Measuring health system resilience: Understanding the relationship between excess mortality and health system performance

Irene Papanicolas and Jorge Ledesma

Health Policy, 2025, vol. 161, issue C

Abstract: The COVID-19 pandemic has underscored the importance of resilient health systems that can manage and adapt to large-scale health crises. However, the relationship between resilience and health system performance remains unclear. While some view performance as a feature of resilience, others conflate the two. Excess mortality—defined as the difference between observed and expected deaths during a given period—is often used to assess resilience, but may introduce bias. In particular, countries with stronger pre-pandemic performance and lower baseline mortality may appear to have worse resilience simply because they had less “room” for mortality to rise under normal conditions.

Keywords: Health system resilience; Health system performance; Excess mortality; Covid-19 (search for similar items in EconPapers)
Date: 2025
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Persistent link: https://EconPapers.repec.org/RePEc:eee:hepoli:v:161:y:2025:i:c:s016885102500185x

DOI: 10.1016/j.healthpol.2025.105430

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