Program Goals

Sponsoring activities ranging from high-level international policy forums to the Harkness Fellowships and an annual health policy survey, The Commonwealth Fund’s International Program in Health Policy and Innovation promotes cross-national learning by:

• sparking high-level creative thinking about health policy among industrialized countries; 
• encouraging comparative research and collaboration among industrialized nations; 
• building an international network of health care researchers devoted to policy; and 
• showcasing international innovations in policy and practice that can inform U.S. health reform.

The program is led by Vice President Robin Osborn, M.B.A..

The Issue

Across the industrialized world, health care policymakers face mounting pressure to provide access to expensive new drugs and medical technologies, improve the quality and safety of care, and ensure that the care patients receive is responsive to their needs and preferences. Learning about other countries' approaches to attaining a high performance health care system—one that provides comprehensive health insurance coverage and delivers cost-effective, timely, high-quality health services—is of particular benefit to the United States, which continues to spend far on health care per capita than any other nation and yet receives less in return than most.

Recent Projects

2011 International Symposium on Health Care Policy
For the past 14 years, The Commonwealth Fund has hosted an annual international health care policy symposium in Washington, D.C., organized in collaboration with the leading U.S. health policy journal, Health Affairs. The 2011 symposium, “Achieving a High Performing and Sustainable Health Care System: Bending the Cost Curve,” brought together health ministers and 65 leading policy thinkers from Australia, Canada, France, Germany, New Zealand, the Netherlands, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

Kicking off the symposium was Annette Widmann-Mauz, Parliamentary State Secretary for Health for Germany, who outlined her vision of a 21st-century health care system. In the annual John M. Eisenberg International Lecture, David Blumenthal, M.D., Samuel O. Thier Professor of Medicine and Health Policy at Harvard Medical School and chair of The Commonwealth Fund Commission on a High Performance Health System, noted the “performance improvement imperative” in the U.S. and laid out general principles to guide strategic use of the new tools provided by health reform to raise health system performance. Guest speaker Naoki Ikegami, M.D., Ph.D., a health economist from Keio University in Japan, described how prices are controlled in Japan’s multipayer health system. Japan, which celebrated 50 years of universal coverage in 2011, has been successful in restraining health spending while providing good access to care and producing excellent patient outcomes. Japan spends less than half as much per capita on health care as the U.S.

A highlight of the symposium was the presentation of findings from the 2011 Commonwealth Fund International Health Policy Survey, which found that adults with complex medical conditions benefit from receiving their care from a medical home. According to the survey, which focused on the care experiences of “sicker” adults in the U.S. and 10 other high-income countries, patients connected with primary care practices that have medical home characteristics were less likely to report medical errors, test duplication, and other care coordination failures. Moreover, they reported better relationships with their doctors and rated their care more highly. An article based on the survey findings was published by Health Affairs (Nov. 9, 2011). The survey was conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

Harkness Fellowship in Health Care Policy and Practice

Targeted toward promising health care policy researchers and practitioners in nine countries, the Harkness Fellowships provide a unique opportunity to spend up to 12 months in the United States conducting a policy-oriented research study, gaining firsthand exposure to innovative models of health care delivery, and working with leading health policy experts. In 2011, Sweden joined Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Switzerland, and the United Kingdom as participants in the program.

Harkness alumni continue to generate important research based on their fellowship work and move into high-profile positions back home. For example:

• In a feature article in Milbank Quarterly (March 23, 2011), Geraint Lewis (U.K., 2007–08), Rhema Vaithianathan (U.K., 2007–08), Peter Hockey (U.K., 2007–08), and coauthors identified lessons from the aviation industry that could be applied to patient safety improvement efforts. 
• In a piece in the New England Journal of Medicine (April 14, 2011), Adam Elshaug (Australia, 2010–11) and colleagues examined the budget impact of two medical procedures commonly covered by insurers (percutaneous vertebroplasty and kyphoplasty) that recent comparative-effectiveness research suggests may not only be ineffective but also raise safety concerns. 
• Stephanie Stock (Germany, 2007–08) reported in Health Affairs (Dec. 28, 2010) the successes of German diabetes management programs in lowering mortality, complications, and costs for diabetics.

