The COVID-19 pandemic had massive consequences for societies and health systems across the OECD and beyond. Health systems were not resilient enough. Resilient health systems plan and are ready for shocks, such as pandemics, economic crises or the effects of climate change.

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.

In this Handbook, Steve Thomas and Padraic Fleming compile invaluable and original insights on the resilience of health systems in the face of shocks and crises, from economic and climate emergencies, to conflicts and pandemics. They examine how health system resilience has been conceptualised by scholars and applied in specific contexts, assessing different theoretical models for measuring and evaluating resilience, as well as highlighting the growing challenges facing health systems now and in the future.

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 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.

The COVID-19 pandemic had massive consequences for societies and health systems across the OECD and beyond. Health systems were not resilient enough. Resilient health systems plan and are ready for shocks, such as pandemics, economic crises or the effects of climate change. They are able to minimise the negative consequences of crises, recover as quickly as possible, and adapt to become better performing and more prepared. Smart, targeted investments in health system resilience are needed to improve health and ensure the next shock is less disruptive and costly. This report reviews the lessons of the COVID-19 pandemic and applies them to build policy recommendations to ensure the global community is ready for the next crisis. The reviews and recommendations cover health system issues, including workforce, digitalisation, continuity of care and mental health, and other topics, including long-term care, supply chains and international co-operation

This report offers insights into the risks and vulnerabilities of the supply chains of medicines and medical devices. Policy options to anticipate and mitigate risks of shortages of medicines and medical devices, both routinely and in the context of severe crises, are analysed. Most importantly, the report shows that strengthening the long-term resilience of medical supply chains requires collaborative approaches that balance measures best undertaken by the private sector with those more appropriately managed by governments or supranationally.

With population ageing, the demand for helping older people with daily activities – so-called long-term care – is set to increase across OECD countries by more than one-third by 2050. Older people with long-term care needs are more likely to be women, 80-years-old and above, live in single households, and have lower incomes than the average. Currently, across OECD countries, publicly funded long-term care systems still leave almost half of older people with care needs at risk of poverty, particularly those with severe care needs and low income. Out-of-pocket costs represent, on average, 70% of an older person’s median income across the OECD. This report suggests avenues to improve funding to make long-term care systems better able to meet the demand for their services, and suggests policy options to improve the targeting of benefits and seek efficiency gains to contain the costs of long-term care.

Latin American countries were hard hit by COVID-19 with rates of excess mortality above the OECD average. The pandemic brought additional stress to health systems already overstretched by a growing burden of chronic diseases, unequal access to health care services, overall under-investment in health and strong budgetary restrictions, and systemic inefficiencies.

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.