Ramsay, the large private hospital operator, has been on the acquisition warpath for some time.

They had a tilt at Spire, and couldn’t quite get the deal over the line. This time, Elysium.

We are in an environment of record low real rates, and high equity prices.

Now is absolutely the time to use the balance sheet strength, use scrip, use whatever you can, as long as you can lock it in, to get big.


Now, the history of M&A is such that most deals don’t ever hit the target IRR, let alone the post synergy estimate.

But for many companies, the WACC is just not that high a hurdle. There’s a lot of room between the number you hit, and zero (the real funding cost on the debt side).

As such, we are pleased to see the efforts to grow inorganically.

As a follow up observation, about equities and our process more generally, consider the below slide.

It is effectively laying out the RHC “competitive advantage”. And that, many analysts would say (including us) is the reason to own such a stock, in one’s portfolio.

But why exactly?

Well, it should contribute to one’s SAA. There is an equity risk premium, embedded in stocks, and the ability to grow earnings means that the stock should generate capital gains and pay dividends and help you hit the overall SAA objective. If you can find a stock that can do those things, but doesn’t really have much of a propensity or probability to suddenly go bankrupt, than you can sleep at night, and make (some) money.

That’s 95% of what we are trying to do.

Okay, good, what else. Well, within equities, we are also trying to beat the benchmark. That means, RHC needs to either grow faster than the market expects, or, have an earnings multiple that turns out to be higher than the market expects.

How precisely this happens is a mystery, including to fund managers, most whom aren’t aware that that’s how the mechanism has to work.

Perhaps it is that people systematically underpay for those competitive advantages (the multiple bit). Perhaps people underestimate just how all of those competitive advantages lead to earnings strength.

Imagine a government putting out a tender (it doesn’t really matter how the example unfolds, just go with this one). The government has a choice between two operators, company a) which is known for clinical best practice, and, is known for providing genuinely good care.

The other, company b) is known as a ruthlessly good cost controlling operator, priced to match.

Well, perhaps that current crop of government officials cares more about the former than the latter, and overly favours (allocates) based on the perceived community feedback, and does this year after year.

And now company a) has grown quicker than you might otherwise have expected.

A fund manager couldn’t know this ahead of time, based on one example, but if it keeps happening, might twig that there’s something in the competitive mix (which we outlined above) that generates the surprise.

And that leads to outperformance, which leads to alpha, and everyone is happy [except perhaps company b)].

Those observations about the patient care. Most things, eventually, collapse back to some kind of net promoter score. We all have a “voice of the customer” metric, somewhere, in our KPI’s, explicitly or otherwise, and hospitals are no different. If your customers are telling you your product is good, you will likely get paid, and the person doing the paying will likely be happy to keep doing so.

Why write any of this. Well, because it helps to be clear on what’s the mechanism.

Our industry has too much handwaving about how the supposed magic is meant to happen.

Important Information: This document has been prepared by Aequitas Investment Partners ABN 92 644 165 266 (“Aequitas”, “our”, “we”), a Corporate Authorised Representative (no. 1284389) of C2 Financial Services, (Australian Financial Services Licensee no. 502171), and is for distribution within Australia to wholesale clients and financial advisers only.

This document is based on information available at the time of publishing, information which we believe is correct and any opinions, conclusions or forecasts are reasonably held or made as at the time of its compilation, but no warranty is made as to its accuracy, reliability or completeness. To the extent permitted by law, neither Aequitas nor any of its affiliates accept liability to any person for loss or damage arising from the use of the information herein.

Please note that past performance is not a reliable indicator of future performance.

General Advice Warning: This document has been prepared without taking into account your objectives, financial situation or needs, and therefore you should consider its appropriateness, having regard to your objectives, financial situation and needs. Before making any decision about whether to acquire a financial product, you should obtain and read the relevant Product Disclosure Statement (PDS) or Investor Directed Portfolio Service Guide (IDPS Guide) and consider talking to a financial adviser.

Taxation warning: Any taxation considerations are general and based on present taxation laws and may be subject to change. Aequitas is not a registered tax (financial) adviser under the Tax Agent Services Act 2009 and investors should seek tax advice from a registered tax agent or a registered tax (financial) adviser if they intend to rely on this information to satisfy the liabilities or obligations or claim entitlements that arise, or could arise, under a taxation law.

Receive our investment insights

Something went wrong. Please check your entries and try again.