Examination – Advantages & Disadvantage

Eating/Drinking: Establishment Name (egg. Lotus Restaurant) Type of establishment (Restaurant/Cafe/Bar/Pub/Tavern) Timings Dcord (interiors, theme, lighting, ambiance) Cuisine Served Conference/Banquet Rooms: Conference Rooms Room Size (square feet)Facilities Available (secretarial services, audio-visual equipment) Other Details: 24-hour front desk Air-condition public areas Airport transport- surcharge Airport transportation free Arcade/game room ATM/banking Audio-visual equipment Banquet facilities Bar/lounge Barbecue grill(s) Suitable for children Beauty Services Breakfast services Casino Catering Babysitting or child care Business center Cell phone rental Clubhouse Coffee shop or cafe Complimentary Newspapers Complimentary breakfast Computer rental Spa services nearby Spa services on site – Free Golf camps GardensConcierge Boating Dance performances Travel counter Swimming pool Library Safari Book Shop Night club Luggage storage Backup generator Jacuzzi Wedding services Tr anslation services Currency exchange Doorman Elevator/lift Exhibit space Express check-in/check-out Fireplace in lobby Fitness equipment Floor butler Front desk Full-service health spa Gift shops or newsstand Grocery Health club Internet access-complementary Internet access-dial-up Internet access-high-speed Internet access-surcharge Internet access-wireless Laundry facilities Limousine service available Marina on siteMassage-treatment room(s) Medical services Meeting room(s) small groups Microwave in lobby Multilingual staff Nightclub Number of floors Parking(free) Parking(secure) Parking(surcharge) Parking(valet) Parking garage Parking nearby Patio-property Picnic area Pool Table Poolside Bar Porter/bellhop Private beach Restaurant Room service Room service(24 hours) Room service(limited hours) Safe deposit box-front desk Sauna Secretarial services Security guard Shoe shine Shopping on site Ski shuttle Ski storage Ski-in/ski-out Smoke-free property Spa services on site. .

Health Financing in India

Institute for Financial Management and Research Centre for Insurance and Risk Management Delivering Micro Health Insurance Through the National Rural Health Mission A Strategy Paper Rupalee Ruchismita, Imtiaz Ahmed and Suyash Rai August 2007 Rupalee Ruchismita (rupalee. [email  protected] ac. in) and Imtiaz Ahmed ([email  protected] ac. in) are with the Centre for Insurance and Risk Management at IFMR, Chennai (http://ifmr. ac. in/cirm). Suyash Rai is with the ICICI Centre for Child Health and Nutrition, Pune. The views expressed in this note are entirely those of the authors and do not in any way re? ct the views of the Institutions with which they are associated. . Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Contents 1 Introduction 2 Health Financing in India 3 Key issues in Health Financing 4 Exploring Risk Transfer and Pooling Strategies 5 Proposal for a National Apex Body 6 Conclusion 7 Annexures 7. 1 ANNEXURE I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 2 ANNEXURE II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 3 Objectives, Activities, and Services . . . . . . . . . . . . . . . . . . . . . . . 1 1 3 4 8 13 14 14 19 22 0 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 1 Introduction The Indian health scenario is fairly complex and challenging with successful reductions in fertility and mortality offset by a signi? cant and growing communicable as well noncommunicable disease burden1 , persistently high levels of child undernutrition2 , increasing polarisation in the health status of the rich and the poor3 and inadequate primary health care coexisting with burgeoning medical tourism! This situation is further complicated by the presence and practice of multiple systems of medicine and medical practitioners (several of whom are not formally certi? ed and recognised) and very limited regulation. In such a context, this paper highlights the challenges in ? nancing health in India and examines the role of health insurance in addressing these. It proposes an operational framework for developing sustainable health insurance models under the National Rural Health Mission, responding to the contextual needs of different states. 2 Health Financing in India The total spending on the health sector in India is not low. According to the National Health Accounts 2001-02, the total health expenditure in India for the year was Rs. 1,057,341 million, which accounted for 4. 6 percent of the Gross Domestic Product (GDP). The concern lies in the fact that households are the major ? nancing sources, accounting for 72 percent of the total health expenditure incurred in India. State Governments contribute 12. 6 percent of the total health expenditure, Central Government 6. 4 percent and the public and private ? rms 5. 3 percent. External support from bilateral and multilateral agencies accounts for 2. percent of health expenditure in India, a majority coming in as grant to the Central Government. So, only about 20% of the overall funding comes from India accounts for only 16. 5% of the global population, it contributes to approximately a ? fth of the world’s share of diseases: a third of the diarrheal diseases, tuberculosis, respiratory and other infections, parasitic infestations and perinatal conditi ons; a quarter of maternal conditions; a ? fth of nutritional de? ciencies, diabetes, cardiovascular diseases, and the second largest number of HIV/AIDS cases in the world. Report of the National Commission on Macreconomics and Health. 2005. New Delhi: Ministry of Health and family Welfare. ) 2 National Family Health Survey III, 2005-06. Mumbai: International Institute of Population Sciences. 3 The poorest 20 percent of Indians have more than twice the rates of mortality, malnutrition, and fertility of the richest 20 percent. (Peters DH et al. Better Health Systems for India’s Poor. 2002. New Delhi: World Bank. 1 Although 1 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission he government, which is one of the lowest in the world. This is a signi? cant problem in a country where the government has mandated itself to provide comprehensive quality health care to all. The problem of household expenditure for health care is compounde d by the fact that 98 percent of this is â€Å"out-of-pocket†, which is fundamentally regressive and burdens the poor more. Also, the absence of proper pooling and collective purchasing mechanisms for the households’ money further worsens the situation because of the resulting inef? ciencies. Most of the household expenditure on health goes to the fee-levying and largely unregulated private providers. The share of household consumption expenditure devoted to health care has also been increasing over time, especially in rural areas where it now accounts for nearly 7 per cent of the household budget4 . This situation is not surprising since public and private expenditure on health are closely linked. Given that government spending on health stands at less than 1 per cent of the GDP, which is very low by international standards, the need for private out-ofpocket expenditure increases. Seventy percent of the total ? nancial resources ? ow to health care providers in the for pro? t private sector. Only 23 percent are spent on public providers. In an environment of minimal regulation, this provides signi? cant opportunity for the exploitation of health care seekers. In addition, there are signi? cant inter-state differences in health ? nancing. Among the major states, Himachal Pradesh ranks highest in terms of per capita public spending on health (Rs. 493 per year) and also has the highest public expenditure as percentage of total expenditure (37. 8%). On both these parameters, Uttar Pradesh is the lowest ranking state, with a per capita public spending on health of Rs. 84 per year, and only 7. 5% of the total health expenditure is public expenditure. All India per capita expenditure on health is Rs. 997 (207 from public and 790 from private)5 . There are also indications of declining state government spending in crucial areas. Overall health spending declined over the decade 1993-94 to 2002-03 in 3 states, and declined between 1998-99 and 2002-03 in 6 4 Government Health Expenditure in India: A Benchmark Study. 2006. New Delhi: Economic Research Foundation. All India public expenditure including expenditure by the Ministry of Health and Family Welfare, Central Ministries and local bodies, while private expenditure includes health expenditure by NGOs, ? rms and households. 2 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission states6 . There are also sharp and generally growing rural- urban disparities in spending in most states. 3 Key issues in Health Financing Drawing from the above analysis and other related literature, the following emerge as the key issues in reforming health ? ancing in India. Increasing government spending on public and more speci? cally, primary health care As discussed earlier, the government spending on public health in India, constituting about 4% of its total expenditure and less than 1% of the GDP, is very low. In per capita terms, the government spends only USD 4 annually on public health. According to the World Health Report (2000), only twelve other countries spend less than India on public health, most of them in Africa. For most other nations, government spending on health is more than 10 percent of the total government expenditure. The Commission on Macroeconomics and Health has estimated that public spending in low income countries should be within the range of $30-$45 per capita to ensure achievement of public health goals. In India, most of the government spending is on medical colleges, into tertiary centres, and very little trickles down to the primary and secondary levels. There is therefore a strong case for increasing government spending across the board, with a much higher focus on primary care services. This will reduce the need for spending by the poor and also improve the overall health status. The options for increasing public ? ancing of health include reallocation of the government budget (possibly by re-routing other direct and indirect subsidies) and earmarked taxes (such as the taxes levied for ? nancing the Sarva Shiksha Abhiyan). Addressing the supply and demand-side factors that prevent the poor from bene? ting from the health sector In general the poor bene? t much less from the health sec tor than the rich do largely because of their inability to seek timely and adequate health care. The poorest quintile of Indians are 2. 6 times more likely than the richest to forgo medical treatment when ill7 . Government Health Expenditure in India: A Benchmark Study. 2006. New Delhi: Economic Research Foundation. 7 Peters, D. et al. Better Health Systems for IndiaSs Poor: Findings, Analysis, and Options. 2002. Washington 3 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission However, whatever care they do access, the poor are found to rely signi? cantly on the public system for preventive and inpatient care including 93 percent of immunizations, 74 percent of antenatal care, 66 percent of inpatient bed days, and 63 percent of delivery related inpatient bed days. Improvements in the public system through increased and more effective spending would therefore bene? t the poor signi? cantly. Increasing the effectiveness of public health spending would require attention to supply side factors such as facility location, availability of staff, medicines, equipment and quality of care as well as demand-side factors such as indirect costs (travel, wage loss), non formal charges, awareness levels, perception of quality and uncertainty about payment. Mitigating risks due to out-of-pocket expenditure, particularly catastrophic expenditure for the oor At least 24 per cent of all Indians fall below the poverty line because they are hospitalised8 . It is estimated that out-of-pocket spending on hospital care might have raised the proportion of the population in poverty by 2 per cent. Risk-pooling and collective purchasing mechanisms could increase the ef? ciency and equity with which the households’ money is collected, managed and used, so that the households’ burden is reduced. 