AUNA (AUNA) Q4 2025: Peru Lifts EBITDA 14% as Mexico Recovery Drives 2026 Outlook

2026-03-11 | By EarningsIQ Research

Peru’s operational scale and margin strength offset Mexico’s weak 2025, positioning AUNA for a volume-led rebound in 2026. Management’s strategic reset in Mexico and new B2G partnerships in Peru underpin guidance for double-digit growth, while disciplined capital allocation and debt refinancing provide a platform for sustainable expansion. Investors should watch for margin recovery in Mexico and execution on major public-private projects as key catalysts ahead.

Summary

• Peru Margin Expansion: Healthcare services in Peru delivered record-low medical loss ratios and double-digit EBITDA growth.
• Mexico Turnaround Initiatives: Operational stabilization and physician alignment in Mexico set the stage for volume and margin gains.
• Strategic Leverage Reduction: Debt refinancing and free cash flow gains enhance financial flexibility for 2026 growth investments.

Performance Analysis

AUNA’s Q4 2025 results reflect a business in transition, with regional diversification cushioning the impact of a challenging year in Mexico. Consolidated revenue rose 6% FX-neutral, led by Peru’s 11% growth and Colombia’s 6% advance, offsetting a 3% decline in Mexico. Adjusted EBITDA contracted 14% FX-neutral, primarily due to Mexico’s underperformance and tough comps in Colombia, where prior-year extraordinary items inflated the base.

Peru’s healthcare platform demonstrated its role as the group’s growth engine, with OncoSalud plan memberships up 4.4% and oncology MLR hitting a record low 48.5%, signaling disciplined cost control and pricing power. In Mexico, stabilization was evident as revenues held steady quarter-over-quarter, and oncology revenues jumped 35% sequentially, marking early signs of recovery. Colombia’s pivot to risk-sharing contracts (PGPs, population-based payment models) helped sustain cash flow and reduce exposure to unreliable payers, though this shift weighed on margin mix.

• Peru Outperformance: Higher complexity services and equipment investments drove revenue and margin gains, with EBITDA up 14% for the quarter and year.
• Mexico Recovery Signs: Out-of-pocket revenue rose to 12% of segment total in December, up from 8% in Q3, reflecting traction in high-margin segments.
• Colombia Cash Cycle Discipline: Expanded risk-sharing contracts now comprise 21% of revenue, supporting working capital improvement despite margin dilution.

Free cash flow surged 35% for the year, aided by improved cash conversion and lower interest expense following a major debt refinancing. The group’s cash position rose 42%, reinforcing its ability to fund growth initiatives and absorb shocks from lagging segments.

Executive Commentary

Strategic Positioning

1. Mexico: Operational Reset and Volume Focus

AUNA’s Mexico segment underwent a strategic overhaul, with new leadership, physician engagement programs, and preferred provider agreements restoring access to large insured populations. The ISTE León contract extension brought a double-digit price increase and tighter control on prescription costs, improving margin visibility. Oncology integration and out-of-pocket segment growth are expected to drive both volume and profitability in 2026.

2. Peru: Scale, Margin, and B2G Expansion

Peru’s healthcare platform remains the group’s anchor, with consistent revenue and EBITDA growth, record-low loss ratios, and high complexity service mix. The Centro Ambulatorio Treka (public-private partnership, B2G outpatient facility) will expand AUNA’s reach to 3 million eSalud patients, targeting a new payer segment and expected to represent up to 25% of Peru revenues at maturity. This move deepens AUNA’s B2G (business-to-government) exposure, diversifying revenue streams and reducing payer risk.

3. Colombia: Risk Mitigation and Cash Flow Protection

Colombia’s pivot to risk-sharing models (PGPs) reduced exposure to government-intervened payers and improved cash conversion, though at the cost of EBITDA margin. The focus remains on sustainable growth and working capital discipline, with limited near-term upside but decreased balance sheet risk.

4. Capital Structure and Deleveraging

The $825 million debt refinancing lowered all-in rates by over 100 basis points and shifted 56% of debt to local currency, substantially reducing FX risk. Free cash flow after interest payments is now positive, supporting further deleveraging and strategic reinvestment. The group targets a medium-term leverage ratio of 3 times net debt to EBITDA.

