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

4. Key lessons and recommendations

This comparative analysis shows that these five international surveys collecting PROMs and PREMs are largely complementary rather than substitutable. Although they share some overlapping concepts and instruments, differences in purpose, target population, survey design and analytical structure mean that each initiative generates distinct types of policy‑ and practice‑relevant insights. No single survey provides a comprehensive picture of population health, care experiences and health system performance from the patient perspective. Instead, policymakers are best served by understanding the comparative advantage of each survey and using them strategically, either individually or in combination, depending on the policy question at hand.

The analysis confirms that the primary determinant of a survey’s usefulness is its underlying purpose. Population-based surveys such as EHIS and SHARE are well-suited for monitoring population health, health behaviours and social gradients, while experience‑focussed surveys such as the IHP survey and PVS provide rapid insights into access, affordability, and perceived system performance. PaRIS occupies a distinct position by focussing on people living with chronic conditions who use primary care services, enabling a more granular assessment of care processes, outcomes and self-management support.

Policymakers should therefore avoid direct comparisons across surveys without careful alignment of reference populations. Differences in age coverage, eligibility criteria and sampling frames influence reported outcomes and experiences. PaRIS’ multilevel design allows patient-reported outcomes and experiences to be analysed in relation to primary care practice characteristics and system contexts, while accounting for clustering at the practice and country level. This allows assessment of differences both between and within countries (between practices). This analytical capability is largely absent from other international surveys and results in country estimations corrected for the practice effect. This is particularly important for patient experiences where practice effect can account for up to 7% of the variation (OECD, 2025[16]). By contrast, longitudinal designs such as SHARE provide unique insights into trajectories over time, while rapid-cycle surveys such as the IHP survey and PVS prioritise timeliness over depth. These design choices imply trade‑offs between causal inference, benchmarking potential, responsiveness to policy change and operational feasibility.

Only a small number of indicators can be meaningfully compared across surveys, and these are concentrated in specific domains. Patient experience indicators show the greatest overlap between PaRIS, the IHP survey and PVS, while PROMs are more comparable between PaRIS, EHIS and SHARE. Lifestyle and behavioural indicators are largely confined to EHIS (and to a lesser extent, SHARE).

Collecting only PROMs and PREMs is not sufficient. A survey’s policy value depends on governance arrangements, analytical capacity, and pathways linking data to quality improvement, accountability and system reforms. Surveys differ substantially in the extent to which they are embedded in national health information systems. PaRIS’ co-development with countries and its alignment with healthcare system performance assessment frameworks strengthen its potential for policy use, but real impact depends on national follow-up and institutionalisation.

4.1. Choosing the right source of information for a given policy question

The surveys considered in this report differ not only in their substantive focus but also in the balance they strike between methodological rigour, operational complexity and ease of implementation. These differences have important implications for the types of policy questions they are best suited to address.

Surveys such as PVS prioritise speed, flexibility and ease of field implementation. Its rapid data‑collection model and predominantly telephone‑based approach enable broad geographic coverage, including low‑ and middle‑income countries across all continents, and timely insights into perceived access, barriers to care and experiences of health system responsiveness. However, this efficiency comes with trade‑offs. Shorter instruments and reliance on telephone sampling may under‑represent populations with greater health needs, including people who are sicker, more frail or less reachable by phone, which should be considered when interpreting results.

By contrast, PaRIS adopts a more resource‑intensive and methodologically complex design. It requires substantial upfront investment in field testing, co‑ordination with primary care practices and structured patient recruitment, reflecting its two‑stage sampling framework anchored in healthcare delivery settings. This complexity allows PaRIS to generate more granular and clinically relevant insights, particularly for people living with chronic conditions, by directly linking patient‑reported outcomes and experiences to characteristics of primary care practices. Importantly, PaRIS is the only survey among those reviewed that actively involves healthcare professionals and primary care practices, and it uniquely enables feedback of results at the practice level, supporting local quality improvement and system‑level learning.

Geographic scope and comparability also differ markedly across surveys. PVS is the only instrument with truly global reach, covering a diverse mix of low‑, middle‑ and high‑income countries. This diversity is a major strength for understanding broad patterns in perceived access and experience but limits direct benchmarking across more comparable health systems. In contrast, PaRIS, EHIS, SHARE and the International Health Policy Survey primarily cover OECD or European countries, facilitating comparison among systems with more similar economic contexts, institutional arrangements and health system capacities.

Policymakers should begin by clearly defining the policy question and then selecting the survey best aligned with that purpose:

• To monitor population health status, health behaviours and equity in Europe, population-based surveys such as EHIS (and SHARE for ageing populations) are most appropriate.

• To assess access, affordability and perceived system performance, the IHP survey provides timely insights, as does the PVS survey, which assesses confidence in the health system.

• To benchmark healthcare performance for people living with chronic conditions across OECD Member and partner countries, link outcomes and experiences and identify practice‑level levers for improvement, PaRIS offers unique added value.

Rather than viewing surveys in isolation, policymakers should develop strategies that combine insights across initiatives. For example, EHIS can identify population groups with unmet needs, while PaRIS can shed light on how care is delivered to those groups once they contact the healthcare system. Such a layered approach improves diagnostic precision and supports more targeted interventions.

Direct comparisons of indicator levels across surveys should be avoided unless populations, recall periods and response categories are carefully aligned. Where comparisons are needed, policymakers should rely on standardisation to a common reference population and transparent documentation of methodological differences. Headline comparisons without such adjustments risk misleading conclusions and inappropriate policy responses.

Countries participating in PaRIS should actively leverage its multi-level design to examine how primary care organisation, structures and care processes are associated with health outcomes and care experiences. This includes identifying practice‑level variation and informing targeted quality improvement initiatives. PaRIS data are particularly well-suited to informing chronic care strategies, primary care strengthening and people‑centred care reforms.

Embedding PROMs and PREMs in routine performance assessment and quality improvement cycles is essential for translating measurement into meaningful change. To maximise impact, countries should invest in analytical capacity to interpret patient-reported data, clear governance arrangements defining ownership and use, and feedback mechanisms that return results to healthcare professionals, policymakers and the public.

International surveys of patient-reported outcomes and experiences have become indispensable tools for people‑centred health system governance. This analysis demonstrates that their value lies in the diversity of design and purpose. PaRIS adds a distinctive and policy-relevant lens by linking what matters to patients with how primary care is organised and delivered. When used thoughtfully and in combination with other international data sources, these surveys can strengthen evidence‑informed policymaking and support the transition toward more people‑centred, high-performing health systems.