1. How is the focused factory model suitable for cancer healthcare?

1. The focused manufacturing model is one that focuses on a small number of items. The factory is simple
and focuses mostly on one or two important jobs.

2. In the instance of Health Care Global, it served as a focused factory that served as a one-stop shop for
patients.

3. Its main focus was on cancer therapy, with the goal of providing treatment in both rural and urban
locations. For both children and adults, it covered every specialty and subspecialty.

4. It concentrated on imaging, therapies, and laboratory services as part of its treatment.

5. It owned a chain of pharmacies that charged consumers a distributor or retailer fee, allowing low-income
patients to access well-tested generic medications.

6. As a result, we may conclude that the concentrated factory model aided in the improvement of healthcare.
2. Compare and contrast the focus factory of Health Care Global (HCG) with other such
factories in the US (use 6 forces analysis).
It was founded by Dr. Bernard Salick.
This arrangement divides therapy into two types: inpatient and outpatient.
His cancer centers were in charge of the outpatient portion.
Inpatient methods were established for bone marrow transplants and other such difficult procedures.
This strategy teaches families how to treat and employ processes with precision.
Training families resulted in a more patient-centered approach as well as a decrease in hospital expenditures without sacrificing care.

It was founded by Richard J Stephenson.

It was designed as a targeted factory, with two-thirds of the patients having advanced cancer.
CTCA was in charge of every aspect of the patient care process.
It took care of the patient's and one family member's flight reservations.
The Dana-Farber Cancer Institute is located in Boston, Massachusetts.
It was a non-profit cancer institution that offered multidisciplinary clinics for every kind and subtype of cancer in adults and children, as well as
outpatient cancer treatment through its partners.
Dana-Farber employed full-time medical radiation oncologists, whereas its partner institution employed surgical oncologists
3. Trace the status of cancer health care in India before and after 1990.

BEFORE 1990

● Earlier the detection and treatment were major issue in cancer related mortalities.
● There were lack of hospital beds in the country.
● At that time cancer care was considered a service that should be provided by government or
trust hospitals.
● It was believed that Indians cannot afford specialised cancer care services.
● Government hospitals were poorly run and usually had long waiting period due to excessive
demand.

AFTER 1990

● After this period there were many private hospitals which provided facility for cancer care.
4. Comment on the hub and spoke expansion model adopted by HCG in India.

The hub and spoke expansion model adopted by HCG in India are:

● HCG’s hub-and-spoke expansion model was key to its value proposition.

● A hospital was categorized as a “hub” if it provided all three treatment specialties (medical,
radiation, and surgical oncology) with high-end technology.
● Its “Center of Excellence” hub in Bangalore also provided specialized services such as robotic
radiosurgery, molecular imaging, nuclear medicine, and sub specialties in oncology.
● “Spokes,” typically chemotherapy centers providing basic therapy and follow ups, were located in
small cities and towns.
● HCG had also established “mini-hubs” in larger cities like Delhi in Ahmedabad, providing all
services except high-end diagnostics and therapy.
● The spokes allowed patients to remain in their local community for most of their treatment.
5. What were the challenges/ entry barriers faced by HCG during establishing its
operations in India?

Challenges/ entry barriers faced by HCG during establishing its operations in India were :
1. Corruption among the local bureaucracies

2. Regulation for using the radiation equipment , as it was new to India.

3. Public hospitals
6. What steps did HCG take to ensure the high quality of its services?

HCG take to ensure the high quality of its services in two ways:

1. First, both physics (planning of radiation treatment) and pathology (the study and diagnosis of a disease) were centralized functions.
Through centralization, a team of highly qualified physicists could design complex treatment plans for patients in spoke hospitals.

2. The most complex part of the cancer treatment, was controlled by HCG’s highly specialized hub doctors.

3. Once the diagnosis was finalized in the hub, the treatment plan could be implemented by the doctors in spokes.

4. HCG’s centralized drug procurement was an important component of quality control. The quality of its drugs was vetted centrally and procured
in bulk.
7. Comment on HCGs CSR efforts.

HCGs CSR efforts:

● They provided treatment for low income patients at night who could not pay.
● They opened scope facility in smaller and medium city for the convenience of its
customer.
● They regularly offered and at times, free treatment to indigent patient and they
also determined their ability to pay.
● They conducted camps regularly to raise awareness about cancer and also
offered second opinion services at nominal costs.
● They also convinced suppliers to give them free drugs for poor patients who
could not pay on a case-by-case basis.
8. What effect did the changing insurance landscape in the country has on HCG’s
operations?

People living in poverty are covered by the government.

Approximately 40% of HCG patients were covered by insurance.
Approximately 40% of HCG's patients were covered by insurance,
with 15% being government and 25% being private.
Reimbursement from the government is abysmal
9. How did the Human Resources Model of HCG help ensure the success of the
organization?
The Human Resources Model of HCG help ensure the success of the organisation by:

● HCG’s recruit thousands of staff members by established relationships with nursing schools and
medical colleges.
● HCG also prioritized recruiting strong managers for its hospitals and recruited regularly on-campus
from management schools for full-time and summer-interns to work in its hospitals.
● HCG rarely had to compete with other hospitals for doctors because its cancer focus attracted
specialized doctors.
● HCG felt it was the hospital of choice for Indian-origin doctors moving back to India, particularly from
the U.K. These doctors were typically salaried and earned similar wages in India after adjusting for
purchasing power parity (PPP). Most of them had significant savings and wanted to move back to India.
● The professionalism with which it operated as well as the strong culture of service and philanthropy that
permeated the organization were major reasons for this choice for doctor of Foreign origin.
10. Comment on the financing model of HCG and its financial performance.

● Initially HCG experienced the explosive growth in the last five years, with
revenue growing at a 70% CGAR and EBITDA 115%.
● HCG experienced losses Millan, a fertility clinic chain in which HCG had a
50.1% interest, accounted 6.69% of revenues, declined by 3.89% as the
cancer division grew by 19.7%.
● HCG saw very low margins on brand- names drugs, given their high prices,
and maintained higher margins on generics.
● HCG’s each new centres take $4-$10 mn to set up depending up on the scale.
● HCG partnered to create new spokes owned 20% of the equity in the company
collectively and HCG also have three private equity investors.
11. What recommendations do you have for Dr. Ajay Kumar for expansion in India with
an IT focus?

● Initially HCG experienced the explosive growth in the last five years, with
revenue growing at a 70% CGAR and EBITDA 115%.
● HCG experienced losses Millan, a fertility clinic chain in which HCG had a
50.1% interest, accounted 6.69% of revenues, declined by 3.89% as the
cancer division grew by 19.7%.
● HCG saw very low margins on brand- names drugs, given their high prices,
and maintained higher margins on generics.
● HCG’s each new centres take $4-$10 mn to set up depending up on the scale.
● HCG partnered to create new spokes owned 20% of the equity in the company
collectively and HCG also have three private equity investors.
 12. Should Dr. Ajay Kumar go ahead with his plans of setting up cancer centers across
Africa?

•Yes, he should go ahead with his plan of setting up cancer centers across Africa in coming years.

•He should go for partnership with common wealth development which is arm of British govt.
•Establish corporation in Mauritius which will drive the African initiative not only in terms of setting up clinics but also starting actual
centres due to unmet demand of centers to establish.

•For awareness regular medical camps in East Africa through check ups.

•Role of govt is very limited just only to perform online registration.

•Marketing of their services can be done through local consultants, insurance groups and health check up plans.
•HCG provides travel, insurance and financial services to their patients.

•Have capacity to deal with corruption as in India well handled the situation of corruption.