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THE SWIFTshareCOMPANY

We are true to our name

9/21/2010


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The SWIFTshare Company

It is a company that came into being as a franchisee of Heartland in Jan2011 and whichbecame independent by Oct2011. It started with a mission to remain true to its name. We will

be swift and share the data as fast as possible in interaction maintaining quality with our clients.

We wanted to name ourselves something that defined us and the philosophy we aspire to follow.

Thats how we came to be known as SWIFTshare .

A group of six individuals, who started a year back with a promise and resolution that we

are going to make it global and make it big. Meet us Praveen, Shaswata, Shiva, Terine, Venu and

Srinivas who had made a promise to each other and ourselves that we will make a difference. Atthe beginning of the very second year of us in business we are taking our first small baby step

into the world of globalization.

We six individuals, share a lot of things apart from the fact that we all are under-30 and

representing the young and energetic India, the first being our alma mater Amrita School of

Business, our belief in quality over quantity, passion for success, integrity and a diehard

attitude. We have known each other for the last six years and have a bonding which extends

beyond the professional life and each of us has had a lasting impression over each other. Thus weshare a long relationship which has helped us in making the overall environment so conducive to

work.

For the last 1 year, we have had some wonderful learning experience and the journey till

now has been exciting. We started with a lot of in depth research about the field but it was

largely based on secondary research and second hand information. A genuine unending interest

in the field and strive to succeed in it has led us to explore this field.

So what does SWIFTshare deal with? We are into medical transcription sector. It is a

sector which has been growing rapidly in the last few years. It is one of the fastest growing

sectors in the world of outsourcing. Before looking into the medical transcription sector, lets

look into what are the sources we have and why we decided to enter into international business.

SWIFTshare started with an employee size of 40 and over the last 1 year have increased

the number of employees to 70. People around us have told that we have maintained a snails


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pace in recruiting people. But we believe in quality over quantity. Thus we recruit only those

people who complete this organization and believe in it and make it as a part of their own

life. We dont need employees who we hire and fire but bits and pieces that complete the overall

SWIFTshare . These has resulted into productivity per employee almost twice that of any other

company in the industry. We believe in the fact that if there is zeal to work nothing else matters.

These can only come when employees are given some attainable yet challenging targets. As we

moved into the second year we had a meeting among all the peers (all employees are called

peers). Most of them raised their voice that we should move into the international market.

Interestingly we had pre decided (the time when we began) that we would look to the west by the

end of the third year of business. However since few experienced people joined us and gave ussome great insight about the functioning of the industry we leapfrogged many and have started

competing with the other competitors who have been in this field for 3-4 years.

The main criterion to move into the international business in the medical transcription

business according to data monitor is a minimum of 18 months of experience in this field

before any client seriously looks into you as a prospective outsourcing location. A company

which was started on the total cash (Rs.50 lakhs) we six had and a 50 lakhs initial investment

with Mr. Satish Agrawal, who was impressed by our business plan, it has been a wonderfuljourney. With annual turnover as of now is 2.5 crores, we are looking into a brighter side. With

an overwhelming agreement on this issue that we should move into outsourcing and maximize

our profits as the lions share of the business was outside India and not in India. But we had

started in India to gain experience before moving into the more profitable and more risky

international venture. The next step was obviously to pick the countries which we would like to

enter. For these we allotted a team of 5 the work to shortlist five prospective countries to enter

and then discuss among themselves the best two and keep the rest three as future viable option.

But before looking into the prospective countries let us have a look into what is Medical

transcription industry all about.


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A brief introduction of Medical Transcription

Medical transcription is a service oriented industry which deals with recording andconverting the voice recorded reports into text formats for maintain the records of various

patients. These voice records are those which are recorded by doctors/physicians giving details

of the patients case details. The voice records are converted to text formats. This conversion

process is done by medical transcriptionist. The equipment used by them is known as

Transcriber. The conversions into text are kept in the Personal Medical Records and medication

is provided according to this text.

One of the biggest advantages in this field which attracted us to this sector was therelatively low educational qualifications required. Only a basic knowledge in English and

knowhow of the various medical terminologies is required. Thus it does not require highly

specialized workers. This also means India with such a high amount of cheap labor, there are

huge prospects for these industry to bloom. The wages of Indian labor for this sector are as

low as 1/8 th of what paid in USA. The past records of this sector shows that India is the most

prospective center for Medical Transcription outsourcing centers. India has the largest market

share in the USA outsourcing market. Many competitors of ours dont provide any initial

training about these terminologies. We provide a professional who gives these MTs a 2 week

crash course and keep on updating them throughout the year with the latest medical

terminologies. This provides us core competency w.r.t. the various competitors.


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Evolution of this sector in I

Source: http://www.zinnov.co

1990-2000

O W St

2001-2006

Co T

a T

cli

2006-2010

Tein

In F

dia

m/presentation/Healthcare_Outsourcing_Ov

tsourcing started in late 1990s in Indiaas one of the first sector to be outsourcearted as a niche segment due to complex

mpliance with HIPAA allowed more freetsourcing in this sectore transcription companies started integrd coding function alongwith ite IT companies started providing softwanics and hospitals

le radiology and medical animation proctroduceddian Professionalscusing on bio medical market too

rview.pdf

dity

flow of

ting billing

es to small

ss to be


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Top Trends in Medical Transcription Industry

The various top trends that we have seen in this sector are follows:

With HIPPA coming in play since 1996, which requires compliance of certain norms and

regulations quality can be ensured. This has led to decrease in negative perceptions about

outsourcing and off shoring.

