Digital Connectivity and Health-System Performance: A 24-Year Panel Analysis of Global Economies, 2000–2023
DOI:
https://doi.org/10.65166/tb6tep93Keywords:
digital connectivity, universal health coverage, life expectancy, Internet penetration, mobile subscriptions, panel dataAbstract
This study examined the relationship between digital connectivity, health-system performance, and population health using World Development Indicators data for 2000–2023. Internet use and mobile cellular subscriptions were analyzed separately as measures of digital connectivity, while the Universal Health Coverage (UHC) Service Coverage Index and life expectancy served as principal health outcomes. The core analytical sample comprised 4,221 country-year observations from 186 countries and economies, with a 130-country balanced panel used for robustness analysis. Descriptive and correlational analyses showed strong positive cross-country relationships between connectivity, UHC, and life expectancy. However, two-way fixed-effects models revealed a more differentiated pattern. Internet penetration did not retain its positive association after country and year effects were controlled and became negative in the fully adjusted specifications, indicating that its favorable raw relationship largely reflected broader between-country development and common global trends. Mobile subscriptions showed a smaller but more consistent positive within-country association with UHC and life expectancy, including lagged associations with longevity. UHC remained strongly associated with life expectancy after adjustment for connectivity, income, health expenditure, urbanization, country effects, and year effects. Nonlinear models further indicated diminishing returns to mobile connectivity around universal subscription density. The findings suggest that digital connectivity is best understood as enabling infrastructure whose health value depends on integration with service coverage, institutional capacity, and broader socioeconomic development rather than as an independent determinant of health improvement.
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Aerts, A., & Bogdan-Martin, D. (2021). Leveraging data and AI to deliver on the promise of digital health. International Journal of Medical Informatics, 150, 104456. https://doi.org/10.1016/j.ijmedinf.2021.104456
Ahmed, M. M., Okesanya, O., Olaleke, N. O., Adigun, O., Adebayo, U. O., Oso, T. A., Eshun, G., & Lucero-Prisno, D. E. (2025). Integrating digital health innovations to achieve universal health coverage: Promoting health outcomes and quality through global public health equity. Healthcare, 13. https://doi.org/10.3390/healthcare13091060
Atento, A. G., & Atento, R. G. (2025). A Case Study of Mercury Drug Corporation: Strategic Adaptation to Universal Healthcare and Digital Disruption in the Philippines. International Journal of Health & Business Analytics, 1(1). https://doi.org/10.65166/zhw7dd39
Atento, A. G., Atento, R. G. O., Espelita, C. A. M. H., & Lantin-Magana, L. M. (2026). Digital Connectivity and Financial Inclusion in Asia: A Thematic Review of Mobile Infrastructure, Account Ownership, and Policy Implications Using Global Findex 2025 Evidence. Asian Financial Economics and Policy, 1(1). https://doi.org/10.65166/9h1wkj82
Atento, R. G., & Quinto, L. (2026). SDG 8 Dynamics and SDG 3 Outcomes in ASEAN: Two-Way Fixed Effects Evidence on Under-5 and Neonatal Mortality (2000–2023). International Journal of Health & Business Analytics, 2(1). https://doi.org/10.65166/4qvazm02
Atento, R. G. O., Quinto, L. F., Espelita, C. A. M. H., & Atento, A. G. (2026). Digital Financial Inclusion and Supply Chain Resilience in Manufacturing: A Comparative Analysis Across the Digital Access Divide. Journal of Enterprise Strategy and Management Innovation, 1(3). https://doi.org/10.65166/dg5t7027
Awad, A., Trenfield, S. J., Pollard, T., Ong, J. J., Elbadawi, M., McCoubrey, L. E., Goyanes, A., Gaisford, S., & Basit, A. W. (2021). Connected healthcare: Improving patient care using digital health technologies. Advanced Drug Delivery Reviews, 113958. https://doi.org/10.1016/j.addr.2021.113958
Bayar, Y., Ozen, A., Sasmaz, M. U., & Danilina, M. (2024). ICT penetration and life expectancy in emerging market economies: Panel evidence from asymmetric causality analysis. BMC Public Health, 24. https://doi.org/10.1186/s12889-024-18323-1
Blake, A., Hazel, A., Jakurama, J., Matundu, J., & Bharti, N. (2023). Disparities in mobile phone ownership reflect inequities in access to healthcare. PLOS Digital Health, 2. https://doi.org/10.1371/journal.pdig.0000270
