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.

Featured Works

Supplement | HBS Case Collection | February 2015
The Affordable Care Act (A): Legislative Strategy in the House of Representatives
Joseph L. Bower and Michael Norris
In early 2009, the Obama administration and the Democratically-led Congress began working on what would eventually become the Affordable Care Act. The (A) case in this series discusses the legislative strategy in the House of Representatives, where three different committees each had jurisdiction over health care legislation.
Keywords: health care; health care policy; Government and Politics; Government Administration; Health Care and Treatment; Health Industry; United States;

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act (A): Legislative Strategy in the House of Representatives." Harvard Business School Supplement 315-032, February 2015. View Details
Cite View Details Purchase Related
Blog Post | Health Affairs Blog
Innovation in Health Care Education: A Call to Action
Regina E. Herzlinger, Vasant Kumar, Kevin Schulman and Karen Staman
Health care administration educators are at a crossroads: the health care sector is rife with inefficiencies, erratic quality, unequal access, and sky-high costs, complex problems which call for innovative solutions, and yet, according to our content analysis of top U.S. health administration schools and a recent article in the Lancet, our educational systems focus their curricula on isolated,theoretical subjects, such as analytics and quantitative problem solving, rather than the team-oriented, practical problem-solving skills required for innovation. All too often, when graduates of these programs enter the workforce, they find themselves unequipped to meet the challenges for innovation of 21st century health care.
Keywords: health care; health care education; Education; Health; Health Care and Treatment; Health Industry; Education Industry;

Citation:
Herzlinger, Regina E., Vasant Kumar, Kevin Schulman, and Karen Staman. "Innovation in Health Care Education: A Call to Action." Health Affairs Blog (January 29, 2015). http://healthaffairs.org/blog/2015/01/29/innovation-in-health-care-education-a-call-to-action/. View Details
Cite View Details Read Now Related
Article | Journal of Public Economics | December 2014
No Margin, No Mission? A Field Experiment on Incentives for Public Services Delivery
Nava Ashraf, Oriana Bandiera and B. Kelsey Jack
A substantial body of research investigates the effect of pay for performance in firms, yet less is known about the effect of non-financial rewards, especially in organizations that hire individuals to perform tasks with positive social spillovers. We conduct a field experiment in which agents recruited by a public health organization to sell condoms are randomly allocated to four groups. Agents in the control group are hired as volunteers, whereas agents in the three treatment groups receive, respectively, a small monetary margin on each pack sold, a large margin, and a non-financial reward. The analysis yields three main findings. First, non-financial rewards are more effective at eliciting effort than either financial rewards or the volunteer contract and are also the most cost-effective of the four schemes. Second, non-financial rewards leverage intrinsic motivation and, contrary to existing laboratory evidence, financial incentives do not appear to crowd it out. Third, the responses to both types of incentives are stronger when their relative value is higher. Indeed, financial rewards are effective at motivating the poorest agents, and non-financial rewards are more effective when the peer group is larger. Overall, the findings demonstrate the power of non-financial rewards to motivate agents in settings where there are limits to the use of financial incentives.
Keywords: incentives; non-monetary rewards; intrinsic motivation; Motivation and Incentives; Employees; Service Industry; Health Industry;

Citation:
Ashraf, Nava, Oriana Bandiera, and B. Kelsey Jack. "No Margin, No Mission? A Field Experiment on Incentives for Public Services Delivery." Journal of Public Economics 120 (December 2014): 1–17. View Details
Cite View Details Find at Harvard Read Now Related
Case | HBS Case Collection | August 2001 (Revised January 2015)
SonoSite: A View Inside
Clayton Christensen and Jeremy Dann
After its spin-off from one of the world's largest ultrasound makers, Sonosite attempts to popularize a new kind of handheld ultrasound units. Sonosite needs to decide if it should focus on new markets that will value the portability and ease of use of its products, or if it should evolve its offerings so that they appeal to radiologists and cardiologists, the largest purchasers of ultrasound systems.
Keywords: Customers; Disruptive Innovation; Product Positioning; Demand and Consumers;

