Prepared remarks
Good morning, and welcome to Auna's First Quarter 2026 Earnings Conference Call. My name is Rob, and I will be your operator for today's call. Please note that this call is being recorded. Now I would like to turn the call over to Ana Maria Mora, Head of Investor Relations. Ma'am, please go ahead.
Thank you, operator. Hello, everyone, and welcome to Auna's Conference Call to review our First Quarter Results. Please note that there is a webcast presentation to accompany the discussion during this call. If you need a copy of the presentation, please go to our Investor Relations website or contact Auna's Investor Relations team. Please note that when we discuss variances, we will be doing so on a year-over-year basis and in FX-neutral or local currency terms with regard to Mexico and Colombia, unless we note otherwise. Let's move to Slide 2. In addition to reporting unaudited financial results in accordance with International Financial Reporting Standards, we will discuss certain non-IFRS financial measures and operating metrics, including foreign exchange neutral calculations. Investors should carefully read the definitions of these measures, the metrics and reconciliations included in our earnings press release published yesterday after market close to ensure that they understand them. Non-IFRS financial measures and operating metrics should not be considered in isolation as a substitute for or superior to IFRS financial measures and are provided as supplemental information only. Before we begin our remarks, please also note that certain statements made during the course of today's discussion may constitute forward-looking statements, which are based on management's current expectations and beliefs and which are subject to a number of risks and uncertainties that could cause actual results to materially differ, including factors that may be beyond the company's control. This includes, but are not limited to, our target leverage ratio, suppliers and information systems in Mexico, the results of the key initiatives we are implementing in Mexico, Colombia and Peru, the expected capacity and market of Torre Trecca once built, the execution of our strategic plan, including the recovery of our growth levels and the rollout of the AunaWay in Mexico, our planned investments, our expected revenue growth and adjusted EBITDA growth, our revenue and adjusted EBITDA guidance and the creation of further growth and sustainable value for all stakeholders. For a description of risks that may impact our forward-looking statements, please refer to our Form 20-F filing with the U.S. Securities and Exchange Commission and our earnings press release. Slide 3, please. On today's call, we have Suso Zamora, our Executive Chairman and President; Gisele Ferrero, our Chief Financial Officer and Executive Vice President; and Lorenzo Massart, our Executive Vice President of Strategy and Equity Capital Markets. They will discuss Auna's consolidated and segment financial and operating results for the first quarter as well as provide an update on our various strategic growth initiatives. After that, we will open the call for your questions. Suso, please go ahead.
Thanks, Annie. Let's move to Slide 4, please. We got off to a good start in 2026, building commercial momentum across our regional health care platform, accelerating growth and generating strong cash flows. We have stabilized and restored growth in Auna Mexico's hospital platform. We have strengthened Auna Colombia's hospital platform by expanding our unique risk-sharing businesses and deepening our relationships with the country's largest and best capitalized payers. We continue to grow revenues from Auna Peru's hospital platform by further expanding our higher complexity services and by growing plan memberships. Our path forward is clear: simplify our model; do more of what we do best; and extend the reach of the AunaWay. Now turning to our financial results. Our topline grew 10% FXN in the first quarter, with revenues increasing across all segments. However, due to 2 extraordinary items, which we will detail later in the presentation, adjusted EBITDA decreased 5% FXN and margin contracted by 2.9 percentage points. Nonetheless, we are tracking well against our 2026 guidance. In Mexico, we delivered higher service volumes and utilization levels increased. More importantly, utilization grew in high complexity services, particularly in surgery and oncology. Our