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The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India.

Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program.

India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government.

Teaching Notes are available for educators only.

CSS: 10 Public Sector Management.

It was mid-March 2014, and GE's John F. Welch Technology Centre in Bangalore, India was brimming with activity. GE had developed an advanced, scalable positron emission tomography-computed tomography (PET/CT) scanner as part of its global Healthymagination initiative to provide better healthcare for more people at a lower cost. Munesh Makhija, Managing Director, GE India Technology Centre and Chief Technology Officer (CTO), GE South Asia, was thumbing through a report prepared by the PET/CT product development team and GE's healthcare market research team. In another office, Suresh Kumar R.(Kumar), General Manager of the Essential PET Segment, was putting the finishing touches on a presentation outlining a commercialisation strategy for the new PET/CT product, Discovery IQ (Exhibit 1).

Discovery IQ was a revolutionary product that would be useful for staging, treatment planning and post-treatment planning assessment. Early reviews from nuclear physicians had been positive. However, the product was still too costly for the bottom of the pyramid (BoP) market. Kumar and his team were scheduled to meet with Makhija the following morning to discuss a “go-to-market strategy”. Kumar knew that Makhija would want to talk about their segmentation strategy and the underlying needs of various customer types. He also expected Makhija to focus on return on investment (ROI) projections because diagnostic centres in India first looked at various financial return measures before investing in any new equipment. Kumar wanted to present a commercialisation strategy for Discovery IQ, which required a significant commitment of resources to tackle supply and distribution challenges across tier II and tier III cities^a in India.

India's diagnostics business valued at USD 10 billion was growing at 20% annually. Several players with different business models competed. Dr. Lal PathLabs, the world's largest histopathology centre led with a menu of 3,500 tests, 1,600 collection centres and 7,000 pick-up points. Its Initial Public Offer had been oversubscribed 33.41 times and the team at Dr. Lal PathLabs was excited about expanding its international footprint. Two overseas companies were incorporated in Netherlands and Nepal. Yet, there were enormous unmet needs in India alongside potential for public-private partnerships. Trade-offs over portfolio choice and regional versus international footprint needed thinking through.

The subject area is entrepreneurship.

Graduate and executive education level in leadership, entrepreneurship and strategic management are used to discuss leadership, entrepreneurship and strategy in health services.

This case talks about the passionate journey of a pediatrician practicing in the Mumbai city of India, who as an individual private practitioner is contributing to the fulfilment of the global health agenda and the fourth Millennium Development Goal (MDG) – “reduce child mortality”. His vision is to make quality and affordable expert pediatric care accessible to all the individuals, right from pre-birth to adulthood. Surya Mother and Child Care Hospital (SMCH) is being strengthened as a nation-wide network of mother and child hospital offering patient/consumer-centric integrated collaborative quality care, and it needs to be seen how this model can be made sustainable as it enlarges in scale for the future.

The case is structured to achieve the following learning outcomes: to understand about effectuation as a logic for entrepreneurial success through the lens of Dr Avasthi and his venture SMCH; To understand and apply Porter’s Principles of value transformation that essentially focus on outcome-driven cost-efficient work practices in a collaborative integrative fashion, where transformation must come from within (some practices suggested can be applied to the Indian Healthcare Services Delivery systems); to critically analyze the overall strategic position of SMCH as an organization and its competitive environment; to discuss the factors influencing health-care delivery capacity build up, given the MDGs 2015, Every Newborn Action Plan and Indian Newborn Action Plan framework, as applicable to India; and to discuss and analyze mechanisms for future sustainable service delivery options for SMCH. Although each of these principles is important, possibly, the instructor could emphasize and encourage more discussions on potential models of shared partnerships that can help quality health-care services reach the unreached and the incorporation of technology in achieving this. The learning process can also facilitate discussions about leadership qualities in the creation of health-care entrepreneurs, for the “Change That They Would Want To See”.

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

CSS:3 Entrepreneurship.

Diagnostics services in India were growing at 20% annually with billing of USD 3.4 billion. With WTO's GATS, foreign competition was arising. Dr. Lal PathLabs had formidable brand recognition and Dr. Arvind Lal was wondering whether to accept private equity and induct management professionals to keep pace with competitors through acquisitions or greenfield or sell out. He worried over loss of proprietary control. The industry practice of incentivizing doctors for referrals meant that acquisitions brought perverse incentive systems. The choice of compromising ethics or inventing another business model had to be made alongside whether to expand in India or abroad.

It is January 2014, and the case protagonist, David Milestone (senior advisor at the Center for Accelerating Innovation and Impact at the U.S. Agency for International Development's Global Health Bureau), is preparing for a meeting of global stakeholders and pharmaceutical manufacturers who are interested in reducing mortality caused by childhood pneumonia and are prepared to donate $10 million to support this effort.

Milestone's goal is to propose a strategy to address childhood pneumonia in Uganda, toward which the $10 million donation would go. In addition to effectively and sustainably reducing childhood pneumonia deaths, the plan must align the interests of various stakeholders behind the problem. A successful strategy in Uganda could be a model for interventions elsewhere. The United Nations Commission on Lifesaving Commodities for Women and Children recently identified Uganda as a “pathfinder” country, meaning it could serve as the example for other countries wrestling with the same issues. This is a remarkable opportunity to change the lives of children in Uganda—and all around the world.