Speech Recognition/Voice Recognition software are day by day improving and gaining

acceptance as a means of recording and transferring data.

The use of Visual Black Character (VBC) pricing, which is endorsed by AHIMA andMTIA, is emerging as the industry standard.

Faster response time is becoming a major core competency factor in recent years.

Off shoring to Philippines (due to lower labor cost) and India (higher quality and better English

skills) have been on a high and account for 10% of the US market

Countries like UK, Germany and France have also in recent years also started off shoring.

Why IB?

The answer is as simple as it gets. The importance of going into IB for this sector is as

important as water for fish. No company can survive in this sector on the market base in India.

As in India, medical transcription has hardly any relevance. All the major companies are

surviving on outsourced market. So it becomes quite obvious that why is it required for us to get

into IB. In short we can say that since the market for medical transcription is outsourced IB is

unavoidable.


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Services Related to this sector

Most of the Indian companies are doing one or more of the following allied services.

The below given service sector are the one that SWIFTshare is looking to get into apart

from medical transcription in the coming years as a part of their international path planned. They

are as follows:

Medical Billing and coding

Document Management

Scanning and Indexing

Appointment Scheduler

Lab Order Integration

Patient Reminder Services

The major countries that we can look in the coming future are as follows:

USA

UK

Switzerland

Germany

France


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SWOT Analysis

STRENGTHS WEAKNESS

Lower Labor Cost.(1/8 th that of USA)

English speaking labor

India is one of the most preferred outsourcing

centers in healthcare sector.

12 hour time zone difference

Off shoring to India will continue to rise

A new entrant might find it tough as market is

competitive

Differentiating factors like highly qualified

professionals, infrastructures are negated.

OPPORTUNITIES THREATS

Declining outsourcing centers in Europe due to

sluggish economy. Thus major companies are

looking towards Asia for outsourcing.

One of the only sectors which has not been

affected by recession.

Still a huge untapped market left to explore.

Other countries like China, Philippines, Sri Lanka,

and Australia etc are major threats.

Recently US Govt. has looked for checking

unemployment by stopping such back end jobs

being outsourced. However these are just

indications.

120-150 Indian companies in this sector

Apart from this many individuals/households too

are working at much lower cost


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AAA Frame work:

In this as we are a staSince the services that we pr

adapt our technology so that

that suits to their local prefere

In order get the adv

activity we will go for Arbitr

the other works to small firms

Global Market for Medical

The global market siz

has a CAGR value of 15%.

can be shown below

Source: Slideshare.com

0

10

20

30

40

50

60

2010 2011 201

Global Mar

rtup company so we are looking for the Advide is according to the requirements of th

e can deliver the services in correct time in

nces.

ntage of our core employees who are sp

ge where we will do the projects where we h

on cost basis advantage.

ranscription Industry

e of Medical Transcription Industry is USD

projected growth rate of the global Medic

2013 2014 2015

et for Medical Transcription(in USD billion)

Global MaTranscriptibillion)

ptation and Arbitrage.e clients so we should

specified requirements

cialized in particular

ave strengths and give

25 billion in 2010. It

l transcription market

ize

rket for Medicalon size (in USD


10/47

Number of Employees in the medical transcription sector in India

The current employee strength of India-based medical transcription vendors isapproximately 52000 by 2010. Large players, primarily US MTSOs with India presence

dominate the vendor space, accounting for almost 70% of the revenues and 65% of the

manpower in the industry.

Why US?

After thorough research it was found out that US is the best market for SWIFTshare due to the

following factors:

Only 50% as of the industry as of now gets outsourced. In this pie 10% is the share that

India has. However as things are going India will have a sharp rise in its share. The USA's

medical industry comprises of more than 750,000 physicians and 5,200 hospitals. USA witnesses

approximately 3.8 million in patient visits and 20 million outpatients visit on a daily basis.

Furthermore, the United States of America has the largest workforce i.e. one in every 11 US

residents employed in the health care business. Also the healthcare expenditure in USA is the

highest.

Introduction of EPR and EHR will keep the USA market afloat and much more vibrant

than other market.

USA Outsourcing of Medical Transcription

As of 2010, it was valued at USD 5.65 and it was growing at a CAGR value of 16.1%


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Indias expected share in the

As of 2010, India will have

presents itself a huge prospect

Source: NASSCOM

0

2

4

6

8

10

12

2010 2011 201

5.65162 6.5557.6

USA Med

647, 81

Market S

S medical transcription in 2010.

81% market share of the overall US off s

for India It service players in this field

2013 2014 2015

38.8196

10.2311.8669

cal Transcription Outsourcin

Market

USA MediOutsourci

153, 19%

are of US offshoring industr

oring market. Thus it

al Transcriptiong Market

India

Others


12/47

India remained a preferred offshore destination primarily due to availability of manpower and

industry maturity.

Competitor Analysis

The competitors can be analyzed into three segments

Indian units of large US players - Typically comprise American companies or Medical

Transcription Service Organizations (MTSOs) who have successfully set up their transcription

centers in India. The large players include CBay, Spheris, Spryance, Acusis and Heartland.

These large players account for almost 70 percent of Indian medical transcription off shoring

revenues.

Mid-sized players - There are a number of medium sized players (< 500 employees) in India.

Most of them work as franchisees or vendors of the larger players and have limited marketing

presence in the US.

