A framework for assessing health system resilience in an economic crisis: Ireland as a test case.

Steve Thomas,Sarah Barry,Charles Normand,Conor Keegan,Richard Layte,Matt Jowett

doi:10.1186/1472-6963-13-450

Abstract

BackgroundThe financial crisis that hit the global economy in 2007 was unprecedented in the post war era. In general the crisis has created a difficult environment for health systems globally. The purpose of this paper is to develop a framework for assessing the resilience of health systems in terms of how they have adjusted to economic crisis. Resilience can be understood as the capacity of a system to absorb change but continue to retain essentially the same identity and function. The Irish health system is used as a case study to assess the usefulness of this framework.MethodsThe authors identify three forms of resilience: financial, adaptive and transformatory. Indicators of performance are presented to allow for testing of the framework and measurement of system performance. Both quantitative and qualitative methods were used to yield data for the Irish case study. Quantitative data were collected from government documents and sources to understand the depth of the recession and the different dimensions of the response. Semi-structured interviews were conducted with key decision makers to understand the reasons for decisions made.ResultsIn the Irish case there is mixed evidence on resilience. Health funding was initially protected but was then followed by deep cuts as the crisis deepened. There is strong evidence for adaptive resilience, with the health system showing efficiency gains from the recession. Nevertheless, easy efficiencies have been made and continued austerity will mean cuts in entitlements and services. The prospects for building and maintaining transformatory resilience are unsure. While the direction of reform is clear, and has been preserved to date, it is not certain whether it will remain manageable given continued austerity, some loss of sovereignty and capacity limitations.ConclusionsThe three aspects of resilience proved a useful categorisation of performance measurement though there is overlap between them. Transformatory resilience may be more difficult to assess precisely. It would be useful to test out the framework against other country experiences and refine the measures and indicators. Further research on both the comparative resilience of different health systems and building resilience in preparation for crises is encouraged.

Highlights

Context and scope The financial crisis that hit the global economy in 2007 was unprecedented in the post war era. It quickly transformed into an economic crisis which saw European Union real Gross Domestic Product (GDP) shrink by 4.3 per cent in 2009, the sharpest contraction in its history [1]a
The purpose of this paper is to develop a framework for assessing the resilience of health systems in terms of how they have adjusted to economic crisis
The overall timeline of the government health system response to the recession in Ireland is shown in Table 1, noting key budgetary and policy decisions from 2008 to the end of 2011

Summary

Introduction

Context and scope The financial crisis that hit the global economy in 2007 was unprecedented in the post war era. It quickly transformed into an economic crisis which saw European Union real Gross Domestic Product (GDP) shrink by 4.3 per cent in 2009, the sharpest contraction in its history [1]a. Key questions relate to how well the health system has continued to function in the face of austerity and how well the vulnerable have been protected. It has particular relevance for the current European context or where scarcity is pronounced and economic sovereignty threatened. Resilience can be understood as the capacity of a system to absorb change but continue to retain essentially the same identity and function [4]

Objectives

Methods

Results

Discussion

Conclusion