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Archived: International Program in Health Policy and Innovation

See the International Health Policy and Practices Innovation program description for updated information.

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 among industrialized countries about ways to improve the performance of health systems. It does this by:

  • sparking creative thinking about health policy
  • encouraging comparative research and collaboration on quality improvement and other reform initiatives
  • building an international network of health care researchers devoted to health policy
  • showcasing international innovations in policy and practice that can inform U.S. health reform.

The Issue

Across the industrialized world, health care policymakers face mounting pressure to bend the cost curve while providing access to expensive new drugs and medical technologies, improving the quality and safety of care, and ensuring 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 more on health care per capita than any other nation and yet receives less in return than most.

Recent Projects

2012 International Symposium on Health Care Policy
For the past 15 years, The Commonwealth Fund has hosted an annual international health care policy symposium in Washington, D.C., organized in collaboration with the journal Health Affairs. The 2012 symposium, “International Lessons for the Financial Sustainability of Health Systems, ” brought together health ministers and more than 60 leading policy thinkers from Australia, Canada, France, Germany, New Zealand, the Netherlands, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

In the opening keynote address, New Zealand minister of health Tony Ryall outlined his vision for a high-performing 21st-century health care system and “better, sooner, more convenient care,” citing examples of his nation’s efforts to ensure patient-centered care, better access, and the provision of services closer to home. In the annual John M. Eisenberg International Lecture, Commonwealth Fund president Karen Davis reflected on 15 years of cross-national learning and highlighted innovations in policy and practice that have contributed to high performance in many of the nations’ health care systems.

During the symposium, international experts compared the strategic choices countries make for containing health care costs; the ways that different health systems have responded to the current economic downturn; and how countries use primary care as a driver of performance to achieve better care, higher quality, and lower costs. Presenters at a session on “frugal innovations” described how some low-income countries have used mobile phones and community workers to provide vulnerable populations with essential care in ways that are cheaper and sometimes achieve better clinical outcomes than those in high-income countries.

In an inspiring closing address to symposium participants, Ontario Minister of Health Deb Matthews shared her vision for Ontario’s health care system and the province’s bold agenda to transform primary care through use of multidisciplinary family health teams, greater transparency and public reporting, and an overall focus on wellness and care coordination.

A highlight of the symposium was the presentation of findings from the 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, conducted in the U.S. and 10 other countries. According to the survey, primary care doctors increasingly use electronic medical records in their practice, particularly in the U.S. and Canada, which have both seen a 50 percent increase in uptake since 2009. However, majorities of doctors in all countries reported failures of, and delays in, communication between specialists and hospitals. The survey was conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., and the U.S. An article discussing the survey results was published by Health Affairs in November 2012.

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 U.S. 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. For example in August 2012, Harkness Fellows published perspectives in the New England Journal of Medicine. Philip Van der Wees (Netherlands, 2011–12) and his Harkness mentor John Ayanian, M.D., of Harvard Medical School described Massachusetts’ ambitious efforts to limit the growth of health care spending and support delivery system reform toward accountable care organizations and patient-centered medical homes. Ewout van Ginneken (Netherlands, 2011–12) and his mentor Katherine Swartz, Ph.D., of the Harvard School of Public Health offered lessons for states from European countries’ experiences with health insurance exchanges. In Milbank Quarterly (June 2011), Ruth Thorlby (U.K., 2008–09) and her Harkness mentors John Ayanian and Bruce Siegel, M.D., of the National Association of Public Hospitals and Health Systems examined how health care organizations are using patients’ race and ethnicity to improve quality of care.

Returning to their home country, Harkness alumni continue to move into positions of influence. Based on a recent 10-year review of the Harkness Fellowships, one of three Harkness alumni was rated as a national leader within academia, government, or the health care delivery system in their home country. 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.

Expanding the OECD Health Systems Database 

Since 2004, the Commonwealth Fund has provided support for the Organization for Economic Cooperation and Development (OECD) Health Care Quality Indicators project to enable policymakers to benchmark and compare country performance. Two current initiatives sponsored by the Fund are seeking to develop and pilot cross-national indicators to measure patient experiences as well as health systems’ adoption and use of health information technology. Both projects aim for the measures to be routinely collected in all 34 OECD member countries and included in the OECD database of health indicators, providing a new window on how national health systems compare.

The organization’s 2011 OECD Health at a Glance report included, for the first time, patient safety indicators developed by the Fund-supported Health Care Quality Indicators Project. The indicators are: obstetric trauma, foreign body left in during procedure, accidental puncture or laceration, postoperative pulmonary embolism or deep vein thrombosis, and postoperative sepsis.

Building a Go-To Online Resource for International Health System Comparisons

Over the past year, The Commonwealth Fund has expanded the online resources for learning about and comparing industrialized health systems. In addition to Fund-supported publications and chartpacks, information on the Harkness Fellowships and Alumni, and the International Health Policy Center—which allows users to generate their own graphs and tables—the Fund launched the new publication series Issues in International Health Policy to report on major health reform initiatives from around the world. Topics covered in 2012 include strengthening access to after-hours care, bundling payments, and using no-fault administrative systems, or health courts, for compensating injured patients. The Fund also re-launched a monthly online newsletter, International Health News Briefing, with summaries of health policy news in Canada, France, Australia, New Zealand, Netherlands, and the U.K.

To reach out to a global audience and showcase findings from the 2011 international survey, the Fund held a webinar in January 2012. Moderated by Robin Osborn, the webinar featured Fund senior vice president Cathy Schoen presenting the 2011 survey findings, followed by reactions from international experts.

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).




Partner Organization: International Survey

Partner Organization: Harkness Fellowships


Health Council of Canada

Health Quality Ontario

Quebec Health Commission

Health Quality Council of Alberta

Canada Health Infoway

Canadian Health Services Research Foundation


National Health Authority (HAS)

National Fund for Health Insurance for Employees (CNAM)



Federal Ministry of Health

German National Institute for Quality Measurement in Health Care (BQS)

B. Braun Foundation

Robert Bosch Foundation


Ministry for Health, Welfare,
and Sport

Scientific Institute for Quality of Healthcare (IQ Healthcare)

Ministry for Health, Welfare,
and Sport


Norwegian Knowledge Centre for the Health Services

Research Council of Norway


Ministry of Health and Social Affairs

Ministry of Health and Social Affairs


Federal Office of Public Health

Swiss Medical Foundation

Careum Foundation

United Kingdom


Nuffield Trust

NHS National Institute for Health Research

Future Directions

The Commonwealth Fund’s 2013 international health policy survey will assess health care system performance from the perspective of the general population. Conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States, the study will include questions about health care access and affordability, coordination and communication between clinicians, patient engagement and care for chronic conditions, and health system views. Survey findings will be released at the Fund’s 2013 International Symposium.

In July 2013, The Commonwealth Fund and the Nuffield Trust will hold their 14th annual trans-Atlantic policy forum in Washington, bringing together senior government policymakers and experts from the U.K. and the U.S. for a policy forum focused on improving health care system quality and efficiency. Lessons learned from the 2012 meeting were highlighted in a paper published in Lancet (Oct. 2012) by David Blumenthal, M.D., of Harvard Medical School and Partners HealthCare System, and Jennifer Dixon, director of the Nuffield Trust, who compared the sweeping health reforms under way in the English and U.S. health care systems.

Most of the unrestricted grant money disbursed by the International Program in Health Policy and Innovation is for small grants of 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.