Does Healthcare Deliver? Results from the Patient‑Reported Indicator Surveys (PaRIS): Iceland
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 of Iceland. 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 Icelandic 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.
In Iceland, nearly two‑thirds (65%) of people with chronic conditions report good physical health, slightly below the OECD PaRIS average of 70%. Similarly, 82% report good mental health, aligning closely with the OECD PaRIS average of 83%.
Nearly three‑quarters (74%) of people with chronic conditions in Iceland report positive well-being, exceeding the OECD PaRIS average of 71%.
One‑third (35%) of people with chronic conditions in Iceland feel confident managing their own health, which is significantly below the OECD PaRIS average of 59% and 57 percentage points lower than the highest-performing country (92%).
Slightly more than half (53%) of people with chronic conditions in Iceland receive enough support to manage their own health, which is below the OECD PaRIS average of 63%.
About one‑third (34%) of people in Iceland report good care co‑ordination, which is below the OECD PaRIS average of 59% and 47 percentage points lower than the highest-performing country (81%).
Fewer than half of the people (46%) with three or more chronic conditions in Iceland report that their medication was reviewed by a healthcare professional over the past 12 months; this is about 30 percentage points below the OECD PaRIS average of 75%.
Less than 1% of patients are managed in primary care practices that report being well-prepared to co‑ordinate care, which is far below the OECD PaRIS average of 56%.
In Iceland, people with chronic conditions have poorer experiences of healthcare, compared to the OECD PaRIS average. While more people with chronic conditions report good well-being, favourable physical health and social functioning are 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 Iceland, the likelihood of achieving good health outcomes for people with chronic conditions is comparable to the OECD PaRIS average (Figure 1).
Nearly two‑thirds (65%) of people with chronic conditions in Iceland report good physical health, as measured by physical function, pain, and fatigue. This is slightly below the OECD PaRIS average of 70% and 17 percentage points lower than the highest-performing country (82%).
More than four out of five (82%) people with chronic conditions in Iceland report good mental health, which refers to quality of life, emotional distress, and social health. This is similar the OECD PaRIS average of 83% and 11 percentage points lower than the highest-performing country (93%).
More than three‑quarters (78%) of people with chronic conditions in Iceland report good social functioning, which measures how well people carry out their usual social activities and roles. This is slightly below the OECD PaRIS average of 83% and with a 15 percentage point difference with the highest-performing country (93%).
Nearly three‑quarters (74%) of people with chronic conditions in Iceland report positive well-being, which reflects mood, vitality, and fulfilment. This is slightly above the OECD PaRIS average of 71% and only 6 percentage points below the highest-performing country (80%).
Nearly two‑thirds (62%) of people with chronic conditions in Iceland report good general health, which is slightly below the OECD PaRIS average of 66%, but 31 percentage points lower than the highest-performing country (93%).
The percentage of people with chronic conditions having good experiences of healthcare in Iceland below the OECD PaRIS average (Figure 1).
Slightly more than one‑third (35%) of people with chronic conditions in Iceland feel confident managing their own health, which is below the OECD PaRIS average of 59% and 57 percentage points lower than the highest-performing country (92%).
About one‑third (34%) of people with chronic conditions in Iceland report good care co‑ordination, which is below the OECD PaRIS average of 59% and 47 percentage points lower than the highest-performing country (81%).
Just over three‑quarters (77%) of people with chronic conditions in Iceland report good person-centred care, care focusing on patient’s needs, which is below the OECD PaRIS average of 87% and 20 percentage points lower than the highest-performing country (97%).
Nearly three‑quarters (74%) of people with chronic conditions in Iceland report experiencing good quality of care, which is below the OECD PaRIS average of 87% and 23 percentage points lower than the highest-performing country (97%).
More than half (54%) of people with chronic conditions in Iceland trust their healthcare system, which is 8 percentage points below the OECD PaRIS average of 62%.
Source: See Chapter 2 for more details.
People in Iceland 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). This pattern is consistent with other countries. Specifically:
In Iceland, people with three or more chronic conditions are less likely to report good health compared to those with two chronic conditions. This pattern is consistent with other countries’ results.
