1. IntroductionHealthcare is an object of great interest since it is the world’s most rapidly developing service sector [1]. Therefore, concerns are growing about the quality of healthcare and patient safety, especially in terms of costs, malpractice, or healthcare reform [2]. The research into the quality of healthcare services is significant since it relates to one of the most important sectors, which directly affects the lives of individuals and society [3]. Additionally, one may observe the gap in healthcare access and quality between the most and least disadvantaged groups [4]. The COVID-19 pandemic worsened health inequalities even further [5,6]. According to the authors of the report “2022 Global Health Care Outlook. Are we finally seeing the long-promised transformation?” [7], prepared by the Deloitte consulting company, disproportions are nothing new, but a crisis caused by the pandemic influenced social groups that commonly experienced barriers to effective care. At that time, the structural flaws in healthcare systems and inequalities in the so-called social determinants of the level of healthcare were highlighted. Undoubtedly, in this situation, for the survival of organizations operating in the sector, the key business strategy is to satisfy customer needs and expectations [8]. Due to the private and public deliverers of medical services [9], competition in the sector increased, which forced healthcare organizations to improve quality and overcome shortcomings [10]. It is one of the key sectors since it also affects other areas of operation of specific countries, such as business, politics, society, or finance [11,12]. Therefore, it is essential to understand the importance of the quality of healthcare not only at the micro level, concerning individual healthcare facilities, but also at the macro level, from the point of view of the entire healthcare system. Depending on the country, this system may be organized differently and be based on public or private resources or a combination of them. Despite ownership differences, both public and private entities, thanks to contractual relations, may belong to one integrated health system. The general framework of this system and the scope of its integration are usually determined by government regulations and affect the efficiency and responsiveness of healthcare. Financing health systems in most countries is based on public, private, and external sources [13]. Unfortunately, it is often insufficient, leading to underfunding of public healthcare in some countries [14]. Increasing costs and concern for the quality of health services make many countries face the issue of health system reform and the appropriate balance of public and private medical services [15]. Therefore, the high quality of the functioning of the entire system and its health services is of key importance and can be the answer to many emerging problems.The quality of healthcare services is much more difficult to define and measure than in other sectors [16]. Different characteristics of the healthcare sector, such as immateriality, heterogeneity, and simultaneity, make it difficult to define and measure quality [17,18,19]. Fundamentally, however, the quality of healthcare services depends on the service process and interaction between the customer and the service provider. Some characteristics of the healthcare quality, such as timeliness, consistency and accuracy, are difficult to measure beyond the subjective judgement of the customer. Healthcare services may differ between their providers, recipients, or places of delivery, and quality standards are difficult to establish. They are manufactured and consumed simultaneously, which impedes their quality control. The patient cannot assess the “quality” before purchasing the service and its consumption. Therefore, healthcare outcomes cannot be guaranteed, and their quality level is subjective, complex, and multidimensional [20]. While making any efforts to define, measure and improve the quality of healthcare, one should consider various perspectives, desires, and priorities of healthcare stakeholders. Although much empirical research was conducted to assess the quality of healthcare organization, little research was carried out to identify the impact of the crisis in healthcare on the quality of healthcare services. Most research was limited to identifying factors affecting the quality of medical services, patient satisfaction or multi-faceted assessment of the quality of medical services from the point of view of service providers and recipients. In addition, most studies were limited to single hospitals/groups of hospitals or were based on the analysis of existing literature. For example, Khamis and Njau [21] determined patients’ level of satisfaction with the quality of healthcare delivered at the outpatient department in selected hospitals. Abuosi and Atinga [22], based on questionnaires administered to 250 patients, examined patients’ hospital service quality perceptions and expectations using SERVQUAL. Ghahramanian et al. [23] investigated the quality of healthcare services from patients’ perspectives and its relationship with patient safety culture and nurse–physician professional communication. They conducted research on a group of 300 surgery patients and 101 nurses caring for them in a public hospital in Tabriz–Iran. Mohebifar et al. [24] examined 360 patients from six academic hospitals in Qazvin and focused on evaluating the quality of service in teaching hospitals using an importance–performance analysis matrix. Kitapci, Akdogan, and Dortyol [25] conducted research on the effect of satisfaction on word-of-mouth communication and repurchase intention and searched for a significant relationship between these factors. Their study included 369 patients facing a range of services. Hincapie et al. [26] evaluated the association between patients’ perceived healthcare quality and self-reported medical, medication, and laboratory errors in a multinational sample. They based their research on a CWF survey, which was conducted in 11 countries in 2010 and consisted of a national representative sample of adults 18 years and older. Whereas Padma, Rajendran, and Sai [27], based on the existing models and the literature on healthcare services, determined the dimensions of service quality in Indian hospitals from the perspectives of patients and their family members/friends. Naidu [28], using a systematic review of 24 articles from international journals, tried to build a comprehensive conceptual model to understand and measure variables affecting patient satisfaction-based healthcare quality.In times of ubiquitous changes and economic crisis, special attention should also be paid to resources and facilities, which constitute important environmental factors that affect providing quality healthcare services [20]. This was particularly evident during the COVID-19 pandemic, which intensified the existing problems in healthcare. It can even be said that it significantly changed the entire system and its services [29,30]. It turned out to be a huge burden for the healthcare system, causing the need to adapt and concentrate virtually all resources on one threat, while limiting the availability of diagnostics and treatment in other areas [31,32]. Therefore, national governments decided to implement special solutions and strategies to prevent the spread of the virus and support healthcare [33]. Various restrictions were imposed on entire societies, promoting self-isolation and maintaining social distance [34]. In many countries, healthcare systems were temporarily and drastically redesigned. Specialist hospitals and wards for COVID-19 patients (including temporary ones) were established, to which some healthcare professionals from other areas were directed. Many healthcare providers suspended the implementation of planned medical procedures, limiting themselves only to necessary procedures, and services provided by general practitioners were in the form of telephone consultations [35,36]. All this meant that national healthcare systems faced completely new challenges that could not remain without affecting the quality of entire systems and the health services they provide.

