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HSA 599
Strayer University−Online
Winter 2016
HSA 599: Winter 2016
Strayer University−Online
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HSA 599: Winter 2016
Table of Contents
“GE Healthcare (A): Innovating for Emerging Markets” by
Singh, Jasjit 1
“GE Healthcare (B): A CSR Dilemma” by Singh, Jasjit 13
Bibliography 17
i
ii
GE Healthcare (A):
Innovating for Emerging Markets
07/2013-5776
This case was written by Jasjit Singh, Associate Professor of
Strategy at INSEAD. It is intended to be used as a basis
for class discussion rather than to illustrate either effective or
ineffective handling of an administrative situation.
Copyright © 2011 INSEAD
COPIES MAY NOT BE MADE WITHOUT PERMISSION. NO
PART OF THIS PUBLICATION MAY BE COPIED, STORED,
TRANSMITTED, REPRODUCED OR DISTRIBUTED
IN ANY FORM OR MEDIUM WHATSOEVER WITHOUT THE
PERMISSION OF THE COPYRIGHT OWNER.
1
Copyright © 2011 INSEAD 1 07/2013-5776
“If GE doesn’t come up with innovations in poor countries and
take them global,
the new competitors from the developing world will... GE has
tremendous respect
for traditional rivals like Siemens, Philips, and Rolls-Royce.
But it knows how to
compete with them; they will never destroy GE. By introducing
products that
create a new price-performance paradigm, however, the
emerging market giants
very well could. Reverse innovation isn’t optional; it’s oxygen.”
GE CEO Jeffrey Immelt and co-authors1
GE Healthcare
As of 2010, GE Healthcare was a $17 billion division of the
$180 billion giant General
Electric, employing over 46,000 people worldwide. It was
created in 2004 after GE Medical
Systems was merged with British bioscience/medical imaging
firm Amersham and several
healthcare IT firms as a part of CEO Jeffrey Immelt’s increased
emphasis on R&D.2
GE Healthcare had a strong track record in selling high-end
medical imaging and diagnostic
products globally. It operated in India as Wipro GE Healthcare,
a 51:49 joint venture with
Wipro. Partnering with a leading Indian company had helped
GE address the regulatory
constraints and institutional complexities of operating in India
as a foreign multinational.3
India as a Base for Global R&D
GE had four major sites for its R&D efforts: the U.S.
(Niskayuna), India (Bangalore), China
(Shanghai) and Europe (Munich). Additional research centres in
Brazil (Sao Paulo) and the
U.S. (Detroit) were also being considered. In locating R&D
overseas its chief considerations
were availability of talent and being close to important markets.
The John F. Welch Technology Centre (JFWTC) in Bangalore
was GE’s largest R&D centre
outside the U.S. Opened in 2000, the $175 million centre had
grown to about 4,300
technologists (about 1,100 in Healthcare) by 2010.4 India was
an attractive base not just for
cost reasons but also for an ample supply of world-class talent
and the presence of some well-
known educational and research institutions in an otherwise
relatively less developed country.
JFWTC carried out R&D for GE businesses in areas as diverse
as healthcare, energy, aviation
and transportation. Its traditional focus had been addressing the
needs of developed market
customers. However, there was now an increasing emphasis also
on products tailored for
emerging markets like India, including those developed
specifically for particularly low-
income customers (the so-called “bottom of the pyramid” or
BOP).5
1 Jeffrey R. Immelt, Vijay Govindarajan and Chris Trimble,
“How GE is Disrupting Itself”, Harvard
Business Review, October 2009.
2 Tarun Khanna and Elizabeth A. Raabe, “General Electric
Healthcare, 2006”, Harvard Business School
Publishing Case 9-806-478.
3 “GE Healthcare exploring distribution tie-ups”, Business
Line (The Hindu), March 10, 2010.
4 Joe Leahy, “A nation develops”, Financial Times, January 11,
2010.
5 Dibeyendu Ganguly, “How GE's Bangalore engineers are
taking on technology challenges”, The Economic
Times, October 2, 2010.
2
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India as a Healthcare Market
As of 2010, India’s healthcare industry was worth about $30
billion and was expected to
double in size in the next five years. Estimates put the medical
devices market segment
somewhere in the $3 billion to $6 billion range, with growth of
between 10% and 15% a year.
Of the 700 domestic healthcare device makers in India, most
only made low-value products
such as needles and catheters. Of the few that did produce more
sophisticated equipment, few
could match international players in terms of quality or
performance. Nevertheless, they
typically had a significant cost advantage, which made them
formidable competitors in mass
markets where customers had limited purchasing power and
were highly price sensitive.
High-quality specialist products came mainly from MNCs like
GE, Siemens and Philips, with
GE being the #1 provider of diagnostic equipment like ECG,
MRI, CT and ultrasounds. Given
the price points, however, most of the $400-500 million annual
revenue of GE Healthcare in
India had come from sales to large hospitals.6
GE Healthcare had recently launched a global $6 billion
“Healthymagination” campaign, with
stated goals of reducing the cost, increasing access and
improving the quality of healthcare
around the world. This included significant investment in
solutions for BOP patients.7 In
addition to providing growth opportunities and building new
capabilities for emerging
markets, this was expected to be good for GE’s corporate social
responsibility (CSR) image.
GE Organization in India
In 2005, GE had set a revenue goal for India of $5 billion across
all businesses by 2010. But it
had actually realized less than $3 billion by 2010. Within the
Healthcare division, India still
accounted for less than 2% of revenues. Recognizing that this
fell far short of potential,
Immelt set an ambitious 30% annual growth target for GE India
over the next five years in
order for the Indian business to cross the $10 billion mark by
2015.8
A key barrier to GE’s growth in India had been its inability to
fully tap into the mass market.
Since sales from India comprised a tiny fraction of overall
sales, the idiosyncratic needs of the
Indian market did not get much attention in the highly
centralized global organization. As a
result, even R&D initiatives carried out in India had a tendency
to gravitate towards meeting
the needs of the relatively high-end segments that resembled
GE’s developed market
customers. A senior leader at GE Healthcare summarized the
problem: “We were selling what
we were making [rather than] making what the customers here
needed.” 9
To overcome the above challenges, GE introduced a new “in
country, for country” strategy
for India. This involved two key changes in the organizational
structure. First, on the
geographic dimension of the organizational matrix, India was
now to be treated as an
6 Rina Chandran, “In India, for India: medical device makers
plug in”, Reuters, July 5, 2010.
7 “GE Healthcare recognized for its efforts to take healthcare
to the masses in India”, GE Healthcare Press
Release, September 13, 2010.
8 Josey Puliyenthuruthel “GE Learns New Tricks in India”
Business Today October 31, 2010.
9 “Reverse Innovation: GE Makes India a Lab for Global
Markets” [email protected] May 20, 2010.