4 Exploring Risk Transfer and Pooling Strategies Exploring Risk Transfer and Pooling Strategies in the context of the NRHM In attempting to understand the potential of risk pooling or risk transfer mechanisms such as insurance (which immediately addresses the cost which a household spends on hospitalization) in achieving public health goals within the overall NRHM mandate, the following issues become relevant: 1. The potential value addition that insurance could provide 2. The various models of health insurance for the poor 3. Implementation of the insurance programme in the context of the NRHM D. C. : The World Bank. 8 Ibid 4 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 1. Health Insurance leads to: †¢ Risk pooling for in patient care (hospitalization): As discussed, one of the major causes of poor households slipping into the poverty cycle is out of pocket expenditure incurred for hospitalization. In such a scenario, insurance, which allows for risk pooling, helps in making available additional source of ? nancing for the household thereby reducing overall vulnerability and smoothening expenditure shocks for larger unpredictable catastrophic health events. Increased utilisation of health services: It is expected that the introduction of health insurance will lead to greater utilisation of health care services. Across the world it has been found that the overall use of curative services for adults and children was up to ? ve times higher for members of health insurance programmes than non-members9,10 . †¢ Standardization and cost effective q uality health care: Insurance as a mechanism attempts to standardize protocols, procedures and bring down cost through rate negotiations. This ensures the availability of cheaper healthcare, controlling fraud and possibility of rent seeking behaviour which is high in the case of the poor who have comparatively lesser knowledge about their health status or possible treatment required. Further due to Health Insurance, the out of pocket expenditures per episode of illness are signi? cantly lower for members as compared with those for non-members11 . Under the NRHM it is hoped that a national level expert committee will play a pivotal role in standardizing treatment protocol and rates. Presently such an activity has been undertaken by World Health Organisation (WHO), India-Of? e, in collaboration with Armed Forces Medical College (AFMC). †¢ Cover for access barriers (loss of wage, transportation cost) and new and emerging diseases: It has been seen that since most of the micro insurance models evolved from community institutions and NGOs, they packaged critical P. , and F. Diop. Synopsis of Results on the Community â €“ Based Health Insurance (CBHI) on Financial Accessibility to Healthcare in Rwanda. HNP Discussion Paper. 2001. Washington, D. C: World Bank. 10 Preker, A. S, Carrin, G. SHealth Financing for Poor People – Resource Mobilisation and Risk Sharing. T 2004. ? ? Washington D. C. : World Bank. 11 Preker, A. S and G Carrin. Health Financing for Poor People – Resource Mobilisation and Risk Sharing. 2004. Washington D. C. : World Bank. 9 Schneider 5 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission access barriers as part of their insurance cover. Also, insurance as a concept works on the principle of risk pooling and cross subsidization for low frequency events. The cost of healthcare for life style diseases like diabetes or critical illnesses and HIV/AIDS, is very high. Community Insurance models delivered at a large aggregation can cover for these rare events and ensure that the poor do not fall back into poverty in the process for paying for this high cost event. This has been tried in some schemes like the Arogya Raksha Yojna (ARY)12 . †¢ Development of stronger referral linkages: Insurance as a mechanism to be sustainable requires developing strong upward as well as downward referral mechanisms. Strong referrals ensure non escalation of cases, thus ensuring ‘right care at the right time’, reducing possibilities of collusion and fraud. †¢ Ef? ciency in the health system in terms of: – Allocative ef? iency in addressing the most risky event a household faces i. e. hospitalisation and by diverting the surplus premium to strengthen the health infrastructure and incentivise manpower. – Value for money: Presently the expenditure on health by the poor includes leakages such as transport costs, spurious drugs, unlice nsed medical practitioners who offer health care of sub optimal quality. 2. Various Models of Health Insurance for the Poor Models of micro health insurance may be categorized into the following: †¢ Social Health insurance: Such insurance models are found in about 8 countries across the world. The overall model works with a differential premium payment mechanism where the economically secure pays a relatively higher premium than what their risk pro? le dictates and the poor pay a comparatively lower premium commensurate with their income. This leads to cross subsidization across the rich and poor category. In India it is mostly seen in the formal sector in the form of ESIS and the CGHS scheme. 12 With Narayana Hrudayalaya, Biocon and ICICI Lombard in Anekal Taluka of Bangalore district of Karnataka. 6 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Community Based Health Insurance (CBHI): There are three basic designs of CBHI, depending on who the insurer is. In Type I (or HMO design), the hospital plays the dual role of providing health care and running the insurance programme. In Type II (or Insurer design), the voluntary organisation is the insurer, while purchasing care from independent providers and ? nally in Type I II (or Intermediate design), the voluntary organisation (NGO/CBO) plays the role of an agent, purchasing care from providers and insurance from insurance companies. This seems to be a popular design, especially among the recent CBHIs13 . The merit14 of the last model is the aggregating role and the context speci? city that the NGO/CBO assumes. Since the NGO has systematically addressed information asymmetry, and also shares the community’s trust, these initiatives show better results (as seen in case of Dhramasthala insurance programme). In the case of a national roll out this can be the best model as it will capture the diverse nature of health requirements in the different NRHM states. The provider model or insurer model may not work out as customisation to local condition becomes the main crux of success or failure of the scheme. Further an NGO along with an insurer will be in a better position to retain the large risk of the community as compared to an individual entity like a provider or an NGO alone. It is crucial to ? nd NGOs that have a long term stake and therefore would act as ‘conscientious players’ who will ensure that the insurance programme, generates long term positive impact on the health system of the speci? c geography. 3. Some suggestions for the proposed Health Insurance Programme As discussed earlier, the health system in India is characterised by grave inequities leading to a political economy that makes health care access income and classdependent. This creates the need to explore various types of innovations and changes that could improve this unacceptable situation. Insurance is potentially one such et al. Community-based Health Insurance in India: An Overview. July 10, 2004. Economic and Political Weekly. New Delhi. 14 The Yeshaswani insurance programme (the large health insurance programme in the country) follows this model through the various cooperatives facilitated by the department of cooperatives. Other example is the Dharamasthala insurance programme where the NGO (Dharmastahala trust) is the aggregator and has about 1 million insured under its scheme. 3 Devadasan 7 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission innovation. However, for health insurance to effectively improve the ef? ciency of health spending and ultimately improve health status, it would need to be conceptualised as a part of a larger effort to improve the accessibility and quality of health care s ervices, especially for the poor. In the Indian context, any health insurance programme will have to take into account the plural nature of the health system, especially the presence of a large fee-levying, unregulated and ill understood private sector. It will have to explore synergies and integration with the widespread public health system and its current ? nancing mechanisms. Questions such as who should pay the premiums for the poor and how should incentives be aligned will have to be carefully thought through to ensure the management of problems such as adverse selection, inadequate monitoring and moral hazard, exacerbated because of extreme information asymmetries inherent in health services and goods. Internationally and within India, there is a signi? ant body of literature regarding the impact of different health insurance programmes on the health system. For the Indian context, it would be important to learn from these various experiences, develop a theory about the mechanisms through which insurance can contribute to public health goals, run pilots in different contexts within India to understand feasibility and impact, and determine the ? nal programme based on these learnings. 5 Proposal for a National Apex Body Proposal for a National Apex Body Working as a Coordinating Centre for Micro Health Insurance: It is proposed that a National Apex Body, ideally placed within the Insurance Regulatory and Development Authority (IRDA), be established to monitor and coordinate the implementation of the micro health insurance operations in the country (see ANNEXURE 2). The Apex body should have capacity in the areas of public health and insurance, host national and state-level dialogues on the idea of insurance in the context of health systems, implement pilots in speci? geographies and take forward the learning, and ensure knowledge sharing so that progressively larger regions can be covered under the micro 8 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission insurance scheme. ANNEXURE 2 provides details of potential roles this apex body (tentatively named Micro-insurance Coordinating Centre) could play in taking forward the agenda of usefully employing the strategy of insurance to get closer to the public health goals of the country, focusing on the vulnerable. It is envisaged that this body should play a knowledge-building, technical advisory, policy advisory, facilitative coordination role with a long-term aim of achieving universal health insurance coverage by an optimal combination of social and micro health insurance mechanisms, in a manner that it integrates seamlessly with the overall health system. The proposed apex body should host a process that ‘arrives’ at a framework of implementing health insurance under NRHM. Based on our understanding, the following emerge as important aspects of any national level health insurance programme developed under the NRHM. The health insurance model under the NRHM should explore the Partner-Agent approach which includes both the insurance partner (risk partner) and the agent (NGO). Based on experiences from the pilots, the insurance cover could be a compulsory, cash less health insurance product with a family ? oater with minimum initial deductibles. Depending on the availability and quality of providers, the insured should have the choice to access the nearest (private or public) health care facility and should be allowed to choose between any provider within a given geographical parameter. The client could be issued a biometric ID card which is updated with diagnostic information and refers her/ him to the desired care provider to control overcrowding at the tertiary facility. 