Health Care Access for All: Making the Dream a Reality 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 Health Care Access for All: Making the Dream a Reality case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Health Care Access for All: Making the Dream a Reality case study is a Harvard Business School (HBR) case study written by John A. MacDonald, Anita M. McGahan, Will Mitchell. The Health Care Access for All: Making the Dream a Reality (referred as “Health Care” from here on) case study provides evaluation & decision scenario in field of Strategy & Execution. 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

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Case Description of Health Care Access for All: Making the Dream a Reality Case Study

For generations, the model for receiving health care services in the developed world has been straightforward. It starts with showing your insurance card at the reception desk and ends with a 10-minute examination/discussion with a doctor. In developing countries, this model is structurally untenable: according to the World Health Organization, there is a global shortage of four million health care providers, and in 57 countries, this amounts to a crisis. The authors present several new models for delivering health care services in developing countries that use ICT (information and communication technologies)-i.e., cell phones, tablets and computers. It is only a matter of time, they say, before these models spread to more resource-rich settings.

Case Authors : John A. MacDonald, Anita M. McGahan, Will Mitchell

Topic : Strategy & Execution

Related Areas :

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Calculating Net Present Value (NPV) at 6% for Health Care Access for All: Making the Dream a Reality Case Study

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 6 %	Discounted Cash Flows
Year 0	(10011488)	-10011488	-	-
Year 1	3449912	-6561576	3449912	0.9434	3254634
Year 2	3960073	-2601503	7409985	0.89	3524451
Year 3	3965747	1364244	11375732	0.8396	3329718
Year 4	3222518	4586762	14598250	0.7921	2552536
TOTAL			14598250		12661339

The Net Present Value at 6% discount rate is 2649851

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.

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Capital Budgeting Approaches

Methods of Capital Budgeting

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

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

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Formula and Steps to Calculate Net Present Value (NPV) of Health Care Access for All: Making the Dream a Reality

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 Health Care 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 Health Care 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	(10011488)	-10011488	-	-
Year 1	3449912	-6561576	3449912	0.8696	2999923
Year 2	3960073	-2601503	7409985	0.7561	2994384
Year 3	3965747	1364244	11375732	0.6575	2607543
Year 4	3222518	4586762	14598250	0.5718	1842485
TOTAL					10444336

The Net NPV after 4 years is 432848

(10444336 - 10011488 )

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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	(10011488)	-10011488	-	-
Year 1	3449912	-6561576	3449912	0.8333	2874927
Year 2	3960073	-2601503	7409985	0.6944	2750051
Year 3	3965747	1364244	11375732	0.5787	2294992
Year 4	3222518	4586762	14598250	0.4823	1554069
TOTAL					9474039

The Net NPV after 4 years is -537449

At 20% discount rate the NPV is negative (9474039 - 10011488 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Health Care 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 Health Care has a NPV value higher than Zero then finance managers at Health Care 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 Health Care, then the stock price of the Health Care 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 Health Care 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 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.

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.

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.

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Negotiation Strategy of Health Care Access for All: Making the Dream a Reality

References & Further Readings

John A. MacDonald, Anita M. McGahan, Will Mitchell (2018), "Health Care Access for All: Making the Dream a Reality Harvard Business Review Case Study. Published by HBR Publications.