3
Copyright © 2011 INSEAD 3 07/2013-5776
independent region (on a par with the U.S. and China). As a
former GE Healthcare employee
put it, “In our global meetings, India overnight went from
getting only two slides in the GE
International presentation to getting a whole presentation on its
own.”
The second organizational change was that GE India was the
first country to be made a profit
and loss centre on its own. The Indian business heads were to
now report primarily to the
country CEO, with only a dotted-line link to the global business
heads. Immelt said: “We will
treat GE India just as we would any other GE business with its
own growth strategy,
leadership development and budgeting processes.” Managing
the entire local value chain from
India itself was expected to improve local adaptation and speed
up decision-making. 10
The 39-year old T.P. Chopra – an Indian who had been the
country CEO in the old
organization – was replaced by John Flannery, a senior vice-
president from GE’s global
leadership team. With the new CEO being well-connected with
GE’s global business heads, it
was hoped that decentralization of decision-making would not
compromise on global
integration of strategy and knowledge exchange would still take
place across boundaries.
Rather than making development of “value-for-money” products
targeting low-income
markets also a responsibility for existing R&D teams, GE set up
new product teams
specifically for developing and commercializing such solutions.
The local boost for R&D was
complemented by enhanced efforts in local marketing, sourcing,
manufacturing and service.
Aggressive growth targets were set for adapting better to the
Indian market, while also cutting
costs drastically and achieving speedier decision-making
through decentralization.11
A New ECG Device for India?
GE’s Healthcare division was an early adopter of the new “in
India, for India” approach, with
several new initiatives in this spirit having been started even
before the new organization was
fully in place, as was illustrated by GE’s efforts to develop
inexpensive electrocardiogram
(ECG) products specifically with the Indian market in mind.
Cardiovascular disease was the largest and still growing cause
of deaths globally, accounting
for over 17 million (or 30%) of all deaths.12 Non-
communicable diseases had in the past been
associated with the more affluent nations, but this was no longer
the case. Over 80% of heart-
related deaths now occurred in mid-to-low income countries,
and over 2 million in India
alone. Between 2005 and 2015, the Indian economy was
projected to lose $237 billion due to
the most common non-communicable diseases like heart
disease, stroke and diabetes.13
The number of heart patients in India was already over 60
million (30% below age 40). India
was expected to soon be host to more than half of all worldwide
heart patients, making ECG
testing of tremendous value in early detection. But as
mainstream ECG machines (such as the
10 Such a restructuring was not needed for China because the
Chinese business was bigger and able to directly
influence global decision-making in response to its needs.
Another strategic market being considered for
such a structure had been Brazil, but less developed local R&D
capabilities there made it less ideal.
11 “GE plans major investment in ‘for India' facility” Business
Line (The Hindu) September 17, 2010.
12 http://www.who.int/mediacentre/factsheets/fs317/en/
13 “Cardiovascular diseases in India” Report by Deloitte and
Assocham India, 2011.
4
Copyright © 2011 INSEAD 4 07/2013-5776
MAC 5500 machine shown in Exhibit 1, priced at over $10,000)
were designed to meet the
needs and budgets of large modern hospitals, they only skimmed
the top of the Indian market.
With per capita income just over $1,000 per annum, few Indians
could afford expensive
testing using high-end machines. However, affordability was
not the only issue. People living
in small towns and rural areas lacked easy access to hospitals.
Simply producing stripped-
down versions of GE’s existing products would therefore not
suffice. There were unique
challenges of the BOP to bear in mind, and the product and
solutions would have to be
suitable for the less sophisticated doctors that low-income
patients typically relied upon.
While price was generally important, these potential customers
would also place a lot of
importance on perceived quality and appropriateness of any
product for their needs.
The MAC 400 ECG Device
GE management assigned the task of designing an ECG solution
for India to the JFWTC.
Using local R&D turned out to have three benefits. First, the
team had a better knowledge of
Indian customers. Second, it had greater awareness of off-the-
shelf components available
locally. Third, development costs were much lower than for an
equivalent project in the U.S.
An ECG device targeting the BOP – called the MAC 400 (see
Exhibit 2) – was developed in
just 22 months, with development costs of about $500,000. (A
similar global product
development effort could have taken twice as long and cost
several million dollars.) The
device was small enough to fit in a backpack. At 1.3kgs it was
much lighter than conventional
models, which often weighed over 7kgs. It had rechargeable
batteries that could be charged in
three hours and allowed over 100 ECGs, or a week of operation,
between charges.
The expensive printer typical of classic ECG machines was
replaced by a small printing
gadget adapted from a model used for portable ticket machines.
The traditional 12-channel
printer output in high-end ECGs was replaced by a three-
channel output in the MAC 400. The
full-scale keyboard was replaced by just four buttons, and the
large graphical colour display
by a small text-only display used for set-up. The machine had a
simple one-touch operation,
with embedded software interpreting the ECG data to print out a
simple easy-to-read intuitive
report. This eliminated the need for a specialist to tell whether a
patient had a heart condition.
Importantly, the relentless focus on eliminating non-core
features found in high-end ECG
machines (such as on-screen display, advanced analysis, full
network connectivity and inter-
operability, barcode and magnetic card scanning, data storage
and export, security, etc.) did
not mean that the development team compromised on the core
functionality. Employing the
industry-standard Marquette 12SL algorithm that all GE’s ECG
machines used, the analysis
performed by the MAC 400 was as reliable as that of a full-
scale ECG device.14
The MAC 400 was priced around $1,000, a third of the price of
medium-sized conventional
devices and under a tenth of many full-size models.15 The
effective cost of a single electro-
14 “A special report on innovation in emerging markets: First
break all the rules”, Economist Intelligence Unit
Executive Briefing April 19, 2010.
15 Jena McGregor “GE: Reinventing Tech for the Emerging
World”, Bloomberg Businessweek, April 17,
2008.
5
Copyright © 2011 INSEAD 5 07/2013-5776
cardiogram turned out to be less than $1, which was considered
low enough for widespread
adoption. Although the margins in selling MAC 400 were
smaller than those on high-end
equipment, GE hoped that the sales volume would justify the
product nevertheless.
Some cost reductions naturally resulted from making a smaller
size device with limited
features, but savings also resulted from the creative use of
standard parts available locally.
Instead of using a customized processing chip, the R&D team
came up with a clever solution
relying upon a commercial chip that cost only a quarter of the
price. Similarly, rather than
developing a customized printer the team adapted one widely
used in bus terminal kiosks.
As the MAC 400 was being developed, the local R&D team had
access to all of GE’s
accumulated knowledge. For example, by borrowing a process
originating elsewhere for
building fast plastic-mould prototypes, the team was able to
avoid costly changes later by
getting early feedback from doctors. Similarly, it was able to
take GE’s past experience in
developing printers for dusty conditions and fine-tune the
printer’s suitability for ECG.
