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. Task Shifting in Surgery: Lessons from an Indian Heart Hospital

    Budhaditya Gupta, Robert S. Huckman and Tarun Khanna

    We present a case study that illustrates task shifting, the transfer of activities from senior to junior colleagues, in the context of cardiac surgery at the Narayana Health City Cardiac Hospital (NH) in India. The case discusses the factors driving the adoption of task shifting at NH and identifies the implications of task shifting for surgeon training, surgical capacity, and procedure costs. A comparison of the outcomes of two senior surgeons with similar experience, workload, and patient profiles—but varying in their level of task shifting—suggests that shifting of lower complexity tasks by senior surgeons to trained junior colleagues does not negatively impact in-hospital mortality and post-procedure length of stay. The study concludes with a discussion of task shifting’s potential to improve access to affordable tertiary care in resource-constrained settings.

    Keywords: Service Delivery; Rank and Position; Health Care and Treatment; Health Industry; India;

    Citation:

    Gupta, Budhaditya, Robert S. Huckman, and Tarun Khanna. "Task Shifting in Surgery: Lessons from an Indian Heart Hospital." Healthcare: The Journal of Delivery Science and Innovation 3, no. 4 (December 2015): 245–250. View Details
  2. Developing Bundled Reimbursement for Cancer Care

    Thomas Feeley, Tracy E. Spinks and Alexis Guzman

    This case study describes the development of a bundled reimbursement pilot for head and neck cancer patients treated at the University of Texas MD Anderson Cancer Center. The study describes the steps involved and the challenges to new alternative payment models in healthcare reimbursement.

    Keywords: Insurance; Health Care and Treatment; Insurance Industry; Health Industry;

    Citation:

    Feeley, Thomas, Tracy E. Spinks, and Alexis Guzman. "Developing Bundled Reimbursement for Cancer Care." NEJM Catalyst (November 25, 2015). View Details
  3. Active Postmarketing Drug Surveillance for Multiple Adverse Events

    Joel Goh, Margrét V. Bjarnadóttir, Mohsen Bayati and Stefanos A. Zenios

    Postmarketing drug surveillance is the process of monitoring the adverse events of pharmaceutical or medical devices after they are approved by the appropriate regulatory authorities. Historically, such surveillance was based on voluntary reports by medical practitioners, but with the widespread adoption of electronic medical records and comprehensive patient databases, surveillance systems that utilize such data are of considerable interest. Unfortunately, existing methods for analyzing the data in such systems ignore the open-ended exploratory nature of such systems that requires the assessment of multiple possible adverse events. In this article, we propose a method, SEQMEDS, that assesses the effect of a single drug on multiple adverse events by analyzing data that accumulate sequentially and explicitly captures interdependencies among the multiple events. The method continuously monitors a vector-valued test-statistic derived from the cumulative number of adverse events. It flags a potential adverse event once the test-statistic crosses a stopping boundary. We employ asymptotic analysis that assumes a large number of observations in a given window of time to show how to compute the stopping boundary by solving a convex optimization problem that achieves a desired Type I error and minimizes the expected time to detection under a pre-specified alternative hypothesis. We apply our method to a model in which the interdependency among the multiple adverse events is captured by a Cox proportional hazards model with time-dependent covariates and demonstrate that it provides an approximation of a fully sequential test for the maximum hazard ratio of the drug over multiple adverse events. A numerical study verifies that our method delivers Type I /II errors that are below pre-specified levels and is robust to distributional assumptions and parameter values.

    Keywords: drug surveillance; health care; stochastic models; queueing; diffusion approximation; Brownian motion; Health;

    Citation:

    Goh, Joel, Margrét V. Bjarnadóttir, Mohsen Bayati, and Stefanos A. Zenios. "Active Postmarketing Drug Surveillance for Multiple Adverse Events." Operations Research 63, no. 6 (November–December 2015): 1528–1546. (Finalist for 2012 Pierskalla Award, INFORMS Health Applications Society.) View Details
  4. Behavioral Hazard in Health Insurance

    Katherine Baicker, Sendhil Mullainathan and Joshua Schwartzstein

    A fundamental implication of standard moral hazard models is overuse of low-value medical care because copays are lower than costs. In these models, the demand curve alone can be used to make welfare statements, a fact relied on by much empirical work. There is ample evidence, though, that people misuse care for a different reason: mistakes or "behavioral hazard." Much high-value care is underused even when patient costs are low, and some useless care is bought even when patients face the full cost. In the presence of behavioral hazard, welfare calculations using only the demand curve can be off by orders of magnitude or even be the wrong sign. We derive optimal copay formulas that incorporate both moral and behavioral hazard, providing a theoretical foundation for value-based insurance design and a way to interpret behavioral "nudges." Once behavioral hazard is taken into account, health insurance can do more than just provide financial protection—it can also improve health care efficiency.

