Executive summary

Health systems are under intense pressure to adapt to evolving needs and megatrends driven by population ageing, digitalisation, and climate change, as well as to be better prepared to withstand sudden, large-scale natural or man-made shocks such as pandemics, natural and environmental disasters, biological, chemical, cyber, financial and nuclear threats, and social unrest. We need a new vision of health system performance assessment that integrates key dimensions of performance, such as resilience, people-centredness, and environmental sustainability.

Health System Performance Assessment (HSPA) is a crucial element in ensuring that health systems meet people’s health needs and preferences and provide quality healthcare for all. By consistently and systematically evaluating health systems, it helps policy makers to identify areas that require improvement, support the best allocation of resources, and assess the achievement of key policy objectives.

The renewed Framework builds on existing frameworks that guide OECD’s work on health, including the 2015 revision (https://doi.org/10.1093/intqhc/mzv004) of the HSPA Framework (https://doi.org/10.1787/440134737301), the People-Centred Health System Framework (https://doi.org/10.1787/c259e79a-en), and the Resilience Shock-Cycle Framework (https://doi.org/10.1787/1e53cf80-en). It places people at the centre of health systems and incorporates new key health system objectives (such as sustainability, from both the economic and environmental perspectives), and more clearly stresses the interconnectedness and potential trade-offs across different health systems dimensions (such as balancing efficiency and equity, efficiency and people-centredness, or sustainability and resilience).

The renewed Framework will facilitate international collaboration by providing a common language, definitions and shared understanding among policy makers, stakeholders and organisations. It provides a foundation for the development of future indicators, data collection, policy analysis and knowledge integration. It is not intended to replace national-level health system performance assessment frameworks, but to enable international benchmarking and mutual learning.


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