Smaller players - There are a large number of such small players with


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From the graphs the growth rates for the years 2001-03 for the both years are low due to the

slowdown in the economy due to the terrorist attack on the WTC and the fall of the information

technology.

Trends in the Growth Rate of Exports and Imports:

The growth rate trends in the imports and the exports are shown in the graph.

Imports Growth Rate for Chosen countries

Exports Growth Rate for Chosen countries

From the Graphs we can find that during the years 2001-03 and 2007-08 the growth rates in the

exports and imports had decreased. The main reason is due to the slowdown in the economy

8.95

4.78 4.90

2.16

6.85 7.05

9.63

-1.51-0.55

-6

-4

-2

0

2

4

6

8

1012

14

2000 2001 2002 2003 2004 2005 2006 2007 2008

Growth Rate in Imports for US

Growth rate in Imports for UK

-10

-5

0

5

10

15

2000 2001 2002 2003 2004 2005 2006 2007 2008

Growth Rate in Exports for USGrowth Rate in Exports for UK


16/47

which affected the developed nations more. The decrease in the consumption in these countries

will have impact on other countries which reduces their trade with the developed nations, which

affects their BOP.

Trends in the Percapita GDP in current Prices in $

The trends show that the percapita GDP is increasing for both the countries. This will increase

the consumer spending, thus results in more trade for this countries.

Trends in the Exchange Rates

From the graph we can see that the Rupee has depreciated against the Euro but during the current

fiscal year the Rupee appreciated against the Euro due to the crisis in the Euro zone and the

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

2000 2001 2002 2003 2004 2005 2006 2007 2008

PercapitaGDP at Current prices forUS in$

PercapitaGDP at Current prices forUK

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006 2007 2008

Euro Vs RupeeDollar Vs Rupee


17/47

Greece Debt crises. The depreciation of the rupee is good for our country as we are in the

exporting industry. The appreciation of the rupee in the recent months will affect our financial

position unless we hedge our exchange rate risk. We are going for futures for hedging our risk in

the exchange rates with the company Thomas Cook. The trend of the dollar is almost like a linear

trend, but we are considering the option of hedging the exports we made to US from the

exchange rate risks.

Trends in the Inflation Rates:

The change in the Inflation rates will affect the Exchange rates and the Interest rates in the

country. The countries having high inflation rate will try to reduce it by using the MonetaryPolicy, which uses the Interest rates as a Tool, which indirectly affects the decrease in the money

supply and the changes in the exchange rates. So the countries having the Inflation rate less and

stable will be better for choosing the country for doing business.

The graph below shows that the Inflation has decreased in the both the countries, this is

due to the recession where the consumer spending has decreased, so the Interest rates are

decreased in both the countries. This will increase the outflow of their currency, which causes

the appreciation of the India currency. But the Inflation in the US has increased to 6% in 2010,interest rates are increased. The outflow of $ decreased, so the Rupee depreciated with respect to

dollar. This will benefit the exporters.

3.4

2.6 2.7

4.4

1.1

2.8

3.2

4.2

3.6

2.3

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

2005 2006 2007 2008 2009

Inflation Rate in US

Inflation Rate in UK


18/47

UK- Degree of Regionalization of trade:

The degree of regionalization of trade is very high for UK as we can see lot of RTAs has beensigned and some are under negotiations. The RTAs confirmed are EU-Chile, EU-Mexico, EU-

European Free Trade Area, and EU-South Africa.

The ongoing negotiations for RTAs are

EU and the Gulf Cooperation Council (GCC), comprising of Bahrain, Kuwait, Oman, Qatar,

Saudi Arabia, and the United Arab Emirates (UAE),

EU and Mercosur (Argentina, Brazil, Paraguay and Uruguay, and Venezuela which joined thegroup on 4 July 2006),

EU and its Mediterranean Partners (Morocco, Algeria, Tunisia, Egypt, Israel, Jordan, the

Palestinian Authority, Lebanon, Syria, Turkey)

EU and the Association of South East Nations (ASEAN), comprising of Philippines, Indonesia,

Malaysia, Singapore, Thailand, Brunei, Vietnam, Laos, Burma, and Cambodia,

EU and Korea, and the EU and India.

US- Degree of regionalization is high in US, because we can see lot of agreements internally and

externally of USA. USA has a separate office to maintain trade relations with Western

Hemisphere of world. Some of the following are the RTAs signed by USA

Israel- FTA signed in 1985

Jordan- FTA signed in 2001

Morocco- FTA signed in 2006

North American Free trade Agreement signed in 1994.

Chile-FTA signed in 2004

Colombia FTA signed in 2006

Dominican Republic Central America FTA signed in 2004


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Economic Facts

Macroeconomic Factors:

ECONOMIC

INDICATOR

UNIT

AME

YEAR 2008

Values in dollars

GDP in Trillion $(PPP) 14.52

GDP Growth rate 0%

GDP percapita Income 47700Unemployment Rate 5.80

Inflation Rate 3.80

Central Bank Interest

Rates

0.86

Commercial Bank

lending rates

5.09

The graph for the GDP in pur

From the graph it is fo

due to the recession in the 20

0

2

4

6

8

10

12

14

16

2008

ED STATES OF

ICA

UNITED KINGDOM

2009 2008 2009

14.14 2.238 2.128

-2.60% -0.10% -4.90%

46000 36700 348009.30% 5.60% 7.60%

-0.30% 3.60% 2.20%

0.50% 0.86% 0.50%

4.63%

hasing power parity is as shown:

und that the GDP in PPP had fallen for Both

8-09. This has increased the unemployment

2009

INDIA

2008 2009

3.324 3.57

7.20% 7.40%

2900 310010.40% 10.70%

8.30% 10.90%

6% 4.75%

13.31%

the US & UK. This is

rate which led to take

GDP in PPP for US

GDP in PPP for UK

GDP in PPP for India


20/47

protective steps by those countries for increasing the Employment in their countries. US have

increased the Fees for the H1B1 visa people and they are providing Tax benefits that will reduce

the outsourcing and produce jobs for their country. This will impact the Developing countries

which has huge outsourcing projects from US.

