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Minister of Health Vicent Cremades finds himself faced with the daunting task of meeting rising health care needs with reduced funding from the government in Spain’s coastal autonomous community of Valencia. With a population of over five million with 17.5% aged over 65, hospitals were already at capacity and in need of improvements. Forced to find solutions, Cremades considers the private sector as a solution to provide part or all of the health care services needed. In this case, students will look into PPPs (Public-Private Partnerships) as a potential solution to this dilemma and decide which model would best suit the particular needs of the Valencian people.

This case focuses on one of the thorniest problems of the 21st century, which is how to save wilderness and ecosystems at a time when the countries where they are concentrated in are immersed in a rapid development process and resource hunger around the world is stronger than ever. The NGO that is analyzed in the case, a South African-based NGO called African Parks, has developed an innovative approach to preserving natural spaces and species that combines private, charitable finance and efficient private management with local government cooperation. African Parks now spans seven countries in sub-Saharan Africa and sees its task as preserving the iconic ecosystems of the continent from destruction. The case poses critical questions about: how to solve the “tragedy of the commons” while promoting local development; how private managers can address social issues, especially through the PPP (Public-Private Partnership) formula; and how the unique traits of NGOs make them ideal partners to tackle problems that the free market does not easily solve, in cooperation with governments and the private sector.

This case takes a look at the events that led up to the bursting of Japan’s stock-market bubble in 2010. It begins by describing the economic situation in Japan in the 1980s at the start of the crisis, delving into the appreciation of the yen, loss of competitiveness, low interest rates, the over-valuation of the stock market leading to inflation and the upward trend in the unemployment rate. It emphasizes that there were twenty years of poor political leadership where the political party changed frequently. The case outlines the government in Japan during the nineties and includes a detailed description of how each prime minister’s actions affected the economy. Then in 2001, seeking economic recovery, Koizumi’s government launched a comprehensive plan of reforms based on solving the problem of bad debts, establishing a stable financial system and defining seven programs of structural reform. When Koizumi left office, the economic situation was unstable and between 2006 and 2009, up to three different prime ministers occupied the post. Between 2007 and 2009, stimulus packages implemented by the government caused public debt as a percentage of Japan’s GDP to increase nearly 55 percent. This led the Bank of Japan to take emergency measures. In 2009, Hatoyama came into power, ending the Koizumi era. The government then had their chance to put an end to the “lost years.”

This case takes a look at the events that led up to the bursting of Japan’s stock-market bubble in 2010. It begins by describing the economic situation in Japan in the 1980s at the start of the crisis, delving into the appreciation of the yen, loss of competitiveness, low interest rates, the over-valuation of the stock market leading to inflation and the upward trend in the unemployment rate. It emphasizes that there were twenty years of poor political leadership where the political party changed frequently. The case outlines the government in Japan during the nineties and includes a detailed description of how each prime minister’s actions affected the economy. Then in 2001, seeking economic recovery, Koizumi’s government launched a comprehensive plan of reforms based on solving the problem of bad debts, establishing a stable financial system and defining seven programs of structural reform. When Koizumi left office, the economic situation was unstable and between 2006 and 2009, up to three different prime ministers occupied the post. Between 2007 and 2009, stimulus packages implemented by the government caused public debt as a percentage of Japan’s GDP to increase nearly 55 percent. This led the Bank of Japan to take emergency measures. In 2009, Hatoyama came into power, ending the Koizumi era. The government then had their chance to put an end to the “lost years.”

The objective of this short case is to familiarize students with what it is like to do business at the base of the pyramid; and to use a practical situation to review the concepts of fixed and variable costs, implicit and explicit costs, and accounting profit vs economic profit. Students are also asked to reflect on the implications of operating in a perfectly competitive market, and to offer suggestions from market structure theory for a firm like the one described here, that would enable it to break out of its inevitable zero-profit equilibrium and move toward economic profits in the long run.

Felipe Izcaray, the new general manager of the Clínica Santa Sofía in Madrid, a hospital specializing in gynecological and pediatric care, was put in charge of improving management and increasing profitability. Although the company was well-managed in terms of processes, it did not have its objectives clearly defined. Although the company has improved in terms of operational efficiency and cost control, their profits had not gone up. Izcaray decided to hold a meeting with the Board of Directors to present his analysis of hospital management. He proposed making changes in the departmental structure and drawing up a new department-by-department organizational chart, providing 24-hour emergency service and treating customers in a way that their stay is a true pleasure. The conclusions from the meeting were that profitability needed to be increased by attracting high-value customers, comprehensive service needed to be provided in order to achieve cross-sales to the customer, they needed to continue arrangements with the public health system, and to improve the clinic’s reputation. The clinic’s new management committee then got together to draw up a strategic control chart. The committee was made up of managers from different departments who did not totally agree on what the clinic’s strategy should be and who all had different concerns. The managing physician emphasized that although the company was seeking profitability and economic results, they could not spare measures or restrict the use of resources. They needed to avoid giving precedence to profitability above patient health. The head of sales and public relations also mentioned that excellent service is important since word of mouth will get them new customers and positive references could create cross-sales. The nurse mentioned that the employees’ level of satisfaction also needed to be taken into account to achieve a low turnover. Someone else mentioned that they could use referrals from renowned physicians or public figures to gain more customers. When the head of management control brought up reducing costs, the managing physician strongly disagreed and said he would not ask professionals to concern themselves with cross-sales, bed turnover, etc. Izcaray knew that the support of the managing physician was essential. He needed to be sensitive to ideas from all the areas and reorient those that did not fall within the objectives of the company in order to prepare and implement a strategic control chart. The case discussion is centered in the difficulties of balancing profitability with excellent healthcare service.

Felipe Izcaray, the new general manager of the Clínica Santa Sofía in Madrid, a hospital specializing in gynecological and pediatric care, was put in charge of improving management and increasing profitability. Although the company was well-managed in terms of processes, it did not have its objectives clearly defined. Although the company has improved in terms of operational efficiency and cost control, their profits had not gone up. Izcaray decided to hold a meeting with the Board of Directors to present his analysis of hospital management. He proposed making changes in the departmental structure and drawing up a new department-by-department organizational chart, providing 24-hour emergency service and treating customers in a way that their stay is a true pleasure. The conclusions from the meeting were that profitability needed to be increased by attracting high-value customers, comprehensive service needed to be provided in order to achieve cross-sales to the customer, they needed to continue arrangements with the public health system, and to improve the clinic’s reputation. The clinic’s new management committee then got together to draw up a strategic control chart. The committee was made up of managers from different departments who did not totally agree on what the clinic’s strategy should be and who all had different concerns. The managing physician emphasized that although the company was seeking profitability and economic results, they could not spare measures or restrict the use of resources. They needed to avoid giving precedence to profitability above patient health. The head of sales and public relations also mentioned that excellent service is important since word of mouth will get them new customers and positive references could create cross-sales. The nurse mentioned that the employees’ level of satisfaction also needed to be taken into account to achieve a low turnover. Someone else mentioned that they could use referrals from renowned physicians or public figures to gain more customers. When the head of management control brought up reducing costs, the managing physician strongly disagreed and said he would not ask professionals to concern themselves with cross-sales, bed turnover, etc. Izcaray knew that the support of the managing physician was essential. He needed to be sensitive to ideas from all the areas and reorient those that did not fall within the objectives of the company in order to prepare and implement a strategic control chart. The case discussion is centered in the difficulties of balancing profitability with excellent healthcare service.