Health Care

Health Care is a featured research topic and an initiative at Harvard Business School.
Over the past several decades, HBS has built a foundation in health care research, from Clayton Christensen's application of disruptive innovations and Regina Herzlinger's concept of consumer-driven health care to Michael Porter's use of competitive strategy principles. Today our research focuses on 
  • how management principles and best practices from other industries can be applied;
  • how the process of innovation can be improved;
  • how principles of strategy and consumer choice can be utilized;
  • how information technology can expand access, decrease costs, and improve quality;
  • how new approaches in developing nations can impact global health.
  1. The National Football League and Brain Injuries

    The National Football League (NFL) was both the most popular spectator sport in the U.S. and a major economic entity, taking in roughly $10 billion a year in revenue. However through the early twenty-first century, an increased understanding of the long-term effects of head injuries on NFL players indicated a serious threat to the long-term viability of the game. Particularly concerning was the indication that some deceased professional football players had developed chronic traumatic encephalopathy (CTE)—a neurodegenerative disease which had a strong influence on a person's mental and physical health—most likely as a result of repetitive hits sustained during their football careers and which may have contributed to their deaths.
    Over 4,000 retired players had jointly sued the NFL over the head injuries they had sustained during their time in the NFL and the resulting health problems they attributed to these injuries. In part, the lawsuit alleged that the NFL had not been forthcoming with players about the health risks of head injuries. The two sides had reached a tentative $765 million settlement in 2013, the bulk of which would go to compensating retired players suffering from such diseases as Alzheimer's or dementia.
    While this settlement compensated retired players, it was not applicable to current or future players. Could the NFL preserve the sport by making it safer through new rules or equipment changes, or was football an inherently physical game that no amount of new rules or equipment could make completely safe? Were current and future players, now knowing full well the potential long-term health implications of football, tacitly accepting the risks involved? As a team owner, is now the time to sell while franchise value and fan support are at their peaks, or will the business of the NFL be viable for years to come?

    Keywords: employee safety; Safety; Employees; Sports; Health; Sports Industry; United States;


    Hamermesh, Richard G., and Matthew G. Preble. "The National Football League and Brain Injuries." Harvard Business School Case 815-071, October 2014. View Details
  2. La Ribera Health Department

    La Ribera was a privately managed, publicly funded health department in the Valencia region of Spain. The model began in 1999, when a new hospital was opened to cover the secondary health care needs of the health department's inhabitants. In 2003, the model was extended to also cover primary care. The health department received a capitation fee for each registered inhabitant of the health department, and provided health services at a 25% lower cost than public hospitals in the region. However, profits for the private operators remained low, in the region of 1%. In order for La Ribera to remain a viable option the hospital began working with a consulting firm to look into future options for growth, and potentially higher returns. A key factor for any of the options considered was the public perception that tax-financed access to care was a longstanding public good in Spain, and allowing private operators to profit from health care delivery was a thorny issue.

    Keywords: Health Care and Treatment; Government Administration; Innovation Strategy; Vertical Integration; Business Model; Health Industry; Europe; Spain;


    Herzlinger, Regina E., Emer Moloney, and Daniela Beyersdorfer. "La Ribera Health Department." Harvard Business School Case 315-006, September 2014. View Details
  3. Fresno's Social Impact Bond for Asthma

    In 2014, Social Impact Bonds (SIBs) were quickly gaining popularity as an investment vehicle which joined together private investors and nonprofits to tackle social issues. Although numerous SIB projects and proposals had cropped up across the U.S. following the launch of the first SIB in the UK in 2010, none were explicitly focused on healthcare. Fresno, California announced the first healthcare SIB in 2013 to fund home-based programs to reduce asthma attacks. If successful, the Fresno SIB model would help solve the challenge of delivering preventative care efficiently in at-risk communities.

