Health System Performance Assessment (HSPA) plays a vital role in ensuring that health systems meet people’s health needs and preferences, and provide high-quality, accessible healthcare for all. Consistent and systematic evaluation of health systems helps policy makers to identify areas that require improvement, support the best allocation of resources, and assess the achievement of key policy objectives. Over the past three decades, the OECD created comprehensive conceptual frameworks to assess various dimensions of health system performance that have enabled effective benchmarking and policy analysis. But as the policy environment of health systems changes rapidly, the approach to assessing health system performance also need to evolve.
There is growing awareness that people’s needs and preferences must be placed at the centre of health systems. Additionally, the resilience of health systems against major shocks has emerged as a critical issue to be addressed. The COVID‑19 pandemic revealed that even the most affluent health systems were underprepared and lacked resilience in the face of major shocks. Its legacy continues to reverberate, alongside enduring and emerging crises. Moreover, population ageing and increasing digitalisation of health systems are bound to have a significant impact on health and healthcare in the future.
The need to address these issues can serve as a catalyst for countries to work together to build more people‑centred, sustainable and resilient health systems. The conceptual framework underpinning the assessment of health system performance and the OECD’s work on health need to reflect the current and future challenges faced by health systems.
This report presents the renewed HSPA Framework as approved by the Health Committee via written procedure on 6 December 2023 and prepared for publication by the OECD Secretariat. It emphasises people‑centredness, placing people’s needs and preferences at the core of health systems, as requested at the 2017 OECD Meeting of Health Ministers. It also integrates new dimensions of performance – notably resilience and environmental sustainability – but also gives more prominence to inequalities, including gender inequalities. The main elements of the Framework are presented in relation to each other at a high level, not detailing all possible conceptual relationships. This approach makes it suitable for application to countries with different geographical characteristics, economies and health systems. The renewed Framework sets out an overarching vision, and more detailed measures, indicators and programmes of work will facilitate work to realise that vision.
A fit-for-purpose framework is a tool that consolidates a collective understanding of key policy objectives of health systems. It is not intended to replace national-level HSPA frameworks, rather, it facilitates international or regional-level benchmarking and mutual learning. It provides a shared vision of the main elements of health systems that deserve policy attention in the hope that this will help guide health systems towards ever stronger performance.
This renewed Framework is the culmination of a process of discussion and active engagement with OECD member countries to ensure its relevance and usefulness based on the most pressing policy needs. It was welcomed by Ministers at the 23 January 2024 OECD Meeting of Health Ministers.