Document Type : Original Article
Authors
Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
Abstract
BACKGROUND: The COVID‑19 pandemic has spread rapidly across the world and has currently
impacted most countries and territories globally. This study aimed to identify health‑care determinants
of mortality and recovery rates of COVID‑19 and compare the efficiency of health systems in response
to this pandemic.
MATERIALS AND METHODS: A cross‑sectional study was conducted using data obtained from the
World Bank database, that provides free and open access to a comprehensive set of health‑ and
socioeconomic‑related data, by September 12, 2020. An adjusted linear regression model was
applied to determine predictors of mortality (per 1 million population [MP]) and recovery rates (per 1
MP) in the included countries. One‑way analysis of variance was applied to assess health systems’
efficiency in response to COVID‑19 pandemic using mortality and recovery rate (output variables)
and current health expenditure (CHE) per capita (input variable).
RESULTS: Globally, San Marino and Qatar had the highest mortality rate (1237/1 MP) and confirmed
case rate (43,280/1 MP) until September 12, 2020, respectively. Iran had a higher mortality rate (273/1
MP vs. 214.5/1 MP) and lower recovery rate (4091.5/1 MP vs. 6477.2/1 MP) compared to countries
with high CHE per capita. CHE per capita (standardized coefficient [SC] = 0.605, P < 0.001) and
population aged 65 years and over as a percentage of total population (SC = −0.79, P < 0.001)
significantly predicted recovered cases from COVID‑19 in the included countries.
CONCLUSION: This study revealed that countries with higher CHE per capita and higher proportion of
older adults were more likely to have a higher recovery rate than those with lower ones. Furthermore,
our study indicated that health systems with higher CHE per capita statistically had a greater efficiency
in response to COVID‑19 compared to those with lower CHE per capita. More attention to preventive
strategies, early detection, and early intervention is suggested to improve the health system efficiency
in controlling COVID‑19 and its related mortalities worldwide.
Keywords
2019 (COVID‑19): Current status and future perspectives. Int J
Antimicrob Agents 2020;55 (5):105951.
2. World Health Organization (WHO). Coronavirus
Disease (COVID‑19), Situation Report–116 2020. Available
from: https://www.who.int/docs/default‑source/
coronaviruse/situation‑reports/20200515‑covid‑19‑sitrep‑116.
pdf?sfvrsn=8dd60956_2. [Last accessed on 2020 May 18].
3. Khan KS, Torpiano G, McLellan M, Mahmud S. The impact of
socioeconomic status on 30‑day mortality in hospitalized patients
with COVID‑19 infection. J Med Virol 2021;93(2):995‑1001.
4. Liang LL, Tseng CH, Ho HJ, Wu CY. Covid‑19 mortality
is negatively associated with test number and government
effectiveness. Sci Rep 2020;10(1):12567.
5. OrganizationWH. The World Health Report 2000: Health Systems:
Improving Performance: World Health Organization; 2000.
6. Gile PP, Buljac‑Samardzic M, Klundert JV. The effect of human
resource management on performance in hospitals in Sub‑Saharan
Africa: A systematic literature review. Hum Resour Health
2018;16:34.
7. Lane H, Sarkies M, Martin J, Haines T. Equity in healthcare
resource allocation decision making: A systematic review. Soc
Sci Med 2017;175:11‑27.
8. Hussey PS, de Vries H, Romley J, Wang MC, Chen SS, Shekelle PG,
et al. A systematic review of health care efficiency measures.
Health Serv Res 2009;44:784‑805.
9. The World Bank. Understanding the Coronavirus (COVID‑19)
Pandemic through Data; 2020. Available from: http://datatopics.
worldbank.org/universal‑health‑coverage/coronavirus/. [Last
accessed on 2020 May 18].
10. Al‑Tawfiq JA, Leonardi R, Fasoli G, Rigamonti D. Prevalence and
fatality rates of COVID‑19: What are the reasons for the wide
variations worldwide? Travel Med Infect Dis 2020; 35( May–June
2020):101711.
11. Baud D, Qi X, Nielsen‑Saines K, Musso D, Pomar L, Favre G. Real
estimates of mortality following COVID‑19 infection. Lancet Infect
Dis 2020;20:773.
12. Kang SJ, Jung SI. Age‑related morbidity and mortality among
patients with COVID‑19. Infect Chemother 2020;52:154‑64.
13. Lu L, Zhong W, Bian Z, Li Z, Zhang K, Liang B, et al. A comparison
of mortality‑related risk factors of COVID‑19, SARS, and MERS:
A systematic review and meta‑analysis. J Infect 2020;81:e18‑25.
14. Moreno‑Serra R, Anaya‑Montes M, Smith PC. Potential
determinants of health system efficiency: Evidence from Latin
America and the Caribbean. PLoS One 2019;14 (5):e0216620.
15. Hollingsworth B. Health System Efficiency: Measurement and
Policy. Health System Efficiency: How to Make Measurement
Matter for Policy and Management. WHO Regional Office for
Europe, Denmark: European Observatory on Health Systems
and Policies; 2016.
16. Zhang L, Cheng G, Song S, Yuan B, Zhu W, He L, et al. Efficiency
performance of C hina’s health care delivery system. Int J Health
Plann Manage 2017;32:254‑63.
17. Ahmed S, Hasan MZ, MacLennan M, Dorin F, Ahmed MW,
Hasan MM, et al. Measuring the efficiency of health
systems in Asia: A data envelopment analysis. BMJ Open
2019;9 (3):e022155.
18. Allin S, Guilcher S, Riley D, Zhang YJ. Improving health system
efficiency: Perspectives of decision‑makers. Healthc Q 2017;
20:10‑3.
19. Joob B, Wiwanitkit V. Variation of 2019 novel coronavirus
complete genomes recorded in the 1(st) month of outbreak:
Implication for mutation. J Res Med Sci 2020;25:33.
20. Sookaromdee P, Wiwanitkit V. Can thermo‑scan screening
predict the presence of Wuhan coronavirus infection: Observation
on detection rate and efficacy from Thailand. J Res Med Sci
2020;25:53.
)