1. Product Cover: To begin with, the product should cover basic hospitalisation at the secondary care level (either at the cluster of village, block or district level). It should include the cost of: †¢ Hospitalisation †¢ Diagnostic services †¢ Medicine and consumables †¢ Consultation and nursing charges †¢ Operative charges 9 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission The product should also try to cover for access barriers like transportation cost (with a initial deductible to control frauds and limited to only the cheapest mode of transport available, customized according to the district), loss of wage (in case of the male or female member of the household as de? ned by the state according to the minimum wage guaranteed by the state government. This could be done in tandem with the National Rural Employment Guarantee Scheme (NREGS). In geographies where investment in directed preventive and promotive services can bring down the need for seeking in-patient care, directed primary care primary level care can be provided by the insurance programme. For example, Directed preventive promotive community health education could lead to reduction in the frequency of inpatient care due to vector borne diseases in several geographies15 . Thus based on the speci? location package of additional community health intervention will be developed, which can be paid from the insurance model The insurance programme can work with District Health Societies to offer rehabilitative care and ? nancial help to patients who have recovered but are disabled due to diseases like leprosy or polio. It can also help the People Living with HIV/AIDS (PLHIV) by providing additional services like providing nutritional supplement and other additional services wh ich will supplement the current care being provided by the national programme for control of HIV/AIDS. 2. Health providers: Both private and public facilities at the secondary care level could be empanelled as providers. Private care hospitals could include nursing homes or 20 bedded medical facilities as seen in the Missionary hospitals as well as entrepreneur led inpatient care. For the government hospitals such as the district hospital, the difference in rates could be used for improving infrastructure and incentivising staff. 3. Building information systems: There is a need for a reliable transparent MIS sys15 For Insurance covering hospitalization due to events that can be impacted by Sspeci? S preventive promo? tive health education, it makes economic sense to proactively invest in Community Health Education, which will reduce the probability of hospitalization due to the event. Vector borne diseases show a high degree of sensitivity to such Community Health Education programmes. 10 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission tem to improve the overall ef? ciency of the system. This would reduce paper work, streamline referral linkages and aggregate data helpful for product customization. The community health insurance model could generate a much needed Electronic Health Records (EHR) system. This would imply that as per commonly agreed terms all health related information of an individual (parameters like diagnostic test results (blood pressure, body temperature, pulse rate, ECG), diseases to which he/she is prone; past illnesses etc) is stored onto a system or a database. This database can be accessed by all ensuring anonymity and therefore all insurers, health workers and policy makers can access and interpret the health data to be able to conduct community risk assessment. This will encourage insurers to compete for risk pricing of the community in the said geography and lead to cheaper insurance premiums. The focus of the EHR system would be to ensure – Universality, Consistency, Open Standards, Non-Proprietary, and Acceptability. To institutionalize a reliable EHR system it should be made compulsory that any treatment/diagnosis/medical intervention be updated into the individual’s EHR, such that the EHR is the most authentic source of health information about an individual. The other challenge that needs to be addressed for development of better health insurance products as well as better health care delivery is the challenge of targeting and uniquely identifying the individual. Such identi? cation could be achieved through a biometric identi? cation smart card. The smart card can be used to not only help in identi? cation, but also for storing of? ine health information With an EHR and smart card system, the insured can freely access b oth the public and private health care facilities available in the geography. This helps the insured as well as the medical practitioners and improves diagnosis and response time. The Smart Card can also be used to store health insurance related information of the client. The health provider can thus check the eligibility of the individual in terms of insurance before delivering treatment. The same card can also be used as a payment instrument to capture the payments that need to be made to the health providers. The card can be used to pass 11 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission n incentives to clients as well as the hospital to keep using the card. The biometric card will have terminals (which can upload data of? ine) in the various network hospitals to upgrade data whenever the insured avail care. 4. Formative Research: a Community Needs Assessment (CNA) will need to be done to list down the health needs and the willingness to pay, a mapping of the healthcare facilities in the geography, an unde rstanding about the type of premium and payout that the community are expecting from the insurance scheme and the broad range of social protection measures that they want the insurance to take up. Based on the information provided above the product and the EHR can be developed. Initially, it is advisable to undertake health insurance pilots in different contexts to develop and ? nalise the health insurance programme. 5. Implementation and monitoring: The proposed National Apex body, should monitor and coordinate the implementation of the micro health insurance operations in the country (see Annexure- 2). The following ideas can potentially strengthen the monitoring and implementation of the programme: †¢ The District Health Accounting System and the proposed ombudsman (to be created under NRHM to monitor the District Health Fund Management) will work closely with the NGO and the insurer to ensure the smooth running and monitoring of the programme. †¢ At the backend, the insurance programme with the EHR system will develop a rich data source and act as a Fraud control mechanism. This data will help in identifying disease patterns for the community and could be a critical tool for the NRHM team to de? e ? nancial allocations, target services and make evidence based policy recommendations. (While developing this EHR we should ensure that we are following international standards to be able to be coded properly and stored in a card). In the long run, this apex body should aim at achieving universal health insurance coverage by combination of social and community based health ins urance mechanisms. There is a case for building facilitative institutional arrangements of the ‘right’ stakehold12 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission rs who will pursue this goal. The learning from the challenges and processes involved in implementing Universal Health Insurance Scheme (UHIS) will be very valuable. 6 Conclusion Promoting health and confronting disease requires action across a range of challenges in the health system. These include improvements in the policy making and stewardship role of the government; better access to human resources, drugs, medical equipment, and consumables; and a greater engagement of both public and private provider of services. Insurance has a limited but important role to play in solving some of the health ? nancing challenges. Innovative pilots of partner agent model led micro health insurance could giver useful insights for designing a national level programme, led by an apex body. Such a programme could systematically impact the health system in the country. 13 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 7 Annexures 7. 1 ANNEXURE I Beyond the pilot, the initial cover will be modi? ed to cover primary and tertiary tier of the health systems in the country. . Primary level: The Insurance will cover: †¢ Diagnostic charges incurred on low and high end diagnostic16 †¢ Medications including expensive medication (like life saving drugs, higher antibiotics etc), injectibles and other consumables not usually available in the primary health centre †¢ Based on the recommendation given in the NRHM document, practitioners of AYUSH and other speci alties can be roped in to act as the Primary Physician †¢ Based on the scale and/or the insurance experience in 1st year, further social security bene? s can be added as follows: †¢ Reimbursement of transportation charges, wage loss, ? nancial compensation for attendant, compensation for disability and subsequent rehabilitation. 2. Impacting infrastructure and Manpower: †¢ Depending on the claims experience and the volume, some monies can be utilized to purchase new or replace old goods/equipment at the Primary Health Centre (PHC) and such activity monitored by District Health Mission through district health accounting system and the proposed ombudsman under NRHM. Besides there is a need for 5-10 bedded hospitals to come up at the taluka or clusters of village level in severely resource constrained area for which emerging entrepreneurs like the Vatsalaya hospitals who have already set up such hospitals elsewhere in the country (especially in Karnataka in this case). L ocal doctors looking at running hospitals can set up such hospital and run it on a franchise model. in this realm may lead to cost effective and customised diagnostic solution. in this regard ICICI Knowledge Park is involved in coming out with such customised solution for the rural poor 16 Innovation 14 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission †¢ There is also a need for high end diagnostic chain to come in to the rural space with similar franchise model of commercial diagnostic companies17 . Standardization of all the services will be done by a committee of experts in each state. These services will include outpatient, in-patient, laboratory and surgical interventions. †¢ Manpower: The ANMs/CHWs/ASHA/MPWs can be incentivised to provide their services more ef? ciently and quickly from such fund given to the Panchayat either from the government or from the insurance fund. It is assumed that with the introduction of ICT component (EHR and biometric cards) like smart card, the 40% of time wasted by ANM on documentation will be saved18 . – To incentivise the doctors to work in the PHC: – Posting of quali? ed graduate doctors in PHCs can be made mandatory and also made necessary pre-requisite for eligibility to sit for Post Graduate Medical Entrance Examination. – Top 10 or 20 high performing PHC doctors in the entire state might be allowed to join specialty of their choice in P. G courses directly or some higher percentage of quotas may be assigned to them which will facilitate them to get admission. Transparency and accountability in the whole service delivery can be brought about by making the health manpower within the PHCs and other levels accountable to the PRIs and the Village Health Committee through a rigorous and scienti? c accountability system19 . †¢ Additional Services: De? ned amounts of fund can be made available to the local Panchayat or a certain percentage of premium collected be allowed to remain with them and be spent for these purposes according to their discretion 17 This entity can set up satellite diagnostic centre at the taluka or district level. They can have sample collection unit which collects the pathological samples from the villages and brings it to the satellite centre where it is examined. The report is either passed on to the patient the next day when the sampling collection team goes to the villages or can be sent directly to the referred doctor under the health insurance scheme. 