The decrease in the percapita income will reduce the purchasing power of the consumers;

this in turn will affect the economy which is in recession. In order to increase the domestic

consumption the central banks of the US, UK and all over the world as reduced the interest rates.

Balance of Payments

ECONOMIC INDICATOR UNITED STATES OF

AMERICA

UNITED

KINGDOM

INDIA

YEAR 2008 2009 2008 2009 2008 2009

Amount in Billion $

Trade Account -840 -517 -50.4374 -128.7 -120 -58

Current Account -706.1 -419.9 -32.5884 -32.68 -12.03 -28.7

Capital Account 271.708 496.865 27.8109 11.5648 10.5 8.7

Reserves 77.65 130.8 52.98 66.72 254 275

From the Table we can find that all the three countries are having a trade deficit. The

countries are having good Financial/Capital account. They attract huge amount of the FDI into

the countries. The trade deficit will affect the Exchange rates. Since the dollars, euro goes out

more there is chance of these currencies get depreciated in the long run, which in turn appreciate

the exporting country currency and reduces the exports of India, thus bring into equilibrium.

Exchange Rates

The currencies of the countries where we are exporting our services are Dollar and Euro.

The UK clients can also make payments in Great Britain Pound. But most of the payments are

made either in Dollars or Euros. The exchange rate of our country is a Dirty float where the

exchange rates are determined by the market supply and demand, RBI intervention.


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The fluctuations in Exchange Rates will affect the profits of our company as we are doing

the outsourcing business to the clients in the US & UK. The payments will be made in Dollars or

in Euros. Since we have risk of rupee appreciating we will go for hedging where we buy the

futures to amount that we are expected to get from our clients. The different types of futures

available are EURINR, GBPINR (Great Britain Pound), USDINR. This will reduce the risk to

some extent. We also go for contracts with the customers so that the risk of the rupee

appreciating or depreciating will not effect for budgeted income projections. We have financial

analysts who will give projections that will benefit the company.

Year 1Euro=Rs 1US$=Rs

2000 41.40554 44.94161

2001 42.2246 47.18641

2002 45.74866 48.61032

2003 52.57504 46.58328

2004 56.26823 45.31647

2005 54.84253 44.09998

2006 56.83689 45.30701

2007 56.59241 41.34853

2008 63.72755 43.50519

2010 59.8325 45.705


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The exchange rate movement for Dollar and Euro are shown in the above Graph.

From the table we can see that the Euro has depreciated in the last two years, the reason

is due to the uncertainty in the European economy and due to the debit crisis in Greece.

Foreign Trade

Foreign Trade UNITED STATES OFAMERICA

UNITEDKINGDOM

INDIA

YEAR 2008 2009 2008 2009 2008 2009

Amount in Billions $

Exports(Goods and Services) 1277 1046 467.3 357.3 203.1 164.3

Imports(Goods and Services) 2117 1563 641.3 486 323.9 268.9

From the Table we can see that the three countries are having a trade deficit, where theyare importing more than the exports they made. This will lead to more requirement of foreign

currency to buy those products which will depreciate the rupee. The decrease in the trade for all

the three countries is due to the recession which reduced the consumption or purchasing of the

customers. The decrease in the consumption will further deepen the economy and leads to great

depression. In order to prevent that the central banks all over the world has decreased the interest

rates, that will make the people to spend more than to save.

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006 2007 2008

Euro Vs Rupee

Dollar Vs Rupee


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Major Exports (Goods and Services)

US UK India

Agri products Manufactured

Goods

Petroleum Products

capital Goods Fuels Precious Stones

consumer goods food and

Beverages

Machinery

industrial supplies Chemicals Iron Ore and Steel

telecommunication equipment Tobacco Chemicals & Pharmacy

Textile &apparelSoftware products

The major imports for the countries are shown below:

Major Imports (Goods and Services)

US UK India

Agri products Manufactured Goods Crude oilcapital Goods Fuels Precious Stones

consumer goods food and Beverages Machinery

industrial supplies Machinery Fertilizers

Chemicals

Iron & steel

The major trading partners for these countries are as shown in the graphs:


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UK EXPORTS MAJOR TRADING PARTNERS

UK IMPORTS MAJOR TRADING PARTNERS

14.24%

11.12%

19.30%

6.14%4.53%

44.67%

Canada

Mexico

China

Japan

Germany

others

14.24%

11.12%

19.30%

6.14%

4.53%

44.67%

Canada

Mexico

China

Japan

Germany

others


25/47

US EXPORTS MAJOR TRADING PARTNERS

US IMPORTS MAJOR TRADING PARTNERS

From the both the country details about their major trade partners China plays an

important role in these two countries imports. The major trade partners the UK are from the

European Union. The Trade for the US is majorly from their Trade partners from the NAFTA

trade agreement. The RTA has been playing an important role in the trade for these two

countries.

