ABSTRACT
Objectives: The COVID-19 pandemic has highlighted the need for sustainable and resilient healthcare systems to protect population health. This requires measuring the relative progress of health systems towards becoming more sustainable and resilient. In this research, we design, construct and estimate a country-level healthcare system sustainability and resilience index (HSSRI) that reflects and combines the two dimensions. Method(s): The HSSRI aims to summarise the performance of a health system in the different domains contributing to its sustainability and resilience. These domains are: i) health system governance, ii) health system financing, iii) health system workforce, iv) medicines and technologies, v) health service delivery, vi) population health and social determinants, and vii) environmental sustainability. As part of our analyses, we conduct a rapid evidence assessment to identify indicators reflecting the domains included in the sustainability and resilience dimensions. We assess the domain indicators' suitability by the quantity and quality of the literature supporting their inclusion. The variables in each indicator are extracted from publicly available data sources, such as the OECD, World Bank, and others. The period covered is from 2000 to 2020. Weighted means of the indicators are used to construct the domains' indices in each dimension. We apply a geometric mean to combine the domain indices into one final index. Result(s): The HSSRI is piloted using data from five high-income countries, providing a credible instrument for measuring and reporting healthcare system sustainability and resilience. The results enable policy-makers and stakeholders to observe how different domains of sustainability and resilience have evolved across countries and time. Conclusion(s): The HSSRI will facilitate better understanding and monitoring of the healthcare system's relative weaknesses and strengths, and empower policy-makers to design interventions that improve its resilience and sustainability.Copyright © 2022
ABSTRACT
The separate governments in England, Scotland, Wales, and Northern Ireland have been in charge of planning and executing health care services since devolution in the late 1990s. Residents of the UK have access to a National Health Service (NHS) based on clinical need, not financial capacity. Contrarily, free access to social care services is means-tested and subject to a variety of eligibility requirements depending on the United Kingdom country. In comparison to the majority of other high-income nations, the UK has significantly lower levels of physicians and nurses, hospital beds, and diagnostic tools. Due to these deficiencies, the nation has minimal capacity to absorb sudden shocks like the COVID-19 pandemic. Additionally, they have caused an increase in the number of people on waiting lists for elective care, with over 6 million people in England alone in 2022. In the past, the UK's health spending has seen periods of both continuous expansion and austerity. Nevertheless, over the past ten years, total health spending has grown, reaching just over 10% of GDP in 2019. Around 80% of all health spending is public money, which is a significant share and has been stable over the past 20 years. As a result, UK people have little out-of-pocket spending and high levels of protection from the financial effects of illness. To enable real integration amongst health care providers, a number of obstacles still exist in all four countries, including disconnected health information technology systems, duplicate governance structures, and a dearth of strategic planning. Although efforts to encourage such integration through cross-sectoral partnerships have advanced in England, Scotland, and Wales in recent years, Northern Ireland remains the only United Kingdom component county where the NHS and social care are completely organisationally linked.