Comparing patient‑reported outcome and experience measures in international health surveys

1. The patient voice in health policymaking

In recent decades, policymakers and health authorities have increasingly shown interest in transitioning to a people‑centred healthcare model, putting the needs and preferences of patients at the centre of care delivery and performance management (OECD, 2021[1]). Reflecting this shift, the renewed OECD Health System Performance Assessment Framework positions people’s health needs and preferences both as an objective of health systems, and as a key lever for achieving other policy objectives (OECD, 2024[2]).  Although healthcare systems aim to maximise the health and well-being of the people they serve, few systematically assess their performance from people’s perspectives. Traditional performance measures have focussed on inputs (such as the number of healthcare professionals), processes (such as the number of prescriptions) and clinical and biomedical outcomes such as mortality or morbidity rates. While this information is highly valuable, an essential piece of information is missing, namely data from the patient perspective.

Patient-reported outcome and experience measures (PROMs and PREMs) have been increasingly filling this gap by assessing health outcomes and care experiences of people through validated standardised tools, without the interpretation of a healthcare professional or others (Valderas and Alonso, 2008[3]). PROMs capture patients’ perspectives on health status, physical and social functioning, symptom burden, and psychological well-being. PREMs capture care experiences and interactions with healthcare professionals including communication, co‑ordination, shared decision making, and respect.

Patient-reported data, collected through PROMs and PREMs, serve multiple functions across different levels of the healthcare system. At the clinical level (micro), PROMs and PREMs can offer useful insights into individual patients’ outcomes and experiences, and improve communication between patients and healthcare professionals, and shared-decision making (Forefront Group, 2019[4]). At the organisational level (meso), aggregated results can inform care delivery and enhance the quality of care (Greenhalgh et al., 2017[5]). At the system level (macro), aggregated results can be used for assessing the performance of healthcare systems in delivering quality of care (Ernst et al., 2022[6]; Kendir et al., 2025[7]; Kendir et al., 2022[8]; Kendir et al., 2026[9]; Kendir et al., 2025[10]).

1.1. International data collections provide standardised and harmonised data, allowing cross-country comparison and learning

International data collections can produce standardised, harmonised datasets, facilitating benchmarking and cross-country learning. The OECD’s flagship publication Health at a Glance, published on a biennial basis, includes a set of standardised performance indicators for international benchmarking of healthcare systems’ performance on access, quality and health financing (OECD, 2025[11]). Since 2017, a selected set of PROMs and PREMs have been collected through national and subnational data sources and reported internationally in Health at a Glance to benchmark the quality of care from the patient perspective. These indicators include PREMs, patient-reported incidence measures (PRIMs), patient-reported quality of life before and after hip and knee replacement surgery, care experiences among people with mental health conditions and satisfaction with outcomes following breast cancer surgery (OECD, 2023[12]; OECD, 2021[13]; OECD, 2019[14]). Yet, the international comparability has remained limited due to variations in data sources and methods as well as the limited set of countries which were able to report such patient-reported data (Kendir et al., 2022[8]; de Bienassis et al., 2022[15]).

OECD Member and Partner countries work together in the Patient Reported Indicator Surveys (PaRIS) initiative to develop, standardise and collect harmonised data on PROMs and PREMs from primary care users (OECD, 2025[16]). Following an extensive design and development phase, co-developed with patients, healthcare professionals and academic experts, PaRIS collected data from over 107 000 primary care users in 2023‑2024 (van den Berg et al., 2024[17]; Kendir et al., 2023[18]; Kendir et al., 2024[19]). Based on the PaRIS conceptual framework, the questionnaires collected information on patients’ physical and mental health, social functioning, well-being, general health, experienced care quality, care co‑ordination, people‑centredness, trust, as well as sociodemographic characteristics and health behaviours and capabilities (Valderas et al., 2024[20]; Valderas et al., 2025[21]). Complementing the patient questionnaire, a primary care practice questionnaire was used to collect information from their primary care practices regarding the provision of care, allowing analysis of characteristics of primary care associated with better health outcomes and care experiences (Bloemeke-Cammin et al., 2024[22]).

While PaRIS has become an essential source of information, it is not the only international initiative collecting data on PROMs and PREMs. Policymakers have other sources of information at the international level such as International Health Policy (IHP) Survey of the Commonwealth Fund survey, People’s Voice Survey (PVS) and European Health Interview Survey (EHIS) (Commonwealth Fund, 2024[23]; Eurostat, 2019[24]; Lewis et al., 2023[25]). While these initiatives may appear to collect similar types of information, they differ in their purpose, scope and methods. This abundance of information can create complexity for policymakers and hamper the selection of the right source of information for a given policy question. Key factors to consider include whether different initiatives overlap or complement each other, how their results compare, and what unique insights each survey offers for understanding and improving the performance of healthcare systems. This paper provides guidance to policymakers on choosing the most relevant data sources for specific policy needs.

This paper compares five major international surveys collecting PROMs and PREMs: OECD’s PaRIS, EHIS, the IHP survey, PVS and SHARE. It examines the distinct value proposition of each survey and compares the results across a selected comparable set of indicators. These surveys are selected based on their large international scope and visibility, as well as on the availability of information on the methods and microdata on PROMs and/or PREMs.

Section 2 details the methodological comparison of these selected surveys, including the conceptual domains and questionnaire items assessing PROMs and PREMs. Section 3 compares the results on a selected set of comparable indicators across PaRIS, EHIS, the IHP survey and PVS, and presents the results on selected indicators through strict harmonisation and standardisation. Section 4 provides an overview of the unique value of each survey and includes recommendations for policymakers.