operations in Mexico have delivered as planned, 19% quarter-over-quarter increase in adjusted EBITDA. The Peru segment of our integrated platform performed well, maintaining its growth momentum during the quarter despite adjustments related to payer reconciliations that impacted revenue and, therefore, profitability. Revenues increased 9%, supported by strong volume growth in health care services, including high complexity services, while OncoSalud continued to add new plan members through growing B2B sales. Our path forward is clear: simplify our model, do more of what we do best and extend the reach of the AunaWay. Our balance sheet: our leverage ratio was 3.7x. Our cash position increased 22% to PEN 409 million, with free cash flow increasing 2.6x versus the comparable period last year, an important indicator of our ability to optimize our operations for effective cash management across our regional platform. Let's turn to Slide 5. Growing volumes at higher levels of capacity utilization in health care, combined with increased plan memberships, helped drive the quarter's strong topline growth and cash flow. As you can see in the bottom left of this slide, total utilization increased 1.4 percentage points to 66%. However, our focus is on increasing utilization in higher-margin, high complexity services rather than on-bed occupancy alone. In Peru, where our business is vertically integrated, health care plan memberships grew 6%, while oncology plans grew 3%. Furthermore, the oncology MLR was below 50% within its expected range. The run rate profitability of our regional platform also improved significantly during the quarter. Again, adjusted EBITDA was down 5% FXN, primarily due to revenue adjustments and certain payroll increases. Let's now move to Slide 7 for a closer look at the performance of each segment of our platform, starting with Mexico. Our Mexico operations recovered strongly during the quarter, with revenues increasing 8%. This resulted from our new status in preferred provider tiers with 2 major payers at Doctors Hospital, the substantially improved economics of our new ISSSTELEON contract, expanded B2B service packages and additional growth in the out-of-pocket segment. This also produced a 19% quarter-over-quarter increase in adjusted EBITDA and a 3.5 percentage point increase in margin. On a year-over-year basis, EBITDA increased 23% year-over-year. Please turn to Slide 8. Revenue growth in Peru was 9% and was impacted by revenue adjustments related to higher revenue reconciliation penalties implemented by payers in the market. Revenues from health care services grew 7%, reflecting the advantages of our growing scale; commercial initiatives drove most of the volume and utilization increases. On the insurance side, OncoSalud revenues grew 12%, driven both by annual price increases and growth in B2B plan memberships, including the 20,000 employees of a new group policy for the nation's judiciary that we were awarded. We see a growing opportunity for commercial initiatives to increase our share of the B2B segment of Peru's insurance market. First quarter adjusted EBITDA decreased 3%, with margin contracting by 2.3 percentage points, impacted by the aforementioned revenue adjustments as well as a delay in rebate recognitions and an increase in doctor compensation. Excluding the revenue adjustments, Peru's adjusted EBITDA would have increased 7%. Let's move to Colombia on Slide 9. Our revenue growth in Colombia accelerated, growing 13% in the first quarter as we further reduced our reliance on intervened payers and increased the proportion of risk-sharing agreements with payers, which rose 6 percentage points to 21% of Colombia's total revenue. It is important to note that revenues from intervened payers fell 5 percentage points year-over-year from 19% to 14%. At the same time, revenues from new payers increased 1.5x versus the prior year quarter and currently represent 12% of total revenue. Clearly, our franchise is strong in Colombia. We have effectively navigated the falloff from last year's payer interventions and have emerged growing at a faster pace. Adjusted EBITDA increased 7%, with the margin decreasing by 1.7 percentage points. The lower margin mainly reflects the higher proportion of risk-sharing contracts and increased variable costs related to higher volumes serviced in high complexity care. Now I'll turn the call over to Gisele, who will review our results in more detail.
