The Origins of HCP

In 1987, two forces led the administration of Harvard Medical School to consider creating a new “quadrangle-based” department devoted to health policy. The first was the belief that health care policy was becoming more relevant to physicians at all stages of their careers. The second was the pending arrival of Joseph P. Newhouse as the new leader of the university-wide Division of Health Policy Research and Education.

The school believed that physicians were likely to play an increasingly important role in health policy in future years and that interactions with social scientists would be mutually beneficial. Thus, plans for a new academic Department of Health Care Policy were begun. Barbara J. McNeil led the development of these plans, and later became head of the new department—a position she holds to this day.

The Inaugural Celebration of the Department heard remarks about “Health Care in the ‘90s: The Impending Revolution”  from William Roper, then Deputy Assistant for Domestic Policy and Director of the White House Office of Policy Development and Joseph Califano, then Senior Partner, Dewey Ballantine, Bushby, Palmer, and Wood. See link to view the symposium.

Starting a new department in any medical school was challenging, particularly because there were no obvious roadmaps to describe optimal types and numbers of faculty, students, or postdoctoral fellows, kinds of courses suitable for medical students, or the scope of a multidisciplinary research portfolio. At that time, most health policy groups were located either in schools of public health with faculty who were drawn largely from the social sciences, or in research groups whose primary mission was not academic.

Harvard wished to have a department where physicians and social scientists were on equal footing, who taught and did research together, who were located in the same physical space, and who had the same chances of academic advancement. This roadmap was novel, especially for the late ’80s. Since that time, approximately 15 other medical schools have established academic departments, centers, or divisions devoted to research and education in health policy.

The Harvard department came together quickly because three of its founding members, Paul D. Cleary, Arnold M. Epstein, and Barbara J. McNeil, were already close friends and collaborators. Joseph P. Newhouse quickly joined the group upon his arrival to Boston. Together they searched for a statistician, and recruited Constantine Gatsonis from the Department of Statistics at Carnegie Mellon. This group felt that its combined expertise allowed the department to study important policy areas related to health care costs, patient outcomes, clinical effectiveness, and technology assessment.

Early on, there was immediate need for another social scientist. Paul Cleary identified Edward Guadagnoli from Brown University as the best candidate. This new group, along with colleagues from the Brigham and Women’s Hospital, organized its first collaborative research project—one of the first Patient Outcome Research Teams (PORTs) on acute myocardial infarction. This grant provided a model for research that has continued to this day: multidisciplinary groups that always have a statistician devoting a significant amount of time to the project, a physician, and one or two social scientists.