Does Healthcare Deliver? Results from the Patient‑Reported Indicator Surveys (PaRIS): Portugal
Table of contents
The OECD Patient-Reported Indicator Surveys (PaRIS) is a groundbreaking initiative that fills a critical gap in health data by measuring the health outcomes and care experiences of people. This is an essential piece of information still lacking: the views of those directly concerned by health services – the patients – about their experience with the healthcare system and the outcomes as reported by them. By capturing the perspectives of over 107 000 people across 1 800 primary care practices in 19 countries, PaRIS provides an internationally comparable assessment of how outcomes and experiences of primary care users aged 45 years and older vary across countries and how healthcare systems deliver the care people with chronic conditions need.
As the global population of people living with chronic conditions continues to grow, the need for healthcare systems to adapt to their needs has never been more urgent. PaRIS plays a crucial role in informing this shift by offering data that supports the reorganisation of healthcare around the care experiences and health outcomes that matter most to people. Unlike disease‑specific assessments, PaRIS takes a broader approach, measuring how healthcare impacts people’s lives across various dimensions. This comprehensive perspective has the potential to revolutionise the way we assess the performance of healthcare systems on a global scale.
PaRIS findings emphasise the need for more people‑centred and co‑ordinated care, especially for the 80% of primary care users aged 45 years and older that live with at least one chronic condition and the 50% that live with multiple (two or more) chronic conditions. Targeted policies are essential to address inequalities, enhance care co‑ordination, and build trust in healthcare systems. Encouraging patient involvement in care decisions and fostering strong relationships with healthcare professionals can lead to better health outcomes, greater trust in the system, and increased confidence in managing their own health. At the same time, a well-staffed healthcare workforce and primary care practices organised around people’s needs are key to achieving improved patient outcomes and experiences.
This country note leverages the main findings of the publication, Does Healthcare Deliver: Results from the Patient-Reported Indicator Surveys (PaRIS), to provide a focused assessment for Portugal. Drawing on the analysis of the ten key patient-reported outcome and experience measures used in the survey (Table 1), it explores findings in the Portuguese context and compares them to the OECD PaRIS average. The OECD PaRIS average is the simple average of the 17 OECD member countries participating in PaRIS.
More than half (57%) of people with chronic conditions in Portugal report good physical health, as measured by physical function, pain, and fatigue. This is below the OECD PaRIS average of 70% and 25 percentage points lower than the highest-performing country (82%).
Two-thirds (67%) of people with chronic conditions in Portugal report good mental health, referring to quality of life, emotional distress, and social health. This is the lowest percentage among PaRIS countries and constitutes a 26 percentage points difference with the highest-performing country (93%).
Fewer than half (49%) of people with chronic conditions in Portugal report good care co‑ordination, which is below the OECD PaRIS average of 59% and 32 percentage points below the highest-performing country (81%).
Slightly more than half (54%) of people with chronic conditions in Portugal trust their healthcare system, below the OECD PaRIS average of 62%.
More than four out of five people (86%) with two or more chronic conditions in Portugal are managed in primary care practices that offer follow-up and regular consultations of more than 15 minutes; this is almost 40 percentage points above the OECD PaRIS average of 47%.
Most people (97%) with two or more chronic conditions are managed in primary care practices where non-physician staff is involved in chronic disease management; this is 14 percentage points higher than the OECD PaRIS average of 83%.
Slightly less than half (49%) of the patients with chronic conditions in Portugal receive enough support to manage their own health, below the OECD PaRIS average of 63%.
About one out of ten people with chronic conditions (12%) report confidence in using health information from the internet in Portugal, compared to the OECD PaRIS average of 19% (lowest-highest: 5‑34%).
In Portugal people with chronic conditions have poorer health outcomes compared to many other PaRIS countries and in general have care experiences below the OECD PaRIS average (Chapter 2). This assessment is based on the 10 key patient-reported outcome measures (PROMs) – physical health, mental health, social functioning, well-being and general health and patient-reported experience measures (PREMs) – confidence to self-manage, experienced co‑ordination of care, experienced person-centred care, experienced quality of care and trust in healthcare system (Figure 1).
In Portugal, people living with chronic conditions are less likely to report good health outcomes compared to the OECD PaRIS average:
More than half (57%) of people with chronic conditions in Portugal report good physical health, as measured by physical function, pain, and fatigue. This is significantly below the OECD PaRIS average of 70% and 25 percentage points lower than the highest-performing country (82%) (Figure 1).
Two-thirds (67%) of people with chronic conditions in Portugal report good mental health, referring to quality of life, emotional distress, and social health. This is the lowest percentage among participating countries and constitutes a 26 percentage points difference with the highest-performing country (93%).
