Assessing Post-Pandemic Health System Resilience: Evidence From OECD Countries

Health system resilience is increasingly central to health policy, yet comparative assessments often rely on absolute resource volumes that favour larger economies. This study evaluates post-pandemic health system resilience across 37 OECD countries using exclusively per-capita indicators, removing population-scale bias. Indicators are referenced to the 2021-2023 pandemic period, most at their 2021 values. Seven criteria spanning structural capacity, human resources, and population health and crisis outcomes were weighted objectively with the CRITIC method, and countries were ranked with the VIKOR compromise method; robustness was tested through Entropy weighting, TOPSIS ranking, strategy-parameter sensitivity analysis, leave-one-out criterion analysis, and resampling-based rank intervals. Physician density, hospital-bed capacity, and COVID-19 mortality per million were the most informative criteria; per-capita health expenditure was the least discriminating. Japan ranked first and satisfied both VIKOR acceptability conditions, followed by Austria, Switzerland, France, and Luxembourg. The United States-the highest per-capita spender-ranked 32nd of 37, an expenditure-outcomes paradox reflecting VIKOR's penalisation of the weakest criterion; the country rises to mid-table under compensatory TOPSIS. Findings are consistent with resilience-related performance being associated with the conversion of per-capita resources into outcomes rather than with spending volume, supporting outcome-oriented performance frameworks for future public health crises.