Byanyima, F. B., Yawe, B., & Nnyanzi, J. B. (2026). Does the internet add years to life? Evidence from Sub-Saharan Africa. African Social Science and Humanities Journal. https://doi.org/10.4314/asshj.v7i2.1
Byaro, M., Rwezaula, A., & Ngowi, N. (2023). Does internet use and adoption matter for better health outcomes in Sub-Saharan African countries? New evidence from panel quantile regression. Technological Forecasting and Social Change. https://doi.org/10.1016/j.techfore.2023.122445
Cai, Y.-Y. (2026). Digital access and health outcomes: The moderating role of socioeconomic status in health information seeking. Digital Health, 12. https://doi.org/10.1177/20552076261427777
Chen, G., & He, J. (2026). From access to capability: Digital literacy and health inequality in contemporary China. Frontiers in Public Health, 14. https://doi.org/10.3389/fpubh.2026.1843334
Chen, X., Huang, X., Xu, Y., Xu, J.-B., Wang, Y., Ren, X.-Y., Zhu, X.-B., Xie, X., & Yang, Y. (2024). Developing an intelligent mobile clinic—A medical vehicle for improve access to healthcare in remote areas: Evidence from China. JMIR Medical Informatics, 13. https://doi.org/10.2196/59103
Craig, A. T., Beek, K., Godinho, M. A., Ansari, S., Jonnagaddala, J., Asgari-Jirhandeh, N., Linhart, C., Hall, J., & Liaw, S. (2023). Digital health and universal health coverage: Opportunities and policy considerations for low- and middle-income Pacific Island countries and territories. Pacific Health, 6. https://doi.org/10.24135/pacifichealth.v6i.64
Craig, A., Lawford, H., Miller, M., Chen-Cao, L., Woods, L., Liaw, S.-T., & Godinho, M. A. (2025). Use of technology to support health care providers delivering care in low- and lower-middle-income countries: Systematic umbrella review. Journal of Medical Internet Research, 27, e66288. https://doi.org/10.2196/66288
Curtis, M., Clingan, S. E., Guo, H., Zhu, Y., Mooney, L. J., & Hser, Y. (2021). Disparities in digital access among American rural and urban households and implications for telemedicine-based services. The Journal of Rural Health, 38, 512–518. https://doi.org/10.1111/jrh.12614
Elkefi, S., & Asan, O. (2022). Digital twins for managing health care systems: Rapid literature review. Journal of Medical Internet Research, 24. https://doi.org/10.2196/37641
Erku, D., Khatri, R., Endalamaw, A., Wolka, E., Nigatu, F., Zewdie, A., & Assefa, Y. (2023). Digital health interventions to improve access to and quality of primary health care services: A scoping review. International Journal of Environmental Research and Public Health, 20. https://doi.org/10.3390/ijerph20196854
Gawai, V., & Deller, S. C. (2024). Is there a link between access to broadband and health outcomes? The American Journal of Economics and Sociology. https://doi.org/10.1111/ajes.12608
Haenssgen, M. J., Charoenboon, N., & Zanello, G. (2021). You’ve got a friend in me: How social networks and mobile phones facilitate healthcare access among marginalised groups in rural Thailand and Lao PDR. World Development. https://doi.org/10.1016/j.worlddev.2020.105156
Hameed, K., Naha, R., & Hameed, F. (2024). Digital transformation for sustainable health and well-being: A review and future research directions. Discover Sustainability, 5. https://doi.org/10.1007/s43621-024-00273-8
Hrytsenko, L., Sheliemina, N., & Latysh, D. (2026). Digital government and health system performance: Does digitalization improve the effectiveness of health expenditure? Health Economics and Management Review. https://doi.org/10.61093/hem.2026.1-02
Iacoella, F., Dehingia, N., Almanzar, M., Huynh, U., & Bruckauf, Z. (2024). Healthcare access in humanitarian settings: Mobile services successes and limits in Afghanistan. Social Science & Medicine, 364, 117541. https://doi.org/10.1016/j.socscimed.2024.117541
International Telecommunication Union. (2025). Measuring digital development: Facts and figures 2025. https://www.itu.int/en/ITU-D/Statistics/Pages/facts/default.aspx
Jabin, M., & Nyatuka, R. D. (2026). Bridging the data–power paradox: A conceptual–empirical analysis of solar-powered digital health systems in low-resource settings. Frontiers in Digital Health, 8. https://doi.org/10.3389/fdgth.2026.1848840
Jiang, C., Chang, H.-L., & Shahzad, I. (2022). Digital economy and health: Does green technology matter in BRICS economies? Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.827915
Kan, L., Shimada, Y., Hussen, A. M., Kiyomoto, A., Pandya, S., Mechael, P., Tilahun, B., Kimball, M., Gorgens, M., Veerappan, M., Wong, E., & Agarwal, S. (2025). Associations between digital maturity in health and primary health care performance, 109 countries. Bulletin of the World Health Organization, 103, 592–606A. https://doi.org/10.2471/BLT.24.292706
