Commonwealth Fund

The Commonwealth Fund is an American private foundation devoted to improving health care and health policy, with particular attention to people who are vulnerable within the health system, including low-income people, uninsured people, and people of color. Its work combines grantmaking, independent research, comparative analysis, fellowships, and dissemination of evidence intended to influence health care professionals, policymakers, institutions, and the broader public. Unlike a commercial health care company, the Commonwealth Fund does not sell a consumer product or operate a health insurance plan. Its principal public-facing offerings are research reports, data analysis, policy briefs, surveys, rankings, fellowships, and support for health-related institutions and initiatives. The foundation was established in 1918 by Anna M. Harkness with an endowment of almost $10 million. Harkness, the widow of Standard Oil investor Stephen V. Harkness, created the organization with the aim of contributing to human welfare. Her son, Edward Stephen Harkness, became its first president and helped develop its early institutional direction. Additional gifts and bequests from the Harkness family between 1918 and 1959 increased the endowment substantially. By the end of 2021, the endowment was reported to be close to $840 million. During its early decades, the Commonwealth Fund supported a broad range of welfare initiatives, especially programs related to children, hospitals, medical schools, community health, rural health care, mental hygiene, medical research, and medical education. The foundation played a significant role in bringing together Columbia Medical School and Presbyterian Hospital in New York City. That effort culminated in the creation of Columbia-Presbyterian Medical Center in 1922, an institution now associated with NewYork-Presbyterian and Columbia University Irving Medical Center. The organization also helped develop health care capacity outside major urban centers. From the late 1920s through the 1940s, it supported rural hospital construction, work that contributed to the policy environment preceding the Hill-Burton Act of 1946. After the Second World War, it supported the development of medical schools and other efforts intended to address physician shortages and improve services in communities with limited access to care. Its historical work has also been associated with the Rochester Regional Hospital Council, the development of nurse practitioner and physician assistant roles, and support for medical research. In the 1940s, Commonwealth Fund support contributed to Georgios Papanikolaou's research associated with the Pap test, while foundation-backed research on cardiac catheterization contributed to advances later recognized with a Nobel Prize. The Commonwealth Fund's priorities evolved over time. Its work in the 1960s and early 1970s emphasized urban health care systems; in the late 1970s it supported improvements to medical education curricula; and in the 1980s it became associated with the patient-centered care movement and with greater attention to the health needs of older Americans. Its international fellowship program, launched in 1925 and later known as the Harkness Fellowships, initially welcomed scholars from a wide range of disciplines and helped support people who later became prominent in science, the arts, business, and public affairs. Since 2004, the Commonwealth Fund has published comparative assessments of health systems in high-income countries. These reports draw on survey and administrative data, including material from the OECD and the World Health Organization, and examine access to care, care processes, administrative efficiency, equity, and health outcomes. The reports have consistently identified the United States as the weakest overall performer among the countries included in successive comparisons, despite the country's high level of health spending. The 2021 comparison placed Norway, the Netherlands, and Australia among the strongest-performing systems. The foundation generally does not solicit ordinary donations, but several gifts and asset transfers have expanded its resources and program scope. These included the 1986 transfer of assets from the James Picker Foundation, a 1996 grant from the Health Services Improvement Fund for metropolitan New York health care work, and later bequests and contributions. The Commonwealth Fund remains an independent health policy institution whose influence comes primarily from research, convening, fellowships, and long-term philanthropic support rather than commercial operations.

The Commonwealth Fund was founded in 1918 by Anna M. Harkness, who provided an initial endowment of nearly $10 million. It was among the early major foundations established by a woman. Harkness created the organization as a philanthropic vehicle intended to advance human welfare. Her son, Edward Stephen Harkness, served as its first president, and he and his wife, Mary Harkness, helped give the foundation a strong orientation toward social reform and the improvement of American health services. The foundation's original grantmaking was broad. Early support included child welfare and other social programs, followed by assistance for medical schools, hospitals, clinics, public health programs, mental hygiene, community health, rural hospitals, medical education, and medical research. The Harkness family's additional gifts and bequests between 1918 and 1959 brought total family contributions to more than $53 million. In New York City, the Commonwealth Fund and Edward Harkness were important participants in the merger of Columbia Medical School and Presbyterian Hospital. The resulting Columbia-Presbyterian Medical Center opened in 1922 and is now part of the NewYork-Presbyterian / Columbia University Irving Medical Center complex, which includes the Harkness Pavilion and the Edward S. Harkness Eye Institute. The organization developed a significant rural and regional health agenda from the late 1920s through the 1940s. Its support for rural hospital construction helped demonstrate the need for public investment in local medical infrastructure and contributed to the policy background of the Hill-Burton Act of 1946. Following the Second World War, the foundation supported the creation and development of medical schools intended to help relieve physician shortages and extend care to underserved communities. Other historical contributions included support for the Rochester Regional Hospital Council and initiatives associated with the emergence of nurse practitioner and physician assistant professions. Commonwealth Fund grants also supported medical research. In the 1940s, the foundation backed work by Georgios Papanikolaou that helped establish the Pap test as a method for detecting cervical cancer. Support for researchers refining cardiac catheterization contributed to advances in cardiovascular medicine that were later recognized by a Nobel Prize in 1956. These activities reflected the foundation's long-standing practice of combining institutional grants with efforts to improve clinical knowledge and health care delivery. The focus changed with the needs of the health system. During the 1960s and early 1970s, the foundation concentrated on urban health care systems. In the late 1970s, it supported work to improve medical school curricula. During the 1980s, it played a prominent role in the development of patient-centered care and helped bring greater attention to older Americans' health needs. Its international fellowship program, created in 1925, operated for many decades as the Commonwealth Fund Fellowships and later became known as the Harkness Fellowships. Until the 1990s, the program accepted scholars from many academic disciplines and supported participants who went on to careers in science, the arts, business, and other fields. Several later asset transfers expanded the foundation's capacity. In 1986, Jean and Harvey Picker transferred $15 million in James Picker Foundation assets into the Commonwealth Fund. In 1996, the Health Services Improvement Fund provided $1.7 million with a mandate to improve coverage, access, and quality in the greater New York metropolitan region. Floriana Hogan left a $100,000 bequest in 1999, and Frances Cooke Macgregor contributed $3.1 million to the endowment in 2002. Since 2004, the Commonwealth Fund has been particularly visible for its international comparisons of health system performance. These studies use survey and administrative sources, including OECD and World Health Organization data, and assess access, care processes, administrative efficiency, equity, and outcomes. The reports have repeatedly found that the United States performs poorly overall relative to other wealthy countries despite spending a larger share of gross domestic product on health care. By the end of 2021, the foundation's endowment stood at nearly $840 million. It continues to operate as an independent private foundation centered on health research, policy analysis, grantmaking, fellowships, and public communication.

