Health City Cayman Islands, Spanish Version 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 City Cayman Islands, Spanish Version case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Health City Cayman Islands, Spanish Version case study is a Harvard Business School (HBR) case study written by Tarun Khanna, Budhaditya Gupta. The Health City Cayman Islands, Spanish Version (referred as “Cayman Nh” from here on) case study provides evaluation & decision scenario in field of Strategy & Execution. It also touches upon business topics such as - Value proposition, Disruptive innovation, Emerging markets, Growth strategy, Knowledge management, Marketing, Pricing.

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 City Cayman Islands, Spanish Version Case Study

Narayana Health (NH) had been successfully delivering affordable high quality tertiary care to the masses in India through its chain of hospitals for over a decade. To encourage the adoption of the NH affordable care delivery model worldwide, Dr. Shetty, Chairman of NH, was keen to establish a hospital in the western hemisphere and believed that it was important to demonstrate the model to the US. Thus when the Cayman Islands Government was interested in developing the island as a medical tourism hub during 2008-09, Dr. Shetty agreed to develop the Health City Cayman Islands (HCCI), a 2,000 bed conglomeration of multiple super-specialty hospitals within a single campus located on the Grand Cayman Island. The first phase of HCCI, a 104 bed hospital focused on cardiac care and orthopedics, was developed jointly by NH and Ascension, the largest non-profit hospital system in US. The hospital was inaugurated in February, 2014 but there were open questions related to pricing of the procedures and the related target patient segment and volumes. Also, HCCI senior management realized the need to adapt the NH model developed in and for India to fit the new environment at Cayman and was open to experimentation in coming months.

Case Authors : Tarun Khanna, Budhaditya Gupta

Topic : Strategy & Execution

Related Areas : Disruptive innovation, Emerging markets, Growth strategy, Knowledge management, Marketing, Pricing

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Calculating Net Present Value (NPV) at 6% for Health City Cayman Islands, Spanish Version Case Study

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 6 %	Discounted Cash Flows
Year 0	(10024948)	-10024948	-	-
Year 1	3459478	-6565470	3459478	0.9434	3263658
Year 2	3960426	-2605044	7419904	0.89	3524765
Year 3	3939386	1334342	11359290	0.8396	3307584
Year 4	3225959	4560301	14585249	0.7921	2555262
TOTAL			14585249		12651270

The Net Present Value at 6% discount rate is 2626322

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. 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 Cayman Nh 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. Cayman Nh shareholders have preference for diversified projects investment rather than prospective high income from a single capital intensive project.

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Formula and Steps to Calculate Net Present Value (NPV) of Health City Cayman Islands, Spanish Version

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 Cayman Nh 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 Cayman Nh 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	(10024948)	-10024948	-	-
Year 1	3459478	-6565470	3459478	0.8696	3008242
Year 2	3960426	-2605044	7419904	0.7561	2994651
Year 3	3939386	1334342	11359290	0.6575	2590210
Year 4	3225959	4560301	14585249	0.5718	1844453
TOTAL					10437556

The Net NPV after 4 years is 412608

(10437556 - 10024948 )

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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	(10024948)	-10024948	-	-
Year 1	3459478	-6565470	3459478	0.8333	2882898
Year 2	3960426	-2605044	7419904	0.6944	2750296
Year 3	3939386	1334342	11359290	0.5787	2279737
Year 4	3225959	4560301	14585249	0.4823	1555729
TOTAL					9468660

The Net NPV after 4 years is -556288

At 20% discount rate the NPV is negative (9468660 - 10024948 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Cayman Nh 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 Cayman Nh has a NPV value higher than Zero then finance managers at Cayman Nh 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 Cayman Nh, then the stock price of the Cayman Nh 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 Cayman Nh 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 –

Understanding of risks involved in the project.

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

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.

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Negotiation Strategy of Health City Cayman Islands, Spanish Version

References & Further Readings

Tarun Khanna, Budhaditya Gupta (2018), "Health City Cayman Islands, Spanish Version Harvard Business Review Case Study. Published by HBR Publications.