Thanks, Suso. Beginning with Slide 11, the revenue growth was strong across our regional platform with consolidated revenue reaching PEN 1.2 billion at quarter end and year-over-year growth of 10% in FX-neutral terms. As Suso noted, the growth follows the strategic measures that we implemented in Mexico and Colombia last year, helping us to build a healthier revenue mix, while Peru continues leveraging its scale to capitalize on the many growth opportunities that remain in its market. Taking a closer look at Mexico's recovery, this was primarily driven by surgery and oncology volumes, which grew 15% and 32% sequentially. In Peru, growing B2B sales were a major growth driver, particularly the 20,000 additional plan memberships through the group policy that we secured with the nation's judiciary and in our health care network, higher conversion rates drove surgery volumes up significantly, while emergency treatments increased 20% from commercial initiatives applied to corporate policyholders. Colombia grew the strongest during the quarter. In addition to the growth drivers that Suso has already highlighted, it is important to note that our capacity utilization returned to 2024 levels before the revenue rebalancing we conducted, reducing exposure to government intervened payers. Let's now move on to adjusted EBITDA on Slide 12. Consolidated adjusted EBITDA decreased 5% FX-neutral and includes the impact of revenue adjustments in Peru and payroll increases in Mexico due to higher compensation costs related to the newly appointed leadership team and to investments in attracting and incentivizing physicians. In Colombia, a 23% increase in the minimum wage drove compensation costs higher versus last year. Adjusted EBITDA recovered in Mexico, growing 19% quarter-on-quarter versus fourth quarter of 2025. Let's now turn to adjusted net income on Slide 13. Reflecting the underlying strength of Auna's regional platform, our operating profit increased 11% to PEN 155 million in the first quarter, which was more than offset by noncash FX losses due to the depreciation of the Peruvian sol below the levels of the protective range of the new hedging structure that we put in place at the end of 2025. This reset will help reduce FX losses in the future, which otherwise would have been higher this quarter. Slide 14, please. Our free cash flow increased 2.6x versus the first quarter of 2025 to PEN 152 million, primarily on a 45% increase in pretax operating cash flow shown at the left of the bridge. This reflects our strong growth, coupled with higher cash conversions, resulting from solid working capital management as well as supplier financing initiatives that we've undertaken. Moving to the middle of the bridge, CapEx, which represented 3% of revenue, primarily consisted of infrastructure upgrades, purchases of medical equipment and costs related to the implementation of the new hospital information system and ERP, mainly in Mexico. This cash use was reduced by an inflow resulting from the continued rebalancing of Auna Seguros' investment portfolio towards liquid securities. The PEN 88 million in financing activities at the right of the bridge is comprised of PEN 54 million of interest and hedge premium payments and interest on working capital facilities as well as a PEN 34 million decrease in working capital borrowings. Lastly on this slide, the increase in free cash flow and the reduction in interest payments mean that we expect positive cash flow generation after interest payments to grow in 2026. This will work towards achieving our leverage target of 3x in the medium term, while also continuing to invest in our growth initiatives. Let's now move on to Slide 15. We began 2026 with a stronger capital structure, benefiting from lower interest expenses and improved maturity profile and reduced FX exposure. It's important to note again that although our leverage ratio rose slightly to 3.7x in the quarter, this was primarily due to noncash FX effects. Following last year's refinancing exercise, we have generated approximately USD 8 million in annualized interest plus tax payment efficiencies, while reducing short-term debt by 40% versus the third quarter of 2025 prior to the refinancing exercise. At quarter end, 55% of our debt was denominated in local currency, while the remaining U.S. dollar-denominated debt was 85% hedged to the Peruvian sol. Additionally, 75% of our Mexican floating interest rate debt is also hedged to fixed rate. Finally, it is important to note that Auna has approximately USD 175 million in revolving credit facilities, of which only approximately USD 66 million are currently drawn and the remaining USD 109 million continue to be available. That concludes my review of the quarter. Before we open the call for questions, Suso has a few final remarks to wrap up our presentation.
Thanks, Gisele. I would like to briefly summarize the key points from today's review. First, given the significant progress we have made in our growth plan and the strong underlying fundamentals across Auna's regional platform, we are reaffirming our annual revenue and EBITDA guidance. Given the base effect of 2025, we expect this growth to be generated in the second semester of the year. Peru has ample room for growth as demonstrated by the expansion of our health care plans. In addition, the Trecca ambulatory Tower Lima, once completed, will significantly expand our addressable market in the country. In the near term, we are implementing initiatives to mitigate the impact of the revenue adjustments. Not only are we shortening our internal billing cycle to ameliorate penalties going forward, but also we will continue increasing our plan members and revenues in our OncoSalud segment. These are just the more immediate initiatives implemented, and there will be more to come in our health care network. With a substantially improved payer mix in key service lines, Colombia is experiencing positive performance levels. Growth and profitability are expected to continue strengthening. Furthermore, cash flow remains a priority and growing our risk-sharing businesses is a substantial and unique opportunity for Auna. Mexico will continue to strengthen, led by higher volumes, improved high complexity mix and growth in our out-of-pocket segment. Lastly, we expect operating cash flow and organic cash flow to be strong as our integrated health care platform grows across our markets and as we benefit from a more efficient capital structure, which also gives us the financial flexibility to advance our growth strategy this year and beyond.
