Methodology and framework

EuroHOPE is based on analysing the progress of a disease, with specific interest in the role of health services and health care policy as a determinant of the progress. The main idea of the approach is that it analyses performance by using detailed data pertaining to specific health conditions to illuminate the interconnected aspects, i.e. financing, organisational structures, medical technology choices, that are responsible for health system performance, health outcomes and expenditure. The project focuses on five important disease groups: acute myocardial infarction (AMI), ischemic stroke, hip fracture, breast cancer and very low birth weight and very preterm infants (VLBWI).

By making use of available databases, the project will update and further develop research infrastructure with the aim of evaluating the performance of health care systems in terms of outcomes, quality, use of resources, and cost. This includes maintaining and updating the protocols of the work with selected conditions. The protocols include e.g. inclusion and exclusion criteria, definition of the cycle of care, comorbidities used in risk adjustment, and describe the specification of process, utilization, cost and outcome measures. EuroHOPE began with linkable patient-level data covering the years 2006-2008 available from national sources of Finland, Hungary, Italy, the Netherlands, Norway, Scotland and Sweden. The data of AMI, stroke and hip fracture will be updated for the years 2005-2014. In addition, the episode-based approach will be extended to include primary health care and social services in a pilot study using data from Copenhagen, Helsinki, Madrid, Oslo and Stockholm.

A performance measure must be carefully constructed and be appropriate for multinational comparisons. Performance indicators will vary due to type of hospital, regional or individual level variations or random variation. The focus of our interest is in variation at the hospital level, regional level and country level. In EuroHOPE, the effect of cross-country heterogeneity in patient casemix on the measures is reduced by using risk-adjustment methods for individual-level data.

Ideally, there would be detailed cost accounting data available for each individual patient and standardized method of costing across countries. Although many of the countries are using Diagnostic Related Groups (DRGs) or a similar system to calculate resource use related to standardized patients, there is no common method of grouping patients and DRG tariffs may not accurately reflect costs. Since the costing method may have an important impact on how the effects of explanatory variables on cost are assessed, it is important to find measures that are considered to be valid and comparable. As a prerequisite each country should be capable of providing the necessary data input. In EuroHOPE, the cost and utilization measures were initially limited to hospital care and pharmaceuticals dispensed outside hospital, but these measures will be extended to include primary care and social care.


► Häkkinen U, Iversen T, Peltola M, Seppälä TT, Malmivaara A, Belicza É, Fattore G, Numerato D, Heijink R, Medin E, Rehnberg C. Health care performance comparison using a disease-based approach: The EuroHOPE project. Health Policy, Volume 112, Issues 1-2, September 2013, Pages 100-109.

Cost measurement and estimation of cost functions [pdf]

► Moger TA, Peltola M. Risk adjustment of health-care performance measures in a multinational register-based study: A pragmatic approach to a complicated topic. SAGE Open Medicine January - December 2014 vol. 2

► Iversen T, Aas E, Rosenqvist G, Häkkinen U. 2015. Comparative analysis of treatment costs in EuroHOPE. Health Economics 24 (Suppl. 2): 5-22.

► Heijink R, Engelfriet P, Rehnberg C, Kittelsen SAC, Häkkinen U. 2015. A window on geographic variation in healthcare: insights from EuroHOPE. Health Economics 24 (Suppl. 2): 164-177.

[Dec. 4th 2015]