Serving citizens scorecards
This chapter describes how OECD countries are performing in terms of access, responsiveness and quality of services, based on the OECD Serving Citizens Framework, which seeks to address the main determinants of satisfaction with services. The scorecards summarise key aspects of countries’ services systems (access, responsiveness and quality) by displaying a subset of sector-specific measures from education, health and justice. They illustrate how the performance of public services can be compared, even when they are organised in different ways and address different aspects of societal and individual life. Although country rankings are provided, these are only calculated to compare indicators that differ in measurement units and the underlying phenomena they measure. As such, the scorecards do not provide a unified picture of which countries have the best overall services, nor should they be used for this purpose.
The Serving Citizens Scorecards were introduced in the 2017 Government at a Glance, and the indicators were selected by experts from the OECD on each subject. The criteria were: 1) adequacy (i.e. the indicator represents the concept being measured); 2) policy relevance; 3) data availability and coverage; and 4) data interpretability (i.e. no ambiguity that a higher/ lower value means better/worse performance). The selected indicators intend to provide an overview of the relevant aspects for each service. For this reason, the choice of measures differs among services (e.g. school enrolment for education and health care coverage for health care are measures of access).
Scorecard interpretation
Each scorecard focuses on one dimension of the framework (access, responsiveness or quality) and compares across services (education, health and justice). For each indicator, countries are classified into three groups: 1) green for values above (or below, depending on the indicator) a standard deviation from the mean; 2) red for values below (or above, depending on the indicator) a standard deviation from the mean; and 3) orange for values within one standard deviation of the mean.
Additionally, each country is ranked among those countries for which data are available, so as to provide additional information on performance (the country with the best performance is ranked number 1). If several countries have the same value for an indicator, they are assigned the same rank.
When trend data are available, arrows indicate whether countries’ absolute performance has improved (↑), declined (↓) or remained stable (→). Unless specified otherwise, the criterion for showing improvement or decline is a change of 1 percentage point (if the indicator is expressed as a percentage) or of 1%.
The last row of the scorecard indicates both the base year and the reference year for the comparison.
Access to services
Most OECD countries have achieved universal health care coverage, either through private or public insurance schemes. Coverage has remained stable among most top performers since 2014. In Greece, the last economic crisis meant around 30% of the population lost access to care, but by 2018 the country had once more achieved universal coverage after introducing remedial legislation in 2016 to secure funding for the system and restore universal coverage. In Lithuania health care coverage increased by 6 p.p. between 2014 and 2018. The National Health Insurance Fund provides coverage for all residents of the country, subject to confirmed insurance status, so the 2% of people who are not covered may be those who lost their employment and had not made the mandatory contributions to the health care system, or people living abroad registered as residents (OECD/European Observatory, 2019). On the other hand, Mexico has seen a reduction in health care coverage from 93% in 2014 to 88% in 2018, in line with declining spending on health as a proportion of GDP (OECD, 2021).
The range of services covered by health insurance schemes and the extent to which patients have to cover expenses from their own budgets vary across OECD countries. For example, in Mexico, given the limited coverage of health care, a large proportion of health expenditure comes from citizens’ pockets. However, the share of out-of-pocket (OOP) expenditure on household consumption alone does not indicate whether citizens are benefiting from access to care. During the COVID-19 pandemic, a large proportion of citizens had to forego care due to lockdown restrictions and the lack of remote alternatives, such as telemedicine. For instance, in Germany OOP spending as a share of health expenditure is in line with the OECD mean, but a larger proportion of citizens than in other countries were able to keep their doctors’ appointments.
Education systems across the OECD provide universal access to education for children of compulsory school age, which varies across countries. However, access to early childhood and tertiary education depends partially on public resources made available to finance them. For instance, in Colombia, a large share of expenditure on education from primary to tertiary level comes from private sources, which results in lower enrolment rates in early childhood and primary education among 4-year-olds, and in tertiary education for those under the age of 25. In other countries, such as Finland, where there is a tracking system in place (i.e. students are assigned to classes or types of secondary education curricula according to their achievements), the relationships between public funding and enrolment rates at the two ends of the education cycle are not linear.
The high share of private funding in some countries is due to grants and transfers to individuals or private institutions. For example, the United Kingdom has achieved 100% enrolment in early childhood education because every 4-year-old is entitled to 15 hours of free care whether in public or private institutions. Chile introduced a law in 2018 that established tertiary education as a right that should be accessible for everyone without discrimination. In order to implement this law, universities can request financing from the government to provide free tertiary education, but they are not obliged to do so. Chile has achieved the highest enrolment rate under the age of 25 in the OECD. Chile’s first-time tertiary enrolment rate under the age of 25 has also increased between 2013 and 2018.