People living with several chronic conditions in Iceland have poorer physical health compared to those living with one chronic condition with a 7‑point difference, a pattern consistent with the OECD PaRIS average. The physical health scores for people with one, two, or three or more chronic conditions in Iceland are comparable to the OECD PaRIS average (Figure 2). People with three or more chronic conditions in Iceland score below the good-fair cutoff point (42), similar to the OECD PaRIS average.
Iceland performs comparable to 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 Iceland report poorer mental health than those with one chronic condition with a five‑point difference, comparable to the OECD PaRIS average (Figure 3).
People with multiple chronic conditions less often report good social functioning than people with one chronic condition in Iceland, as elsewhere (Figure 4). While 87% of people with one chronic condition in Iceland have good social functioning, this goes down to 66% of people with three or more chronic conditions, which is slightly below the OECD PaRIS average of 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.
Iceland performs generally well in the primary care features assessed (Figure 5):
Four out of five people (81%) with two or more chronic conditions in Iceland are managed in primary care practices that offer follow-up and regular consultations of more than 15 minutes; this is more than 34 percentage points higher compared to the OECD PaRIS average of 47%.
In Iceland, almost all people (99%) with two or more chronic conditions are managed in primary care practices where non-physician staff is involved in chronic disease management; this is 16 percentage points higher than the OECD PaRIS average of 83%.
Less than half of the people (46%) with three or more chronic conditions in Iceland report that their medication was reviewed by a healthcare professional over the past 12 months; this is about 30 percentage points below the OECD PaRIS average of 75%.
More than half of the people with two or more chronic conditions (56%) in Iceland report being with the same primary care professional for more than five years; this is comparable to 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 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.
On several indicators of people‑centred care, Iceland demonstrates mixed performance compared to the OECD PaRIS average (Figure 6):
Around 53% of patients with chronic conditions in Iceland receive enough support to manage their own health, which is notably below the OECD PaRIS average of 63%.
Iceland’s digital health literacy is slightly below average, with 17% of people with chronic conditions reporting confidence in using health information from the internet, compared to the OECD PaRIS average of 19% (range of 5‑34%).
Less than 1% of patients are managed in primary care practices that report being well-prepared to co‑ordinate care, which is far below the OECD PaRIS average of 56%.
However, 61% of patients are managed in practices that can exchange medical records electronically, which is slightly above the OECD PaRIS average of 57% (Figure 6).
These results highlight Iceland’s strong adoption of electronic medical records but reveal significant challenges in care co‑ordination and providing sufficient support for patients with chronic conditions.
Among people with chronic conditions, there are differences in well-being and trust in the healthcare systems across genders in Iceland, both indicators being generally lower for women (Figure 7 and Figure 8).
The gender gap in well-being in Iceland is comparable to the OECD PaRIS average (5 points). This gender gap mirrors results for other countries, but both men and women in Iceland report above‑average levels of well-being.
In Iceland, 62% of men with chronic conditions trust the healthcare system, compared to only 49% of women with chronic conditions (Figure 8). These results for trust are much lower than the OECD PaRIS average, particularly for women (58%).
The gender gap in trust in Iceland (14 percentage points) is somewhat larger than the OECD PaRIS average gap (9 percentage points).
Similar to other OECD countries, people with chronic conditions and higher incomes report higher well-being and trust in the healthcare system (Figure 9 and 10):
Across OECD PaRIS countries, people with chronic conditions and higher incomes report better well-being than those with lower incomes (3 point difference). However, well-being levels in Iceland are higher in all groups compared to the OECD PaRIS average.
In Iceland, among people living with chronic conditions, six out of ten people (62%) with higher incomes trust the healthcare system, compared to 50% of people with lower incomes. The trust levels in the healthcare system across income groups are much lower than the OECD PaRIS average for high (70%) and low (59%) income groups.
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 professionals. 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 Iceland are based on 1 864 patients and 36 primary care practices. Patients were sampled by probability sampling from the registry of patients of participating practices. All primary care practices from the National registry of healthcare providers were invited to participate in the survey.
In Iceland, primary care practices responded to the questionnaire online. Patients responded to the questionnaire online.
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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