To learn more about the Harkness Fellowships and about alumni fellows, visit the Harkness Fellowships page.

In collaboration with the Australian Department of Health and Ageing, The Commonwealth Fund also offers the Australian–American Health Policy Fellowship, a “reverse Harkness Fellowship” designed to enable midcareer U.S. policy researchers or practitioners to spend six to 10 months in Australia conducting research and gaining an understanding of that country’s health care system.

International Meeting on Quality of Health Care

Since 1999, The Commonwealth Fund and The Nuffield Trust have sponsored annual symposia bringing together senior government officials, leading health researchers, and practitioners from the United States and the United Kingdom for an exchange on quality improvement policies and strategies. The 12th conference in this series, held in July 2011 at Pennyhill Park, England, compared country reform strategies for transforming the delivery system and bending the cost curve through accountable care organizations in the U.S. and clinical commissioning groups in the U.K. The discussion centered on getting the right balance between competition, collaboration, and regulation to drive quality and integration; using institutional payment mechanisms as drivers of quality and accountability; and creating a policy environment that enables models of excellence and innovation to thrive.

Since its inception, this meeting has underpinned a cross-national collaboration on quality led in the U.S. by Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), and, until 2011, in the U.K. by Sir Liam Donaldson, former chief medical officer for England’s Department of Health.

Capitol Hill Briefings

In November 2011, The Commonwealth Fund and the Alliance for Health Reform cosponsored a Capitol Hill briefing for congressional staff, policymakers, and journalists to highlight the policies other countries use to improve value in pharmaceutical purchasing. The panelists, who included the directors of the U.K.’s National Institute for Health and Clinical Excellence (NICE), Germany’s Federal Joint Committee, and France’s National Authority for Health, discussed the roles of such tools as comparative effectiveness research, limited-entry agreements, and reference pricing.

Harkness Alumni Policy Forum

At a Washington, D.C., forum held in May 2011, senior U.S. policymakers and alumni of the Harkness Fellowships program gathered to share information about international innovations in health care delivery and lessons for health reform. Fellows presented findings on such topics as shared services in primary care, after-hours care arrangements, mobile health interventions, and patient safety strategies. Among the U.S policymakers taking part in the event were Donald M. Berwick, M.D., former head of the Centers for Medicare and Medicaid Services; Jeanne Lambrew, Ph.D., Deputy Assistant to the President for Health Policy; David Blumenthal, M.D., former director of the Office of the National Coordinator for Health Information Technology; and Carolyn Clancy, director of the Agency for Healthcare Research and Quality.

Partnerships with International Foundations

The Commonwealth Fund has more than 20 ongoing international partnerships with health ministries, research organizations, and health care foundations whose cofunding and collaboration support the expansion of the Harkness Fellowships and the Fund’s annual International Health Policy Survey, in addition to important cross-national research on comparative health system performance (see table).

Future Directions

The 2012 International Health Policy Survey will assess health care system performance from the perspective of primary care physicians, focusing on practices’ capacity to serve as medical homes and coordinate care, deployment of care teams for chronically ill patients, use of electronic health records with information exchange capabilities, payment arrangements, and job satisfaction. The findings will be released at the Fund’s 15th annual

Most of the International Program’s unrestricted grant money is for small grants up to $50,000 and for issue briefs and case studies. Topics of particular interest include health care delivery system integration; patient-centered primary care models; governance structures for ensuring quality, cost-containment, and competition; and comparative pricing and utilization for pharmaceuticals, medical imaging, and medical devices.

To apply for a grant from The Commonwealth Fund's International Program in Health Policy and Innovation, visit the Applicant and Grantee Resources page.