Questions and answers
Your first question comes from the line of Mauricio Cepeda from Morgan Stanley.
We have 2 questions. The first one on Mexico, the margin mix there. It seems that you're shifting increasingly towards oncology there and other higher growth service lines. So how should we think about the medium-term margin trajectory for the segment? Should investors expect oncology to structurally dilute margins versus the historical core hospital business? Or do you see room for operating leverage as volumes scale? And the second one is on Colombia, the political and regulatory risk. We saw that the exposure to intervened EPS has declined and EPS dependence is lower, which is obviously positive. But we wanted to know whether you see additional pressure under a potentially less favorable future government or any future regulatory environment? And how protected is the current cash generation strategy under a more challenging policy scenario?
Great. On the first question, in Mexico, first of all, revenue momentum is real. I think there is momentum in how the new tier classifications of our hospitals there accumulate a growing number of policy members. I believe Q2 will capture a full quarter of this tier classification. First quarter did not capture all three months of it. ISSSTE price adjustments have improved dramatically the contract and the oncology ramp-up, which you mentioned. So volume growth in chemotherapy and radiotherapy and in surgeries is already visible, and we will see margins recover as utilization rises. There's also in the first quarter of 2026 some nonrecurring severance and leadership payroll costs, which is minimal, but it does take a couple of margin points off. And I see Mexico adjusted EBITDA increase 19% versus fourth quarter 2025. EBITDA increased 23% on a year-on-year basis. So we're targeting over 20% EBITDA margin on a consolidated basis for Auna. I do see oncology has always been a richer business, and I think slowly it would accrete higher margins. But it's a scale business. Right now, we need to continue to scale. We're growing at double-digit numbers of the volumes in oncology. So we'll see that improve the margins. On Colombia, I would say a couple of things. My own view is that I've seen we've seen the worst of regulatory changes and political upheaval with President Petro. And I think in both scenarios of the current leading polls and candidates to the presidency, I think the Colombian health care sector will not get worse than we've seen in 2025. In both scenarios, we are a unique player with these risk-sharing contracts and a unique positioning in high complexity. We see payers grant us a preferred status in their payment lists, and that's also critical. So I believe it will not affect Auna in the near coming months and this full year. Gisele, I don't know if you want to say something about Colombia and accounts receivable and how you see—as you're closer to the payers in the accounting lines as well.
Yes, Suso, thank you. Maybe on my end to complement both points, first, starting with Mexico then with Colombia. Thank you for the question. In the case of Mexico, Suso was very clear around how revenue trends and fundamental trends that we're seeing in revenue are what's helping us recover margin, and we're seeing that into the first quarter of this year also after the ISSSTELEON contracts have been renegotiated. To answer the question of how we're seeing those structural margins in Mexico, it is important to note the recovery that we're seeing into this quarter versus what we saw in the fourth quarter. While some of the services included within oncology, such as chemotherapy, may have lower margins, what we're seeing is that from a consolidated point of view, we will continue to recover margins in Mexico this year and going into next year, getting closer to those structural margins of 30% in Mexico. In the case of Colombia, Auna has done a really good job in rebalancing its revenue mix. Everything that we've mentioned in the call today vis-à-vis the increase in the percentage of risk-sharing contracts as well as the diversification away from intervened payers has helped us to produce the much more solid cash conversion that we've seen over the past 12 to 18 months. This has been accomplished as a factor of the improved revenue mix. So we are very optimistic about what is to come. In Colombia, we think that the new revenue mix will help protect us against any impacts that we might see in the way that funds flow in the sector and in universal health care. And obviously, as we've mentioned previously, we also are being protected by how important we are in the high complexity services in the different cities that we operate in and how that's led to payers prioritizing Auna in terms of payment. Additionally, we've been very successful in supplier financing initiatives as well to balance the complete cash conversion cycle.
