Using evidence in health policy: the role of health system performance assessment in Europe

Abstract Health System Performance Assessment (HSPA) refers to the country-specific process of monitoring, assessing, reporting, and reviewing the performance of health systems in relation to strategic objectives. HSPA is a key instrument for evidence-based policymaking, supporting transparency, priority setting, and accountability across the health sector. Despite its importance, the extent to which HSPA is integrated into political decision-making processes remains underexplored. This study aims to investigate the implementation of HSPA and its influence on policy across European countries. A qualitative, cross-country comparative approach was adopted to examine similarities and differences in national HSPA practices. Data were collected in 2023 using a standardized, self-administered questionnaire completed by members of the European Commission's Expert Group on HSPA. The survey addressed four key areas: organizational, technical, and methodological aspects of HSPA; dissemination strategies; political impact; and barriers and facilitators to implementation. The findings were complemented by a comprehensive literature review. A follow-up survey will be conducted in April-May 2025. 20 countries participated in the initial study. Of these, 14 had implemented a regular HSPA, 5 were planning implementation, and 1 had no such plans. Some countries reported a legal basis for periodic HSPA linked to political decision-making. Others are still developing frameworks and objectives. Common challenges include fragmented data systems, limited political commitment, and decentralized health structures. Nonetheless, most countries recognize HSPA's growing importance and its potential to more strongly inform health policy. HSPA contributes meaningfully to evidence-informed public health decision-making in Europe. To unlock its full potential, stronger integration into policy processes is required, enabling it to not only support but also shape and drive strategic health system reform. Key messages • HSPA is already being used in many European countries for evidence-based health policy, but its full potential for policy influence is not yet realized. • Barriers such as fragmented data systems and lack of political commitment hamper the full implementation of HSPA, yet its increasing importance is expected.