18 This will give her more time to cover more villages, services and bring about ef? ciency in the overall healthcare delivery. It will also reduce paper work and make information easily accessible at each level. 9 Smart card technology will be used to increase transparency and accountability of the health staff bringing about good people governance. In this the gram Panchayat and the Village Health Committee will completely evaluate the work of ANM and other staffs (including the doctor). Their performance will be graded in a scale devised in consultation with the representatives of the PRIs and the District Health Mission and accordingly incentive/disincentive can be given based on the score. This information can be made available online for access to the general public. 5 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission and mutual decision (It can also cover other expenses like loss of wage and destitute supports). †¢ Health Database management system: ICT component in the form of smart card technology (in the form of a biometric card) be introduced which will ensure the capturing of health and insurance data of the population and minimize fraud. †¢ It requires a decoder cum uploading device which will be portable and hand held. This can be used by ANM/Health staff/PRI/Hospitals to upload or read information starting from the primary to tertiary level †¢ Will be able to transmit images and radiographic reports (X-ray and ultrasound, CT scan) apart from other routine test results. This can be done of? ine (Because in villages, the power supply is erratic or absent and the internet connectivity is lacking) and can be the precursor of telemedicine20 . 3. Tertiary level: It will cover all high cost, sophisticated care which may not be available at the secondary level. The diseases that can be covered are as follows: †¢ Cancer †¢ Myocardial infarction †¢ Major organ transplant †¢ Paralysis †¢ Multiple sclerosis †¢ Bypass surgery †¢ Kidney failure †¢ Stroke †¢ Heart valve replacement 20 With internet connectivity through satellite (which are now provided free of cost by ISRO to interested NGOs and CBOs) which will mean that the patient will not have to travel to district level or tertiary level care and can walk in to such tele-consulting centre within the village where his diagnostic reports are accessed by punching in the unique I. D number of the patient on the smart card. The specialist sitting at the district level can then assess the prognosis of the case and decide whether the patient needs to travel or else advices the local doctor on what is the line of treatment for the patient which then can be carried out locally. This will save a lot of money (on traveling and loss of wages), time and resources which the patient would have spent otherwise. 16 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 4. Impacting infrastructure, Manpower and Services: †¢ It is envisaged that the government medical college hospitals, other government health institutions, central or regional health institution operating in the state can act as the tertiary care provider. †¢ Insurance can start paying for upgrading these infrastructures and incentivising the medical work force in a similar way as was explained under primary level care. Besides private healthcare who will start the franchise model or other wise interested (and agreeable to the negotiated rate for the insured) will act as the tertiary care providers21 . The government should play a central and leading role in developing a strong referral linkage in the state. †¢ As most high level tertiary care hospital are charitable trust hospital and get substantial subsidies and exemption from the government in return for providing subsidized services for the poor (but in reality a very few actually provide such services) it should be made mandatory and compulsory for these hospitals to treat the insured poor. 5. Health Database Management: †¢ There will be a Central Data Warehouse which will develop from the EHR integrate all the information collected from the primary level upwards, making it accessible to each level and hence acting as a central store house of information. †¢ Additionally it will have personnel(s) who will analyse such data. Such analysis will be invaluable for monitoring, evaluation and mid-course correction. This will help in achieving the following: – Help revise insurance premium – Incentivise and monitor providers 21 The bene? will be two fold – it will provide quality care to the poor (through a TPA and the District Health Mission and Rogi Kalyan Samiti which will empanel hospital) which will ensure compliance to a particular standard of care) and will also help reduce crowding in the government hospital. At the tertiary level, a working arrangement should be made with national level government hospital (like AIIMS,CMC etc), regional ins titutes, post graduate medical institutes (JIPMER) and large private/corporate hospital (Apollo, Wockhardt, Fortis etc) so that patient requiring advanced critical care can be referred to them. 7 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission – Control fraud The developing of referral linkages is very much possible with insurance playing a central role and ICT in the form of smart card technology will ensure equity, ef? ciency and quality in healthcare delivery at each level. The coupling of the whole machinery with tele-medicine will bring about synergy and help the poor in terms of saving money on traveling and also loss of wages. It has to be always borne in mind by all the stakeholders that all component of health care i. . preventive, promotive, curative and rehabilitative care as emphasized under National Rural Health Mission as well as the coming of all stakeholders to work together will ensure harmonious and ef? cie nt delivery of quality healthcare with insurance playing a vital role. None of the components or stakeholders can be undermined as each will ensure that we will be able to see demonstrable impact in the health indicators of the community in days to come. 18 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 7. 2 ANNEXURE II Setting up of a national coordinating and development entity: One of the key issues recognised by many is that increased coordination as well as sharing of knowledge and resources among the various actors in the sector would greatly stimulate success of NRHM as well as micro insurance development. This is especially true of health micro insurance for which few (if any) truly successful and sustainable programs have been observed to date. Hence it is felt that there has to be an apex body in the form of a coordinating centre which will initiate, regulate and monitor these activities. Following is a matrix which delineates the various stakeholder who will be represented in such a supra structure. 19 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Stakeholders Stakeholder Needs Coordinating Centre’s Criteria for Success 1. Bene? ciaries * Simpli? ed claims procedures with minimal bureaucracy * Solutions that result in fast claims payment 1. 1 BPL families * Timely payments of * Service satisfaction from bene? ciaries * Solutions leading to affordable insurance products with quality servicing promised bene? s * Systematic increase in product coverage to ensure reduction of access barriers * Access to health services and health risk protection services 2 Microinsurers, Insurers, reinsurers * Access to technical assistance, actuarial studies, EHR records and the Centralized Data Warehouse reports, exposure to international innovations * Long term sustainability of microinsurance programs servicing the poor * E ffective, broad-based microinsurance delivery channels * Microinsurance pro? ts commensurate to investment risk * Competent pool of microhealth experts insurance technical Service packages developed and patronized * Service satisfaction from micro-insurers * Insurers aggressively competing to offer superior products and services to MICC client governments * Investment and ? nancial support from insurers 20 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Stakeholders Stakeholder Needs Coordinating Centre’s Criteria for Success 3 NGOs, MFIs, trade unions, employer grassroots organizations, organizations, * Strong partnerships with hospitals, diagnostic players, NRHM team, AYUSH, ASHA workers and insurers Satisfaction with the coordinating agency’s ability represents all stakeholders’ interest and re? ected by strong involvement and support and investment through time in the centres work corporate sector, co-opera tive sector, etc. * Successful delivery of risk protection services to their memberships and clientele 4 Insurance Regulatory Development Authority * Robust, vibrant health microinsurance industry * Insurance regulations followed * Robust and vibrant network of micro-insurer clientele * Mandate and support from the IRDA * Achievements towards supportive and enabling policy 5 Health Providers * Timely payment from insurers * Reliable stream of BPL clients utilizing their services * Reasonable pro? tability * Positive ratings from health providers * Service satisfaction of BPL clients * Minimal problems with * Fast claims turnaround Solutions that result in: fraud and overcharging, etc. 6 TPAs Innovative and effective collection, distribution, and servicing channel 21 Sharing best practices Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Stakeholders Stakeholder Needs Coordinating Centre’s Criteria for Success 7 State Governments * BPL population covered Support and mandates from governments * Ef? cient utilisation of resources and resources leveraged through a resource center * Moving closer to the goals stated under NRHM 8 Government of India * Access to comprehensive and quality health care for all * Improvement in national statistics on accessibility of health care services 8. 1 Ministry of Health and Family Welfare 8. Department of Insurance, Ministry of Finance * In synergy with existing programmes and structures * Proper utilization of departmental funds * National statistics on health insurance penetration * Increase in the number of legalized community health insurance programmes * Moving towards universal coverage * Regularising illegal community health insurance programmes Other major stakeholders that will have to be consulted are the likes of Indian Medical Association (IMA), Institute of Public H ealth (IPH), Federation of Obstetric and Gynecological Societies of India (FOGSI) and Institute of Health Management Research (IHMR). . 