International_Paper_Business_Proposal_Paper

Business Proposal: Macroeconomic Policy and Implications [Overview] Macroeconomic policy seeks to secure income, stabilize prices, educate, and provide universal healthcare. Macroeconomic policy seeks to stabilize an economy via long term sustainable growth. A major goal of macroeconomic policy is the ability of an economy to expand its capacity to produce. Furthermore, macroeconomic policy is about maintaining economic equilibrium. The Bombay Renal Dialysis Center Outlook: Five years have passed and the Bombay Renal Dialysis Center is looking to expand overseas. The center has identified a market and population in Sub-Saharan Africa that has unmet demand for renal dialysis services. Note: The business proposal resumes the scope of its renal dialysis nature and growing spectrum of the renal dialysis market in Sub-Saharan Africa. It further analyzes macroeconomic policy and its implications internationally. The business proposal will address whether or not the price for dialysis services would be higher or lower than what the center charges domestically to include if the center will hire domestically or outside the country. Entry barriers to Sub-Saharan Africa and possible limits of supply will also be noted. Finally, the business proposal will state how foreign consumers will react to the center’s service offerings. [Sub-Saharan Africa] An estimated 11% of the world’s people reside in Sub-Saharan Africa. That estimated 11% of people residing in Sub-Saharan Africa contributes to 24% of the burdening costs of global disease (The Business of Health in Africa, 2008). Public resources are limited. As a result, use of the private sector has the potential to extend healthcare access, boost financing, and make better the quality of healthcare goods and services in Africa. Most countries in Sub-Saharan Africa are currently in a low financial state. Only a small number of countries pay a $34-40 per person per year requirement for basic healthcare. Sub-Saharan Africa is a region where infrastructure, facilities, and qualified medical personnel are lacking (The Business of Health in Africa, 2008). Whether from the public sector, private sector, donors or other stakeholders, new investments are desperately needed. Healthcare demand for all health sectors will continue to rise. What is important is the evidence of economic growth in Sub-Saharan Africa for some time. The Bombay Renal Dialysis Center’s investment in Sub-Saharan Africa will improve its macroeconomic environment. What the Sub-Saharan Africa region demands are channels through which strict health standards and quality health services are provided. The Bombay Renal Dialysis Center has chosen to aid in meeting those demands. [Barriers to Entry] Starting a business venture in a foreign country requires a number of procedures that includes the acquiring of licensing permits, legal rights to credit and corporate governance, and a contractual agreement to determine property or investment registration (World Bank Group, 2005). The countries in Sub-Saharan Africa have diversified investment laws that depend on the stability of their political and economical status. Civil conflicts resulting in political crises can affect business transactions and agreements to be conjured between the Bombay Renal Dialysis Center and the local government. Corruption, inefficiencies, and uncoordinated bureaucratic procedures from the post-war government will likely pose a challenge for the center to gain timely investment permits and contractual agreements. Apart from barriers to entry such as entrance regulation for investment start up, policies that “impede access to health supplies such as high tariff fees on medical goods and burdensome customs processes that cause lengthy port delays increase costs to customers” (The Business of Health in Africa, 2008, p.47). This can pose a challenge to management at the Bombay Renal Dialysis Center to import renal dialysis equipment and medical items to countries in Sub-Saharan Africa. Cultural diversity within the population such as different beliefs or faiths toward modern medicine can pose another barrier to entry for the Bombay Renal Dialysis Center. The traditional medicine or Shamanism is still a very strong influence in the Sub-Saharan Africa region. Trust in and acceptance of modern medicine such as the technology of renal dialysis in providing medical solutions for chronic renal disease will require public education, awareness and support from the local government. Entry regulation, the local government’s trade policies and the local nationals’ acceptance toward a foreign company such as the Bombay Renal Dialysis Center are significant barriers to entry to Sub-Saharan Africa. [Limits of Supply] Economic and manpower factors are limiting factors that can affect successful outcomes for the Bombay Renal Dialysis Center’s investment. The limitations to regular maintenance hemodialysis include “the paucity of dialysis units, restriction of those units to urban centers, and the absence of government funding and health insurance to cover the relatively high costs of dialysis” (Bamgboye, 2003). Bamgboye (2003) stated that the funding or subsidy for dialysis is practically nonexistent