And also Gisele, I would add that chemotherapy has an interesting margin, but radiotherapy has a higher margin, and we're inaugurating a new state-of-the-art facility, the only one in Monterrey that's going to be operational in about one to one and a half months. That will also produce a bump in volume, but most probably in margins as well.
Your next question comes from the line of Giovanni Vescovi from JPMorgan.
I have 2 questions. First is on understanding how your company is weighing buyback programs and leverage. Although, we understand that the company has a target of 3x leverage. We want to see if there are any levels that make the company more likely to implement a buyback program, maybe at $4.50 on the stock price level. And the other question regards ISSSTELEON. We saw a nine-point contribution margin increase. We just want to know if there is any more color you can give on future margin increases, if there are any?
Thank you very much. The Board has continually discussed the best use of cash and has been discussing it in the past without a decision or a determination to use cash to implement a buyback program. So currently, there is no such decision, although the Board is actively discussing the best use of that cash to sustain value and, of course, that will be aligned with the market and investors. On the second question, margins from ISSSTELEON increased because we renegotiated the whole contract with better volume and much better margins. More importantly, something that's not fully represented in our public disclosures is that we have full control of the usage of devices and pharmaceuticals to make sure that we control the cost of the services delivered to ISSSTELEON. So we're very excited about that contract with much higher margins. As I indicated before in the previous question, Mexico will continue to improve its margins based on scale. We also benefit in variable costs; scale and fixed cost dilution and variable cost efficiencies will continue to improve generally in Mexico and I think much more significantly in our oncology practice there. Gisele, do you want to add something on the last point?
No, I think Suso covered it well.
There are no more questions from the phone line. I will now turn the call over to Ana Maria Mora from Auna to proceed with the closing comments for the webcast platform.
Thank you, operator. Good morning, everyone. Let me begin with the questions from the webcast. Our system isn't displaying the individual names this morning, but I'd still like to make sure we address the questions themselves. A few of them have already been touched on, but if there's anything else you'd like to ask on these topics, please jump in. The first question is, can you please comment on the impact related to the postponed rebates related to medicines? And the second part of the question is, in order to reach the guidance, the EBITDA needs to strongly accelerate in the second half of the year. What are the main drivers behind this potentially strong acceleration?
Great. So maybe I'm going to start with the second question, and Gisele can go into the pharma rebate response. First of all, I want to repeat something that's important. We enter the remainder of 2026 with improving trends across the three markets. We have clear sight to achieve our annual targets. That's why we are reaffirming our revenue and adjusted EBITDA guidance. This is supported by our revenue growth and cash flow momentum: Mexico's improving trends, revenue normalization in Peru and Colombia continuing to grow. Our adjusted EBITDA guidance was always expected to be softer in the first half of the year. We did see limited growth expected in the first and second quarters. Against that backdrop, our first quarter performance gives us confidence in our ability to deliver this full year adjusted EBITDA range. Our integrated health care model and the structural market opportunity that remains in the three markets position us to deliver on 2026. As I indicated, we expect a stronger second semester than the first. The first quarter is always a slower quarter; it has been historically. Gisele, do you want to add something on this or go into the pharma rebate question?
Yes, I'll tackle the first part related to the pharmacy rebates that were postponed that we mentioned during the call. This is specifically in the case of Peru, where we've had some pharmaceutical rebates that have been delayed into the year to go. They have not been lost. They've simply been delayed. This often has to do with how we're managing inventories during the year, but it should be a delay into the year to go.