Describing the full potential of ultra-portable ECG devices like
the MAC 400, a senior official
at the JFWTC said, “It will become the stethoscope of
cardiologists.”16 According to another
official, “The dream would be to sell at least one device to each
GP (general practitioner).”17
For cost-effective distribution, GE hoped to rely not just upon
the network from its JV with
Wipro but also to explore novel partnerships with
pharmaceutical companies, surgical
companies and large pharmacies. To educate potential
customers it conducted courses on the
technical aspects of using an ECG device as well as making the
business case for investing in
one. To help potential buyers overcome financing constraints, it
tied up with State Bank of
India, whose extensive rural network was used to arrange no-
interest loans for buyers.
At the time when the MAC 400 project was initiated, GE had
limited market research and
distribution channels in place for the new customers it was
trying to reach. Therefore, rather
than evaluating the project purely on a financial basis, the
company viewed it also as an
experiment into the BOP opportunity more broadly and as a way
to build resources and
capabilities for the future. Other product categories where GE
Healthcare was similarly trying
to tap into low-income markets included baby warmers, X-ray
and ultrasound systems.
As an experiment, the MAC 400 turned out to be a success not
only in India but also in
numerous countries worldwide where it was in fact often sold at
higher price points. Even
commercially, MAC 400 became a reasonable success by
generating $20 million in revenues
within the first two years. This was still a small fraction of the
revenues for GE Healthcare as
a whole, no surprise given that it was an early foray for GE into
an unfamiliar market and that
the entire ECG category anyway was a small part of the overall
healthcare portfolio.
The MAC i ECG Device
While GE had hoped to use MAC 400 to reach the mass market,
actual sales ended up being
limited and to a large extent within the traditional customer
segments. A better reach into the
16 “Frugal innovation”, Business Standard, June 13, 2009.
17 “GE Healthcare exploring distribution tie-ups”, Business
Line (The Hindu), March 10, 2010.
6
Copyright © 2011 INSEAD 6 07/2013-5776
BOP needed further investment into appropriate sales,
distribution and service networks. In
addition, GE needed a truly mass-market product that was much
cheaper than even MAC 400.
Relying upon the MAC 400 experience and extensive market
research, GE came up with a
new ECG device, the MAC i (“i” for India), that weighed less
than 1kg, used a single-channel
printer output and eliminated even PC connectivity. Launched
in November 2009, it was
priced at just $500. Like MAC 400, it was also manufactured
using off-the-shelf components.
As differentiating elements for the new product, GE emphasized
its technological reliability,
user-friendliness, interpretation software and channel
upgradability options.18
GE was not the only company targeting the BOP market. While
other MNCs like Schiller,
Philips and Siemens carried out similar efforts, the most
successful had been an Indian player
called BPL. Established in 1963, BPL had focused much of its
time and energy developing
the right products at low cost for the mass market, nurturing a
strong local brand, and having a
deep sales and distribution network. As one industry insider
quoted, “For BPL, the mass
market is bread and butter and jam. For GE, it is just an
option.” However, GE hoped that
BOP market being largely untapped and MAC i being an
excellent GE-branded product at an
affordable price (even if more expensive than BPL) would help
it do well in the coming years.
BPL’s brand perception turned out to be as high as GE’s, and its
single channel ECG matched
MAC i in quality of print and user friendliness. In addition,
many buyers assumed GE ECGs
would be too expensive to even consider. The purchasing
experience was also often smoother
when buying from BPL. For instance, when a doctor wished to
purchase from GE, he couldn’t
make payment in cash and often had to wait a week for delivery.
In contrast, BPL accepted
cash orders, was more flexible in giving discounts and could
make deliveries within a day.
As of 2011, the ECG equipment market in India stood at 39,914
in overall volume and $27.7
million in total value (see Exhibit 3). Single-channel ECGs
contributed to about 72% of the
volume and 40% to the overall value in the industry.19 GE’s
sales for MAC i had only grown
from 500 units in 2010 to 2,000 units in 2012 at the same time
that BPL’s single-channel
ECG sales had grown from 17,000 units to 22,000 units.
Overall, BPL remained the ECG
market leader in India with 58% of the market share, and the
next five players - Schiller,
Maestros (an Indian company), Philips, GE and Siemens -
trailed significantly behind.
The MAC 800 ECG Device
While the MAC 400 was being developed in India, GE's R&D
personnel in China built upon
the idea to develop another portable ECG – the MAC 800 (see
Exhibit 4). The new product
targeted not only remote locations but also the typical clinics
and hospitals in China.
Weighing 3kg, the MAC 800 was larger than the MAC 400,
though still much smaller than
GE’s high-end ECG machines. Recognizing China’s familiarity
with SMS-texting, it
incorporated a telephone-style keypad to allow users to input
data. It included a full-size
colour display (with multiple language options) based on an
intuitive Windows-based
platform, offering a preview of ECG results. It also allowed
ECG data to be stored and sent.
18 Rina Chandran, “In India, for India: medical device makers
plug in”, Reuters, July 5, 2010.
19 “ECG Equipment: Diagnosis for a Smarter Planet”, Medical
Buyer, Dec 15, 2012
7
Copyright © 2011 INSEAD 7 07/2013-5776
The product design, the pricing strategy and the channels GE
Healthcare relied upon to
distribute MAC 800 exploited the fact that higher local income
levels as well as greater
involvement of the government in healthcare standard-setting
and purchasing decisions led to
lower price sensitivity in China than in India and opened up a
different kind of opportunity.
Costing around $2,500, the MAC 800 was over twice as
expensive as the MAC 400, but still
less than one third of GE’s high-end ECGs.20 Early indications
were that it was selling well,
exceeding 20,000 installations in more than 50 countries as of
2010.21
“Reverse Innovation”
In an interesting development, GE started selling the MAC 800
even in developed markets.
While it held a 34% share of the U.S. mainstream ECG market,
GE saw an opportunity to use
the MAC 800 to expand the ultrasound market to include
primary care doctors, rural clinics,
emergency rooms and accident sites.22 Market studies revealed
that U.S. physicians found the
device user-friendly, and considered its SMS texting-style
keypad acceptable.23 The U.S.
market was found to have greater connectivity requirements
than those offered by the Chinese
prototype, but GE was able to address that through adaptations
like USB and Ethernet ports.
For a company that primarily sold products developed for
developed economies in emerging
markets, this exemplified a reversal in the direction in which
innovation flowed. The
phenomenon was labelled “reverse innovation” by Immelt, who
considered such an approach
critical to the very survival of Western multinational fighting
the threat of emerging market
companies going global with their own disruptive business
models. 24
The Right Global Strategy?
Although GE earned favourable press coverage and several
awards for its innovative BOP
products, it was too early to declare its BOP initiatives a big
commercial success because the
revenues generated were still small by GE standards, margins
were thinner than GE was used
to, and the competition was starting to heat up.
