Longitudinal bi-criteria framework for assessing national healthcare responses to pandemic outbreaks

Pandemics like COVID-19 have illuminated the significant disparities in the performance of national healthcare systems (NHCSs) during rapidly evolving crises. The challenge of comparing NHCS performance has been a difficult topic in the literature. To address this gap, our study introduces a bi-criteria longitudinal algorithm that merges fuzzy clustering with Data Envelopment Analysis (DEA). This new approach provides a comprehensive and dynamic assessment of NHCS performance and efficiency during the early phase of the pandemic. By categorizing each NHCS as an efficient performer, inefficient performer, efficient underperformer, or inefficient underperformer, our analysis vividly represents performance dynamics, clearly identifying the top and bottom performers within each cluster of countries. Our methodology offers valuable insights for performance evaluation and benchmarking, with significant implications for enhancing pandemic response strategies. The study's findings are discussed from theoretical and practical perspectives, offering guidance for future health system assessments and policy-making.