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  • All HBS Web  (1,083)
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    • News  (292)
    • Research  (600)
    • Multimedia  (12)
  • Faculty Publications  (252)
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  • Working Paper

Rebates in the Pharmaceutical Industry: Evidence from Medicines Sold in Retail Pharmacies in the U.S.

By: Pragya Kakani, Michael Chernew and Amitabh Chandra
Rising list prices are often used to illustrate the burden of prescription drug spending, but payers routinely negotiate rebates from manufacturers that generate differences between list and net prices. List prices are easily available and affect patient cost-sharing,... View Details
Keywords: Pharmaceuticals; Rebates; Health Care and Treatment; Markets; Price; Analysis; Pharmaceutical Industry
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Kakani, Pragya, Michael Chernew, and Amitabh Chandra. "Rebates in the Pharmaceutical Industry: Evidence from Medicines Sold in Retail Pharmacies in the U.S." NBER Working Paper Series, No. 26846, March 2020.
  • August 2016
  • Article

Value-Based Breast Cancer Care: A Multidisciplinary Approach for Defining Patient-Centered Outcomes

By: Fayanju M. Oluwadamilola, Tinisha L. Mayo, Tracy E. Spinks, Seohyun Lee, Carlos H. Barcenas, Benjamin D. Smith, Sharon H. Giordano, Rosa F. Hwang, Richard A. Ehlers, Jesse C. Selber, Ronald Walters, Debu Tripathy, Kelly K. Hunt, Thomas A. Buchholz, Thomas W. Feeley and Henry M. Kuerer
Purpose. Value in healthcare—i.e., patient-centered outcomes achieved per healthcare dollar spent—can define quality and unify performance improvement goals with health outcomes of importance to patients across the entire cycle of care. We describe the process... View Details
Keywords: Health Disorders; Value; Health Care and Treatment; Performance Improvement; Health Industry
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Oluwadamilola, Fayanju M., Tinisha L. Mayo, Tracy E. Spinks, Seohyun Lee, Carlos H. Barcenas, Benjamin D. Smith, Sharon H. Giordano, Rosa F. Hwang, Richard A. Ehlers, Jesse C. Selber, Ronald Walters, Debu Tripathy, Kelly K. Hunt, Thomas A. Buchholz, Thomas W. Feeley, and Henry M. Kuerer. "Value-Based Breast Cancer Care: A Multidisciplinary Approach for Defining Patient-Centered Outcomes." Annals of Surgical Oncology 23, no. 8 (August 2016). (Published online early, March 15, 2016.)
  • August 17, 2016
  • Article

How a Cancer Center Rapidly Developed Patient-Centered Outcome Measures

By: Kevin P. Shah, Tracy E. Spinks and Thomas W. Feeley
In 2014, The University of Texas MD Anderson Cancer Center created a streamlined process for developing measure sets for patient-centered outcomes, including provider-generated and patient-reported outcomes, at an accelerated pace. These comprehensive sets are... View Details
Keywords: Information Technology; Measurement and Metrics; Quality; Service Delivery; Health Care and Treatment; Health Industry; Texas
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Shah, Kevin P., Tracy E. Spinks, and Thomas W. Feeley. "How a Cancer Center Rapidly Developed Patient-Centered Outcome Measures." NEJM Catalyst (August 17, 2016).
  • October 2016 (Revised January 2017)
  • Background Note

The U.S. Health Club Industry, 2005–2016

By: John R. Wells and Gabriel Ellsworth
In 2015, the U.S. health-club industry generated revenues of $25.8 billion, up from $14.8 billion in 2004. Members of health clubs accounted for 17% of the population, up from 14%. The number of clubs had grown from 26,830 in 2004 to 36,180. In the process, the list of... View Details
Keywords: Health Clubs; Fitness; Gyms; Chain; Weight Loss; Obesity; Exercise; Personal Training; Retention; Bally Total Fitness; 24 Hour Fitness; YMCA; Gold's Gym; Curves; Franchise; Franchising; Subscription; Promotional Sales; Promotions; Fixed Costs; Body; Business Ventures; Strategy; Health; Investment; Entertainment and Recreation Industry; Health Industry; United States
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Wells, John R., and Gabriel Ellsworth. "The U.S. Health Club Industry, 2005–2016." Harvard Business School Background Note 717-421, October 2016. (Revised January 2017.)
  • 01 Jun 2020
  • Working Paper Summaries