    Keywords: social enterprise; health care; marketing; bonds; financing; asthma; air pollution; air quality; chronic disease; public health; Health; Health Care and Treatment; Finance; Health Industry; Financial Services Industry; United States;


    Quelch, John A., and Margaret L. Rodriguez. "Fresno's Social Impact Bond for Asthma." Harvard Business School Case 515-028, September 2014. View Details
  4. Mayo Clinic: The 2020 Initiative

    Describes the challenges facing Dr. John Noseworthy, President and CEO, in implementing a long-term strategy for the growth of the Mayo Clinic—a leading academic medical center with a reputation for excellence in tertiary and quaternary health care. The case highlights the concurrent forces of regional and national competition and federal health care reform as factors complicating the plans of Mayo Clinic to grow through several channels. Students must ultimately decide whether Mayo Clinic should focus its future growth on its current areas of expertise (regional provision of integrated medical care and international provision of tertiary and quaternary care), new opportunities in a broader range of services and treatment channels (e.g., telemedicine, mobile health, enterprise learning and training for other health care systems), or some combination of these opportunities.

    Keywords: health; health care industry; health care policy; Health Care and Treatment; Health Industry; United States;


    Herzlinger, Regina E., Robert S. Huckman, and Jenny Lesser. "Mayo Clinic: The 2020 Initiative." Harvard Business School Case 615-027, September 2014. View Details
  5. Don't Take 'No' for an Answer: An Experiment with Actual Organ Donor Registrations

    Over 10,000 people in the U.S. die each year while waiting for an organ. Attempts to increase organ transplantation have focused on changing the registration question from an opt-in frame to an active choice frame. We analyze this change in California and show it decreased registration rates. Similarly, a "field in the lab" experiment run on actual organ donor registration decisions finds no increase in registrations resulting from an active choice frame. In addition, individuals are more likely to support donating the organs of a deceased who did not opt-in than one who said "no" in an active choice frame.

    Keywords: Decision Choices and Conditions; Health Care and Treatment; Giving and Philanthropy; Health Industry;


    Kessler, Judd B., and Alvin E. Roth. "Don't Take 'No' for an Answer: An Experiment with Actual Organ Donor Registrations." NBER Working Paper Series, No. 20378, August 2014. View Details
  6. BMVSS: Changing Lives through Innovation One Jaipur Limb at a Time (Abridged)

    Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS) is an Indian not-for-profit organization engaged in assisting differently-abled persons by providing them with the legendary low-cost prosthesis, the Jaipur Foot, and other mobility-assisting devices, free of cost. Known for its patient-centric culture, its focus on innovation, and for developing the $20 Stanford-Jaipur knee, BMVSS has assisted over a million people in its lifetime of 44 years. As the founder, Mr. D.R. Mehta, thinks about the financial sustainability of BMVSS, he must devise a strategy that will sustain its human impact well into the future.

    Keywords: Nonprofit Organizations; Financial Condition; Health Care and Treatment; Diversity Characteristics; Growth and Development Strategy; Giving and Philanthropy; Medical Devices and Supplies Industry; Health Industry; India;


    Datar, Srikant, Saloni Chaturvedi, and Caitlin Bowler. "BMVSS: Changing Lives through Innovation One Jaipur Limb at a Time (Abridged)." Harvard Business School Case 115-009, July 2014. View Details
  7. Household Bargaining and Excess Fertility: An Experimental Study in Zambia

    We posit that household decision-making over fertility is characterized by moral hazard due to the fact that most contraception can only be perfectly observed by the woman. Using an experiment in Zambia that varied whether women were given access to contraceptives alone or with their husbands, we find that women given access with their husbands were 19% less likely to seek family planning services, 25% less likely to use concealable contraception, and 27% percent more likely to give birth. However, women given access to contraception alone report a lower subjective well-being, suggesting a psychosocial cost of making contraceptives more concealable.
    Click here to access the online appendix.

