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  • All HBS Web  (1,491)
    • People  (1)
    • News  (376)
    • Research  (865)
    • Events  (5)
    • Multimedia  (25)
  • Faculty Publications  (421)
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  • Article

Supporting Value-Based Health Care—Aligning Financial and Legal Accountability

By: Mark M. Zaki, Anupam B. Jena and Amitabh Chandra
U.S. health care payment and delivery-system reforms have focused on improving care by making organizations accountable for outcomes, quality, and costs. Payers have supported the implementation of accountable care organizations (ACOs), bundled-payment models, and... View Details
Keywords: Value-based Health Care; Accountability; Health Care and Treatment; United States
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Zaki, Mark M., Anupam B. Jena, and Amitabh Chandra. "Supporting Value-Based Health Care—Aligning Financial and Legal Accountability." New England Journal of Medicine 385, no. 11 (September 9, 2021): 965–967.
  • August, 2022
  • Article

Billing and Insurance-Related Administrative Costs: A Cross-National Analysis

By: Barak D. Richman, Robert S. Kaplan, Japees Kohli, Dennis Purcell, Mahek Shah, Igna Bonfrer, Brian Golden, Rosemary Hannam, Will Mitchell, Daniel Cehic, Garry Crispin and Kevin A. Schulman
Billing and insurance-related costs are a significant source of wasteful health care spending in Organization for Economic Cooperation and Development nations, but these administrative burdens vary across national systems. We executed a microlevel accounting of these... View Details
Keywords: Health Care Costs; Administrative Costs; Cost; Health Care and Treatment; Health Industry
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Richman, Barak D., Robert S. Kaplan, Japees Kohli, Dennis Purcell, Mahek Shah, Igna Bonfrer, Brian Golden, Rosemary Hannam, Will Mitchell, Daniel Cehic, Garry Crispin, and Kevin A. Schulman. "Billing and Insurance-Related Administrative Costs: A Cross-National Analysis." Health Affairs 41, no. 8 (August, 2022): 1098–1106.
  • May–June 2020
  • Article

The Agenda for the Next Generation of Health Care Information Technology

By: Thomas W. Feeley, Zachary Landman and Michael E. Porter
As the diffusion of value-based health care efforts accelerates globally, the need for interoperable information technology systems that support value-based care is essential. Such systems are needed to facilitate dramatic improvements in patient outcomes and... View Details
Keywords: Value-based Health Care; Health Care and Treatment; Information Technology; Integration; Performance Improvement; Performance Efficiency
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Feeley, Thomas W., Zachary Landman, and Michael E. Porter. "The Agenda for the Next Generation of Health Care Information Technology." NEJM Catalyst Innovations in Care Delivery 1, no. 3 (May–June 2020).
  • 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.
  • October 2023
  • Article

Clinician Response to Patient Medication Prices Displayed in the Electronic Health Record

By: Anna D Sinaiko, Caroline E Sloan, Mark J Soto, Olivia Zhao, Chen-Tan Lin and Foster R Goss
Keywords: Prescription Drugs; Electronic Health Records; Physicians; Prescription Drug Costs; Health Care and Treatment; Price; Health Industry
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Sinaiko, Anna D., Caroline E Sloan, Mark J Soto, Olivia Zhao, Chen-Tan Lin, and Foster R Goss. "Clinician Response to Patient Medication Prices Displayed in the Electronic Health Record." JAMA Internal Medicine 183, no. 10 (October 2023): 1172–1175.
  • Article

Assessing the Impact of Health System Organizational Structure on Hospital Electronic Data Sharing

By: A Jay Holmgren and Eric Ford
Horizontal consolidation in the hospital industry has gained momentum in the United States despite concerns over rising costs and lower quality. Hospital systems frequently point to potential gains in interoperability and electronic exchange of patient information as... View Details
Keywords: Hospitals; Health Information Technology; Health Care; Health Care and Treatment; Data and Data Sets; Information Technology; Consolidation; Knowledge Sharing; Health Industry
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Holmgren, A Jay, and Eric Ford. "Assessing the Impact of Health System Organizational Structure on Hospital Electronic Data Sharing." Journal of the American Medical Informatics Association 25, no. 9 (September 2018): 1147–1152.
  • October 2022
  • Article

It’s Not Just the Prices: Time-Driven Activity-Based Costing for Initiation of Veno-Venous Extracorporeal Membrane Oxygenation at Three International Sites—A Case Review

