The CINTESIS researcher and professor at the Faculty of Medicine of the University of Porto (FMUP) João Vasco Santos warns of discrepancies in health indicators depending on the methods used in European-level studies and recommends a combination of indicators to compare the health systems of the various countries and outline sound policies.

“There is an urgent need for greater commitment from European institutions and bodies in the development and use of solid indicators to evaluate and compare the effectiveness of European health systems and design health policies appropriate to the reality,” he says.

This is one of the conclusions of several studies conducted by João Vasco Santos in the scope of his doctorate in Clinical Research and Health Services (PDICSS) and which involved the participation of researchers from countries like Belgium, the Netherlands, and Italy.

In one of these studies, the researcher analyzed healthy life expectancy by gender in 28 EU countries from 2010 to 2017 based on different methods: self-perceived life expectancy, used by the European Commission (Eurostat), and disability-adjusted healthy life expectancy (through disability-adjusted life years – DALYs), used in the Global Burden of Disease Study, with which he collaborates.

Healthy life expectancy is a measure that combines mortality and the level of health or disability from disease and can be calculated using different methods. You would expect that the methods would have no influence on the numbers, but the truth is that they do. And a lot of it.

In fact, healthy life expectancy figures for the population of the European Union can vary significantly depending on which indicators are used. The difference is greatest in the figures concerning women.

“There is an important variability of plus or minus three years of healthy life (in a total of six years) and a systematic difference between indicators,” says the CINTESIS researcher in the area of health systems and health policies, Assistant Professor at the FMUP and specialist in Public Health at the Northern Regional Health Administration (ARS-Norte).

On a practical level, “these data can impact the evaluation and comparison of the effectiveness of health systems. More importantly, this data may condition the decisions that are made in terms of health policies. As João Vasco Santos states, “to intervene, it is necessary to measure in the first place”. In fact, “this will be an essential topic in the context of the upcoming implementation of the European Health Data Space, in which decisions related to data policy will also have implications for health policies and the type of health interventions to be prioritized.

Knowing that “there are few robust measures of morbidity and mortality indicators” and that “indiscriminately using one measure or another can lead to misinterpretations,” the solution may lie in improving and combining methods.

“For the evaluation and comparison of the effectiveness of health systems, it is recommended to use several final indicators of morbidity and mortality simultaneously, namely the age-adjusted DALYs rate and different methods of healthy life expectancy,” he advises.

The next steps are to evaluate other dimensions of health systems, besides effectiveness, and try to understand how health policies can be framed and improved, taking into account the performance of these systems.