A framework for assessing health system resilience in an economic crisis: Ireland as a test case.
A framework for assessing health system resilience in an economic crisis: Ireland as a test case.
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DOI：
10.1186/1472-6963-13-450
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发表时间：
2013-10-30
影响因子：
2.8
通讯作者：
Normand C
中科院分区：
文献类型：
--
作者：
Thomas S;Keegan C;Barry S;Layte R;Jowett M;Normand C
2007年席卷全球经济的金融危机在战后时代是前所未有的。总的来说，这场危机给全球卫生系统造成了困难的环境。本文的目的是制定一个框架，用于评估卫生系统如何适应经济危机的复原力。弹性可以理解为系统吸收变化但继续保留基本相同的特性和功能的能力。爱尔兰卫生系统被用作案例研究来评估该框架的有用性。作者确定了三种形式的复原力：财务复原力、适应性复原力和变革复原力。提供性能指标是为了测试框架和测量系统性能。定量和定性方法都用于为爱尔兰案例研究提供数据。从政府文件和来源收集定量数据，以了解经济衰退的深度和不同方面的应对措施。对关键决策者进行半结构化访谈，以了解做出决策的原因。在爱尔兰的案例中，关于复原力的证据好坏参半。卫生资金最初受到保护，但随后随着危机的加深而大幅削减。有强有力的证据表明适应性弹性，卫生系统显示出经济衰退带来的效率提高。尽管如此，效率已经轻松提高，持续的紧缩将意味着福利和服务的削减。建立和维持变革韧性的前景尚不确定。虽然改革的方向是明确的，并且至今仍被保留，但鉴于持续的紧缩、一些主权丧失和能力限制，尚不确定改革是否仍然可控。复原力的三个方面被证明是绩效衡量的有用分类，尽管它们之间存在重叠。变革弹性可能更难以准确评估。根据其他国家的经验测试该框架并完善措施和指标将是有用的。鼓励进一步研究不同卫生系统的相对复原力和增强应对危机的复原力。
The 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. The 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. In 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. The 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.
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影响因子：
3.2
作者：
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通讯作者：
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影响因子：
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作者：
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