Two Years, Three Lessons: What We Learned in Scanning the Globe for Health Care Innovations

Just over two years ago, as the Commonwealth Fund’s international team sought solutions to deep-seated health disparities in the United States, we looked for inspiration in the National Health Service’s groundbreaking report on racism in British health care. Our analysis became the first International Insight. In the 31 Insights since, we’ve covered everything from how Finland fosters housing security to bolster health outcomes, to Chile’s national plan for reducing depression, to Indonesia’s journey toward universal health coverage — always coming back to what the U.S. can learn.

As the U.S. moves into a new health policy era under a second Trump administration, it’s a good time to reflect on some of the key lessons we’ve learned from our peers around the world.

Lesson 1: Universal Coverage Is Critical for Accessing Health Care

Despite the U.S. uninsured rate reaching an all-time low in 2022, nearly 27 million Americans remain without health coverage. Millions more are underinsured, with inadequate coverage that causes them to avoid seeking care and filling prescriptions and results in poor health outcomes, debt, and more. But the conversation around universal coverage has largely died down at the national level, with little mention of health care during the 2024 election cycle.

Recognizing the importance of universal coverage, Indonesia — the fourth-most populous country in the world — has been on a journey to bring all its citizens into the Jaminan Kesehatan Nasional (JKN) public health insurance system. In our 2023 deep dive, we reported that the JKN covered 87 percent of the country in 2021. By August 2024, Indonesia’s vice president announced that the share had reached 98 percent and called for continuous monitoring of health care quality.

Our piece on Türkiye’s universal health care system found it has played a critical role in expanding access to primary care to most of the population. The country was able to reduce overall mortality, particularly for infants and older people, and increase access to reproductive and family planning services, resulting in a reduction of pregnancies and births among teenagers and young women. Türkiye’s life expectancy has increased 9 percent since 2003, while U.S. life expectancy has remained largely unchanged.

Lesson 2: Improving People’s Health Requires Addressing Their Broader Needs

We know that universal coverage alone is not enough to meet people’s health needs. Research shows factors like housing security, nutrition, access to transportation, and interpersonal safety have a profound impact on our individual and collective well-being. These social drivers of health account for up to 50 percent of health outcomes. While state Medicaid programs have taken steps to address social drivers for beneficiaries, the U.S. underinvests at a national level.

Finland has been taking innovative steps to address unmet social needs as a pathway to improving people’s health. Recognizing that affordable and secure housing improves both mental and physical health outcomes, the Finnish government provides immediate, stable housing without conditions to residents who would otherwise be homeless. The government is also converting homeless shelters into apartments and building new affordable units. In addition to housing, the program helps people navigate finances, find jobs, and ultimately become financially independent. The Housing First model has led to an 82 percent decline in homelessness in Finland over the past four decades as well as reductions in emergency room visits and hospitalizations, and less time spent in hospitals overall.

Gun violence is a critical public health issue in the U.S., and our 2023 Insight on the crisis noted that disparities in housing, education, and community investment are risk factors for violent crime. Some countries, including Singapore, have shown that improving people’s material conditions — by providing affordable housing and investing in early childhood education — can reduce social inequities and crime. U.S. policymakers could adopt similar public health approaches to mitigate gun violence, especially in underserved communities.

Lesson 3: Prioritizing Women’s Health Can Reduce Maternal Mortality

One of our most-covered topics — and a key issue in the recent U.S. elections — is women’s health. Amidst the backdrop of the U.S. maternal mortality crisis and historic rollbacks of reproductive rights, we have highlighted examples of how countries around the world prioritize women’s health to improve maternal and child outcomes.

The Maldives and Chile, for example, have enacted policies to expand access to midwives and medical home visits in the postpartum period, and both nations have seen reductions in maternal and infant mortality as a result. Belgium began covering in vitro fertilization through its public insurance scheme, expanding affordable access for parents. The program became so successful that citizens of other countries now go to Belgium to receive affordable care. We’ve also highlighted national policies that should serve as a warning for the U.S., namely Poland’s abortion ban, which has led to rising maternal and infant mortality and neonatal deaths.

A common thread in International Insights is that inadequate investment in health care, and inadequate resources for addressing broader social needs that facilitate good health, can lead to poorer health outcomes and wider disparities. Universal coverage, social drivers of health, and women’s health are three areas that the Commonwealth Fund will continue to emphasize in its mission to improve health care for all.

We are deeply grateful for the opportunity to collaborate with researchers and experts from around the world to highlight the profound interconnectedness of global health policy. We look forward to continuing to unearth new insights, beginning with our January issue.

The author would like to thank the Commonwealth Fund’s Christina Ramsay .