Rebates in the Pharmaceutical Industry: Evidence from Medicines Sold in Retail Pharmacies in the U.S.

Keywords: by Pragya Kakani, Michael Chernew, and Amitabh Chandra; Health; Pharmaceutical
  • 2020
  • Working Paper

Cutting the Gordian Knot of Employee Health Care Benefits and Costs: A Corporate Model Built on Employee Choice

By: Regina E. Herzlinger and Barak D. Richman
The U.S. employer-based health insurance tax exclusion created a system of employer-sponsored insurance (ESI) with limited insurance choices and transparency that may lock employed households into health plans that are costlier or different from those they prefer to... View Details
Keywords: After-tax Income; Consumer-driven Health Care; Health Care Costs; Health Insurance; Income Inequality; Tax Policy; Health Care and Treatment; Cost; Insurance; Employees; Income; Taxation; Policy; United States
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Herzlinger, Regina E., and Barak D. Richman. "Cutting the Gordian Knot of Employee Health Care Benefits and Costs: A Corporate Model Built on Employee Choice." Duke Law School Public Law & Legal Theory Series, No. 2020-4, December 2019. (Revised January 2021.)
  • September 2017 (Revised February 2023)
  • Case

Intermountain Healthcare: Pursuing Precision Medicine

By: Richard G. Hamermesh, Kathy E. Giusti, Robert S. Huckman and Julia Kelley
Headquartered in Salt Lake City, Intermountain Healthcare operates 23 hospitals and hundreds of clinics in Utah and Idaho and provides insurance to approximately 850,000 patients through its insurance arm, SelectHealth. In 2013, Intermountain, known for its commitment... View Details
Keywords: Precision Medicine; Healthcare; Innovation; Cancer; Cancer Research; Health Care; Technology; Health Care and Treatment; Innovation Leadership; Disruptive Innovation; Entrepreneurship; Decision Choices and Conditions; Health Industry; Insurance Industry; Utah; United States; North America
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Hamermesh, Richard G., Kathy E. Giusti, Robert S. Huckman, and Julia Kelley. "Intermountain Healthcare: Pursuing Precision Medicine." Harvard Business School Case 818-018, September 2017. (Revised February 2023.)
  • 12 Jul 2004
  • Research & Ideas

Michael Porter’s Prescription For the High Cost of Health Care

We believe that competition is the root of the problem with U.S. health care performance. But this does not mean we advocate a state-controlled... View Details
Keywords: by Michael E. Porter; Health
  • 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
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Herzlinger, Regina E., Richard Boxer, and James Wallace. "Bipartisan Tax-Free Solution to Health Care Financing: Coupling HRAs With a Public Option." Health Affairs Blog (June 30, 2020).
  • December 2016
  • Article

Health Care Needs Real Competition

By: Leemore S. Dafny and Thomas H. Lee
The U.S. health care system is inefficient, unreliable, and crushingly expensive. There is no shortage of proposed solutions, but central to the best of them is the idea that health care needs more competition. In other sectors, competition improves quality and... View Details
Keywords: Competition; Health Care and Treatment; Health Industry; United States
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Dafny, Leemore S., and Thomas H. Lee. "Health Care Needs Real Competition." Harvard Business Review 94, no. 12 (December 2016): 76–87.
  • February 2025
  • Article

Innovations in Evaluating Ambulatory Costs of Cystic Fibrosis Care: A Comparative Study Across Multidisciplinary Care Centers in Ireland and the United States

