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A Conceptual Framework for the OECD Health Care Quality Indicators Project

The Issue

The Organization for Economic Cooperation and Development (OECD) is leading an international effort to develop a common set of indicators for assessing health and health care across member countries, called the Health Care Quality Indicator (HCQI) Project. Based upon reviews of performance measurement systems, consultation with national representatives, and analysis, the authors of this Commonwealth Fund–supported study created a framework for development of the measures.

What the Study Found

The proposed framework embeds health care within the broader health system as well as within the economic, social, and political contexts of member countries. It has four tiers:

  • Health: broad measures of health influenced by factors related to health care as well as other factors.
  • Non-Health Care Determinants: societal factors that influence health. 
  • Health Care System Performance: measures of the processes, efficiency, and equity of health care systems. 
  • Health System Design and Context: measures to account for national policies and health delivery systems that affect costs, expenditures, and utilization.

The HCQI expert group recommended that indicators be developed in the priority areas of cardiac care, mental health, diabetes, patient safety, and primary care, and prevention/health promotion.


 Based on their study, the authors propose a framework for the HCQI Project that “focuses on the quality of health care, maintains a broader perspective on health and its determinants, and recognizes the key aims of health policy.”

Publication Details



O. A. Arah, G. P. Westert, J. Hurst et al., "A Conceptual Framework for the OECD Health Care Quality Indicators Project," International Journal for Quality in Health Care, Sept. 2006 18(Suppl. 1):5–13.