Evidence map›Paper›PMID 41166255›Full record

ArticlePloS one2025

Health systems performance in health outcomes, health financing and COVID-19 pandemic: Lessons from 31 countries.

Pirhossein Kolivand, Jalal Arabloo, Peyman Saberian, Taher Dorooudi, Soheila Rajaie, Fereshte Karimi, Behzad Raei, Masoud Behzadifar, Arash Parvari, Seyed Jafar Ehsanzadeh and 4 more

Abstract read
In one paragraph

Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Pirhossein KolivandResearch Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran.
Jalal ArablooHealth Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
Peyman SaberianResearch Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran.
Taher DorooudiResearch Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran.
Soheila RajaieResearch Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran.
Fereshte KarimiResearch Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran.
Behzad RaeiDepartment of Health, Safety, and Environment Management, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran.
Masoud BehzadifarSocial Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
Arash ParvariDepartment of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Seyed Jafar EhsanzadehEnglish Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Saeid HomayounFaculty of Education and Economics, University of Gävle, Gävle, Sweden.
Shahrzad SalehbeigiDepartment of Cardiology, ST. Antonius Hospital, Cologne, Germany.
Peyman NamdarDepartment of Emergency Medicine, Metabolic Disease Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
Samad AzariHealth Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.ORCID https://orcid.org/0000-0003-2781-7793

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundssssHealth system performance is a multifaceted concept that encompasses various dimensions of a nation's healthcare infrastructure. This study aims to assess and rank the performance of health systems across different regions of the world. METHODOLOGY: We employed the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method in 2023 to evaluate and rank the health system performance of 31 countries across six geographical regions. Our evaluation included six general categories and twelve indicators related to health, finance, and the COVID-19 pandemic. The final weights for these indicators were determined using the Three-scale method and the Entropy-weighting method. Additionally, we categorized health system performance into three groups: high, moderate, and low. Hierarchical clustering of health system performance scores was conducted using SPSS software (version 26).

resultsLuxembourg emerged as the only high-performing health system, while Qatar and the Netherlands fell into the moderate-performance group. Other countries exhibited low-performing health systems. Notably, within the low-performance group, the United States of America, Australia, Singapore, Canada, England, and Germany achieved relatively better rankings. Conversely, Yemen, Egypt, Afghanistan, and Bolivia ranked lowest in terms of health system performance.

conclusionContrary to the assumption that higher health spending guarantees improved performance, the experience of COVID-19 among high-income countries revealed mixed results. Strengthening resilience, investing in public health systems, and ensuring sustainable financial resources are crucial for enhancing health system performance.

Indexed as

COVID-19Delivery of Health CareHealthcare FinancingHumansPandemicsSARS-CoV-2

Identifiers

PMID41166255
PMCPMC12574844

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.