{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:24:53Z","timestamp":1787790293529,"version":"build-2784847793"},"reference-count":50,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Social Science & Medicine"],"published-print":{"date-parts":[[2026,9]]},"DOI":"10.1016\/j.socscimed.2026.119522","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T15:45:54Z","timestamp":1782229554000},"page":"119522","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Technical efficiency and resilience of health systems in Japan during the COVID-19 pandemic"],"prefix":"10.1016","volume":"405","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3950-1799","authenticated-orcid":false,"given":"Ayumi","family":"Hashimoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3663-6564","authenticated-orcid":false,"given":"Hideki","family":"Hashimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8503-9278","authenticated-orcid":false,"given":"Hiroyuki","family":"Kawaguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5505-8988","authenticated-orcid":false,"given":"Yoko","family":"Ibuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.socscimed.2026.119522_bib1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s10198-023-01567-w","article-title":"The trade-off between health system resiliency and efficiency: evidence from COVID-19 in European regions","volume":"25","author":"Almeida","year":"2024","journal-title":"Eur. J. Health Econ."},{"key":"10.1016\/j.socscimed.2026.119522_bib4","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s11123-013-0354-y","article-title":"The StoNED age: the departure into a new era of efficiency analysis? A monte carlo comparison of StoNED and the \u201coldies\u201d (SFA and DEA)","volume":"41","author":"Andor","year":"2014","journal-title":"J. Prod. Anal."},{"issue":"1","key":"10.1016\/j.socscimed.2026.119522_bib2","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jiac.2023.09.005","article-title":"Differences in COVID-19 treatment across Japan: analysis of the COVID-19 registry Japan (COVIREGI-JP)","volume":"30","author":"Asai","year":"2024","journal-title":"J. Infect. Chemother."},{"key":"10.1016\/j.socscimed.2026.119522_bib3","article-title":"Differences in patient characteristics, treatments, and mortality of COVID-19 between 2022 and 2020-2021","author":"Aso","year":"2024","journal-title":"Jpn. J. Infect. Dis."},{"key":"10.1016\/j.socscimed.2026.119522_bib5","article-title":"Explaining COVID-19 performance: what factors might predict national responses?","volume":"372","author":"Baum","year":"2021","journal-title":"BMJ"},{"key":"10.1016\/j.socscimed.2026.119522_bib6","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1177\/1536867X1301300404","article-title":"Stochastic frontier analysis using stata","volume":"13","author":"Belotti","year":"2013","journal-title":"STATA J."},{"issue":"2","key":"10.1016\/j.socscimed.2026.119522_bib7","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.jeconom.2017.09.005","article-title":"Consistent inference in fixed-effects stochastic frontier models","volume":"202","author":"Belotti","year":"2018","journal-title":"J. Econom."},{"issue":"2","key":"10.1016\/j.socscimed.2026.119522_bib8","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1111\/1477-9552.12512","article-title":"Estimating persistent and transient technical efficiency and their determinants in the presence of heterogeneity and endogeneity","volume":"74","author":"Bokusheva","year":"2023","journal-title":"J. Agric. Econ."},{"key":"10.1016\/j.socscimed.2026.119522_bib9","series-title":"An Introduction to Efficiency and Productivity Analysis","author":"Coelli","year":"2005"},{"key":"10.1016\/j.socscimed.2026.119522_bib10","first-page":"180","article-title":"Production functions for medical services","volume":"3","author":"Cohen","year":"2014"},{"issue":"10334","key":"10.1016\/j.socscimed.2026.119522_bib11","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1016\/S0140-6736(21)02867-1","article-title":"Variation in the COVID-19 infection-fatality ratio by age, time, and geography during the pre-vaccine era: a systematic analysis","volume":"399","year":"2022","journal-title":"Lancet"},{"issue":"10334","key":"10.1016\/j.socscimed.2026.119522_bib12","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1016\/S0140-6736(22)00172-6","article-title":"Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021","volume":"399","year":"2022","journal-title":"Lancet"},{"issue":"1","key":"10.1016\/j.socscimed.2026.119522_bib14","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1186\/s12913-023-10246-8","article-title":"Non-homogeneity in the efficiency evaluation of health systems","volume":"23","author":"Dlouh\u00fd","year":"2023","journal-title":"BMC Health Serv. Res."