have accelerated the company’s expansion over the past 5 years, future growth is expected to follow a balanced approach. The company plans to continue expanding through a combination of brownfield additions, greenfield hospitals and selective acquisitions, with the objective of strengthening leadership in its existing markets while entering carefully chosen new micro-markets. It plans to add about 483 licensed beds through expansions at existing hospitals and another 1,943 licensed beds through greenfield projects by 2030.
Alongside physical expansion, the company intends to deepen its presence in complex tertiary and quaternary care. The company also believes its acquisition model has become a repeatable growth platform.
Between March 2021 and March 2026, it was the leading consolidator among private hospital chains in India in terms of beds added through acquisitions, adding 5,548 beds. Going forward, management intends to continue balancing acquisitions with organic expansion while integrating new hospitals through common clinical governance, operating systems and quality frameworks.
The broader industry backdrop remains supportive. According to the industry assessment cited in the prospectus, organised hospital chains continue to benefit from rising demand for tertiary and quaternary care, increasing insurance penetration, growing preference for organised healthcare providers, and the need for sustained investments in technology and specialised clinical infrastructure. These structural trends are expected to favour integrated hospital networks with the scale, capital and clinical capabilities required to meet rising patient expectations.
Corporate hospitals
Within this landscape, India’s organised hospital industry has developed around a relatively small group of national and regional players. Apollo Hospitals pioneered the corporate hospital model, while Max Healthcare, Fortis Healthcare, Narayana Health, Aster DM Healthcare, Medanta and KIMS have each built distinctive regional and speciality strengths.
Expansion, however, is only one measure of performance. Hospital businesses are equally judged by how efficiently they utilise expensive clinical infrastructure while maintaining quality of care. Metrics such as occupancy, average length of stay, revenue generated per occupied bed, and return on capital employed provide a clearer indication of operational performance than the number of hospitals alone.
Looking ahead, the company intends to continue following a balanced growth strategy rather than relying on any single route to expansion. It plans to combine brownfield additions at existing hospitals, greenfield developments and selective acquisitions to strengthen leadership in its established markets while entering carefully chosen new micro-markets.
“Acquisitions are expected to remain an important component of this strategy,” says Jose, who intends, going forward, to build on this experience by integrating future acquisitions through common governance, operating systems, procurement platforms and clinical quality frameworks, while continuing to invest in infrastructure and advanced medical technologies across the network.
As India builds the healthcare infrastructure needed for the decades ahead, the challenge will be to combine scale with quality, growth with governance and technology with compassionate patient care. Those institutions that can achieve that balance will help shape the next chapter of Indian healthcare. Judging by the course it has charted so far, Manipal Health Enterprises appears well placed to remain among the industry’s principal architects.
Interview
Dr Ramdas Madhava Pai, the largest shareholder of Manipal Hospital, is an Indian health administrator, the incumbent Chancellor at the Manipal Academy of Higher Education, and the chairman of the Manipal Education and Medical Group. Excerpts from an interview:
Manipal’s roots were in medical education. What prompted the family to move into hospital care with the first Manipal Hospital in Bengaluru in 1991? What do you remember about those early years and the thinking behind the venture?
The hospital business has been part of the Manipal Group for over three decades. When I joined the family business in 2000, Manipal Hospital in Bengaluru was our only hospital and it was loss-making. One of my priorities was to professionalise the business by bringing in experienced management and creating the right organisational structure. Over time, we strengthened the business and laid the foundation for future expansion.
Those early years taught me the importance of building institutions with a long-term perspective. Healthcare is a business where execution, strong leadership and patience matter far more than short-term gains.
From one flagship hospital in Bengaluru, Manipal has grown into a national network. Looking back, what were the two or three turning points that transformed Manipal into a pan-India healthcare group?
One important turning point was recognising that greenfield expansion alone would not allow us to scale at the pace we wanted. Building a hospital from scratch typically takes three to four years, from identifying land to obtaining approvals and completing construction. Acquisitions therefore became an important part of our growth strategy.
Another significant milestone was the acquisition of Columbia Asia. It allowed us to expand into multiple markets through high-quality assets and accelerated our journey towards becoming one of India’s largest hospital networks. Throughout this journey, we have remained disciplined in evaluating opportunities and focused on long-term value creation rather than pursuing growth at any cost.
Acquisitions such as Columbia Asia, AMRI, Medica and Sahyadri have dramatically accelerated Manipal’s growth. What makes you decide that a hospital in Manipal is right for you?
We look at acquisitions from both a strategic and financial perspective. The asset should strengthen our presence in key markets and fit with our long-term strategy. We have evaluated many opportunities over the years, but we have also walked away when valuations did not make sense.
Mergers and acquisitions are never easy. As I have said before, closing a transaction is one challenge; successfully executing it afterwards is another. We therefore focus on opportunities where we believe we can create long-term value through disciplined execution.
Looking ahead ten years, what would you like Manipal Hospitals to become?
India’s healthcare sector still has significant headroom for growth, and I believe there will continue to be opportunities to build scale. My focus is on continuing to grow the hospital business through a combination of organic expansion and acquisitions while maintaining financial discipline.
I have always believed in building institutions for the long term rather than pursuing short-term outcomes. Our objective is to continue strengthening Manipal Hospitals as one of India’s leading healthcare providers while creating lasting value for all stakeholders.