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June 2018 (Revised November 2018)
Case

Innovation at Insigne Health

By: Srikant M. Datar, Linda A. Cyr and Caitlin N. Bowler

Insigne Health is a fictional for-profit, integrated health insurer/health care provider whose leadership believes that by shifting members’ focus from “sickness” to “well-being” it could increase the overall health of its insured population and decrease the resources... View Details

Keywords: Design Thinking; Behavior Change; Chronic Disease; Health Care; Health Care and Treatment; Design; Behavior; Change; Innovation and Management

September 2022
Technical Note

Addressing Social Determinants of Health in the American Landscape

By: Susanna Gallani and Jacob Riegler

Social determinants of health (SDOH) have gained significant attention in recent years. A growing body of research shows that a person’s health is influenced by a large number of non-genetic factors, most of which operate outside the realm of health care and are... View Details

Keywords: Socioeconomic Determinants Of Health; Social Determinants Of Health; Population Health; Health; Health Care and Treatment; Social Issues; Health Industry; Health Industry; Health Industry; United States

August 14, 2020
Comment

How Has COVID-19 Affected Health Insurance Offered by Small Businesses in the U.S.? Early Evidence from a Survey

By: Leemore S. Dafny, Yin Wei Soon, Zoë Cullen and Christopher T. Stanton

As the COVID-19 pandemic stretches toward its third quarter, loss of health insurance coverage has not figured prominently in the public debate. Data in this report demonstrate why that is, but also suggest that the apparent stability is fragile, with potentially... View Details

Keywords: Health Pandemics; Health Care and Treatment; Insurance; Small Business; Surveys; United States

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October 2012
Article

The Impact of Tort Reform on Employer-Sponsored Health Insurance Premiums

By: Ronen Avraham, Leemore S. Dafny and Max Schanzenbach

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2016
Blog

Building A Culture of Health - John A. Quelch: Creating A Culture of Health

By: John A. Quelch

All American companies are in the health business whether they like it or not. The private sector directly pays for one-fifth of the whopping 17.5% of GDP spent on healthcare in the United States. Rather than viewing health merely as an insurance expense to be... View Details

Article

Narrow Networks on the Health Insurance Marketplaces: Prevalence, Pricing, and the Cost of Network Breadth

By: Leemore S. Dafny, Igal Hendel, Victoria Marone and Christopher Ody

Anecdotal reports and systematic research highlight the prevalence of narrow-network plans on the Affordable Care Act’s health insurance Marketplaces. At the same time, Marketplace premiums in the period 2014–2016 were much lower than projected by the Congressional... View Details

Keywords: Health Care and Treatment; Insurance; Cost; United States

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2023
Working Paper

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

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... View Details

Keywords: Public Sector; Insurance; Health Care and Treatment; Policy; Innovation and Invention

July 2018
Article

Reimagining Health Data Exchange: An Application Programming Interface-Enabled Roadmap for India

By: Satchit Balsari, Alexander Fortenko MD, MPH, Joaquin A. Blaya PhD, Adrian Gropper MD, Malavika Jayaram LLM, Rahul Matthan LLM, Ram Sahasranam, Mark Shankar MD, Suptendra N. Sarbadhikari PhD, Barbara Bierer, Kenneth D. Mandl MD, Sanjay Mehendale MD, MPH and Tarun Khanna

In February 2018, the Government of India announced a massive public health insurance scheme extending coverage to 500 million citizens, in effect making it the world’s largest insurance program. To meet this target, the government will rely on technology to... View Details

Keywords: Health Information Exchange; India; Health APIs; Health Care and Treatment; Information; Analytics and Data Science; Information Technology; Health Industry; India

February 2020 (Revised June 2020)
Case

From Cradle to Heaven: Taikang Insurance Group

By: William C. Kirby, Shu Lin, John P. McHugh and Yuanzhuo Wang

Taikang Insurance Group was a leading Chinese insurance and financial services institution. It operated in the insurance, asset management, and health and senior care industries. Due to China’s underdeveloped social welfare state, Taikang saw an opportunity for the... View Details

Keywords: Health; Insurance; Strategy; Insurance Industry; China

June 30, 2020
Article

Bipartisan Tax-Free Solution to Health Care Financing: Coupling HRAs With a Public Option