• 2021

  Endowment approaches $840 million

  [1]Commonwealth Funden.wikipedia.org

  The foundation's endowment was reported at almost $840 million at the end of 2021.

• 2004

  International health system comparisons begin

  [1]Commonwealth Funden.wikipedia.org

  The foundation began publishing recurring comparisons of health systems in high-income countries.

• 1986

  James Picker Foundation assets transferred

  [1]Commonwealth Funden.wikipedia.org

  Jean and Harvey Picker transferred $15 million in James Picker Foundation assets to the Commonwealth Fund.

• 1956

  Supported cardiac catheterization research receives Nobel recognition

  [1]Commonwealth Funden.wikipedia.org

  Researchers whose work was supported by the foundation contributed to cardiac catheterization advances associated with a Nobel Prize.

• 1946

  Rural hospital work contributes to the Hill-Burton policy environment

  [1]Commonwealth Funden.wikipedia.org

  The foundation's support for rural hospital construction helped advance discussion of public investment in hospital infrastructure before passage of the Hill-Burton Act.

• 1925

  International fellowship program launched

  [1]Commonwealth Funden.wikipedia.org

  The Commonwealth Fund began its international fellowship program, later known as the Harkness Fellowships.

• 1922

  Columbia-Presbyterian Medical Center created

  [1]Commonwealth Funden.wikipedia.org

  The foundation and Edward Harkness helped orchestrate the merger of Columbia Medical School and Presbyterian Hospital, resulting in the creation of Columbia-Presbyterian Medical Center in New York City.

• 1918

  Commonwealth Fund established

  [1]Commonwealth Funden.wikipedia.org

  Anna M. Harkness founded the private foundation with an endowment of almost $10 million. Edward Stephen Harkness became its first president.

Independent health care philanthropy and policy research focused on improving access, quality, equity, and efficiency, particularly for underserved populations.

• Comparative health policy research · 2004

  International Health System Comparisons

  Recurring reports compare health systems in high-income countries using survey and administrative evidence. Their analytical framework covers access to care, the care process, administrative efficiency, equity, and health outcomes. The reports are designed to show how different systems perform relative to one another and to identify areas where policy and delivery can improve.

• Research fellowship · 1925

  Harkness Fellowships

  The Harkness Fellowships originated as the Commonwealth Fund's international fellowship program, launched in 1925. For much of its history the program was open to scholars across academic disciplines, supporting research and professional exchange. Alumni included people who later achieved distinction in science, the arts, business, and other fields.

• Philanthropic research and grantmaking · 1918

  Health Policy Research and Grants

  The foundation supports research, policy analysis, and institutional initiatives addressing health care access, quality, equity, efficiency, public health, medical education, and the needs of underserved populations. Historically, its grants have also supported hospitals, clinics, medical schools, rural care infrastructure, and clinical research.

• 2004International Health System Performance Comparisons

  United States · International

  The Commonwealth Fund began a continuing program of comparative reports examining health systems in high-income countries through common measures of access, care quality, administration, equity, and outcomes.

  Outcome. The reports became a prominent source of international health policy comparison and repeatedly highlighted the United States' comparatively weak overall performance and high spending.

  Source
• 1925Commonwealth Fund Fellowships

  International

  The foundation established an international fellowship program to support scholars and professional exchange. The program was later renamed the Harkness Fellowships.

  Outcome. The fellowship operated for decades and supported participants from multiple academic disciplines, including people who later became notable in science, the arts, and business.

  Source

• 1996

  New York metropolitan health improvement mandateStrategy

  Background

  The Health Services Improvement Fund provided resources with a specific mandate concerning health coverage, access, and quality in the greater New York metropolitan region.

  Action taken

  The Commonwealth Fund accepted $1.7 million for work focused on improving regional coverage, access, and care quality.

  Aftermath

  The grant expanded the foundation's ability to support health system improvement projects in the New York metropolitan area.

  Restricted grant. $1.7 million (1996)

  Source

• 1986

  Integration of James Picker Foundation assetsM&A

  Background

  Jean and Harvey Picker sought to combine assets of the James Picker Foundation with the Commonwealth Fund.

  Action taken

  The Commonwealth Fund received $15 million in James Picker Foundation assets.

  Aftermath

  The transfer increased the Commonwealth Fund's resources and broadened its capacity for health-related philanthropic work.

  Transferred assets. $15 million transferred (1986)

  Source

1. 1Commonwealth Funden.wikipedia.org
2. 2Commonwealth Fund official websitecommonwealthfund.org
3. 3Commonwealth Fund records, 1863–2002rockarch.org