Health Care

The dynamic business of health care has long been a top research priority at HBS. Over the past several decades, we have been building a foundation on which our research continues to grow – from striving to find a "cure" to health care delivery through Clayton Christensen's application of disruptive innovations or the pioneering work of Regina Herzlinger, the "Godmother" of consumer-driven health care, to Michael Porter's use of competitive strategy principles. Our research has always been aimed at finding ways to improve all sectors of health care and, in turn, the quality of the lives of people across the world. Our faculty's deep connection to practice brings us a unique perspective from which to examine health care. Through collaborative research that cuts across our academic units, we explore all facets of the health care industry from pharmaceuticals and biotech to hospitals, insurance, diagnostics, and medical devices, with a focus on such topics as:
  • Applying management principles and best practices to health care delivery
  • Improving the process of innovation
  • Employing the principles of strategy and consumer choice in health care
  • Identifying regulatory mechanisms for emerging health care fields
  • Developing approaches to delivering high-impact health care in developing nations
We draw heavily on our direct experience in the field at hospitals, laboratories, and other locations where health care leaders make critical decisions. As an example, Richard Bohmer draws on stories of health care institutions as well as his own years of experience as a physician to explain the habits shared by high-value health care organizations. And, Gary Pisano conducts in-depth field research to understand why the biotech industry failed to perform up to expectations despite all its promise - such as his study of innovation and growth at one of Europe's largest biotech companies. Through a wide array of research projects across the globe, our insights are helping our students, as well as practitioners and policymakers, shape a better future for health care worldwide.
 
  1. Redefining Health Care: Creating Value-Based Competition on Results

    This presentation draws on a forthcoming book with Elizabeth Olmsted Teisberg (Redefining Health Care: Creating Positive-Sum Competition to Deliver Value, Harvard Business School Press). Earlier publications about the work include the Harvard Business Review article “Redefining Competition in Health Care” and the associated Harvard Business Review Research Report “Fixing Competition in U.S. Health Care” (June 2004).

    Keywords: Health; United States;

    Citation:

    Porter, Michael E. "Redefining Health Care: Creating Value-Based Competition on Results." New Models of Health Care, Boston, MA, April 12, 2005.
  2. salaUno: Eliminating Needless Blindness in Mexico

    In May 2013 the co-founders and co-CEOs of salaUno, Javier Okhuysen and Carlos Orellana, were encouraged by the results of their fledgling start-up. salaUno was founded as a for profit enterprise in order to have the capital needed for rapid growth and to fulfill its mission of Eliminating Needless Blindness in Mexico. salaUno had grown from doing 75 cataract surgeries in its first month of operation to a high of 388 surgeries 21 months later. This case explores the challenges in scaling up a healthcare venture within a developing country.

    Keywords: medical services; developing countries; developing markets; health care industry; health services; healthcare ventures; healthcare startups; Health Care and Treatment; Health; Medical Specialties; Developing Countries and Economies; Health Industry; Mexico; Mexico City;

    Citation:

    Hamermesh, Richard, Regina Garcia Cueller, and Valerie Moy. "salaUno: Eliminating Needless Blindness in Mexico." Harvard Business School Case 814-041, March 2014.
  3. Martini Klinik: Prostate Cancer Care

    Since its establishment in 2005, Hamburg's Martini Klinik had single-mindedly focused on prostate cancer care with a commitment to measure long term health outcomes for every patient. A wholly owned subsidiary of the Hamburg University Hospital, Martini was a "hospital in a hospital" in close proximity to other hospital departments and services. By 2013, Martini Klinik had become the largest prostate cancer treatment program in the world with 5,000 outpatient cases and more than 2,200 surgical cases annually, with patients coming from all over Germany and from other countries. However, German private insurers were cutting reimbursement for prostate cancer by 15 percent, and denying extra payment for some new procedures, while reimbursement by public health plans was not covering costs. Dr. Hartwig Huland, Martini's founder and Medical Director, was considering how to respond.

