Reducing Regional Inequalities in Healthcare Systems Through Data, Interoperability and Artificial Intelligence: An Equity-Oriented Systemic Framework

This article examines how health data, system interoperability and Artificial Intelligence (AI) can help reduce regional inequalities in healthcare systems, with particular attention to the Portuguese National Health Service (NHS). Methodologically, the study adopts a qualitative conceptual synthesis of purposively selected academic literature and authoritative policy and regulatory sources across three intersecting domains: territorial inequalities in health systems; digital health, interoperability and data governance; and AI and health equity. The synthesis identifies recurring mechanisms linking territorial disparities to data fragmentation, institutional capacity and AI adoption, which inform the authors’ synthesis tables and five-layer systemic framework. The evidence shows that disparities in access, service availability, coordination and outcomes remain structurally embedded across Europe and persist in Portugal despite universal coverage. The study argues that data infrastructures and interoperability are not merely technical enablers, but core determinants of governance capacity and equity. It situates this argument within the European Health Data Space (EHDS) and HealthData@PT, distinguishing between primary use of health data for care delivery and secondary use for research, innovation, policy evaluation and system learning. The analysis highlights AI’s dual potential: poorly governed, it may reinforce inequalities through biased data, uneven adoption and institutional fragmentation; properly governed, it can support predictive planning, coordination, waiting-list management, equitable triage, value-based outcome measurement and disparity monitoring. The proposed framework integrates territorial equity governance, data infrastructure and interoperability, analytical and AI capability, organisational integration, and Continuous Evaluation and Equity Monitoring. The study concludes that digital transformation may contribute to reducing regional inequalities, but such effects should not be assumed: they depend on alignment with territorial need, equity-oriented governance, secure interoperable infrastructures, transparency, citizen trust and institutional capacity, and require empirical evaluation.