Highlighting global inequities in health services quality research: a systematic review and quantitative evidence (2014-2023).

Abstract

Background: Health service quality is important for adequate and equitable health systems. However, research on this topic may reflect imbalances in global scientific production, visibility and collaboration. This study examines global trends and disparities in health service quality research over the past decade, focusing on thematic priorities, geographic distribution and structural inequities.

Objectives: This review aims to (1) analyse the evolution of the quality of health services literature over time, assessing published articles and their impacts; (2) identify key trends, themes and significant contributions; (3) examine the geographical distribution of contributions to identify which nations excel in this area; (4) identify the key journals, authors and affiliations that significantly improve the quality of health services research; (5) assess the main factors that influence the citation impact of high-quality health services research; and (6) identify gaps in the quality of health services literature and suggest future research directions based on bibliometric insights.

Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. We integrated bibliometric analysis (using co-word networks, citation counts and keyword trends) with econometric modelling to map and synthesize publication patterns, visibility and thematic priorities. Specifically, panel regression was applied to examine the structural and content-related predictors of citation impact across a longitudinal dataset of peer-reviewed studies (2014-2023). The combination of bibliometric and econometric methods enhanced the analytical depth of the systematic review, enabling quantification of disparities and explanatory insights beyond descriptive synthesis.

Results: Out of 9121 records identified, 8857 articles were included in the final analysis. The included studies covered a broad range of regions and languages. Global publication volume increased steadily, peaking in 2021. Three dominant research themes were identified: patient experience, service delivery and health outcomes. Institutions from high-income countries, particularly those in North America and Europe, accounted for the most output and citations. Articles in English had significantly higher visibility than non-English publications. Citation impact was positively associated with international collaboration and reference count but negatively associated with title length and excessive keyword use.

Limitations of evidence: The review relied on a single database [Web of Science (WoS)], which may have excluded relevant articles indexed elsewhere. Citation lag affected newer studies. The bibliometric nature of the study limits direct conclusions on the quality of interventions or clinical outcomes.

Conclusions: Despite the growth in global research output, significant disparities persist in the visibility and influence of health services quality research. Linguistic, institutional and geographic factors contribute to uneven dissemination and recognition. Promoting inclusive publishing practices and fostering cross-regional collaboration are essential to reducing structural inequities and enhancing the global relevance of health systems research.

Registration: The protocol is publicly available through the Protocol Exchange Platform and can be accessed at https://doi.org/10.17504/protocols.io.261ge8ypyg47/v1 .