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. 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; Gender Characteristics; Household 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
  2. 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
  3. Johnson & Johnson: The Pursuit of Wellness

    To create the world's healthiest workforce, diversified health care giant Johnson & Johnson (J&J) mandated participation in its "Culture of Health" program globally, customized by location, culture, and specific health needs to offer prevention-focused education, rewards for healthy behavior, and workplace environments that encouraged healthy employee behavior. By 2015, 90% of J&J's 128,000 employees would participate in Culture of Health programs; 80% would know their key health indicators (e.g., blood pressure, body-mass index, blood sugar, cholesterol); and 80% would have a "low risk" health profile. To hit these goals, J&J managers in 2014 sought to: 1) reduce national variation in program adoption and popularity, 2) do more to help employees ensure their overall—physical, mental, and spiritual—health, and 3) accurately measure the investments in and return on the program.

    Keywords: healthcare; human resources; employee motivation; Transformation; Ethics; Health; Human Resources; Leadership; Management; Personal Development and Career; Problems and Challenges; Strategy; Health Industry; Medical Devices and Supplies Industry; Pharmaceutical Industry; North and Central America; Middle East; Latin America; Europe; Asia;


    Quelch, John A., and Carin-Isabel Knoop. "Johnson & Johnson: The Pursuit of Wellness." Harvard Business School Case 514-112, June 2014. View Details
  4. Access Health CT: Marketing Affordable Care

    At the close of open-enrollment in March of 2014, Kevin Counihan, CEO of Access Health CT, Connecticut's state health insurance exchange, stops to consider the success it has experienced so far and think about how to ensure its long-term sustainability.

    Keywords: health care; health care industry; health care policy; public health insurance exchange; Health Care and Treatment; Health Industry; Connecticut;


    Quelch, John A., and Michael Norris. "Access Health CT: Marketing Affordable Care." Harvard Business School Case 514-119, June 2014. (Revised July 2014.) View Details
  5. Better Accounting Transforms Health Care Delivery

    The paper describes the theory and preliminary results for an action research program that explores the implications from better measurements of health care outcomes and costs. After summarizing Porter's outcome taxonomy (Porter 2010), we illustrate how to use process mapping and time-driven activity-based costing to measure the costs of treating patients over a complete cycle of care for a specific medical condition. With valid outcome and cost information, managers and clinicians can standardize clinical and administrative processes, eliminate non-value added and redundant steps, improve resource utilization, and redesign care so that appropriate medical resources perform each process step. These actions enable costs to be reduced while maintaining or improving medical outcomes. Better measurements also allow payers to offer bundled payments, based on the costs of using efficient processes and contingent on achieving superior outcomes. The end result will be a more effective and more productive health care sector. The paper concludes with suggestions for accounting research opportunities in the sector.

    Keywords: Activity Based Costing and Management; Research; Health Care and Treatment; Health Industry;


    Kaplan, Robert S., and Mary L. Witkowski. "Better Accounting Transforms Health Care Delivery." Accounting Horizons 28, no. 2 (June, 2014): 365–383. View Details
  6. Improving Value with TDABC

    The article discusses the benefits of time-driven activity-based costing (TDABC) combined with outcomes measurement for healthcare organizations. Topics covered include improving resource efficiency, optimizing care over the complete care cycle, and planning and budgeting of resource capacity. It also mentions that TDABC enhances quality of care and clinical outcomes while reducing healthcare costs.

    Keywords: Goals and Objectives; Activity Based Costing and Management; Health Care and Treatment; Health Industry;


    Kaplan, Robert S. "Improving Value with TDABC." hfm (Healthcare Financial Management) 68, no. 6 (June 2014): 76–83. View Details
  7. Health Care Accountability: Examples in Cancer Treatment

    This case is designed to support a discussion of the importance of outcomes evidence in empowering the public to make better health care decisions, the desired level of transparency and accountability for health care providers, and the issues with current measuring and reporting practices that undermine the quality and comparability of outcomes data. The case describes two approaches to measuring cancer treatment outcomes. First, it describes a prostate cancer outcomes study conducted by Radiotherapy Clinics of Georgia, a subsidiary of Vantage Oncology, including a senior Vantage Oncology executive's views on the distinctive merits of this study's design. Second, the case describes treatment outcomes research by Memorial Sloan-Kettering Cancer Center (MSKCC) that compares cancer survival rates and costs of MSKCC and various comparator groups. The case briefly introduces a third approach, taken by Cancer Treatment Centers of America, in an Appendix.