After reading and analyzing the case, students will be able to:

• Perform a stakeholder analysis

• Appreciate the challenges involved in improving public health, especially in developing countries

• Create a patient journey and use it to identify potential impact points

Perform a stakeholder analysis

Appreciate the challenges involved in improving public health, especially in developing countries

Create a patient journey and use it to identify potential impact points

The case documents the evolution of an eye care hospital promoted by a not-for profit organization located in Mandvi, Surat, close to the tribal community of Gujarat state, India. In a short span of five years (as of 2016), the trust has evolved as a community hospital. The value proposition of the trust is a portfolio of activities, which includes awareness by education, prevention of eye care diseases through eye screening camps, treatment, and rehabilitation on need basis and addressing direct and indirect healthcare needs of the community. The managerial challenge before the board of trustees is to carefully balance (a) The purpose for which the trust was created, (b) the gap between the ground realities and the need in the relevant tribal community (c) the accomplishments of the eye hospital so far.

Health Management and Leadership, Marketing Social Causes, Strategy, International Business.

Post-graduates, Practitioners.

General Electric has been operating in the Middle East, North Africa (MENA) region for over a century. GE is committed to corporate citizenship having launched ecomagination in 2005 and healthymagination in 2009. For sustainability, GE believes that both innovation and localization are critical. This case deals with contextualization of breast cancer campaign for the Kingdom of Saudi Arabia through healthymagination. Rania Rostom, Communications Director, Middle East, North Africa and Turkey region, GE, reviews the campaign implemented and looks at roll-out across the MENA region. The situation is unique, as breast cancer strikes women in the region ten years earlier than the West, and the cultural context does not allow the discussion of the topic in public. One of the peculiarities of this region was the high penetration of social media and its large adoption rate by the young. GE used a unique Facebook campaign to drive awareness on the topic, encourage screening appointments, seek treatment and reduce the discomfort associated with the process.

On completion of utilizing the case study as an exercise, students should be able to gain case-specific skills – critically examine the importance of the consumer behavior, health marketing, marketing strategy and aspects of international business in the Middle East, KSA, in particular, and demonstrate this by analyzing real regional/world examples using complex theoretical frameworks; identify examples of best practice and explain the dynamics toward consumer behavior, health marketing, marketing strategy, international business with reference to a range of theoretical models and apply these in a meaningful way to the MENA region – discipline-specific skills – synthesize and critically evaluate a corpus of academic literature and government reports on consumer behavior, health marketing, marketing strategy, international business – and personal and key skills – reflect on the process of learning and undertake independent/self-directed learning (including time management) to achieve consistent, proficient and sustained attainment; work as a participant or leader of a group and contribute effectively to the achievement of objectives in the field of consumer behavior, health marketing, marketing strategy, international business.

Teaching Notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

Innovation, information technology, e-marketing and sales, strategy and entrepreneurship.

The case is intended for use in advanced graduate and executive education level management and technical programs of study. The case is high inter-disciplinary appropriate for all courses dealing in use of innovation, information technology, entrepreneurship, marketing and sales and strategy.

Practo Technologies Pvt Ltd is a company established in 2008 by entrepreneurs Shashank, N.D. along with Abhinav Lal. At Practo Technologies engineers practice to create technology that supports healthcare industry. In India, there is not enough assistance given to the patients in terms of searching for appropriate doctors and fixing an appointment with them easily. The patient's data lie scattered in reports and the patient's medical history goes unrecorded. Practo provides a robust platform for doctors and patients to collaborate together under one umbrella. It provides patients with open basket of doctor profiles and special search based on doctor's specialty. The case showcases the journey of transformation healthcare sector in India has gone through. The change was resisted, it never came that easy! The case explores issues in implementing information technology for clinics and hospitals in India. This case illustrates interesting facts Indian healthcare and the preparation they need to equip with to manage global technology tide.

The case can be used for teaching service innovation. Managing innovative practices and low-cost online business models is illustrated. In particular, it deals with how the early start up employs innovation to set up new working ideas. The case is designed to stimulate discussions of broad array of issues regarding deployment of IT services specifically in the hospitals and clinics across India. Evaluate the advantages and liabilities of expanding globally at a very early start up stage. The case focuses on Practo early development with only concept in hand and transforming it into a profit generating business. Evaluate the advantages and challenges of innovation, technology development, deployment and training of manpower to use it. The case offers students opportunity to understand and take view of strategically building early start up and management of concerns with no prior experience. To identify business opportunities and explore various possibilities of expansion into IT healthcare business. The students are given base to explore sales and marketing strategies for online model. The students get overview of cutting edge business offerings and surviving the dynamic competition in the era of globalization.

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

The case puts students in the shoes of Todd Davis, founder and CEO of a boutique brownfield redevelopment firm, Hemisphere Development, in 2010. Davis is wrestling with decisions and processes surrounding the potential acquisition and redevelopment of the former Delphi Automotive plant in Columbus, Ohio. When making the investment decision, Davis (and students) must consider various factors: What is Hemisphere's implicit investment strategy, and what are the firm's core competencies? How should the firm finance this transaction to achieve an acceptable return?

• Practice creatively structuring and financing unique transactions

• Describe the importance of baseline analysis in dealing with contaminated or potentially contaminated properties, and understand that the timing of baseline analysis can be crucial in determining the viability of a transaction

• State the importance of each type of constituent in public-private transactions

• Recognize the benefits of specialized/niche expertise in deal-makin

Practice creatively structuring and financing unique transactions

Describe the importance of baseline analysis in dealing with contaminated or potentially contaminated properties, and understand that the timing of baseline analysis can be crucial in determining the viability of a transaction

State the importance of each type of constituent in public-private transactions

Recognize the benefits of specialized/niche expertise in deal-makin