Thank you, Gisele. I'll move on to the second question. Could you elaborate on the revenue adjustments and the delays in pharmacy rebates in Peru? Do you see them as one-off items or part of a broader trend that could persist going forward?
Sure. Regarding the pharmaceutical rebates, as mentioned, these are delays rather than losses. On the revenue adjustments we saw in Peru this quarter, these are related to certain penalties applied by some insurance payers related to billing; some billing cycles have taken a little longer, and some settlement agreements are currently being negotiated. Is this a one-off item? We have been actively working on our cash conversion and revenue cycle management across the three countries, and Peru is no exception. We have reduced our internal billing cycle materially over the last 12 months, and this will help protect us in the current market context in Peru, where insurance payers, given the higher level of MLRs, have become much stricter in controls and the application of penalties when billing cycles increase in days. We are prepared to tackle this market context; we've been proactively working on it for the last 12 months. This should help to mitigate this effect in the coming quarters and put us in a better position going into the second half of the year.
Thank you, Gisele. The next question is, when do you expect to see an inflection in Mexico margins? And what are the key drivers that should support margin expansion in line with your guidance?
I think directionally I responded to that in previous comments. We see improvement in margins in the remainder of the year and, more importantly, in the second semester. This is based on oncology gaining scale, diluting fixed costs and delivering variable cost efficiencies—not only in oncology but in other practices as well. We see clear evidence of margin improvement in Mexico today, and the ISSSTELEON contract in particular is delivering a much improved margin.
Thank you, Suso. The next question is about the supplier financing initiatives. Could you provide more color on the supplier financing initiatives you have implemented across these three geographies?
Yes. We've been proactively managing working capital and specifically on supplier financing initiatives. In Peru, the most material action has been certain new working capital facilities with financial institutions. These structures, in addition to what we had in the past, have permitted us to increase accounts payable days, which has improved working capital in the quarter. Throughout Colombia and Mexico, we have also been able to extend payment days and increase the amount of factoring lines that we're utilizing.
Thank you, Gisele. The next question is on the FX impact. I'm going to bundle that with another question. Could you elaborate on the FX impact on the Q1 results and the strategy going forward? Also, could you discuss the FX loss in the quarterly income statement as well as the large OCI FX gain via the equity statement?
Of course. In 2025, we had FX gains that impacted our financial results, driven by appreciation of the Peruvian sol relative to the prior hedges. Once we conducted the refinancing exercise in the fourth quarter of last year, we reset the FX levels in the call spread hedges that we had in place to have a range more in line with current FX levels, which should reduce FX volatility going forward. The impact in the first quarter of this year was due to a slight depreciation of the Peruvian sol below the new call spread hedge, which would have been much larger if we had not reset the levels on our hedging instruments. We therefore expect less FX volatility in the year to go than in the past. Regarding OCI, our hedging instruments receive accounting hedge treatment and their results are accumulated in OCI accounts.
Thank you, Gisele. The next question is about Colombia. I have one question. Colombia's PGP revenue reached 21% of segment revenues, up from 15% in 1Q '25. However, the adjusted EBITDA margin compressed to 11.4%. As PGP scales further, how do you expect the margin profile to evolve going forward?
More generally, we see stable margins in Colombia. The playbook for Auna is to capture volume at attractive margins and then scale that practice to increase margins. Colombia's risk-sharing business, with sound payers, represents about 21% of our revenues. Intervened payers have fallen as we've indicated. Our risk-sharing business has high predictability and better cash characteristics, though it can have an initial small impact on margin. As we optimize clinical pathways at scale—covering millions of lives—we see margin expansion through cost dilution, both fixed and variable. We expect to recover a couple of points of the margin dilution we normally see at the onset of these PGP programs. Much of the growth in PGP programs occurred in 2025, so we expect stabilization and improvement as we move forward.
That's a good summary, Suso. I would add that we normally see lower margins in Colombia in the first quarter of the year. We should be seeing margins stable to what we've been seeing in the last year and also increasing versus those levels as we stabilize the new risk-sharing populations.