from the government. The lack of established health insurance in public and private insurance companies did not clarify reimbursements for long-term end stage renal disease patients. As a result, health insurance packages left patients in need of hemodialysis without those services. Transportation services for patients who live far away are also limited. Poor transportation systems led to patients being unable to attend regular renal dialysis treatments. The often harsh climates of Sub-Saharan Africa will pose a challenge for the Bombay Renal Dialysis Center to ensure proper storage of renal dialysis agents and components such as erythropoietin in a colder environment. The erratic power supply in Sub-Saharan Africa might cause storage of dialysis agents to be drastically affected. This would cause losses and further limit the supplies for renal dialysis treatment procedures. Apart from poor infrastructure, the lack of qualified manpower would also be limited. Bamgboye (2003) further stated that the lure of a better living as a result of higher payments in richer countries such as the Middle East and the Western world have been the cause of an exodus of specialists and skilled laborers such as physicians, nurses and therapists to emigrate to these countries. For the operation of our the dialysis center opening in Sub-Saharan Africa, we will be hiring qualified medical staff from here in the United States as well as from other modernized countries around the globe. There are few openings in the dialysis center which will need to be filled domestically during the first three years of operation in Sub-Saharan Africa. We will hire around 5 registered dialysis nurses and 10 dialysis technicians for the first year of operation. By the end of the second year, we hope employ 8 nurses and 15 technicians when the clinic is operating at full capacity, adding three local nurses and 5 local technicians. Also, one to two local physicians will be brought on board to provide direct care to patients. In order to attract qualified staff we will recruit heavily in the healthcare ranks of the military as these professionals are much more willing and prepared to live and work in Sub-Saharan Africa than people who have not traveled here. During the second year, we will establish a training program designed specifically to train local nurses and medical staff to begin working in the facility. It is very important for the community to be involved in the operation of the clinic thus even though the clinic will be operated by foreign health professionals, local residents are incorporated. It improves the knowledge and health of the community. [Would the price be more or less than what you charge domestically] Throughout the world there are thousands of patients that are suffering with dialysis. When it comes to treating patients with kidney within industrialized countries, the percentage can range differently based on the patients condition. 25% of the medical expenses of kidney disease will go towards trying to elevate the patient blood sugar. 25% will be based on the patients long term complications of the disease and the other 50% of the patient cost will be based on the patient medical care to help with treating the disease. The cost to treat a patient with end stage kidney disease will be about 4 to 5 times higher than the cost to treat someone with no complications and diabetes. Within the United States, hospitals will distribute about 55% of kidney cost followed by: • 20% for outpatient care • 15% for drugs and supplies • 10% for nursing care In many countries like the Caribbean, the drug to reduce patient blood sugar levels has been accounted for at least 50% of all patients spending. Within the middle class income families, half of kidney medical expenses are used to help with the control of patient blood sugar. With the prevention of life threatening issues, the remainder of the expenses will help with all the chronic complications and the general patient medical care. The cost for patient medical care is much higher in several countries to assist patients with kidney services. In many countries there are a lot of assistance to assist families with the ability get the necessary medical care that is need to help them survive with kidney failure disease. Patients have the ability to use a medical insurance system or they can get assistance from the government such as Medicare. Theoretically looking at the cost of the services for patients to receive medical care for kidney services, the cost should not any higher than the current domestically charges. All patients that suffer with kidney disease need the need the proper care to assist with the loss of their kidney functioning properly. The cost for domestically and international patients will be the same. The only way patients would be charged different would be based on their current condition and how much treatment is needed. There will be some patients that condition is worse than others, however all patients are there for the doctors and nurses to help them survive and get through with their illness. The cost for patients to receive medical assistance and drugs with Hemodialysis will be $25475, where as the Peritoneal dialysis will be $18579. The difference