},{"key":"10.1016\/j.socscimed.2026.119522_bib15","first-page":"1","article-title":"Depoliticising resilience? Uncovering the political theories of health system resilience","volume":"9","author":"Ewert","year":"2026","journal-title":"Health Econ. Pol. Law"},{"issue":"1","key":"10.1016\/j.socscimed.2026.119522_bib16","first-page":"6","article-title":"Health system resilience: what are we talking about? A scoping review mapping characteristics and keywords","volume":"9","author":"Fridell","year":"2020","journal-title":"Int. J. Health Pol. Manag."},{"key":"10.1016\/j.socscimed.2026.119522_bib17","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s41256-020-00149-0","article-title":"Managing healthcare delivery system to fight the COVID-19 epidemic: experience in Japan","volume":"5","author":"Gai","year":"2020","journal-title":"Glob. Health Res. Pol."},{"issue":"1","key":"10.1016\/j.socscimed.2026.119522_bib18","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1186\/s12913-022-08859-6","article-title":"How can we strengthen partnership and coordination for health system emergency preparedness and response? Findings from a synthesis of experience across countries facing shocks","volume":"22","author":"Gooding","year":"2022","journal-title":"BMC Health Serv. Res."},{"issue":"10","key":"10.1016\/j.socscimed.2026.119522_bib19","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1002\/hec.938","article-title":"Distinguishing between heterogeneity and inefficiency: stochastic frontier analysis of the world health Organization's panel data on national health care systems","volume":"13","author":"Greene","year":"2004","journal-title":"Health Econ."},{"key":"10.1016\/j.socscimed.2026.119522_bib20","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jeconom.2004.05.003","article-title":"Reconsidering heterogeneity in panel data estimators of the stochastic frontier model","volume":"126","author":"Greene","year":"2005","journal-title":"J. Econom."},{"issue":"6","key":"10.1016\/j.socscimed.2026.119522_bib21","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1038\/s41591-021-01381-y","article-title":"Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries","volume":"27","author":"Haldane","year":"2021","journal-title":"Nat. Med."},{"issue":"1","key":"10.1016\/j.socscimed.2026.119522_bib22","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1186\/s12879-022-07929-8","article-title":"Time-dependent risk of COVID-19 death with overwhelmed health-care capacity in Japan, 2020-2022","volume":"22","author":"Hayashi","year":"2022","journal-title":"BMC Infect. Dis."},{"issue":"6","key":"10.1016\/j.socscimed.2026.119522_bib24","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1002\/hec.751","article-title":"The efficiency of health production: re-estimating the WHO panel data using parametric and non-parametric approaches to provide additional information","volume":"12","author":"Hollingsworth","year":"2003","journal-title":"Health Econ."},{"key":"10.1016\/j.socscimed.2026.119522_bib25","first-page":"292","article-title":"Evaluating efficiency of a health care system\u00a0in the developed world","volume":"1","author":"Hollingsworth","year":"2014"},{"key":"10.1016\/j.socscimed.2026.119522_bib26","article-title":"Analysis of the conceptualization, frameworks, and operationalization of health system resilience in empirical research","volume":"25","author":"Hou","year":"2026","journal-title":"J. Evid. Base Med."