Exploring the relationship between National eHealth development and Hofstede's Cultural Dimensions using the WHO Global eHealth Surveys

Abstract

Objective: Promote eHealth development by examining supportive non-economic factors.

Background: Technological advances enable cost-savings and quality improvements through adoption of eHealth, telehealth, and other initiatives. While more developed countries with greater resources at its disposal have developed better eHealth infrastructure, other high-income economies have not done so.

Methods: The national policy status on eHealth and other related programs are obtained from the WHO Global eHealth Surveys of 2009 and 2015. The dependent variables consist of selected questions with either binary (yes/no) or checkbox responses. Explanatory variables include: healthcare expenditures per capita, hospital beds per 10000 persons, ICT Development Index, and values from Hofstede's (1989) Cultural Dimensions for the year 2015. OLS and logistic regression were used to correlate cultural factors with the decision to commit to an eHealth policy and means to do so.

Results: The "Uncertainty Avoidance" dimension is negative correlated with the probability of establishing a national eHealth policy (WHO 2015, Q3). Hospital beds per capita are positively correlated with the probability of adopting a Health Information Systems policy (WHO 2015, Q6), suggesting that HIS systems are developed in response to the need to organise and maintain larger healthcare systems. Using fixed-effects regression to account for unobserved factors, we find that the ICT development index is positively related to the diversity of funding sources for eHealth development (WHO 2009 q1.17-q1.20, WHO 2015 q7-q10).

Conclusion: Hesitation to commit to eHealth initiatives may be better explained by a location’s cultural aversion to novelty and uncertainty, rather than resource constraints.