OECD Series on Health Care Quality Reviews





OECD Health Care Quality Reviews provide a toolkit to improve the quality of health care 

OECD Health Care Quality Reviews seek to examine what works and what does not work in different countries – both to benchmark the efforts of countries and to provide advice on reforms to improve their health system.

The reviews will cover around 10 to 12 country reports. Each report highlights best practices and offers recommendations for improvement. A final report on policies to drive improvements in health care quality across countries will be produced in 2015.

Why review health care quality policies?

  • OECD countries spent nearly a tenth of their GDP on health. As spending rises, there is pressure to ensure that resources help people live healthier lives.
  • Most OECD countries have seen increased public interest in ensuring that patients receive care that is safe, effective, and responsive to their needs.
  • OECD Health Care Quality Indicators show wide variations in quality across OECD countries, yet little is known about the policies that sit behind the numbers.


Country reports and lessons learnt

The country reports, published in English or French, are available for download below and on the OECD iLibrary.



Australia - Released 15 November 2015

  • Australia’s health system is highly fragmented, making it difficult for patients to navigate. Devolving primary care to the states and territories would better align health services, increase efficiency, and reduce the disruption to continuity of patient care.
  • The development of ten national standards for mandatory hospital accreditation represents an important element of the safety and quality improvement architecture of Australia’s health system. Expanding the scope of the standards to take in aged care, mental health services and primary health care should be a priority.
  • Australia’s national system for regulating 14 health professions makes Australia a leader among OECD countries. The system includes annual registration linked with compulsory continuing professional development, and a website that consumers can use to verify the registration of health professionals. Expanding the system to include other health professions should be the next step.
  • The existence of areas of extreme remoteness has challenged Australian health service delivery in a way that few countries have experienced. The country heavily relies on foreign doctors, and has experimented with changing scopes of practice and innovations such as telehealth to meet the needs of remote inhabitants. The quality of rural health care can be improved with strong governance, flexible funding, and by increasing the capacity of telehealth and other innovations. High-performing health services should be rewarded with greater autonomy.



Czech Republic - Released 25 June 2014

  • The Czech Republic’s data infrastructure is weak and fragmented, and there is little information for patients on hospital performance. More solid infrastructure and data collection would make it easier to monitor quality, and make patients better informed.
  • The Czech Republic takes a voluntary approach to quality assurance, which enables hospitals to escape scrutiny. A shift to mandatory accreditation would give hospitals stronger incentives to improve performance.
  • The Czech Republic’s primary care system is failing to prevent chronic disease. Focusing more on evidence-based prevention and screening programmes would help reduce the incidence of these conditions.
  • GPs aren’t playing an active role in managing complex patients with diabetes. Giving GPs incentives and training to adopt a leading role in diabetes treatment would improve quality and co-ordination of care.



Denmark - Released 30 April 2013

  • Denmark's impressive health care quality initiatives have been developed over more than 20 years; linkages across them must now be built so as to improve quality of the system as a whole, and not just focusing on individual initiatives.
  • Special focus ought to be on measuring and maximising the contribution of the primary care sector, including on the co-ordination between the primary, secondary, and community care sector.
  • To exploit the full potential of the hospital reform, Danish authorities should support the diffusion of good practices, strengthen pre-hospital care services and track data on individual physicians performance to stimulate continuous improvement by clinicians.
  • Better use of data from quality registers and other rich data sets would help documenting the extent of inequalities in health and health care and would leave Denmark better equipped to address inequalities in health.



Israel - Released 26 November 2012

  • Israel has a world class primary care system based on teams of professionals working in community clinics that are held to account by extensive data collection and strong after hours services.
  • The government ought to address the relatively poor information on quality of care in hospitals by encouraging better hospital quality reporting and improvement programmes.
  • Improving the flow of clinical information will help coordination between primary care and hospitals. 
  • Dedicated health programmes for the disadvantaged have helped address inequalities though renewed efforts are needed along with tackling the social determinants of health and avoiding further increases in co-payments.



Italy - Released 15 January 2015

  • Italy’s health system is fully regionalised. It is a good illustration of the tension that can arise between allowing regional health systems to develop their own quality monitoring and improvement frameworks, whilst ensuring national consistency. Italy has sought to resolve this tension by creating dedicated agencies (such as AGENAS) and forums that aim to share best practice and offer targeted support to weaker regions.
  • Marked differences in health system performance across regions persist, however, as measured by indicators such as 30-day mortality after a heart attack. Even more striking are the differences within regions. This underlines the need for regions to performance manage local hospitals, clinics and professionals in a consistently effective manner.
  • In order to strengthen primary care, and effective management of chronic diseases in particular, Italy has made considerable efforts to experiment with new models of community care services, such as community care networks and community hospitals. These are characterised by a high level of integration between levels of care and rely on multidisciplinary care teams and personalised care plans.
  • Italy has placed special emphasis on how training and continuing professional development of the medical workforce can drive quality improvement, and reduce regional disparities. Going forward, a particular challenge will be to better use patient feedback and other sources of routine data to encourage health professionals to reflect on and improve their practice.

The report was launched on January 15 at the Italian Ministry of Health, with results presented by Stefano Scarpetta, Director of the Directorate for Employment, Labour and Social Affairs and Francesca Colombo, Head of the Health Division. Read more about the event and access the agenda.




