Health systems are under intense pressure to adapt to evolving needs and megatrends driven by population ageing, digitalisation, and climate change. They also need to be better prepared to withstand sudden, large-scale shocks such as pandemics, financial crises, natural disasters, or cyberattacks. This shifting policy context and emerging challenges called for a revision in how OECD countries assess health system performance, to help ensure that health systems meet people’s health needs and preferences while providing quality healthcare for all. This document presents the OECD’s renewed health system performance assessment framework. It incorporates new performance dimensions, notably people-centredness, resilience, and environmental sustainability, and places increased emphasis on addressing inequalities, including those related to gender. This framework expands on existing OECD efforts in these domains and integrates the most recent advancements in health system performance assessment. By offering common definitions and fostering a shared understanding among policy makers, stakeholders and organisations, the updated framework will enhance international collaboration. Furthermore, it lays the foundation for developing future indicators, facilitating data collection, policy analysis, and the integration of knowledge.
Rethinking Health System Performance Assessment
Abstract
Executive Summary
Towards a future‑proof OECD Health System Performance Assessment Framework
Health systems are under intense pressure to adapt to evolving needs and megatrends driven by population ageing, digitalisation, and climate change, as well as to be better prepared to withstand sudden, large‑scale natural or man-made shocks such as pandemics, natural and environmental disasters, biological, chemical, cyber, financial and nuclear threats, and social unrest. We need a new vision of health system performance assessment that integrates key dimensions of performance, such as resilience, people‑centredness, and environmental sustainability.
Health System Performance Assessment (HSPA) is a crucial element in ensuring that health systems meet people’s health needs and preferences and provide quality healthcare for all. By consistently and systematically evaluating health systems, it helps policy makers to identify areas that require improvement, support the best allocation of resources, and assess the achievement of key policy objectives.
The renewed Framework builds on existing frameworks that guide OECD’s work on health, including the 2015 revision (https://doi.org/10.1093/intqhc/mzv004) of the HSPA Framework (https://doi.org/10.1787/440134737301), the People‑Centred Health System Framework (https://doi.org/10.1787/c259e79a-en), and the Resilience Shock-Cycle Framework (https://doi.org/10.1787/1e53cf80-en). It places people at the centre of health systems and incorporates new key health system objectives (such as sustainability, from both the economic and environmental perspectives), and more clearly stresses the interconnectedness and potential trade‑offs across different health systems dimensions (such as balancing efficiency and equity, efficiency and people‑centredness, or sustainability and resilience).
The renewed Framework will facilitate international collaboration by providing a common language, definitions and shared understanding among policy makers, stakeholders and organisations. It provides a foundation for the development of future indicators, data collection, policy analysis and knowledge integration. It is not intended to replace national-level health system performance assessment frameworks, but to enable international benchmarking and mutual learning.
The renewed OECD Health System Performance Assessment Framework
This renewed Framework acts as a foundational guide to facilitate a collective vision for health system performance.
Health system outcomes are considered both at individual and population levels and refer to the impact on population health of health system activities, policies, and interventions. The social, demographic, economic and environmental contexts influence and are influenced by individual and population health as well as the health systems that support them. These therefore constitute the background of the Framework.
People’s health needs and preferences are at the core of the Framework and are seen both as an objective of health systems, as well as being instrumental to achieving other policy objectives. Health systems aim to deliver access to high-quality healthcare services and public health interventions. These include all activities that fall under health systems, including curative care, long-term care, and mental health, but also prevention and health promotion. The renewed Framework also draws attention to four “cross-cutting” dimensions of health system performance, namely efficiency and equity on one side, and sustainability and resilience on the other.
Health systems resources and characteristics represent the “structural” elements of health systems, i.e. the inputs necessary to enable them to function.