    Keywords: Partners and Partnerships; Health; Household Characteristics; Gender Characteristics; Zambia;


    Ashraf, Nava, Erica Field, and Jean Lee. "Household Bargaining and Excess Fertility: An Experimental Study in Zambia." American Economic Review 104, no. 7 (July 2014). (Online Appendix.) View Details
  8. Second-Opinion Pathology Review is a Patient Safety Mechanism that Helps Reduce Error and Decrease Waste

    We have a crisis in health care delivery, originating from increasing health care costs and inconsistent quality-of-care measures. During the past several years, value-based health care delivery has gained increasing attention as an approach to control costs and improve quality. One proven way to control costs and improve the quality of health care is subspecialty pathologic review of patients with cancer before initiation of therapy. Our study examined the diagnostic error rate among patients with cancer treated at a tertiary care hospital and demonstrated the value of subspecialty pathologic review before initiation of treatment.
    Methods: From September 1 to September 30, 2011, all patients seeking a clinical consultation had pathology submitted to and reviewed by a pathologist with subspecialty expertise and correlated in our pathology database.
    Results: A total of 2,718 patient cases were reviewed during September 2011. There was agreement between the original pathologist and our departmental subspecialty pathologist in 75% of cases. In 25% of cases, there was a discrepancy between the original pathology report and the subspecialty final pathology report; 509 changes in diagnosis were minor discrepancies (18.7%), and in 6.2% of patients (169 reports), the change in diagnosis represented a major discrepancy that potentially affected patient care.
    Conclusion: Second review of a patient's outside pathology by a subspecialist pathologist demonstrates the value of multidisciplinary cancer care in a high-volume comprehensive cancer center. The second review improves clinical outcomes by providing patients with evidence-based treatment plans for their precise pathologic diagnoses.

    Keywords: Pathology; diagnostic errors; Health; Health Industry; North and Central America;


    Middleton, Lavinia, Thomas W. Feeley, Heidi W. Albright, Ronald Walters, and Stanley Hamilton. "Second-Opinion Pathology Review is a Patient Safety Mechanism that Helps Reduce Error and Decrease Waste." Journal of Oncology Practice 10, no. 4 (July 2014): 275–280. (e-Pub 4/2014.) View Details
  9. Kathy Giusti and the Multiple Myeloma Research Foundation

    What do you do when your rising professional career is cut short by an unexpected cancer diagnosis? Kathy Giusti shifted careers, built a new organization that transformed how cancer research is done, and now faces the challenge of sustaining the organization and its funding for its newest venture.

    Since she was first diagnosed with multiple myeloma (MM) in 1996, Giusti had led an effort to better understand and treat the disease. She had co-founded the Multiple Myeloma Research Foundation (MMRF), helped form the Multiple Myeloma Research Consortium (MMRC), and brought together a diverse body of academics, researchers, pharmaceutical and biotech companies, physicians, and patients to combine their efforts around the disease. The MMRF had helped facilitate clinical trials for promising drugs, sponsored research, and raised a substantial amount of money for these purposes.

    In 2014, the MMRF was in the midst of its CoMMpass program; a multi-year effort to collect tissue samples from 1,000 patients at key junctures in their disease, sequence these samples to better understand the genetic underpinnings of MM and its many sub-types, and thus enable researchers to study a comprehensive sampling of patients. CoMMpass also had a patient-facing element which allowed the patient community to communicate with one another and with professional moderators. By mid-2014, some 550 patients were enrolled and 85 hospitals were participating.

    As a non-profit, the MMRF had historically relied on donations to fund its research operations. Giusti wanted to find a way to ensure a reliable revenue stream for the organization and give it greater financial stability. The MMRF had historically given away its resources and knowledge for free in order to speed research; Giusti worried if charging for some of its functions would be at odds with its mission and historical practices. She worked with her executive team to examine potential sources of revenue, and to decide if this was the right thing to do.

    Keywords: leadership; philanthropy; philanthropy funding; entrepreneurship; health care; management styles; management skills; personalized medicine; health care outcomes; cancer; Cancer care in the U.S.; personal care; Leading Change; Social Entrepreneurship; Giving and Philanthropy; Health Care and Treatment; Leadership Style; Management Style; Growth and Development Strategy; Business Strategy; Health; Health Industry; United States; Canada; Spain;


    Hamermesh, Richard G., Joshua D. Margolis, and Matthew G. Preble. "Kathy Giusti and the Multiple Myeloma Research Foundation." Harvard Business School Case 814-026, June 2014. View Details
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