Health systems across OECD Member countries have become increasingly data-rich environments, yet many still struggle to turn this wealth of information into useful insights for policy decisions. This paradox of being “data rich but information poor” has intensified discussions among Member countries on how to design and use health system performance assessment (HSPA) frameworks effectively to drive evidence‑based improvement.
HSPA is a key instrument for ensuring that health systems meet people’s needs and deliver high-quality care for all. Regular and systematic evaluation helps policymakers identify areas needing improvement, allocate resources efficiently, and assess progress toward key health goals. At the national level, HSPA frameworks serve as strategic tools to monitor performance, ensure accountability, and guide policy, while addressing challenges such as rising costs, ageing populations, and the need for stronger system resilience.
This policy paper summarises emerging lessons from cross-country experience in developing and implementing HSPA frameworks. It draws on national activities in Australia, Belgium, Canada, Czechia, Estonia, Ireland, Italy, Latvia, Luxembourg, the Slovak Republic and Slovenia, with additional examples from other countries where relevant. The analysis combines desk research, direct country support provided by the OECD Secretariat, and inputs from the OECD Health Committee and related working parties. It examines how countries structure their HSPA frameworks, identifies key enabling factors for policy impact, and explores governance arrangements that determine whether assessments lead to tangible health system improvements.
The analysis identified seven main purposes for which countries use national HSPA frameworks, most commonly for performance monitoring, public accountability, and policy development. A comparative perspective on these frameworks reveals three main findings:
First, countries show convergence on core measurement principles, while adapting implementation to national contexts. Most frameworks are structured around inputs, processes, and outcomes, but disaggregation differs. Federal systems such as Australia and Canada break down data by jurisdiction, while smaller, centralised systems aggregate most indicators nationally. Governance models also vary, influencing how effectively results feed into policymaking. Four governance features were found to matter most:
Institutional arrangements that balance independence with co‑ordination;
Legal or political mandates ensuring systematic use of findings;
Timing of reporting aligned with policy cycles;
Broad stakeholder engagement that turns technical insights into policy action.
Second, countries use their frameworks to identify priority areas for measurement. They often include placeholder indicators to mark areas of future development. In Estonia’s HSPA framework, for example, 38% of indicators are placeholders, showing how countries set forward-looking ambitions even when data or methods are not yet fully developed.
Third, analysis of thematic domains within HSPAs shows both established and emerging policy priorities. All frameworks assess health workforce, quality and safety, financing, and access, while new domains are gaining importance. For example, Belgium added resilience as a cross-cutting theme in 2023, and environmental sustainability and person-centredness are now increasingly included. Countries thus maintain shared measurement principles while tailoring implementation to their specific contexts and evolving health system challenges.
The report also highlights three enabling conditions for successful and sustained HSPA implementation:
Robust health data infrastructure, which both supports HSPA and can be strengthened through it;
Broad stakeholder engagement, ensuring ownership and co‑ordination across institutions;
Alignment with national health policy priorities, facilitating long-term implementation and collaboration.
The OECD has a long-standing role in supporting health system performance and quality assessment and continues to strengthen its support for national HSPA efforts. In January 2024, OECD Health Ministers endorsed a renewed OECD HSPA framework, reflecting countries’ needs for internationally comparable indicators across diverse challenges, including ageing, digitalisation, and climate change. Beyond developing metrics, the OECD Secretariat provides direct technical assistance to help countries design frameworks through participatory and inclusive processes. This approach ensures that frameworks remain nationally relevant, enable international comparison, build sustainable capacity, and promote stakeholder ownership – all essential to achieving evidence‑based improvements in health system performance.