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Healthcare
Special Issues
Performance of Healthcare Systems During and After the COVID-19 Pandemic
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Performance of Healthcare Systems During and After the COVID-19 Pandemic

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: 29 June 2026 | Viewed by 6622

Special Issue Editor

Dr. Dimitris Zavras

E-Mail Website
Guest Editor
Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
Interests: socioeconomic impact of COVID-19; access to healthcare; utilization of healthcare services; healthcare provider choice; unmet healthcare needs; catastrophic health spending; health status measurement; research on health services; impact of economic crises on healthcare; research on health systems
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The COVID-19 pandemic found most health systems worldwide unprepared to respond to this overwhelming public health crisis. Their weaknesses became particularly evident during the first and second waves of the pandemic, affecting primary, secondary, and tertiary care. The resulting reactions of health systems involved all aspects of care in an attempt to meet the needs of both emergent COVID-19 and non-COVID-19 patients. The question now is how health systems worldwide are functioning today having returned to normalcy, given the changes that took place during the pandemic.

The evaluation of health systems is more relevant and important today than ever, as it reveals whether the lessons learned from the pandemic have transformed operations within the framework of upgrades. The purpose of this Special Issue is to examine the changes that have taken place and their outcomes. Research areas may include (but are not limited to) the following: crisis management, operations research (medical prioritization, capacity planning, staffing, patient scheduling, etc.), systems research, healthcare management and decision making, health policy, and the assessment of health system performance through the presentation of health system evaluation indicators.

Based on the previous points, this Special Issue attempts to highlight the performance of healthcare systems after the COVID-19 pandemic, emphasizing patient care and healthcare delivery.

High-quality scientific and policy papers, both empirical and theoretical, from academics and researchers are welcome.

I look forward to receiving your contributions.

Dr. Dimitris Zavras
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • COVID-19
  • performance of health systems
  • healthcare delivery
  • performance indicators
  • health policy
  • decision making
  • healthcare management
  • crisis management
  • operations research
  • systems research

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Published Papers (4 papers)