Citation:
Christensen, Clayton, and Jeremy Dann. "SonoSite: A View Inside." Harvard Business School Case 602-056, August 2001. (Revised January 2015.) View Details
Cite View Details Educators Purchase Related
Case | HBS Case Collection | March 2014 (Revised December 2014)
Vision 2020: Takeda and the Vaccine Business
John A. Quelch and Margaret L. Rodriguez
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 Business." Harvard Business School Case 514-084, March 2014. (Revised December 2014.) View Details
Cite View Details Educators Purchase Related
Case | HBS Case Collection | August 2015 (Revised August 2015)
Hoag Orthopedic Institute
Robert S. Kaplan and Jonathan Warsh
Two groups of orthopedic surgeons form a joint venture with a community hospital to establish Hoag Orthopedic Institute, a for-profit hospital and two ambulatory service centers. By controlling and integrating all aspects of the patients' medical treatment, the physicians deliver superior outcomes, which they communicate with an annual public outcomes report. They also introduce bundled payment contracts with three insurers for orthopedic surgeries, and join a multi-hospital study for applying time-driven activity-based costing to identify process improvement and cost reduction opportunities. The case concludes with HOI leaders examining several options for expansion and growth.
Keywords: outcomes measurement; bundled payment; health care; competitive strategy; activity-based costing and management; measurement and metrics; Measurement and Metrics; Activity Based Costing and Management; Competitive Strategy; Medical Specialties; Health Care and Treatment; Outcome or Result; Health Industry;

Citation:
Kaplan, Robert S., and Jonathan Warsh. "Hoag Orthopedic Institute." Harvard Business School Case 115-023, August 2015. (Revised August 2015.) View Details
Cite View Details Educators Purchase Related

Recent Publications

Article | Annals of Internal Medicine | 2010
Estimating the Attributable Cost of Physician Burnout in the United States
Shasha Han, Tait D. Shanafelt, Christine A. Sinsky, Karim M. Awad, Liselotte N. Dyrbye, Lynne C. Fiscus, Mickey Trockel and Joel Goh
Background: Although physician burnout is associated with negative clinical and organizational outcomes, its economic costs are poorly understood. As a result, leaders in health care cannot properly assess the financial benefits of initiatives to remediate physician burnout.
Objective: To estimate burnout-associated costs related to physician turnover and physicians reducing their clinical hours at national (U.S.) and organizational levels.
Design: Cost-consequence analysis using a mathematical model.
Setting: United States.
Participants: Simulated population of U.S. physicians.
Measurements: Model inputs were estimated by using the results of contemporary published research findings and industry reports.
Results: On a national scale, the conservative base-case model estimates that approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States. This estimate ranged from $2.6 billion to $6.3 billion in multivariate probabilistic sensitivity analyses. At an organizational level, the annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7600 per employed physician each year.
Limitations: Possibility of nonresponse bias and incomplete control of confounders in source data. Some parameters were unavailable from data and had to be extrapolated.
Conclusion: Together with previous evidence that burnout can effectively be reduced with moderate levels of investment, these findings suggest substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians.
Keywords: Physicians; burnout; Health; Health Care and Treatment; Employees; Cost; Programs; Policy; Health Industry;

Citation:
Han, Shasha, Tait D. Shanafelt, Christine A. Sinsky, Karim M. Awad, Liselotte N. Dyrbye, Lynne C. Fiscus, Mickey Trockel, and Joel Goh. "Estimating the Attributable Cost of Physician Burnout in the United States." Annals of Internal Medicine 170, no. 11 (June 4, 2019): 784–790. View Details
Cite View Details Read Now Related
Article | Harvard Business Review (website) | May 16, 2019
To Improve Food Inspections, Change the Way They're Scheduled
Maria Ibanez and Michael W. Toffel
Health inspections are an important tool to increase food safety, but there are still 48 million cases of food-borne illnesses and 128,000 hospitalizations every year in the United States. Our research finds that inspectors reported fewer health code violations as they conducted subsequent inspections throughout the day, and even fewer violations at inspections that risked prolonging their work day. Also, inspectors reported more code violations when the previous establishment the inspector visited had many violations. Based on these patterns, we propose scheduling adjustments that would increase inspectors’ scrutiny and significantly reduce food-borne illnesses and hospitalizations.
Keywords: inspection; scheduling; Food; Safety; Health; Governing Rules, Regulations, and Reforms; Performance Improvement;

