![]() Theoretically, if in the case of other health crises (SARS, MERS-COV, bird flu, Ebola) some countries might not have been prepared to face such challenges, in practice, the experience gained by going through them, should lead to the implementation of transformative policies to stabilize systems. Furthermore, path development evolution significantly affects the ability to react to shocks. The quality of the responses provided to the crisis depends, in particular, on endogenous factors. The globalized context of this crisis requires that, periodically, inventories be made in terms of the input-output relationship, so that the way of action of decision makers and the adaptation of governance systems can be done in accordance with the particularities of each state. Although, over time, Europe has faced various crises, which have varied in intensity, the COVID-19 pandemic has perhaps one of the most pronounced dynamism related to the rapid transmission of the virus and the loss of human lives. In combating them, a major role is played by the type of crisis management that applies in each country. The relevance of approaching a topic revolving around COVID-19 lies in the multitude of its negative implications, felt at all levels of society. At the same time, they can be used internationally to achieve a coherent and effective community response to the pandemic. The results obtained could serve as starting points for health policymakers to perform comparative analyzes in terms of good practices in the health system and to develop national plans to better deal with health crises. After Tobit regression, results of the study show that the influencing elements are different for the three stages: concerning the first wave, comobirdities, population age, and population density are important for relaxation period a great influence have government effectiveness and power distance with respect to second wave, the relevant factors are education and population density. Instead, Eastern European countries were hit hard by the inefficiency of health systems (Bulgaria, Greece, Hungary, Romania). In the relaxation phase and in the second wave, the Western states, severely affected at the beginning of the pandemic, began to take adequate measures and improve the efficiency of their sanitary systems. The obtained outputs show that, especially in the first phase of the pandemic, the inefficiency of the health systems was quite high, mainly in Western countries (Italy, Belgium, Spain, UK). We evaluated the efficiency of health systems in Europe against COVID-19, starting from health inputs (COVID-19 cases, physicians, nurses, hospital beds, health expenditure) and output (COVID-19 deaths). The results for the public health systems of European states were determined for each country and period. After measuring the efficiency, we used the Tobit type regression to establish the influencing elements on it. In evaluating the determinants of the efficiency of health systems, six major fields of influence were taken into account: health care, health status, population, economic, cultural/societal and governmental issues, all covering 15 indicators. The research was performed considering three stages: the first wave (January 1–June 15), the relaxation period (June 15–October 1) and the second wave (October 1–December 31). The methodology used in the research was Data Envelopment Analysis (DEA), through which efficiency scores for health systems have been calculated. This study aims at analyzing the efficiency of the health systems of 31 European countries in treating COVID-19, for the period Janu– January 1, 2021, by incorporating some factors from a multidimensional perspective.
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