Health Care
Health Care
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.
Initiatives & Projects
The Health Care Initiative and the Social Enterprise Initiative connect students, alumni, faculty, and practitioners to ideas, resources, and opportunities for collaboration that yield innovative models for health care practice.
Health CareSocial EnterpriseRecent Publications
Natura: Weathering the Pandemic at Brazil's Cosmetic Giant
By: Brian Trelstad, Pedro Levindo and Carla Larangeira
- January 2023 |
- Case |
- Faculty Research
Brazil's Natura, a multi-brand cosmetics group, has taken several measures to safeguard the livelihoods of its thousands of employees and millions of sales representatives during the COVID-19 health and economic crisis. The company has also made strides in its efforts to increase digital sales. Now the purpose-driven group must decide whether to vocalize its opposition to private companies buying COVID-19 vaccines to inoculate their employees before priority groups in Brazil's public health system.
Keywords: COVID-19 Pandemic; ESG Reporting; Acquisition; Customer Focus and Relationships; Decision Making; Social Entrepreneurship; Environmental Sustainability; Environmental Management; Climate Change; Ethics; Moral Sensibility; Values and Beliefs; Global Strategy; Corporate Governance; Health Pandemics; Human Resources; Human Capital; Crisis Management; Growth and Development Strategy; Marketing; Distribution Channels; Supply Chain; Corporate Social Responsibility and Impact; Mission and Purpose; Organizational Culture; Customer Ownership; Relationships; Business and Community Relations; Business and Stakeholder Relations; Networks; Partners and Partnerships; Science-Based Business; Reputation; Human Needs; Social Issues; Strategy; Equality and Inequality; Beauty and Cosmetics Industry; Brazil; Latin America
The END Fund: To Eliminate Neglected Tropical Diseases
By: V. Kasturi Rangan and Courtney Han
- January 2023 |
- Case |
- Faculty Research
Founded in 2012, the END fund focused on eliminating five Neglected Tropical Diseases that accounted for 80% of the tropical diseases affecting nearly 1.5 billion people worldwide. Its roughly $25 million/year annual budget was fully committed when it got news that the British Government would be cutting back its funding for the sector, putting at risk nearly 50,000 people for a tropical disease (visceral leishmaniasis-VL), which the End Fund was currently not addressing. The case question is whether the End Fund should redirect its resources to VL. The case highlights the difficult decisions that noprofits have to make balancing resource stretch and mission focus.
Cleave Therapeutics: Taking a Risk on Oncology Drug Discovery
By: Regina Herzlinger and Brian Walker
- January 2023 |
- Case |
- Faculty Research
How can a successful executive assess her next move as the CEO of a firm with a promising and yet uncertain new drug? Amy Burroughs’ mandate to find a therapeutic window for Cleave Therapeutics oncology drug was on track but faced an uncertain future. Overseeing the human trials of a refined second-generation drug candidate, Amy had led the company back from the “valley of death” after Cleave’s initial offering resulted in off-target toxicity. Still, after completing multiple dose escalation cohorts, Cleave’s scientists told Amy that they could not draw any definitive conclusions about the benefits of the drug. Amy and her team knew the importance of speed and capital in the high-risk business of oncology drug development where success often takes more resources and time than expected and competitors lurk. Nearing the close of a five-year investment window, should the thinly staffed Cleave 2.0 continue to recruit patients and clear dosing cohorts at a rapid rate, or should Amy prioritize funding and partnership discussions?
Achieving Universal Health Insurance Coverage in the United States: Addressing Market Failures or Providing a Social Floor?
By: Katherine Baicker, Amitabh Chandra and Mark Shepard
- 2023 |
- Working Paper |
- Faculty Research
The United States spends substantially more on health care than most developed countries, yet leaves a greater share of the population uninsured. We suggest that incremental insurance expansions focused on addressing market failures will propagate inefficiencies and are not likely to facilitate active policy decisions that align with societal coverage goals. By instead defining a basic bundle of services that is publicly financed for all, while allowing individuals to purchase additional coverage, policymakers could both expand coverage and maintain incentives for innovation, fostering universal access to innovative care in an affordable system.
