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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.

This case study is designed to enable students to analyze the competitive landscape of a business impacted by technological disruption; evaluate the viability of an organic growth strategy using stakeholder analysis; evaluate the revenue and cost structure of Apollo 24/7 and decide on the future investment strategy; and analyze funding strategies of traditional hospitals versus pure digital players.

To extend its reach, Apollo Hospitals Enterprise (Apollo Hospitals), a leading private sector brick-and-mortar hospital chain in India known for using state-of-the-art technology, launched a unified virtual mobile platform Apollo 24/7 in February 2020, 45 days into the COVID-19 pandemic. The management believed that the digital platform had a unique ecosystem that could not be replicated. The analysts were optimistic about the impact of the decision on the future performance of Apollo Hospitals, as it was expected to lead to higher penetration and increased revenue. They also anticipated the unlocking of value, as and when the venture capitalist (VC) would invest in Apollo Hospitals. However, with increasing operating expenses on account of burgeoning technological and marketing expenses, things did not seem to go going as planned. Three years later, in February 2022 after the Q3 of financial year 2023 results. Suneeta Reddy, the company’s managing director found herself pondering whether the digital platform could boost Apollo Hospitals’ profitability in addition to expanding its reach and increasing affordability when the company missed the analyst estimates. In India, which was then the second most populous country, “incremental access” and “affordability” were what mattered to the patients, However, for the investors and analysts, it was quarter-on-quarter performance. The change in the macroeconomic environment stalled the company’s plan of raising money from VCs.

Furthermore, the financing dilemma also plagued Reddy. She knew there was a difference between financing for conventional businesses that for digital businesses. She also had to take decide between short-term profitability with which investors were obsessed versus long-term sustainability, which involved taking care of stakeholders’ interests.

This case study is basically aimed at postgraduate courses and executive management courses.

Teaching notes are available for educators only.

CSS11: Strategy.

This case examines issues surrounding the choice of financing arrangements for the acquisition of Radiologix in July 2006. The case follows Mark Stolper, the CFO of RadNet, as he considers how to raise the $363 million in funds necessary to finance the acquisition. When completed, the combined firms will be the largest private diagnostic-imaging provider in the United States. When Stolper joined RadNet in 2003, he confronted a company with “too much debt, and the wrong kind of debt.” His goal is to finance the acquisition in a way that further enhances the financial strength and operating flexibility of the company. Given the large size of funding required, the firm is unlikely to be able to fund the entire transaction with first-lien or bank debt. His financial advisors differ in their recommendations for how to raise the remaining funds—one suggests using second-lien debt, and the other, high-yield debt.

The purpose of the case is to familiarize students with frequently encountered types of debt financing that are used to finance mergers and acquisitions and other corporate transactions. The case provides information on the distinctions among first-lien, second-lien, and high-yield debt in relation to their price, availability, flexibility of covenants, repayment ease, and composition of likely investors. The case is designed for use in courses that cover corporate financing, M&As, and debt financing.

Organisational behaviour; Leadership; Organisational development; Public–Private partnership; Health care management; Public health.

Masters students in Business Administration, Post Graduate Diploma, Clinical Training of Medical Professionals, Health Leadership Programme.

Prof Jannie Hugo, the protagonist in the case, was considering his dilemma of aligning the multiple partners involved in public health care. A high level of collaboration was required of a multitude of stakeholders in developing the Daspoort clinic into a pilot site for the Tshwane district’s implementation of the National Health Insurance system. In addition, the re-engineering of primary health care with the focus on the patient and community orientated approach were launched on this site.

Gaining insight into international and national landscapes and principles of health care systems. Critically analyse the role of technology in delivering innovative health and social services. Present judgment of Prof Jannie Hugo’s contextual leadership effectiveness in enhancing collaboration between the multiple stakeholders and recommend next steps.

2 × DVDs on Vimeo, Slides and teaching plan with discussion or exam questions with model answers.

CSS 7: Management Science.

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.

Human resource management; Employee benefits management.

It can be used at undergraduate or postgraduate level for students at institutions of higher learning taking courses related to employee benefits management or human resource management.

