Navalok Eye Care Institute

• Hire experienced surgeons with competitive and realistic pay.
• Invest in research and development (R&D) and in equipment.
• Raise capital (shareholders and banks) to build the hospital and cover operating expenses.
• Manage prices and collections from clients (insurers, large employers, health authorities, NGOs).
• Ensure operational efficiency: nursing, anaesthesia, administration and surgical materials (e.g. intraocular lenses) are outsourced; staff are essentially the surgeons.

Each doctor starts with wealth of ₹30.0 million (Indian rupees) and has an annual cost of living of ₹3.0 million. Running out of cash means losing the game. To maximise their wealth, each doctor decides:

• Invest (be a shareholder): up to the whole wealth may be invested in the hospital of their region, sharing profits in proportion to the stake. Money not invested earns 7% a year.
• Work as a surgeon: agree a wage with the CEO, who pays everyone the same (reference: ₹5.5 million/year; last year wages ranged from ₹4.0 to ₹7.0 million).
• Without agreement, a doctor may offer to work for a competing hospital, announcing the minimum wage required. Without a job, they receive an uncertain, non-negotiable unemployment benefit (₹2.0 to ₹5.0 million/year).
• Be the administrator (CEO): may also invest (up to ₹30.0 million), has no fixed wage and does not count as a surgeon; earns a bonus of 30% of gross profit (80% paid in the year, 20% in following years after the accounts are approved).
• Roles add up: each doctor may be a surgeon and/or an investor.

• Within the same year a doctor may only lower the wage asked, and the CEO may only raise the wage offered, so proposals converge. A new year starts with no such limit.
• The wage is AGREED as soon as the CEO offers an amount equal to or above the request.
• The stake accepted by the CEO is contracted and used in the accounts. Later changes stay pending until the other party approves them.

• The hospital needs at least ₹20.0 million of funding (share capital and/or loans) per surgeon hired.
• Bank loans pay 15% interest a year and may not exceed twice the share capital.
• 90% of the funds raised are invested in the building and equipment (10-year useful life; 10% depreciation a year). The rest stays in cash for business payments.

• Each surgeon performs 500 cataract surgeries a year (1 operating theatre per 3 surgeons; maximum 9 surgeons).
• Optional ₹10.0 million technology and R&D investment, paid in full at the start of year one and carried out over 2 years, raising output by 5%, 10%, 15% or 20% in the first year.
• If it invests in R&D, the hospital receives a ₹3.0 million non-repayable state subsidy, paid up front.
• The hospital may accept unemployed surgeons from other regions, provided they accept the wage in place.

• Nursing, anaesthesia, administration, surgical materials and other supplies: ₹22,000 per surgery performed (per eye).

• Insurers, large employers, regional health authorities and NGOs buy surgery packages in advance on a futures market; the equilibrium price results from supply and demand.
• The hospital focuses on standard surgery (phacoemulsification with monofocal lens) and may also perform intermediate-advanced surgery (MICS with multifocal lens). No laser, robotics or trifocal lenses.
• Reference price: ₹52,000 per eye, ranging from ₹45,000 to ₹60,000.
• The CEO records the number of surgeries and the minimum acceptable price. If the ask is above the equilibrium price, output is sold at the uncertain current market (spot) price. Surgeries cannot be stored.

• The hospital pays a 25% effective income tax (an advance payment of ₹10.0 million has already been made).
• Bad debt risk: ₹20.0 million of client debts are overdue, with a 10% to 40% chance of collection.

• Individual winner: the doctor with the highest wealth.
• Best manager: the CEO with the best return on equity (ROE).
• Winning team: the group with the best income per capita.

• Register in the game app.
• Ask the professor for the game (class) code.
• Talk to your group and decide whether you want to be CEO.
• If you are the CEO, open the game, choose the hospital, note its code and share it with investors and surgeons.
• If not, ask the CEO for the hospital code and start taking investment, savings and employment decisions.
• Prepare the final decision with provisional ones: save drafts and review the provisional reports produced by the app.
• Submit the final decisions and analyse the results.