{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:47:51Z","timestamp":1793296071555,"version":"4.5.0"},"reference-count":82,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"\n Background<\/jats:title>\n Despite substantial public investment, no study has examined Kuwait's health-system inputs and service utilisation or quantified COVID-19's impact across nationality strata.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A retrospective interrupted time-series analysis examined 39 indicators from Kuwait Ministry of Health reports (2011\u20132022), stratified by nationality, covering infrastructure, expenditure, workforce, utilisation, and vaccination. Segmented regression with a 2019.5 breakpoint modelled the pre-pandemic trend (\n \u03b2<\/jats:italic>\n 1<\/jats:sub>\n ), pandemic-onset level shift (\n \u03b2<\/jats:italic>\n 2<\/jats:sub>\n ), and post-pandemic slope change (\n \u03b2<\/jats:italic>\n 3<\/jats:sub>\n ), fitted by ordinary least squares (OLS) and AR(1) generalised least squares (GLS) for all indicators, with the AR(1) estimates used where autocorrelation was detected.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Hospital beds rose pre-pandemic (\n \u03b2<\/jats:italic>\n 1<\/jats:sub>\n \u2009=\u2009\u2009+\u200988.9\/year,\n p<\/jats:italic>\n \u2009&lt;\u2009.001) and increased at onset (\n \u03b2<\/jats:italic>\n 2<\/jats:sub>\n \u2009=\u2009\u2009+\u2009842, +11.5%,\n p<\/jats:italic>\n \u2009=\u2009.002), with no further change (\n \u03b2<\/jats:italic>\n 3<\/jats:sub>\n ,\n p<\/jats:italic>\n \u2009=\u2009.28). Government salaries grew pre-pandemic (\n \u03b2<\/jats:italic>\n 1<\/jats:sub>\n \u2009=\u2009+KWD 61.2 million\/year,\n p<\/jats:italic>\n \u2009&lt;\u2009.001), rose at onset (\n \u03b2<\/jats:italic>\n 2<\/jats:sub>\n \u2009=\u2009+KWD 95.8 million, +9.5%,\n p<\/jats:italic>\n \u2009=\u2009.025), then decelerated (\n \u03b2<\/jats:italic>\n 3<\/jats:sub>\n \u2009=\u2009\u2212KWD 71.4 million\/year,\n p<\/jats:italic>\n \u2009=\u2009.002). Kuwaiti nurses fell pre-pandemic (\n \u03b2<\/jats:italic>\n 1<\/jats:sub>\n \u2009=\u2009\u221220.6\/year,\n p<\/jats:italic>\n \u2009&lt;\u2009.001) but recovered afterwards (\n \u03b2<\/jats:italic>\n 3<\/jats:sub>\n \u2009=\u2009\u2009+\u200942.6\/year,\n p<\/jats:italic>\n \u2009=\u2009.013). Utilisation showed the sharpest disruption: Kuwaiti general-practitioner (GP) visits dropped at onset (\n \u03b2<\/jats:italic>\n 2<\/jats:sub>\n \u2009=\u2009\u22127.07 million, \u221268.3%,\n p<\/jats:italic>\n \u2009&lt;\u2009.001) before recovering (\n \u03b2<\/jats:italic>\n 3<\/jats:sub>\n \u2009=\u2009\u2009+\u20091.40 million\/year,\n p<\/jats:italic>\n \u2009&lt;\u2009.001), while non-Kuwaiti GP visits fell by 2.32 million (\u221248.6%,\n p<\/jats:italic>\n \u2009=\u2009.012) without recovery. Kuwaiti diabetes-care visits declined at onset (\u221268,601, \u221217.0%,\n p<\/jats:italic>\n \u2009=\u2009.006) then recovered (\n \u03b2<\/jats:italic>\n 3<\/jats:sub>\n \u2009=\u2009\u2009+\u200925,919\/year,\n p<\/jats:italic>\n \u2009=\u2009.012). Non-Kuwaiti influenza vaccinations fell at onset (\n \u03b2<\/jats:italic>\n 2<\/jats:sub>\n \u2009=\u2009\u2212106,731,\n p<\/jats:italic>\n \u2009=\u2009.027) before recovering (\n \u03b2<\/jats:italic>\n 3<\/jats:sub>\n \u2009=\u2009\u2009+\u200941,184\/year,\n p<\/jats:italic>\n \u2009=\u2009.044); meningitis and most routine vaccinations showed no significant change (\n p<\/jats:italic>\n \u2009&gt;\u2009.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Kuwait's health system expanded over 2011\u20132022. COVID-19 caused significant utilisation disruption with substantial recovery, reflecting resilience. Nursing remains expatriate-dependent; sustained investment in primary and preventive care is critical.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/frhs.2026.1850596","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:42:50Z","timestamp":1784266970000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Health system development and utilisation in Kuwait, 2011\u20132022: insights from national healthcare data"],"prefix":"10.3389","volume":"6","author":[{"given":"Sultan E.","family":"Alsalahi","sequence":"first","affiliation":[{"name":"Ministry of Health","place":["Kuwait City, Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Almari","sequence":"additional","affiliation":[{"name":"Department of Health Policy & Management, College of Public Health, Kuwait University","place":["Kuwait City, Kuwait"]},{"name":"Department of Health Services 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