Nearly three‑quarters (73%) of people with chronic conditions in Portugal report good social functioning, which measures how well people carry out their usual social activities and roles. This is 10 percentage points below the OECD PaRIS average of 83% and 20 percentage points below the highest-performing country (93%) (Figure 1). Similarly, three out of five people (61%) with chronic conditions in Portugal report positive well-being, which reflects mood, vitality, and fulfilment. This is 10 percentage points below the OECD PaRIS average of 71% and 19 percentage points below the highest-performing country (80%).
Four out of ten (42%) of people with chronic conditions in Portugal report good general health, significantly below the OECD PaRIS average of 66% and 51 percentage points lower than the highest-performing country (93%).
The percentage of people with chronic conditions who report good experiences of healthcare in Portugal is also lower than the OECD PaRIS average, except for confidence in self-management:
Nearly two‑thirds (61%) of people with chronic conditions in Portugal feel confident in managing their own health, slightly above the OECD PaRIS average of 59%. This is, however, 31 percentage points below the highest-performing country (92%) (Figure 1).
Fewer than half (49%) of people with chronic conditions in Portugal report good care co‑ordination, which is 10 percentage points below the OECD PaRIS average of 59% and 32 percentage points below the highest-performing country (81%).
Close to four out of five (77%) people with chronic conditions in Portugal report person-centred care, care focusing on their needs, which is below the OECD PaRIS average of 87% and 20 percentage points lower than the highest-performing country (97%).
Seven out of ten (69%) people with chronic conditions in Portugal report experiencing good quality of care, significantly below the OECD PaRIS average of 87% and 28 percentage points lower than the highest-performing country (97%).
Slightly more than half (54%) of people with chronic conditions in Portugal trust their healthcare system, 8 percentage points below the OECD PaRIS average of 62% but 35 percentage points lower than the highest-performing country (89%).
Source: See Chapter 2 for more details.
People living with multiple chronic conditions report lower levels of physical and mental health, well-being and social functioning compared to those who live with one or no chronic condition (Chapter 3). This is also the case in Portugal, yet the scores are generally below the OECD PaRIS average. Specifically:
In Portugal, people with three or more chronic conditions are less likely to report better health compared to those with two chronic conditions. This pattern, consistent with other countries’ results, underscores the compounded health burdens experienced by people with multiple chronic conditions, emphasising the escalating toll that each additional chronic condition takes on their health and well-being.
People living with multiple chronic conditions in Portugal have poorer physical health compared to those living with one chronic condition with an eight‑point difference, a pattern consistent with the PaRIS average. However, the physical health scores for people with one, two, or three or more chronic conditions in Portugal are below the OECD PaRIS average (Figure 2). People with three or more chronic conditions in Portugal score on average under the good-fair cut off point (42) for physical health in Portugal, similar to the OECD PaRIS average.
Similarly, Portugal performs lower than the OECD PaRIS average regarding the mental health of people living with one, two, and three or more chronic conditions. People with multiple chronic conditions in Portugal report poorer mental health than those with one chronic condition with a five‑point difference. Additionally, people with two and three or more chronic conditions score below the OECD PaRIS average for people with three or more chronic conditions (Figure 3). All results score on average above the good-fair cut off point (40) for mental health.
People with multiple chronic conditions less often report good social functioning than people with one chronic condition in Portugal, as elsewhere (Figure 4). While 83% of people with one chronic condition in Portugal have good social functioning, this goes down to 60% of people with three or more chronic conditions, which is 14 percentage points below the OECD PaRIS average.
Primary care consultation features associated with higher levels of experienced quality care are related to time, both time‑scheduled for regular, follow-up consultations, and length of relationship with the same primary care professional (Chapter 3). The role of staff other than physicians supporting the management of people with chronic conditions also plays a role in improving healthcare delivery for people with multiple chronic conditions (Chapter 3). Systematic medication reviews in people with multiple chronic conditions can enhance medication safety and efficacy while also increasing experienced care co‑ordination.
Portugal shows some positive primary care characteristics, yet the continuity with the same primary care professional can be further improved (Figure 5):
More than four out of five people (86%) with two or more chronic conditions in Portugal are managed in primary care practices that offer follow-up and regular consultations of more than 15 minutes; this is more than far above the OECD PaRIS average of 47%.
In Portugal, most people (97%) with two or more chronic conditions are managed in primary care practices where non-physician staff is involved in chronic disease management; this is 14 percentage points higher than the OECD PaRIS average of 83%.
Seven out of ten people (71%) with three or more chronic conditions in Portugal report that their medication was reviewed by a healthcare professional over the past 12 months; this is comparable to the OECD PaRIS average of 75%.
