There is considerable variance in just what a healthcare system is and how resources and assets are configured to deliver the highest value. Many variables need to be taken into consideration when agreeing the very best scale, scope and distribution of infrastructure across geographies to match demand and capacity, stimulate markets and choice, to assure efficiency and effectiveness, quality and adaptability. The benchmarking or business case appraisal of stand-alone hospital is a common practice. The hospitals however are more and more a part of regional service system that must integrate provider organisations, specialist and generalist care and social services and find appropriate ways to share assets. The properties of such are often unknown. Regional benchmarking at European level is necessary and will bring new knowledge. The benchmarking of different services, at different organisational levels will help achieve comparative data, and case studies in hospitals in Finland, France, Hungary, The Netherlands, Germany Sweden and United Kingdom. Several efficacy performance measurements will be contrasted with the structure and function of the regional systems and various different organisations and variations in baseline data. This work will help to differentiate in-hospital effects from the systemic effects arising from the differences of the regional health services and provide guidance and best practice to improve overall efficacy of services.