Citation:
Ibanez, Maria, and Michael W. Toffel. "To Improve Food Inspections, Change the Way They're Scheduled." Harvard Business Review (website) (May 16, 2019). View Details
Cite View Details Read Now Related
Article | Journal of Medical Economics | 2019
Time-Driven Activity-Based Cost Analysis for Outpatient Anticoagulation Therapy: Direct Costs in a Primary Care Setting with Optimal Performance
Robert S. Kaplan, Rohit A. Bobade, Richard A. Helmers, Thomas M. Jaeger, Laura J. Odell and Derek A. Haas
Objectives: To determine how overall cost of anticoagulation therapy for warfarin compares with that of Novel Oral Anticoagulants (NOACs). Also, to demonstrate a scientific, comprehensive, and an analytical approach to estimate direct costs involved in monitoring and management of anticoagulation therapy for outpatients in an academic primary care clinic setting, post-initiation of therapy.

Methods: Time-Driven Activity-Based Costing (TDABC) was applied in a population-based cross-sectional study at Mayo Clinic’s warfarin anticoagulation clinic. The study measured the personnel and supplies costs to monitor and manage anticoagulation therapy for 5,526 patients.

Results: The cost of warfarin management for patients who display unstable International Normalized Ratio (INR) is more than three times those who display stable INR over time. For complex anticoagulation patients, the total cost of medication and monitoring for warfarin anticoagulation therapy is similar to that for NOACs.

Conclusion: Despite warfarin being significantly less expensive to purchase than NOACs, overall warfarin management incurs higher costs due to laboratory monitoring and provider time than NOACs. NOAC treatment, therefore, may not be more expensive than warfarin therapy management for complex anticoagulation patients.
Keywords: Time-Driven Activity-Based Costing; Activity Based Costing and Management; Health Care and Treatment; Analysis;

Citation:
Kaplan, Robert S., Rohit A. Bobade, Richard A. Helmers, Thomas M. Jaeger, Laura J. Odell, and Derek A. Haas. "Time-Driven Activity-Based Cost Analysis for Outpatient Anticoagulation Therapy: Direct Costs in a Primary Care Setting with Optimal Performance." Journal of Medical Economics 22, no. 5 (2019): 471–477. View Details
Cite View Details Purchase Related
Working Paper | 2019
Treatment for Commercially Insured Patients with Opioid Use Disorder in the U.S.: What Are We Doing, and What Should We Be Doing?
Leemore S. Dafny, Karen Shen and Eric Barrette
Keywords: Health Care and Treatment; Health Disorders; Health Industry; United States;

Citation:
Dafny, Leemore S., Karen Shen, and Eric Barrette. "Treatment for Commercially Insured Patients with Opioid Use Disorder in the U.S.: What Are We Doing, and What Should We Be Doing?" Working Paper, April 2019. View Details
Cite View Details Related
Working Paper | 2019
Throwing the Baby Out with the Drinking Water: Unintended Consequences of Arsenic Mitigation Efforts in Bangladesh
Nina Buchmann, Erica Field, Rachel Glennerster and Reshmaan Hussam
The 1994 discovery of arsenic in ground water in Bangladesh prompted a massive public health effort to test all tubewells in the country and convince nearly one-quarter of the population to switch to arsenic-free drinking water sources. According to numerous sources, the campaign was effective in leading the majority of households at risk of arsenic poisoning to abandon backyard wells in favor of more remote tubewells or surface water sources, a switch widely believed to have saved numerous lives. We investigate the possibility of unintended health consequences of the wide-scale abandonment of shallow tubewells due to higher exposure to fecal-oral pathogens in water from arsenic-free sources. Significant small-scale variability of arsenic concentrations in ground water allows us to compare trends in infant and child mortality between otherwise similar households in the same village who did and did not have an incentive to abandon shallow tubewells. While child mortality rates were similar among households with arsenic-contaminated and arsenic-free wells prior to public knowledge of the arsenic problem, post-2000 households living on arsenic-contaminated land have 27% higher rates of infant and child mortality than those not encouraged to switch sources, implying that the campaign doubled mortality from diarrheal disease. These findings provide novel evidence of a strong association between drinking water contamination and child mortality, a question of current scientific debate in settings with high levels of exposure to microbial pathogens through other channels.
Keywords: child mortality; Arsenic; Unintended Consequences; Health Disorders; Safety; Outcome or Result; Bangladesh;