The different trade agreements for the US are NAFTA, APEC (Asia-Pacific Economic

Cooperation Forum), Transatlantic Economic Partnership (TEP) with the European Union.

14.24%

11.12%

19.30%

6.14%4.53%

44.67%

Canada

Mexico

China

Japan

Germany

others

14.24%

11.12%

19.30%

6.14%4.53%

44.67%

Canada

MexicoChina

Japan

Germany

others


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UK- Degree of Regionalization of trade:

The degree of regionalization of trade is very high for UK as we can see lot of RTAs has beensigned and some are under negotiations. The RTAs confirmed are EU-Chile, EU-Mexico, EU-

European Free Trade Area, and EU-South Africa.

The ongoing negotiations for RTAs are

EU and the Gulf Cooperation Council (GCC), comprising of Bahrain, Kuwait, Oman, Qatar,

Saudi Arabia, and the United Arab Emirates (UAE),

EU and Mercosur (Argentina, Brazil, Paraguay and Uruguay, and Venezuela which joined thegroup on 4 July 2006),

EU and its Mediterranean Partners (Morocco, Algeria, Tunisia, Egypt, Israel, Jordan, the

Palestinian Authority, Lebanon, Syria, Turkey)

EU and the Association of South East Nations (ASEAN), comprising of Philippines, Indonesia,

Malaysia, Singapore, Thailand, Brunei, Vietnam, Laos, Burma, and Cambodia,

EU and Korea, and the EU and India.

US- Degree of regionalization is high in US, because we can see lot of agreements internally and

externally of USA. USA has a separate office to maintain trade relations with Western

Hemisphere of world. Some of the following are the RTAs signed by USA

Israel- FTA signed in 1985

Jordan- FTA signed in 2001

Morocco- FTA signed in 2006

North American Free trade Agreement signed in 1994.

Chile-FTA signed in 2004

Colombia FTA signed in 2006

Dominican Republic Central America FTA signed in 2004


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Degree of globalization

Globalization involves the diffusion of ideas, practices and technologies. It issomething more than internationalization and universalization. It isn't simply modernization or

westernization. It is certainly isn't just the liberalization of markets. It is about the change and the

way we understand geography and experience localness.

Globalization, thus, has powerful economic, political, cultural and social dimensions.

Economic Globalization

Political Globalization

Social Globalization.

For US:

American companies have migrated most of their manufacturing jobs to foreign countries

where it is cheaper to do business. The service and technical jobs are currently undergoing a

large exodus to foreign labour too. This is the outsourcing and off shoring which is a major

driver in US nowadays. The economic interconnection has increased which made someperipheral political changes and countries have become even more dependent on the big central

economies such as the USA where the capital and technical expertise tend to be located. The

shift in power from the nation state and multinational corporations is happening. The

globalization is also on an increasing note. It is because some large corporations and

organizations operate across many different countries and they have also developed and

marketed products that could be sold as well in US. Superior brands like Adidas, Nike, Sony, etc.

have become part of the fabric of vast numbers of people's lives.

The degree of globalization can be measured by three factors:

Economic Globalization

Trade Agreements can create opportunities for Americans and help to grow the U.S.

economy. The USTR has principal responsibility for administering U.S. trade agreements. The

United States is Member of the World Trade Organization and the Marrakesh Agreement


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Establishing the World Trade Organization. The United States and other WTO Members are

currently engaged in Doha Development Round of world trade talks. The United States has free

trade agreements with 17 countries. These FTAs build on the foundation of the WTO which is

more comprehensive.

The Trade and Investment Framework Agreement is one of the important agreements

made. TIFAs provide frameworks and methodologies for resolving trade and investment issues

at the initial stages. These agreements are also a means to identify and work on capacity

building. NAFTA created the world's largest free trade area linking 444 million people

producing $17 trillion worth of goods and services. The trade started between the United States

and its NAFTA partners since the agreement was made.

The United States has $735 billion in total (two ways) goods trade with NAFTA

countries namely Canada and Mexico during 2009. Goods exports totaled $334 billion; Goods

imports totaled $401 billion. The US economic growth during the 14 years of NAFTA has been

strong. The different sectors like employment, Investment, manufacturing, etc. started growing at

a good pace.

Political Globalization:

For US:

In the 21st century, the United States of America has become the dominant system of

political organization worldwide and the vast majority of the global population now lives in this

nation. The globalization is serving as a counter balance to nationalism which has some benefits

and disadvantages.

The nation and the forces of nationalism represent competing paradigms on the one handwith the nationalism creating cohesion of shared cultural identity. But on the other nationalism

factors the conflict increases with other nations based on competition for resources. The political

Globalization of the US depends on the interests and improvements shown towards the APEC

and the G8. APEC acts on forging an interconnected Asia Pacific. APEC created a transitional

membership category that allowed the U.S. to join the scheme even though it does not meet all

the criteria of the APEC Business Travel Card.


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Social Globalization :

The ranking for the United States in the Globalization index is 27.

For UK:

Economic Globalization:

There has been a rapid growth in the number of regional trade agreements [RTAs] in

recent years. In Europe, these are mainly centered on the European Union, spreading to the

Central and Eastern European countries. The DFID/BIS Trade Policy Unit maintains bilateral

relations with the world through two processes:

As a member of the European Union, the UK is party to the EU Regional Trade

Agreements (RTAs), which are negotiated by the European Commission with another country or

trading bloc with the aim to enter into a preferential trading arrangement with each other.