Sceptics wondered whether GE really had a sound long-term
strategy, especially as the
competitive advantage in serving BOP markets was unclear.
Past successes had come from
delivering standardized products globally, relying upon scale to
drive down costs and tight
organization to ensure control. For the company to move
towards an “in country, for country”
approach for specific countries seemed far from the obvious
direction to take.
20 John Schmid, “GE Healthcare advances global reach with
new heart monitor”, Journal Sentinel, March 14,
2009.
21 Kala Vijayraghavan, “Products built on Indian innovations
flowing into world markets”, The Economic
Times, December 2, 2010.
22 Reena Jana, “Innovation Trickles in a New Direction”,
Bloomberg Businessweek, March 11, 2009.
23 GE Press release, “GE’s First Portable ECG, “Medical
Texting” Arrives in US”, March 13, 2009.
24 Jeffrey R. Immelt, Vijay Govindarajan and Chris Trimble,
“How GE is Disrupting Itself” Harvard Business
Review October 2009.
8
Copyright © 2011 INSEAD 8 07/2013-5776
Exhibit 1
GE MAC 5500 ECG System (Designed for Large Modern
Hospitals)
Source: http://www.gehealthcare.com
9
Copyright © 2011 INSEAD 9 07/2013-5776
Exhibit 2
GE MAC 400 ECG Device (Designed for Rural India)
Source: http://www.gehealthcare.com
10
Copyright © 2011 INSEAD 10 07/2013-5776
Exhibit 3
The ECG Equipment Market in India
Source: “ECG Equipment: Diagnosis for a Smarter Planet”
Medical Buyer, 12 Mar 2012.
Note: Overall market size of Rs 133.02 Crore translates into
$27.7m (1 Crore = 10 million; $1 = about Rs. 48)
11
Copyright © 2011 INSEAD 11 07/2013-5776
Exhibit 4
GE MAC 800 ECG Device (Designed for China Market)
Source: http://www.gehealthcare.com
12
GE Healthcare (B):
A CSR Dilemma
03/2011-5776
This case was written by Jasjit Singh, Assistant Professor of
Strategy at INSEAD. It is intended to be used as a basis for
class discussion rather than to illustrate either effective or
ineffective handling of an administrative situation.
Copyright © 2011 INSEAD
TO ORDER COPIES OF INSEAD CASES, SEE DETAILS ON
THE BACK COVER. COPIES MAY NOT BE MADE
WITHOUT PERMISSION. NO PART OF THIS PUBLICATION
MAY BE COPIED, STORED, TRANSMITTED, REPRODUCED
OR DISTRIBUTED IN ANY FORM OR MEDIUM
WHATSOEVER WITHOUT THE PERMISSION OF THE
COPYRIGHT OWNER.
13
The Venue 40 Ultrasound
In the 1990s, GE had attempted to develop an inexpensive
ultrasound machine focused on
offering the basic ultrasound functionality using PC-based
software. These efforts were
subsequently shelved because the machine’s performance was
not considered adequate for
GE’s mainstream markets. However, a decade later, the idea
was revived by GE’s China
R&D team as worth exploring for the local market, given the
trade-offs that low-income
consumers there were willing to make and the technologically
more advanced laptop-based
platforms that could now be potentially used.
The R&D team in China came up with a compact ultrasound –
the Venue 40 – that relied on
touch-screen technology and eliminated the buttons, knobs and
keyboards of conventional
machines. Further, the device’s smooth surface facilitated the
cleanliness required in sterile
environments, and its intuitive interface appealed to physicians
new to ultrasound.
While GE’s conventional machines could cost over $100,000,
the cheapest Venue 40 sold for
under $20,000. Soon after the product’s China launch in 2009,
GE started selling different
variants in other emerging markets and in untapped segments
back in developed markets.1
A Corporate Social Responsibility (CSR) Dilemma
GE would, however, need to carefully manage the marketing,
sales and distribution of the
new device in markets where ultrasound technology was seen to
have exacerbated the
problem of the disproportionate number of abortions of female
foetuses, leading to major
concerns about gender imbalance. For example, one news report
estimated gender selection to
be a $100 million business in India, and the cause of 10 million
“missing girls” over two
decades.2 Another article estimated the missing girl count for
China to exceed 40 million over
a decade, again blaming easy availability of ultrasounds for
much of that.3 As a market leader
in ultrasounds, GE was caught up in the controversy.
While both India and China had made gender determination
illegal, enforcement remained a
challenge. Critics argued that GE’s aggressive marketing
encouraged the practice. It was also
accused of insufficiently monitoring whether its machines sold
through third parties were
used legally. In response, GE had tightened its sales process in
2004, and had even suffered a
dip in sales as a result. Meanwhile, a significant fraction of
illegitimate practitioners
continued to manage access to ultrasound machines by other
means and GE remained a
regular target of NGO protests and court cases.
GE faced a dilemma, especially as it was trying to portray many
of its BOP-related efforts as
CSR initiatives. How aggressively should it market ultrasound
machines to the mass market
beyond large hospitals? Was it worth being conservative, even
at the risk of losing a large
chunk of legitimate sales? More broadly, how far should it get
involved in trying to fix the
core issue – a continuing preference for male children in some
cultures?
1 Jeffrey R. Immelt, Vijay Govindarajan and Chris Trimble,
“How GE is Disrupting Itself” Harvard Business
Review October 2009.
2 Kate Darnton, “Where are the baby girls?” International
Herald Tribune December 3, 2010.
3 “China grapples with legacy of its ‘missing girls’”, China
Daily, September 15, 2004. 14
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971 2 446 0303
Printed by INSEAD
15
16
Bibliography
"GE Healthcare (A): Innovating for Emerging Markets." Singh,
Jasjit. Case No. 5776.
Published 3/29/2011, Revised 07/01/2013. INSEAD, 2010. (12
pages).
"GE Healthcare (B): A CSR Dilemma." Singh, Jasjit. Case No.
5776. Published 3/29/2011,
INSEAD, 2010. (3 pages).
17
18
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Front CoverTitle PageTable Of ContentsGE Healthcare (A):
Innovating for Emerging MarketsGE Healthcare (B): A CSR
DilemmaBibliographyBack Cover

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  • 1. CPID 560897 No return if unwrapped HSA 599 Strayer University−Online Winter 2016 HSA 599: Winter 2016 Strayer University−Online THIS PRINT COURSEPACK AND ITS ELECTRONIC COUNTERPART (IF ANY) ARE INTENDED SOLELY FOR THE PERSONAL USE OF PURCHASER. ALL OTHER USE IS STRICTLY PROHIBITED. XanEdu™ publications may contain copyrighted materials of XanEdu, Inc. and/or its licensors. The original copyright holders retain sole ownership of their materials. Copyright permissions from third parties have been granted for materials for this publication only. Further reproduction and distribution of the materials contained herein is prohibited.
