Healthcare System Resilience: How Countries Handled Recent Strain

What "resilience" means in a health system

Most healthcare comparisons describe a system in normal times: how much it spends, how long people wait, how long they live. Resilience asks a different question. What happens when demand suddenly jumps, staff fall ill, or supplies stop arriving?

The OECD's 2023 report Ready for the Next Crisis? Investing in Health System Resilience describes resilient systems as ones that plan and are ready for shocks such as pandemics, economic crises or climate change. They limit the harm, recover quickly, and adapt so they work better afterwards. That gives four stages you can use to judge any system:

1. Prepare: spare capacity, stockpiles, plans and trained staff in place before a crisis.
2. Absorb: keep essential services running while the shock hits.
3. Recover: clear the backlog of care that was postponed.
4. Adapt: change how the system works so the next shock does less damage.

The OECD's verdict on the COVID-19 period was blunt: health systems were not resilient enough. The report's recommendations focus on the health workforce, digital tools, continuity of care, mental health, long-term care, supply chains and international co-operation.

The shock: what broke first

The clearest early picture comes from a World Health Organization pulse survey published in August 2020. It covered March to June 2020 and drew responses from 105 of the 159 countries asked. The Americas were not included. Ninety percent of responding countries reported disruption to essential health services. On average, countries reported disruption in half of the 25 tracer services WHO asked about.

Source: WHO global pulse survey, 31 August 2020 (data March–June 2020).

The pattern makes sense. Systems protected emergency care far better than routine and chronic care. Most countries kept emergency departments and emergency surgery going, while screening, chronic disease management and mental health took the hit.

Why planned care is cut first

The same survey found that cancelling elective services was the most common supply-side cause of disruption, reported by 66% of countries. Staff were also moved to COVID-19 work, and equipment and supply chains were interrupted. On the demand side, 76% of countries saw fewer outpatient visits, linked to lockdowns and money worries. Postponing planned care is a sensible way to absorb a shock. But every postponed operation becomes part of the backlog that has to be cleared later.

The recovery: England as a case study

England publishes detailed monthly waiting-time data, so it shows the recovery stage unusually clearly. The benchmark to measure against is England's constitutional target: more than 92% of people on the list seen within 18 weeks of referral. Here is how the waiting list compared on either side of the pandemic, from NHS England's referral-to-treatment statistics (June 2026 data):

Two things stand out. First, recovery is happening but slowly. The share treated within 18 weeks improved by 4.3 percentage points in the year to June 2026, and the list shrank by 1.3%. Second, even in March 2020, before the shock fully hit, performance was already below the 92% standard. A system that is short of capacity going into a crisis has less room to absorb it and a longer climb back.

The starting point matters as much as the shock

Canada shows the same idea over a longer period. The Fraser Institute's 2025 survey of physicians reports a median wait of 28.6 weeks from GP referral to treatment. That is down slightly from 30.0 weeks in 2024, but far above the 9.3 weeks it reported for 1993. Whatever you think of the method, the trend says the strain began long before 2020. A pandemic added to an existing problem rather than creating it.

This is the core insight of resilience analysis. Two systems can look similar in a normal year. The one running close to full capacity, with thin staffing and little slack in beds or supplies, will be hit harder and take longer to recover. Workforce depth is a large part of that slack. See our comparisons of nurse-to-patient ratios and doctor-to-patient ratios.

The levers that make a system resilient

• Workforce depth: enough trained staff that redeploying some to a surge does not shut down everything else.
• Surge space: beds, intensive care capacity and operating time that can be expanded temporarily.
• Supply chains: diversified sources for drugs, consumables and equipment, so one disruption does not stop care.
• Digital continuity: remote consultations, electronic records and e-prescribing. WHO found triage and online consultations among the most common ways countries kept services going.
• Financial protection: keeping cost from becoming a barrier during a crisis. WHO noted that only 14% of responding countries had removed user fees, despite recommending it.

What resilience means for you as a patient

Resilience can sound like a topic for policymakers. It has practical consequences for anyone deciding where and when to get care.

• Your home waiting list is partly a recovery problem. If you are waiting for planned surgery, check whether your system's backlog is shrinking, flat or growing. The trend tells you more than a single month's figure. Our elective surgery wait times comparison gives context.
• Planned care is the first thing cut, everywhere. That includes private hospitals and hospitals abroad. If you book elective treatment, ask what happens to your date if the facility faces a surge, and what the rebooking and refund terms are.
• Ask about supplies, not just surgeons. For implant or device-based procedures, ask whether the specific product is in stock locally or depends on a single import route.
• Keep your own records. Digital continuity at the system level only helps if you can get your own documents. Keep copies of referrals, imaging and test results.

How to read a backlog trend

A single month's waiting figure tells you little about resilience. Three readings over time tell you much more:

• Direction: is the share treated within the target time rising, flat or falling compared with a year earlier?
• The tail: is the longest-wait group shrinking? In England, the 92nd-percentile wait is the figure that shows whether the slowest-moving patients are being reached.
• The pre-shock baseline: how far is today's figure from where the system stood before the crisis, and was that baseline itself meeting the standard?

Frequently Asked Questions

What is healthcare system resilience?

It is a system's ability to prepare for a shock, keep essential services running during it, recover the care that was postponed, and adapt afterwards. The OECD uses this framing in its 2023 report on resilience.

Which health services were disrupted most during COVID-19?

In WHO's 2020 pulse survey, routine immunisation outreach (70% of countries), non-communicable disease care (69%), family planning (68%), mental health (61%) and cancer care (55%) were the most often disrupted. Emergency services were disrupted far less often.

Has the NHS waiting list recovered since the pandemic?

Not fully. In June 2026, 65.8% of patients had been waiting under 18 weeks, compared with 79.5% in March 2020. The national standard is 92%. Performance did improve by 4.3 percentage points over the year to June 2026.

Why does elective surgery get cancelled first in a crisis?

Because it can be postponed without immediate danger, which frees staff, beds and supplies for urgent needs. WHO found cancelling elective services was the most common supply-side cause of disruption in 2020. The cost is a backlog that takes years to clear.

Are private or overseas hospitals immune to these pressures?

No. Any facility can postpone planned procedures during a surge or a supply shortage. Before you book, ask about rescheduling and refund terms, and whether critical supplies for your procedure are held locally.