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Saturday 24 June 2017

Netcare Case Study Questions

The strategic challenges of Netcare can be summarised as: variant external environment conditions, and lack of resources and capabilities that can create a sustainable competitive advantage.

The external environment has a significant impact on Netcare’s international expansion strategy is the variation of external factors. These factors are shaped by the influence of the different stakeholders including governments, competitors and the general market (Johnson, Whittington and Scholes, 2011). In the stakeholder mapping grid below, government can be described as a key player due to the fact that it has a very high interest in healthcare service provision while also wielding immense power over the actions of the private sector players. 
As a stakeholder, government actions determine the mode of operation, the range of services that can be offered, prices that can be charged, and other restrictions on operations and ownership of business ventures (Harrison, 2003). For instance, the push by the South African government to demand that the general public is served by private hospitals makes it imperative for them to review their operational approaches to enable them maximise on the high quantity-low margin services (Case, p. 239). Such initiatives would not be needed in countries like Brazil where there is no requirement for private hospitals to serve the general public (Case, p. 249). Their actions can also have a direct impact on the affordability of healthcare. The strategic challenge of the organisation is therefore on how to accommodate these different legal and political climates while ensuring that the global brand is maintained. Netcare is therefore likely to be forced to abandon its standardised approach to strategic management and concentrate on embracing diversified approaches. For instance, it could successfully concentrate on serving higher end customers in the UK and Brazil while modifying its services to enable them serve the general public in South Africa.

In international expansion, the organisation has to choose between embracing a localisation or a globalised approach. In localisation, the strategic approach as well as leadership and management styles applicable is modified to suit differences in the external environment (Frynas and Mellahi, 2011). The level of psychic distance between the countries in question is among the factors that must be taken into consideration when determining the level of local differentiation that can be embraced. The influence of the psychic distance is demonstrable in the success of the organisation in its international expansion endeavours in the UK and in Rwanda. In the UK, there was no significant psychic distance since the South African private healthcare sector was largely conformant to the standard of world class healthcare as is common in the developed countries (Case, p. 236).

In determining the culture distance as relates to Netcare, it is important to delink the traditional market served from the general South African public. Nevertheless, subsequent legal and political changes have forced the organisation to redefine its target market hence giving them an edge in understanding the experiences of developing markets (Case, p. 241). In Rwanda, however, there was a significant psychic distance with differences and suspicions among different sections of the population making it necessary for a unique approach to leadership and operations to be embraced (Case, p. 247). This rendered Netcare’s attempt to embrace a standardised approach to be unsuccessful.

Competition plays a critical role in determining the extent to which an organisation can be successful in the international markets. Where competition levels are high, it becomes critical for the organisation to develop its resources and capabilities to become more competitive (De Wit and Meyer, 2010). Netcare’s competitive edge may be drawn from its competence in excellence in operational efficiency, ability to attract the best talent, strong partnerships with physicians, and quality service to patients. A critical examination of these competencies indicates that the organisation may not be having a source of competitive advantage when the competencies are subjected to the VRIN framework. The VRIN framework dictates that a resource or competence should be valuable, rare, inimitable and non-substitutable for it to be a source of competitive advantage for the organisation (Ramsay, 2001). Additional capabilities for Netcare are financial strength and strategic agility as developed from its diverse international experience. The evaluation of the same is as below:

Capability/ competence
Valuable
Rare
Inimitable
Non-Substitutable
Competitive status
Operational excellence
Yes
No
Yes
Yes
Temporary competitive advantage
Attractiveness for top talent
Yes
No
Yes
Yes
Competitive parity
Strong partnerships with physicians
Yes
No
Yes
Yes
Competitive parity
Financial strength
Yes
No
Yes
No
Competitive parity
Strategic agility
Yes
Yes
No
Yes
Temporary competitive advantage

From the critique tabulated above, Netcare can be said to only have a temporary competitive advantage in a few areas. This means that its main challenge is to develop its resources and competencies in a manner that can yield a sustainable competitive advantage. This challenge needs to be tackled in conjunction with the need to ensure that the competitive strategies adopted conform to the environmental factors of the new markets. Its preference for standardisation across different countries can be a source of competitive disadvantage in markets with a high psychic distance from its home market.


