Narayana Hrudayalaya: From Heart Care to Human Care 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 Narayana Hrudayalaya: From Heart Care to Human Care case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Narayana Hrudayalaya: From Heart Care to Human Care case study is a Harvard Business School (HBR) case study written by Tanusree Mazumder, Radha R. Sharma. The Narayana Hrudayalaya: From Heart Care to Human Care (referred as “Cardiac Nh” from here on) case study provides evaluation & decision scenario in field of Leadership & Managing People. It also touches upon business topics such as - Value proposition, International business, Leadership, 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 Narayana Hrudayalaya: From Heart Care to Human Care Case Study

Narayana Hrudayalaya (NH), a leading cardiac hospital network with many firsts to its credit, has revolutionized heart care in India. It has a market share close to 15 per cent in the cardiac sector, has successfully completed 70,000 surgeries and has given insurance to over four million farmers through its microinsurance scheme. Its motto, "caring with compassion," is its guiding philosophy and the telemedicine network set up at NH has been able to provide treatment for over 50,000 cardiac patients free of charge. The case highlights the evolution of NH and the vision of its founder, and outlines his ambitions and struggles in seeking to increase the number of cardiac surgeries performed each day. How can he retain the top surgeons and fulfill his mission to offer affordable heart care while the compensation of doctors is rapidly increasing? Tanusree Mazumder is affiliated with Management Development Institute. Radha R. Sharma is affiliated with Management Development Institute.

Case Authors : Tanusree Mazumder, Radha R. Sharma

Topic : Leadership & Managing People

Related Areas : International business, Leadership, Strategy

Calculating Net Present Value (NPV) at 6% for Narayana Hrudayalaya: From Heart Care to Human Care Case Study

Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Cash Flows
Year 0 (10000129) -10000129 - -
Year 1 3446129 -6554000 3446129 0.9434 3251065
Year 2 3955104 -2598896 7401233 0.89 3520028
Year 3 3953233 1354337 11354466 0.8396 3319211
Year 4 3243271 4597608 14597737 0.7921 2568974
TOTAL 14597737 12659279

The Net Present Value at 6% discount rate is 2659150

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

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. Cardiac Nh 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 Cardiac 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.

Formula and Steps to Calculate Net Present Value (NPV) of Narayana Hrudayalaya: From Heart Care to Human Care

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 Leadership & Managing People 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 Cardiac 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 Cardiac 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 %
Cash Flows
Year 0 (10000129) -10000129 - -
Year 1 3446129 -6554000 3446129 0.8696 2996634
Year 2 3955104 -2598896 7401233 0.7561 2990627
Year 3 3953233 1354337 11354466 0.6575 2599315
Year 4 3243271 4597608 14597737 0.5718 1854351
TOTAL 10440926

The Net NPV after 4 years is 440797

(10440926 - 10000129 )

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 %
Cash Flows
Year 0 (10000129) -10000129 - -
Year 1 3446129 -6554000 3446129 0.8333 2871774
Year 2 3955104 -2598896 7401233 0.6944 2746600
Year 3 3953233 1354337 11354466 0.5787 2287751
Year 4 3243271 4597608 14597737 0.4823 1564077
TOTAL 9470202

The Net NPV after 4 years is -529927

At 20% discount rate the NPV is negative (9470202 - 10000129 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Cardiac 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 Cardiac Nh has a NPV value higher than Zero then finance managers at Cardiac 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 Cardiac Nh, then the stock price of the Cardiac 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 Cardiac 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 –

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

Understanding of risks involved in the project.

What can impact the cash flow of 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 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.

References & Further Readings

Tanusree Mazumder, Radha R. Sharma (2018), "Narayana Hrudayalaya: From Heart Care to Human Care Harvard Business Review Case Study. Published by HBR Publications.