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  • 3. XanEdu Publishing, Inc. does not exert editorial control over materials that are included in this course pack. The user hereby releases XanEdu Publishing, Inc. from any and all liability for any claims or damages, which result from any use or exposure to the materials of this course pack. Items are available in both online and in print, unless marked with icons. − Print only − Online only HSA 599: Winter 2016 Table of Contents “GE Healthcare (A): Innovating for Emerging Markets” by Singh, Jasjit 1 “GE Healthcare (B): A CSR Dilemma” by Singh, Jasjit 13
  • 4. Bibliography 17 i ii GE Healthcare (A): Innovating for Emerging Markets 07/2013-5776 This case was written by Jasjit Singh, Associate Professor of Strategy at INSEAD. It is intended to be used as a basis for class discussion rather than to illustrate either effective or ineffective handling of an administrative situation. Copyright © 2011 INSEAD COPIES MAY NOT BE MADE WITHOUT PERMISSION. NO PART OF THIS PUBLICATION MAY BE COPIED, STORED, TRANSMITTED, REPRODUCED OR DISTRIBUTED IN ANY FORM OR MEDIUM WHATSOEVER WITHOUT THE PERMISSION OF THE COPYRIGHT OWNER. 1
  • 5. Copyright © 2011 INSEAD 1 07/2013-5776 “If GE doesn’t come up with innovations in poor countries and take them global, the new competitors from the developing world will... GE has tremendous respect for traditional rivals like Siemens, Philips, and Rolls-Royce. But it knows how to compete with them; they will never destroy GE. By introducing products that create a new price-performance paradigm, however, the emerging market giants very well could. Reverse innovation isn’t optional; it’s oxygen.” GE CEO Jeffrey Immelt and co-authors1 GE Healthcare As of 2010, GE Healthcare was a $17 billion division of the $180 billion giant General Electric, employing over 46,000 people worldwide. It was created in 2004 after GE Medical Systems was merged with British bioscience/medical imaging firm Amersham and several healthcare IT firms as a part of CEO Jeffrey Immelt’s increased emphasis on R&D.2 GE Healthcare had a strong track record in selling high-end medical imaging and diagnostic products globally. It operated in India as Wipro GE Healthcare, a 51:49 joint venture with Wipro. Partnering with a leading Indian company had helped GE address the regulatory constraints and institutional complexities of operating in India as a foreign multinational.3
  • 6. India as a Base for Global R&D GE had four major sites for its R&D efforts: the U.S. (Niskayuna), India (Bangalore), China (Shanghai) and Europe (Munich). Additional research centres in Brazil (Sao Paulo) and the U.S. (Detroit) were also being considered. In locating R&D overseas its chief considerations were availability of talent and being close to important markets. The John F. Welch Technology Centre (JFWTC) in Bangalore was GE’s largest R&D centre outside the U.S. Opened in 2000, the $175 million centre had grown to about 4,300 technologists (about 1,100 in Healthcare) by 2010.4 India was an attractive base not just for cost reasons but also for an ample supply of world-class talent and the presence of some well- known educational and research institutions in an otherwise relatively less developed country. JFWTC carried out R&D for GE businesses in areas as diverse as healthcare, energy, aviation and transportation. Its traditional focus had been addressing the needs of developed market customers. However, there was now an increasing emphasis also on products tailored for emerging markets like India, including those developed specifically for particularly low- income customers (the so-called “bottom of the pyramid” or BOP).5 1 Jeffrey R. Immelt, Vijay Govindarajan and Chris Trimble, “How GE is Disrupting Itself”, Harvard Business Review, October 2009.
  • 7. 2 Tarun Khanna and Elizabeth A. Raabe, “General Electric Healthcare, 2006”, Harvard Business School Publishing Case 9-806-478. 3 “GE Healthcare exploring distribution tie-ups”, Business Line (The Hindu), March 10, 2010. 4 Joe Leahy, “A nation develops”, Financial Times, January 11, 2010. 5 Dibeyendu Ganguly, “How GE's Bangalore engineers are taking on technology challenges”, The Economic Times, October 2, 2010. 2 Copyright © 2011 INSEAD 2 07/2013-5776 India as a Healthcare Market As of 2010, India’s healthcare industry was worth about $30 billion and was expected to double in size in the next five years. Estimates put the medical devices market segment somewhere in the $3 billion to $6 billion range, with growth of between 10% and 15% a year. Of the 700 domestic healthcare device makers in India, most only made low-value products such as needles and catheters. Of the few that did produce more sophisticated equipment, few could match international players in terms of quality or performance. Nevertheless, they typically had a significant cost advantage, which made them
  • 8. formidable competitors in mass markets where customers had limited purchasing power and were highly price sensitive. High-quality specialist products came mainly from MNCs like GE, Siemens and Philips, with GE being the #1 provider of diagnostic equipment like ECG, MRI, CT and ultrasounds. Given the price points, however, most of the $400-500 million annual revenue of GE Healthcare in India had come from sales to large hospitals.6 GE Healthcare had recently launched a global $6 billion “Healthymagination” campaign, with stated goals of reducing the cost, increasing access and improving the quality of healthcare around the world. This included significant investment in solutions for BOP patients.7 In addition to providing growth opportunities and building new capabilities for emerging markets, this was expected to be good for GE’s corporate social responsibility (CSR) image. GE Organization in India In 2005, GE had set a revenue goal for India of $5 billion across all businesses by 2010. But it had actually realized less than $3 billion by 2010. Within the Healthcare division, India still accounted for less than 2% of revenues. Recognizing that this fell far short of potential, Immelt set an ambitious 30% annual growth target for GE India over the next five years in order for the Indian business to cross the $10 billion mark by 2015.8
  • 9. A key barrier to GE’s growth in India had been its inability to fully tap into the mass market. Since sales from India comprised a tiny fraction of overall sales, the idiosyncratic needs of the Indian market did not get much attention in the highly centralized global organization. As a result, even R&D initiatives carried out in India had a tendency to gravitate towards meeting the needs of the relatively high-end segments that resembled GE’s developed market customers. A senior leader at GE Healthcare summarized the problem: “We were selling what we were making [rather than] making what the customers here needed.” 9 To overcome the above challenges, GE introduced a new “in country, for country” strategy for India. This involved two key changes in the organizational structure. First, on the geographic dimension of the organizational matrix, India was now to be treated as an 6 Rina Chandran, “In India, for India: medical device makers plug in”, Reuters, July 5, 2010. 7 “GE Healthcare recognized for its efforts to take healthcare to the masses in India”, GE Healthcare Press Release, September 13, 2010. 8 Josey Puliyenthuruthel “GE Learns New Tricks in India” Business Today October 31, 2010. 9 “Reverse Innovation: GE Makes India a Lab for Global Markets” [email protected] May 20, 2010. 3
