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Centro de Gestion Hospitalaria 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 Centro de Gestion Hospitalaria case study


At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Centro de Gestion Hospitalaria case study is a Harvard Business School (HBR) case study written by Roberto Gutierrez. The Centro de Gestion Hospitalaria (referred as “Gestion Hospitalaria” from here on) case study provides evaluation & decision scenario in field of Strategy & Execution. It also touches upon business topics such as - Value proposition, Leadership, Organizational structure, Social enterprise, Strategy.

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 Centro de Gestion Hospitalaria Case Study


The Centro de Gestion Hospitalaria (Hospital Management Center), a nonprofit organization created in Colombia in 1992 "to promote and lead health management transformation in order to contribute to the overall development of the sector," registered a loss of about $91,000 in 2001. Top management needed a strategy to put an end to operating losses and ensure its survival. To trigger alternative courses of action, the case provides information on the organization's background, activities, and achievements in its 10 years of existence; its structure and daily operation; and its associations with several companies. Outlines the center's main features to provide the necessary background for strategic decisions on how to tackle its operating losses and how to keep providing the training, consulting, research, and informational products needed by industry players. Covers up to mid-2002, and discussions may close with the developments that took place when the new government took office in August of that year.


Case Authors : Roberto Gutierrez

Topic : Strategy & Execution

Related Areas : Leadership, Organizational structure, Social enterprise, Strategy




Calculating Net Present Value (NPV) at 6% for Centro de Gestion Hospitalaria Case Study


Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Discounted
Cash Flows
Year 0 (10023764) -10023764 - -
Year 1 3448388 -6575376 3448388 0.9434 3253196
Year 2 3957586 -2617790 7405974 0.89 3522237
Year 3 3975867 1358077 11381841 0.8396 3338215
Year 4 3229504 4587581 14611345 0.7921 2558070
TOTAL 14611345 12671718




The Net Present Value at 6% discount rate is 2647954

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

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 Gestion Hospitalaria 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. Gestion Hospitalaria 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 Centro de Gestion Hospitalaria

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 Strategy & Execution 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 Gestion Hospitalaria 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 Gestion Hospitalaria 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 (10023764) -10023764 - -
Year 1 3448388 -6575376 3448388 0.8696 2998598
Year 2 3957586 -2617790 7405974 0.7561 2992504
Year 3 3975867 1358077 11381841 0.6575 2614197
Year 4 3229504 4587581 14611345 0.5718 1846479
TOTAL 10451778


The Net NPV after 4 years is 428014

(10451778 - 10023764 )








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 (10023764) -10023764 - -
Year 1 3448388 -6575376 3448388 0.8333 2873657
Year 2 3957586 -2617790 7405974 0.6944 2748324
Year 3 3975867 1358077 11381841 0.5787 2300849
Year 4 3229504 4587581 14611345 0.4823 1557438
TOTAL 9480268


The Net NPV after 4 years is -543496

At 20% discount rate the NPV is negative (9480268 - 10023764 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Gestion Hospitalaria 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 Gestion Hospitalaria has a NPV value higher than Zero then finance managers at Gestion Hospitalaria 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 Gestion Hospitalaria, then the stock price of the Gestion Hospitalaria 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 Gestion Hospitalaria 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 uncertainties surrounding the project Initial Cash Outlay (ICO’s). ICO’s often have several different components such as land, machinery, building, and other equipment.

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.

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 Centro de Gestion Hospitalaria

References & Further Readings

Roberto Gutierrez (2018), "Centro de Gestion Hospitalaria Harvard Business Review Case Study. Published by HBR Publications.


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