},{"key":"10.1016\/j.socscimed.2026.119522_bib27","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s11123-005-1330-y","article-title":"Misspecification preferred: the sensitivity of inefficiency rankings","volume":"23","author":"Jensen","year":"2005","journal-title":"J. Prod. Anal."},{"key":"10.1016\/j.socscimed.2026.119522_bib28","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/0304-4076(82)90004-5","article-title":"On the estimation of technical inefficiency in the stochastic frontier production function model","volume":"19","author":"Jondrow","year":"1982","journal-title":"J. Econom."},{"issue":"1","key":"10.1016\/j.socscimed.2026.119522_bib29","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-023-44942-6","article-title":"Evaluating the COVID-19 vaccination program in Japan, 2021 using the counterfactual reproduction number","volume":"13","author":"Kayano","year":"2023","journal-title":"Sci. Rep."},{"issue":"6","key":"10.1016\/j.socscimed.2026.119522_bib30","doi-asserted-by":"crossref","DOI":"10.1111\/1475-6773.14382","article-title":"Health system resilience during the COVID-19 pandemic: a comparative analysis of disruptions in care from 32 countries","volume":"59","author":"Ledesma","year":"2024","journal-title":"Health Serv. Res."},{"issue":"1","key":"10.1016\/j.socscimed.2026.119522_bib31","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s13561-022-00358-y","article-title":"COVID-19 and the efficiency of health systems in Europe","volume":"12","author":"Lupu","year":"2022","journal-title":"Health Econ Rev"},{"key":"10.1016\/j.socscimed.2026.119522_bib32","doi-asserted-by":"crossref","DOI":"10.1016\/j.ssmhs.2023.100003","article-title":"Healthcare system efficiency and drivers: Re-evaluation of OECD countries for COVID-19","volume":"2","author":"Manavgat","year":"2024","journal-title":"SSM - Health Systems"},{"issue":"2","key":"10.1016\/j.socscimed.2026.119522_bib33","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s40258-022-00785-2","article-title":"Analysing the efficiency of health systems: a systematic review of the literature","volume":"21","author":"Mbau","year":"2023","journal-title":"Appl. Health Econ. Health Pol."},{"issue":"2","key":"10.1016\/j.socscimed.2026.119522_bib34","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s10729-020-09539-9","article-title":"Assessing the efficiency of Malaysia health system in COVID-19 prevention and treatment response","volume":"24","author":"Md Hamzah","year":"2021","journal-title":"Health Care Manag. Sci."},{"issue":"8","key":"10.1016\/j.socscimed.2026.119522_bib35","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-002429","article-title":"A checklist to improve health system resilience to infectious disease outbreaks and natural hazards","volume":"5","author":"Meyer","year":"2020","journal-title":"BMJ Glob. Health"},{"key":"10.1016\/j.socscimed.2026.119522_bib41","series-title":"Vital statistics","year":"2023"},{"key":"10.1016\/j.socscimed.2026.119522_bib43","article-title":"Efficiency analysis in the management of COVID-19 pandemic in India based on data envelopment analysis","volume":"2","author":"Mohanta","year":"2021","journal-title":"Curr Res Behav Sci."},{"key":"10.1016\/j.socscimed.2026.119522_bib44","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2021.791182","article-title":"Japan's slow response to improve access to inpatient care for COVID-19 patients","volume":"9","author":"Nakahara","year":"2022","journal-title":"Front. Public Health"},{"key":"10.1016\/j.socscimed.2026.119522_bib46","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2023.115716","article-title":"Health systems resilience: is it time to revisit resilience after COVID-19?","volume":"320","author":"Paschoalotto","year":"2023","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119522_bib47","article-title":"Building a health system resilience framework: national, state, regional, and local perspectives","volume":"54","author":"Paschoalotto","year":"2025","journal-title":"Lancet Reg. Health, Am."