between the two treatments will be $6896. Acording to Foreman, Rob, The Kidney Care Council Statement on the House SCHIP/Medicare Package – The CHAMP Act. “Dialysis providers are working hard to ensure access to quality dialysis care for all patients, regardless of where they live and in spite of an outdated payment system. The Care Council is disappointed to see a proposal in the U.S. House of Representatives that would make even deeper cuts in the current program, does not provide for an annual update, and reduces the bundles payment from 100 percent to 96 percent in ESRD reimbursements. This proposal could disproportionately impact patients who are African American, Hispanic, poor, and elderly.” Foreman, Rob also stated that, “With 85 percent of dialysis patients relying on Medicare to pay for their treatments, funding cuts will hurt some of the most vulnerable in our country. The impact of this proposal could be felt nationwide, including the urban areas and rural locations where many minorities and low-income patients are currently served. The Kidney Care Council has been working with Congress to improve the current Medicare ESRD payment policy. We have developed payment reform options to ensure that Medicare reimbursement keeps pace with treatment costs while preserving patient access to high quality care. Although the House proposal (The CHAMP Act) includes positive education and training provisions, its overall impact would not be positive to the program. Reducing Medicare payments and not providing for an annual payment update could significantly impact patient access to dialysis care. The current proposal needs more work to make it an improvement for patients over the current system.” [Reactions of Foreign Consumers to Dialysis Service Offerings] What is desired even in Sub-Saharan Africa is high-quality, low-cost, universal healthcare. However, it is evident that a thriving healthcare system is desperately needed. In fact, those essential elements of a thriving healthcare system – qualified medical personnel, medical resources, efficient services, and funds – are lacking in Sub-Saharan Africa. At this point, foreign consumers just want healthcare services, even dialysis services for those in need! The need for the private sector to improve Sub-Saharan Africa healthcare is widely recognized. After all, the private sector yields an enormous percentage of the international market. Even though communication between the government and the private sector is weak to include monitoring and enforcing regulations, the IFC World Bank Group partnered with the Gates Foundation to improve Sub-Saharan Africa healthcare (The Business of Health in Africa, 2008). The Bombay Renal Dialysis Center will take part in improving healthcare, particularly dialysis services, in Sub-Saharan Africa. It is true that consumer reactions will vary. After all, we are an unknown entity. Some consumers will want to know why we really chose their region. Some will be suspicious of our role. Existing barriers will cause some consumers to not consider our service offerings. Still, some will believe our service offerings too impossible to meet such a huge demand. Some foreign consumers will at least be grateful for the dialysis offerings from the center, as they have been grateful also for the aid received from different health sectors in the past! With dialysis service offerings, hopefully health education will spread and play its role in improving healthcare. It is in hopes that foreign consumers will be able to see the difference in the healthcare system via dialysis service offerings from the Bombay Renal Dialysis Center. Even though a majority of the countries pay the $34-40 per person per year requirement, with different sectors pulling together, healthcare services to include dialysis services will be accessible to all. After all, the region is full of health investment opportunities. Signs of economic growth have led to almost half of the world’s major investors focusing on the healthcare of the region. With further economic growth, a demand for our dialysis services will increase. The Bombay Renal Dialysis Center believes it will be able to provide dialysis service offerings in the region of Sub-Saharan Africa with a widespread view of consumers to improve its healthcare state in more ways than one! References Bamgboye, E.L. (2003). Hemodialysis: Management problems in developing countries, with Nigeria as surrogate. Kidney International. 63:83. Retrieved July 29, 2009, from EBSCOhost Database. The business of health in Africa: Partnering with the private sector to improve people’s lives [Electronic version]. International Finance Corporation. Retrieved July 28, 2009, from http://www.ifc.org/ifcext/healthinafrica.nsf/AttachmentsByTitle/IFC_HealthinAfrica_Final/$FILE/IFC_HealthinAfrica_Final.pdf World Bank Group. (2005). Doing business in 2005 Sub-Saharan Africa. Regional profile. Retrieved July 28, 2009, from http://www.undp.org/ticad2/Publications/doing%20business.pdf Forman, Rob. The Kidney Care Council Statement on the House SCHIP/Medicare Package – The CHAMP Act. Retrieved August 1, 2009. http://www.redorbit.com/news/health/1012589/the_kidney_care_council_statement_on_the_house_schipmedicare _package/index.html.