A handbook to access health care data for cross-country comparisons of efficiency and quality



Maria M. Hofmarcher


Flip Maas, Juliane Winkelmann


CEPS/INSTEAD (Luxemburg)

Institut de Recherche et Documentation en Economie de la Santé (France)

London School of Economics and Political Science (United Kingdom)

Maccabi Institute for Health Services Research (Israel)

National Institute for Welfare and Health (Finland)

Technical University Berlin (Germany)

University of Tartu (Estonia)

Imperial College London (United Kingdom)


The last ten years have witnessed an increased investment in European and international initiatives and projects to improve health data for cross-country research. The major goals have been to help national policy-makers, on the one hand, to better assess the health status of their populations and on the other hand, to monitor how health care systems of their countries perform compared to other countries. There are, however, limits to what can be learnt from comparisons at the aggregate, health care system level of analysis. Disease level analysis has therefore been receiving increased attention (e.g. OECD, 2003). This approach is of particular interest when studying health care for chronic diseases. Indeed a large share of health care resources and public and private expenditure is presently spent on health care services for patients with a chronic illness, the majority of which are usually 50 years old or more. Due to ageing populations and medical-technological progress, European countries have experienced a shift in the burden of disease towards chronic diseases.


EuroREACH is a coordination action that aims to overcome the compartmentalisation of data collection and analysis of chronic diseases – both on a national and European level – in order to study the questions listed above in a cross-country, comparative perspective. European datasets for comparable health care data so far mainly have relied on strategies to make the best use of data originally produced at the national level.


The following approaches are followed in order to link the various datasets of chronic patients who tend to slip “in and out of the health system”:

  • Review of the health care information landscape in a selection of EU Member States, which have all approached the data challenges and performance management of health care for chronic care patients in innovative ways. These are represented by partners from six EU countries and Israel. The experience from other EU countries and from non-EU countries that are leading in the field of health information (Canada, US, and Australia) are gathered with the support of External Expert Panels.
  • Review the results of relevant European projects and initiatives to improve the information base for these types of chronic conditions, and of data relevant for studying them.
  • Review ways and best practice on how to make use of international frameworks, classifications, and European-level data systems. This includes coordinating and further developing strategies on how to link data from European data collections to metadata information including qualitative structural indicators. This enables these data to be understood in their national context, such as by linking back to national sources that allow for a more detailed breakdown and by providing information on the context of national organisations of health care systems. A special consultation with leading experts on international comparisons deal with the crucial question of how to link data analysis to a system of institutional indicators, which has been recommended as indispensable for cross-country comparisons (Häkkinen and Jourmard, 2007).
  • The results of these coordination activities are brought together in the form of a systematic synthesis of the findings on data domains needed, types of questions to be answered with these, types of linkages needed, including recommendations on how to make data accessible (based on best practice gathered from country examples and from European initiatives and projects). These are brought together in a web-based “Handbook to access health care data for cross-country comparisons of efficiency and quality” (hereafter Handbook). The latter, which addresses the health data situation both in individual countries and on a European level, are tested in a generic way by drafting pilot guides to accessing data for two to three pilot countries, following the blueprint and structure of the Handbook.
  • The work sketched out above are based on a methodological framework that systematically addresses the question about what types of data sources, data linkages (including surveys) can be envisaged, and how these relate to a well-defined set of research questions of comparative performance measurement with a focus on questions of efficiency and quality.

Although the focus is on health care for chronically ill patients, many of the findings and recommendations, as well as the generic guidance that the Handbook provides, are also relevant and apply to other health services research and public health research more broadly. Indeed the latter face similar data challenges and frequently use the same main data sources, such as patient registries and other administrative systems.The findings from the EuroREACH project feed into a digital compendium of health data initiatives and information systems, the Health Data Navigator (HDN). It was developed as part of the EuroREACH project and serves as a toolbox to researchers, policy makers and other stakeholders. Ultimately it aims to improve the quality of comparative health systems analysis and performance measurement and to encourage cross-country exchange of good practice data use. The Health Data Navigator can be accessed under the following link: www.healthdatanavigator.eu


The HDN lists national and international data bases relevant for performance assessment with a particular focus on patient-level and disease-oriented data. An important added value of the HDN is to inform visitors of the *appropriateness and quality of data* they may want to use. In particular, data sources reported in the HDN are described in greater detail where information exists in regard to accessibility, coverage, quality, linkage and strenghts and weaknesses.

The Health Data Navigator offers guidance on pertinent issues in international health research including:

Health Data Navigator



Seventh Framework Programme, EC


03/2010 – 05/2013