ArticlePloS one2020
Inside the black box of comparative national healthcare performance in 35 OECD countries: Issues of culture, systems performance and sustainability.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Built to last? Barriers and facilitators of healthcare program sustainability: a systematic integrative review.Implementation science : IS · 2023Pooled it
- Community pharmacy transformation under universal health coverage: Implementation barriers, cultural determinants, and cross-national lessons from Japan's ongoing transition - A narrative review.Exploratory research in clinical and social pharmacy · 2026Review
- Using country-level variables to discover country clusters beyond traditional health policy and performance metrics: An unsupervised machine learning approach for HIV healthcare delivery and financing.PLOS global public health · 2025Article
- 28-country global study on associations between cultural characteristics and Recovery College fidelity.Npj mental health research · 2024Article
- Economic Indicators, Quantity and Quality of Health Care Resources Affecting Post-surgical Mortality.Journal of epidemiology and global health · 2024Review
- Health System Performance and Resilience in Times of Crisis: An Adapted Conceptual Framework.International journal of environmental research and public health · 2023Review
- Orchestration versus bookkeeping: How stakeholder pressures drive a healthcare purchaser's institutional logics.PloS one · 2021Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIs national healthcare performance associated with country-level characteristics, and if so what are the implications for international health policy? METHODS AND
findingsWe 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).
conclusionsNational 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.
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