Japan - Released 21 August 2015

  • The overarching policy priority in the Japanese health system has, for many years, been tight fiscal governance. Whilst this has worked well to contain costs and should not be relaxed, it is important that equal attention is now paid to quality governance. This will require a more consolidated approach to quality monitoring and continuous quality improvement.
  • Given Japan’s rapidly ageing population, a clear orientation toward preventive and holistic elderly care will be necessary. A specialist primary care sector, delivering comprehensive, continuous and coordinated care across the life-course will be essential to Japan’s reorientation toward more cost-effective preventive health care.
  • As differentiation of the hospital sectors occurs into acute beds and less intensive beds, with the aim of reducing inappropriate use, a sufficiently sophisticated quality monitoring and improvement architecture will need to be built to evaluate the reforms’ impacts. More data on outcomes, rather than just inputs and processes, are needed.
  • Japan must also continue to develop high quality care in the community for severe mental illness, while turning attention to improving care available for mild-to-moderate mental illness. Good mental health care should be at the heart of the new speciality of primary care.

Visit the OECD Tokyo Centre site for further information (in Japanese)




Korea - Released 21 March 2012

  • Korea’s substantial policy reforms over the past decades have equipped it with an ideal institutional architecture from which to pursue further reforms.
  • Governments ought to take early action to develop primary care infrastructure and establish gate-keeping by primary care professionals.
  • There are risks of oversupply of hospital services at the expense of quality. Strong budgetary or regulation on supply, and payments that reward providers for doing better rather than doing more are important to avoid this. 
  • Governments and purchasers should demand accountability for the quality of health care for the substantial payments they make to health care providers.



Norway - ‌Released 21 May 2014

  • Through the 2012 ‘Coordination Reform’ Norway set out a strategic vision for its health system, seeking to increase the role of primary and community services, including through a number of financial penalties and incentives.
  • The Coordination Reform’s financial incentives should be a strong driver for municipalities to strengthen care in the community and support early discharge from hospital, but may be working less well to promote good management of chronic conditions and prevent avoidable hospital admissions.
  • The core incentives of the Coordination Reform were directed at service delivered by municipalities, meaning that key players in reducing hospital admissions and promoting coordination of care, e.g. GPs and the mental health sector, have much weaker incentives for change.
  • Under-developed data infrastructures in primary care have limited progress towards securing better quality, and a lack of electronic patient records that are portable across care settings may impede smooth patient pathways across service settings.



Portugal - ‌Released 27 May 2015

  • The Portuguese National Health Service has responded well to financial pressure, successfully balancing the twin priorities of financial consolidation and continuous quality improvement, and reforms hold lessons for other OECD countries. Portugal’s rich information infrastructure, which covers all system levels, is impressive.
  • More focus on clinical processes, pathways and standards of care is needed, particularly in hospitals, where health care associated infections appear more common than elsewhere (with a reported prevalence of 10.7% of in-patients in 2011/12, compared to 6.0% EU average). Caesarean-section rate is still the fifth highest rates in the OECD although it is falling.
  • Long average lengths of stay after a heart attack, high volumes of non-generic and inappropriate prescribing, and significant variation in medical practice across regions are, however, areas that still need to be addressed.
  • Portugal now needs to reflect on the strategic direction of the primary care system which, following an impressive reform to increase accountability and value-for-money, now risks developing into a two-model system with increasingly divergent levels of care quality.



Sweden - ‌Released 12 December 2013‌

  • Sweden has developed a care infrastructure that allows seven out of ten dependent elderly people to receive most health and social care in their homes. Compared to the hospital sector though, there is still a relative lack of standards, guidelines and indicators to measure and assure the quality of community-based care.
  • Sweden has a long-established and extensive set of quality registers for many areas of health and social care. Open comparison of municipality-level results has been instrumental in developing an ambitious quality-improvement culture across the country. More needs to be done though to build links between quality registers, in order to build up a picture of the complete pathway of care for patients with complex needs.
  • Sweden is pioneering the issue of data linkage by linking individual patient data across its Senior Alert, Dementia, Behavioural Symptoms and Palliative Care registers. This will allow a comprehensive assessment of the quality of care for patients with dementia starting from early detection, through to diagnosis and management, deterioration and end of life.
  • Sweden is expanding the role of non-traditional care providers (such as private sector providers or community organisations) in an attempt to expand patient choice and encourage quality-based competition. Close evaluation of these reforms will be needed to ensure that other objectives, such as coordinated care and equity of access, are not compromised.



Turkey - ‌Released 25 November 2014

  • Strong central leadership was critical to the success of Turkey’s Health Transformation Programme. In a maturing system, the role of the central authorities can now shift to setting out broad system goals, getting the right incentives in place and enabling local service providers to meet those goals.
  • Most data in the Turkish health system largely focuses on supply and activity. Now that UHC has been achieved, governance focussed on quality and outcomes must become the priority. Open comparison of service-level data should be promoted, to drive up quality standards and reduce variation.
  • Current quality assurance activities tend to focus on minimum standards.To build a quality culture, the focus of on-going reform should move from one of control and penalising bad performers to one of encouraging continuous improvement. Greater involvement of patients and their carers will be instrumental in delivering safer, more effective care.
  • Payment and incentive structures focus on quantity and productivity enhancement. This may risk ensuring that care is delivered in the most appropriate settings. Stronger primary care, and guidelines that cover the entire patient pathway, will be vital to ensure sustainable, high-quality and patient-centred care.




For a description of the health system in these countries and many others, visit the European Observatory's Health Systems in Transition (HiT) series.


Ms. Francesca Colombo (tel.: +33 1 45 24 93 60 or
Mr. Ian Forde (tel.: +33 1 45 24 81 24 or
Mr. Ian Brownwood (tel.: +33 1 45 24 92 79 or


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