From Health Spending to Social Value: Why Bilbao Must Measure What Really Matters

Road to Bilbao | Editorial Reflections inspired by Iñaki Gutiérrez-Ibarluzea at the Servimedia–POP Dialogue "Investing in Health: The Value of Focusing on the Patient"

As we continue the Road to Bilbao, one of the central questions we must ask is not only how to make health data available, interoperable and secure, but how to ensure that it helps us measure what really matters.

This question was recently brought into sharp focus by Iñaki Gutiérrez, Director of Research, Innovation and Health Evaluation at the Basque Government, during a Servimedia dialogue organised by the Plataforma de Organizaciones de Pacientes under the title "Investing in Health: The Value of Focusing on the Patient."

The discussion addressed a challenge that every health system in Europe now faces: how to understand health expenditure not only as a budgetary pressure, but as a social investment.

According to the Servimedia report, Iñaki shared a powerful insight from analysis carried out by the Basque Government's health department: almost half of what is spent on healthcare can return to society in the form of wellbeing, productivity and improved quality of life.

This is more than an economic observation. It is a reminder that health systems are not simply cost centres. They are part of the social infrastructure of a country.

Beyond the Internal Logic of the Health System

One of the most important messages from Iñaki's intervention was the need to move beyond what he described as the internal logic of the health system.

Too often, health system evaluation remains focused on direct healthcare expenditure, activity levels, clinical outputs and institutional performance. These indicators are necessary, but they are not sufficient.

If we want to understand the real value of investing in health, we must also measure what happens beyond the walls of hospitals and clinics: the impact on families, carers, employment, autonomy, quality of life, prevention, social cohesion and the capacity of people to live meaningful lives.

This wider lens is especially important as European health systems face the growing burden of chronic disease, ageing populations, workforce pressure and financial constraints. The question is no longer only how much healthcare costs. It is also how much value health systems generate for people and society.

A New Social Pact for Sustainable Health Systems

The Servimedia dialogue also pointed to the need for a broader social pact to sustain health systems over time.

This is a crucial point.

Health systems cannot be sustained only through better accounting or short-term cost control. They require a new conversation between patients, citizens, policymakers, professionals, innovators, industry and public institutions.

Such a pact must include prevention, innovation and an intersectoral view connecting healthcare, social services, the economy and employment. It must also recognise that the burden of illness is not carried only by health budgets. It is carried by families, carers, workplaces and communities.

This is why measuring social value is not a secondary issue. It is part of the future legitimacy of health systems.

Why This Matters for Bilbao 2026

The Health Data Forum Global Hybrid Summit 2026 in Bilbao will focus on a practical and urgent question:

How do we make the European Health Data Space work in real-world settings, particularly for high-dimensional data such as genomics and imaging, while ensuring trust, security, interoperability and meaningful secondary use?

At first sight, this may sound like a technical agenda. But it is not only technical.

EHDS implementation is ultimately about creating the conditions for better decisions, better research, better care and better outcomes. It is about ensuring that data can be used responsibly to generate public value.

The conversation opened by Iñaki helps us frame Bilbao in precisely this way. Health data should not only help systems count activity. It should help systems understand value.

It should help us ask better questions:

What outcomes matter most to patients?

How does health investment affect autonomy, employment, family life and social participation?

How can prevention be valued before illness becomes more costly and more complex?

How can data infrastructures support fairer, more transparent and more sustainable decisions?

And how can secondary use of health data serve society in ways that citizens can understand, trust and support?

From Wales to Bilbao: Trust, Transparency and Visible Benefit

This reflection also builds naturally on the legacy of the Wales Joint Charter, developed through the Health Data Forum dialogue in Cardiff.

Wales reminded us that trust is not a transaction. It is a relationship. It begins before consent, continues throughout the data lifecycle and must be maintained after data use.

One of the strongest insights from that dialogue was the importance of visible societal benefit. People are more likely to trust health data use when they can see how their contribution leads to better care, fairer access, better research, safer innovation and improved outcomes.

Bilbao now gives us the opportunity to take this further.

If Wales helped us articulate the foundations of trust, equity and transparency, Bilbao must help us translate those foundations into implementation priorities.

This means connecting policy to practice, infrastructure to value, and data access to public benefit.

Health Data as Social Infrastructure

The Road to Bilbao is not only a campaign to invite people to an event. It is an invitation to join a deeper conversation about the future of health systems.

The European Health Data Space will not succeed if it is understood only as a legal framework or a technical architecture. It must become part of a wider social compact around trustworthy health data use.

That compact requires clarity about what data is used for, who benefits, what safeguards are in place and how value is returned to patients, health systems and society.

In that sense, health data should be understood as social infrastructure.

Like roads, schools, hospitals and public institutions, data infrastructures shape what societies can become. They influence how we discover disease, how we plan services, how we measure inequalities, how we allocate resources and how we prepare for the future.

But infrastructure only earns legitimacy when people can see its purpose.

Making EHDS Real Means Measuring What Matters

Bilbao 2026 will bring together policymakers, health system leaders, researchers, patient voices, technology partners and international experts to explore how EHDS can move from aspiration to implementation.

The themes of genomics, imaging, cybersecurity, trusted data environments, interoperability and secondary use are all central to that journey.

But the deeper question remains: what are these systems for?

They are for better health, better care, better science, better decisions and better lives.

They are for a future in which innovation is not only faster, but more legitimate; not only more intelligent, but more trustworthy; not only more efficient, but more human.

Iñaki's reflection offers a timely reminder as we prepare for Bilbao: the value of health systems cannot be measured only from inside the health system.

If we want to make EHDS real, we must also make value visible.

That is one of the conversations we will continue in Bilbao.

References

Servimedia– Spanish Platform of Patient Organisations (POP) Dialogue "Investing in Health: The Value of Focusing on the Patient"