What do the two terms mean?
Public health talks about resilience. Economics talks about financial protection. HSREP's argument is that they describe the same thing from two sides.
Health-system resilience
The World Health Organization's Eastern Mediterranean office describes it as the ability of a health system exposed to a shock "to resist, absorb, accommodate and recover" from its effects, keeping its essential structures and functions.1
Economic protection
Usually called financial protection: people get the care they need without the cost pushing them into hardship or poverty. It is one of the two things universal health coverage is measured by, under Sustainable Development Goal indicator 3.8.2.2
HSREP's claim
Health protection is economic infrastructure, not a budget line to cut. A system that holds under shock is what protects household income, the workforce and public finances when the shock arrives.
Who pays when a health system fails?
Households pay first, then clinics and public budgets. The question is never whether a shock costs money. It is who absorbs the cost, and how early.
| Step | When the system holds | When it does not |
|---|---|---|
| 1. The shock | An illness, a bill, an outbreak or a disaster arrives. | The same shock arrives. |
| 2. The household | Care is reachable and affordable; work and schooling continue. | Families delay care, borrow, sell assets or pay out of pocket. |
| 3. The clinic and the public purse | Services absorb the demand and keep running. | Clinics, budgets and public services take the overflow, often as emergency care. |
| 4. The economy | Livelihoods, productivity and trust are protected. | Lost income, lost workdays and lost trust outlast the shock. |
This chain is HSREP's framing of the argument made across its Season 1 articles. It is a model for reading the evidence below, not a measured result.
What does the evidence show?
Three figures from three settings, each with its source and year.
| Setting | Figure | Source |
|---|---|---|
| World | An estimated 2.1 billion people faced financial hardship from out-of-pocket health costs in 2022, including 1.6 billion pushed into poverty or deeper into it by those costs. | WHO and World Bank, Tracking universal health coverage: 2025 global monitoring report3 |
| United States | 41% of adults have debt caused by medical or dental bills. Among them, 64% say they or a family member put off needed care because of cost in the past year. | KFF Health Care Debt Survey, fielded February to March 20224 |
| Bangladesh | 79.3% of current health expenditure in 2023 was paid out of pocket by households. | World Bank, from the WHO Global Health Expenditure Database5 |
Two figures for Bangladesh, and why
HSREP's Season 1 articles cite "nearly 69 percent" (68.5% in the accounts), from the Bangladesh National Health Accounts 1997 to 2020, which measures out-of-pocket payments as a share of total health expenditure in 2020. The 79.3% above is the international series for 2023, measured as a share of current health expenditure. The two use different years and different denominators; both say that households carry most of the cost.
Why two countries
The United States and Bangladesh finance health in very different ways. HSREP works across both because the same failure shows up in each: when the system does not hold, the household pays.
What does it not mean?
Not "spend more, anywhere"
The argument is about where protection fails: prevention that is recommended but not completed, first contact people cannot afford, a workforce that does not stay. A new building does not protect a household that cannot afford the follow-up.
Not only for disasters
Earthquakes and outbreaks make the failure visible. Much of the cost arrives quietly, one bill and one skipped screening at a time.
Not partisan, and not proof
HSREP is independent and non-partisan. This page states a position and the evidence behind it; it does not claim that resilience spending has been shown to pay for itself in every setting.
How does HSREP apply the idea?
The idea is argued in public, measured, and turned into something a clinic could use.
| Work | What it does |
|---|---|
| Season 1 | A two-country campaign of nine published pieces across the United States and Bangladesh, February to April 2026, drawing 57,274 views and impressions at $0 ad spend. Every figure is reconciled on the methodology page. |
| Articles | The arguments in full: medical debt, prevention, workforce, disaster readiness, health financing and health messaging. |
| Prevention Gap Map | Colorectal cancer screening at Michigan's federally funded health centers in 2025, from HRSA's Uniform Data System, against the Healthy People 2030 target. |
| Prevention Adoption Initiative | A proposed, in-development toolkit to close the gap between recommended and completed preventive care in safety-net clinics. Nothing has been deployed. |
| Roundtable | Three open questions for people who work in or around care, answered in writing and on the record. |
| Open data | The Gap Map and Season 1 datasets as CSV files, with methods and citations. |
Quick answers.
What does "health-system resilience as economic protection" mean?
It means a health system that keeps working through a shock also protects household income, the workforce and public budgets. HSREP treats health protection as economic infrastructure rather than a budget line to cut.
Is resilience the same as emergency preparedness?
Preparedness is part of it. Resilience also covers the everyday shocks: a bill a family cannot pay, a screening that is recommended but never completed, a clinic that loses its staff.
Is this only a problem in low-income countries?
No. In the United States, 41% of adults have debt from medical or dental bills (KFF, 2022). In Bangladesh, households paid 79.3% of current health expenditure out of pocket in 2023 (World Bank). The financing differs; in both, households carry costs the system did not absorb.
How is economic protection measured?
Under Sustainable Development Goal indicator 3.8.2, by the share of people whose out-of-pocket health spending exceeds 40% of their household's discretionary budget. By that measure, an estimated 2.1 billion people faced financial hardship in 2022, according to WHO and the World Bank. Reports before 2025 used thresholds of 10% and 25% of the total household budget.
Where each figure comes from.
- World Health Organization, Regional Office for the Eastern Mediterranean. Health systems resilience.
- United Nations Statistics Division. SDG indicator metadata, 3.8.2.
- World Health Organization and World Bank. Tracking universal health coverage: 2025 global monitoring report, December 2025; and the news release of 6 December 2025.
- KFF. Health Care Debt in the U.S.: The Broad Consequences of Medical and Dental Bills, 2022.
- World Bank. Out-of-pocket expenditure (% of current health expenditure), Bangladesh. The "nearly 69 percent" figure (68.5% of total health expenditure, 2020) is from the Bangladesh National Health Accounts 1997 to 2020, as cited in HSREP's article on public health investment. It was checked here against the Health Economics Unit's Bangladesh Pharmaceutical Expenditure Tracking by Diseases, 2020, which reprints the accounts' indicators; the accounts report itself could not be opened on the ministry's site on the day of checking.
All sources checked on 13 November 2026.
Use it, with credit.
Suggested citation
HSREP. (2026). What is health-system resilience as economic protection? Health System Resilience & Economic Protection. https://hsraep.org/what-is-health-system-resilience.html
Licensed under Creative Commons Attribution 4.0 (CC BY 4.0). Found an error? It goes in the corrections log.