Spending on health care keeps increasing and induces European countries to improve system efficiency. Under these circumstances, countries might benefit from routine international comparisons of health system performance, as benchmarking provides opportunities to identify and learn from the best practices. Despite the need for international performance comparisons, there is a lack of good quality research in the field. This is not because of a lack of interest among the researchers, but rather because of incomparability of data necessary to measure performance. Patient-level and sector-level data from various sources often show inferior comparability, which reduces their feasibility in benchmarking and impedes interpretation. International hospital performance information is usually at the national level (e.g. OECD 2013) without the possibility of evaluating what happens to patients during an episode and after discharge from a hospital.To fill this gap, EuroHOPE (European Health Care Outcomes, Performance, and Efficiency) aims at facilitating knowledge-based health policy by making efficiency comparisons with available register data (Häkkinen et al., 2013). EuroHOPE applied disease level analysis to study five conditions: acute myocardial infarction (AMI), stroke, hip fracture, breast cancer, and very low birth weight (VLBW) and very low gestational age (VLGA) infants. The data were obtained from a variety of national authorities in Finland, Hungary, Italy, the Netherlands, Norway, Scotland, and Sweden. The opportunities to link data from various sources at an individual level were utilised to enable rich risk-adjustment to control for heterogeneity, follow-up to evaluate outcomes and resource use, and follow-down to make the patient cohorts consist of first-ever cases solely. In addition, the productivity of Nordic hospitals was compared against their quality of care.EuroHOPE had two broader tasks. The first task was related to developing indicators and methods for international register-based healthcare performance measurement and comparison, giving proposals concerning the data content of national registers in order to improve intranational-level and international-level continuous monitoring and implementing European-wide healthcare benchmarking. We have developed and reviewed the methodology (Häkkinen et al., 2013;Medin et al., 2013; Moger and Peltola 2014) as well as created databases for this kind of performance analysis (Malmivaara et al., 2015;Numerato et al., 2015).