    Keywords: health care; Germany; Michael Porter; Jens Deerberg-Wittram; Clifford Marks; prostate cancer; health care policy; value agenda; integrated practice units; outcomes measurement; Value; Health Disorders; Insurance; Medical Specialties; Outcome or Result; Business Processes; Insurance Industry; Health Industry; Germany;

    Citation:

    Porter, Michael E., Jens Deerberg-Wittram, and Clifford Marks. "Martini Klinik: Prostate Cancer Care." Harvard Business School Case 714-471, March 2014.
  4. Vision 2020: Takeda and the Vaccine Industry

    In 2014, Yasuchika Hasegawa was orchestrating the transformation of Takeda from a Japanese pharmaceutical company with a global footprint into a global company with a Japanese heritage. A 33-year veteran of Takeda, Hasegawa-san was appointed president of Takeda in 2003 and chief executive in 2009. By 2013, Takeda was in the midst of implementing its new Vision 2020 plan, a strategic plan for the evolving global corporation, which included developing a global vaccine business.

    Keywords: health care; global; NGO; public health; pharmaceutical industry; Japan; GSK; "vaccine,"; supply chain; Market entry; Health; Health Care and Treatment; Trade; Market Entry and Exit; Global Strategy; Health Industry; Pharmaceutical Industry;

    Citation:

    Quelch, John A., and Margaret L. Rodriguez. "Vision 2020: Takeda and the Vaccine Industry." Harvard Business School Case 514-084, March 2014.
  5. Waste, Recycling and Entrepreneurship in Central and Northern Europe, 1870–1940

    This working paper examines the role of entrepreneurs in the municipal solid waste industry in industrialized central and northern Europe from the late nineteenth century to the 1940s. It explores the emergence of numerous German, Danish, and other European entrepreneurial firms explicitly devoted to making a profitable business out of conserving and returning valuable resources to productive use, while maintaining public sanitation and in many cases offering nascent environmental protections. These ventures were qualitatively different from both earlier smaller private waste traders, and the later garbage agglomerates, and have been neglected in an era that historians have treated as a period of municipalization. These entrepreneurs sometimes had strikingly modern views of environmental challenges and the need to overcome them. They initiated processes for sorting and recycling waste materials that are still employed today. Yet it proved difficult to combine making profits and achieving social value in accordance with the “shared value” model of today. As providers of public goods such as health and sanitation and a cleaner environment, the entrepreneurs were often unable to capture sufficient profits to sustain businesses. Recycled-goods markets were volatile. There was also a tension between the constant waste stream on the collection side and a seasonal/cyclical demand for recycled products. The frequent failure of these businesses helps to explain why in more recent decades private waste companies have been associated with late entry into recycling, often trailing municipal governments and non-profit entities.

    Keywords: Environmental Entrepreneurship; business history; Entrepreneurship; Health; History; Green Technology Industry; Germany; Denmark; Hungary; United Kingdom;

    Citation:

    Jones, Geoffrey, and Andrew Spadafora. "Waste, Recycling and Entrepreneurship in Central and Northern Europe, 1870–1940." Harvard Business School Working Paper, No. 14-084, March 2014.
  6. Bio-Piracy or Prospering Together? Fuzzy Set and Qualitative Analysis of Herbal Patenting by Firms

    Since the 1990s, several Western firms have filed patents based on medicinal herbs from emerging markets, evoking protests from local stakeholders against 'bio-piracy'. We explore conditions under which firms and local stakeholders share rents from such patents. Our theoretical model builds on two distinct strategy literatures: firms appropriating rents from new technologies and firms managing stakeholders. We predict that a win-win outcome emerges when the patent strength is moderate and when local stakeholders form a coalition with larger national stakeholders to initiate litigation against the focal firm. We test our predictions using a two-pronged empirical strategy. Our empirical context relates to herbal patents from emerging markets and given that we have a small sample (N=17), we employ a fuzzy set QCA methodology. In addition, we develop four in-depth qualitative case studies to support our predictions.

    Keywords: Rents from New Technology; Local Stakeholders; Herbal Patents; QCA; Fuzzy Set Analysis; Qualitative Case Studies; Plant-Based Agribusiness; Patents; Emerging Markets; Health Care and Treatment; Business and Stakeholder Relations; Cross-Cultural and Cross-Border Issues; Agriculture and Agribusiness Industry; Pharmaceutical Industry;

    Citation:

    Choudhury, Prithwiraj, and Tarun Khanna. "Bio-Piracy or Prospering Together? Fuzzy Set and Qualitative Analysis of Herbal Patenting by Firms." Harvard Business School Working Paper, No. 14-081, February 2014.
  7. Codifying Prior Art and Patenting: Natural Experiment of Herbal Patent Prior Art Adoption at the EPO and USPTO

