Program Goals:

As a nation that spends more on health care than any other and yet receives less in return than most, the United States can learn a great deal from the experiences of other countries in providing health insurance coverage and delivering cost-effective, timely, high-quality health care. To promote cross-national learning, the Commonwealth Fund's International Program in Health Policy and Practice aims to:

• build an international network of health care researchers devoted to policy;
• encourage comparative research and collaboration among industrialized nations; and
• spark creative thinking about health policy through international exchanges.

The program's key activities include high-level international policy forums, the Harkness Fellowships in Health Care Policy and Practice, and an annual international survey on health policy issues. The International Program in Policy and Practice is led by Vice President Robin Osborn, M.B.A.

Recent Projects:

2008 International Symposium on Health Care Policy. For the past 11 years, the Fund has hosted an annual international health care policy symposium. The 2008 symposium, held in November in Washington, D.C., brought together nearly 100 policy experts around the theme, "Towards a High Performance Health Care System: Best Practices for Achieving Access to Care and Value for Money." Participants included health ministers or their designates from Australia, Canada, France, Germany, the Netherlands, New Zealand, Switzerland, the United Kingdom, and the United States, as well as senior government officials and leading researchers from each country.

A highlight of the symposium was the presentation of findings from the 2008 International Health Policy Survey, the eleventh in a series of cross-national surveys, by Cathy Schoen, M.S., Fund Senior Vice President, and Robin Osborn, M.B.A. The survey compared sicker adults' health care experiences in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. The survey results, which were published as a Health Affairs Web Exclusive, showed major differences in health care access, safety, and efficiency, with U.S. patients at particularly high risk of forgoing care because of costs and experiencing errors or inefficient, poorly organized care.

A policy roundtable discussion among the health ministers at the symposium provided the opportunity for an exchange of views on what defines a high performance health care system and how to strike the right balance between health care quality, efficiency, innovation, and health system sustainability.

International Working Group on Quality Indicators. In 2004, the Fund's International Working Group on Quality Indicators produced the first-ever set of quality-of-care indicators—30 in all—for benchmarking and comparing health care system performance across countries. In collaboration with the Fund, the Organization for Economic Cooperation and Development (OECD) is building on this work through its International Healthcare Quality Indicators Project. The project, which includes 23 countries, is chaired by Harvard School of Public Health's Arnold Epstein, M.D., who previously chaired the Fund's Working Group.

The OECD project's first report, published in March 2006, included comparative data on 14 quality indicators in the 23 countries. The OECD continues to develop the scope and depth of the indicator set, and had produced 50 internationally comparable quality measures by late 2007.

Harkness Fellowship in Health Care Policy and Practice. Aimed at developing promising health care policy researchers and practitioners in Australia, Germany, the Netherlands, New Zealand, Norway, Switzerland, and the U.K. the Harkness Fellowship provides a unique opportunity for individuals to spend up to 12 months in the U.S. conducting a policy-oriented research study, gaining firsthand exposure to managed care and other models of health care delivery, and working with leading health policy experts.

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

• Adam Oliver (U.K., 2005-06) published a case study of the reform of the Veterans Health Administration in The Lancet.
• Mark Exworthy (U.K., 2002-03) and colleagues compared U.S. and U.K. progress on reducing health inequalities in an article published in the Milbank Quarterly.
• New Zealand Fellow Marie Bismark (2004-05) co-authored studies on New Zealand's no-fault medical malpractice system that appeared in Quality and Safety in Health Care and Health Affairs.

Australian American Policy Fellowship. The Australian American Policy Fellowship, a "reverse Harkness Fellowship" program established in 2002, is designed to enable two mid-career U.S. policy researchers or practitioners to spend up to 10 months in Australia conducting research and gaining an understanding of Australian health policy issues relevant to the U.S. Chaired by Andrew Bindman, M.D., the selection committee met in November 2008 and selected the fifth round of fellows.

Future Directions:

In the coming year, the program plans to host several Capitol Hill briefings on international health reforms, cosponsored by the Alliance for Health Reform. One such briefing in April 2008, "Private Financing and High-Level Functioning: Some International Approaches to Health Reform," was attended by more than 200 congressional staff, policymakers, and journalists. It highlighted innovative policy approaches being taken in the Netherlands and Germany to address universal health coverage.

Since 1999, the Fund and The Nuffield Trust have sponsored annual symposia that brought together senior government officials, leading health researchers, and practitioners from the United States, the United Kingdom, and Australia for an exchange on quality improvement policies and strategies. The 10th conference in this series will explore the use of incentives and provider payment policies.

The 2009 International Health Policy Survey will assess health care system performance from the perspective of primary care physicians. Conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, the United States, and, for the first time, Switzerland, the study will include questions about clinical information capacity, payment incentives, perception of health care quality, and factors viewed as impeding or supporting high-quality, efficient, patient-centered care. Survey findings will be released at the Fund's 2009 International Symposium.