Background Despite the great number of studies and interests in this field, research in this area is still scarce, and some aspects don’t emerge. For this reason, it is important to conduct an international healthcare system debate by showing the findings of SLR putting attention to healthcare efficiency, and organizing the articles in a more systematic and holistic way.Methods The present study provides a comprehensive structured literature review (SLR) of the papers dealing with efficiency in the healthcare sector from an international perspective. For this purpose, this study examines articles published in journals until 2023, by extracting crucial insights about healthcare efficiency, in terms of structures and services.Results A sample of 292 articles extracted from Scopus is preliminarily submitted for bibliometric analysis, then 126 articles are examined with bibliographic coupling and content analysis to identify the different areas of topic categorizations. In light of this, the study through the PRISMA framework and, then the content analysis provides the areas most affected by academic literature, and consequentially, the areas that have not yet been explored systematically.Conclusions Due to this, the research agenda underlines the unexplored areas and lays the foundation for future academic studies.