Does Healthcare Deliver? Results from the Patient‑Reported Indicator Surveys (PaRIS): Belgium
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 Belgium. 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 Belgian 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 two‑thirds (68%) of people with chronic conditions in Belgium report good physical health, as measured by physical function, pain, and fatigue. This is slightly below the OECD PaRIS average of 70%.
More than four out of five (83%) people with chronic conditions in Belgium report good mental health, measured in terms of quality of life, emotional distress, and social health. This matches the OECD PaRIS average but is 10 percentage points lower than the highest-performing country (93%).
More than nine out of ten (93%) people with chronic conditions in Belgium report good person-centred care, care focusing on patient’s needs, which is above the OECD PaRIS average of 87%.
Two-thirds (67%) of people with chronic conditions in Belgium report good care co‑ordination, which is well above the OECD PaRIS average of 59%. Yet less than half (45%) of people are managed in primary care practices that are well-prepared to co‑ordinate care, which is below the OECD PaRIS average of 56%.
About two out of three people (65%) with two or more chronic conditions in Belgium are managed in primary care practices that offer follow-up and regular consultations of more than 15 minutes; this is about 18 percentage points higher compared to the OECD PaRIS average of 47%.
Almost half of people in Belgium (46%) with two or more chronic conditions are managed in primary care practices where non-physician staff is involved in chronic disease management; this is 37 percentage points lower than the OECD PaRIS average of 83%.
All people with chronic conditions in Belgium are managed in primary care practices that can exchange medical records electronically, far above the OECD PaRIS average of 57%.
Around one in ten people (8%) with chronic conditions feels confident in using health information from the internet, compared to the OECD PaRIS average of 19% (range of 5‑34%).
Both experiences of healthcare and health outcomes of people with chronic conditions in Belgium are around the OECD PaRIS average, with more people with chronic conditions reporting experienced good quality of care and care focusing on their needs (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 Belgium, people with chronic conditions have health outcomes comparable the OECD PaRIS average (Figure 1).
More than two‑thirds (68%) of people with chronic conditions in Belgium report good physical health, as measured by physical function, pain, and fatigue. This is slightly below the OECD PaRIS average of 70% and 14 percentage points lower than the highest-performing country (82%).
More than four out of five (83%) people with chronic conditions in Belgium report good mental health, measured in terms of quality of life, emotional distress, and social health. This matches the OECD PaRIS average but is 10 percentage points lower than the highest-performing country (93%).
More than four out of five (85%) people with chronic conditions in Belgium report good social functioning, which measures how well people carry out their usual social activities and roles. This is slightly above the OECD PaRIS average of 83% but 8 percentage points below the highest-performing country (93%). Similarly, more than seven out of ten (71%) people in Belgium report positive well-being – which reflects mood, vitality, and fulfilment. This matches the OECD PaRIS average but is 9 percentage points lower than the highest-performing country (80%).
Nearly three‑quarters (72%) of people with chronic conditions in Belgium report good general health, which is well above the OECD PaRIS average of 66% but 21 percentage points lower than the highest-performing country (93%).
In Belgium, people living with chronic conditions are more likely to have good experiences of quality of care, person-centred care -care focusing on patient’s needs- and co‑ordination of care compared to the OECD PaRIS average (Figure 1).
Nearly two‑thirds (63%) of people with chronic conditions in Belgium feel confident managing their own health, which is above the OECD PaRIS average of 59% but 29 percentage points lower than the highest-performing country (92%).
Two-thirds (67%) of people with chronic conditions in Belgium report good care co‑ordination, which is well above the OECD PaRIS average of 59% but 14 percentage points lower than the highest-performing country (81%).
More than nine out of ten (93%) people with chronic conditions in Belgium report good person-centred care, care focusing on patient’s needs, which is considerably above the OECD PaRIS average of 87% and only 4 percentage points lower than the highest-performing country (97%).
Most people with chronic conditions in Belgium (95%) report experiencing good quality of care, which is significantly above the OECD PaRIS average of 87% and only 2 percentage points lower than the highest-performing country (97%).
Seven out of ten (70%) people with chronic conditions in Belgium trust their healthcare system, which is 8 percentage points above the OECD PaRIS average of 62%.
Source: See Chapter 2 for more details.
In Belgium, 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 chronic condition (Chapter 3). People with three or more chronic conditions in Belgium are less likely to report good health compared to those with two chronic conditions, particularly for physical health. This pattern is consistent with other countries’ results.
