Health System Performance Assessment


The assessment of health system performance is a crucial element for ensuring that health systems meet people’s health needs and preferences, and provide high-quality accessible healthcare for all. It helps policy makers identify areas that require improvement, support the best allocation of resources, and assess the achievement of key policy objectives.

For the past 30 years, the OECD has developed conceptual frameworks to assess various dimensions of health systems, to facilitate reliable benchmarking and policy evlauation.


The need for a renewed OECD’s HSPA framework

As the world changes, so must the approach to how health system performance is assessed. The COVID-19 pandemic revealed that health systems were underprepared and therefore not as resilient as they should have been or were thought to be. As the legacy of this crisis continues to reverberate, an interrelated set of enduring and emerging crises – cost of living, climate change, war – calls for urgent action to ensure that health systems are more resilient to future shocks. At the same time, megatrends such as ageing populations and increasing digitalisation are likely to have a significant impact on health and healthcare in the coming years.

These seismic shifts present not only an immense challenge but also an opportunity to chart a path collectively towards building greener, more sustainable and more resilient health systems that yield dividends for populations, societies and economies. The conceptual framework underpinning assessment of health system performance and the OECD’s work on health need to reflect both the policy challenges health systems face today and those that are certainly expected for the future.

The purpose of an HSPA framework is to provide a shared vision of the main elements of health systems that require focused policy attention. The “classic trio” that is at the basis of most HSPA frameworks – input, process and outcomes – is visible in this renewed framework: resources and policies are fed into healthcare services and interventions that, in turn, produce health outcomes. 




Roles of OECD’s HSPA framework

The OECD’s HSPA Framework provides a structure to help describe, analyse and understand how countries are making progress towards achieving high-performing, resilient and people-centred health systems in this new policy landscape. It facilitates international collaboration by providing a common language, definitions and shared understanding among country officials, policy makers, stakeholders and organisations. It also provides a foundation for indicator development, data collection and policy analysis, providing the basis for future work by the OECD Health Committee and its subcommittee bodies (expert groups and working parties). This facilitates knowledge integration from different sources and streams of work, and stimulates innovative analyses such as assessing the impact of health systems on the environment.‌


Funded by the EU

The Health Division of the OECD and the DG REFORM of the European Commission are cooperating in providing technical support to countries to establish Health System Performance Assessment (HSPA) programs:


Health System Performance Assessment Framework for Estonia 



Health System Performance Assessment Framework for the Czech Republic

The Health Division of the OECD is also supporting the Dubai Health Authority in developing and implementing a new HSPA framework.



Establishing a Health System Performance Assessment Framework for Dubai

The Dubai Health Authority of the United Arab Emirates requested technical assistance from the OECD to assess the state of the health information infrastructure and support the creation and implementation of a Health System Performance Assessment Framework. The initial project consisted of four parts: 1) the development of an HSPA framework for Dubai, 2) assessment of the health data infrastructure, 3) the selection of indicators, and 4) analysis and reporting of the first HSPA report.



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