  • 10. Copyright © 2011 INSEAD 3 07/2013-5776 independent region (on a par with the U.S. and China). As a former GE Healthcare employee put it, “In our global meetings, India overnight went from getting only two slides in the GE International presentation to getting a whole presentation on its own.” The second organizational change was that GE India was the first country to be made a profit and loss centre on its own. The Indian business heads were to now report primarily to the country CEO, with only a dotted-line link to the global business heads. Immelt said: “We will treat GE India just as we would any other GE business with its own growth strategy, leadership development and budgeting processes.” Managing the entire local value chain from India itself was expected to improve local adaptation and speed up decision-making. 10 The 39-year old T.P. Chopra – an Indian who had been the country CEO in the old organization – was replaced by John Flannery, a senior vice- president from GE’s global leadership team. With the new CEO being well-connected with GE’s global business heads, it was hoped that decentralization of decision-making would not compromise on global integration of strategy and knowledge exchange would still take place across boundaries. Rather than making development of “value-for-money” products
  • 11. targeting low-income markets also a responsibility for existing R&D teams, GE set up new product teams specifically for developing and commercializing such solutions. The local boost for R&D was complemented by enhanced efforts in local marketing, sourcing, manufacturing and service. Aggressive growth targets were set for adapting better to the Indian market, while also cutting costs drastically and achieving speedier decision-making through decentralization.11 A New ECG Device for India? GE’s Healthcare division was an early adopter of the new “in India, for India” approach, with several new initiatives in this spirit having been started even before the new organization was fully in place, as was illustrated by GE’s efforts to develop inexpensive electrocardiogram (ECG) products specifically with the Indian market in mind. Cardiovascular disease was the largest and still growing cause of deaths globally, accounting for over 17 million (or 30%) of all deaths.12 Non- communicable diseases had in the past been associated with the more affluent nations, but this was no longer the case. Over 80% of heart- related deaths now occurred in mid-to-low income countries, and over 2 million in India alone. Between 2005 and 2015, the Indian economy was projected to lose $237 billion due to the most common non-communicable diseases like heart disease, stroke and diabetes.13 The number of heart patients in India was already over 60
  • 12. million (30% below age 40). India was expected to soon be host to more than half of all worldwide heart patients, making ECG testing of tremendous value in early detection. But as mainstream ECG machines (such as the 10 Such a restructuring was not needed for China because the Chinese business was bigger and able to directly influence global decision-making in response to its needs. Another strategic market being considered for such a structure had been Brazil, but less developed local R&D capabilities there made it less ideal. 11 “GE plans major investment in ‘for India' facility” Business Line (The Hindu) September 17, 2010. 12 http://www.who.int/mediacentre/factsheets/fs317/en/ 13 “Cardiovascular diseases in India” Report by Deloitte and Assocham India, 2011. 4 Copyright © 2011 INSEAD 4 07/2013-5776 MAC 5500 machine shown in Exhibit 1, priced at over $10,000) were designed to meet the needs and budgets of large modern hospitals, they only skimmed the top of the Indian market. With per capita income just over $1,000 per annum, few Indians could afford expensive testing using high-end machines. However, affordability was not the only issue. People living in small towns and rural areas lacked easy access to hospitals.
  • 13. Simply producing stripped- down versions of GE’s existing products would therefore not suffice. There were unique challenges of the BOP to bear in mind, and the product and solutions would have to be suitable for the less sophisticated doctors that low-income patients typically relied upon. While price was generally important, these potential customers would also place a lot of importance on perceived quality and appropriateness of any product for their needs. The MAC 400 ECG Device GE management assigned the task of designing an ECG solution for India to the JFWTC. Using local R&D turned out to have three benefits. First, the team had a better knowledge of Indian customers. Second, it had greater awareness of off-the- shelf components available locally. Third, development costs were much lower than for an equivalent project in the U.S. An ECG device targeting the BOP – called the MAC 400 (see Exhibit 2) – was developed in just 22 months, with development costs of about $500,000. (A similar global product development effort could have taken twice as long and cost several million dollars.) The device was small enough to fit in a backpack. At 1.3kgs it was much lighter than conventional models, which often weighed over 7kgs. It had rechargeable batteries that could be charged in three hours and allowed over 100 ECGs, or a week of operation, between charges.
  • 14. The expensive printer typical of classic ECG machines was replaced by a small printing gadget adapted from a model used for portable ticket machines. The traditional 12-channel printer output in high-end ECGs was replaced by a three- channel output in the MAC 400. The full-scale keyboard was replaced by just four buttons, and the large graphical colour display by a small text-only display used for set-up. The machine had a simple one-touch operation, with embedded software interpreting the ECG data to print out a simple easy-to-read intuitive report. This eliminated the need for a specialist to tell whether a patient had a heart condition. Importantly, the relentless focus on eliminating non-core features found in high-end ECG machines (such as on-screen display, advanced analysis, full network connectivity and inter- operability, barcode and magnetic card scanning, data storage and export, security, etc.) did not mean that the development team compromised on the core functionality. Employing the industry-standard Marquette 12SL algorithm that all GE’s ECG machines used, the analysis performed by the MAC 400 was as reliable as that of a full- scale ECG device.14 The MAC 400 was priced around $1,000, a third of the price of medium-sized conventional devices and under a tenth of many full-size models.15 The effective cost of a single electro- 14 “A special report on innovation in emerging markets: First break all the rules”, Economist Intelligence Unit Executive Briefing April 19, 2010.
