{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T03:23:15Z","timestamp":1792293795354,"version":"4.4.0"},"reference-count":63,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>ssssHealth system performance is a multifaceted concept that encompasses various dimensions of a nation\u2019s healthcare infrastructure. This study aims to assess and rank the performance of health systems across different regions of the world.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Luxembourg 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Contrary 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0334693","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:26:33Z","timestamp":1761845193000},"page":"e0334693","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Health systems performance in health outcomes, health financing and COVID-19 pandemic: Lessons from 31 countries"],"prefix":"10.1371","volume":"20","author":[{"given":"Pirhossein","family":"Kolivand","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jalal","family":"Arabloo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peyman","family":"Saberian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taher","family":"Dorooudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soheila","family":"Rajaie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fereshte","family":"Karimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behzad","family":"Raei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoud","family":"Behzadifar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arash","family":"Parvari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyed Jafar","family":"Ehsanzadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeid","family":"Homayoun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahrzad","family":"Salehbeigi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peyman","family":"Namdar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2781-7793","authenticated-orcid":true,"given":"Samad","family":"Azari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"pone.0334693.ref001","volume-title":"Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies","author":"Organization WH","year":"2010"},{"key":"pone.0334693.ref002","volume-title":"Health system performance assessment: a framework for policy analysis","author":"I Papanicolas","year":"2022"},{"key":"pone.0334693.ref003","volume-title":"Health system performance assessment: A renewed global framework for policy-making","author":"S Lessof","year":"2022"},{"key":"pone.0334693.ref004","unstructured":"Murray CJ, Frenk J, Organization WH. 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