Health systems are under intense pressure to adapt to evolving needs and megatrends driven by population ageing, digitalisation, and climate change. They also need to be better prepared to withstand sudden, large-scale shocks such as pandemics, financial crises, natural disasters, or cyberattacks. This shifting policy context and emerging challenges called for a revision in how OECD countries assess health system performance, to help ensure that health systems meet people’s health needs and preferences while providing quality healthcare for all. This document presents the OECD’s renewed health system performance assessment framework. It incorporates new performance dimensions, notably people-centredness, resilience, and environmental sustainability, and places increased emphasis on addressing inequalities, including those related to gender. This framework expands on existing OECD efforts in these domains and integrates the most recent advancements in health system performance assessment. By offering common definitions and fostering a shared understanding among policy makers, stakeholders and organisations, the updated framework will enhance international collaboration. Furthermore, it lays the foundation for developing future indicators, facilitating data collection, policy analysis, and the integration of knowledge.