Socio-Economic Planning Sciences xxx (xxxx) xxx Please cite this article as: Francesco Campanella, Socio-Economic Planning Sciences, https://doi.org/10.1016/j.seps.2020.100813 Available online 15 February 2020 0038-0121/© 2020 Published by Elsevier Ltd. The evaluation of performance in the European public e-health services sector by Generalized Estimating Equations Francesco Campanella a, * , Luana Serino a , Mario Mustilli a , Anna Crisci b , Antonello D’Ambra a a Department of Economics, University of Campania “Luigi Vanvitelli”, Capua, Italy b Department of Economic, Management, Institutions, University of Naples Federico II, Italy A R T I C L E INFO Keywords: Consumers satisfactions ehealth Generalized estimating equations Organizational performance ABSTRACT Progressive attention to well-being and personal care is a salient aspect of modern living. In this sense, digital innovation can represent a fundamental strategic element to respond to challenges that arise today for the healthcare system. The purpose of this paper is to demonstrate: 1) the positive relationship between the use of ehealth information system and the level of consumer satisfaction; 2) the positive relationship between ehealth system and the organizational performance of health centers. The sample used for this empirical research is composed of 553 health care centers operating in Europe, during the years 2014-2017. Adopting the Generalized Estimating Equations for count data under Exchangeable working correlation structure, we show ehealth tools meet the needs and expectations of citizens, specifcally, facilitating communication and accessing information and health resources, and at the same time they improve the quality of services with benefts in terms of organizational performance. 1. Introduction The economic crisis and the institutional reforms from the perspec- tive of the spending review have had repercussions on the National Health System in Europe, worsening the supply of services. In recent years there has been a profound change in the socio- economic scenario in which health services are provided: on the one hand, the cost of health services has increased due to the progressive aging of the population and the consequent spread of chronic diseases, on the other hand the greater availability of digital technologies allow the “personalization” of health care (from predictive medicine, to the experimentation of robotic surgery, to the analysis of clinical big data for diagnostic-therapeutic scoring). The combination of these changes reveals the need to adopt new models of knowledge management that can redesign the offer of health services by involving the patient in all aspects that concern the care of their health. The application of Information and Communication Technology (ICT) represents a valid opportunity to balance the need for higher quality of services with a more prudent use of available fnancial re- sources, without neglecting the level of satisfaction perceived by the patient. The purpose of this paper is to demonstrate by using Generalized Estimating Equations for count data [1]: 1) the positive relationship between the use of ehealth information system and the level of consumer satisfaction; 2) the positive relationship between ehealth system and the organizational performance of health centers. The paper is organized as follows: Section 2 provides the literature review and hypothesis devel- opment; Section 3 describes the methodology and data; Section 4 reports the empirical fndings; Section 5 discusses the fndings and concludes, indicating some suggestions for future research. 2. Literature review and research hypothesis The ability to produce innovation is a fundamental factor for the competitiveness of industries and for the economic development of a country. Innovation, understood as the ability to create, disseminate and transform knowledge into new products, processes and services [2] is considered as the main element capable of generating improvements in terms of productivity, competitiveness and well-being of local and na- tional economic systems [3]. Information and Communication Technology (ICT) is an integral part of developed economies, causing profound and rapid changes. ICT ser- vices are increasingly used by citizens for the needs of everyday life * Corresponding author. E-mail address: francesco.campanella@unicampania.it (F. Campanella). Contents lists available at ScienceDirect Socio-Economic Planning Sciences journal homepage: http://www.elsevier.com/locate/seps https://doi.org/10.1016/j.seps.2020.100813 Received 20 December 2019; Received in revised form 5 February 2020; Accepted 12 February 2020