    In the patenting literature, economists and legal scholars have focused on the question of improving the quality of prior art available to patent examiners and mitigating the filing and granting of patents where prior art exists in common knowledge. In this paper, we create a unique dataset of Chinese and Indian herbal patents filed on the USPTO and EPO between 1977 and 2010 and exploit a natural experiment where the USPTO and EPO adopted a codified database of traditional herbal prior art at different points in time. This initiative was titled the 'Traditional Knowledge Depository Library' (TKDL) and was pioneered by Indian state-owned R&D labs and provided the EPO and USPTO with systematic evidence of prior art on herbal patents based on a translation of ancient Indian texts. We conduct additional analyses to establish that the time lag of the USPTO adopting the TKDL agreement compared to the EPO was related to idiosyncratic differences in how the agreements were structure and negotiated, not differences in policy towards herbal patents at the EPO and USPTO. We also find that the adoption of TKDL appears to shift patenting in the West from pure herbal remedies that can be contested in court, to new applications involving herbals and synthetics, which are less contestable. Further, we study the ethnic origins of the inventors of herbal patents filed on the USPTO. For this analysis, we use ethnic name matching for all patentees of herbal patents. We also exploit an exogenous reduction in H1B (visa) quotas and find that herbal patents filed by Western firms based in the U.S. are driven by scientists of ethnic Indian and Chinese origin.

    Keywords: Plant-Based Agribusiness; Patents; Ethnicity Characteristics; Health Care and Treatment; Pharmaceutical Industry; Agriculture and Agribusiness Industry; China; India;

    Citation:

    Choudhury, Prithwiraj, and Tarun Khanna. "Codifying Prior Art and Patenting: Natural Experiment of Herbal Patent Prior Art Adoption at the EPO and USPTO." Harvard Business School Working Paper, No. 14-079, February 2014.
  8. Hospital Clínic de Barcelona

    Keywords: health care; provider organizations; hospital; leadership; organization structure; Leadership; Organizations; Health; Health Industry; Europe; Spain;

    Citation:

    Bohmer, Richard M.J., Daniela Beyersdorfer, and Jaume Ribera. "Hospital Clínic de Barcelona." Harvard Business School Case 614-058, February 2014.
  9. Nudging Physicians to Pursue Careers in Underserved Areas: A Case for Behavioral Economics

    Currently, more than 60 million Americans live in "Health Professional Shortage Areas." Unless policymakers can encourage more physicians to practice in medically under-resourced areas, an increased number of uninsured individuals newly able to obtain health insurance coverage under the Affordable Care Act may contribute to even greater physician access problems in these communities. Behavioral economics is a discipline that recognizes the limits of rational decision-making based on the principle that human behavior is influenced by cognitive biases and the social/emotional context in which decisions are made. Behavioral economics-based policy approaches that aim to change the context in which physicians make practice decisions have received little attention thus far. In this paper, we propose a behavioral economics-based policy framework for carefully designing program and policy options to nudge physicians toward practice in medically underserved, under-resourced areas in the U.S.

    Keywords: Access to care; health economics; health reform; minority health; disparities; Health Care and Treatment; Health Industry;

    Citation:

    Lopez, Joseph, Mona Singh, Nava Ashraf, and Joel Weissman. "Nudging Physicians to Pursue Careers in Underserved Areas: A Case for Behavioral Economics." (Working Paper, February 2014. Under review.)
  10. 23andMe: Genetic Testing for Consumers (A)

    On November 22, 2013, the direct-to-consumer genetic testing provider, 23andMe, received a letter from the U.S. Food and Drug Administration (FDA) ordering the company to halt the sale and promotion of its genetic testing kit. The FDA stated that the product was marketed as a diagnostic and preventative tool and that it was subject to the agency’s regulations for medical devices. Company co-founder Anne Wojcicki and chairman Andy Page carefully considered the potential impact of the FDA's letter on 23andMe's position in the industry and the sustainability of its operations.

    Keywords: marketing; public health; strategy; genome testing; health care; genetics; ancestry; 23andMe; Marketing; Product Launch; Health; Health Care and Treatment; Health Testing and Trials; Genetics; Strategy; Health Industry; United States;

    Citation:

    Quelch, John A., and Margaret L. Rodriguez. "23andMe: Genetic Testing for Consumers (A)." Harvard Business School Case 514-086, January 2014. (Revised March 2014.)
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