The 1st question that you'll have to answer if you've to build/expand your hospital is - "Where exactly should I go?" Should I expand the existing one or build more centres in the same city or open satellite or smaller ones to pull neighbouring population to the HQs?
Let's see what Manipal Hospitals (MHEL) has done:
On a broader level, from a hospital beds pov, they have around half (49%) in Karnataka, 18% in Maharashtra & Goa, 23% in Eastern India and the remaining 10% in the rest of India.
But let's dig deeper:
KARNATAKA
Bengaluru - 11 Hospitals | 2,215 Beds
Mangaluru - 1 Hospital | 440 Beds
Manipal/Udupi/Karkala/Attavar/Kateel - 5 Hospitals | 3,285 Beds
Mysure - 1 Hospital | 100 Beds
The biggest acquisition for expansion in Bengaluru was that of Columbia Asia Hospitals Pvt. Ltd. that added 5 hospitals.
MAHARASHTRA/ GOA
Goa - 1 Hospital | 280 Beds
Nashik - 1 Hospital | 204 Beds
Ahilyanagar - 1 Hospital | 260 Beds
Pune - 9 Hospitals | 1,284 Beds
Karad - 1 Hospital | 160 Beds
As we all know, the majority of hospitals in Maharashtra came from the very expensive acquisition of Sahyadri Hospitals at Rs.4.3Cr/Bed.
EASTERN INDIA
Siliguri - 2 Hospitals | 174 Beds
Gangtok - 1 Hospital | 500 Beds
Ranchi - 1 Hospital | 300 Beds
Kolkata - 5 Hospitals | 1,513 Beds
Bhubaneswar - 1 Hospital | 400 Beds
The East India expansion saw acquisition of legacy brands like AMRI Hospitals & Medica synergie hospitals in a total investment of Rs.3,800Cr.
Manipal Hospitals DRHP - pg 223
REST OF INDIA
Delhi - 1 Hospital | 380 Beds
Patiala - 1 Hospital | 80 Beds
Jaipur - 1 Hospital | 225 Beds
Ghaziabad - 1 Hospital | 97 Beds
Gurugram - 1 Hospital | 90 Beds
Vijaywada - 1 Hospital | 250 Beds
Salem - 1 Hospital | 130 Beds
Gurugram, Patiala & Ghaziabad units came from Columbia Asia's acquisition.
What are the LEARNINGS for small-hospitals?
They are mostly non-existent in NCR & would be looking to acquire a few hospitals to consolidate their position in competition to Max Healthcare & Fortis Healthcare.
All of this expansion has come in last 5yrs since 2021 hence, there is a huge need of operational consolidation which if not done efficiently might lead to bad Patient Experiences locally leading to benefit to nearby hospitals.
Hyderabad & Chennai are still close to non-existent, could it be due to Apollo Hospitals ?
Mostly, the Tier-2 ones are spokes feeding into Tier-1s HQs.
A few relevant INSIGHTS by Doctors & HCPs
Manipal, KIMS, Aster DM, Care etc have more presence in South whereas Max & Fortis have more North India business. Apollo is perhaps the only hospital group with pan India presence. It is shortly coming up in Gurugram as well. Manipal Gurugram has now expanded to a 240 Bed facility with new OT complex, daVinci Xi Robot and all Superspecialty Departments.
The next phase won’t be about adding more pins on the map, but about integrating them into one consistent clinical and patient experience engine
In markets like Bengaluru and Pune, it’s not just presence but network effect multiple units within a city enabling referrals, specialization hubs, and better asset utilization. That density often matters more than entering too many new geographies.
For smaller hospitals, the big takeaway is to be intentional about the role of each asset (hub, spoke, or niche CoE) and to obsess over post-acquisition integration – clinical standards, IT, brand and patient experience.
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