Presentation (CTI)

OBJECTIVES: Health systems worldwide face increasing pressures from aging populations, rising chronic disease, fiscal constraints, and persistent inequities in access. While resources remain essential, evidence suggests that performance depends more on how efficiently countries convert structural capacity into health outcomes. Digital health technologies may strengthen this conversion, yet empirical models integrating structural capacity, operational efficiency, and digital maturity remain limited. This study presents a protocol for a cross-country Structural Equation Modeling (SEM) analysis to examine how structural capacity, digital adoption, and operational efficiency interact to shape national health system performance. Specifically, it tests whether operational efficiency mediates the impact of resources on performance and whether digital maturity moderates the relationship between structural capacity and efficiency.
METHODS: A country-level SEM framework grounded in the health production function, efficiency theory, and digital transformation literature is proposed. Four latent constructs use standardized indicators: Structural Capacity (workforce density, beds, expenditure); Operational Efficiency (UHC index, DTP3 coverage, IHR SPAR); Digital Adoption (maturity indices, EHR penetration, interoperability); and System Performance (life expectancy, DALYs, avoidable mortality). Data for ~170 countries (2022) will be sourced from WHO, OECD, Global Digital Health Monitor, and World Bank. Analyses include construct validation, invariance testing, and estimation of direct, mediated, and moderated effects.
RESULTS: Expected outcomes include a validated model demonstrating how digitalization enhances efficiency and strengthens the conversion of structural capacity into population health outcomes.
CONCLUSIONS: This study introduces a novel HEOR framework for evaluating how structural, operational, and technological determinants interact to enhance health system performance globally. Results will highlight that performance depends not only on the volume of resources but on the efficiency of their conversion into outcomes. Digital technologies act as critical enablers, improving efficiency directly and amplifying the return on structural investments. Policymakers should integrate digital transformation strategies with infrastructure investments to build resilience and maximize system performance.