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Rockland Hospitals: Innovating Health Care in India (A) Net Present Value (NPV) / MBA Resources

Introduction to Net Present Value (NPV) - What is Net Present Value (NPV) ? How it impacts financial decisions regarding project management?

NPV solution for Rockland Hospitals: Innovating Health Care in India (A) case study


At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Rockland Hospitals: Innovating Health Care in India (A) case study is a Harvard Business School (HBR) case study written by Neena Sondhi. The Rockland Hospitals: Innovating Health Care in India (A) (referred as “Hospitals Rockland” from here on) case study provides evaluation & decision scenario in field of Sales & Marketing. It also touches upon business topics such as - Value proposition, .

The net present value (NPV) of an investment proposal is the present value of the proposal’s net cash flows less the proposal’s initial cash outflow. If a project’s NPV is greater than or equal to zero, the project should be accepted.

NPV = Present Value of Future Cash Flows LESS Project’s Initial Investment






Case Description of Rockland Hospitals: Innovating Health Care in India (A) Case Study


Rockland Hospitals, a family-run entrepreneurial health care venture, had gone from a 90-bed capacity in 2004 to 808 beds in 2014. It had created an identity as an affordable, quality-driven health care provider in the National Capital Region of India. However, the managing director needed a growth plan that would achieve his goal of creating a medical corridor in the National Capital Region with a consortium of four super-specialty hospitals. Should he focus on capacity utilization and enhancing the efficiency of existing hospitals? Was attracting more medical tourists from foreign countries the answer? Or should he strive to create a health care network that reached the remotest corners of India? Neena Sondhi is affiliated with International Management Institute.


Case Authors : Neena Sondhi

Topic : Sales & Marketing

Related Areas :




Calculating Net Present Value (NPV) at 6% for Rockland Hospitals: Innovating Health Care in India (A) Case Study


Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Discounted
Cash Flows
Year 0 (10017786) -10017786 - -
Year 1 3468023 -6549763 3468023 0.9434 3271720
Year 2 3958158 -2591605 7426181 0.89 3522747
Year 3 3974895 1383290 11401076 0.8396 3337398
Year 4 3232088 4615378 14633164 0.7921 2560116
TOTAL 14633164 12691981




The Net Present Value at 6% discount rate is 2674195

In isolation the NPV number doesn't mean much but put in right context then it is one of the best method to evaluate project returns. In this article we will cover -

Different methods of capital budgeting


What is NPV & Formula of NPV,
How it is calculated,
How to use NPV number for project evaluation, and
Scenario Planning given risks and management priorities.




Capital Budgeting Approaches

Methods of Capital Budgeting


There are four types of capital budgeting techniques that are widely used in the corporate world –

1. Profitability Index
2. Net Present Value
3. Internal Rate of Return
4. Payback Period

Apart from the Payback period method which is an additive method, rest of the methods are based on Discounted Cash Flow technique. Even though cash flow can be calculated based on the nature of the project, for the simplicity of the article we are assuming that all the expected cash flows are realized at the end of the year.

Discounted Cash Flow approaches provide a more objective basis for evaluating and selecting investment projects. They take into consideration both –

1. Timing of the expected cash flows – stockholders of Hospitals Rockland have higher preference for cash returns over 4-5 years rather than 10-15 years given the nature of the volatility in the industry.
2. Magnitude of both incoming and outgoing cash flows – Projects can be capital intensive, time intensive, or both. Hospitals Rockland shareholders have preference for diversified projects investment rather than prospective high income from a single capital intensive project.






Formula and Steps to Calculate Net Present Value (NPV) of Rockland Hospitals: Innovating Health Care in India (A)

NPV = Net Cash In Flowt1 / (1+r)t1 + Net Cash In Flowt2 / (1+r)t2 + … Net Cash In Flowtn / (1+r)tn
Less Net Cash Out Flowt0 / (1+r)t0

Where t = time period, in this case year 1, year 2 and so on.
r = discount rate or return that could be earned using other safe proposition such as fixed deposit or treasury bond rate. Net Cash In Flow – What the firm will get each year.
Net Cash Out Flow – What the firm needs to invest initially in the project.

