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This special issue aims to contribute to current knowledge held on mixed hospital systems from a historical perspective, as there is nowadays much debate on the sustainability and efficiency of public and private healthcare systems in the world in the COVID-19 pandemic. By focusing on the evolution of mixed hospital systems through the case study of the history of such systems in Catalonia in the last century, the authors of this special issue show that mixed hospital systems take a long period of time to be used, and trusted, by the population. It is also considered how public healthcare regulators can create a diversity of mechanisms that facilitate access by the population to healthcare services in times of external shocks such as pandemics. This introductory text begins with a section about the international context which explains the relevance of mixed hospital systems, which is followed by a summary of the main historical points regarding the Catalan model of mixed hospital provision since the 19th century. It also highlights the most significant contributions of the seven articles of this special issue, which consider how the Catalan society confronted social, economic, and political changes and how those actions led to configure a distinctive mixed model of hospital system. Finally, this text also sheds light on areas of research regarding the rich history of hospital healthcare that still need to be addressed
