Can artificial intelligence improve health performance? The mediating role of health innovation and the moderating role of digital infrastructure.

This study examines whether artificial intelligence improves health performance in developing countries and identifies the mechanisms and conditions through which this effect occurs. Using panel data for 19 developing countries over the period 2015-2023, the study investigates the mediating role of health innovation and the moderating role of digital infrastructure in the relationship between artificial intelligence and health performance. The study applies Hayes' PROCESS macro to estimate direct, mediation, moderation, and moderated mediation effects. To strengthen the reliability of the findings, two robustness checks are conducted: two-step System GMM estimation and alternative measurement using infant mortality and disaggregated artificial intelligence indicators. The results show that artificial intelligence has a positive and statistically significant effect on both life expectancy and UHC service coverage. Health innovation partially mediates these relationships, indicating that artificial intelligence improves health performance not only directly through healthcare delivery, diagnosis, surveillance, and resource allocation, but also indirectly by stimulating medical and life-science innovation. The findings further reveal that digital infrastructure strengthens artificial intelligence's effect on health innovation and amplifies its direct effect on both health performance indicators. The moderated mediation results confirm that the artificial intelligence-health innovation-health performance pathway strengthens as digital infrastructure improves. The robustness tests support these conclusions. System GMM confirms the partial mediation mechanism after accounting for dynamic panel-data concerns, while the alternative-measure analysis shows that artificial intelligence patent applications, industrial robots, and artificial intelligence scholarly publications reduce infant mortality through health innovation under stronger digital infrastructure. These findings indicate that artificial intelligence yields greater health benefits when combined with health innovation capacity and digital infrastructure, while also showing that not all artificial intelligence dimensions contribute equally to health-system improvement.