OBJECTIVES Health Performance Indicators (HPIs) provide a quantitative tool to assess the performance of health care policies.  Available HPIs may be strongly correlated, limiting further inferential use. In this study we converted published HPIs into a set of independent HPIs (iHPIs) using factor analysis. We subsequently used iHPIs to perform regional health care performance comparisons. METHODS We used the set of 27 HPIs on 43 European countries from 7 geographical regions of Mackenbach (Mackenbach JP, McKee M. European Journal of Public Health 23 (2), 195-201, 2013). We extracted only indicators related to direct health care services having limited missing data (< 20%) and applied factor analysis to obtain iHPIs. The performance of the 7 regions was analysed using iHPIs in cluster analysis and non-parametric ANOVA (significance level at 0.05). RESULTS