},{"key":"10.1016\/j.socscimed.2026.119522_bib48","doi-asserted-by":"crossref","DOI":"10.1016\/j.healthpol.2026.105586","article-title":"Governance for health system resilience: lessons from Brazil's decentralized health system","volume":"167","author":"Paschoalotto","year":"2026","journal-title":"Health Policy"},{"key":"10.1016\/j.socscimed.2026.119522_bib49","doi-asserted-by":"crossref","DOI":"10.1016\/j.eswa.2022.118362","article-title":"A network data envelopment analysis to estimate nations' efficiency in the fight against SARS-CoV-2","volume":"210","author":"Pereira","year":"2022","journal-title":"Expert Syst. Appl."},{"key":"10.1016\/j.socscimed.2026.119522_bib50","unstructured":"Sakamoto H, Rahman M, Nomura S, Okamoto E, Koike S, Yasunaga H. et al. Japan health system review. Health systems in transition. 2018;8(1).World Health Organization. Regional Office for South-East Asia."},{"key":"10.1016\/j.socscimed.2026.119522_bib23","series-title":"Governance of Health Risk Management: lessons from the COVID-19 Pandemic","author":"Shiroyama","year":"2024"},{"key":"10.1016\/j.socscimed.2026.119522_bib51","first-page":"1","article-title":"Examining operational efficiency with prudent risks of COVID-19: a contextual DEA analysis with an undesirable intermediate measure","author":"Singh","year":"2023","journal-title":"Ann. Oper. Res."},{"issue":"9","key":"10.1016\/j.socscimed.2026.119522_bib52","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-072136","article-title":"Healthcare resilience: a meta-narrative systematic review and synthesis of reviews","volume":"13","author":"Tan","year":"2023","journal-title":"BMJ Open"},{"key":"10.1016\/j.socscimed.2026.119522_bib53","first-page":"8097","article-title":"How is health system resilience being assessed? A scoping review","volume":"13","author":"Tonga","year":"2024","journal-title":"Int. J. Health Pol. Manag."},{"key":"10.1016\/j.socscimed.2026.119522_bib54","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.socscimed.2019.04.020","article-title":"Conceptual analysis of health systems resilience: a scoping review","volume":"232","author":"Turenne","year":"2019","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119522_bib55","doi-asserted-by":"crossref","DOI":"10.1016\/j.healthpol.2026.105583","article-title":"Valuing health system resilience: the limits of conventional economic evaluation under catastrophic risk","volume":"167","author":"Wharton","year":"2026","journal-title":"Health Policy"},{"key":"10.1016\/j.socscimed.2026.119522_bib56","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijid.2024.01.017","article-title":"Case fatality rates of COVID-19 during epidemic periods of variants of concern: a meta-analysis by continents","volume":"141","author":"Xia","year":"2024","journal-title":"Int. J. Infect. Dis."},{"issue":"5","key":"10.1016\/j.socscimed.2026.119522_bib57","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1089\/hs.2020.0227","article-title":"Assessment of critical care surge capacity during the COVID-19 pandemic in Japan","volume":"19","author":"Yamamoto","year":"2021","journal-title":"Health Secur"},{"key":"10.1016\/j.socscimed.2026.119522_bib58","doi-asserted-by":"crossref","DOI":"10.1016\/j.onehlt.2021.100213","article-title":"Assessing the impact of non-pharmaceutical interventions on the transmissibility and severity of COVID-19 during the first five months in the Western Pacific region","volume":"12","author":"Yeoh","year":"2021","journal-title":"One Health"}],"container-title":["Social Science & Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0277953626005988?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0277953626005988?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:09:12Z","timestamp":1787789352000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0277953626005988"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":50,"alternative-id":["S0277953626005988"],"URL":"https:\/\/doi.org\/10.1016\/j.socscimed.2026.119522","relation":{},"ISSN":["0277-9536"],"issn-type":[{"value":"0277-9536","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Technical efficiency and resilience of health systems in Japan during the COVID-19 pandemic","name":"articletitle","label":"Article Title"},{"value":"Social Science & Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.socscimed.2026.119522","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier Ltd.","name":"copyright","label":"Copyright"}],"article-number":"119522"}}