Citation:
Buchmann, Nina, Erica Field, Rachel Glennerster, and Reshmaan Hussam. "Throwing the Baby Out with the Drinking Water: Unintended Consequences of Arsenic Mitigation Efforts in Bangladesh." NBER Working Paper Series, No. 25729, April 2019. View Details
Cite View Details Read Now Related
Case | HBS Case Collection | March 2019
HelloSelf: Foundation
John R. Wells and Benjamin Weinstock
On January 6, 2019, HelloSelf, a London-based “BrainTech” company, founded a year earlier by Charles Wells, soft launched. The proposition was simply to help its members “Be your Best Self.” The company provided its registered members with access to a clinical psychotherapist, a life coach, and an AI engine that personalized advice. The platform provided members with the ability to set goals, track progress, and discover new things about themselves. Throughout the previous nine months, over 500 people had registered interest in the proposition, price points had been tested, competitors analyzed, members and specialists interviewed, and wireframes developed, but there were several questions still crossing Wells’ mind. Did the subscription LifeCoach bot model combined with pay-as-you-go therapist sessions make sense? How could he attract an early cohort of users? How would HelloSelf interact with the broken mental health solutions in the UK? How quickly would the platform scale and learn to provide meaningful AI support for both therapists and the LifeCoach bot? And most importantly, would the platform deliver on the mission “to help everyone discover, understand and experience their Best Self”?
Keywords: Startup; start-up; startup management; startup marketing; Startups; start-ups; BrainTech; marketing research; strategic decision making; strategy development; strategy dynamics; neuroscience; cognition; Cognitive psychology; health ＆ wellness; health care; health care reform; health care outcomes; self-awareness; mental health; wellbeing; well-being; wellness; funding; equity financing; Raising Capital; synergies; Team building; national health insurance; artificial intelligence; MVP; Business Startups; Health; Health Care and Treatment; Management; Marketing; Marketing Channels; Decision Making; Strategy; Technology; United Kingdom; London;

Citation:
Wells, John R., and Benjamin Weinstock. "HelloSelf: Foundation." Harvard Business School Case 719-492, March 2019. View Details
Cite View Details Educators Related
Case | HBS Case Collection | March 2019 (Revised April 2019)
Gilead: Hepatitis C Access Strategy (A) (Abridged)
V. Kasturi Rangan, Vikram Rangan and David E. Bloom
Gilead had come up with an innovative drug for Hepatitis C, which affected 180 million people worldwide. The drug was priced at $1,000 a pill for the US market. Gilead had to decide how to price and market the pill in developing countries that bore the brunt of the disease. The company had earned accolades for its work in HIV/AIDS, where its innovative medicines now accounted for 60% of all patients on Anti-Retroviral (ARV) medicines. Much of this was accomplished through generic licensing, which brought a $10,000/year treatment regimen down to $100! Should the company replicate that strategy for Hepatitis C? If so, how would its US Healthcare customers, who were paying $84,000 per patient, react? On the other hand, Gilead had to balance the interests of its shareholders, who paid $11 billion for an acquisition that led to the new Hepatitis C drug.
Keywords: healthcare; Pharmaceuticals; pricing; Access to care; Emerging Markets; Health Care and Treatment; Price; Strategy; Ethics; Health Industry; Pharmaceutical Industry;

Citation:
Rangan, V. Kasturi, Vikram Rangan, and David E. Bloom. "Gilead: Hepatitis C Access Strategy (A) (Abridged)." Harvard Business School Case 519-077, March 2019. (Revised April 2019.) View Details
Cite View Details Educators Related
Case | HBS Case Collection | March 2019
The DivaCup: Navigating Distribution and Growth
Ayelet Israeli
When the mother-daughter founders of DivaCup set out with a mission to disrupt the menstrual care industry with an innovative product form, they initially struggled to gain legitimacy and convince retailers to carry their unique product. Fifteen years later, the product was available online and in more than 35,000 retail stores worldwide, and the company was struggling with omnichannel distribution challenges and frequent violations of their pricing policy due to intense competition among channel partners. International distribution and the prevalence of gray market sellers were causing large price dispersions across markets, which was harming the brand further. In October 2018, the entry of a formidable competitor, P&G (owner of menstrual care brands Tampax and Always), into the niche product segment causes the CEO and her team to consider the best plan to reposition and differentiate its product to broaden its appeal to users of other product forms, while maintaining its market leadership in the menstrual cup segment. This challenge is made more difficult due to prevalent miseducation about menstrual care and menstrual cups in particular.
Keywords: female; female ceo; Female Entrepreneur; female protagonist; health ＆ wellness; healthcare; price policies; minimum advertised price; differentiation; positioning; Growth; Health; Health Care and Treatment; Price; Disruption; Distribution; Distribution Channels; Competitive Strategy; Competition; Growth Management; Mission and Purpose; Product Development; Product Marketing; Product Launch; Product Positioning; Advertising; Business Startups; Internet; Entrepreneurship; Social Entrepreneurship; Social Issues; Social Enterprise; Retail Industry; Medical Devices and Supplies Industry; Manufacturing Industry; Health Industry; Green Technology Industry; Education Industry; Distribution Industry; Consumer Products Industry; Canada; United States; United Kingdom;