By: Regina E. Herzlinger, Richard Boxer and James Wallace

A combination of health insurance initiatives by the presumptive 2020 Democratic and Republican presidential nominees could expand health care coverage and significantly reduce costs, without raising taxes. Along the way, the combination could revitalize private... View Details

Keywords: Health Care Financing; Public Option; Health Reimbursement Arrangement (HRA); Health Care and Treatment; Insurance; Cost Management

September 2, 2020
Article

How to Pay for Public Option Without Tax Hike

By: Regina E. Herzlinger and Richard Boxer

A bipartisan combination of the two parties’ most popular initiatives can expand health care coverage, significantly reduce costs, and enable freedom of choice, without raising taxes. Along the way, we can revitalize competition between public and private plans. Our... View Details

Keywords: Health Insurance; Public Option; Health Care and Treatment; Insurance; Cost Management; United States

September 1998 (Revised July 1999)
Case

Discovery Health (B)

By: Samuel S. Chun and Shaun Matisonn

A South African health insurance company grapples with designing a financially viable coverage solution for a new prescription drug treatment for male impotence. View Details

Keywords: Motivation and Incentives; Service Delivery; Insurance; Health Care and Treatment; Insurance Industry; South Africa

November 2014 (Revised March 2016)
Background Note

Mental Health and the American Workplace

By: John A. Quelch and Carin-Isabel Knoop

Mental illness has been described as an epidemic affecting nearly a quarter of all Americans in their lifetimes, often during their most productive working years. Managers who can design organizations that maximize mental health can minimize these risks and boost... View Details

Keywords: Public Health; Productivity; Competitiveness; Stress Management; Depression; Absenteeism; Presenteeism; Work Culture; Business or Company Management; Work-Life Balance; Performance Productivity; Organizational Culture; Medical Specialties; Health Care and Treatment; Health Industry; United States

May 11, 2017
Article

Good Riddance to Big Insurance Mergers

By: Leemore S. Dafny

Federal judges issued preliminary injunctions halting mergers of four of the five largest U.S. health insurers. These decisions provide more precedent to support challenges of mergers between competitors in health care markets—whether payers or providers. View Details

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

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April 2012
Article

Paying a Premium on Your Premium? Consolidation in the U.S. Health Insurance Industry

By: Leemore S. Dafny, Mark Duggan and Subramaniam Ramanarayanan

June 2023
Teaching Note

From Cradle to Heaven: Taikang Insurance Group

By: William C. Kirby and Noah B. Truwit

Teaching Note for HBS Case No. 320-088. The case explores the rise of Taikang Insurance Group and its quest to be a leader of one of China's fastest-growing industries. Due to China's underdeveloped social welfare state, Taikang saw an opportunity for the private... View Details

Keywords: Health Care and Treatment; Government and Politics; Health Industry; China

February 2015
Background Note

A Note on the Affordable Care Act and the U.S. Health Care System

By: Joseph L. Bower and Michael Norris

This note provides an overview of the U.S. health care system as it stood in 2014, including an overview of hospitals, doctors, insurance companies, and other health care providers. It also discusses the major political actions on health care in the 20th century,... View Details

Keywords: Health Care; Health Care Policy; Political Process; Health Care and Treatment; Health Industry; United States

Research Summary

Consumer-Driven Health Care

By: Regina E. Herzlinger

Since 1999, Professor Herzlinger's work in this area has provided the major impetus for the transformation of the health care sector: first in new consumer-driven insurance products sold by established insurers such as Aetna, United and CIGNA, as well as... View Details

Article

More Insurers, Lower Premiums: Evidence from Initial Pricing in the Health Insurance Marketplaces

By: Leemore S. Dafny, Jonathan Gruber and Christopher Ody

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March 2015 (Revised November 2017)
Case

Bonitas

By: Regina E. Herzlinger and Natalie Kindred

Bonitas, a South African medical scheme (i.e., health insurer), must navigate highly restrictive regulations that make it difficult for Bonitas to innovate, grow, and compete with market leader Discovery as well as providers of alternative insurance products. Bonitas... View Details

Keywords: Health Insurance; Health Care; South Africa; Medical Scheme; Public Policy; Bonitas; Bonitas Medical Fund; National Health Insurance; Health; Health Care and Treatment; Insurance; Policy; Health Industry; Health Industry; South Africa; Johannesburg; Africa

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