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Background: Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept. Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience. Four databases and gray literature were searched using the keywords \"health system\" and \"resilience\" for published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization (WHO) health system framework. The scoping review identified eleven sources with descriptions and 24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience. Discussion: No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience primarily focus on major shocks. Adjustments to long-term changes and the element of learning should be considered for a better understating of health system resilience.

Background The COVID-19 pandemic strained health systems worldwide, diverting resources and disrupting routine healthcare services. These disruptions may lead to health risks from delayed or reduced care. Health system resilience (HSR) – a critical factor in maintaining health services during crises – refers to a system’s ability to anticipate, prepare for, absorb, respond to, recover from, and adapt to disruptions. To be effective, HSR must also be equitable, ensuring that all socioeconomic groups have access to healthcare services during crises. Sweden’s approach, which relied on public adherence to government recommendations rather than enforcing restrictions, presents a unique case for studying HSR. Aim This study aims to evaluate aspects of HSR in Sweden during the COVID-19 pandemic by analysing changes in essential health service utilisation across different phases of the pandemic, and by examining sociodemographic differences in utilisation by education and sex. Method This study utilises interrupted time series analysis to evaluate changes in healthcare service utilisation across various levels of the Swedish health system with stratification by education and sex. Primary care was measured through diabetes diagnoses, emergency care through appendicitis cases, inpatient care through hospital admission for inflammatory bowel disease (IBD), and cancer diagnostics through diagnosis rates. Data were obtained from various population based Swedish health registries through the SWECOV project. Results The findings highlight varying degrees of disruptions and resilience across different sectors. Emergency care, primary care, and symptom-based cancer diagnosis showed signs of recovery after an initial drop, whereas cancer screening, was more affected. In the case of inpatient care for IBD, the number of admissions declined, though the length of hospital stays remained unchanged. Education level did not impact healthcare utilisation for most indicators, and differences between men and women were generally small. Conclusion The Swedish HSR during the COVID-19 pandemic was challenged but remained intact in most healthcare sectors. The health system on different levels also managed to a large degree cater for the diagnoses covered in this study, largely independent of educational level and sex. As data availability increases with time further research will help gain a deeper understanding of the outcomes of the pandemic on health services unrelated to COVID-19, including the role of education in influencing healthcare utilisation.