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
Health Care Innovation Opportunities Created by COVID-19 and How to Make Them Happen
- 3 Jun 2023 |
- Talk |
- Faculty Research
The crush of patients created by COVID enabled the creation of sites for care outside the traditional hospital, such as retail pharmacies, ambulatory surgery centers, urgent care centers, telemedicine, and wireless sensors. Public policy mirrored these changes by allowing access to telemedicine and pharmaceuticals by mail and by redefining care of the home as an insured benefit and the ownership role of physicians. Some newly public health insurers added technology as a major asset, and VCs and PEs invested heavily in these new businesses. How sustainable is this new health care system, and what opportunities and risks does it create for patients, employers, and investors?
Decarbonizing Health Care: Engaging Leaders in Change
By: Vivian S. Lee, Kathy Gerwig, Emily Hough, Kedar Mate, Robert Biggio and Robert S. Kaplan
- May 2023 |
- Article |
- NEJM Catalyst Innovations in Care Delivery
Health care leaders are often surprised to learn that their operations contribute
significantly to a warming climate. In addition to their roles as responders to and victims
of extreme weather events, health care organizations have an obligation to reduce their
substantial greenhouse gas emissions as part of their overall mission to do no harm and
to improve health. Representing close to one fifth of the U.S. gross domestic product, the
health care sector can use its purchasing power to drive the transition to clean energy
and a low-carbon supply chain for the rest of the nation. Moreover, much of the shift
in focus to preventive models of care and safer, higher-quality care that reduces
unnecessary utilization will naturally produce lower carbon footprints. With the Inflation
Reduction Act of 2022, nonprofit organizations can now use the new tax credit provisions
for renewable energy to support desired investments in buildings, energy infrastructure,
and transportation, among others. Health care organizations and their global value chains
can be influential and important catalysts for the journey to a net-zero carbon future.
Here, the authors share recommendations for how leaders can build climate-smart
strategies that take advantage of tax incentives and drive changes that can both energize
their employees and build a more resilient system to care for their communities.
Falling Insulin Prices—What Just Happened?
By: Leemore S. Dafny
- April 20, 2023 |
- Article |
- NEJM.org
Recently, more than 100 years after insulin was developed, manufacturers announced price reductions for insulin products. Pressure to reduce prices had long been building, so why would they act now?
We Need an Operation Warp Speed for Long COVID
By: Esther K. Choo and Scott Duke Kominers
- April 5, 2023 |
- Article |
- Scientific American (website)
With millions of people affected and at least $1 trillion of economic value at stake, long COVID is our next national health emergency.
Roche: ESG and Access to Healthcare
By: George Serafeim, Susanna Gallani and Benjamin Maletta
- March 2023 |
- Case |
- Faculty Research
In May 2022, Roche Group, one of the largest healthcare companies in the world, hosted its first ESG investor event focused exclusively on its efforts to impact access to healthcare. While Roche had recently set an ambitious goal to double the number of patients that had access to its innovative medicines and diagnostic solutions within ten years, it was not at all clear how the firm should structure its resource allocation criteria, performance evaluations, reporting and incentive systems to align efforts internally toward these goals. Group CFO and CIO Alan Hippe was presented with two options, none of which he was particularly enthusiastic about. One was to lower the hurdle rate for projects related to ESG issues, thus relaxing profit expectations. The alternative was to incorporate a set of minimum ESG requirements in all of Roche’s new project proposals. In this case, however, the risk was to reduce the focus on ESG from a strategic priority to a compliance exercise. In the presentation shared with investors at the ESG event, access to healthcare had been positioned as Roche’s greatest contribution to society. This type of public commitment required more than a compliance-level of effort. In September, Alan Hippe would sit down with the executive committee to chart a path for integrating ESG issues into Roche’s project selection and business planning. Hippe went on to define three objectives for ESG at Roche, “we need to align on targets, we need to get resource allocation right, and we need to report both internally and externally.”
Keywords: ESG (Environmental, Social, Governance) Performance; Sustainable Finance; Growth Strategy And Execution; Sustainability Targets; Impact Evaluation; Healthcare Access; Healthcare Innovation; Healthcare Systems; Healthcare Operations; Finance; Strategy; Health Testing and Trials; Health Care and Treatment; Growth Management; Measurement and Metrics; Innovation Strategy; Corporate Social Responsibility and Impact; Health Industry; Pharmaceutical Industry; Switzerland; North America; Europe; Asia; Latin America; Africa
Comparison of COVID-19 Hospitalization Costs across Care Pathways: A Patient-level Time-driven Activity-based Costing Analysis in a Brazilian Hospital
By: Ricardo Bertoglio Cardoso, Miriam Allein Zago Marcolino, Milena Soriano Marcolino, Camila Felix Fortis, Leila Beltrami Moreira, Ana Paula Coutinho, Nadine Oliveira Clausell, Junaid Nabi, Robert S. Kaplan, Ana Paula Beck da Silva Etges and Carisi Anne Polanczyk
- 2023 |
- Article |
- BMC Health Services Research
The COVID-19 pandemic raised awareness of the need to better understand where and how patient-level costs are incurred in health care organizations. This study used time-driven activity-based costing to estimate COVID-19 patient-level hospital costs in a Brazilian hospital for COVID-19 care management for 208 patients, stratified by hospital care pathway and Ordinal Scale for Clinical Improvement (OSCI) category. The most expensive care pathway was the ICU only, registering a median cost per patient of $13,519. All care pathways that included the ICU unit registered a higher cost per patient. The findings of how patient-level cost varied with Covid-19 care pathway can be used to develop sustainable value-reimbursement strategies in middle-income countries such as Brazil.