By: Michael Nurok, Vin Pellegrino, Marc Pineton de Chambrun, Jonathan Warsh, Meredith Young, Erik Dong, Neil Parrish, Syed Shehab, Alain Combes and Robert S. Kaplan
The United States spends more for intensive care units (ICUs) than do other high-income countries. We used time-driven activity-based costing (TDABC) to analyze ICU costs for initiation of extracorporeal membrane oxygenation (ECMO) for respiratory failure to estimate... View Details
Keywords: Healthcare; Cost; Time-Driven ABC; Health Care and Treatment; Cost Management; Activity Based Costing and Management; Health Industry
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Nurok, Michael, Vin Pellegrino, Marc Pineton de Chambrun, Jonathan Warsh, Meredith Young, Erik Dong, Neil Parrish, Syed Shehab, Alain Combes, and Robert S. Kaplan. "It’s Not Just the Prices: Time-Driven Activity-Based Costing for Initiation of Veno-Venous Extracorporeal Membrane Oxygenation at Three International Sites—A Case Review." Anesthesia & Analgesia 135, no. 4 (October 2022): 711–718.
  • Article

Lessons from England's Health Care Workforce Redesign: No Quick Fixes

By: Richard Bohmer and Candace Imison
In 2000 the English National Health Service (NHS) began a series of workforce redesign initiatives that increased the number of doctors and nurses serving patients, expanded existing staff roles and developed new ones, redistributed health care work, and invested in... View Details
Keywords: Health Care; Work Force Management; United Kingdom
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Bohmer, Richard, and Candace Imison. "Lessons from England's Health Care Workforce Redesign: No Quick Fixes." Health Affairs 32, no. 11 (November 2013): 2025–2031.
  • 24 Sep 2018
  • Research & Ideas

How Cost Accounting is Improving Healthcare in Rural Haiti

Medical records at a healthcare clinic in Lascahobas, Haiti. Ryan McBain A few years ago, the Boston-based nonprofit health care organization Partners in Health (PIH) set out to quantify the View Details
Keywords: by Carmen Nobel; Health
  • December 2013
  • Article

Measuring the Value of Process Improvement Initiatives in a Preoperative Assessment Center using Time-driven Activity-based Costing

By: Katy E. French, Heidi W. Albright, John C. Frenzel, James R. Incalcaterra, Augustin C. Rubio, Jessica F. Jones and Thomas W. Feeley
Background: The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing(TDABC)in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel... View Details
Keywords: Quality Improvement; Value Agenda; Time-Driven Activity-Based Costing; Accounting; Health; Measurement and Metrics; Value; Health Industry; North and Central America
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French, Katy E., Heidi W. Albright, John C. Frenzel, James R. Incalcaterra, Augustin C. Rubio, Jessica F. Jones, and Thomas W. Feeley. "Measuring the Value of Process Improvement Initiatives in a Preoperative Assessment Center using Time-driven Activity-based Costing." Healthcare: The Journal of Delivery Science and Innovation 1, nos. 3-4 (December 2013): 136–142.
  • May 2024
  • Article

True Costs of Uterine Artery Embolization: Time-Driven Activity-Based Costing in Interventional Radiology Over a 3-Year Period

By: Julia C. Bulman, Nicole H. Kim, Robert S. Kaplan, Sarah Schroeppel DeBacker, Olga R. Brook and Ammar Sarwar
The study used time-driven activity-based costing (TDABC) to estimate the costs to perform uterine artery embolization (UAE). Utilization times for patients undergoing outpatient UAE for fibroids or adenomyosis were captured from electronic health record timestamps and... View Details
Keywords: Cost Accounting; Health Care and Treatment; Health Industry
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Bulman, Julia C., Nicole H. Kim, Robert S. Kaplan, Sarah Schroeppel DeBacker, Olga R. Brook, and Ammar Sarwar. "True Costs of Uterine Artery Embolization: Time-Driven Activity-Based Costing in Interventional Radiology Over a 3-Year Period." Journal of the American College of Radiology 21, no. 5 (May 2024): 721–728.
  • Article

Teaming: An Approach to the Growing Complexities in Health Care: AOA Critical Issues

By: Haseeb Nawaz, Amy C. Edmondson, Tony H. Tzeng, Jamal K. Saleh, Kevin J. Bozic and Khaled J. Saleh
Confronted with rising costs and patients who often have multiple comorbidities, the orthopaedic surgeon needs to face the challenge of providing high-quality health care. One solution is to increase and improve coordination, communication, and teamwork. The... View Details
Keywords: Teaming; Health Care; Health Care and Treatment; Health Industry
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Nawaz, Haseeb, Amy C. Edmondson, Tony H. Tzeng, Jamal K. Saleh, Kevin J. Bozic, and Khaled J. Saleh. "Teaming: An Approach to the Growing Complexities in Health Care: AOA Critical Issues." Journal of Bone and Joint Surgery: American Volume 96, no. 21 (November 5, 2014).
  • June 2018
  • Supplement

Amil and the Health Care System in Brazil (B)

