SSM - Health Systems最新文献

{"title":"Implementation of perennial malaria chemoprevention in infants at district-level in Togo: mixed methods assessment of health system readiness","authors":"Natacha Revollon ,&nbsp;Koku Delanyo Dzoka ,&nbsp;Diane Fifonsi Gbeasor-Komlanvi ,&nbsp;Arnold Sadio ,&nbsp;Shino Arikawa ,&nbsp;Abraham Atekpe ,&nbsp;Rodion Konu ,&nbsp;Bandana Bhatta ,&nbsp;Martin Tchankoni ,&nbsp;Cristina Enguita-Fernàndez ,&nbsp;Francisco Saute ,&nbsp;Mohamed Samai ,&nbsp;Bernard Tossou Atchrimi ,&nbsp;Valérie Briand ,&nbsp;Clara Menendez ,&nbsp;Didier Koumavi Ekouevi ,&nbsp;Joanna Orne-Gliemann ,&nbsp;for the MULTIPLY project consortium","doi":"10.1016/j.ssmhs.2024.100012","DOIUrl":"10.1016/j.ssmhs.2024.100012","url":null,"abstract":"<div><h3>Introduction</h3><p>In June 2022, WHO recommended the administration of Perennial Malaria Chemoprevention (PMC) alongside Expanded Immunization Programmes for children under two years. We investigated the health systems readiness for PMC implementation in Togo.</p></div><div><h3>Method</h3><p>As part of the multi-country MULTIPLY project, we conducted a mixed methods implementation research study in the 27 health facilities of Haho district in Togo. All district health care providers (n=188) and a sample of community health workers (n=43) were invited to respond to a self-administered Knowledge-Attitudes-Practices questionnaire. Structured observations in 4 health facilities and 19 semi-structured interviews were conducted. Descriptive analysis was conducted on quantitative data. Qualitative data was analysed thematically, using an inductive approach. We report here on the implementation context for PMC, its infrastructural feasibility and its acceptability among health care workers (HCWs).</p></div><div><h3>Results</h3><p>Overall, respondents perceived PMC as relevant in the context of high malaria burden and had a good knowledge about malaria and its prevention. HCWs foresaw good community acceptability of PMC. Although some HCWs did not understand the rationale of PMC if children are not sick, they also believed PMC would be effective, in line with their perceptions of preventive malaria treatment during pregnancy. Several challenges were foreseen such as distance barriers for accessing health facilities, difficulties in accessing drinking water, supplies for PMC administration, or lack of dedicated health workforce and area for PMC administration.</p></div><div><h3>Conclusion</h3><p>At district-level in Togo, overall pre-intervention acceptability of PMC was encouraging. Structural and operational challenges were identified as possible barriers to implementation feasibility.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100012"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000059/pdfft?md5=3d606829699d8e8faf769b134447d984&pid=1-s2.0-S2949856224000059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141040249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a multidimensional measure of health care access among LGBTQ midlife and older adults in the United States","authors":"Meghan Romanelli,&nbsp;Karen Fredriksen-Goldsen,&nbsp;Hyun-Jun Kim","doi":"10.1016/j.ssmhs.2024.100011","DOIUrl":"10.1016/j.ssmhs.2024.100011","url":null,"abstract":"<div><h3>Purpose</h3><p>Lesbian, gay, bisexual, transgender, and queer (LGBTQ) midlife and older adults are a health disparity population whose health and health care needs are distinguished by the intersection of gender, sexuality, and age. Research and measurement considering multidimensional factors influencing health care access among this population, however, remain limited. Theoretically cohesive indicators of health care access were combined to develop a comprehensive and reliable, yet parsimonious scale that assesses the unique health care access needs and experiences of LGBTQ midlife and older adults.</p></div><div><h3>Methods</h3><p>Data from the U.S.-based Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) were used, including 2322 LGBTQ participants from the 2015 wave of data collection. Twenty-four items were initially included in an assessment of scale reliability. The underlying factor structure of health care access was tested. Differences in mean health care access scores were examined across sexual identity, current gender, gender identity, and age cohort.</p></div><div><h3>Results</h3><p>Nineteen items remained in the final scale (α=0.90). Data supported health care access as multidimensional among NHAS participants. Heterogeneity in health care access scores was identified across participants. Bisexual, straight, and sexually diverse participants, women and gender diverse participants, and transgender participants faced more difficulties accessing care. Participants aged 66–80 and 81+ reported significantly higher health care access scores.</p></div><div><h3>Conclusion</h3><p>Final indicators represented the complex health care experiences of LGBTQ midlife and older adults<em>.</em> This scale can be utilized in future health equity research. Using NHAS longitudinal data, future research could assess changes in access over the life-course and as a predictor of health outcomes.