By: Emma Brady, Ryan C. Perkins, Kate Cullen, Gregory S. Sawicki, Robert S. Kaplan and Gerardine Doyle
Lead clinicians at two large pediatric cystic fibrosis (CF) centers in the United States and Ireland measured and compared their ambulatory care costs. The clinicians selected three strata of patients (0–11 months, 1–5 years, and 6–17 years of age). Process maps were... View Details
Keywords: Health Care and Treatment; Cost; Service Delivery; Resource Allocation; Health Industry
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Brady, Emma, Ryan C. Perkins, Kate Cullen, Gregory S. Sawicki, Robert S. Kaplan, and Gerardine Doyle. "Innovations in Evaluating Ambulatory Costs of Cystic Fibrosis Care: A Comparative Study Across Multidisciplinary Care Centers in Ireland and the United States." NEJM Catalyst Innovations in Care Delivery 6, no. 2 (February 2025).
  • January–February 2022
  • Article

Mobilizing the U.S. Military’s TRICARE Program for Value-Based Care: A Report From the Defense Health Board

By: Robert S. Kaplan, Paul R. Schaettle, Vivian S. Lee, Michael D. Parkinson, Gregory H. Gorman and Michael-Anne Browne
The U.S. Military Health System spends about $50 billion annually through its TRICARE health plans to provide care to 9.6 million active duty service members, retirees, and their families. TRICARE, historically, has used the predominant U.S. fee-for-service payment... View Details
Keywords: Military Health System; Value-based Healthcare; Health Care and Treatment; United States
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Kaplan, Robert S., Paul R. Schaettle, Vivian S. Lee, Michael D. Parkinson, Gregory H. Gorman, and Michael-Anne Browne. "Mobilizing the U.S. Military’s TRICARE Program for Value-Based Care: A Report From the Defense Health Board." Military Medicine 187, nos. 1-2 (January–February 2022): 12–16.
  • 13 Jul 2009
  • Research & Ideas

Diagnosing the Public Health Care Alternative

of its inadequate payments. In the end, the Democrats' health care reform will require drastic rationing of health View Details
Keywords: by Staff; Health
  • January 2019 (Revised June 2019)
  • Technical Note

U.S. Commercial Health Insurance Industry

By: Susanna Gallani, Mary Witkowski and Harry B. Wolberg
This note describes the role of commercial payers in the U.S. healthcare industry. We begin with a review of the historical evolution of commercial payers and their role in the market, from the beginning to the Affordable Care Act and beyond. Every wave of reforms in... View Details
Keywords: Health Care and Treatment; Insurance; Governing Rules, Regulations, and Reforms; Organizational Change and Adaptation; Health Industry; Insurance Industry; United States
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Gallani, Susanna, Mary Witkowski, and Harry B. Wolberg. "U.S. Commercial Health Insurance Industry." Harvard Business School Technical Note 119-064, January 2019. (Revised June 2019.)
  • August 2011 (Revised May 2012)
  • Supplement

Narayana Hrudayalaya Heart Hospital: Cardiac Care for the Poor (B)

By: Tarun Khanna and Tanya Bijlani
Narayana Hrudayalaya (NH) has expanded into a multi-specialty health city in Bangalore and has grown to twelve locations across India. The hospital plans to build 300-bed secondary-care hospitals in smaller cities across India, with a goal to operate 30,000 beds in... View Details
Keywords: Emerging Markets; Growth and Development Strategy; Goals and Objectives; Social Enterprise; Health Care and Treatment; Poverty; Welfare; Health Industry; Bangalore; Cayman Islands; Africa
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Khanna, Tarun, and Tanya Bijlani. "Narayana Hrudayalaya Heart Hospital: Cardiac Care for the Poor (B)." Harvard Business School Supplement 712-402, August 2011. (Revised May 2012.)
  • March 2012
  • Article