People living with multiple chronic conditions in Belgium have poorer physical health compared to those living with only one chronic, a pattern consistent with the OECD PaRIS average (Figure 2). For example, in Belgium, the average physical health score of people with three or more chronic conditions is below the good-fair cutoff point (42), about 8‑points lower than people with one chronic condition, comparable the OECD PaRIS average.
Similarly, mental health scores of people with chronic conditions in Belgium are comparable with the OECD PaRIS average. People with multiple chronic conditions in Belgium report poorer mental health than those with one chronic condition with a four‑point difference. Nevertheless, the average mental health score for people with three or more chronic conditions in Belgium is above the good-fair cutoff of 40, as is the OECD PaRIS average (Figure 3).
Like in most countries, people with multiple chronic conditions in Belgium less often report good social functioning than people with one chronic condition (Figure 4). While 91% of people with one chronic condition in Belgium have good social functioning, this goes down to 76% of people with three or more chronic conditions, comparable to the OECD PaRIS average for this group (75%).
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.
Belgium performs generally well in primary care features compared to the OECD PaRIS average (Figure 5). Belgium is significantly above the OECD PaRIS average in the time‑scheduled for consultations, yet it is below average for non-physician staff involved in chronic care management:
About two out of three people (65%) with two or more chronic conditions in Belgium are managed in primary care practices that offer follow-up and regular consultations of more than 15 minutes; this is about 18 percentage points higher compared to the OECD PaRIS average of 47%.
In Belgium, almost half of people (46%) with two or more chronic conditions are managed in primary care practices where non-physician staff is involved in chronic disease management; this is 37 percentage points lower than the OECD PaRIS average of 83%.
Four out of five people (82%) with three or more chronic conditions in Belgium report that their medication was reviewed by a healthcare professional over the past 12 months; this is 7 percentage points higher than the OECD PaRIS average of 75%.
Almost six out of ten people with two or more chronic conditions (58%) in Belgium report being with the same primary care professional for more than five years; comparable to the OECD PaRIS average.
People‑centred care, healthcare systems addressing the needs of people, is an essential indicator of the quality and performance of healthcare systems and primary care practices (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.
Belgium demonstrates mixed performance on indicators of people‑centred care, compared to the OECD PaRIS average (Figure 6):
Around 69% of people with chronic conditions in Belgium receive enough support to manage their own health, which is above the OECD PaRIS average of 63%.
However, Belgium lags significantly behind in digital health literacy, with only 8% of people with chronic conditions feels confident in using health information from the internet, compared to the OECD PaRIS average of 19% (range of 5‑34%).
All people with chronic conditions in Belgium are managed in primary care practices that can exchange medical records electronically, far exceeding the OECD PaRIS average of 57%.
Conversely, only 45% of people with chronic conditions are managed in practices that are well-prepared to co‑ordinate care, which is below the OECD PaRIS average of 56% (Figure 6).
These results highlight Belgium’s strong infrastructure for electronic medical records but point to significant opportunities to enhance digital health literacy and care co‑ordination in primary care practices.
Among people with chronic conditions, there are differences in well-being and trust in the healthcare systems across genders in Belgium, both indicators being lower for women (Figure 7 and Figure 8).
The gender gap in well-being in Belgium is similar to the OECD PaRIS average (5 points). This gender gap mirrors results for other countries. Belgium performs comparable to the OECD PaRIS average in terms of well-being for both men and women.
While about 74% of men in Belgium have trust in the healthcare system, the percentage for women is lower (67%). These results for trust are higher than the OECD PaRIS average for both men (67%) and women (58%).
The gender gap in trust in Belgium (7 percentage points) is smaller than the OECD PaRIS average gap (9 percentage points).
As in other OECD countries, people with chronic conditions and higher incomes reports higher well-being and trust in the healthcare system (Figure 9 and Figure 10):
Across OECD PaRIS countries, people with chronic conditions and higher incomes report better well-being than those with lower incomes (seven points). Belgium levels are around the OECD PaRIS average.
Almost eight out of ten people (77%) with chronic conditions and higher incomes in Belgium trust the healthcare system, compared to 64% of people with lower incomes. The trust levels in the healthcare system across income groups are higher than the OECD PaRIS average for high (70%) and low (59%) income groups. The gap between high- and low-income groups in Belgium is comparable to the OECD PaRIS average.
PaRIS at a glance
PaRIS contains information on patient-reported outcome 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 for Belgium are based on 4 372 patients and 83 primary care practices. Patients were sampled by probability sampling from the registry of patients of participating practices. All primary care practices from the National Institute for Health and Disability Insurance were invited to participate in the survey.
In Belgium, 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.
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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
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