Digital Maturity and Performance of Health Systems: a Cross-Country Analysis and Priorities for Public Regulation

Using data for countries of the WHO European Region, this article examines whether the digital maturity of health systems is related to how well they perform. The question matters because the introduction of digital technologies does not by itself lead to better care, and countries differ considerably in how they integrate electronic health records, ensure interoperability, govern health data and use information for decision-making. The aim is to estimate the relationship between the digital maturity of health systems and their performance, to identify which components of digital transformation (institutional or technological) are associated with better outcomes, and to set out regulatory priorities for Ukraine. Drawing on primary data from the Health Information System and Data Governance (HISGOV) database of the WHO Regional Office for Europe (34 of 68 indicators, 53 countries), we construct a composite Digital Maturity Index (DMI) with five sub-indices: strategic, regulatory and institutional, technological, integration, and analytics and workforce. The index shows acceptable reliability (Cronbach’s α = 0.75; the first principal component explains 51.8% of the variance). For 48 countries, the index is related to performance indicators (life expectancy at birth, the UHC service coverage index and under-five mortality) while adjusting for national resources (GDP per capita in PPP terms, current health expenditure per capita and physician density), so as to separate the role of digital maturity from that of national wealth. Countries with higher digital maturity achieve better outcomes even at a similar income level: a one-standard-deviation increase in the DMI is associated with life expectancy that is on average 0.77 years longer (p = 0.006) and a UHC index that is 1.25 points higher (p = 0.040). No such association is found for under-five mortality. The sign of the association is the same in all 276 alternative model specifications, although it weakens statistically once health expenditure is also taken into account. Outcomes are linked mainly to the regulatory and institutional and the strategic components (legislation, data governance rules and strategies) rather than to the technological or integration components. Cluster analysis identifies four types of countries by digital maturity profile. Ukraine (DMI = 0.85; ranked 8th of 48) formally belongs to the group of “integrated leaders”, yet it has gaps in the legal basis for secondary use of health data, regular assessment of interoperability, workforce training and the use of analytical information at facility level, and it identifies insufficient funding as the most serious obstacle. The novelty of the study lies in an index of digital maturity of national health systems built on primary HISGOV data which, unlike models designed for individual health care facilities, captures the strategic and regulatory and institutional components and allows cross-country comparison. The study also provides cross-country evidence that health system performance is associated primarily with the institutional rather than the technological components of digital maturity. On this basis, regulatory priorities for Ukraine are proposed, centred on the move from formal digital maturity (mechanisms exist) to functional digital maturity (data are actually used to inform decisions).