Inside the black box of comparative national healthcare performance in 35 OECD countries: Issues of culture, systems performance and sustainability.

Background Is national healthcare performance associated with country-level characteristics, and if so what are the implications for international health policy? Methods and findings We compared Hofstede's six cultural dimensions against relative health systems performance of 35 countries. Hier...

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Bibliographic Details
Published in:PLOS ONE
Main Authors: Jeffrey Braithwaite, Yvonne Tran, Louise A Ellis, Johanna Westbrook
Format: Article in Journal/Newspaper
Language:English
Published: Public Library of Science (PLoS) 2020
Subjects:
R
Q
Online Access:https://doi.org/10.1371/journal.pone.0239776
https://doaj.org/article/28db81d15d044304805606cd39db2e16
Description
Summary:Background Is national healthcare performance associated with country-level characteristics, and if so what are the implications for international health policy? Methods and findings We compared Hofstede's six cultural dimensions against relative health systems performance of 35 countries. Hierarchical cluster analysis identified best-matched groupings of countries. Performance was measured by the Organisation for Economic Co-operation and Development's (OECD's) Health at a Glance indicators data framework (five dimensions with 57 indicators) and the United Nations' (UNs') Sustainability Development Goals (SDG) data set (15 indicators). Three country clusters emerged: Collective-Pyramidal (n = 9: comprising Slovak Republic, Mexico, Poland, Greece, Spain, Turkey, Portugal, Chile, and Slovenia); Collaborative-Networked (n = 12: UK, Canada, Australia, USA, Ireland, New Zealand, Netherlands, Finland, Iceland, Norway, Denmark, and Sweden); and Orderly-Future Orientated (n = 14: Korea, Estonia, Latvia, Austria, Israel, Japan, Czech Republic, Hungary, Italy, Belgium, France, Germany, Luxembourg and Switzerland). The Collaborative-Networked cluster had significantly better performing health systems measured by both the Health at a Glance and SDG performance data, followed by the Orderly-Future Orientated cluster, followed by the Collective-Pyramidal cluster. The Collaborative-Networked Cluster was characterized by low power distance (e.g., greater levels of equity), low uncertainty avoidance (e.g., toleration of others' opinions), individualism (e.g., self-reliance) and indulgence (e.g., drives and norms to enjoy life and have fun). Conclusions National cultures are associated with healthcare performance on two key international measures. In national and international efforts to improve health system performance, cultural characteristics play an important role. This information may be of value to regulators, policymakers, researchers and clinicians examining the practical impact of culture on healthcare performance.