The case is about the intention of Universiti Utara Malaysia (UUM) in purchasing health insurance for its employees in early 2011. For this purpose, a tender for group medical Takaful for UUM staff was placed in two major Malaysian newspapers on 20 February 2011. Then, after the tender closing date, a report was prepared and sent to the bursar of UUM, En Amron, on 28 April 2011. Ten companies had submitted their tenders; thus, En Amron had to identify the optimal group medical Takaful offered by the tenderers, so that he could put forward his recommendation to UUM tender committee board for its consideration and approval before the matter was brought to higher authorities for endorsement and implementation.

This teaching case will enable students to explain the reasons why an employer provides health insurance, to evaluate the advantages and disadvantages of providing health insurance programme as non-contributory and contributory plans, to conduct company and plan assessment in making decision to purchase group medical Takaful and to evaluate either to purchase group health insurance directly from life insurer or to engage insurance broker.

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

A midsize community hospital must choose a strategy to compete with an expanding regional rival. The strategy, focused on acquiring patient volume, includes expanding investment into integrated care, setting the reimbursement structure for revenue collection, and moving to a capitation-based payment system. The case presents an evaluation of revenue models to select that which best supports a given business strategy.

This case is designed to introduce a health care audience to financial analysis. It provides a straightforward introduction to hospital financial-statement ratio analysis and hospital operating statistics, so it can also serve to introduce any audience with a business or medical background to hospital finance.

Strategic management, IT strategy, Business & IT Consulting, International Business.

PGDM and Executive programmes.

Cognizant Technology Solutions, one of the giants in the Indian information technology (IT) industry, has been continually evolving new strategies and business models to cater to the global IT demand. Starting as an in-house technology unit of Duns & Bradstreet, the case highlights the various pioneering and transformative decisions taken by Cognizant to become one among the Fortune 500 companies of the world. However, despite its supremacy in the global market, they are facing tremendous competition from the other IT giants – TCS, Infosys and Wipro, to name a few. Also, the expansion of global IT players like Accenture and International Business Machines (IBM) in India is making matters worse. This intense competition, when juxtaposed with commoditization and price sensitivity on behalf of the IT demand, makes sustainability a big question mark. The million-dollar question remains “How should Cognizant strategize to ensure inorganic growth in the price-sensitive industry?”

The case highlights the market dynamics of the Indian IT industry – from its humble beginning as an attraction for low-cost labour to being one of the strategic outsourcing geographies of the IT sector – and thereby categorically points out the significance of continuous evolution on behalf of the IT firms to stay alive in this client-driven industry. The students are expected to analyze the IT industry of India, keeping in mind its vulnerabilities – price sensitivity, dependence on developed economies and intense competition – and relate the same to different strategies incorporated by Cognizant to remain one of the powerhouses of the Indian IT industry.

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

Impact investing, Social enterprise.

MBA, EMBA, Executive Education.

Zoona mobile money: investing for impact details a slightly altered version of the real events that occurred in late 2011 with the series A round of investment in Zoona, a mobile money business in Zambia. The focus is on the decisions that have to be made by the management team of a socially innovative tech start-up (Zoona) providing mobile money and financial services to previously unbanked consumers in Zambia.

By the end of this case, the student should be able to: understand the basics of term sheets and be able to perform a high level analysis and comparison of two distinct term sheets; identify investor objectives, ultimately recognising the general differences between private equity and venture capital investors; identify and weigh the costs and benefits of term sheets, as well as identify negotiating points and necessary trade-offs in the investment process; and identify and understand the “soft” benefits of investors and weigh these in relation to a term sheet analysis.

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 1: Accounting and Finance.

Impact investing, Social entrepreneurship.

MBA, EMBA, Executive Education.

CareCross Health describes the impact due diligence leading up to an investment into CareCross Health by impact investor Palm Capital. The case follows the protagonist, Caitlin Stevens, CEO of Palm Capital, as she identifies CareCross Health as a potential investment target, performs an initial screening of the company and visits the company and its sites as part of an in-depth impact due diligence.

By the end of this case, the student should be able to consider the critical steps associated with conducting an impact due diligence; understand the challenges associated with conducting an impact due diligence, with a particular focus on due diligence in an emerging market scenario; analyse a potential impact investment, in this case CareCross Health, and make a preliminary recommendation on whether the investment is viable from an impact perspective; identify the trade-offs between private sector and public sector provision of services to low-income groups, and consider unintended consequences in analysing the impact of a social enterprise; and prepare possible scenarios and weigh the potential outcomes of various arrangements to ensure alignment of investor objectives.

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 1: Accounting and Finance.