Does Healthcare Deliver? Results from the Patient‑Reported Indicator Surveys (PaRIS): Spain
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 Spain. 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 Spanish 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.
Eight out of ten (81%) of people with chronic conditions report good mental health, and 69% report good well-being, both comparable to the OECD PaRIS average.
A large majority of people with chronic conditions rate the quality of care as good (86%) and experience care as person-centred (85%), but very few primary care practices report scheduled consultations times of 15 minutes or more (4%), significantly below the OECD PaRIS average (47%).
In Spain, 67% of people with chronic conditions are confident in managing their own health, and only 9% report confidence in using health information from the internet.
Spain performs well in care co-ordination (65% of people with chronic conditions reporting good co-ordination) and demonstrates high involvement of non-physician staff (97% of primary care practices) in chronic disease management.
While trust in primary care professionals is high (89%), less than half (45%) of people with multiple chronic conditions in Spain have been with the same primary care professional for more than five years, falling short of the OECD PaRIS average (58%).
In Spain, people with chronic conditions have experiences of healthcare around the OECD PaRIS average, however, there remains room for improvement in certain health outcomes when compared to the OECD 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 Spain, the percentage of people living with chronic conditions reporting good health outcomes is slightly lower the OECD PaRIS average (Figure 1):
Three out of five people (60%) with chronic conditions in Spain report good physical health, less than the OECD PaRIS average of 70% and 22 percentage points lower than the highest value in PaRIS. Physical health is measured with respect to physical function, pain and fatigue.
Four out of five people (81%) with chronic conditions in Spain report good mental health, measured in terms of quality of life, emotional distress and social health. This is 14 percentage points higher than the lowest value in PaRIS (67%) and comparable to the OECD PaRIS average (83%).
While most people (79%) with chronic conditions report that they are well able to carry out their usual social activities and roles (social functioning) in Spain. This is 5 percentage points lower than the OECD PaRIS average and 14 percentage points below the highest value in PaRIS.
Overall well-being – which measures how positive a person feels in terms of mood, vitality, and fulfilment in Spain is comparable to the OECD PaRIS average of 71%. In Spain, almost seven out of ten (69%) people with chronic conditions report good well-being (cross-country range: 59‑80). However, about half of people (55%) with chronic conditions in Spain experience their general health as good to excellent, compared to the 66% of OECD PaRIS average (cross-country range: 39‑93).
In Spain, the percentage of people living with chronic conditions reporting good experiences of healthcare is similar to the OECD PaRIS average (Figure 1):
In Spain, 67% of people with chronic conditions are confident that they can manage their own health. Similarly, about 65% of people with chronic conditions in Spain experience good care co-ordination. Both these measures are above the OECD PaRIS average (59%).
A high percentage (85%) of people in Spain perceive care as person-centred, and 86% experience good quality of care, which is in line with the OECD PaRIS average, where the highest values exceed 90%.
Most people (89%) living with chronic conditions in Spain have trust in the healthcare system. In Spain, the trust measure refers specifically to trust in the primary care professionals within people's primary care practice (see Table 1).
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 chronic condition (Chapter 3). In Spain this pattern is similar, yet with scores slightly below the OECD PaRIS average. Specifically:
In Spain, 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 wellbeing.
In Spain, people with multiple chronic conditions report poorer physical health than people with one chronic condition. While the gap between people with one, two and three or more chronic conditions is comparable to the OECD PaRIS average, people with three or more chronic conditions in Spain have physical health 3‑points below the good-fair cutoff of 42 (Figure 2).
Like in all countries, people with multiple chronic conditions in Spain report poorer mental health than people with one chronic condition. The gap between people with one, two and three or more chronic conditions is 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 Spain, as elsewhere (Figure 4). This is also the case in Spain, where people with 3 or more chronic conditions less likely to report good social functioning than those with one chronic condition (20 percentage point difference).
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 for people with multiple chronic conditions can enhance medication safety and efficacy while also increasing experienced care co-ordination.
Spain performs close to the OECD PaRIS average in most primary care features, yet below average for time scheduled for regular and follow-up consultations (Figure 5):
The percentage of people with two or more chronic conditions managed in primary care practices scheduling more than 15 minutes for regular or follow-up consultations, as reported by the participating practices, is notably low in Spain (4%), lower than the OECD PaRIS average (47%). Nearly 80% of people with multiple chronic conditions are managed in primary care practices in Spain reporting scheduled times between 5 and 10 minutes.
The involvement of non-physician staff in chronic disease management is among the highest in Spain (97%), 14 percentage points higher compared to the OECD PaRIS average (83%), highlighting strong multidisciplinary approaches in managing chronic conditions.
The percentage of people with three or more chronic conditions in Spain who report that a healthcare professional has reviewed all the medications they take with them is slightly below the OECD PaRIS average (71% vs 75%).
Additionally, the percentage of people with one or more chronic conditions in Spain who have been with the same primary care professional for more than five years is also lower than the OECD PaRIS average (respectively 45% and 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, Spain demonstrates mixed performance compared to the OECD PaRIS average:
Around two‑thirds (64%) of people with chronic conditions in Spain receive enough support to manage their own health, comparable to the OECD PaRIS average of 63% (Figure 6).
Spain shows a comparatively low level of digital health literacy, with less than one out of ten (9%) 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%) (Figure 6).
A higher proportion (61%) of people with chronic conditions are managed in primary care practices that report being well-prepared to co-ordinate care, which is above the OECD PaRIS average of 56% (Figure 6).
These results highlight Spain's strong focus on care co-ordination and support for patients.
Among people with chronic conditions, there are differences in well-being and trust in the healthcare systems across genders in Spain, both indicators being lower for women.
The gender gap in well-being in Spain is larger compared to the OECD PaRIS average (5 points). This gender gap mirrors results for other countries. Spain performs similar to the OECD PaRIS average in terms of well-being for men and women (Figure 7).
Among people with chronic conditions, slightly more men (90%) than women (87%) in Spain have trust in the healthcare system (Figure 8). These trust levels are the highest among the OECD PaRIS countries for both men (67% on average) and women (58% on average). In Spain, the trust measure refers specifically to trust in the primary care professionals within people's primary care practice (see Table 1).
The gender gap in trust in Spain (3 percentage points) is the smallest among the OECD PaRIS countries and is not statistically significant.
As in other OECD countries, people with chronic conditions and higher incomes report higher well-being and are more likely to trust the healthcare system:
Across OECD PaRIS countries, people with chronic conditions and higher incomes report better well-being than those with lower incomes (seven points). Spain’s levels are similar the OECD PaRIS average (Figure 9).
Almost nine out of ten (88%) people with chronic conditions in Spain with higher incomes trust the healthcare system, compared to 84% of people with lower incomes. In both groups trust levels are much higher compared to the OECD PaRIS average (Figure 10).
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 for Spain are based on 19 067 patients and 251 primary care practices. Patients were sampled by probability sampling from the National Health Card Database. Primary care practices were sampled by probability sampling from the Primary Care Information System.
In Spain, primary care practices responded to the questionnaire online. Patients responded to the questionnaire via telephone and 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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