The UK also engages with third countries, which are not part of the EU, and non-EU

regional groupings with the aim of developing open and competitive markets for UK countries.

The Trade Policy Unit leads on both the engagement with third countries and represents the UK

in the EU regional trade agreements.

Working primarily from within the EU, its efforts will be vital to the maintenance of

progress in multilateral trade negotiations. The distribution by demographics on this issue follows

previously reported patterns on other questions. Men [50%] are more likely to think the UK

benefits than women [42%], and the younger the person, the greater the likelihood they think the

UK benefits.

The terms and ways to shift the activities with global market forces are represented fromAPEC to the EU. Within the interstices of this system operate the social groups of an emerging

transnational civil society, from the International Chamber of Commerce to the Jubilee 2000

campaign, seeking to promote, contest and bring to account the agencies of economic

globalization. Economic globalization has been accompanied by a significant internationalization

of political authority associated with a corresponding globalization of political activity.


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Political Globalization:

The political globalization of the United Kingdom is based on the two fundamentaltransformations that have shaped the constitution of contemporary political life. The first of these

involved the development of territorially based political communitys i.e. Modern nation states.

The second transformation is that it has led to a break in the exclusive link between geography

and political power namely the institutionalization of a fragile system of multilayered global and

regional governance. It has also instigated new forms of multilateral, regional and transnational

politics.

The OECD is home to the Development Assistance Committee and the EconomicsDepartment of the OECD has two work streams namely country reviews and cross cutting macro-

economic and structural analysis. The Delegation is most involved in the country work, and plays

an active role in the examination of the UK economy, as well as the peer review process of the

Economic Development Review Committee [EDRC].The UK is about to host the G8 event in

2013 which will further develop the relations of its resources and trades with many countries.

The ranking for the United Kingdom in the Globalization index is 24.

Political and Legal System

System of Governance

The Government type in US and India are Federal Republic where as in UK it is

constitutional Monarchy. The all three countries are democratic and the representatives of the

state for US are elected for every 4 years. The senators will be elected for every 6 years. The

head and chief of the state for US is the President Barack H.Obama. The chief of the state for

UK is queen Elizabeth II, the head of the government is the Prime Minister David Cameron. Thechief of India is President and the head of the government is the prime minister.

Political stability for past two years

The political system in the US has changed when the Democratic Party candidate is

elected as the President. The US president has promised to stop the war against Iraq and bring

the soldiers to their country. The senator elections are going to be held in the November of this


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year where exist polls are saying that the Republican Party will gain most of the states. The

country has started taking protective measure that will affect the outsourcing firms outside US in

order provide more jobs for their people as the unemployment rate is at 10%. In UK the

Conservative party has came into power during the current year.

The two countries are rated on stability of the government basing on three factors like

Government cohesion, Legislative strength and popular support done by PRS group. In which

the UK and US has rated like 6 and 9.

Legal system in operation

The legal system in the US, UK and the India is based on the common law. But in US

each state has its own legal system which is based on common law. The UK is based on the

Roman and modern continental influences. In India separate personal law codes apply to

Christians, Hindus, and Muslims.

System of Governance

United Kingdom United States of America

System of Governance Constitutional Monarchy Presidential

Current Head of State Queen Elizabeth II Obama

Political Stability in past 2yrs Stable Stable

Legal System in Operation Common Law Federal Law

IPR regime Strong Strong

Degree of Protection offered to

Foreign Investors

High, Rank -10 High, Rank -5

Ease of doing Business in the

Country

Rank- 5 around the world Rank- 4 around the world


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CULTURAL HIGHLIGHTS

United Kingdom

Language

English is the common language used in United Kingdom but it should be noted that Queens

English and American English are different.

Major languages spoken

Wales: People in Wales speak a completely different language. About 25% of the people there

still speak in their native Celtic tongue called welsh.

Scotland: In some regions of Scotland, Gaelic is used as a first language

Northern Ireland: In Northern Ireland about 7% speak Irish according to the 2009 census report

Ethnic Composition of UK

Religion

Britain is a multi faith society in which everyone has the right to religious freedom.

Although Britain is historically a Christian society, people are usually very tolerant towards the

faiths of others and those who have no religious beliefs.


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The main religion in Britain is Christianity. Most Christians belong to the Church of

England or the Church of Scotland. These are Protestant Churches. There are also many Roman

Catholics.

Although religious faith in Britain is predominantly Christian, most of the worlds religions are

also practiced. There are large Hindu, Jewish, Muslim and Sikh communities, and also smaller

communities of Bah, Buddhists.

Religion in daily life

In UK its found in a survey that though most people claim they are religious they admit

that they dont practice it in a proper manner. Those who do profess religion in the UK are

largely inactive.

United States

Language

The official language spoken wide over United States is English.

Major languages spoken in US

Spanish has continued to be the non-English language most commonly spoken at home at

29.1 million speakers. Chinese has moved from fifth place to become the second most widely

spoken non-English language. Of the twenty non-English languages most frequently spoken at

home, Russian showed the largest proportional increase, nearly tripling from 242,000 to 706,000.

The second largest increase was for French Creole speakers --a group that includes Haitian

Creoles -- who more than doubled from 188,000 to 453,000. The number of Vietnamese

speakers doubled over the decade as well, from about 507,000 to just over 1 million.

Source: U.S. Census Bureau.

Ethnic Composition


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Major Religion

The majority of Americanscatholic denominations. Ther

and Judaism, Islam. There

religious belief or no religiou

Importance of Religion in d

Christians generally claim t

difficult times and other crisi

claim that it has its affects in t

religious country. "Its first Ch

doing and why," At the heart

go to church.

