The problem is not with set up costs but toensure contracts, which are difficult. A typical contract lasts for 15-24 months. The most difficult thing in thisbusiness is to get an order from one of the hospitals. Since it is difficult to obtain,the logic of sub contracting is relevant because one can tie up with an existing medicaltranscription company and become a sub contractor. The idea is to gain experience, build ateam and then contact the end user directly.
Economies of scale is the key to success, allother things being same.
The government needs to take somesteps and because the customer in USA wants a 24 hours response time. Medicaltranscription should be made into an essential services otherwise problems like leave,religious holidays, ladies working in night shifts, etc would create disruptions whichcannot be afforded. Other areas to be strengthened are infrastructure like power andtelecom. Marketing is critical for successin this business. As mentioned earlier end user contracts are difficult to obtain, hencetie ups with any American transcription company is a way to surmount the problem.