In March 2020, the coronavirus pandemic hit Finland, leading to a prolonged state of emergency. The pandemic has posed a substantial challenge to the healthcare system and to society, prompting the need for in-depth investigations about the strengths and weaknesses of health care systems. Many policy briefs in Finland, call for systemic and macro-level standardization in order to create system resilience and to secure welfare services in the future. Research-based policy recommendations and studies of pandemic management have, emphasized the need to manage the system’s actions in the event of a disruption in an increasingly centralized way, based on a more comprehensive view of the situation.

However, the case study presented in this article brings forward strengths that partially contradict how systemic resilience in welfare services is often perceived. To further understand this contradiction, a system theoretic approach was taken by utilizing the nominal theory of Jürgen Habermas and its system-lifeworld dichotomy. Taking after the view of Niklas Luhmann, a key element of system’s is their ability to become differentiated, developing according to its own principles. In response to Luhmann, Jürgen Habermas turned his sights into the areas that could not be regarded as systems, what he termed as the lifeworld. Where systems operate through material reproduction, cultural reproduction happens in the realm of the lifeworld. What is more, the systems also depend on the “socialization patterns for acquisition of generalized competences for action”, as Habermas puts it. In this article, we present a case study of welfare professionals that challenges trends of standardization and centralization and balances them with “lifeworld” principles, that can strengthen our welfare services and their resilience.

The case of Herttoniemi reserve hospital in Helsinki, Finland, examined through thematic interviews of key actors, highlights some of the neglected aspects of resilience by employing the conceptual framework of three different worlds of justification: fabrication, agency, and care. These frameworks of both lifeworld and system origin, stem lifeworld processes of social reproduction at the outskirts of a system. These non-system processes and the frameworks that exemplify them, paint a picture of resilience formed jointly by the combination of the strengths from both the system and the lifeworld.

Health care professionals are crucial for delivery of high-quality services. This was highlighted during the recent covid pandemic, which also saw remarkable displays of flexibility and service orientation among health care personnel in many European countries. – However, the experiences during covid-19 also appear to have accelerated a long-term trend of problems in recruitment and retention particularly among nursing staff and primary care doctors. All the Nordic countries are currently experiencing shortages particularly of nursing staff and primary care doctors in rural and socially disadvantaged areas. This is particularly problematic as the pressure on health services is increasing due to aging populations and growing numbers of citizens with (multiple) chronic care needs, and primary care is pivotal for management of such issues.

In this paper we compare developments in the supply of health care professionals in the five Nordic countries with a particular focus on primary care and specialized nursing staff. We discuss the underlying reasons, and we compare the policy initiatives that have been introduced to address this issue in the five countries.

The Nordic region is particularly interesting, as all five countries have high numbers of health care professionals compared to the European average (State of Health in Europe report 2023). Furthermore, all the Nordic countries have a long tradition of organized labor market negotiations for mostly publicly employed health care personnel. Still, the Nordic countries experience misalignments and shortages of specialized nurses and primary care doctors. Nurses are leaving the public hospitals to work in primary health care, private hospitals or temporary agencies. Many nurses also prefer to work less than full time. The shortage of primary care (general practitioners) is particularly evident in rural areas and in economically disadvantaged areas.

A key issue is why misalignments and shortages remain an issue, and which policy measures have been applied to address this.

This study analyses the effect of institutional and social context factors on the performance of national health systems and addresses two research questions: How does the institutional context, and its administrative, political, and social dimensions, affect the performance of health systems? Is the administrative tradition of a country systematically related to its health system performance?

We conceptualize health systems as embedded in a wider administrative, political and social context. We aim to disentangle the effect of healthcare system structure, administrative traditions and political institutions and preferences, and thereby contribute to a better distinction between these context factors. This approach answers calls in the health field to bring power and politics (Witter et al. 2023), governance (Saulnier et al. 2021) and institutional context in (Torbica et al. 2018; 2020) to study healthcare from a systemic perspective.

The paper has an ambitious and unique global scope that goes beyond the widely studied OECD or EU countries. We are currently collecting data on healthcare system type and performance for historically underrepresented and underexamined non-Western countries, contributing to a global mapping and investigation of healthcare systems. We combine this information with data on administrative traditions, political institutions and preferences (government party ideology) and societal factors (e.g. trust). We analyze this data with RE models.

Besides the outlined contributions to the (public) health field, the paper advances knowledge in public administration by testing the explanatory power of the administrative traditions concept in a global study. While this concept (seminally Painter and Peters 2010) is widely used to explain variation in the adoption and success of administrative reforms, it is much less commonly applied to other substantial policy fields (most recently to climate adaptation, Biesbroek et al. 2018). By concurrently testing the explanatory power of administrative traditions with related concepts such as welfare (healthcare) system and political preferences, the paper contributes to much needed concept development and sharpens the boundaries of the administrative traditions concept.

Central results suggest that more interventionist administrative traditions, such as the socialist and Napoleonic, are systematically and positively correlated with various measures of health system performance, while results for political factors and social trust are mixed. Health system funding including social health insurance and public health expenditure remain largely insignificant.

This paper investigates the extent in which economic growth achieves the improvement of general well-being. For this purpose, we combine input-output analysis with welfare economics to measure whether the sectoral decomposition of economic growth is compatible with the development of economic sectors that better promote general well-being. We apply our analysis in four European countries, i.e. Germany, Greece, Italy and Netherlands. The results indicate that economic growth is partially compatible with the improvement of general well-being only in the cases of the Italian and the Dutch economies.