{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:33:06Z","timestamp":1788496386168,"version":"build-2803163510"},"reference-count":13,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"unspecified","delay-in-days":43,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["HEPL"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We present a methodology for a new composite, quantitative \u201cmash-up\u201d index of health system sustainability and resilience, drawing on a qualitative framework developed to assess these dimensions of the health system. The paper summarises quantifiable measures of sustainability and resilience, with sustainability defined through 7 domains and 50 indicator variables, while health system resilience is based on 6 domains and 23 variables. Each domain is captured by a separate index. A composite index is constructed through aggregation across the two dimensions, and their associated domains and indicators. All indices are aggregated through estimation of a geometric means, and are bound between 0 and 100. We pilot across 5 countries over 23 years, with the ultimate aim of identifying health policy strategies for improving national health system capacities and performances; as well as facilitating policy responses to address problematic issues of sustainability and resilience. Face validity suggests that the index captures the non-resilience to the COVID-19 pandemic. The pilot study reveals considerable differences at both the dimension and domain levels within and between the examined countries, while suggesting scope for improvement in both dimensions across all countries. The index thus provides an indicative approach for temporal and spatial yardstick comparison.<\/jats:p>","DOI":"10.1017\/s1744133125100182","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T07:51:17Z","timestamp":1755071477000},"page":"313-325","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":5,"title":["Health system sustainability and resilience: a preliminary provision of measurement through a \u201cmash-up\u201d index"],"prefix":"10.1017","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5367-9841","authenticated-orcid":false,"given":"A.","family":"McGuire","sequence":"first","affiliation":[{"name":"London School of Economics and Political Science"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Wharton","sequence":"additional","affiliation":[{"name":"London School of Economics and Political Science"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Hodgson","sequence":"additional","affiliation":[{"name":"Office of Health Economics (OHE)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Kourouklis","sequence":"additional","affiliation":[{"name":"Office of Health Economics (OHE)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Jofre-Bonet","sequence":"additional","affiliation":[{"name":"Office of Health Economics (OHE)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.L.","family":"Tran","sequence":"additional","affiliation":[{"name":"University of Oxford"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"S1744133125100182_ref25","doi-asserted-by":"publisher","DOI":"10.4337\/9781803925936.00013"},{"key":"S1744133125100182_ref6","volume-title":"Healthcare Sustainability and Resilience Index: Quantifying Sustainable and Resilient Healthcare Systems","author":"McGuire","year":"2022"},{"key":"S1744133125100182_ref23","unstructured":"Wharton, G , Gocke, D , McGuire, A and Sturm, T (2021) The Partnership for Health System Sustainability and Resilience: Interim report of the pilot phase. Partnership for Health System Sustainability and Resilience. Available at https:\/\/www.weforum.org\/publications\/wef_phssr_interim_report_of_the_pilot_phase."},{"key":"S1744133125100182_ref14","doi-asserted-by":"publisher","DOI":"10.1086\/425380"},{"key":"S1744133125100182_ref4","volume-title":"Human Development Index","year":"2023"},{"key":"S1744133125100182_ref20","doi-asserted-by":"publisher","DOI":"10.1093\/oxrep\/grv019"},{"key":"S1744133125100182_ref32","volume-title":"Everybody\u2019s Business: Strengthening Health Systems to Improve Health Outcomes: WHO\u2019s Framework for Action","year":"2007"},{"key":"S1744133125100182_ref36","volume-title":"UHC Service Coverage Index [Indicator]","year":"2025"},{"key":"S1744133125100182_ref1","volume-title":"Mirror, Mirror: International Comparison of Health Systems","year":"n.d."},{"key":"S1744133125100182_ref15","volume-title":"Troubling Trade-offs in the Human Development Index","author":"Ravallion","year":"2010"},{"key":"S1744133125100182_ref16","doi-asserted-by":"publisher","DOI":"10.1093\/wbro\/lkr009"},{"key":"S1744133125100182_ref18","volume-title":"Human Development Report 2023\/2024: Breaking the Gridlock: Reimagining Cooperation in a Polarized World","year":"2024"},{"key":"S1744133125100182_ref2","unstructured":"Global Health Security Index (2021) The 2021 Global Health Security Index. GHS Index. https:\/\/www.ghsindex.org."}],"container-title":["Health Economics, Policy and Law"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1744133125100182","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T12:45:53Z","timestamp":1757594753000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1744133125100182\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":13,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["S1744133125100182"],"URL":"https:\/\/doi.org\/10.1017\/s1744133125100182","relation":{},"ISSN":["1744-1331","1744-134X"],"issn-type":[{"value":"1744-1331","type":"print"},{"value":"1744-134X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}