By: Regina Herzlinger, Ana Maria Malik, Ruth Costas and Priscilla Zogbi
Brazilian Managed Care Organization Amil faces a series of challenges while trying to redefine the terms of its relationship with hospitals and clinics and to implement a new health care model based on primary care and family medicine. View Details
Keywords: Health Care; Brazil; Managed Care; Innovation; Health Care Industry; Health Care and Treatment; Health; Cost Management; Innovation and Invention; Competitive Strategy; Health Industry; Health Industry; Brazil
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Herzlinger, Regina, Ana Maria Malik, Ruth Costas, and Priscilla Zogbi. "Amil and the Health Care System in Brazil (B)." Harvard Business School Supplement 318-149, June 2018.
  • 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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Dafny, Leemore S., Igal Hendel, Victoria Marone, and Christopher Ody. "Narrow Networks on the Health Insurance Marketplaces: Prevalence, Pricing, and the Cost of Network Breadth." Health Affairs 36, no. 9 (September 2017).
  • March 1978 (Revised October 1978)
  • Case

Rosemont Hill Health Center

An administrator of a neighborhood health center is considering changing his cost accounting system from a single cost per visit to a cost per visit for each department in the center. Used to illustrate several issues related to cost accounting in health care:... View Details
Keywords: Cost Accounting; Health Care and Treatment; Health Industry
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Young, David W. "Rosemont Hill Health Center." Harvard Business School Case 178-189, March 1978. (Revised October 1978.)
  • Research Summary

Cost Management and Management Control Systems in Hospitals

By: V.G. Narayanan

 Hospitals tend not to have very good cost accounting and control systems. More broadly,  there is enormous opportunity for managing costs and aligning incentives in the health care industry. I am studying how cost accounting methods can be used to... View Details

  • 2013
  • Working Paper

The Impact of Conformance and Experiential Quality on Healthcare Cost and Clinical Performance

By: Claire Senot, Aravind Chandrasekaran, Peter T. Ward and Anita L. Tucker
The quality of operational processes is an important driver of performance in hospitals. In particular, processes that reliably deliver both evidence-based and patient-centered care, which we call conformance and experiential quality, respectively, have been argued to... View Details
Keywords: Healthcare; Experiential Quality; Conformance Quality; Clinical Outcomes; Cost Efficiency; Quality; Service Operations; Health Care and Treatment; Performance; Outcome or Result; Health Industry
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Senot, Claire, Aravind Chandrasekaran, Peter T. Ward, and Anita L. Tucker. "The Impact of Conformance and Experiential Quality on Healthcare Cost and Clinical Performance." Harvard Business School Working Paper, No. 14-024, September 2013.
  • 2023
  • Article

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
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... View Details
Keywords: Health Care and Treatment; Cost; Health Industry; Brazil
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Cardoso, Ricardo Bertoglio, 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. "Comparison of COVID-19 Hospitalization Costs across Care Pathways: A Patient-level Time-driven Activity-based Costing Analysis in a Brazilian Hospital." BMC Health Services Research 23, no. 198 (2023).
  • 25 Sep 2019
  • Research & Ideas

The Economic Cost of Physician Burnout

Physician burnout costs the United States health care industry $4.6 billion a year, a number that brings a new spotlight to an age-old problem. In a paper published in the journal Annals of Internal Medicine... View Details
Keywords: by Michael Blanding; Health
  • November 2004 (Revised September 2019)
  • Background Note

The U.S. Health Club Industry in 2004

By: John R. Wells, Gabriel Ellsworth and Benjamin Weinstock
In 2004, the $16.8 billion U.S. health club industry continued its strong record of growth. There were almost 27,000 health clubs in the United States, up from 6,700 two decades earlier, and these clubs claimed 41 million members, over 14% of the U.S. population.... View Details
Keywords: Health Clubs; Fitness; Gyms; Chain; Weight Loss; Obesity; Exercise; Personal Training; Bally Total Fitness; 24 Hour Fitness; YMCA; Gold's Gym; Curves; Franchise; Franchising; Subscription; Promotional Sales; Promotions; Fixed Costs; Body; Accrual Accounting; Revenue Recognition; Buildings and Facilities; Business Growth and Maturation; Business Model; For-Profit Firms; Trends; Customers; Demographics; Age; Income; Private Equity; Financing and Loans; Profit; Revenue; Geographic Scope; Multinational Firms and Management; Health; Nutrition; Business History; Employees; Retention; Human Capital; Working Conditions; Contracts; Business or Company Management; Goals and Objectives; Growth and Development Strategy; Markets; Demand and Consumers; Supply and Industry; Industry Growth; Industry Structures; Operations; Service Operations; Franchise Ownership; Private Ownership; Public Ownership; Problems and Challenges; Sales; Salesforce Management; Situation or Environment; Opportunities; Nonprofit Organizations; Welfare; Sports; Strategy; Business Strategy; Competition; Competitive Strategy; Consolidation; Corporate Strategy; Customization and Personalization; Expansion; Segmentation; Hardware; Health Industry; United States
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Wells, John R., Gabriel Ellsworth, and Benjamin Weinstock. "The U.S. Health Club Industry in 2004." Harvard Business School Background Note 705-445, November 2004. (Revised September 2019.)
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