    Keywords: Insurance; Consumer Behavior; Health Care and Treatment; Insurance Industry;

    Citation:

    Baicker, Katherine, Sendhil Mullainathan, and Joshua Schwartzstein. "Behavioral Hazard in Health Insurance." Quarterly Journal of Economics 130, no. 4 (November 2015): 1623–1667. (Online Appendix.) View Details
  5. Exposure to Harmful Workplace Practices Could Account for Inequality in Life Spans Across Different Demographic Groups

    Joel Goh, Jeffrey Pfeffer and Stefanos A. Zenios

    The existence of important socioeconomic disparities in health and mortality is a well-established fact. Many pathways have been adduced to explain inequality in life spans. In this article we examine one factor that has been somewhat neglected: people with different levels of education get sorted into jobs with different degrees of exposure to workplace attributes that contribute to poor health. We used General Social Survey data to estimate differential exposures to workplace conditions, results from a meta-analysis that estimated the effect of workplace conditions on mortality, and a model that permitted us to estimate the overall effects of workplace practices on health. We conclude that 10%–38% of the difference in life expectancy across demographic groups can be explained by the different job conditions their members experience.

    Keywords: occupational health; inequality; life expectancy; socioeconomic issues; Health;

    Citation:

    Goh, Joel, Jeffrey Pfeffer, and Stefanos A. Zenios. "Exposure to Harmful Workplace Practices Could Account for Inequality in Life Spans Across Different Demographic Groups." Health Affairs 34, no. 10 (October 2015): 1761–1768. View Details
  6. Emdeon's Acquisition of Change Healthcare: Innovating Transparency Solutions for Health Care Consumers

    Regina E. Herzlinger, Jeet Guram and Aanchal Raj

    Case describes acquisition of Change Healthcare, which provides health care cost and quality information, by Emdeon, a health information exchange, and discusses health care transparency. Emdeon is a billion-dollar company that has grown through acquisitions; at its core, it transmits health insurance claims and payments between providers and insurers. The health care marketplace is becoming increasingly electronic, but this move comes with risks. Increased consumerism in health care is creating a need for information on cost and quality. Change Healthcare responds to this need and markets primarily to health insurers. The company has unique ways to drive enrollee engagement. However, the transparency space is becoming competitive, with entrants from public and private sources. In this shifting environment, Emdeon must decide how best to integrate Change.

    Keywords: healthcare; healthcare industry; healthcare innovation; Health Care and Treatment; United States;

    Citation:

    Herzlinger, Regina E., Jeet Guram, and Aanchal Raj. "Emdeon's Acquisition of Change Healthcare: Innovating Transparency Solutions for Health Care Consumers." Harvard Business School Case 316-026, September 2015. View Details
  7. Is Mandatory Nonfinancial Performance Measurement Beneficial?

    Susanna Gallani, Takehisa Kajiwara and Ranjani Krishnan

    We use value of information theory and examine the effect of regulation requiring mandatory measurement and peer disclosure of nonfinancial performance information in the hospital industry. We posit that mandatory nonfinancial performance measurement has an information effect and a referent performance effect. The information (referent performance) effect arises because the new performance signals induce more precise posterior beliefs about individual (relative) performance. Using panel data from the Japanese National Hospital Organization, we analyze performance improvements following regulation requiring standardized measurement and peer disclosure of absolute and relative patient satisfaction performance. After controlling for ceiling effects, bounded dependent variables, and regression to the mean, results show that mandatory nonfinancial performance information measurement and peer disclosure improves overall performance (information effect) with larger improvements for poorly performing hospitals (referent performance effect). These effects are found even in the absence of any compensation-based incentives to improve performance.

    Keywords: value of information; patient satisfaction; mandatory performance measurement; health care; Information; Health Care and Treatment; Performance Evaluation; Health Industry;

    Citation:

    Gallani, Susanna, Takehisa Kajiwara, and Ranjani Krishnan. "Is Mandatory Nonfinancial Performance Measurement Beneficial?" Harvard Business School Working Paper, No. 16-018, August 2015. View Details
  8. Blinded by Experience: Prior Experience, Negative News and Belief Updating

    Bradley R. Staats, Diwas S. KC and Francesca Gino

    Traditional models of operations management involve dynamic decision-making assuming optimal (Bayesian) updating. However, behavioral theory suggests that individuals exhibit bias in their beliefs and decisions. We conduct both a field study and two laboratory studies to examine the phenomena in the context of health. In particular, we examine how an individual's prior experiences and the experiences of those around them alter the operational decisions that the individual makes. We draw on an exogenous announcement of negative news by the Food and Drug Administration (FDA) and explore how this affects an operational decision—production tool choice—of interventional cardiologists deciding between two types of cardiac stents. Analyzing 147,000 choices over 6 years, we find that individuals do respond to negative news by using the focal production tool less often. However, we find that both individual's own experience and others' experience alter their responses in predictable ways. Moreover, although individual and other experience act as substitutes prior to negative news, the two types of experience act as complements following the negative announcement—leading to even greater use of the same production tool. Two controlled lab studies replicate our main findings and show that behavioral biases, not rational expectations, drive the effect. Our research contributes not only to operations management research, but also to the practice of healthcare and operations more generally.

    Keywords: behavioral operations; egocentric bias; experience; healthcare Operations; Prejudice and Bias; Behavior; Operations; Decision Making; Health Care and Treatment;

    Citation:

    Staats, Bradley R., Diwas S. KC, and Francesca Gino. "Blinded by Experience: Prior Experience, Negative News and Belief Updating." Harvard Business School Working Paper, No. 16-015, August 2015. View Details
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