3 Objectives, Activities, and Services The stakeholders and clients of the Microinsurance Coordinating Centre envision a network of professionally-managed micro-insurers and accredited service providers offering 22 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission affordable, comprehensive, quality risk protection to the majority of poor people in India. Similarly, the Mission Statement may read as follows: The Microinsurance Coordinating Centre aspires to facilitate delivery of innovative health ? ancing and health insurance solutions in the country and improve the health indicators. It also aims to improve the capacity of insurance providers to provide risk protection services on a sustainable basis. The Centre is committed to building a vibrant health ? nancing and risk pooling sector through coll ective advocacy and through concentration, leveraging, and focusing on resources and knowledge towards developing innovative technologies. More speci? cally, activities and services of the MCC may include the following: †¢ To diagnose the feasibility and requirements of proposed micro-insurance projects in speci? districts of the identi? ed NRHM states; †¢ To develop and offer comprehensive, feasible, customized technical solutions complete with onsite guidance and implementation assistance; †¢ To facilitate strengthening the technical and cost effective management capacities of the NRHM team at the district level; †¢ To analyze and document the leading and best practices in the health microinsurance industry; †¢ To provide a forum for regular exchange and dissemination of ideas, innovations, lessons learned, achievements, and international best ractices; †¢ To develop and support EHR central data warehousing and tools; †¢ To develop health microin surance performance standards and prudential indicators, and the supporting technologies and tools that will enable micro-insurers to meet these standards; †¢ To provide a rating service of NRHM districts with micro health insurance pilots micro-insurers with respect to the standards and indicators; 23 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission To facilitate and strengthen collaboration and partnerships among the various microinsurance providers and Health Ecosystem partners †¢ To establish linkages between insurers and resource institutions such as funding agencies, ? nancial institutions, and research institutions; †¢ To accredit a network of providers delivering affordable, quality health care through use of clinical protocols and negotiated tariff schedules; †¢ To provide and manage a data repository and also a national helpline for query redressal. To conduct industry experience studies and share resul ts for use in pricing and management purposes; †¢ To represent the health microinsurance sector to the Government of India and lobby for favorable and enabling policy; †¢ To identify and facilitate networking and business opportunities among the various stakeholders; and †¢ To elevate the insurance consciousness through awareness campaigns and education. Some of the activities such as product design are already being carried out by insurance companies. However, since microinsurance differs greatly from commercial insurance it requires unique design, marketing, and distribution strategies and skills. The MICC, with its personnel focused and specializing in micro insurance and health (health economists), with access to current data, and with concentration of knowledge about the industry would be positioned to facilitate superior solutions in these areas. 24

Final global business plan Essay

The ASEAN was founded in 1967 to promote the alliances of the countries in Southeast Asia. The current members of the ASEAN are the Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Indonesia, Singapore, Thailand, and Vietnam (ASEAN, 2010) Physical Environment The physical environment of Southeast Asia is primarily a warm climate other than the high elevation areas (Andaya, 2009). The physical environment also differs from the ocean and jungle geographical areas. A primary concern within the physical environment is the availability of safe drinking water in many areas of Southeast Asia and the air quality. Political Stability The political stability within Southwest Asia is very questionable in many areas of the region due to the terrorist activities; however with the support of the U.S. and other countries the threat is reduced just not eliminated. A scoring system was used to evaluate the region based on data that was provided by AMB Country Risk Reports. The rating system is; One – Very Low Risk, two – Low Risk, three – Moderate Risk, four – High Risk, and five -Very High Risk. The country leads the region with are risk score of one is Singapore followed by Indonesia two, Malaysia and Thailand three, Philippines and Viet Nam 4. The Philippines and Viet Nam have significant political risks that need to be taken into consideration (A.M. Best, 2010). Economic Conditions The economic risks within major countries of Southeast Asia are moderate at best. In the recent economic downward trend Southeast Asia is seeing the effects the slowing economic trend with their major trading partners the United States and Europe. The demands for exports are decreasing and forecasts for 2009-2010 expect this trend to continue (A.M. Best, 2010). A scoring system was used to evaluate the region based on data that was provided by AMB Country Risk Reports the rating system is; One – Very Low Risk, two – Low Risk, three – Moderate Risk, four – High Risk, and five -Very High Risk.† The country leads the region with are risk score of one is Singapore, followed by Indonesia two, Malaysia and Thailand three, Philippines and Viet Nam four. The Philippines and Viet Nam have significant economic risks that need to be taken into consideration (A.M. Best, 2010). Financial Options and Risks The financial system within the Southeast Asia region indicates a moderate to high risk on average other than the country of Singapore. As the global economy tightens credit requirements, this can have a significant impact on the financial stability in the region (Country Risk, 2010). A scoring system was used to evaluate the region based on data that was provided by AMB Country Risk Reports. The rating system is; One – Very Low Risk, two – Low Risk, three – Moderate Risk, four – High Risk, and five -Very High Risk. The country leads the region with are risk score of one is Singapore, followed by, Malaysia and Thailand three, Philippines and Indonesia four, and Viet Nam- five. The Philippines, Indonesia, and Viet Nam have significant financial risks that need to be taken into consideration (A.M. Best, 2010). Political stability There is a constant threat of terrorism according to the U.S. Department of State diplomacy in action website: http://www.state.gov/r/pa/ei/bgn/2794.htm, but the political stability is stable because of the continued efforts of the U.S. and other international entities such as the International Monitoring team. Economic conditions The economic conditions are stable; the Philippine government has been working over the past few years to reduce its deficits down to 0.2% of the GDP (Gross Domestic Product) and is continuously working to balance its budget. Finance options available According to an article Philippines: Types of Business Organizations that Foreign Investors may Establish in the Philippines there are several financial options available that are: These include the establishment by a foreign corporation of a (i) local subsidiary through a domestic corporation, (ii) a branch office, (iii) a representative office, (iv) a regional or area headquarters, or (v) a regional operating headquarters. Entry into the Philippines can also be achieved through joint ventures with other domestic corporations (Manalastas, and Guinto, 2000). Physical environment and its affect on trade The locality of the Philippines creates some environmental issues that needs to be taken into consideration there are three main issues the first two are seasonal; the typhoon season from June through November, the monsoon rain season from July through December. The third issue that is unpredictable is the volcanic eruptions that can happen at any time (The Philippines, 2010). Social, health, and environmental conditions The majority of the Philippine people do live in poverty and the mortality rate for babies is high; however the health care is improving the Philippines have been recognized for eliminating Polio (The Philippines, 2010). Although there is a pollution problem, the government of the Philippines is stepping in to help reduce pollution by enacting and enforcing laws that actually is helping clean up their environment. Cultural considerations When doing business in the Philippines there is a couple of cultural consideration to keep in mind such as it is unacceptable behavior to correct a person in public, to cause a person to lose face by refusing or saying no to a person, and do not accept an invitation to a family meal when first asked, if the invitation is asked a second time then it is all right to accept (The Philippines, 2010). Organizational Description Apple Computer, Inc. is headquartered in Cupertino, California. The company is a worldwide producer, designs, markets, manufactures computers, digital music and video players. Founded on April 1, 1976 by Steve Wozniak, Steve Jobs, and Ron Wayne, apple sells to all consumers small, mid-sized, and large businesses. The company sells its products through retail stores, online stores, and also third party wholesalers. The increase in awareness of value of the internet, and convenience it gives to its users will soon bring more to the table for the Philippines. Since the internet has been a big expansion for many markets many businesses have found use to this to expand their business overseas. Since 2000 to 2009 the internet usage has gone up from 2,000,000 (2.6%) to 24,000,000 (24.5%) in the Philippines. Apple’s line of digital music players has taken advantage by providing iPod users to download digital music files to their iPods. Apple Inc., sales a line of iPod digital music and video players to both the Windows and Mac users that also provides online services that can, as described in this article Reuters Profile: Apple INC. (AAPL.O) which states; â€Å"distribute third-party music, audio books, music videos, television shows, movies, podcasts, and applications† (Reuters, 2010), through the iTunes Store. ITunes is a digital music application for downloading and playing digital audio and video files. Since Philippines have about 24,000,000 internet users as of June 2009 which is about 24.5% of the population in the Philippines there is potential growth for this market to grow. With new information about Netflix possibly signing an agreement with Apple Inc. sales can possibly increase since there will be more possibilities for iPod users to download through Netflix servers. Risk Analysis Week 3 The purpose of this document is to analyze the risks that are involved in establishing a global business operation in a foreign country of the Philippines. The document will detail the risks of introducing Apple Incorporated and the iPod to the Philippines. The risks that will be covered include political risks, legal risks, exchange rate financial risks, and taxation risks. The document will also detail a variety of additional risks, specific marketing strategies and performance measurement that will impact the overall success of Apple Incorporated within the country of the Philippines. Political/Legal/Regulatory risks The Philippines is a bureaucratic country. It has a complex network of regulations, permissions, procedures, and authorities with approval procedures. Many of these restrictions are designed to bar off newcomers entering the country’s existing industries. This will not be the case for Apple Inc. The political, legal, and regulatory risks of opening an Apple store in the Philippines vary. Apple’s plan is to acquire an existing retail store and moving under the Apple brand. Even though the political risk is high Apple Inc. is in no way threatening to the political climate in the Philippines. The Philippines has been working in developing relationships with neighboring countries, â€Å"build close ties with neighboring countries in Southeast Asia through the Association of Southeast Asian Nations (ASEAN)† (A.M. Best Company, Inc, 2009).Legally, the risk associated with opening the store could be great, and the company must make sure it is in compliance with rules and regulations regarding the opening and operation of the store. The most immediate regulatory risk to business is because of mandated price agreements used by the government to combat inflation. Apple Inc. sees Philippines as a country poised for a great economic turn-around in the Internet and electronics market. Indicators such as World Stats forecast that the country is on a steady uphill swing. Exchange/ Repatriation of Funds Risks Exchange rates and repatriation of funds needs to be