Fitch maintains 'A' rating for Alliance Saúde with a positive outlook.
The decision reflects the view that the company, specializing in diagnostic medicine, should continue to expand its scale and profitability, even in a competitive sector.
247 - The Fitch Ratings agency reaffirmed on Friday (26) the National Long-Term Rating of 'A (bra)' for Alliança Saúde e Participações SA, maintaining the positive outlook. The decision reflects the view that the company, specialized in diagnostic medicine, should continue to expand scale and profitability, even in a highly competitive sector.
According to Fitch, Alliança's credit profile is supported by increasing operational efficiency, improved margins, and disciplined financial management, despite its medium scale and the concentration of revenue in imaging exams – which represent 86% of revenue and require greater capital intensity.
Expansion and productivity gains
Founded in 2010, Alliança brings together 25 companies, more than 90 outpatient units and a presence in 20 hospitals. In June 2025, the company operated 82 care units, 106 magnetic resonance imaging (MRI) machines and 173 collection rooms, with a strong concentration of revenue in São Paulo, Minas Gerais and Bahia (84%).
Fitch projects that Alliança will reach 110 MRI machines in 2025 and 134 in 2026, with an average productivity of 30 to 31 exams per machine/day, representing a 40% increase in this indicator since 2022. The MRI segment accounts for 35% of the company's revenue.
Financial improvement and positive outlook
EBITDA margin rose to 18% in the first half of 2025, returning to pre-pandemic levels after averaging just 10% between 2021 and 2023. Fitch expects the margin to remain between 17% and 19% in the coming years, driven by process digitization, supplier renegotiation, closure of unprofitable units, and personnel restructuring.
The agency also forecasts a net debt/EBITDA ratio below 2,5 times in 2025 and 2026 — a level considered solid for the category, well below the average of 8,3 times recorded between 2021 and 2023. Pre-IFRS EBITDA should be between R$ 220 million and R$ 255 million in the two-year period, while free cash flow is expected to be positive in 2025, around R$ 70 million, even with investments close to R$ 80 million.
Growth strategy
Alliança has R$172 million in debt maturing by December 2025, but Fitch believes the company will succeed in refinancing its short-term liabilities and extending its debt profile, reducing liquidity risks. The company received R$511 million in capital injections between September 2023 and December 2024, in addition to a future capital increase of R$532 million related to the assumption of debt.
The acquisitions of Cura and Meddi (the latter still subject to approval by CADE) should add approximately R$ 300 million to gross revenue starting in 2026. Fitch assesses that these moves, coupled with the strengthening of commercial partnerships with operators and hospitals, reinforce the expectation of gradual and sustainable growth, which supports the positive outlook for the rating.
The agency notes, however, that delays in debt refinancing or a deterioration in cash flow generation could lead to a negative rating action in the short term.