Citation:
Israeli, Ayelet. "The DivaCup: Navigating Distribution and Growth." Harvard Business School Case 519-055, March 2019. View Details
Cite View Details Educators Related
Working Paper | HBS Working Paper Series | 2019
Can Biometric Tracking Improve Healthcare Provision and Data Quality? Experimental Evidence from Tuberculosis Control in India
Thomas Bossuroy, Clara Delavallade and Vincent Pons
Developing countries increasingly use biometric identification technology to improve the reliability of administrative information and deliver social services more efficiently. This paper exploits the random placement of biometric devices in tuberculosis (TB) treatment centers in urban slums across four Indian states. The devices record health worker attendance and patient adherence to protocol, and they automatically prompt follow-up treatment. We combine data from surveys, independent field visits, and government registers to identify impacts on TB-control outcomes and the quality of data. First, we find that patients enrolled at centers with biometric monitoring are 25% less likely to interrupt their treatment than those at regular centers—an improvement driven by increased attendance and efforts by health workers and greater protocol adherence by patients. Second, the biometric devices decrease overreporting of patient numbers in both NGO data and government registers by 20% and underreporting of treatment interruptions by 25%. We find no effect on worker or patient satisfaction. This suggests biometric technology is both an effective and sustainable way to improve the state capacity to deliver healthcare in challenging areas.
Keywords: biometric technology; Health Care and Treatment; Technological Innovation; Data and Data Sets; Quality; Performance Improvement; India;

Citation:
Bossuroy, Thomas, Clara Delavallade, and Vincent Pons. "Can Biometric Tracking Improve Healthcare Provision and Data Quality? Experimental Evidence from Tuberculosis Control in India." Harvard Business School Working Paper, No. 19-077, March 2019. View Details
Cite View Details Read Now Related
Working Paper | HBS Working Paper Series | 2019
Formal Employment and Organized Crime: Regression Discontinuity Evidence from Colombia
Gaurav Khanna, Carlos Medina, Anant Nyshadham and Jorge Tamayo
Canonical models of criminal behavior highlight the importance of economic incentives and employment opportunities in determining participation in crime (Becker, 1968). Yet, deriving causal corroborating evidence from individual-level variation in employment incentives has proven challenging. We link rich administrative micro-data on socioeconomic measures of individuals with the universe of criminal arrests in Medellin over a decade. We test whether increasing the relative costs to formal-sector employment led to more crime. We exploit exogenous variation in formal employment around a socioeconomic score cutoff, below which individuals receive generous health benefits if not formally employed. Our regression discontinuity estimates show that this popular policy induced a fall in formal-sector employment and a corresponding spike in organized crime. This relationship is stronger in neighborhoods with more opportunities for organized crime. There are no effects on less economically motivated crimes.
Keywords: Gangs; informality; Medellin; Economic Sectors; Crime and Corruption; Health Care and Treatment; Policy; Colombia;

Citation:
Khanna, Gaurav, Carlos Medina, Anant Nyshadham, and Jorge Tamayo. "Formal Employment and Organized Crime: Regression Discontinuity Evidence from Colombia." Harvard Business School Working Paper, No. 19-099, March 2019. View Details
Cite View Details Read Now Related

See all faculty publications on Healthcare »

Faculty & Research

Featured Works

Initiatives & Projects

Faculty

HBS Working Knowledge

Harvard Business Publishing