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100011"},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000047/pdfft?md5=fcd01a455993666cb551d5de2fc9a1d3&pid=1-s2.0-S2949856224000047-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141047538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actioning the Learning Health System: An applied framework for integrating research into health systems","authors":"Robert J. Reid ,&nbsp;Walter P. Wodchis ,&nbsp;Kerry Kuluski ,&nbsp;Nakia K. Lee-Foon ,&nbsp;John N. Lavis ,&nbsp;Laura C. Rosella ,&nbsp;Laura Desveaux","doi":"10.1016/j.ssmhs.2024.100010","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100010","url":null,"abstract":"<div><p>Health systems across the world experience pervasive gaps in the speed with which high quality evidence is generated, implemented and refined. A Learning Health System (LHS) approach that blends research with health care operations is to eliminate or reduce delays. This paper builds on existing LHS frameworks to deepen our practical understanding of the research-health systems operations interface and to provide actionable insights on how to realize a LHS in practice. We present a LHS action framework that describes how research and health care operations are linked and enacted in a comprehensive LHS approach to advance population health and health equity. Health systems seeking to implement a LHS approach can use this framework to identify capabilities necessary to enact the learning elements, including key questions and methods, to ensure a systematic approach to learning and achieving equity-centered quadruple aim metrics.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"2 ","pages":"Article 100010"},"PeriodicalIF":0.0,"publicationDate":"2024-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000035/pdfft?md5=b0f016d7d8e5b152c1af633b1dc5b2dc&pid=1-s2.0-S2949856224000035-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140308885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing health equity for populations with intellectual disabilities: A systematic review of facilitators and barriers to the implementation of health checks and screening","authors":"Anders Larrabee Sonderlund,&nbsp;Fereshteh Baygi,&nbsp;Jens Soendergaard,&nbsp;Trine Thilsing","doi":"10.1016/j.ssmhs.2024.100009","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100009","url":null,"abstract":"<div><p>People with intellectual disabilities (IDs) experience extensive health disparities, including premature mortality and higher incidence of chronic disease. These inequities have been linked to reduced access to preventive health care for this population. We review the evidence as it relates to barriers and facilitators of effective implementation of health checks and screenings for people with IDs. We conducted our review according to the PRISMA guidelines. We systematically searched seven academic databases for articles on barriers and facilitators of health check implementation for people with IDs. A total of 17 articles met our inclusion criteria. Four were quantitative articles and 13 were qualitative. Four of the qualitative studies focused on patient experiences of attending health checks and screenings. The remaining 13 studies reported on health professionals’ perspectives on implementation. We noted implementation barriers and facilitators at three levels: Individual, organizational, and structural. Across these levels, we identified 17 distinct implementation factors that may be avoided or harnessed to facilitate health check implementation and access for people with IDs. We discuss our results and potential solutions for better, more effective implementation of health checks and screenings for people with IDs.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"2 ","pages":"Article 100009"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000023/pdfft?md5=e677ed51e824195bb031b3cadfb98b8c&pid=1-s2.0-S2949856224000023-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139714609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the efficiency in spending for health: A systematic review of evidence","authors":"Nouria Brikci ,&nbsp;Rotimi Alao ,&nbsp;Hong Wang ,&nbsp;Darius Erlangga ,&nbsp;Kara Hanson","doi":"10.1016/j.ssmhs.2024.100008","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100008","url":null,"abstract":"<div><h3>Background</h3><p>Addressing inefficiencies in the way healthcare is financed has been identified as an important source of fiscal space for health systems. The WHO, for example, has argued that up to 40% of resources spent in health are wasted. Which reforms to focus on, their impact on fiscal space, and their feasibility have seldom been documented, however. The aim of this paper is to synthesise the evidence on these points, ascertaining the extent of fiscal space that has, to date, been created by implementing reforms aimed at addressing inefficiencies in health financing.</p></div><div><h3>Methods</h3><p>systematic review of peer-reviewed literature in global databases (Medline, Embase, Global Health, Econlit, Africa-Wide information, Web of Science Core Collection and SciELO citation index). 20 articles were included for narrative analysis. Data extracted included: type of study; countries where the reform was implemented; the specific inefficiency discussed; the specific reform to tackle inefficiency; the efficiency indicator used; the baseline information given; the impact of the reform on health spending; and the feasibility and timing of the reform.</p></div><div><h3>Findings</h3><p>Inefficiencies in health financing exist across the world, and reforms to address these remain important. Yet the empirical evidence on savings that can be created through addressing these inefficiencies is limited, mixed, and suggests that potential savings are more modest than indicated by the WHO. The feasibility of these reforms is seldom documented. The process of implementation of these reforms is similarly poorly documented, although the available evidence suggests that it takes three to ten years for these efficiency-enhancing health financing reforms to translate into actual results.