Post-market Surveillance of Software Medical Devices: Evidence from Regulatory Data
By: Alexander O. Everhart and Ariel D. Stern
- 2022 |
- Working Paper |
- Faculty Research
Medical devices increasingly include software components, which facilitate remote patient monitoring. The introduction of software into previously analog medical devices as well as innovation in software-driven devices may introduce new safety concerns—all the more so when such devices are used in patients’ homes, well outside of traditional health care delivery settings. We review four key mechanisms for post-market surveillance of medical devices in the United States: (1) post-market trials and registries; (2) manufacturing plant inspections; (3) adverse event reporting; and (4) recalls. We use comprehensive regulatory data documenting adverse events and recalls to describe trends in the post-market safety of medical devices based on the presence or absence of software. Overall, devices with software are associated with more reported adverse events (i.e., individual injuries and deaths) and more high-severity recalls, as compared to devices without software. However, in subgroup analyses of individual medical specialties, we consistently observe differences in recall probability but do not consistently detect differences in adverse events. These results suggest that adverse events are a noisy signal of post-market safety and not necessarily a reliable predictor of subsequent recalls. As patients and health care providers weigh the benefits of new remote monitoring technologies against potential safety issues, they should not assume that safety concerns will be readily identifiable through existing post-market surveillance mechanisms. Both health care providers and developers of remote patient monitoring technologies should therefore consider how they might proactively ensure that newly introduced remote patient monitoring technologies work safely and as intended.
Investigating the Association Between Telemedicine Use and Timely Follow-Up Care After Acute Cardiovascular Hospital Encounters
By: Mitchell Tang, A Jay Holmgren, Erin E. McElrath, Ankeet S. Bhatt, Anubodh S. Varshney, Simin Gharib Lee, Muthiah Vaduganathan, Dale S. Adler and Robert S. Huckman
- 2022 |
- Article |
- JACC: Advances
Background: Telemedicine use increased dramatically during the COVID-19 pandemic; however, questions remain as to how telemedicine use impacts care.
Objectives: The purpose of this study was to examine the association of increased telemedicine use on rates of timely follow-up and unplanned readmission after acute cardiovascular hospital encounters.
Methods: We examined hospital encounters for acute coronary syndrome, arrhythmia disorders, heart failure (HF), and valvular heart disease from a large U.S., multisite, integrated academic health system among patients with established cardiovascular care within the system. We evaluated 14-day postdischarge follow-up and 30-day all-cause unplanned readmission rates for encounters from the pandemic “steady state” period from May 24, 2020 through December 31, 2020, when telemedicine use was high and compared them to those of encounters from the week-matched period in 2019 (May 26, 2019, through December 31, 2019), adjusting for patient and encounter characteristics.
Results: The study population included 6,026 hospital encounters. In the pandemic steady-state period, 40% of follow-ups after these encounters were conducted via telemedicine vs 0% during the week-matched period in 2019. Overall, 14-day follow-up rates increased from 41.7% to 44.9% (adjusted difference: +2.0 percentage points [pp], 95% CI: -1.1 to +5.1 pp, P = 0.20). HF encounters experienced the largest improvement from 50.1% to 55.5% (adjusted difference: +6.5 pp, 95% CI: +0.5 to +12.4 pp, P = 0.03). Overall 30-day all-cause unplanned readmission rates fell slightly, from 18.3% to 16.9% (adjusted difference -1.6 pp; 95% CI: -4.0 to +0.8 pp, P = 0.20).
Conclusions: Increased telemedicine use during the COVID-19 pandemic was associated with earlier follow-ups, particularly after HF encounters. Readmission rates did not increase, suggesting that the shift to telemedicine did not compromise care quality.
Objectives: The purpose of this study was to examine the association of increased telemedicine use on rates of timely follow-up and unplanned readmission after acute cardiovascular hospital encounters.
Methods: We examined hospital encounters for acute coronary syndrome, arrhythmia disorders, heart failure (HF), and valvular heart disease from a large U.S., multisite, integrated academic health system among patients with established cardiovascular care within the system. We evaluated 14-day postdischarge follow-up and 30-day all-cause unplanned readmission rates for encounters from the pandemic “steady state” period from May 24, 2020 through December 31, 2020, when telemedicine use was high and compared them to those of encounters from the week-matched period in 2019 (May 26, 2019, through December 31, 2019), adjusting for patient and encounter characteristics.
