Evidence on the impact of nature images has been found in research with hospital patients (Ulrich, 2008, Nanda, Hathorn & Neumann, 2007). The use of art in healthcare environments has become increasingly common (Nanda, Eisen & Baladandayuthapani, 2008). Art is viewed as a positive distraction from stress of the hospital among patients and possibly staff (Ulrich et. al. 1991; Ulrich, Zimring, Quan, & Joseph, 2006). In a previous study art preference study (Nanda, Eisen & Baladandayuthapani, 2008) showed significant difference in the ratings of design students and patients. Findings showed that there was a significant difference in the ratings of the two groups. Furthermore, the emotional rating scale (how does the art picture make you feel) was highly correlated to the selection scale (would you put this art picture in your room) for hospital patients- while this was not the case with the design students. What is the role of culture in the above questions and in how does it impact healthcare design?A total of more than 600 design and non-design students from National University of Mexico, National University of Singapore and University of Texas San Antonio rated images of visual art included abstract, representational and nature images from Mexico, Singapore and Texas representative of the unique cultural contexts, in addition to images that strictly adhere to the evidence-based guidelines for healthcare art laid down by Ulrich & Gilpin (2003) and examples of classic high art.At the end of the survey students re-rated the images again as if they were hospitalized and lying in a patient room. An analysis of preferences across cultures, design disciplines and emotion and selection was undertaken.Results show a surprising amount of agreement across cultures on image rating for hospital rooms. Level of agreement for art selection for personal rooms is significantly lower. This is true in both design and non-design students. Landscapes with a high depth of field, bright colors and verdant foliage were rated consistently high across all cultures, regardless of indigenous elements, with few exceptions, that suggests that there is a certain universal appeal for restorative images of nature that go beyond cultural and educational boundaries. The study showed that empathy (how this art would make you feel) is a stronger determinant of selection than culture, or education, when it comes to art selection for hospitals.