Health outcomes for major medical conditions requiring hospital care vary considerably between and within European countries, according to a study evaluating the performance of seven European health care systems. The EuroHOPE (European Health Care Outcomes, Performance, and Efficiency) research project compared the health outcomes during the latter part of the 2000s for acute myocardial infarction, ischaemic stroke, hip fracture, breast cancer and very low birth weight and very low gestational age newborn infants, as well as all-disease outcome measures.
Each country or region taking part in the project, i.e. Finland, Hungary, Italy, the Netherlands, Norway, Scotland (UK), and Sweden, has the potential to identify areas where performance in their health care system can be improved both in terms of quality of care and use of resources.
EuroHOPE is the first study to comprehensively compare what happens to patients in different countries within a one-year follow-up after onset of the disease. There was great variation in health outcomes between countries as well as within countries at the level of regions and hospitals. The EuroHOPE findings were presented today (8 April) at Karolinska Institutet in Stockholm at a seminar concluding the EU-financed research project.
For example, in acute myocardial infarction the poorest performing Norwegian region registered lower adjusted one-year mortality rates than the best-performing Hungarian region. In Norway and Sweden, regional differences in health outcomes were smaller and mortality lower than in the other countries studied. Acute myocardial infarction mortality was on the same level in the best performing Finnish region as in the poorest performing regions in Sweden and Norway.
There were great regional differences in ischaemic stroke mortality in Scotland and the Netherlands, varying between 23 and 36 per cent, while in Sweden the regional variations were only between 15 and 20 per cent. Further, mortality for infants with birth weight under 1500g and gestational age less than 32 weeks in Finland and Sweden was clearly lower than in Hungary or the Netherlands.
Generally, health outcomes for the five medical conditions were good in Italy, Norway and Sweden. The performance for the Netherlands was average in these patient groups. Health outcomes in Finland were roughly on the same level as in Norway and Sweden, with the exception of acute myocardial infarction where Finland performed worse. The ranking of Scotland varied between conditions. Health outcomes were comparatively poorer in Hungary, likely as a result of economic factors.
Financing mechanism does not explain differences in quality
The study did not find any clear relationship between health care financing and performance. There were both well- and poor-performing countries and regions both among social-insurance and tax-based health care systems. Prospective hospital reimbursement seemed to increase the use of immediate percutaneous coronary intervention among the acute myocardial infarction patients, but the financing mechanism was not related to better health outcomes.
There was no apparent relationship between quality and use of resources, except in the care of acute myocardial infarction patients in Finland and Hungary. Moreover, no correlation was discovered between hospital productivity and quality of care. Hospital productivity was at the same level in Denmark, Finland and Norway, while productivity in Sweden was clearly below the Nordic average.