Results: The study population included 6,026 hospital encounters. In the pandemic steady-state period, 40% of follow-ups after these encounters were conducted via telemedicine vs 0% during the week-matched period in 2019. Overall, 14-day follow-up rates increased from 41.7% to 44.9% (adjusted difference: +2.0 percentage points [pp], 95% CI: -1.1 to +5.1 pp, P = 0.20). HF encounters experienced the largest improvement from 50.1% to 55.5% (adjusted difference: +6.5 pp, 95% CI: +0.5 to +12.4 pp, P = 0.03). Overall 30-day all-cause unplanned readmission rates fell slightly, from 18.3% to 16.9% (adjusted difference -1.6 pp; 95% CI: -4.0 to +0.8 pp, P = 0.20).
Conclusions: Increased telemedicine use during the COVID-19 pandemic was associated with earlier follow-ups, particularly after HF encounters. Readmission rates did not increase, suggesting that the shift to telemedicine did not compromise care quality.
Collaborative Rooming: An Innovative Pilot Project to Overcome Primary Care Challenges
By: Gagandeep Singh, Jill G. Lenhart, Richard A. Helmers, Michele Renee Eberlee, Heather Costley, Joel B. Roberts and Robert S. Kaplan
- December 2022 |
- Article |
- Wisconsin Medical Journal
Primary care physicians are overburdened with growing complexities and increasing expectations for primary care visits. To meet expectations, primary care physicians must multitask during visits and spend extra hours in the office for charting, billing, and documentation. This impacts the physician’s quality of life and may affect the quality of patient care. Many of the administrative tasks performed by physicians could, alternatively, be performed by nonphysician staff, leading to the adoption of team-based collaborative models.
The Regulation of Medical AI: Policy Approaches, Data, and Innovation Incentives
By: Ariel Dora Stern
- 2022 |
- Working Paper |
- Faculty Research
For those who follow health and technology news, it is difficult to go more than a few days without reading about a compelling new application of Artificial Intelligence (AI) to health care. AI has myriad applications in medicine and its adjacent industries, with AI-driven tools already in use in basic science, translational medicine, and numerous corners of health care delivery, including administrative work, diagnosis, and treatment. In diagnosis and treatment, a large and growing number of AI tools meet the statutory definition of a medical device or that of an in-vitro diagnostic. Those that do are subject to regulation by local authorities, resulting in both practical and strategic implications for manufacturers, along with a more complex set of innovation incentives. This chapter presents background on medical device regulation—especially as it relates to software products—and quantitatively describes the emergence of AI among FDA-regulated products. The empirical section of this chapter explores characteristics of AI-supported/driven medical devices (“AI devices”) in the United States. It presents data on their origins (by firm type and country), their safety profiles (as measured by associated adverse events and recalls), and concludes with a discussion of the implications of regulation for innovation incentives in medical AI.
Cost Standard Set Program: Moving Forward to Standardization of Cost Assessment Based on Clinical Condition
By: Anna Paula Beck da Silva Etges, Richard D. Urman, Anne Geubelle, Robert Kaplan and Carisi Anne Polanczyk
- December 2022 |
- Article |
- Journal of Comparative Effectiveness Research
This communication announces the International Cost Standard Set Program. Its goal is to establish global standardized frameworks for measuring the costs of treating specific clinical conditions. A scientific committee, including 16 international healthcare cost assessment experts, met in Lisbon for a first scientific meeting, followed by an international conference at which time-driven activity-based costing applied studies were shared with the community. The cost standard set program will offer standardized instruments to measure, using real-world data, the financial impact of having access to health technologies, improving the ability to evaluate inequitable distribution and access to health care resources. Such advances might represent a paradigm shift in our ability to generate cost information on an individual level.
Distributing a Billion Vaccines: COVAX Successes, Challenges, and Opportunities
By: Eric Budish, Hannah Kettler, Scott Duke Kominers, Erik Osland, Canice Prendergast and Andrew A. Torkelson
- Winter 2022 |
- Article |
- Oxford Review of Economic Policy
By January 2022, the COVAX international vaccine collaboration had allocated over a billion vaccines to over 140 countries. We describe and review the allocation process chosen, which reflected both an objective of equitably distributing vaccines across the world and the need to fund that mission. We show how vaccine supply limitations and constraints on some countries’ absorptive capacity have affected overall allocative outcomes. We also discuss market design approaches that were considered but not implemented, including the use of an exchange mechanism to better match countries’ vaccine allocations to their preferences, as well as a vaccine brokerage under which countries could sell excess vaccines to countries with ongoing need. Our analysis addresses some criticisms of COVAX, and offers suggestions for agencies organizing global vaccine cooperation for future pandemics.