Kaya, F., Rashid, M., Esquivias, M. A., Akter, S., & Podder, S. C. (2025). Bridging technology and health: A panel analysis of internet use, mobile subscriptions, and health spending in G7. Social Sciences & Humanities Open, 12, 101813. https://doi.org/10.1016/j.ssaho.2025.101813
Khoong, E. C., Olazo, K., Rivadeneira, N. A., Thatipelli, S., Barr-Walker, J., Fontil, V., Lyles, C. R., & Sarkar, U. (2021). Mobile health strategies for blood pressure self-management in urban populations with digital barriers: Systematic review and meta-analyses. npj Digital Medicine, 4. https://doi.org/10.1038/s41746-021-00486-5
Kodali, P., & Das, S. (2021). Digital health technologies for universal health coverage: A promising change. Current Science, 120(4), 637–643. https://doi.org/10.18520/cs/v120/i4/637-643
Lantin-Magana, L. M., & Atento, R. G. O. (2026). Digital Reach, Consumption, and Equity Market Deepening: Evidence from ASEAN-5. Asian Financial Economics and Policy, 1(1). https://doi.org/10.65166/nxnfqv94
Li, Y., Cai, J., & Yu, H. (2025). The double-edged sword of internet use in China’s aging population: Thresholds, mediation and digital health policy. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1643510
Liao, Y., & Luo, N. (2024). Does internet use benefit health?—PSM-DID evidence from China’s CHARLS. PLOS ONE, 19. https://doi.org/10.1371/journal.pone.0306393
Lu, G., & Tang, X. (2026). Health financing, digital connectivity, and universal health coverage: A country-year panel study. Frontiers in Public Health, 14, 1928583. https://doi.org/10.3389/fpubh.2026.1928583
Luo, L., Shang, Z., Li, Y.-B., & Zhang, L. (2026). The association between internet use and health among rural-to-urban migrants in China: The mediating role of social integration. BMC Public Health, 26. https://doi.org/10.1186/s12889-026-26643-7
Luo, Y., Yip, P., & Zhang, Q. (2024). Positive association between Internet use and mental health among adults aged ≥50 years in 23 countries. Nature Human Behaviour, 9, 90–100. https://doi.org/10.1038/s41562-024-02048-7
MacAskill, W., Gill, P., Woloszczuk, C., Alam, K., Wallis, K. A., McGrail, M., Kondalsamy-Chennakesavan, S., & Nasir, B. (2026). A systematic review of the scope and impact of rural primary healthcare innovations using digital health technology. BMJ Open, 16. https://doi.org/10.1136/bmjopen-2024-097874
McCool, J., Dobson, R., Whittaker, R., & Paton, C. (2022). Mobile health (mHealth) in low- and middle-income countries. Annual Review of Public Health, 43, 525–539. https://doi.org/10.1146/annurev-publhealth-052620-093850
Memmel, E., & Kerschbaumer, L. (2026). Digital navigation as an access barrier: Waiting times, equity, and universal health coverage in a digitalizing health system. Frontiers in Public Health, 14. https://doi.org/10.3389/fpubh.2026.1810870
Morcilla, J., & Quinto, L. (2026). Integrated Community-Based Primary Healthcare Model to Strengthen Universal Health Coverage: Evidence from CHW Readiness, Service Quality, and Digital Health Acceptability in Selected CALABARZON LGUs. International Journal of Health & Business Analytics, 2(1). https://doi.org/10.65166/tketyh24
Moumin, A. M., Abdi, K. M., & Yousuf, A. M. (2026). Socio-digital stratification and the threshold effects of digital inclusion on maternal health access in Somalia. Global Health Action, 19. https://doi.org/10.1080/16549716.2026.2694167
Okuzu, O., Malaga, R. A., Okereafor, K., Amos, U., Dosunmu, A., Oyeneyin, A., Adeoye, V., Sambo, M., & Ebenso, B. (2022). Role of digital health insurance management systems in scaling health insurance coverage in low- and middle-income countries: A case study from Nigeria. Frontiers in Digital Health, 4. https://doi.org/10.3389/fdgth.2022.1008458
Patron, A. C., Quinto, L., & Atento, R. G. (2026). Universal Health Coverage and Labor Productivity in ASEAN: A Lagged Panel Analysis of Health Systems as Economic Infrastructure, 2000–2023. International Journal of Health & Business Analytics, 2(1). https://doi.org/10.65166/p3v11r43
Peralta-Ochoa, A. M., Chaca-Asmal, P. A., Guerrero-Vásquez, L. F., Ordoñez-Ordoñez, J. O., & Coronel-González, E. J. (2023). Smart healthcare applications over 5G networks: A systematic review. Applied Sciences, 13, 1469. https://doi.org/10.3390/app13031469
Periáñez, Á., Del Río, A. F., Nazarov, I., Jané, E., Hassan, M., Rastogi, A., & Tang, D. (2024). The digital transformation in health: How AI can improve the performance of health systems. Health Systems & Reform, 10. https://doi.org/10.1080/23288604.2024.2387138
