Health policies and data

OECD Health Project (2001-2004)


Given the growing challenges facing health policy and health care systems, the OECD embarked on a three-year Health Project in spring 2001. The project focused on measuring and analysing the performance of health care systems in member countries and factors affecting performance. The purpose of the analysis was to help decision-makers formulate evidence-based policies to improve their health systems' performance.

The OECD Health Project culminated in a Meeting of OECD Health Ministers on 13-14 May 2004. A final report to Ministers, Towards High-Performing Health Systems was disseminated at this meeting. Other reports on the project's component studies were released between autumn 2004 and Autumn 2005.

Why the OECD Health Project?

While health care systems are of crucial importance to both OECD economies and the well-being of their citizens, they are facing a number of major policy challenges:

  • Rising demand due mainly to population ageing and rapid innovation and diffusion of medical technology.
  • Concern about efficiency in provision.
  • Continuing health inequalities.

"Health systems are an important element in social cohesion and represent the largest service sector in many OECD countries. Their efficiency, effectiveness and equity consequences, their impact on public finances, and their ability to meet the challenges of medical advances, ageing populations and rising expectations require creative policy approaches. OECD's Health Project provides policy guidance on these matters..." (OECD Council at Ministerial Level, May 2001).

What was the OECD Health Project?

The OECD Health Project involved both measurement and analysis of the performance of health care systems in OECD countries.  It focused on various factors affecting performance including:

  • the level and mix of resources;
  • institutional and incentive characteristics;
  • regulation and self-regulation of health systems;
  • equity issues.

The project included the following main elements:

A) Measuring and analysing health system performance

i) A component of this work aimed at developing indicators for the technical quality of medical care, as one of the key dimension of health systems performance. Institutions and arrangements for monitoring and improving quality of care were described and analysed in selected OECD countries, with a particular focus of the shifting balance between professional self-regulation and accountability.

ii) Another component included a study on equity of access to health care. This focused on measuring income-related equity of access to health care among OECD countries, and examined causes of variations in equity of access by looking at selected health-system characteristics (e.g., insurance coverage, geographic variations) and other socio-economic factors (e.g., education). A related Health Working Paper (Income-Related Inequality in the Use of Medical Care in 21 OECD Countries) was released in May 2004.

B) Explaining variations in performance

This component included work in three areas:

This work explored which human resource policies best contribute to the efficient and effective health service delivery across OECD health systems. It compared different approaches to investing in the stock of skilled staff and remuneration and incentive policies for physicians and nurses. Two related Health Working Papers (Skill-Mix and Policy Change in the Health Workforce: Nurses in Advanced Roles; Tackling Nurse Shortages in OECD Countries) were released.

ii) Waiting Times

A number of countries have identified waiting times for non-emergency surgery as a major policy concern. This study investigated the causes of variations in waiting times across OECD countries and compared the effectiveness of policies for tackling excessive waiting times. A Health Working Paper (Tackling Excessive Waiting Times for Elective Surgery: A Comparison of Policies in Twelve OECD Countries) (with Annex 1 and Annex 2 was published in July 2003. Stage 2 of the study investigated the causes of variations in waiting times.  A Health Working Paper (Explaining Waiting Times Variations for Elective Surgery across OECD Countries) was released in fall 2003.

The work on private health insurance assessed the interaction between public and private health insurance and its impact on health systems;  it also analysed the preconditions for the development of an efficient and equitable health insurance market. The final publication, Private Health Insurance in OECD Countries, was released in November 2004. Several Health Working Papers were also published on this topic.

Over the course of 2001-2004 work on new and emerging health-related technologies reviewed the different ways by which countries identify and decide on the uptake of technologies likely to have the most significant economic and social effects on the future of health care systems and the well-being of citizens. The challenges that policy makers and health system managers in all countries face in making decisions regarding the uptake of efficient and effective technologies into the health care system and the limitations of current approaches to health technology assessment are identified and analysed in the publication Health Technologies and Decision Making. Follow-up to this project over 2005-2006 includes a Health and Innovation Survey which aims to:  (1) explore the policies in place to create an innovation-friendly atmosphere for health-related technologies; (2) explore the conditions across the whole innovation cycle that affect biomedicine; (3) gather information on different tools and approaches to evaluate such biomedicines; and (4) collect information on a number of case study biomedicines. For more information, see Biotechnology, Innovation and Health.


v) Long-term care for frail elderly persons

Work under this component analysed latest trends in long-term care policies. It studied lessons learnt from countries that undertook major reforms over the past decade and compares trends in expenditure, financing and the number of care recipients. Particular attention was given to consumer direction allowing more individual choice in the way long-term care is received. The final publication Health policies and data was published in July 2005. A study on Consumer Direction and Choice in Long-term Care for Older Persons was published as Health Working Paper.

D) Overall system assessment

Work under this component of the Health Project began with a study of the recent experience in reforming health systems to meet key policy goals. The study reviewed and classified various reform instruments and assessed the effects and trade-offs associated with their use.

Building on the findings from the study of reforms, a framework for describing and assessing health systems in OECD member countries was developed. The framework presents an approach for reviewing a health system, analysing its performance, and identifying and recommending solutions to policy and performance challenges. It serves as a general guide for future reviews commissioned by member countries. A new programme of comprehensive, in-depth reviews and assessments of the health systems of OECD member countries was launched under the Health Project. A study of the Korean and the Mexican Health Systems were released during the Health Project. Reviews of the Finnish and Swiss health systems were also completed during 2005 and 2006.

How was the OECD Health Project carried out?

The OECD Heath Project involved contributions from various OECD Directorates, including inter alia, social and health policy, economics, insurance-related issues and technology, science and industry. The aim was to integrate different perspectives within the OECD on how to measure and analyse the performance of health care systems and factors affecting their performance. The collected reports and analyses form an important body of information that can be used to help formulate new, evidence-based, policy options to improve health care systems. The project enabled the Organisation to strengthen its collaboration with other international organisations. In particular, the Health Project has gone forward under the spirit of the 'Framework for Co-operation' which was agreed with the World Health Organization in December 1999.

The OECD and its Member countries invested substantial new resources in this Project.


Publications in the OECD Health Project series:

In addition, the OECD releases occasional papers on health issues. To download these papers, go to and click on Health Working Papers and on Health Technical Working Papers.

Staff presentations:

For more information

To stay in touch with the OECD Health Project and its follow-up via OECDdirect, check the OECD's alerting and e-newsletter service and choose "health" among your favourite themes. To register, go to

Published reports and other new developments will also be announced via this website

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