A Comparison of Country's Cultural Dimensions and Health Outcomes.

Justin C Matus

doi:10.3390/healthcare9121654

Abstract

Research comparing health care systems of countries, with a particular emphasis on health care spending and health care outcomes, has found unexplained differences which are often attributed to the countries’ cultures, yet these cultural dimensions are never completely identified or measured. This study examines if culture predicts a country’s population health, measured as life expectancy and health care spending. Using the Hofstede country-level measures (six dimensions) of culture as independent variables, two regression models to predict life expectancy and per capita health care using 2016 World Bank data were developed. The original data set included 112 countries which was reduced to a final total of 60 due to missing or incomplete data. The first regression model, predicting life expectancy, indicated an adjusted R square of 0.45. The second regression model, predicting per capita health care spending, indicated an adjusted R square of 0.63. The study suggests culture is a predictor of both life expectancy and health care spending. However, by creating a composite measure for all six culture measures, we have not found a significant association between culture and life expectancy and healthcare expenditure. The study is limited by small sample size, differences in geography, climate and political systems. Future research should examine more closely the relative influence of individualism on life expectancy and assumptions about models of socialized medicine.

Highlights

The purpose of this study is to determine if culture predicts health; does a country’s culture predict the health of that country’s population
While this study will use data from 60 countries, there is an inherent emphasis on the United States for the simple reason that it is the outlier in terms of health care spending vis à vis life expectancy as further described below
When health and social service spending are totaled, the U.S ranks in the middle. They found that, “using health and social expenditure data from 2009 and mixed effects regression models, we find countries with higher ratios of social-to-health spending have significantly higher life expectancy and lower infant mortality after adjusting for health expenditures and gross domestic product (GDP)”

Summary

Introduction

The purpose of this study is to determine if culture predicts health; does a country’s culture predict the health of that country’s population. While this study will use data from 60 countries, there is an inherent emphasis on the United States for the simple reason that it is the outlier in terms of health care spending vis à vis life expectancy as further described below. In the United States, at least, the national conversation about the cost and availability of health care is decades old, dating back at least to President Truman in the 1950s who first proposed some type of national health insurance [1]. Much of the laments of the U.S health care system is about the relatively high cost with a questionable return on the investment—especially as it relates to outcomes as well as the breadth or lack thereof of health care insurance coverage. Perhaps the most damning statement was in the Commonwealth Fund’s 2017 report which read, in part, “Based on a broad range of indicators, the U.S health system is an outlier, spending far more but falling short of the performance achieved by other high-income countries” [2]

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