considered with Apple opening a store in the Philippines. Philippines are very open to foreign investors as a way to grow the local economy. However on January 2007, in an ongoing effort to promote two key goals, â€Å"the Philippine government has issued the Seventh Regular Foreign Investment Negative List† (Baleva, 2007), protecting domestic industries and encouraging foreign investors to participate in certain areas of enterprise. Pricing will also be a factor if the company bases there pricing by US standards. Exchange rate on US dollars to Pesos needs to factor in. Competitive Risk Assessment Apple’s key competitors are already doing business in the Philippines and creating a strong and profitable presence. Competitors such as Sony, Samsung, and Sansa have been doing business in the Philippines for many years. Apple’s target entrance into the market will give consumers more options and encourage more competition within the market. Taxation/Double Taxation Risks The agreement of double taxation outlines what taxes are covered, defines who the parties are and the context of the agreement and itemizes what is covered under the agreement. Underlining the rules under which a business’ profits are taxed and when double taxation comes into action. The double taxation agreement defines the establishment of permanent residence, which Apple Inc. would seek to have by opening a store in the country on a permanent basis. HM revenue & customs defines permanent establishment as, â€Å"a fixed place of business in which the business of the enterprise is wholly or partly carried on† (HM Revenue & Customs, n.d.). Based on the information contained in the agreement it is possible that Apple will be possibly doubled taxed. Market risks (four Ps price, place, promotion, and product) One of the risks that every business needs to address when selling their product in a foreign country is pricing the product to high that only a small portion of customers can afford to buy the product. According to the article Manila’s living costs, wages among the lowest it states; â€Å"To illustrate, workers in Zurich are paid $22.60 per hour ($30.30 gross), while workers in Geneva are paid $20.40 per hour ($29.20 gross)—a far cry from what average workers in Manila are paid: $1.40 per hour ($1.60 gross)† (Victoria, 2009). One of the ways to address this issue is to buy in large quantity, so that cost can be driven down. Currently the Philippines is experiencing a power crisis, which is a risk within itself in the article Philippines’ power at crisis point of the Asian Times it states; â€Å"Recent electricity outages in the Philippines has sparked concern that the country is on its way to its second power crisis in 20 years† (Rubrico, 2010). If there is no electricity, it will be hard to sell iPods to customers especially in the dark. Our company can purchase generators that can be used during the power outages. The Ipods are very popular and expensive in the Philippines, which has created a market of iPod thieves. According to Davao Today article iPod Thieves on the Rise in RP that states; â€Å"iPods may now be joining wallets and mobile phones as attractive targets for thieves and pickpockets† (No author mentioned, 2010). Train both employees and customers how to avoid being a victim, this will show the customers we just don’t think of them as a sale but as a person. Marketing Research Approach The marketing research approach for the Apple Store is a five step process that includes defining potential problems, developing a research plan, collecting relevant information by specifying data, developing findings, and taking marketing actions based on the analysis of data findings (Marketing Research, 2006). The research objectives will be to determine if there is a demand for the products offered by the Apple Store. The research plan will consist of surveying a minimum of 1,000 to 2,000 consumers in the target region of the Philippines. Contact information will be gathered to later obtain positive or negative feedback on the products that are offered by the Apple Store. An online survey will also be conducted through the Apple Store via the internet. This will assist in later developing marketing strategies applicable to the products offer by the Apple Store that are in demand in the target region. Some types of questions that will be asked during the Apple Store survey are as follows: 1) What is your age? 2) What is your gender? 3) Would you purchase the products offered by the Apple Store? 4) What did you like about the product? 5) What did you dislike about the product? 6.) Was the product easy to use? 7.) What would you change about the product, if anything? 8.) Will you continue to use the product? 9.) Would you recommend the product to a friend? 10.) What would you consider a fair price for the product? Apple Store Marketing Mix The marketing mix of product, price, place, and promotion is a crucial part of the introduction of the products being offered at the proposed Apple Store. A strong strategic marketing plan developed by the marketing team will assist the Apple Store in getting of to a positive start. The products offered by the Apple Store will include all items that a consumer can purchase through the on-line Apple Store web address http://store.apple.com/ph. The products include the wide variety of iPod products, iPhones, and Mac products. The physical location of the Apple Store needs to be in a high traffic public area that will attract many customers. The pricing strategy of the products offered at the Apple Store in the Philippines will targeted to under cut the competition in the region during the first 6 months of operation while still maintaining reasonable profit margins on the Apple Store products. This strategy will help in initially establishing the presence of the Apple Store in the target region. Apple Store executives will consistently monitor the progress of the Apple Store in the Philippines during the first 6 months of operations and recommend solutions to any potential risks that come up during this time period. After the first 6 months of operation in the region the product pricing strategy will be revisited. The location of the Apple Store will be critical to the overall financial success of the business. The attributes that are desirable for the physical location of the Apple Store include a highly visible location with heavy consumer traffic. An additional attribute is needs to be considered is the location of the store will be easily accessible for ease of the distribution channels to replenish inventory needs with minimal risk. In selecting a location with these attributes the Apple Store will have a higher probability of meeting or exceeding business goals and objectives. The strategic marketing plan will identify specific dates that will provide the best dates for a promotional sale grand opening of the Apple Store in the Philippines. To start the promotional period the marketing team will start advertising the grand opening of the Apple store several weeks prior to the grand opening. Apple Store products will be advertised by using magazine ads, internet and television spots, and any other means of promotion detailed as a strong promotional tactic in the region. The marketing team will need to pay close attention to see how quickly the product inventory will move from the shelves during the first few weeks of operation if the Apple Store is approved for implementation in the Philippines. The marketing strategy also needs to verify that there is sufficient demand for the Apple Store products. Distribution and supply chain risks There are a few items that make distribution and supply risky in the Philippines, as stated in the Spend Matters article Apple’s Risky iPod Supply Chain; What types of risk? Well, try an active volcano located less than 20 miles away, proximity within an earthquake zone (which makes San Francisco’s seismic activity look tame), and the very real threat of tropic storms and typhoons. And that’s not even considering that the area around the plants is â€Å"subject to regular flooding from storm water, blocking ingress of people and egress of goods †¦ [the factories] even sends people home early when a serious storm is forecast, because of the risk that the roads will be impassable.† (Busch, J. 2006) No one can prevent Mother Nature from happening, but we can be prepared by staying updated on the weather reports and staying alert to nature’s surroundings. By staying prepared and knowing what to do in the event of a natural disaster, will prevent pe rsonal injuries to employees and customers as well as minimizing damages to our product. Distribution Channel Management The marketing team will perform extensive research before the introduction of the Apple Store begins business operations in the Philippines. Determining a reliable distribution channel in a global business operation is an important formula for success. The main distribution channel will start in the United States and products will be distributed to the Philippines based on inventory needs transmitted through an electronic data base. The distribution of the Apple Store products from shipping destination within the Philippines to the Apple store location is an addition characteristic that needs to be considered because of the threat of theft that exists within the target country. Once the store headquarters has been established then logistics such as shipping, receiving, and storage in smaller warehouses will be considered based on distribution risk factors have been evaluated. One prime objective of the Apple Store in the Philippines is to meet or exceed our customers’ needs. Physical and environmental challenges to entering and operating in a target market There are several physical and environmental challenges when operating a business in the Philippines, some of the physical challenges include political unrest, corruption, terrorism, and extortion these are just a few that needs to be address. The environmental challenges include pollution (water and air), natural disasters (volcano eruptions and flooding), unemployment according to Index munbdi: Philippines unemployment rate that shows for 2010 to be an estimated 7.5% (No author mentioned, 2010). Staying informed is key to handling these types of risks, some things can be handled by local authorities and others will have to be dealt with the best way possible depending on the situation. Social and cultural risks In the social and cultural circle, the risk of misunderstanding in many categories is very easily done such as those listed in the article Centre for intercultural learning: Cultural Information – Philippines that are: â€Å"Conversation, Communications Styles, Display of Emotions, Dress, Punctuality, Formality, and Decision Making† (No author mentioned, 2009). Not knowing how to address each of these items can lead to offending the Filipino people, which will cause problems in doing business in the community. Common sense and proper communications will just about handle each of these risk, also by participating in community events and helping the community during a time of crisis will promote unity between the company and the local people. Cyber or Technology Stealing technology and cyber attacks are a big risks, the government of the Philippines still needs to catch up the laws concerning today’s technology. In the article, Experts Call for Stringent Laws against Cyber Crime in Philippines states that; â€Å"The security researchers states that these kinds of e-mail attacks occur more commonly across the Philippines since there aren’t any cyber crime laws in the country to catch and prosecute Internet criminals, particularly e-mail fraudsters† (No author mentioned, 2010). Common sense applies to these risks as well, making sure that our computer systems maintain the most recent updates on security programs and training the employees to never give out passwords and shut down the computer every