The importance, prominence,

identify themselves as Christians, mostlyare also Non-Christian religions including

re also people who identify themselves a

affiliation.

ily life

at religion makes a difference in their liv

s experience. Those who are more committ

heir life orientation and daily activities. Am

ristian inhabitants were only too anxious to

of religious practice is prayer: Americans pr

and conspicuousness

within protestant andBuddhism, Hinduism,

not involved in any

s at times of illness,

ed to the religion also

rica has always been a

xplain what they were

y even more than they


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Intersection of Religion and State

Differing religious traditions and denominations tend to dominate historically in specific states,and religious groups have significantly different patterns of religious intensity among their

adherents. The states have differing racial and ethnic compositions, which in turn are associated

with differing degrees of religiosity. Certain states may attract in-migrants with specific types of

religious intensity. In addition, there may be differing "state cultures" that are themselves

associated with life approaches that give varying degrees to religion as a guiding force.

Cultural Highlights


Language

Official Language for doingBusiness English ( UK) English (USA)

Ethnic Composition

White-92.1%

Mixed Race -1.2%

Others 6.7%

Non-Hispanic Whites 68%

Hispanic 15%

Non- Hispanic Blacks 12%

Asian American 5%Major Languages Spoken English (UK) English(USA)

Major Religions

Different Religions BeingPracticed

Christian 71.6%

No Religion -15.5%

Others 12.9%

Christian 82.3%

Atheist 11.6 %

Judaism 2.2%

Others 3.9%

Importance of Religion indaily life Moderate Moderate

Holidays and Festivals

Official rest days for the week Saturday and Sunday Saturday and Sunday

Important Festivals Christmas, Good Friday,EasterChristmas, Good Friday,Easter

Non Working Holiday Season December- January December- January


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Business Culture

Hofstede Dimension


Power Distance Index Medium Medium

Individualism Very High Very High

Masculinity High High

Uncertainty Avoidance Index Medium Medium

Long Term Orientation Low Low

Very High 100- 81; High 80-61; Medium 60- 41; Low- 40- 21; Very Low 20-1;

Entry Choice Analysis

Global Market for Medical Transcription Industry

The global market size of Medical Transcription Industry is USD 25 billion in 2010. It has a

CAGR value of 15%. A projected growth rate of the global Medical transcription market can be

shown below


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Source: Slideshare.com

Number of Employees in the

The current employee streng

52000 by 2010. Large player

space, accounting for almost

Why US?

After thorough research it wa

following factors:

Only 50% as of the industry

has. However as things are g

industry comprises of more

approximately 3.8 million in

Furthermore, the United Stat

residents employed in the he

highest.

0

10

20

30

40

50

60

2010 2011 201

Global Mar

medical transcription sector in India

th of India-based medical transcription ven

s, primarily US MTSOs with India presenc

0% of the revenues and 65% of the manpow

s found out that US is the best market for S

as of now gets outsourced. In this pie 10%

oing India will have a sharp rise in its shar

than 750,000 physicians and 5,200 hos

patient visits and 20 million outpatients

es of America has the largest workforce i.

alth care business. Also the healthcare exp

2013 2014 2015

et for Medical Transcription

(in USD billion)

Global MaTranscriptibillion)

dors is approximately

dominate the vendor

er in the industry.

WIFTshare due to the

is the share that India

e. The USA's medical

itals. USA witnesses

isit on a daily basis.

. one in every 11 US

nditure in USA is the

ize

rket for Medicalon size (in USD


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Introduction of EPR and EH

other

USA Outsourcing of Medic

As of 2010, it was valued at

Indias expected share in the

As of 2010, India will have

presents itself a huge prospect

0

2

4

6

8

10

12

2010 2011 201

5.65162 6.5557.6

USA Med

R will keep the USA market afloat and m

l Transcription

SD 5.65 and it was growing at a CAGR valu

S medical transcription in 2010

81% market share of the overall US off s

for India It service players in this field

2013 2014 2015

38.8196

10.2311.8669

cal Transcription OutsourcinMarket

USA MediOutsourci

ch more vibrant than

market.

e of 16.1%

oring market. Thus it

al Transcriptiong Market


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Source: NASSCOM

India remained a preferred

and industry maturity.

Competitor Analysis

The competitors can be analy

Indian units of large US

Transcription Service Organi

centers in India. The large

These large players account

revenues.

Mid-sized players - There a

Most of them work as franch

presence in the US.

Smaller players - There are

players are subcontractors to t

647, 81

Market S

offshore destination primarily due to ava

ed into three segments

players - Typically comprise American c

zations (MTSOs) who have successfully set

layers include CBay, Spheris, Spryance,

for almost 70 percent of Indian medical tr

e a number of medium sized players (< 50

isees or vendors of the larger players and h

a large number of such small players with

he other two groups and suffer from unreliab

153, 19%

are of US offshoring industr

lability of manpower

ompanies or Medical

up their transcription

cusis and Heartland.

nscription off shoring

employees) in India.

ave limited marketing

50 employees. These

le revenue flows.

India

Others


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SWIFTshare falls right now on the second category the middle sized companies. It has to

compete with these mid-sized players. SWIFTshare started as a franchisee itself of Heartland but

now has become an independent unit and is looking to venture into.