  • 15. 15 Jena McGregor “GE: Reinventing Tech for the Emerging World”, Bloomberg Businessweek, April 17, 2008. 5 Copyright © 2011 INSEAD 5 07/2013-5776 cardiogram turned out to be less than $1, which was considered low enough for widespread adoption. Although the margins in selling MAC 400 were smaller than those on high-end equipment, GE hoped that the sales volume would justify the product nevertheless. Some cost reductions naturally resulted from making a smaller size device with limited features, but savings also resulted from the creative use of standard parts available locally. Instead of using a customized processing chip, the R&D team came up with a clever solution relying upon a commercial chip that cost only a quarter of the price. Similarly, rather than developing a customized printer the team adapted one widely used in bus terminal kiosks. As the MAC 400 was being developed, the local R&D team had access to all of GE’s accumulated knowledge. For example, by borrowing a process originating elsewhere for building fast plastic-mould prototypes, the team was able to avoid costly changes later by
  • 16. getting early feedback from doctors. Similarly, it was able to take GE’s past experience in developing printers for dusty conditions and fine-tune the printer’s suitability for ECG. Describing the full potential of ultra-portable ECG devices like the MAC 400, a senior official at the JFWTC said, “It will become the stethoscope of cardiologists.”16 According to another official, “The dream would be to sell at least one device to each GP (general practitioner).”17 For cost-effective distribution, GE hoped to rely not just upon the network from its JV with Wipro but also to explore novel partnerships with pharmaceutical companies, surgical companies and large pharmacies. To educate potential customers it conducted courses on the technical aspects of using an ECG device as well as making the business case for investing in one. To help potential buyers overcome financing constraints, it tied up with State Bank of India, whose extensive rural network was used to arrange no- interest loans for buyers. At the time when the MAC 400 project was initiated, GE had limited market research and distribution channels in place for the new customers it was trying to reach. Therefore, rather than evaluating the project purely on a financial basis, the company viewed it also as an experiment into the BOP opportunity more broadly and as a way to build resources and capabilities for the future. Other product categories where GE Healthcare was similarly trying to tap into low-income markets included baby warmers, X-ray
  • 17. and ultrasound systems. As an experiment, the MAC 400 turned out to be a success not only in India but also in numerous countries worldwide where it was in fact often sold at higher price points. Even commercially, MAC 400 became a reasonable success by generating $20 million in revenues within the first two years. This was still a small fraction of the revenues for GE Healthcare as a whole, no surprise given that it was an early foray for GE into an unfamiliar market and that the entire ECG category anyway was a small part of the overall healthcare portfolio. The MAC i ECG Device While GE had hoped to use MAC 400 to reach the mass market, actual sales ended up being limited and to a large extent within the traditional customer segments. A better reach into the 16 “Frugal innovation”, Business Standard, June 13, 2009. 17 “GE Healthcare exploring distribution tie-ups”, Business Line (The Hindu), March 10, 2010. 6 Copyright © 2011 INSEAD 6 07/2013-5776 BOP needed further investment into appropriate sales, distribution and service networks. In addition, GE needed a truly mass-market product that was much
  • 18. cheaper than even MAC 400. Relying upon the MAC 400 experience and extensive market research, GE came up with a new ECG device, the MAC i (“i” for India), that weighed less than 1kg, used a single-channel printer output and eliminated even PC connectivity. Launched in November 2009, it was priced at just $500. Like MAC 400, it was also manufactured using off-the-shelf components. As differentiating elements for the new product, GE emphasized its technological reliability, user-friendliness, interpretation software and channel upgradability options.18 GE was not the only company targeting the BOP market. While other MNCs like Schiller, Philips and Siemens carried out similar efforts, the most successful had been an Indian player called BPL. Established in 1963, BPL had focused much of its time and energy developing the right products at low cost for the mass market, nurturing a strong local brand, and having a deep sales and distribution network. As one industry insider quoted, “For BPL, the mass market is bread and butter and jam. For GE, it is just an option.” However, GE hoped that BOP market being largely untapped and MAC i being an excellent GE-branded product at an affordable price (even if more expensive than BPL) would help it do well in the coming years. BPL’s brand perception turned out to be as high as GE’s, and its single channel ECG matched MAC i in quality of print and user friendliness. In addition, many buyers assumed GE ECGs
  • 19. would be too expensive to even consider. The purchasing experience was also often smoother when buying from BPL. For instance, when a doctor wished to purchase from GE, he couldn’t make payment in cash and often had to wait a week for delivery. In contrast, BPL accepted cash orders, was more flexible in giving discounts and could make deliveries within a day. As of 2011, the ECG equipment market in India stood at 39,914 in overall volume and $27.7 million in total value (see Exhibit 3). Single-channel ECGs contributed to about 72% of the volume and 40% to the overall value in the industry.19 GE’s sales for MAC i had only grown from 500 units in 2010 to 2,000 units in 2012 at the same time that BPL’s single-channel ECG sales had grown from 17,000 units to 22,000 units. Overall, BPL remained the ECG market leader in India with 58% of the market share, and the next five players - Schiller, Maestros (an Indian company), Philips, GE and Siemens - trailed significantly behind. The MAC 800 ECG Device While the MAC 400 was being developed in India, GE's R&D personnel in China built upon the idea to develop another portable ECG – the MAC 800 (see Exhibit 4). The new product targeted not only remote locations but also the typical clinics and hospitals in China. Weighing 3kg, the MAC 800 was larger than the MAC 400, though still much smaller than GE’s high-end ECG machines. Recognizing China’s familiarity
  • 20. with SMS-texting, it incorporated a telephone-style keypad to allow users to input data. It included a full-size colour display (with multiple language options) based on an intuitive Windows-based platform, offering a preview of ECG results. It also allowed ECG data to be stored and sent. 18 Rina Chandran, “In India, for India: medical device makers plug in”, Reuters, July 5, 2010. 19 “ECG Equipment: Diagnosis for a Smarter Planet”, Medical Buyer, Dec 15, 2012 7 Copyright © 2011 INSEAD 7 07/2013-5776 The product design, the pricing strategy and the channels GE Healthcare relied upon to distribute MAC 800 exploited the fact that higher local income levels as well as greater involvement of the government in healthcare standard-setting and purchasing decisions led to lower price sensitivity in China than in India and opened up a different kind of opportunity. Costing around $2,500, the MAC 800 was over twice as expensive as the MAC 400, but still less than one third of GE’s high-end ECGs.20 Early indications were that it was selling well, exceeding 20,000 installations in more than 50 countries as of 2010.21
