Oecd Health Policy Studies Rethinking Health System Performance Assessment A Renewed Framework

This document presents the OECD’s renewed health system performance assessment framework. It incorporates new performance dimensions, notably people-centredness, resilience, and environmental sustainability, and places increased emphasis on addressing inequalities, including those related to gender.

Ensuring a robust and resilient health system involves policy actions which need to be implemented based on the best available evidence. This requires health systems to be monitored regularly to build on their strengths and to overcome any apparent shortcomings. In order to assist in that process, this volume, a collaboration between the World Health Organization and the European Observatory on Health Systems and Policies, presents a new framework to support monitoring of health system performance, with a focus on detailed conceptual links between health system functions and overall system goals. This HSPA framework for Universal Health Coverage thus represents a comprehensive attempt to address fundamental questions regarding regular assessment of health systems, including health system boundaries, component elements and outcomes. In this book, each of the health system function chapters outlines the purpose of the function, the sub-functions that enable it to carry out the key activities necessary to fulfil its purpose, as well as the assessment areas and proposed indicative measures to evaluate how well a system performs. The framework will thus assist policy-makers in understanding possible origins or impact of poor performance on a particular health system outcome, triggering more in-depth analysis.

This report, jointly developed by the European Observatory, OECD, and WHO Europe, serves as a proof of concept for a Health Systems Performance Assessment (HSPA) dashboard. HSPA is pivotal for health system transformation, providing policymakers with key indicators to identify and address system performance issues. This brief represents a step towards more policy-friendly dashboards, emphasizing the need for a focused set of HSPA indicators aligned with policy goals. The brief highlights the alignment and complementarity of the WHO-Observatory global HSPA framework and OECD's renewed framework, which aid policymakers in navigating health systems with actionable, policy-relevant indicators. These frameworks establish connections between performance indicators, health system functions, and overarching goals, supporting a coherent policy dashboard. Tracer indicators, like workforce, digital health, and service delivery outcomes, are emphasized as crucial for assessing key policy areas. The report underscores the importance of investing in data collection and infrastructure at national and international levels to make HSPA effective. It advocates for continuous improvement and collaboration among major international organizations, including WHO, OECD, EU, and the Observatory, to align methodologies and support informed policy decision-making.

This book highlights the core elements of a possible performance measurement framework to assess health systems at the international and national levels. It also addresses further challenges which remain.

Seizing a narrowing policy window in a post-pandemic context, the OECD and the European Observatory on Health Systems and Policies, with support from the European Commission, developed a comprehensive methodology culminating in a handbook on "Strengthening Health Systems: A Practical Handbook for Resilience Testing." Inspired by stress tests in various sectors, this methodology was piloted in Finland, Greece, and Spain throughout 2023.

This publication explores the policy options to finance more resilient health systems whilst maintaining fiscal sustainability. It finds that the scale of the additional health financing needs requires ambitious and transformative policy changes.

This series of seven policy studies cover lessons from experience in health system reform, improving the technical quality of health care, income-related inequality in health care, matching supply with demand for physicians and nurses, excessive waiting times, private health insurance, and more.

This publication describes what international comparable quality measures are currently available and how to link these measures to quality policies such as accreditation, practice guidelines, pay-for-performance, national safety programmes and quality reporting.