Large variation in quality of health care within and between European countries

1 April 2014

Sweden, Italy and Norway have high quality health services overall, according to the EuroHOPE project, but quality and costs vary widely both between and within countries.

The EuroHOPE project compared healthcare data for five different medical conditions in six countries and will present the results in a conference next week in .

This EU project that has run for three years compares the quality and cost of hospital care in Finland, Hungary, the Netherlands, Norway, Scotland, Sweden and certain provinces in Italy. Researchers have focused on care for heart attacks, strokes, hip fractures, very premature infants and certain forms of breast cancer.

“The results show that there is potential to improve the efficiency of health care. We see significant differences in both costs and quality both within and between countries for these diseases. However, there are no clear results that show that the best quality is associated with the highest costs,” says Clas Rehnberg, professor at the Department of Learning, Informatics, Management and Ethics, Karolinska Institutet.

Researchers have linked patient records to mortality registries in different countries and followed up patients for 30 days and one year following discharge from the hospital. The number of deaths has been used as a measure of quality. Using registries to make this kind of comparison is a new approach.

“We have followed individuals who just have one disease in the registries and this means we can draw conclusions about healthcare for the diseases in question. But in general it is a fact that even a country's general health status has an effect. Hungary, for example, is worse in most areas, but it also tends to have a poorer health status with a shorter lifespan. It is clear that it has an effect and makes it difficult to improve results in individual diseases no matter how many resources you can deploy.”

This is the project's final conference and researchers from several countries have been invited to speak. The method used in this project will also be compared with other forms of rankings of health care systems. There will also be discussions about the causes of the differences in quality.

“We do not know the answers to the reasons for the differences. We see no clear differences between how healthcare is financed in different countries. But it could, for example, be that different medical techniques are being employed in different countries. Another hypothesis is that it is due to the centralisation or decentralisation of healthcare or that international guidelines for healthcare are not being followed,” says Clas Rehnberg.

Harry Wood

More information

Conference: Explaining differences in European health care outcomes performance and efficiency Time: 8 April, 2014 from 9.30am to 2pm Location: Karolinska Institutet Campus Solna, Berzelius väg 3, Gustaf Retzius Hall, Sweden.

For the full programme, see:


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