The next question is about Mexico. Congrats on a good quarter. Can you comment on the push towards universal health care in Mexico by 2027? Is it likely to change the competitive dynamics and the target opportunity?
Yes. It's an interesting initiative by the current government. We are excited because, as a player in one of the more sophisticated universal health care markets in Colombia, we've seen ourselves grow in high complexity care. In Mexico, with ISSSTELEON and other state institutions, we see growth in opportunities to deliver more services to the state—this is a growing theme. Universal health care does not mean that the state will do everything; it means the state wants to ensure the population is fully covered, whether by state platforms or private sector platforms. We believe this will grow our business; it's an opportunity rather than a high-risk situation.
Thank you, Suso. The next question is, could you shed some light on what proportion of costs are fixed and variable in each country?
When we look at cost of services rendered, variable costs are more than 60% of the total cost of goods sold structure across the three geographies.
Thank you, Gisele. The next question is, why do the underlying operating metrics not grow more organically? We thought the market was underpenetrated and naturally, your assets would show organic growth in each of your markets.
That's an interesting question. The markets are underpenetrated, principally in relation to formal institutional players that can deliver integrated services. We do see organic growth in most of our operations. In Mexico, there have been some dislocations we discussed previously, but the underlying thesis across the three countries remains: organic volume will continue to grow. We see it in high complexity—surgeries, chemotherapy and radiotherapy. That growth will be the main source of continued growth over the years.
I think that's well summarized, Suso.
I wanted to complement Ana's earlier question about universal health coverage in Mexico. One of the first things the initiative tries to resolve is integrating the state's different institutions that provide services under one umbrella to allow easier access for citizens. This initiative opens important opportunities for public-private partnerships, so I'm very excited about what's going to happen in Mexico in the B2G sector.
To complement that point, what was announced in Mexico is better described as the 'Servicio Universal de Salud,' an initiative to integrate access across Mexico's main public health care systems—IMSS, ISSSTE, and IMSS-Bienestar—so people can receive care in public facilities regardless of their institutional affiliation.
The next question is, how should we think about revenue per patient treatment in the coming years? Will they increase at, below, or above inflation in your markets?
This is a forward-looking question. We manage topline through price, volume and mix—mix meaning high complexity versus low complexity. We're focusing more on GRDs, which are a diagnostic index for high complexity, and that will produce higher revenue per patient treatment. We manage inflation in the three countries by increasing our pricing to reflect medical inflation, sometimes a little above that. So I would expect growth at purchasing power parity or a little above in the three markets.
To complement Suso, we actively manage price, mix and volume to create value. From a medium- and long-term perspective, we believe we will grow above inflation, though much of that depends on mix and efficiencies.
Thank you, Gisele and Suso. And to wrap it up, could you please provide an update on the construction progress of Torre Trecca or on the start of the addendum process?
Great. This month, we made substantial progress in Project Trecca on all the designs and definitions. The internal committee already defined the construction consortium, and it has been or will be awarded this week. We will start construction immediately. This is a 24-month construction process, and we believe we'll complete it slightly shorter than that, between 18 and 24 months. The concession consortium contract will be awarded this week.
Great. Thank you, Suso. With that, we have reached the end of our question queue today. Thank you all for your time and participation. Suso, let me hand it back to you for some final thoughts.
Thank you very much, Annie. I just wanted to tell the investor community that we're excited about what's happening, but we're also sensitive to the fact that sometimes we come to the market and report surprises such as revenue reconciliations in Peru. We will do much better. We'll make sure that there are very few surprises and we're much more deliberate and predictable, and we want to simplify the story so that everyone—investors and research institutions—can more easily understand what we're doing without all the adjustments. We're focused on this, and I think during the course of the year we should deliver something that's much simpler to digest. Underlying that, our business is growing. We're back on track; we will scale; we will improve our margins; and we will deliver more and better services to the communities and populations that we serve. Thank you very much, everybody, and I appreciate having this opportunity to share our thoughts and respond to your questions.
This concludes today's conference call. You may now disconnect.