</p></div><div><h3>Interpretation</h3><p>Further research is needed to understand how to translate identified inefficiencies in the way healthcare is financed into additional fiscal space. Engaging with the political economy of designing and implementing these reforms will be key. Rooting fiscal space analysis projections in country-specific analysis of inefficiencies is also key, as the expectations of financial savings will otherwise be unrealistic.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"2 ","pages":"Article 100008"},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000011/pdfft?md5=a767f1363d3d0a9193c333c21a0ea52b&pid=1-s2.0-S2949856224000011-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139674239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The sustainability of two departmental health insurance units in Senegal: A qualitative study","authors":"Valéry Ridde ,&nbsp;Babacar Kane ,&nbsp;Ndeye Bineta Mbow ,&nbsp;Ibrahima Senghor ,&nbsp;Adama Faye","doi":"10.1016/j.ssmhs.2023.100006","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2023.100006","url":null,"abstract":"<div><p>Despite decades of implementation, community-based health insurance (CBHI) in Africa has not effectively achieved Universal Health Coverage (UHC). As a response, from 2014 to 2017, a Belgian-Senegalese project organized an alternative solution: Departmental Health Insurance Units (UDAM). Professionals managed UDAMs at a departmental level, and healthcare providers charged a flat-rate fee. While research on sustainability is scarce in Africa, this study aims to understand the factors that explain why, four years after the end of the project, UDAMs are sustained. This qualitative research used Schell et al. (2013) conceptual framework on factors influencing sustainability. The data came from 13 months of field observations, a documentation review, 120 interviews at the local level and nine at the regional and national level, and a focus group. We carried out a thematic analysis according to the conceptual framework. The results show that central political support has strengthened over time. UDAMs have managed to stabilize their funding through State subsidies and social marketing strategies to improve membership. UDAMs kept their management fees at 13%, below the 25% standard proposed by the West African Economic and Monetary Union. Multiple partnerships have been established at international, national, and local levels. Building on the professionalization of its staff, UDAMs have strengthened their organizational capacity. Internal controls and a complaints system have been organized to improve UDAMs’ accountability. Many communication activities were carried out before the end of the project to prepare the exit strategy. With their extensive coverage (penetration rate over 60%), UDAMs impact the health system (between 2014 and 2021, they paid 2.5 million EUR to healthcare providers). Innovations have been implemented, such as organizing a group contribution based on collective work in fields of culture supported by the communities and local stakeholders. As part of its UHC strategy, Senegal decided at the end of 2022 to transition its 676 communal CBHI into 46 departmental units. The sustainability of two UDAMs has demonstrated the relevance of this model. However, sustainability can only be assured if the State prioritizes the health sector and donors place greater emphasis on alignment and sustainability. We need to study how it is organized to scale up nationally.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"2 ","pages":"Article 100006"},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856223000065/pdfft?md5=7adb6eabdd7a36f6d14744fae5848446&pid=1-s2.0-S2949856223000065-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139033790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning from Perú: Why a macroeconomic star failed tragically and unequally on Covid-19 outcomes","authors":"Eugenio Villar ,&nbsp;Pedro Francke ,&nbsp;Rene Loewenson","doi":"10.1016/j.ssmhs.2023.100007","DOIUrl":"10.1016/j.ssmhs.2023.100007","url":null,"abstract":"<div><p>Peru’s macroeconomic success and moderate health security rating paradoxically combined with amongst the highest levels of reported COVID-19 mortality globally, and significant inequality in pandemic health outcomes. A thematic analysis of evidence from desk review of online publications and databases was used to examine determinants of this outcome for national and global policy dialogue on pandemic preparedness, prevention and protection. The paradox relates to a concentration of risk and vulnerability in low income, urban households, associated with differentials in social conditions, and in a failure to address deficits in primary care and community systems, or in social protection of vulnerable households. Deeper causes in the political economy, state-society relations and the interests driving policy choices underlie the inequity in the immediate drivers. Neoliberal policy choices generated socio-economic insecurity and informality, which with state underinvestment in social protection and primary health care during early pandemic waves generated a society with elevated risk, disaffected by the state and surviving largely outside formal rule systems. Pandemic responses need to connect with such realities, invest in social conditions and local health systems, (re)connect people to public services and social protection, and regenerate public trust to tackle drivers of and prevent excessive, inequitable pandemic-related mortality.