    Keywords: accountability; health care; cancer; cancer treatment; Memorial Sloan Kettering Cancer Center; Cancer Treatment Centers of America; Vantage Oncology; radiology; risk adjustment; treatment outcomes; health care outcomes; prostate cancer; transparency; Health Care and Treatment; Risk Management; Outcome or Result; Health Industry; United States;


    Herzlinger, Regina E., and Natalie Kindred. "Health Care Accountability: Examples in Cancer Treatment." Harvard Business School Case 314-109, May 2014. View Details
  8. Health City Cayman Islands

    Narayana Health (NH) had been successfully delivering affordable high quality tertiary care to the masses in India through its chain of hospitals for over a decade. To encourage the adoption of the NH affordable care delivery model worldwide, Dr. Shetty, Chairman of NH, was keen to establish a hospital in the western hemisphere and believed that it was important to demonstrate the model to the US. Thus when the Cayman Islands Government was interested in developing the island as a medical tourism hub during 2008-09, Dr. Shetty agreed to develop the Health City Cayman Islands (HCCI), a 2,000 bed conglomeration of multiple super-specialty hospitals within a single campus located on Grand Cayman Island. The first phase of HCCI, a 104 bed hospital focused on cardiac care and orthopedics, was developed jointly by NH and Ascension, the largest non-profit hospital system in US. The hospital was inaugurated in February, 2014 but there were open questions related to pricing of the procedures and the related target patient segment and volumes. Also, HCCI senior management realized the need to adapt the NH model developed in and for India to fit the new environment at Cayman and was open to experimentation in the coming months.

    Keywords: healthcare; emerging economies; innovation; india; institutions; pricing; replication; adoption; adaptation; strategy; Narayana Health; Ascension; Health City Cayman Islands; Dr. Devi Shetty; global strategy; international business; Health Care and Treatment; Innovation Strategy; Innovation and Management; Disruptive Innovation; Cross-Cultural and Cross-Border Issues; Global Strategy; Knowledge Use and Leverage; Management Practices and Processes; Growth Management; Growth and Development Strategy; Market Entry and Exit; Adaptation; Adoption; India; Cayman Islands;


    Khanna, Tarun, and Budhaditya Gupta. "Health City Cayman Islands." Harvard Business School Case 714-510, May 2014. View Details
  9. Vaxess Technologies, Inc.

    In February 2014, Michael Schrader, chief executive of Vaxess Technologies, Inc., was assessing the startup health care company's 2014 marketing plan. On December 31st, 2013, Vaxess had obtained an exclusive license to a series of patents for a silk protein technology that, when added to vaccines, reduced or removed the need for refrigeration between manufacturing and delivery to the end patient. Schrader and his colleagues had to decide on which vaccines to focus and whether and how to target the drug companies that manufactured the vaccines or the quasi-government organizations (such as UNICEF and PAHO) and nongovernment organizations (such as GAVI) that purchased large quantities of vaccines for the developing world.

    Keywords: vaccine; cold chain; antigen; temperature controlled; developing markets; immunization; Health Care and Treatment; Health Pandemics; Global Strategy; Supply Chain; Health; Health Industry; Medical Devices and Supplies Industry;


    Quelch, John A., and Margaret L. Rodriguez. "Vaxess Technologies, Inc." Harvard Business School Case 514-107, May 2014. View Details
  10. Sanofi Pasteur: The Dengue Vaccine Dilemma

    In 2012, Sanofi Pasteur was racing to develop a vaccine against dengue, a mosquito-borne disease, and was evaluating this product in a Phase IIb trial conducted with school children in Thailand. But while the candidate vaccine met the high safety expectations and a good balanced immune answer, it had a proof of efficacy of only 30%, far below the 70% mark the company had targeted. Guillaume Leroy, vice president of the Dengue Company at Sanofi Pasteur, reflected on the Phase IIb trial's surprising outcome and the way forward. He had to decide whether to go ahead with the vaccine trials and production, and if so, needed to develop a strategic plan on how to price and deliver the vaccine for a rapid roll-out.

    Keywords: Health Testing and Trials; Product Launch; Market Entry and Exit; Emerging Markets; Pharmaceutical Industry; France;


    Rangan, V. Kasturi, David E. Bloom, Vincent Dessain, and Emilie Billaud. "Sanofi Pasteur: The Dengue Vaccine Dilemma." Harvard Business School Case 514-074, April 2014. (Revised July 2014.) View Details
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