In order to access justice, individuals must be aware of their rights and of the mechanisms in place to resolve their disputes, and be able to afford the costs that the process entails. Civil justice in Denmark, Germany, and the Netherlands are the most affordable and accessible for citizens, according to data from World Justice Project (WJP). Alternative dispute resolution (ADR) is a way of settling disputes outside of the courtroom. The WJP expert survey asks about the integrity of arbitrators, the costs and timeliness of ADRs, and the enforcement of settlements in commercial cases. According to these data, ADRs in Estonia, Japan, Korea and Norway are the most accessible, impartial and effective.
Responsiveness of services
Communication between health care providers and patients helps to improve patients’ involvement in their own health, by allowing them to make informed decisions about the care that they receive. While a majority of patients in OECD countries with available information reported that their doctor always or often explains things in a way that they can understand, in Australia and New Zealand virtually all patients report that they experience this with their doctors.
Long waiting times can worsen patients’ symptoms and reduce their satisfaction with health care. In the majority of countries with available information, the share of citizens who were not able to get an appointment on the same or the next day the last time they needed care increased between 2016 and 2020. Germany was the only country which improved over that period, and was also the best-performing country. Some countries, like Sweden, are better at providing prompt elective surgery (such as cataract operations) than they are at providing next-day appointments with general practitioners. In others, like Australia, the opposite is true.
Responsive education systems are those that manage to keep students in education until they have acquired the necessary skills to thrive in the labour market. Across the OECD, the age when compulsory education ends ranges from 16 in Colombia to 19 in Iceland and Switzerland. Consequently, these latter countries, along with Luxembourg, the Netherlands and Sweden, have the smallest share of 15-29 year-olds who are not in employment, education or training (NEET), although the situation is improving in almost all countries. What most of these countries have in common is that they make efforts to ensure that all students can access the necessary resources to learn. School principals report that these countries supply the material resources (from infrastructure to textbooks) needed to provide instruction and, in the case of Sweden, school staff help students with their homework if necessary. In contrast, the school system in Chile is not very responsive to students’ needs: despite having the highest enrolment rates in tertiary education, it has one of the highest NEET rates.
Delays in resolving judicial cases can cause plaintiffs to drop their cases, incur unnecessary costs, or dissuade them from pursuing a legal route to solve future issues. The time needed to resolve a case depends on factors including the procedures followed to allocate and solve cases, the complexity of the case, the number of staff working for the judiciary system, the number of incoming cases, and the use of technology to reduce administrative work. Among the countries for which data are available, Hungary, Lithuania and the Netherlands take the least amount of time to resolve cases in first instance courts for civil and commercial (litigious and non-litigious) cases and administrative cases.
Quality of services
The provision of public services is aimed at improving citizens’ quality of life and wellbeing in various areas. For example, health systems are responsible for protecting them from ill health and the judicial system has a significant role in ensuring the rule of law and the respect for human rights, making citizens feel safe. School systems are responsible for equipping students with the knowledge, skills and tools they need for their lifelong development.
The health system is responsible for preventing health problems and addressing acute or chronic health problems when they arise (i.e. treatment). For example, diabetes is a chronic condition that has well-established treatments, most of which can be delivered at the primary care level, in order to prevent unnecessary hospitalisations. Other conditions, such as ischaemic stroke and breast cancer can be treated once detected. Japan’s health care system is effective in treating stroke and breast cancer, and its 30-day mortality rate following stroke hospitalisation has improved between 2007 and 2017. Other countries, such as Lithuania and Poland, are less effective in both preventing and treating health problems, although the situation is improving. Some countries, such as Korea, perform better in some of these indicators than others.
The best-performing education systems are those that combine quality and equity: Canada and Estonia have the best overall performance in Programme for International Student Assessment (PISA) reading but also the smallest share of students below proficiency level 2, and the least variation in scores explained by student’s socio-economic background. In contrast, the Slovak Republic has one of the worst performances in all of these indicators.
In terms of the judicial system, the WJP compiles data on the enforcement of the law around the world by asking experts and the general population how likely individuals are to pursue self-administered justice by resorting to violence to redress grievances, how likely the government is to influence a judge in a lawsuit against the state and how likely court decisions are to be enforced. In Denmark and Norway, justice systems are effective and impartial, and people resolve their disputes in a pacific manner.
References
Baredes, B. (forthcoming), “Serving Citizens: framework and data to measure service delivery”, OECD Working Papers on Public Governance, OECD Publishing, Paris.
OECD (2021), “Health spending” (indicator), https://doi.org/10.1787/8643de7e-en (accessed on 5 March 2021).
OECD/European Observatory on Health Systems and Policies (2019), Lithuania: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels, https://doi.org/10.1787/35913deb-en.