  • 21. “Reverse Innovation” In an interesting development, GE started selling the MAC 800 even in developed markets. While it held a 34% share of the U.S. mainstream ECG market, GE saw an opportunity to use the MAC 800 to expand the ultrasound market to include primary care doctors, rural clinics, emergency rooms and accident sites.22 Market studies revealed that U.S. physicians found the device user-friendly, and considered its SMS texting-style keypad acceptable.23 The U.S. market was found to have greater connectivity requirements than those offered by the Chinese prototype, but GE was able to address that through adaptations like USB and Ethernet ports. For a company that primarily sold products developed for developed economies in emerging markets, this exemplified a reversal in the direction in which innovation flowed. The phenomenon was labelled “reverse innovation” by Immelt, who considered such an approach critical to the very survival of Western multinational fighting the threat of emerging market companies going global with their own disruptive business models. 24 The Right Global Strategy? Although GE earned favourable press coverage and several awards for its innovative BOP products, it was too early to declare its BOP initiatives a big commercial success because the revenues generated were still small by GE standards, margins were thinner than GE was used
  • 22. to, and the competition was starting to heat up. Sceptics wondered whether GE really had a sound long-term strategy, especially as the competitive advantage in serving BOP markets was unclear. Past successes had come from delivering standardized products globally, relying upon scale to drive down costs and tight organization to ensure control. For the company to move towards an “in country, for country” approach for specific countries seemed far from the obvious direction to take. 20 John Schmid, “GE Healthcare advances global reach with new heart monitor”, Journal Sentinel, March 14, 2009. 21 Kala Vijayraghavan, “Products built on Indian innovations flowing into world markets”, The Economic Times, December 2, 2010. 22 Reena Jana, “Innovation Trickles in a New Direction”, Bloomberg Businessweek, March 11, 2009. 23 GE Press release, “GE’s First Portable ECG, “Medical Texting” Arrives in US”, March 13, 2009. 24 Jeffrey R. Immelt, Vijay Govindarajan and Chris Trimble, “How GE is Disrupting Itself” Harvard Business Review October 2009. 8 Copyright © 2011 INSEAD 8 07/2013-5776
  • 23. Exhibit 1 GE MAC 5500 ECG System (Designed for Large Modern Hospitals) Source: http://www.gehealthcare.com 9 Copyright © 2011 INSEAD 9 07/2013-5776 Exhibit 2 GE MAC 400 ECG Device (Designed for Rural India) Source: http://www.gehealthcare.com 10 Copyright © 2011 INSEAD 10 07/2013-5776 Exhibit 3 The ECG Equipment Market in India Source: “ECG Equipment: Diagnosis for a Smarter Planet” Medical Buyer, 12 Mar 2012. Note: Overall market size of Rs 133.02 Crore translates into $27.7m (1 Crore = 10 million; $1 = about Rs. 48)
  • 24. 11 Copyright © 2011 INSEAD 11 07/2013-5776 Exhibit 4 GE MAC 800 ECG Device (Designed for China Market) Source: http://www.gehealthcare.com 12 GE Healthcare (B): A CSR Dilemma 03/2011-5776 This case was written by Jasjit Singh, Assistant Professor of Strategy at INSEAD. It is intended to be used as a basis for class discussion rather than to illustrate either effective or ineffective handling of an administrative situation. Copyright © 2011 INSEAD TO ORDER COPIES OF INSEAD CASES, SEE DETAILS ON THE BACK COVER. COPIES MAY NOT BE MADE
  • 25. WITHOUT PERMISSION. NO PART OF THIS PUBLICATION MAY BE COPIED, STORED, TRANSMITTED, REPRODUCED OR DISTRIBUTED IN ANY FORM OR MEDIUM WHATSOEVER WITHOUT THE PERMISSION OF THE COPYRIGHT OWNER. 13 The Venue 40 Ultrasound In the 1990s, GE had attempted to develop an inexpensive ultrasound machine focused on offering the basic ultrasound functionality using PC-based software. These efforts were subsequently shelved because the machine’s performance was not considered adequate for GE’s mainstream markets. However, a decade later, the idea was revived by GE’s China R&D team as worth exploring for the local market, given the trade-offs that low-income consumers there were willing to make and the technologically more advanced laptop-based platforms that could now be potentially used. The R&D team in China came up with a compact ultrasound – the Venue 40 – that relied on touch-screen technology and eliminated the buttons, knobs and keyboards of conventional machines. Further, the device’s smooth surface facilitated the cleanliness required in sterile environments, and its intuitive interface appealed to physicians new to ultrasound.
  • 26. While GE’s conventional machines could cost over $100,000, the cheapest Venue 40 sold for under $20,000. Soon after the product’s China launch in 2009, GE started selling different variants in other emerging markets and in untapped segments back in developed markets.1 A Corporate Social Responsibility (CSR) Dilemma GE would, however, need to carefully manage the marketing, sales and distribution of the new device in markets where ultrasound technology was seen to have exacerbated the problem of the disproportionate number of abortions of female foetuses, leading to major concerns about gender imbalance. For example, one news report estimated gender selection to be a $100 million business in India, and the cause of 10 million “missing girls” over two decades.2 Another article estimated the missing girl count for China to exceed 40 million over a decade, again blaming easy availability of ultrasounds for much of that.3 As a market leader in ultrasounds, GE was caught up in the controversy. While both India and China had made gender determination illegal, enforcement remained a challenge. Critics argued that GE’s aggressive marketing encouraged the practice. It was also accused of insufficiently monitoring whether its machines sold through third parties were used legally. In response, GE had tightened its sales process in 2004, and had even suffered a dip in sales as a result. Meanwhile, a significant fraction of illegitimate practitioners continued to manage access to ultrasound machines by other
  • 27. means and GE remained a regular target of NGO protests and court cases. GE faced a dilemma, especially as it was trying to portray many of its BOP-related efforts as CSR initiatives. How aggressively should it market ultrasound machines to the mass market beyond large hospitals? Was it worth being conservative, even at the risk of losing a large chunk of legitimate sales? More broadly, how far should it get involved in trying to fix the core issue – a continuing preference for male children in some cultures? 1 Jeffrey R. Immelt, Vijay Govindarajan and Chris Trimble, “How GE is Disrupting Itself” Harvard Business Review October 2009. 2 Kate Darnton, “Where are the baby girls?” International Herald Tribune December 3, 2010. 3 “China grapples with legacy of its ‘missing girls’”, China Daily, September 15, 2004. 14 To order INSEAD case studies please contact one of the three distributors below: ecch, UK and USA Centrale de Cas et de Médias Pédagogiques ecch UK Registered Office: ecch USA Registered Office: www.ecch.com www.ecch.com www.ccmp-publishing.com
  • 28. Tel: +44 (0)1234 750903 Tel: +1 781 239 5884 Tel: 33 (0) 1.49.23.57.25 Fax: +44 (0)1234 751125 Fax: +1 781 239 5885 Fax: 33 (0) 1.49.23.57.41 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] Europe Campus www.insead.edu Boulevard de Constance 77305 Fontainebleau Cedex, France Tel: 33 (0)1 60 72 40 00 Fax: 33 (0)1 60 74 55 00/01 Asia Campus Middle East Campus 1 Ayer Rajah Avenue Muroor Road – Street n°4 P.O. Box 48049 Singapore 138676 Abu Dhabi UAE Tel: 65 6799 5388 Fax: 65 6799 5399 Tel: 971 2 446 0808 Fax: 971 2 446 0303 Printed by INSEAD 15 16 Bibliography "GE Healthcare (A): Innovating for Emerging Markets." Singh, Jasjit. Case No. 5776. Published 3/29/2011, Revised 07/01/2013. INSEAD, 2010. (12
  • 29. pages). "GE Healthcare (B): A CSR Dilemma." Singh, Jasjit. Case No. 5776. Published 3/29/2011, INSEAD, 2010. (3 pages). 17 18 These course materials were produced by XanEdu and are intended for your individual use. If you have any questions regarding these materials, please contact: Customer Service [email protected] 800-218-5971 XanEdu is changing the course of how knowledge is shared and how students engage with content. Learn more about our award-winning digital solutions for web, iPad, and Android tablets at: www.xanedu.com XanEdu 4750 Venture Drive, Suite 400
  • 30. Ann Arbor, MI 48108 Front CoverTitle PageTable Of ContentsGE Healthcare (A): Innovating for Emerging MarketsGE Healthcare (B): A CSR DilemmaBibliographyBack Cover