Macroeconomic Policy and U.S. Competitiveness

By: Richard H.K. Vietor and Matthew Weinzierl
The United States is on a glide path to fiscal disaster, with experts projecting that the federal government will take in far less money than it spends-indefinitely. Our current fiscal policy is eroding competitiveness in several ways, and business conditions in the... View Details
Keywords: Macroeconomics; Government and Politics; Financial Crisis; Policy; Competition; Public Administration Industry; United States
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Vietor, Richard H.K., and Matthew Weinzierl. "Macroeconomic Policy and U.S. Competitiveness." Harvard Business Review 90, no. 3 (March 2012).
  • 2019
  • Working Paper

Thinking Outside the Box (12): The Benefits of Increased Transparency in Employer-Sponsored Health Insurance for the 180 Million Insured

By: Regina E. Herzlinger and Barak D. Richman
Economists have long noted that the tax exclusion of employer-sponsored insurance (ESI) caused workers to purchase health plans that differ in price and other characteristics from those they would otherwise choose for themselves. We explore the short-term and long-term... View Details
Keywords: After-tax Income; Consumer-driven Health Care; Health Care Costs; Health Insurance; Income Inequality; Tax Policy; Health Care and Treatment; Cost; Insurance; Income; Equality and Inequality; Taxation; Policy; United States
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Herzlinger, Regina E., and Barak D. Richman. "Thinking Outside the Box (12): The Benefits of Increased Transparency in Employer-Sponsored Health Insurance for the 180 Million Insured." Duke Law School Public Law & Legal Theory Series, No. 2020-4, December 2019.
  • June 10, 2021
  • Article

Preparing Hospitals for the Next Pandemic

By: Regina E. Herzlinger and Barak D. Richman
The COVID-19 epidemic response has shown that the U.S. is blessed with heroic physicians and other health care providers, researchers, and facilities. But it has also revealed a health care system that was woefully unprepared for the surge of pandemic patients. In the... View Details
Keywords: Hospital; Hospital Management; Hospitals—administration; Health Care; Health Care Industry; Health Care Investment; Health Care Operations; Health Pandemics; Health Care and Treatment; Operations; Performance Improvement; Investment; Health Industry; United States
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Herzlinger, Regina E., and Barak D. Richman. "Preparing Hospitals for the Next Pandemic." Harvard Business Review Digital Articles (June 10, 2021).
  • January 2018
  • Article

The Central and Unacknowledged Role of the U.S. Food and Drug Administration in the Design and Execution of Medical Device Pivotal Trials

By: Aaron V. Kaplan and Ariel D. Stern
The introduction of new medical devices has transformed cardiovascular care in recent decades. Devices, such as heart valves, pacemakers, stents, ventricular assist devices, and implantable defibrillators, have prolonged and improved the quality of life for millions of... View Details
Keywords: Health Testing and Trials; Business and Government Relations; Governing Rules, Regulations, and Reforms; Information Publishing; Medical Devices and Supplies Industry; United States
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Kaplan, Aaron V., and Ariel D. Stern. "The Central and Unacknowledged Role of the U.S. Food and Drug Administration in the Design and Execution of Medical Device Pivotal Trials." JAMA Cardiology 3, no. 1 (January 2018): 5–6.
  • May 2025
  • Case

Dell Med: Transforming Care Delivery & Payment

By: Robert S. Kaplan, David N. Bernstein and Mary L. Witkowski
Health care in the U.S. and globally continues to undergo massive transformation, surging towards a system that rewards value for patients. However, widespread adoption of value-based health care remains a challenge. This case study focuses on the care delivery... View Details
Keywords: Integrated Practice Units; Outcomes Measurement; Time-Driven Activity-Based Costing; Health Care and Treatment; Business Strategy; Leading Change; Decisions; Transformation; Service Delivery; Adoption; Value; Health Industry; United States; Texas
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Kaplan, Robert S., David N. Bernstein, and Mary L. Witkowski. "Dell Med: Transforming Care Delivery & Payment." Harvard Business School Case 125-117, May 2025.
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