Step 1 – Understand the nature of the project and calculate cash flow for each year.
Step 2 – Discount those cash flow based on the discount rate.
Step 3 – Add all the discounted cash flow.
Step 4 – Selection of the project

Why Sales & Marketing Managers need to know Financial Tools such as Net Present Value (NPV)?

In our daily workplace we often come across people and colleagues who are just focused on their core competency and targets they have to deliver. For example marketing managers at Hospitals Rockland often design programs whose objective is to drive brand awareness and customer reach. But how that 30 point increase in brand awareness or 10 point increase in customer touch points will result into shareholders’ value is not specified.

To overcome such scenarios managers at Hospitals Rockland needs to not only know the financial aspect of project management but also needs to have tools to integrate them into part of the project development and monitoring plan.

Calculating Net Present Value (NPV) at 15%

After working through various assumptions we reached a conclusion that risk is far higher than 6%. In a reasonably stable industry with weak competition - 15% discount rate can be a good benchmark.



Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 15 %
Discounted
Cash Flows
Year 0 (10017786) -10017786 - -
Year 1 3468023 -6549763 3468023 0.8696 3015672
Year 2 3958158 -2591605 7426181 0.7561 2992936
Year 3 3974895 1383290 11401076 0.6575 2613558
Year 4 3232088 4615378 14633164 0.5718 1847957
TOTAL 10470123


The Net NPV after 4 years is 452337

(10470123 - 10017786 )








Calculating Net Present Value (NPV) at 20%


If the risk component is high in the industry then we should go for a higher hurdle rate / discount rate of 20%.

Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 20 %
Discounted
Cash Flows
Year 0 (10017786) -10017786 - -
Year 1 3468023 -6549763 3468023 0.8333 2890019
Year 2 3958158 -2591605 7426181 0.6944 2748721
Year 3 3974895 1383290 11401076 0.5787 2300286
Year 4 3232088 4615378 14633164 0.4823 1558684
TOTAL 9497711


The Net NPV after 4 years is -520075

At 20% discount rate the NPV is negative (9497711 - 10017786 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Hospitals Rockland to discount cash flow at lower discount rates such as 15%.





Acceptance Criteria of a Project based on NPV

Simplest Approach – If the investment project of Hospitals Rockland has a NPV value higher than Zero then finance managers at Hospitals Rockland can ACCEPT the project, otherwise they can reject the project. This means that project will deliver higher returns over the period of time than any alternate investment strategy.

In theory if the required rate of return or discount rate is chosen correctly by finance managers at Hospitals Rockland, then the stock price of the Hospitals Rockland should change by same amount of the NPV. In real world we know that share price also reflects various other factors that can be related to both macro and micro environment.

In the same vein – accepting the project with zero NPV should result in stagnant share price. Finance managers use discount rates as a measure of risk components in the project execution process.

Sensitivity Analysis

Project selection is often a far more complex decision than just choosing it based on the NPV number. Finance managers at Hospitals Rockland should conduct a sensitivity analysis to better understand not only the inherent risk of the projects but also how those risks can be either factored in or mitigated during the project execution. Sensitivity analysis helps in –

What will be a multi year spillover effect of various taxation regulations.

Understanding of risks involved in the project.

What are the key aspects of the projects that need to be monitored, refined, and retuned for continuous delivery of projected cash flows.

What can impact the cash flow of the project.

What are the uncertainties surrounding the project Initial Cash Outlay (ICO’s). ICO’s often have several different components such as land, machinery, building, and other equipment.

Some of the assumptions while using the Discounted Cash Flow Methods –

Projects are assumed to be Mutually Exclusive – This is seldom the came in modern day giant organizations where projects are often inter-related and rejecting a project solely based on NPV can result in sunk cost from a related project.

Independent projects have independent cash flows – As explained in the marketing project – though the project may look independent but in reality it is not as the brand awareness project can be closely associated with the spending on sales promotions and product specific advertising.






Negotiation Strategy of Rockland Hospitals: Innovating Health Care in India (A)

References & Further Readings

Neena Sondhi (2018), "Rockland Hospitals: Innovating Health Care in India (A) Harvard Business Review Case Study. Published by HBR Publications.


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