Narayana Hrudayalaya Ltd

Hi Amit, congratulations on a great portfolio performance and getting NH right with a huge allocation.

I do believe the health insurance in USA and India may not be comparable. In the US, if you don’t have health insurance and get sick you are pretty much bankrupt. So everyone has to get it. Obama actually made it illegal to not buy health insurance. This is called regulatory capture… when Obamacare was being proposed, people speculated that the health insurance companies will be hurt. But in reality they have grown more. Check the stock charts of all the health insurance companies from 2009 or 2010 when Obamacare came to being.

Because of the prevalence of health insurance, people don’t really care about the procedure costs when they go to a doctor. I.e. Let’s say my plan says that my deductible is 2k per year. So the first 2k of expense come out of my pocket but then everything above that is paid by insurance. So now if I have exhausted my deductible and then I go to visit a Dr for something, the Dr says it could be a or b or c. To be sure we need to check for each are you sure? I will say yeah go ahead. Why don’t you check for d also. The Dr usually does all these tests because they don’t want to be sued for malpractice.

The net result of all these dynamics is that people end up using more medical facilities than really needed.

Now the dynamics are very different in India. Suing Dr for mal practice is not really a thing in India afaik.

There are very few Dr (hospital, clinic etc)per capita in India so we need to wait to see a Dr. Because Indians have been paying out of pocket mostly, the cost of medical care has not skyrocketed like US.

Even today, you will see that the hospitals will charge you differently based on whether you have insurance or not.

So I am not entirely sure that health insurance sector in USA and India are comparable.

NH having a health insurance company produces synergy for them so it makes but the end mkt cap it’s another thing