There is growing interest in improving the performance of health systems in OECD countries. Many countries are developing initiatives to measure performance to guide and inform the improvement process. Indeed, measurement and improvement are increasingly linked, as is indicated by familiar phrases such as ‘evidence-based medicine’ and ‘evidence-based policy’.

This paper summarises the findings of an investigation of recent initiatives to better measure and improve health performance in four OECD countries: France, the Netherlands, New Zealand and Sweden. It highlights a number of case studies in these countries, which have been chosen to illustrate initiatives to improve performance, which paid greater or lesser attention to measurement issues. An attempt has also been made to describe the role of institutional arrangements as well as various policy and management “levers” which are used to bring about change. The case studies and discussion presented in this paper draw upon a more ...