CAGE MODEL

CULTURE DIFFERENCE

US are a society where there is large number of migrants. Most of the peoples ancestors

are from the other part of the world. US and India both are the colonies of the Great Britain. So

many of the cultures of the US and India can be matched to some extent to that of US. English is

common language between the countries will give a greater advantage to our company. In US

the time is very important where as in India there is no much punctuality followed; this is not the

case in US. They will treat people who are punctual as good and reliable. Since India had been a

colony for UK the people will know their culture.

ADMINISTRATIVE DIFFERENCES:

US and UK has imposed many restrictions on outsourcing industry around the world.

Recently the Ohio state in US has made a law that will prevent the outsourcing of thegovernment contracts to other countries. The President of US has made a statement that there

will be tax benefits to those companies that do not outsource to other countries, but generate jobs

to local people. The American government has increased the fees for the H1B1 visa for funding

the boarder construction that will prevent the illegal immigrants from the bordering countries.

These laws will impact our company where many of our workers go on H1B1 visas for

demonstrating the work done by our company. The US and UK are 3 rd, 4 th largest investors in

our country. The FDI investments made by Indian companies in US include sectors like Oil andGas, computer software services. The FDI made by Indian companies in US include sectors like

Iron and steel, computer software services, automobiles.

GEOGRAPHY

Location: Western Europe, islands including the northern one-sixth of the island of Ireland

between the North Atlantic Ocean and the North Sea, northwest of France.


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Climate:

Current whether: Temperate; moderated by prevailing southwest winds over the North AtlanticCurrent; more than one-half of the days are overcast.

Climate issues:

The world is warming up. As there is burn up the planets coal, oil and gas reserves, and

cut down its remaining forests, greenhouse gases are pouring into the atmosphere. The delicate

balance of atmospheric gases that sustains life is thickening, trapping more and more heat and

irreversibly changing our world.

For all the technological gloss of the 21st century, the UK is still living in an industrial

era, pumping out emissions from coal, oil and gas. Worse, the energy is supplied through a

criminally wasteful, centralized energy system; two thirds of all energy generated in UK power

stations is lost as waste heat up the chimney and along transmission lines. But there are clean,

affordable and proven solutions for the most polluting sectors: electricity, transport, industry and

domestic.

Geography Distance

It's about 5000 miles approximately from London, England, to New Delhi, India. The

geographical has its impact on trade between India and UK, the transportation and travel cost has

always made a negative impact in the trade between the countries.

Time zone: The time difference between and India and UK is 4 hours and 30 minutes.

Geographic Distance

US are approximately 9000 miles away from Mumbai, India. The geographic distance

between the countries is so high that small trades will result in a negative impact. The main mode

of transports is airways and shipping.

Impact of Climate

Over the 20th century, the northern portion of the Midwest, including the upper Great Lakes, has

warmed by almost 4F, while the southern portion, along the Ohio River valley, has cooled by


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about 1F. Annual precipitation has increased, with many of the changes quite substantial,

including as much as 10 to 20% increases over the 20th century.

Time Zone: The time zone difference between India and US is 11.5 hours.

The US has world largest Coal reserves, this will benefit the Indian thermal power plants

and iron & steel companies that are looking for overseas investments. Since India a few coal

fields for generating the power the companies should acquire the raw material from other

countries. Recently the Indian companies are acquiring the Sheal gas fields that will provide

natural gas for many companies. The UK has natural resources like iron ore so many companies

like Tata Steel has brought Corus to gain the advantage of the raw materials.

Since our company is focusing on the providing services the business will not be effected

by any cyclic changes. The geographic distance doesnt play an important role in our business as

we get the data through the internet cables under the sea and only effect is while exporting the

documents the distance matters. The changes in the climate will not affect the business.

ECONOMIC DISTANCE:

US and the UK are the developed nations, but during the recession the growth rates of these countries had showed negative growth rate. The effect of these economies will seriously

affect our profits. As almost 90% of the turnover of our company will be coming from the US

and UK combined, so any change in the economy of these countries will affect our company

profits. In order to safe guard from such risks we are planning to decrease the contribution from

these countries and focus in our own country. The trade deficits for US and UK will impact the

exchange rates, the interest rates in those countries. If interest rates goes up in those countries the

spending by the companies and the customers will decrease. This will lead to less outsourcing by

the pharmacy to oversee as cost cutting measures.


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Country Risk Assessments

i) Political

1. Consumer attitude

The consumer attitude for both US and UK stands at 2.5 and hence both are same. The consumer

attitude remains same as that of India.

2. Government attitude

The government attitude for US is 4.0 and UK is 2.5 and hence US is better than UK.

3. Bureaucracy and corruption

The bureaucracy and corruption in US is higher than that of UK.

4. Political stability

The political stability for US is much higher than that of UK.

5. Religious stability

Both the countries have Christianity as their major religion and hence both are stable.

6. Wars

US are much posed to wars with other countries unlike UK which doesnt wage war.

7. Resistance to globalization

The US is known for its research and development and hence introduce new technology products

than UK. US spend billions of dollars for R & D and hence both countries dont have much

resistance to globalization.

ii) Economic


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3. Foreign debt service as % of exports of goods and services

The foreign debt service as % of exports of goods and services for India is 5.3, for UK is 2.7 andfor US is 2.2. Here we can see that the foreign debt service for India is double than that of UK.

4. Official reserves of months of import cover

The official reserves of months of import cover for India is 17.3 and for UK is 1.0 and for US is

0.1. It shows us that the US official reserves of months of import cover are 10 percent of UK

official reserves of month of import cover.


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