Pu, H., Kang, W., Gao, W., Wang, S.-B., Wu, R., & Ren, Z. (2025). Spatiotemporal effect of internet use on life expectancy: Cross-country insight from a geographically and temporally weighted analysis. BMC Public Health, 25, 569. https://doi.org/10.1186/s12889-025-21760-1
Quinto, L., Atento, R. G., & Nemis, K. C. (2026). Routine Childhood Immunization Coverage and Tuberculosis Incidence in ASEAN and China: Evidence from a Two-Way Fixed-Effects Panel, 2000–2022. International Journal of Health & Business Analytics, 2(1). https://doi.org/10.65166/adzwj863
Shaw, J. A., Abejirinde, I., Agarwal, P., Shahid, S., & Martin, D. (2024). Digital health and equitable access to care. PLOS Digital Health, 3. https://doi.org/10.1371/journal.pdig.0000573
Sun, S., Simonsson, O., McGarvey, S., Torous, J., & Goldberg, S. B. (2024). Mobile phone interventions to improve health outcomes among patients with chronic diseases: An umbrella review and evidence synthesis from 34 meta-analyses. The Lancet Digital Health, 6, e857–e870. https://doi.org/10.1016/S2589-7500(24)00119-5
Sylla, B., Ismaila, O., & Diallo, G. (2025). 25 years of digital health toward universal health coverage in low- and middle-income countries: Rapid systematic review. Journal of Medical Internet Research, 27, e59042. https://doi.org/10.2196/59042
Wang, W., Khelfaoui, I., Ahmed, D., Xie, Y.-T., & Hafeez, M. (2024). Nexus between information and communication technologies and life expectancies of low-income countries: Does technological advancement increase their life span? SSM – Population Health, 25, 101600. https://doi.org/10.1016/j.ssmph.2023.101600
Wang, Y., & Chen, H. (2024). Effects of mobile Internet use on the health of middle-aged and older adults: Evidences from China health and retirement longitudinal study. BMC Public Health, 24. https://doi.org/10.1186/s12889-024-18916-w
Wilson, D., Haas, S., Van Gelder, S., & Hitimana, R. (2023). Digital financial services for health in support of universal health coverage: Qualitative programmatic case studies from Kenya and Rwanda. BMC Health Services Research, 23. https://doi.org/10.1186/s12913-023-09893-8
Wilson, D., Sheikh, A., & Ward, K. (2021). Technology and universal health coverage: Examining the role of digital health. Journal of Global Health, 11. https://doi.org/10.7189/jogh.11.16006
World Bank. (2026). World Development Indicators [Data set]. https://databank.worldbank.org/source/world-development-indicators
World Health Organization. (2025). Global strategy on digital health 2020–2027. https://www.who.int/publications/b/81640
World Health Organization, & World Bank. (2025). Tracking universal health coverage: 2025 global monitoring report. https://www.who.int/teams/health-financing-and-economics/global-monitoring-report/2025
Yao, R., Zhang, W., Evans, R., Cao, G., Rui, T.-Q., & Shen, L.-N. (2021). Inequities in health care services caused by the adoption of digital health technologies: Scoping review. Journal of Medical Internet Research, 24. https://doi.org/10.2196/34144
Yu, J., & Meng, S. (2022). Impacts of the Internet on health inequality and healthcare access: A cross-country study. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.935608
Zhang, D.-L., Zhang, G.-Q., Jiao, Y., Wang, Y., & Wang, P.-N. (2022). “Digital dividend” or “digital divide”: What role does the Internet play in the health inequalities among Chinese residents? International Journal of Environmental Research and Public Health, 19. https://doi.org/10.3390/ijerph192215162
Zhang, H., Qiao, H., Li, X.-P., Uddin, I., Li, R., & Zhang, X. (2025). Determinants of life expectancy in high longevity countries: Evidence from machine learning. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1687871
Zhang, J.-P., Gong, X.-M., & Zhang, H. (2022). ICT diffusion and health outcome: Effects and transmission channels. Telematics and Informatics, 67, 101755. https://doi.org/10.1016/j.tele.2021.101755
Zhang, Y.-T., An, L., & Li, Q. (2026). Internet use and health outcomes among rural residents in China. Medical Research Archives, 14(5). https://doi.org/10.18103/mra.v14i5.7549
Zhen, Z., Tang, D., Wang, X., & Feng, Q. (2024). The impact of digital technology on health inequality: Evidence from China. BMC Health Services Research, 24. https://doi.org/10.1186/s12913-024-12022-8
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Copyright (c) 2026 Ramon George Atento, Leah Quinto, Andrea Gwyneth Atento, Gay Marie Teodosio, Cherry Ann Marie H. Espelita, Faye Del Mundo, Paul Manzana (Author)
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