At the 2017 OECD Ministerial Conference on the Next Generation of Health Reforms, Ministers called for improved efforts to strengthen the people‑centredness of health systems. No recent event has more clearly demonstrated this need than the global COVID‑19 pandemic. COVID‑19 highlighted pre‑existing weaknesses and failures of health systems, and underscored the need for improved analytical tools to help policy makers define how health systems are held accountable for performance and patient-centredness.

The push to make health systems more accountable to the people who use them – in other words, to make health systems more people‑centred – is not a new effort. Health professionals, policy makers and patients themselves have long realised that the institutions making up health systems today are no longer fit for purpose, neither meeting the needs of those who use them, nor sufficiently adaptable to rapidly developing global trends, including digitalisation, population ageing and pandemic shocks.

This chapter presents the OECD Framework for People‑Centred Health Systems and discusses the results of a benchmarking exercise and patient-level analysis that uses existing health data related to people‑centred care – across the domains of voice, choice, co-production, integration, and respectfulness. Results of the Scorecard underscore the importance of all five dimensions presented in the Framework, and find that while people‑centredness is relatively well embedded in certain dimensions – notably choice and respectfulness – no country delivers strongly people‑centred care across all policy areas. Moreover, the lack of strong cross-country data in certain dimensions highlights the need to improve the collection of data to measure people‑centredness: not only through scaling up the systematic collection and reporting of patient-reported measures, but also through better capturing the extent of people‑centredness at the governance and systems level.

This chapter evaluates what OECD countries have done to put in place people‑centred policies in their health systems and considers the extent to which countries have promoted people‑centredness in their policy making across the dimensions of the OECD Framework for People‑Centred Health Systems. It finds that while policies have been adopted that contribute to moving towards a people‑centred approach, they are oftentimes inadvertent – though positive – consequences of other policy priorities and goals. There remains a lack of a holistic understanding of how policies across sectors, actors, and levels of governance can build on each other to create a fully people‑centred approach.

This chapter applies the OECD Framework for People‑Centred Health Systems to the COVID‑19 response pursued by health systems and governments across OECD countries to consider the extent to which the policies put in place to fight the pandemic were people‑centred. It finds that the policies pursued to contain and mitigate the pandemic largely did not prioritise – and in many cases conflicted with – the key principles of people‑centredness. The response to the COVID‑19 pandemic has underscored that many principles of people‑centredness remain poorly institutionalised within health systems policy making. It further argues that while the urgency of the pandemic sometimes necessitated responses that deprioritised people‑centredness, a more person-centred approach to certain challenges raised may in fact have helped to avert some of the difficulties countries continue to face nearly two years into the pandemic.