night before going home are just some suggestions that will prevent problems down the road. Define and clarify mission and objectives The Mission Statement of Apple Incorporated will remain the same as researches through multiple sources according to Investor Relation of Apple (located on the FAQ page) it states that; Apple ignited the personal computer revolution in the 1970s with the Apple II and reinvented the personal computer in the 1980s with the Macintosh. Today, Apple continues to lead the industry in innovation with its award-winning computers, OS X operating system and iLife and professional applications. Apple is also spearheading the digital media revolution with its iPod portable music and video players and iTunes online store, and has entered the mobile phone market this year with its revolutionary iPhone (Apple-History, 2010 6). Philippines Internet use has grown remarkably throughout the years. Internet World Stats estimated as of March 2009, there are 20.6 million Internet users coming to about 21.5% of the entire population in the Philippines. Apple Inc. has selected the Philippines to begin expansion providing stores and Internet downloading over the web for users to download digital audio, video, and podcast files. The primary business objective is to establish a 15% profit margin in the first year of operation within the Philippines. In each subsequent year after the first a 5% increase to the profit margin has been established as a goal until the profit margin reaches a 30%. Additional objectives include obtaining a 10% market share of the products offered by Apple Incorporated and a 4% increase per year over the next 3 years. Customer satisfaction has also been established at a target percentage of 97%. SWOTT Analysis SWOTT analysis is a useful tool to determine the strengths, weaknesses. Opportunities and threats that exist within a global business entity or region are being evaluated for risk factors. The team has developed a SWOTT analysis for the target region to identify these factors prior to engaging in any business operation within the Philippines. This will assist the team in identifying key characteristics in the structure and development of Apple Incorporated within the Philippines. Current Competitors Competitive Landscape The competitive landscape for Apple Store are the following companies that have a strong hold on a large portion of the population that Apple Store will have to compete with in the global market place. These companies manufacture similar technology devices that Apple Store is competing for to increase global market share. Their products are known throughout the global technology market where competition is extremely competitive. Competitors’ of the Apple Store include Dell Incorporated, Hewlett Packard, and Gateway. The engineering development of new improved technology will assist the Apple Store in gaining competitive advantage over the competitors. Customer satisfaction is a primary objective at the Apple Store. A recent survey conducted in 2008 by the University of Michigan named the American Customer Satisfaction Index ACSI indicated that Apple had a ten point advantage over its closest competitor (Computerworld, 2010). The Apple Store that is being considered in the Philippines will have the same target goal in reference to customer satisfaction in the target region. Strategy Selection The strategy selection of Apple Incorporated is to establish a base store that strategically reports back sales results and inventory needs to a home base location within the United States electronically. The strategy of the company will be to promote the iPod through lower price cost structures than existing competitors. The company will also launch a marketing campaign to promote this strategy through established marketing structures that exist within the Philippenes. This will assist Apple Incorporated in notifying consumers of company existence in the region while promoting our lower priced product. The mode of entry to develop Apple Incorporated to enter the Phillipenes will be the direct investment mode. Apple Incorporated will be establishing a location within the country and then based on all business results will determine if additional locations within the country are needed to meet customer demand. Advantages of this mode of entry include high sales potential, low political risk, and the company could be viwed as an insider (Quick MBA, 2010). Because of some of the high risk elements that exist within the Philippenes Apple Incorporated will need to be cautious by limiting the amount capital that the company will spend in the direct investment mode. Control and Evaluation Specific measures will be monitored on a weekly basis to track the progress and continous improvement opportunities that exist to set up operations within the Phillipenes. The key characteristics that impact overall business results will be evaltated to establish a proactive approach to issues that will have an impact these results. The key characteristics will include sales, inventory, taxes, and process limitations. This will assist Apple Incorporated in providing a quick responsive action to any underlying problems that need to be resolved. Sales goals and profit margins will also be evaluated to determine the overall success within the Phillipenes. Contigency Plan Apple Incorporated will need a contigency plan to account for risk factors that have some probability of resulting in business profitability not reaching overall expectations. The contigency plan that Apple Incorporated has in place consists of closing the existing store if business objectives are not achieved with leaving options open for changing the mode of entry into the Phillipenes to exporting the product through established distribution channels. This contigency plan still allows the company to establish sales within the Phillipenes while reducing investment risk. Financial Overview Apple has the possibility for a strong financial investment in the expansion into the Philippines. The risks associated with the investment into the Philippines do not outweigh the benefits that can realistically be achieved. After thoroughly researching the Pilipino market, the Ayala Group, one of the largest firms in the Philippines is supposedly involved in a project to put up an official Apple store in the Philippines (Technograph, 2009). This is beneficial because less money will have to be invested in research and development, as well as marketing and advertising since the organization is already known throughout the Philippines. The economy in the Philippines has not shown extreme changes or any sudden implications that the economy is getting stronger. The Philippine GDP for the year 2009 has barely risen 1% but has, â€Å"weathered the 2008-09 global recessions better than its regional peers due to minimal exposure to securities issued by troubled global financial institutions† (index mundi, 2008). Operating Expenses As projected for expenses for one apple store, the budget chart shows total operating expenses at $5, 482 and operating income at $11,740 and other income and expenses at $326. There are many providers that impact operating expenses such as utilities, taxes, and advertisement. Apple has projected a total operating expense at $5,482 for one apple store. When assembling a budget chart, it is essential to take into account all factors to properly manage a business. It is important to trust that focused investments in Research and Development (R&D) are significant to a company’s future competitive and expansion position in a foreign market and are directed towards the development of new and improved products that are central to the company’s core business strategy. As such, Apple expects to make further investments in R&D to expand and remain competitive in the Filipino market. Other factors of influence that can help expand Apple into the foreign market, is the company’s persistent expansion of its retail division in both international and domestic markets, top stock-based return expenses and higher spending on marketing and advertising (Apple Investor 2010). The chart below shows the estimated monthly general budget of the operation of one store in the Philippines, providing that the decision is made to proceed with the plans to set up and begin operations. This is a rough estimate, because of the many factors that may and will fluctuate either in a positive or negative way can cause a change on the expense side, however the further we proceed the more accurate our budget will become. Financial Overview General Budget Foreign Exchange Risk Studies have found that many Asian-Pacific businesses are exposed to one or more of the world’s major currencies: the Euro, the US dollar, the British pound, and the Japanese Yen. Some of the greatest dangers were produce by fluctuations in the US dollar. This impacted 58 percent in the Philippines, â€Å"currency fluctuations affected the profitability of companies whose financial assets and liabilities (most notably debt) were held in foreign currencies† (Vanderbilt, 2007). When choosing to invest in the Philippines, the foreign exchange risks associated with business ventures are significant because of an Asian financial crisis during (1996-1998), â€Å"more than half of the studied companies in Indonesia, Korea, Malaysia and the Philippines, and about a third of those in Japan and Singapore, were exposed to the dollar, and about a quarter of the firms in Singapore were exposed to the yen† (Vanderbilt, 2007). Risk Management Transaction risk refers to the fact that the cash flow value of foreign currency contracts may change due to exchange rate fluctuations. Additionally, since the organization will be buying and selling goods in foreign currency to a certain extent, the foreign exchange risk increases. The potential negative aspects associated with doing business in the Philippines are significant since the business will be using Filipino Pesos, which has an inflation rate of 4.4 percent. As a result, there is a risk that the exchange rate as with any currency may change unfavorably before the currency is actually exchanged. However, these risks can be counteracted by utilizing forward hedging, which is a way to lock in an exchange rate on an agreed future date. This will allow the organization to be completely aware of future cash inflows and outflows, as well as the value of the organization’s profits in US currency since the exchange rate will not change due to the purchase of forward hedging. Financing Given the current international economic instability, the choice of choosing from domestic or international financing is tough because there are significant risks associated with each. The European Investment Bank (EIB) has offered financing opportunities to the Philippines; currently the EIB has one billion euro allocations in 18 Asian countries including the Philippines. If the company chooses to move forward with the international venture, the company would choose to finance through the EIB. The EIB, â€Å"has provided over 600 million euros in funding for multiple projects in the country coursed through the government and private sector† (European Chamber of Commerce of the Philippines, 2009). Centralized versus Decentral ized The parent company and its iPod department within the parent company, both works as a centralized organization because having an effective control is essential to the everyday operations for both the domestic and global sectors. It would be essential for the parent company to make the final decisions regarding all aspects of the company’s operation, because every unit and sub-unit such as manufacturing plant located in Mexico and the shipping department located in the U.S. of the company has to report all information of their daily operations to the parent company allowing the parent company to know what the left and right hand is doing basically at the same time and can make an