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

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  • Papanicolas, Irene
  • Ledesma, Jorge

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.

Suggested Citation

  • Papanicolas, Irene & Ledesma, Jorge, 2025. "Measuring health system resilience: Understanding the relationship between excess mortality and health system performance," Health Policy, Elsevier, vol. 161(C).
    • Handle: RePEc:eee:hepoli:v:161:y:2025:i:c:s016885102500185x
    DOI: 10.1016/j.healthpol.2025.105430
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    References listed on IDEAS

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