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α: calibrated so average coauthorship-adjusted count equals average raw count
Within last seventy years, healthcare spending in Europe has grown faster than national income. However, this does not always translate into good health indicators, suggesting a problem of efficiency in different European health systems. This paper analyzes the efficiency of such systems for 185 European regions in 17 countries by grouping them into three clusters according to their institutional setting: regulation, funding and service provision. We investigate their productive performance by adopting a metafrontier framework for exploring the role of technological spillovers. Our findings suggest that the three European health systems show similar efficiency performance; the best performers are regions that have adopted social healthcare insurance; kernel analysis indicates that there is convergence toward a single club in each frontier. Finally, we find a dramatic change in the convergence process after the nancial crisis, with European regions converging toward different groups with different levels of efficiency.