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Research

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22 pages, 305 KB  
Article
Public Perceptions on the Efficiency of National Healthcare Systems Before and After the COVID-19 Pandemic
by Athina Economou
Healthcare 2025, 13(17), 2146; https://doi.org/10.3390/healthcare13172146 - 28 Aug 2025
Viewed by 481
Abstract
Background/Objectives: This study examines individual perceptions of national healthcare system efficiency before and after the COVID-19 pandemic across 18 countries grouped into three clusters (the Anglo-world, Europe, East Asia). This paper aims to identify the demographic, socioeconomic, health-related, and macroeconomic healthcare drivers of [...] Read more.
Background/Objectives: This study examines individual perceptions of national healthcare system efficiency before and after the COVID-19 pandemic across 18 countries grouped into three clusters (the Anglo-world, Europe, East Asia). This paper aims to identify the demographic, socioeconomic, health-related, and macroeconomic healthcare drivers of public assessments, and explain changes in attitudes between 2011–2013 and 2021–2023. Methods: Using individual-level data from the International Social Survey Programme (ISSP) for 2011–2013 and 2021–2023, logistic regression models of perceived healthcare inefficiency are estimated. In addition, the Oaxaca–Blinder decomposition model is adopted in order to decompose the assessment gap between the two periods. Models include a range of individual demographic and socioeconomic characteristics and national healthcare controls (healthcare expenditure, potential years of life lost). Results: Health-related factors, especially self-assessed health and trust in doctors, consistently emerge as predictors of more favourable evaluations across regions and periods. Higher national healthcare expenditure is associated with more positive public views and is the single largest contributor to the improved assessments in 2021–2023. Demographic and socioeconomic variables show smaller regionally and temporally heterogeneous effects. Decomposition indicates that both changes in observed characteristics (notably, expenditure and trust) and unobserved behavioural, cultural, or institutional shifts account for the gap in public healthcare assessments between the two time periods. Conclusions: Public assessments of healthcare systems are primarily shaped by individual health status, trust in providers, and national spending rather than differential demographic and socioeconomic traits. Therefore, policymakers should couple targeted investments in the healthcare sector in order to address adequately public healthcare needs, and strengthen doctor–patient relationships in order to sustain public support. Future research should focus on disentangling the cultural and behavioural pathways influencing healthcare attitudes. Full article
(This article belongs to the Special Issue Performance of Healthcare Systems During and After the COVID-19 Pandemic)
14 pages, 779 KB  
Article
Barriers in Access to Healthcare Services in Greece Post-COVID-19: Persisting Challenges for Health Policy
by Kyriakos Souliotis, Christina Golna, Agni Baka, Aikaterini Ntokou and Dimitris Zavras
Healthcare 2025, 13(15), 1867; https://doi.org/10.3390/healthcare13151867 - 30 Jul 2025
Viewed by 1827
Abstract
Background/Objectives: Access to health services is often limited due to socio-economic and organizational determinants of health systems, which lead to increased unmet healthcare needs. This study aimed to identify access barriers for the general population in Greece, including those that may have [...] Read more.
Background/Objectives: Access to health services is often limited due to socio-economic and organizational determinants of health systems, which lead to increased unmet healthcare needs. This study aimed to identify access barriers for the general population in Greece, including those that may have emerged following the COVID-19 pandemic. Methods: This was a cross-sectional survey of 1002 Greek citizens. A questionnaire regarding socio-demographics, healthcare utilization, and access to health services was used. Interviews took place between October and November 2022. Results: Of 837 participants who used health services in 2022, 82.6% had a medical consultation, 80.6% took diagnostic tests, and 63.6% visited a pharmacy for pharmaceuticals. Of those having a medical consultation, 33.1% did so at an NHS health unit, while 75% of the participants taking diagnostic tests visited a contracted private laboratory. Out of the 135 participants requiring hospitalization, 62% were hospitalized in a public hospital, while 85% of the participants requiring pharmaceuticals visited a private pharmacy. Access barriers in the past year were reported by 48% of the participants requiring a medical consultation, 34% of the participants requiring diagnostic tests, and 40% of the participants requiring hospitalization. The most common barriers were long waiting times and financial constraints. The main barrier to accessing pharmaceuticals was the availability and administration of the product. Conclusions: The identified healthcare access barriers highlight the vulnerabilities of the current health system in Greece, which were further exposed during the COVID-19 pandemic crisis. Addressing socioeconomic factors that are considered key access indicators should be the focus of future health policy initiatives. Full article
(This article belongs to the Special Issue Performance of Healthcare Systems During and After the COVID-19 Pandemic)
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26 pages, 362 KB  
Article
Performance of Greek Public Hospitals Before and After the Economic Recession and the Pandemic: Application of a Novel Cost Malmquist Index for Comparing Productivity Across Multiple Groups
by Argyro Fourlopoulou, Panos Xenos, George Messinios and Nikolaos Maniadakis
Healthcare 2025, 13(11), 1253; https://doi.org/10.3390/healthcare13111253 - 26 May 2025
Viewed by 1525
Abstract
Background/Objectives: This study introduces the Multi Group Cost Malmquist Index (CMgm), a novel tool for comparing and ranking the cost efficiency of multiple groups of similar decision-making units operating in different contexts. It was applied to Greek public [...] Read more.
Background/Objectives: This study introduces the Multi Group Cost Malmquist Index (CMgm), a novel tool for comparing and ranking the cost efficiency of multiple groups of similar decision-making units operating in different contexts. It was applied to Greek public hospitals to assess productivity change between 2009 and 2021, covering the period before the economic recession and after the second lockdown during the COVID-19 pandemic. The study aimed to determine the impact of these external shocks on hospital efficiency and to identify differences in cost productivity based on hospital size and regional location. Methods: Data envelopment analysis was employed to compute the Malmquist indices for productivity change and ranking. Overall, 109 Greek public hospitals were analysed using three models: as a single group, classified by bed capacity, and classified by regional health authority (RHA). Cost productivity was decomposed into its core measures. Results: During the economic crisis, hospitals improved their cost productivity by 13.2%, whereas during the pandemic, it declined by 32.1%, primarily due to cost frontier deterioration resulting from increased healthcare demand and strained resources. Medium-sized hospitals exhibited higher cost efficiency than small and large hospitals. Regional disparities were also observed, with hospitals in the 5th and 7th RHAs outperforming those in 1st and 2nd RHAs. Conclusions: The findings highlight the pandemic’s disruptive impact on hospital cost productivity compared to the efficiency gains during the economic crisis. It is encouraging, though, that hospitals are recovering again after the lifting of strict lockdown measures. The CMgm is a valuable tool for policymakers, offering insights into hospital performance across multiple groups. Future healthcare policies should prioritise resource optimisation and address regional disparities to enhance system-wide efficiency and resilience in times of crisis. Full article
(This article belongs to the Special Issue Performance of Healthcare Systems During and After the COVID-19 Pandemic)

Review

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20 pages, 433 KB  
Review
Mental Health Impacts of the COVID-19 Pandemic on College Students: A Literature Review with Emphasis on Vulnerable and Minority Populations
by Anna-Koralia Sakaretsanou, Maria Bakola, Taxiarchoula Chatzeli, Georgios Charalambous and Eleni Jelastopulu
Healthcare 2025, 13(13), 1572; https://doi.org/10.3390/healthcare13131572 - 30 Jun 2025
Viewed by 1647
Abstract
The COVID-19 pandemic significantly disrupted higher education worldwide, imposing strict isolation measures, transitioning learning online, and exacerbating existing social and economic inequalities. This literature review examines the pandemic’s impact on the mental health of college students, with a focus on those belonging to [...] Read more.
The COVID-19 pandemic significantly disrupted higher education worldwide, imposing strict isolation measures, transitioning learning online, and exacerbating existing social and economic inequalities. This literature review examines the pandemic’s impact on the mental health of college students, with a focus on those belonging to minority groups, including racial, ethnic, migrant, gender, sexuality-based, and low-income populations. While elevated levels of anxiety, depression, and loneliness were observed across all students, findings indicate that LGBTQ+ and low-income students faced the highest levels of psychological distress, due to compounded stressors such as family rejection, unsafe home environments, and financial insecurity. Racial and ethnic minority students reported increased experiences of discrimination and reduced access to culturally competent mental healthcare. International and migrant students were disproportionately affected by travel restrictions, legal uncertainties, and social disconnection. These disparities underscore the need for higher education institutions to implement targeted, inclusive mental health policies that account for the unique needs of at-risk student populations during health crises. Full article
(This article belongs to the Special Issue Performance of Healthcare Systems During and After the COVID-19 Pandemic)
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