In international expansion, the organisation seeks to utilise the capabilities developed in the home market to grow internationally. This means that international expansion is greatly enhanced where capabilities developed in the home base are highly valuable.

The home base plays an important role for any organisation wishing to pursue international expansion. One of the main roles of the home base is the provision of financial capabilities that enable the organisation to invest in acquisitions and partnerships across different countries (Harrington and Ottenbacher, 2011). This explains why many of the leading multinationals have their home base in the developed markets from where their financial strength was drawn. The home base also determines the level of operational excellence that is attainable by organisations. This operational excellence is a function of a number of factors: the type of clientele being served, and the level of competition that the organisation is exposed to (Harrington and Ottenbacher, 2011). Diffusion of knowledge and skills within an industry raises the likelihood of excellence in operations and management in industries characterised by organisations seeking high levels of operational excellence. The same can be said of technological advancements.

Considering these factors, South Africa is both advantageous and disadvantageous as a home base. The main advantage comes from its ability to give an organisation an edge in strategic agility. The country is described as two different countries existing side by side where one section is comparable to the developed world while the second is comparable to the developing world (Case, p. 236). Netcare has traditionally served the high end clients comparable to those in the developed world. In this service, the clients were few but with high margins per client. However, with the changes in the legal environment where private hospitals were being compelled to serve the general public, the organisation was compelled to embrace further structural and strategic changes. The new services are accordingly suited for more clients albeit with lower unit margins.

Even though there was a significant psychic distance between South Africa and Rwanda, this distance is not likely to be high when applied to other developing countries. As a developing country, the general South African public has issues that are similar to those afflicting many populations in the developing world. This makes them highly capable of tackling health issues that afflict poor populations hence an ability to implement a successful strategy as a provider of private healthcare services to the relatively poor populations in the developing world. It can therefore operate in an environment of low cost-low margins with remarkable success. This is because it has been able to develop this competence from its experiences in the South African market.

The South African healthcare sector is unique in its ability to provide a developed market perspective despite being located in a developing country. Netcare can draw from its experience in innovation and serving the high end clients to serve developed markets. This means that they’d not be facing a significant psychic distance in the event that they opt to grow into a developed market. Their success in the UK market despite the fact that they did not need to make any significant adjustments to their strategic or operational models is evidence of this. Netcare can therefore expand into the developing markets or enter developing markets to specifically target the high end customers without facing immense difficulties.

Despite the strengths highlighted above, the South African government’s role in the healthcare sector has raised concerns on the implications on the financial performance of the main players. The government’s insistence on the general public being served lowers the highly innovative model whose high cost is offset by the high medical fees paid by the wealthy clients (Case, p. 241). This diverts attention from innovation and quality service delivery. It could therefore break the progress made in innovation and make the organisation less innovative. While the diversified targeting imposed by law could help in improving strategic agility, it is likely to reduce the industry players into regular healthcare sector players with no definite source of competitive advantage. Failure to specialise inhibits the ability of the organisation to build a brand identity that is stands out in the market (Brown, 2005). Having South Africa as a home base can also be a disadvantage in financial terms. Restrictive government policy that can be likened to price controls can inhibit profitability. The resultant weak financial position can inhibit further international expansion efforts.

Having highlighted the pros and cons of South Africa as a home base, it can be concluded that the market is good for the organisation. Its ability to reduce the psychic distance with virtually every country that the organisation could expand to, together with its ability to boost strategic agility, makes it easy for international expansion. These qualities can be utilised to make an organisation very competitive at an international level. 


Entry into foreign markets can be through a number of entry modes whose choice ought to be influenced by the level of knowledge in the market. This can be explained using the international expansion model which recommends that incremental knowledge in the market be accompanied by an additional commitment of resources (Frynas and Mellahi, 2011). The risk taken by the organisation increases as additional injection of resources is done. The risk is accentuated by lack of knowledge or experience in the market. Certain aspects of the foreign markets may be difficult to learn about due to the culture of secrecy that could exist in certain markets. The difficulty of foreigners to access such crucial pieces of information makes it difficult for foreign companies to run successful operations in the organisation.