5. Capital Allocation and Growth Pipeline

Management is prioritizing reinvestment in high-return growth projects—particularly in Mexico and Peru—over share buybacks, despite the stock trading below book value. CapEx will remain disciplined at 4% of revenue, with incremental investments earmarked for IT, infrastructure, and the Treka project ramp beginning in 2027. Inorganic growth remains on the agenda, with ongoing discussions for potential capital increases and partnerships in Mexico.

Key Considerations

AUNA’s Q4 and full-year results highlight the importance of regional diversification, margin management, and capital discipline as the business transitions into a new growth phase.

Key Considerations:

• Mexico Margin Recovery Path: Success depends on converting physician alignment and preferred provider status into sustained volume and higher complexity case mix.
• Peru B2G Ramp: Execution on the Centro Ambulatorio Treka project and integration into eSalud’s payer ecosystem will be critical to unlocking long-term value.
• Colombia Margin Trade-Offs: Risk-sharing models improve cash flow but compress margins, requiring continued focus on payer mix optimization.
• Balance Sheet Flexibility: Lower debt service burden and positive free cash flow give AUNA the capacity to fund growth without sacrificing financial stability.
• Capital Allocation Priorities: Growth investments in Mexico and Peru are prioritized over shareholder returns until the leverage target is achieved and market valuation normalizes.

Risks

Execution risk remains highest in Mexico, where volume recovery and margin normalization are not yet proven at scale. Colombia’s payer environment continues to present credit risk, with no near-term reversal of provisions expected. Large-scale projects like Centro Ambulatorio Treka carry construction and operational ramp risks, though payment structures de-risk capital outlay. Macroeconomic volatility and regulatory shifts in Latin America could impact demand, payer solvency, or cost inflation across all markets.

Forward Outlook

For Q1 2026, AUNA guided to:

• Adjusted EBITDA growth of 12% FX-neutral, supported by cost discipline and operational execution.
• Revenue growth of 12% FX-neutral, driven by Mexico recovery and continued Peru momentum.

For full-year 2026, management maintained:

• CapEx at approximately 4% of revenue, focused on maintenance, IT, and infrastructure.

Management highlighted:

• Mexico’s early 2026 trends show single-digit growth in surgeries and double-digit oncology volumes, with occupancy rates already above 40%.
• Peru’s operational stability and new B2G contracts underpin continued margin and revenue outperformance.

Takeaways

AUNA enters 2026 with a reset operational base, a stronger balance sheet, and clear growth levers in its two largest markets. Investors should monitor Mexico’s volume and margin trajectory, Peru’s B2G project milestones, and ongoing capital allocation discipline as the key determinants of value creation.

• Peru and Mexico as Growth Engines: Management projects these segments will be the primary drivers over the next five years, with Colombia’s relative contribution diminishing as a result.
• Margin and Cash Flow Leverage: Debt refinancing and disciplined CapEx enable self-funded growth, with deleveraging on track for the medium-term target.
• Execution Watchpoints: Sustained margin recovery in Mexico and successful launch of the Treka ambulatory center are critical for delivering on 2026 guidance and beyond.

Conclusion

AUNA’s Q4 2025 results mark the end of a challenging year and the start of a strategic pivot, with Peru’s stable growth and Mexico’s operational reset providing a credible foundation for double-digit expansion in 2026. The balance sheet is now positioned to support both organic and inorganic growth, but execution on volume recovery and new B2G ventures will be the ultimate drivers of investor returns.

Industry Read-Through

AUNA’s experience highlights the resilience of diversified healthcare platforms in volatile Latin American markets. The shift toward B2G partnerships and risk-sharing payer models reflects broader trends in emerging market healthcare, where public-private integration and payer risk management are becoming essential. Margin compression in legacy hospital businesses and the need for disciplined capital allocation are sector-wide realities. Providers with the ability to pivot to higher complexity services and manage payer exposure will be best positioned for sustainable growth as public health systems and private insurers evolve in the region.

AUNA Healthcare Latin America Growth EBITDA Public-Private Debt Oncology