Taking the above aspects into account, the goal of this study is, therefore, to fill the research gap by examining the impact of crisis in the health system (in the example of the COVID-19 pandemic) on individual outcomes of patient service in healthcare using the example of economically developed countries. The article focuses on the resources available to national health systems from the point of view of their preparedness for crisis phenomena, i.e., pandemics and the ability to deal with them.

5. Summary and Discussion of the Research Results The present research selected healthcare resources, including the period before and during the COVID-19 pandemic, as an example of crisis in the health system. The data from several countries allowed for some observations that partially confirm the adopted research hypotheses that the level of patient service, conditioned by the availability of resources, significantly differs due to the occurrence of the pandemic. A similar study, comparing the periods before and at the peak of the pandemic, was carried out by Moynihan et al. [76]. The criteria of their survey assessment included, among others, visits, admissions or hospitalizations, diagnostic services, and therapeutic and preventive interventions. However, these studies were based on a literature review and did not cover the full years 2019–2020. In turn, Ivanov et al. [77] conducted the research over several months of the pandemic and concentrated their research efforts on improving the patient service quality. In addition, they focused on nine hospitals in Serbia, so their research is regional in scope. Okeke [78], in his research based on routine visits to primary care clinics in Nigeria, proved that the quality of healthcare interactions decreased significantly in the early months of the pandemic. Again, however, these were territorially and time-limited studies. Pereira et al. [79] showed that the COVID-19 outbreak (March and April 2020) was associated with a significant reduction in hospital admissions for ACS and STEMI, as well as a reduction in PPCI. Bruch et al. [33] analyzed the consequences of the COVID-19 pandemic on outpatient care in Brandenburg between 22 March and 4 May 2020. They focused on the burden for physicians and psychotherapists in outpatient practices and alternative ways to provide care, particularly telehealth. The results of their research indicate that almost all physicians and psychotherapists recorded fewer admissions, while the number of teleconsultations increased significantly. A significant limitation of both studies is the short time horizon. However, the present study included the analysis of statistical data, which indicated that the quality of patient service is significantly different in the area of the indicators of demographics, finance, human resources and technical resources, and the scope of available services. As a result, the researchers distinguished measures supporting activities aimed at improving the quality of healthcare during the crisis in the health system.Table 13 contains the research results and their impact on patient service during and before the pandemic. Some of them did not indicate significant differences in the analyzed period, and the examination of the impact effect did not indicate that these differences resulted from the occurrence of the pandemic. The comparison of the average value of the indicator for the analyzed years allowed for indicating that the level of primary healthcare during the pandemic is significantly statistically lower than in the conditions before the pandemic. This means that the null hypothesis should be rejected in favor of the alternative hypothesis. The pandemic resulted in increased current and government expenditures and a reduction in out-of-pocket expenditures on healthcare due to the pandemic outbreak. Moreover, the pandemic significantly impacted a decline in the number of employed physicians and an increase in the employment of nurses in healthcare. This is confirmed by the conclusions from the ASPE report [80], according to which the pandemic greatly impacted healthcare professionals, leading to labor shortages. Both professional groups were seriously exposed to