Bartlett et al (2008, p.10) summarise the entry modes in an incremental basis indicating the level of resources invested as well as the level of control over operations. On this scale, direct acquisitions require higher levels of resource commitment than partnerships. However, they come with substantial risks to the organisation. In acquisitions, the organisation buys out an existing business where they are able to take over its assets and impose their operational approach on them (Frynas and Mellahi, 2011). It requires a high level of commitment of resources. The organisation in turns has sole control over the strategic and operational aspects of the organisation.

Having full control over the management of the organisation makes it easy for the organisation to build its global brand. The organisation is thence able to implement its global strategy without any inhibition. The choice on strategy is therefore not restricted to local differentiation and standardisation across countries can be done where the same is found likely to lead to organisational success. Acquisition as an entry mode is advantageous over direct investment into a new subsidiary as it enables the organisation tap into the capability, goodwill and competencies of the business being taken over (Som, 2009). The distribution network that has already been developed can also be of immense value. Besides, the organisation has the option of letting the organisations being acquired to continue functioning as before where it can learn from their experiences and gain more knowledge about the market. This advantage is however rarely realised with many organisations tending to prefer restructuring and conforming the newly acquired subsidiaries to their global strategic and operational models.

The disadvantage of this entry mode is that the risk of loss is much higher. This is especially with regards to organisations that are expanding into markets they do not know much about. In the case of Netcare, this riskiness of acquisitions was evident in the company’s entry into Rwanda. Having entered the market through acquisition, the company would proceed to set up operations that were comparable to its operations in the UK and South Africa. However, it would turn out that their understanding of the Rwandese culture and market was low hence leading to immense failure of their venture (Case, p. 247). In a hypothetical scenario, the presence of a local partner would have gone a long way in enabling them understand the market hence modify their operational and leadership models accordingly.

Entry into a foreign market through partnership involves shared control over the operations of the foreign subsidiary or alliance (Frynas and Mellahi, 2011). This increases the risk of disagreements where the different partners could be competing for influence over the management or influence over operational approaches. These disagreements can nevertheless be minimised through thorough due diligence in the process of identifying a strategic partner. The existence of a shared vision as well as compatibility of organisational cultures should be some of the elements to look out for. In spite of these risks, partnerships can be very beneficial to the organisation.

This advantage is evident in Netcare’s entry into the UK market where its entry was through a partnership with the National Health Service (NHS). This partnership was in form of a contract where Netcare was to conduct 44,737 cataract operations on NHS patients (Case, p. 243). This partnership proved to be a great success. It can be presumed that it is through the success of this venture and the subsequent knowledge of Netcare about the market that prompted the company to make an acquisition of one of the industry players GHG 5 years later.

As the company grapples with the question on whether to embrace acquisitions or partnerships, the main elements for consideration should be: the amount of resources available for investment, and the level of knowledge about the target market. The risk is lower where there is a very low psychic distance between the home market and the target foreign market. Acquisitions are preferable where total control over the foreign subsidiary is crucial. However, it comes with a high risk such as insufficient knowledge about the market. This deficiency can be sealed by having a local partner with thorough knowledge about the target market. This would however come at a cost of loss of partial control and the risk of disagreements with such partners. These are the considerations that Netcare should make on a case by case basis before settling on a foreign entry mode in each of the target markets.


Brown, P., 2005. The evolving role of strategic management development. The Journal of Management Development 24 (3), pp. 209-222
De Wit, B., Meyer, R., 2010. Strategy Synthesis: Text and readings. 3RD Ed. London: Cengage Learning.
Frynas, J.G., Mellahi, K., 2011. Global Strategic Management. 2nd Ed. Oxford: Oxford University Press
Harrington, R.J., Ottenbacher, M.C., 2011. Strategic management. International Journal of Contemporary Hospitality Management 23(4), pp. 439-462
Harrison, J.S., 2003. Strategic Management of Resources and Relationships. Chichester: Wiley
Johnson, G., Scholes, K., Whittington, R., 2011. Exploring Strategy: Text and cases. 9th Ed. Harlow: Pearson Education / FT Prentice Hall
Ramsay, J., 2001. The resource based perspective, rents, and purchasing contribution to sustainable competitive advantage. The Journal of Supply Chain Management, Summer 2001, pp. 38-47

Som, A., 2009. International management: managing the global corporation. Maidenhead: Mc-Graw-Hill Education

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