["Business Strategy and the Environment, EarlyView. ", "\nABSTRACT\nThis study examines the association between environmental, social, and governance (ESG) pillars and firm performance in the global healthcare industry, with a focus on the moderating role of national culture, specifically uncertainty avoidance (UAI). Employing a two‐stage network data envelopment analysis (NDEA) followed by truncated regression, we analyze 185 firm‐year observations from 37 healthcare firms across 15 countries (2019–2023). The production process is divided into two stages: eco‐business efficiency (Stage 1) and market efficiency (Stage 2). Our results reveal a clear “decoupling effect,” where improvements in operational efficiency driven by ESG initiatives do not immediately translate into market valuation. Specifically, UAI serves as an “operational shield,” enhancing the positive impact of all ESG pillars on operational eco‐efficiency (Stage 1). However, financial markets respond differently: Only Governance maintains a significant positive relation to market efficiency (Stage 2), especially in high‐UAI cultures where it acts as a key signal of stability. In high‐UAI cultures, markets may view environmental and social investments as ambiguous sunk costs; however, governance acts as a critical “market signal” and safety net. We find a significant positive interaction between governance and UAI for market efficiency (b = 0.9513, p < 0.05), suggesting that in risk‐averse societies, robust governance is a primary correlate of financial valuation. These findings extend the resource‐based view (RBV) and stakeholder theory by mapping the specific cultural boundary conditions where ESG is associated with value creation.\n"]