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August 2024 (Revised August 2024)
Background Note

Note on Adherence in Healthcare

By: Regina E. Herzlinger, Zachery Page and Ben Creo

This note provides an overview of adherence in healthcare. It discusses systemwide costs of non-adherence, common barriers to adherence, relevant stakeholders, novel compliance tactics, and the impact on digital therapeutic adoption. It is recommended as a companion to... View Details

July 2024
Case

Roja Garimella: Developing a Founder's Judgment

By: Reza Satchu and Patrick Sanguineti

Roja Garimella’s path to becoming a founder was anything but straight. Setting her sights on a career in medicine since childhood, she committed to medical school with her acceptance to college. And yet, throughout her studies, she continually explored alternative... View Details

Keywords: Entrepreneurship; Personal Development and Career; Entrepreneurial Finance; Business Startups; Judgments; Financial Services Industry; Health Industry

September 2023
Article

The Health Costs of Dirty Energy: Evidence from the Capacity Market in Colombia

By: Achyuta Adhvaryu, Theresa Molina, Anant Nyshadham, Jorge Tamayo and Nicholas Torres

The health effects of “dirty” (fossil fuel driven) energy production are difficult to measure accurately due to the endogeneity of fuel choice. We exploit an electricity policy in Colombia that generates a price-based trigger for the use of thermal energy sources.... View Details

Keywords: Pollution; Health Disorders; Energy Industry; Colombia

August 2023 (Revised October 2023)
Case

Beyond the Barricades: Chile 2023

By: Debora Spar, Willis Emmons, Leonard A. Schlesinger and Ruth Costas

Chile, often considered among Latin America's greatest economic success stories, suffered a shocking wave of protests in October 2019, as its citizens demanded reforms across healthcare and education systems, and protested inequality and rising costs of living. As... View Details

Keywords: Government Administration; Developing Countries and Economies; Economic Growth; Social Issues; Wealth and Poverty; Public Opinion; Equality and Inequality; Public Administration Industry; Chile; Latin America; South America

April 2023 (Revised January 2024)
Background Note

Note on Healthcare in Ghana

By: Regina E. Herzlinger and Ben Creo

This note provides an overview of the healthcare system in Ghana. It discusses the public and private sector as well as traditional medical practice. It also discusses the country’s pharmaceutical industry. It is recommended as a companion to Professor Regina... View Details

Keywords: Africa; Pharmaceutical Companies; Pharmacy Benefit Manager; Health Care; Health Care Costs; Health Care Delivery; Health Care Entrepreneurship; Telehealth; Health Equity; Governing Rules, Regulations, and Reforms; Health Care and Treatment; Business and Government Relations; Health Industry; Pharmaceutical Industry; Ghana

December 2022
Article

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

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... View Details

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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October 2022 (Revised September 2024)
Case

mPharma: Scaling Access to Affordable Primary Care in Africa

By: Regina E. Herzlinger and Ben Creo

mPharma hopes to scale up to create the largest pan-African healthcare company ever to provide much-needed primary care in retail pharmacies; a reliable, fairly priced supply of drugs; and micro-insurance for drugs. They must prioritize launching a telemedicine... View Details

June 2022
Article

A New Initiative to Track HIV Resource Allocation and Costs

By: Ryan McBain, AK Nandakumar, Michael Ruffner, Carlyn Mann, Mai Hijazi, Susanna Baker, Linden Morrison, Kalipso Chalkidou, Shufang Zhang, Iris Semini, Fern Terris-Prestholt, Steven Forsythe, Sarah Byakika, Joshua Musinguzi and Robert S. Kaplan

In early 2020, several global health institutions – including the Global Fund to Fight AIDS, Tuberculosis and Malaria; Joint United Nations Program on HIV/AIDS (UNAIDS); United States Agency for International Development; and Office of the Global AIDS Coordinator at... View Details

Keywords: Activity Based Costing; HIV; Cost; Health Care; Healthcare; Health Care and Treatment; Activity Based Costing and Management; Resource Allocation; Health Industry; Africa

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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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September 2022
Article

Cost of Cardiac Stereotactic Body Radioablation Therapy versus Catheter Ablation for Treatment of Ventricular Tachycardia

By: Chen Wei, Michelle Boeck, Pierre C. Qian, Todd Vivenzio, Zoe Elizee, Jeremy S. Bredfeldt, Robert S. Kaplan, Usha Tedrow, Raymond Mak and Paul C. Zei

Cardiac SBRT is a novel way of treating refractory ventricular tachycardia (VT) that may be less costly than catheter ablation, owing to its noninvasive, outpatient nature. We applied time-driven activity-based costing to both procedures. The direct and total... View Details

Keywords: Health Care and Treatment; Activity Based Costing and Management; Cost; Health Industry

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July 1, 2022
Editorial

New Transparency Rule Helps Rein in Health Care Costs

By: Regina E. Herzlinger and Cynthia A. Fisher

Over the last year, consumer prices have grown 60% faster than wages. Employers can help their employees contend with this high inflation by addressing a long-running source: health care costs. View Details

