- This project aimed to compare health systems between OECD countries by examining the potential relationship between health system characteristics and how well they perform.
- The project, co-funded by the Health Foundation, was led by the OECD and ran until the end of December 2024
- The first phase of the project – consisting of a survey which collected information on key policies and institutional characteristics from OECD health systems - is now complete. The results are available here.
How does a country’s health system compare internationally? Which reforms to the way health systems are organised would achieve higher performance? These are some of the questions policy makers are interested in when it comes to their country’s health system. But measuring health system performance is not easy. Performance depends not just on how health systems are organised but on a multitude of political, economic and population-based factors as well. The key features of health systems are also complex to collect and analyse because health systems are subject to frequent reform.
Comparing performance through health system clusters
Despite a large body of literature available on health system classifications, there is no up-to-date and detailed analysis of international health systems characteristics and their potential relationship with health system performance. This project involves an updated survey of health system characteristics (also carried out in 2008, 2012, and 2016) to 1) identify key features of OECD health systems; 2) cluster analysis to group health systems with similar institutional features, and 3) cluster analysis of routine performance data to compare health system performance within and between health system clusters.
As the COVID-19 pandemic has affected both health system policies and performance, the project will compare the performance of health systems before, during and after the COVID-19 pandemic.
Approach
The project involved four stages:
- First, through a new round of the OECD Health Systems Characteristics survey (now complete), the team has collected information on key features of national health systems from 33 countries. This information includes details of how health systems finance health care, organise health care delivery, and allocate resources.
- Second, the team identified a conceptual framework to measure the performance of OECD health systems and select appropriate indicators within this framework to assess and compare health system performance within and between health system clusters. This part of the work involved a review of existing assessment frameworks and potential indicators that could be used, for example, life expectancy. This analysis considered the capacity of the systems to improve health status, but also to meet intermediate objectives, such as effectiveness and accessibility.
- Third, by considering previous analyses by the OECD, the team compared clustering methods to identify interpretable groups of countries with similar health system features. These features were captured through the health system characteristics survey and include factors referring to governance, resource generation, financing and service delivery.
- The final stage involved analysing and comparing health system performance within and between health system clusters to assess whether any institutional characteristics are associated with observed differences in country health system performance at different points in time.
Contact
For more information, please contact: Luca Lorenzoni, project lead at OECD, or Ruth Thorlby, Assistant Director of Policy at the Health Foundation.