This analysis of the 2020 OECD multidimensional fragility framework is a background paper for States of Fragility 2020. It provides a snapshot of the state of fragility in the world today, paying particular attention to the 57 fragile contexts on the framework. The paper starts by unpacking the...

In 2022, the OECD will add a human capital dimension to its fragility framework in acknowledgement of the ambition set forth in States of Fragility 2018 to “never lose sight of the end goal of delivering hope and better lives for all people in fragile contexts”. The COVID-19 pandemic and its...

Belgium has a good record in delivering accessible care, but adaptation to population ageing will be complicated by the fragmentation of responsibilities in the healthcare system and a strong reliance on government regulations. The organisation of the system could be rationalised by giving...

The Netherlands, as other OECD countries, faces the challenge of providing high quality health and long-term care services to an ageing population in a cost-efficient manner. In the health care sector, reforms have aimed at introducing more competition. Despite major changes and some positive...

Israelis enjoy higher life expectancy and have a much younger demographic profile than most OECD countries. However, the demand for health care is expanding rapidly due to population growth and ageing. Also, the country’s wide socio-economic divides are reflected in differences in health...

This paper investigates the vulnerabilities of health care systems in OECD and BRIICS countries to adverse secular trends and large macroeconomic shocks. It identifies policies that can ally vulnerabilities considering the institutional setting of health care systems, such as the public-private...

The recent economic crisis has provided a stress test for the vulnerability of social institutions. This paper assesses the vulnerability of social institutions in light of the current crisis, and surveys past episodes, when social institutions faced similar challenges. Public pay-as-you-go...

In 2017, the “Sláintecare Report” proposed a comprehensive overhaul of the Irish health system including a reform proposal to phase out private practice in public hospitals to end the unequal treatment of public and private patients – private patients typically have quicker access to care...

South Africa has an incomplete social protection system without a mandatory pension savings scheme. Designing a universal insurance pension system would allow to reduce the important government funded pension grant system and ensure that the old-age population has decent income. Only 40% of...

Despite improvements over the past few decades, Slovak health outcomes remains poor compared with most other OECD countries, even after controlling for differences in per capita income and other social, cultural and lifestyle factors. Disparities in access to care and health outcomes between the...