Keywords: Healthcare Costs; Consumer Prices; Inflation and Deflation; Wages; Health Industry

February 8, 2022
Article

Time-Driven Activity-Based Cost Comparison of Treating Five Acute, Low-Severity Conditions

By: Alan Yang, Andy Hung-Yi Lee, Joseph W. Kopp, Katherine D. Rose, Adam M. Licurse, Philip D. Anderson and Robert S. Kaplan

In 2017, patients made 145 million visits to emergency departments (EDs), generating $76.3 billion in charges. About a third of ED visits, however, were for conditions that were treatable in lower-resourced settings. We used time-driven activity-based costing (TDABC)... View Details

Keywords: Time-Driven ABC; Health Care Costs; Activity Based Costing and Management; Health Care and Treatment

Article

Costs Without Value When Treating Pediatric Behavioral Patients in the ED

By: Marcella Jewell, Syed S. Shehab, Robert S. Kaplan, Jack Fanton and Joeli Hettler

Pediatric Emergency Department (ED) visits have greatly increased in recent years. An academic pediatric ED that annually treats about 1,000 behavioral health patients conducted a study to assess the true cost of caring for nonacute behavioral health patients. It... View Details

Keywords: Costs; Value; Healthcare; Health Care and Treatment; Cost Management

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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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Article

Time-Driven Activity-Based Costing in Breast Cancer Care Delivery

By: Navraj S. Nagra, Elena Tsangaris, Jessica Means, Michael J. Hassett, Laura S. Dominici, Jennifer R. Bellon, Justin Broyles, Robert S. Kaplan, Thomas W. Feeley and Andrea L. Pusic

We used time-driven activity-based costing (TDABC) to calculate the complete cost of breast cancer care—initial treatment planning, chemotherapy, radiation therapy, surgical resection and reconstruction, and ancillary services (psychosocial oncology, physical therapy.... View Details

Keywords: Healthcare; Time-Driven Activity-Based Costing; Health Care and Treatment; Cost

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May 2021
Article

Value-Based Healthcare in Urology: A Collaborative Review

By: Chanan Reitblat, Paul A. Bain, Michael E. Porter, David N. Bernstein, Thomas W. Feeley, Markus Graefen, Santosh Iyer, Matthew J. Resnick, C.J. Stimson, Quoc-Dien Trinh and Boris Gershman

Context:
In response to growing concerns over rising costs and major variation in quality, improving value for patients has been proposed as a fundamentally new strategy for how healthcare should be delivered, measured, and... View Details

Keywords: Value-based Healthcare; Integrated Practice Units; Outcome Measurement; Time-Driven Activity-Based Costing; Health Care and Treatment; Value; Cost Management; Strategy; Outcome or Result; Measurement and Metrics

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2021
Working Paper

Diagnosing Quality: Learning, Amenities, and the Demand for Health Care

By: Achyuta Adhvaryu, Emilio Gutierrez, Anant Nyshadham and Jorge Tamayo

We study the role of amenities in increasing demand for underutilized healthcare services. We evaluate the offer of a high-amenity diagnostic consultation for cataracts with a randomized price and find that a lower price for the high-amenity consultation increases... View Details

Keywords: Health Care Demand; Amenities; Health Care Quality; Cataracts; Surgery; Health Care and Treatment; Demand and Consumers; Quality; Learning; Mexico

2021
Government Testimony

How Health Care Consolidation Is Contributing to Higher Prices and Spending, and Reforms That Could Bolster Antitrust Enforcement and Preserve and Promote Competition in Health Care Markets

By: Leemore S. Dafny

Reforms to antitrust law and enforcement can help to address rising healthcare prices and spending. View Details

Keywords: Antitrust Law; Health Care and Treatment; Consolidation; Price; Spending; Cost Management; Governing Rules, Regulations, and Reforms; Competition; United States

Article

Ten Year Sunset Rule for Healthcare Regulation Is a Nonstarter and Discouragement to Post-COVID-19 Investment

By: Regina E. Herzlinger and Eugene Schneller

U.S. healthcare delivery has not benefitted from the same productivity growth as many other service industries, such as bricks and mortar retailing, a loss that has gravely diminished cost control and access. Regulatory capture, which creates barriers to venture... View Details

Keywords: Health Care; COVID-19; Regulation; Health Care and Treatment; Health Pandemics; Governing Rules, Regulations, and Reforms; Investment

March 2021 (Revised January 2022)
Case

Philips: Redefining Telehealth

By: Regina E. Herzlinger, Alec Petersen, Natalie Kindred and Sara M. McKinley

As one of the world’s largest healthcare companies, Philips sought to reach beyond the walls of the hospital and expand its hospital-to-home program to gain future competitive advantage through technology solutions combining predictive analytics with care delivery. By... View Details

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