informative decision for whatever situation may arise. Both the domestic and global units and sub-units operate as a decentralize company, because certain situations such as environmental changes, customer needs, or political unrest will cause problems and disrupt a part of the company operations or even all parts of the company operations these problems to be addressed immediately and cannot wait for the parent company on the other side of the world to make an informed decision, even if the problem had happened before at a different location because what may work domestically may not work globally and vice versa. When making an informed decision whether at the unit, sub-unit, or the parent company level there is a need for a communication chain of command, starting with the employee who is out in the field working upwards to the parent company which may be the CEO (chief executive officer) who usually has the authority to make final decisions that will affect the company or the owner if there is no CEO available. The line of communications should always remain open, in the event of a minor glitch or a major emergency. Regardless of the value of the information, if the line is broken then a decision cannot be made in a timely manner or may not be made at all causing a problem to grow bigger or missing a profitable opportunity. The communication chart below shows the chain of command from the field representative to the parent company, not all information will reach the top because some decisions can be made at lower levels, for example; the parent company should not be bothered with whether a field representative needs office supplies. Exit Strategies The future is unknown, even if there is a planned exit strategy years from now does not guarantee it will happen as planned. Depending on the situation that is either planned, forced or requires our business in the Philippines to implement its exit strategy would determine the best strategy to use. In the event of a political uprising or civil unrest that results in raising the level of possible war, then the shutting down procedure would be best since it involve very little (if any) paper work and is the fastest way for U.S. employees and their families to get out of the country. If there is no time at all complete abandonment might be forced, either course of action will involve a monetary loss. If time allows and there is no rush in exiting the Philippines, handing the business over to our joint venture partner would be the best, this exit does involve legal paper work and would minimize loss (if any), it would also leave the path open for possible future ventures back into the co untry based on a friendly and healthy transfer of the business. Recommendation The Philippine iPod risk analysis team recommends proceeding with entering the Philippines market. After the exhausting task of finding the risks of entering the country, we had found that the benefits (profits) do exceed the risks (costs) even during the economic troubles that the U.S. is currently experiencing. Although we are not the first iPod and iPhone Company to enter the Philippines market, we still can become a major player and take a large percentage of the market. With the Apple Company creating a direct store that basically eliminates the middle man and develops a presence in the area that shows the potential customer that they will get the original iPhone without the worry of receiving a fake and less dependable copycat, which is a major problem in this region. Having direct shipping, of iPhones and iPods from the parent company will help with the recovery costs and to make a profit quicker. The company will gain additional profits once the store becomes fully operational and service contracts are purchased by new customers. Finally with the current economic stability of the Philippines, this is a good time for Apple to enter into this market because like our domestic customers love to have the latest technology, the Filipinos consumers also love to have the latest technology too. Because no other local company can offer the security or the guarantee of authenticity of the iPhone products, this gives our company a very unique position in the Philippine market. The company will be experiencing and dealing with many issues brought up by our customer base, because of the one on one contact with the customers this will help our operation on a global level allowing our technical department to learn from these new problems and coming up with new solutions this will make our product better and easier to sale globally. Conclusion In analyzing the risks invoved with Apple Incorporated conducting business within the Philippines the company will be in a better position to achieve the financial success. The process of risk assessment provides a clearer picture of the obstacles that need to be overcome within the Philipines. Strategic marketing plans can assist the company in establishing positive sales results in the target country. Electronic communication to proactively respond to business needs and issues will lead to satisfied customers. The initial mode of entry and an alternate mode of entry detailed in the contingency plan also indicate the company’s preparation. Establishing key business characteristcs to monitor on a regular basis will identify continous improvement opportunities for the company in conjuction with items identified in the SWOTT analysis. The combination of these critical factors will guide Apple Incorporated to make a more informative decision based on all the factual information c ollected. References Andaya, Barbara, 2009. Introduction to Southeast Asia. Retrieved April 4, 2010 from http://www.asiasociety.org/countries-history/traditions/introduction-southeast-asia A.M. Best Company. Ratings and Analysis Center: Country Risk, Retrieved April 4, 2010 from http://www3.ambest.com/ratings/cr/crisk.aspx ASEAN, 2009. ASEAN Member States. Retrieved April 4, 2010 from http://www.aseansec.org/18619.htm Manalastas, J. M. and Guinto, B. L. 2000, Philippines: Types of Business Organizations that Foreign Investors may Establish in the Philippines. Retrieved April 3, 2010, from website: http://www.mondaq.com/article.asp?articleid=9340&login=true&nogo=1 No Author Mentioned, 2009, TDS: Philippines Asia, Economy. Retrieved April 3, 2010, from website: http://www.traveldocs.com/ph/economy.htm No Author Mentioned, 2010, The Philippines. Retrieved April 3, 2010, from website: http://www.everyculture.com/No-Sa/The-Philippines.html Internet World Stats. (2010). Asia Marketing Research, Internet Usage, Population Statistics and Information. Retrieved from http://www.internetworldstats.com/asia.htm#ph Thomas Reuters. (2010). Apple Inc. (AAPL.O). Retrieved from http://www.reuters.com/finance/stocks/companyProfile?rpc=66&symbol=AAPL.O Internet World Stats. (2009). Internet Usage Stats and Marketing Report. Retrieved from http://www.internetworldstats.com/asia/ph.htm Kian, C.C. (2004). Internet market in the Philippines shows full potential for growth. IDC. Retrieved from http://www.idc.com.my/philippines/press/IDC%20Philippines%20-%20Internet.asp A.M. Best Company, Inc. (2009). AMB Country Risk Report. Retrieved from http://www3.ambest.com/ratings/cr/reports/Philippines.pdf Baleva, M. (2007). Philippines Issues Foreign Investment List for 2007-2009. ALBLegalNews. Retrieved from http://au.legalbusinessonline.com/law-firms/philippines-issues-foreign-investment-list-for-2007-2009/1076/23599 Busch, J. (2006), Apple’s Risky iPod Supply Chain. 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Retrieved April 8, 2010, from http://www.asianjournal.com/dateline-philippines/headlines/2767-manilas-living- costs- wages-among-the-lowest-.html No author mentioned (2009), Centre for intercultural learning: Cultural Information – Philippine. Retrieved April 11, 2010, from http://www.intercultures.ca/cil-cai/ci-ic-eng.asp?iso=ph No author mentioned (2010), Experts Call for Stringent Laws against Cyber Crime in Philippines. Retrieved April 11, 2010, from http://www.spamfighter.com/News-13688- Experts-Call-for-Stringent-Laws-Against-Cyber-Crime-in-Philippines.htm No author mentioned (2010), Index Munbdi: Philippines unemployment rate. Retrieved April 10, 2010, from http://www.indexmundi.com/philippines/unemployment_rate.html No author mentioned, Foreign Market Entry Modes, Retrieved April 12, 2010 from http://www.quickmba.com/strategy/global/marketentry/ No author mentioned (2010) What is Apple’s Mission Statement. 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Database Management Essay

In his book Groupware — Computer Support for Business Teams, Robert Johansen defines groupware as â€Å"specialized computer aids that are designed for the use of collaborative work groups.† This definition is better than the â€Å"shared data† definition because it helps eliminate multiuser databases from the groupware category. Yet electronic mail fits this definition, as well as some other software sharing tools that experts are still debating. A more useful definition also appears to be one of the oldest. Peter and Trudy Johnson-Lenz are credited by many as coining the term groupware in 1978. They defined it as â€Å"intentional group processes plus software to support them.† Groupware enhances collaboration by allowing by the exchange of ideas electronically. All the messages on a topic can be saved in a group, stamped with the data, time, and author. Any group member can review the ideas of others at any time and add to them, or individuals can post a documents for others to comment upon or edit. Members can posts requests for help, allowing others to responds. finally, if a group so chooses, members can store their-work notes on the groupware so that all others in the group can see what programs is being made, what problems occur, and what activities are planned. Groupware utilizes primarily a form of database technology. While there are quite a few differences, groupware has many commonalities with the standard database. Groupware is not just a normal database, rather it is a developing technology to form an application to perform a specific task or set of tasks. Database technology is the main technology that makes groupware able to function as it does, as groupware is more of an extension of database capabilities. Groupware must be able to support interactions between large numbers of people for it to live up to its definition, and it is fairly typical to find it utilizing a client/server system of interaction. Databases are well suited to the task of powering the back end of groupware as they are specifically designed for just this type of interaction process. Databases are also well suited for use in groupware as they offer a persistent storage which always necessary in any type of collaboration environment. Therefore most groupware available will utilize a database as a way to provide this client/server interaction and persistent storage. The typical interaction process flows exactly as it would in a standard database. Requests for data manipulation are sent by the client to the server. The server acknowledges the request, performs the action, and stores the result. Once the action is completed, it sends confirmation back to the client. In this way, groupware at its most basic acts exactly as a normal database would be expected to act. However, what makes groupware an interesting concept is how it is different from a normal database. While groupware is not a new technology, it is a new way of combining established technology in order to achieve a new tool to promote productivity amongst a group of people. Groupware not only changes the way in which we think about databases, but also the way in which databases can be utilized to promote group functionality. By pairing databases with standard productivity tools, an entirely different concept emerges. Groupware, and in particular real time collaborative groupware, is the future of productivity.