Rethinking Health System Performance Assessment

The OECD’s HSPA Framework provides a structure to help describe, analyse and understand how countries are progressing towards achieving high-performing, resilient and people-centred health systems. It supports international collaboration by providing a common language, clear definitions and shared understanding between stakeholders. It also provides a foundation to develop indicators, collect data and conduct policy analysis, such as assessing the impact of health systems on the environment

As the world changes, so too must the way we assess the performance of our health systems

The COVID-19 pandemic exposed gaps in preparedness and showed that many health systems were not as resilient as expected. Today, ongoing and new challenges – including the rising cost of living, climate change, and global instability – make it more urgent than ever to strengthen health systems so they can better withstand future shocks.

At the same time, long-term trends such as ageing populations and rapid digitalisation are set to transform health and healthcare in profound ways. These shifts bring major challenges – but also important opportunities. By rethinking how we evaluate health system performance, we can help shape greener, more sustainable and more resilient systems that deliver real benefits for people, societies and economies.

In this context, both the framework we use to assess performance and the OECD’s approach to health must reflect today’s priorities and prepare for the needs of tomorrow.

The OECD’s renewed Framework builds on existing frameworks that guide OECD’s work on health, including the 2015 revision of the HSPA Framework, the People‑Centred Health System Framework and the Resilience Shock-Cycle Framework.

Key characteristics of OECD’s framework include:

• A strong emphasis on people-centredness, placing people’s needs and preferences at the core of health systems.
• Health system outcomes are assessed at both at individual and population levels, reflecting how policies, services and interventions affect overall health and well-being.
• The framework grounded in an understanding that social, demographic, economic and environmental contexts influence and are influenced by the health of individuals and populations, as well as the health systems that support them.
• High-quality healthcare services and public health services are understood to include a broad range of activities - from curative care, long-term care and mental health services to prevention and health promotion.
• The renewed Framework also highlights four cross-cutting dimensions that shape health system performance: efficiency, equity, sustainability and resilience.

The OECD and the European Commission are cooperating in providing technical support to countries to establish HSPA activities

Implementation of the renewed OECD HSPA framework allows member countries and the OECD to structure work on international measurement of performance, and identify areas where information is lacking. Through OECD’s health database and initiatives like the Patient-Reported Indicator Surveys (PaRIS), countries gain the tools and resources necessary to measure and compare their health system performance across a wide range of domains. This work on indicators is fundamental to translating the conceptual framework into practical and measurable insights in international comparisons.

However, the OECD's approach to HSPA extends beyond simply providing a standardised framework for international comparison. It also actively supports member countries in the development of their own national HSPA frameworks, tailored to their unique local contexts and specific needs. This recognition of the diversity of health system landscapes underscores the OECD's commitment to fostering relevant and actionable performance assessments across its membership.

See recent examples of OECD’s collaboration with countries to develop their national activities:

• Rethinking health system performance assessment (January 2024)
• Also read Assessing Health System Performance: Proof of Concept for a HSPA Dashboard of Key Indicators, jointly developed by the European Observatory, OECD, and WHO Europe (February 2024)

Reach out to our team to discuss how we can support countries’ efforts to develop HSPA activities.

For more information and to start a conversation, please contact:

• Guillaume Dedet (guillaume.dedet@oecd.org) 
• Lucie Bryndova (lucie.bryndova@oecd.org)