Boosting investment in health systems will be essential to deal with future shocks, says OECD


23/02/2023 - Governments should urgently adapt their health systems to better respond to future shocks, given the huge impact of the COVID-19 pandemic on people and the global economy. Major investment is needed in the health workforce, alongside increased spending on prevention and digital infrastructure, according to a new OECD report.

Ready for the Next Crisis? Investing in Health System Resilience says that even the most advanced health systems in the world were not resilient to the COVID-19 pandemic. In 2020, life expectancy fell in 75% of OECD countries. Around 34% of all cumulative COVID-19 deaths were among residents in long-term care facilities by April 2022. The report emphasises three major vulnerabilities: health systems were underprepared and understaffed and faced underinvestment.

On average, 35% of the population of OECD countries had a longstanding illness or health problem in 2019. A high prevalence of chronic disease makes populations less resilient and increased COVID-19 mortality. Yet OECD health systems spent less than 3% of total health expenditure on prevention.

People are key to making systems resilient, says the report. Not having sufficient healthcare workers affected the quality of care during the first year of the pandemic more than, for instance, the number of hospital beds. More workers in health and social care were associated with lower mortality rates.

“There are significant social and economic dividends from health system resilience. Countries need to improve the preparedness of their health systems for the next crisis in order to improve resilience to reduce the impact of shocks and accelerate recovery,” OECD Secretary-General Mathias Cormann said. “Promoting population health, health and social care workforce retention, data collection and use, international cooperation, supply chain resilience, and governance and trust can help to improve access to health services, health and well-being, and full participation in society.”

The legacy of the pandemic could endure for decades. Healthcare worker well-being suffered and has not recovered. A substantial backlog in care remains. For example, 11 million fewer diagnostic and elective surgical procedures were performed in 2020 compared with 2019, across 31 OECD countries. This is compounded by new challenges, including treating “long COVID”, and meeting the substantial increase in mental health care needs, especially in young people. Workforce shortages persist and limit the resolution of this backlog.

Boosting the resilience of health systems requires smart investments, better co-ordination (including to build more resilient medical supply chains) and improved global health co-operation. This report recommends an annual targeted investment of 1.4% of GDP across OECD countries relative to expenditure in 2019. Bolstering the health and long-term care workforce on the front-line accounts for around half of this recommended investment. This would mean over three million additional workers across OECD countries.

The report also proposes investments in health data infrastructure, including to promote quality, real-time information in response to shocks; in preventive and primary care to protect populations; in the development of health technologies needed to address future threats, and in capacity to ensure these technologies can be deployed effectively and equitably.

For further information, journalists should contact Francesca Colombo or Philip Haywood of the OECD’s Health Division.


Working with over 100 countries, the OECD is a global policy forum that promotes policies to preserve individual liberty and improve the economic and social well-being of people around the world.


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