Translating Information into Action: A Public Health Experiment in Bangladesh
By: Reshmaan Hussam, Kailash Pandey, Abu Shonchoy and Chikako Yamauchi
- 2023 |
- Working Paper |
- Faculty Research
While models of technology adoption posit learning as the basis of behavior change, information campaigns in public health frequently fail to change behavior. We design an information campaign embedding hand-hygiene edutainment within popular dramas using mobile phones, randomly distributed to households in Bangladesh. We document substantial improvements in handwashing and health, but no change in hygiene knowledge. Employing machine learning techniques with temporal data on media exposure and handwashing, we find that both cumulative and immediate exposure is correlated with washing, consistent with cue-based habituation. Results highlight how behavior change may be induced by tacit, rather than explicit, knowledge acquisition.
A Randomized Trial of Behavioral Nudges Delivered through Text Messages to Increase Influenza Vaccination among Patients with an Upcoming Primary Care Visit
By: Mitesh S. Patel, Katherine L. Milkman, Linnea Gandhi, Heather N. Graci, Dena Gromet, Hung Ho, Joseph S. Kay, Timothy W. Lee, Jake Rothschild, Modupe Akinola, John Beshears, Jonathan E. Bogard, Alison Buttenheim, Christopher Chabris, Gretchen B. Chapman, James J. Choi, Hengchen Dai, Craig R. Fox, Amir Goren, Matthew D. Hilchey, Jillian Hmurovic, Leslie John, Dean Karlan, Melanie Kim, David Laibson, Cait Lamberton, Brigitte C. Madrian, Michelle N. Meyer, Maria Modanu, Jimin Nam, Todd Rogers, Renante Rondina, Silvia Saccardo, Maheen Shermohammed, Dilip Soman, Jehan Sparks, Caleb Warren, Megan Weber, Ron Berman, Chalanda N. Evans, Seung Hyeong Lee, Christopher K. Snider, Eli Tsukayama, Christophe Van den Bulte, Kevin G. Volpp and Angela L. Duckworth
- 2023 |
- Article |
- American Journal of Health Promotion
Purpose: To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates.
Design: Randomized, controlled trial.
Setting: Two health systems in the Northeastern US between September 2020 and March 2021.
Subjects: 74,811 adults.
Interventions: Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content.
Measures: Influenza vaccination.
Analysis: Intention-to-treat.
Results: Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (p = .005). The top performing text message described the vaccine to the patient as “reserved for you” and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; p < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as “reserved for you.” None of the interventions performed worse than control.
Conclusions: Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.
Design: Randomized, controlled trial.
Setting: Two health systems in the Northeastern US between September 2020 and March 2021.
Subjects: 74,811 adults.
Interventions: Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content.
Measures: Influenza vaccination.
Analysis: Intention-to-treat.
Results: Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (p = .005). The top performing text message described the vaccine to the patient as “reserved for you” and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; p < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as “reserved for you.” None of the interventions performed worse than control.
Conclusions: Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.
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
Digital Public Health Interventions at Scale: The Impact of Social Media Advertising on Beliefs and Outcomes Related to COVID Vaccines
By: Susan Athey, Kristen Grabarz, Michael Luca and Nils Wernerfelt
- January 23, 2023 |
- Article |
- Proceedings of the National Academy of Sciences
Public health organizations increasingly use social media advertising campaigns in pursuit of public health goals. In this paper, we evaluate the impact of about $40 million of social media advertisements that were run and experimentally tested on Facebook and Instagram, aimed at increasing COVID-19 vaccination rates in the first year of the vaccine roll-out. The 819 randomized experiments in our sample were run by 174 different public health organizations and collectively reached 2.1 billion individuals in 15 languages. We find that these campaigns are, on average, effective at influencing self-reported beliefs - shifting opinions close to 1% at baseline with a cost per influenced person of about $3.41. Combining this result with an estimate of the relationship between survey outcomes and vaccination rates derived from observational data yields an estimated cost per additional vaccination of about $5.68. There is further evidence that campaigns are especially effective at influencing users’ knowledge of how to get vaccines. Our results represent, to the best of our knowledge, the largest set of online public health interventions analyzed to date.