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Health Care

Health Care

    • February 2015
    • Supplement

    The Affordable Care Act (A): Legislative Strategy in the House of Representatives

    By: 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.

    • February 2015
    • Supplement

    The Affordable Care Act (A): Legislative Strategy in the House of Representatives

    By: 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.

    • Blog Post

    Innovation in Health Care Education: A Call to Action

    By: 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.

    • Blog Post

    Innovation in Health Care Education: A Call to Action

    By: 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...

    • December 2014
    • Article

    No Margin, No Mission? A Field Experiment on Incentives for Public Services Delivery

    By: 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.

    • December 2014
    • Article

    No Margin, No Mission? A Field Experiment on Incentives for Public Services Delivery

    By: 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...

    • August 2001 (Revised January 2015)
    • Case

    SonoSite: A View Inside

    By: 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.

    • August 2001 (Revised January 2015)
    • Case

    SonoSite: A View Inside

    By: 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...

    • March 2014 (Revised December 2014)
    • Case

    Vision 2020: Takeda and the Vaccine Business

    By: 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.

    • March 2014 (Revised December 2014)
    • Case

    Vision 2020: Takeda and the Vaccine Business

    By: 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...

    • August 2015 (Revised August 2015)
    • Case

    Hoag Orthopedic Institute

    By: 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.

    • August 2015 (Revised August 2015)
    • Case

    Hoag Orthopedic Institute

    By: 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...

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 Care
Social Enterprise

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 Care
Social Enterprise

Recent 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
Citation
Educators
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Trelstad, Brian, Pedro Levindo, and Carla Larangeira. "Natura: Weathering the Pandemic at Brazil's Cosmetic Giant." Harvard Business School Case 323-065, January 2023.

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.
Keywords: Nonprofit Organizations; Health Disorders; Health Care and Treatment; Resource Allocation; Global Range; Decisions; Investment Funds
Citation
Educators
Related
Rangan, V. Kasturi, and Courtney Han. "The END Fund: To Eliminate Neglected Tropical Diseases." Harvard Business School Case 523-063, January 2023.

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?
Keywords: Product Development; Leadership; Health Testing and Trials; Research and Development; Risk and Uncertainty; Financial Condition; Partners and Partnerships; Pharmaceutical Industry
Citation
Educators
Related
Herzlinger, Regina, and Brian Walker. "Cleave Therapeutics: Taking a Risk on Oncology Drug Discovery." Harvard Business School Case 323-045, January 2023.

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.
Keywords: Public Sector; Insurance; Health Care and Treatment; Policy; Innovation and Invention
Citation
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Baicker, Katherine, Amitabh Chandra, and Mark Shepard. "Achieving Universal Health Insurance Coverage in the United States: Addressing Market Failures or Providing a Social Floor?" NBER Working Paper Series, No. 30854, January 2023.

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.
Keywords: Technological Innovation; Safety; Governing Rules, Regulations, and Reforms; Health Care and Treatment; Medical Devices and Supplies Industry
Citation
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Everhart, Alexander O., and Ariel D. Stern. "Post-market Surveillance of Software Medical Devices: Evidence from Regulatory Data." Harvard Business School Working Paper, No. 23-035, November 2022.

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.
Keywords: Health Care; Telemedicine; Health Care and Treatment; Outcome or Result; Behavior; Health Industry; United States
Citation
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Tang, Mitchell, A Jay Holmgren, Erin E. McElrath, Ankeet S. Bhatt, Anubodh S. Varshney, Simin Gharib Lee, Muthiah Vaduganathan, Dale S. Adler, and Robert S. Huckman. "Investigating the Association Between Telemedicine Use and Timely Follow-Up Care After Acute Cardiovascular Hospital Encounters." JACC: Advances 1, no. 5 (2022).

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.
Keywords: Health Care and Treatment; Groups and Teams; Job Design and Levels; Health Industry
Citation
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Related
Singh, Gagandeep, Jill G. Lenhart, Richard A. Helmers, Michele Renee Eberlee, Heather Costley, Joel B. Roberts, and Robert S. Kaplan. "Collaborative Rooming: An Innovative Pilot Project to Overcome Primary Care Challenges." Wisconsin Medical Journal 121, no. 4 (December 2022): 306–309.

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.
Keywords: AI and Machine Learning; Health Care and Treatment; Governing Rules, Regulations, and Reforms; Technological Innovation; Medical Devices and Supplies Industry
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Stern, Ariel Dora. "The Regulation of Medical AI: Policy Approaches, Data, and Innovation Incentives." NBER Working Paper Series, No. 30639, December 2022.

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.
Keywords: Time-Driven Activity-Based Costing; Value-based Health Care; Cost; Health Care and Treatment; Activity Based Costing and Management; Health Industry
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da Silva Etges, Anna Paula Beck, Richard D. Urman, Anne Geubelle, Robert Kaplan, and Carisi Anne Polanczyk. "Cost Standard Set Program: Moving Forward to Standardization of Cost Assessment Based on Clinical Condition." Journal of Comparative Effectiveness Research 11, no. 17 (December 2022): 1219–1223.

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.
Keywords: Vaccines; Pandemics; Health Care and Treatment; Health Pandemics; Distribution; Supply Chain; Equality and Inequality
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Budish, Eric, Hannah Kettler, Scott Duke Kominers, Erik Osland, Canice Prendergast, and Andrew A. Torkelson. "Distributing a Billion Vaccines: COVAX Successes, Challenges, and Opportunities." Oxford Review of Economic Policy 38, no. 4 (Winter 2022): 941–974.
More Publications

Faculty

Michael E. Porter
Regina E. Herzlinger
Robert S. Kaplan
Robert S. Huckman
Ariel D. Stern
Amy C. Edmondson
Richard G. Hamermesh
John A. Quelch
Alvin E. Roth
Leemore S. Dafny
Amitabh Chandra
James E. Austin
→See All

HBS Working Knowlege

    • 01 Feb 2023

    Will Hybrid Work Strategies Pull Down Long-Term Performance?

    Re: James L. Heskett
    • 31 Jan 2023

    Addressing Racial Discrimination on Airbnb

    Re: Michael Luca
    • 31 Jan 2023

    It’s Not All About Pay: College Grads Want Jobs That ‘Change the World’

    Re: Letian Zhang
→More Articles

Harvard Business Publishing

    • December 9, 2020
    • Article

    Give Employees Cash to Purchase Their Own Insurance

    By: Regina E. Herzlinger and Barak D. Richman
    • October 2022
    • Case

    Cost Plus Drugs

    By: Alexander MacKay and James Barnett
→More Harvard Business Publishing
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