Half of the people with two or more chronic conditions in Portugal report being with the same primary care professional for more than five years; this is 8 percentage points below the OECD PaRIS average (58%).
People‑centred care, healthcare systems addressing the needs of people, is an essential indicator of the quality and performance of healthcare systems and individual care providers (Chapter 4). PaRIS data show that a people‑centred approach that prioritises strong patient engagement and effective care co‑ordination, is associated with enhanced health outcomes and patient experiences. This approach is particularly beneficial in managing chronic conditions, as it empowers patients to actively participate in decisions about their health.
While primary care practices in Portugal report availability of digital tools to support patient care, patients need further support to benefit from them (Figure 6):
Slightly less than half (49%) of the people with chronic conditions in Portugal receive enough support to manage their own health, significantly below the OECD PaRIS average of 63%.
Portugal reports low digital health literacy, with 12% of people with chronic conditions reporting confidence in using health information from the internet, which is below the OECD PaRIS average of 19% (range of 5‑34%).
A slightly lower proportion (53%) of people with chronic conditions are managed in primary care practices that report being well-prepared to co‑ordinate care, compared to the OECD PaRIS average of 56%.
However, 80% of people with chronic conditions are managed in practices that can exchange medical records electronically, which is significantly above the OECD PaRIS average of 57%.
These results highlight Portugal’s strengths in electronic medical record adoption but reveal challenges in providing sufficient support for patients and improving digital health literacy and care co‑ordination in primary care settings.
There are differences in well-being and trust in the healthcare systems across genders in Portugal, both indicators being lower for women.
The gender gap in well-being in Portugal is double the OECD PaRIS average (5 points). This gender gap is the largest among the OECD PaRIS countries. Both men and women report lower levels of well-being compared to the OECD PaRIS average (Figure 7).
In Portugal, 57% of men have trust in the healthcare system, compared to 51% of women (Figure 8). These trust levels are much below the OECD PaRIS average for both men (67%) and women (58%).
The gender gap in trust in Portugal (7 percentage points) is smaller than the OECD PaRIS average gap (9 percentage points) and is not statistically significant.
Similar to other OECD countries, people with chronic conditions and higher incomes report higher levels of well-being and trust in the healthcare system:
Across OECD PaRIS countries, people with higher incomes report higher well-being scores than those with lower incomes (seven points difference). Levels in Portugal are lower than the OECD PaRIS average (Figure 9).
Six out of ten people with chronic conditions in Portugal (64%) with higher incomes trust the healthcare system, compared to 48% of people with lower incomes. Trust in the healthcare system is lower than the OECD PaRIS average for both high (70%) and low (59%) income groups (Figure 10).
The gap in trust in healthcare system between high- and low-income groups in Portugal is 16 percentage points, above the 11% OECD PaRIS average.
PaRIS at a glance
PaRIS contains information on patient-reported outcomes and experience measures as well as health behaviours and capabilities, sociodemographic characteristics from patients and primary care practice characteristics information from healthcare providers. The data collection took place in 2023‑24 and first results were released in the publication, Does Healthcare Deliver: Results from the Patient-Reported Indicator Surveys (PaRIS).
Results span 107 011 primary care users (aged 45 years and older) and 1 816 primary care practices in 19 countries: Australia, Belgium, Canada, Czechia, France, Greece, Iceland, Italy, Luxembourg, Netherlands, Norway, Portugal, Romania, Saudi Arabia, Slovenia, Spain, Switzerland, the United States and Wales (United Kingdom). All results in this country note are age-sex standardised to adjust for the different demographic profiles of the countries. In Figure 1, highest (lowest) represents the highest (lowest) values found for each indicator among 17 PaRIS countries. In Italy and the United States, eligibility criteria for patient participation differed from the guidelines, therefore, these countries are not included in this figure. For detailed information on national sampling procedures and other methodological details, see Chapter 7 of the report.
Results from Portugal are based on 11 744 patients and 91 primary care practices. Patients were selected by probability sampling from the registry of patients of participating practices. Primary care practices were selected by probability sampling from the national primary healthcare provider registry.
In Portugal, primary care practices responded to the questionnaire online. Patients responded to the questionnaire online and via paper-and-pencil surveys.
This work is published under the responsibility of the Secretary-General of the OECD. The opinions expressed and arguments employed herein do not necessarily reflect the official views of the Member countries of the OECD.
This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area.
The full book is available in English: OECD (2025), Does Healthcare Deliver?: Results from the Patient-Reported Indicator Surveys (PaRIS), OECD Publishing, Paris, https://doi.org/10.1787/c8af05a5-en.
© OECD 2025
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