illness, burnout, or death risks. At the same time, during the pandemic, the number of hospital beds dropped significantly. The Italian healthcare study conducted by Giancotti [81], covering several months of 2020, shows that the supply of health services and public hospitals, including technical background, was not sufficiently prepared. Additionally, Candel et al. [82] analyzed the problem of no beds in building temporary hospitals as an example of flexibility and adaptation in an epidemic. The presence of COVID-19 also had a large impact on reducing the number of doctor consultations and performed surgical procedures at that time. The literature research results by Moynihan et al. [76] also confirm the deterioration of medical services in general during the pandemic, whereas, according to their analyses, the highest decrease was related to medical visits, diagnostics, and admissions.

The research results are, therefore, generally consistent with the existing results in the literature. However, their advantage is a more comprehensive approach to the impact of crisis events, such as the COVID-19 pandemic, on the quality of healthcare and the fact that data from many countries were analyzed. Therefore, they are not burdened with regional limitations resulting, for example, from the introduction of specific restrictions and methods of fighting the pandemic. In addition, they indicate the differences between the pre-pandemic period and during the pandemic using data for whole years.

6. Conclusions

The quality of healthcare services directly affects the life of individuals and society. The crisis caused by the pandemic influenced this quality, constituting a significant barrier that prevents effective patient care. Undoubtedly, the key strategy for the survival of national public health systems is to satisfy the needs and expectations of patients regardless of the changes taking place and the conditions of their functioning. To this end, it becomes important to identify the areas of healthcare most susceptible to these changes in order to predict and plan actions that satisfy the needs of healthcare at the highest possible level.

The conducted research confirmed that the level of patient service significantly differs due to the occurrence of the pandemic, which is of the nature of sudden and rapid changes in the healthcare system, primarily resulting in the deterioration of the quality of healthcare services. To ensure at least the existing and higher level of service in the period of high morbidity of society, the focus should be placed on the areas that deteriorated significantly during the COVID-19 period. In turn, the pandemic itself should be treated as a test of the national healthcare system and an opportunity to improve it. It was indicated that despite an increase in some indicators of patient service during the pandemic, most of them deteriorated. To improve the healthcare system, it is primarily necessary to ensure the continuity of operational procedures, employ adequate staff, and increase access to medical consultations. At the same time, the conducted study has some limitations that should be considered in further research. The analyzed data come from the period of the pandemic’s beginning and include only selected aspects. In the future, the research period should be extended to before, during, and after the pandemic, comparing the present results to those. Moreover, the scope of the analyzed phenomenon may be considered, considering mental health factors as important during the pandemic period. The currently obtained results can be treated as a determinant for planning and organizing patient healthcare in the event of an epidemic, pandemic, or other similar phenomena affecting human health and life.

The study has some limitations. First, only OECD countries were considered, while the pandemic had a global scope. In addition, due to institutional and cultural settings, individual countries’ health systems differ from each other, which may affect the differences in the results obtained. At the same time, it can be the background for further research in this area, which can be supplemented with research among hospital patients during the pandemic.