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"2 ","pages":"Article 100007"},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856223000077/pdfft?md5=807fc307b79f584a048412abafcd9c76&pid=1-s2.0-S2949856223000077-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139015218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial analysis of primary healthcare accessibility patterns in Migori County, Kenya","authors":"Antony Ondiwa Okundi,&nbsp;Cigdem Varol","doi":"10.1016/j.ssmhs.2023.100005","DOIUrl":"10.1016/j.ssmhs.2023.100005","url":null,"abstract":"<div><p>The inequitable and insufficient evidence-based allocation of health resources has exacerbated the health disparities in developing nations. Indicators of inadequate accessibility and misuse of health resources include urban-centered health facility site selection and overlapping health service areas. This research employed Service area analysis and the Maximum Covering Location Problem (MCLP) to assess spatial accessibility while considering the operational schedules of basic healthcare providers. Utilizing the motorbike model, the spatial accessibility to basic healthcare facilities amounted to 84%. However, certain facilities did not operate during weekends or around the clock. During the weekends, accessibility decreased to 60%, and for 24-hour accessibility, it dropped to 49%. Consequently, it is evident that the operating hours of healthcare facilities have a significant effect on spatial accessibility. This study proposed the upgrade of strategically positioned healthcare facilities to enhance spatial access and bolster the referral network for the local population.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"2 ","pages":"Article 100005"},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856223000053/pdfft?md5=51c689766ed3ecf1933af8196c929bf7&pid=1-s2.0-S2949856223000053-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139025337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between health system affiliation and hospital strategies for COVID-19 preparedness","authors":"Ian J. Barbash ,&nbsp;Billie S. Davis ,&nbsp;Meeta Prasad Kerlin ,&nbsp;Andrew J. Admon ,&nbsp;Deena Kelly Costa ,&nbsp;Kelly C. Vranas ,&nbsp;Jeremy M. Kahn","doi":"10.1016/j.ssmhs.2023.100004","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2023.100004","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the association between health system affiliation and hospitals’ reported responses to the COVID-19 pandemic.</p></div><div><h3>Methods</h3><p>Between September 14, 2020 and November 20, 2020, we conducted a survey of hospital administrators. We linked these survey results to county-level data on COVID-19 incidence and hospital affiliation data from the Agency for Healthcare Research and Quality Compendium on US Health Systems. We analyzed the association between health system affiliation and hospitals’ reported responses to the COVID-19 pandemic.</p></div><div><h3>Results</h3><p>We analyzed data from 217 general, short-stay, acute-care hospitals who responded to the survey. Health system affiliat<strong>ed hospitals reported increased</strong> adoption of policies to accept fewer patients in transfer (adjusted OR 2.06, 95% CI 1.01 – 4.21, p = 0.047), increased adoption of new ICU telemedicine programs (adjusted OR 4.90, 95% CI 1.09 – 22.1, p = 0.039), and decreased repurposing of medical-surgical units as ICUs (adjusted OR 0.51, 95% CI 0.27 – 0.97, p = 0.041).</p></div><div><h3>Conclusions</h3><p>Hospitals affiliated with health systems responded differently to the pandemic than non-system affiliated hospitals, including in ways that may have promoted efficient management of critical care demand and supply across hospitals. These findings suggest interhospital coordination may play an important role in disaster and pandemic preparedness.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"2 ","pages":"Article 100004"},"PeriodicalIF":0.0,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856223000041/pdfft?md5=18eac8e31aae326bbf983f4320e8b554&pid=1-s2.0-S2949856223000041-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138577486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare system efficiency and drivers: Re-evaluation of OECD countries for COVID-19","authors":"Gökçe Manavgat ,&nbsp;Martine Audibert","doi":"10.1016/j.ssmhs.2023.100003","DOIUrl":"10.1016/j.ssmhs.2023.100003","url":null,"abstract":"<div><p>The Covid-19 pandemic has raised concerns about the resilience of health systems. The aim of this study is twofold: i) to measure and compare the resilience of health system efficiency of OECD countries before and during Covid-19 and ii) to determine the healthcare efficiency drivers (e.g., socio-economic) of health system performance. Using a dataset of 31 OECD countries for 2018 and 2020, we first estimate bias-adjusted efficiency scores, followed by a double bootstrap truncated regression procedure to study the drivers associated with health system efficiency. We find that the health system efficiency overall score decreased among OECD countries during the Covid-19 pandemic compared to before Covid-19. Estonia and Japan retained their full efficiency scoreduring Covid-19. We find a negative association between health system efficiency and unemployment rate, share of health expenditure in GDP, and share of population over 65. Conversely, high vaccination rates contribute positively to health system efficiency during the Covid-19 period.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"2 ","pages":"Article 100003"},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294985622300003X/pdfft?md5=5214f43bb951af6186e1bbef52db3ca6&pid=1-s2.0-S294985622300003X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138622398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}