Does Healthcare Deliver? Results from the Patient‑Reported Indicator Surveys (PaRIS): United States
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 the United States. 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 context of the United States and compares them to the OECD PaRIS average for the subgroup of people aged 65 years and older.1 The OECD PaRIS average is the simple average of the 17 OECD member countries participating in PaRIS.
The United States PaRIS sample differs from other participating countries as it excludes both the 45‑64 age group and practice‑level data.2 To facilitate the comparability of the United States results with those of other countries, this country note focuses exclusively on the 65 years and older population across all participating countries and draws solely from the patient questionnaire. The conclusions presented here remain consistent with the findings of the PaRIS flagship report, which is based on the complete and validated dataset. All comparisons have been age‑standardised to ensure alignment with the 65 years and older population in other countries.
In the United States, three out of four people (75%) with chronic conditions aged 65 and older with chronic conditions report good physical health, and nine out of ten (91%) report good mental health. Both indicators rank among the highest across participating countries and are significantly above the OECD PaRIS averages of 69% and 84%, respectively.
More than nine out of ten people with chronic conditions in the United States experience good person-centred care, which is care organised around the needs of the patients, and good quality of care (96% and 94%, respectively). The United States stands out as one of the highest performing countries on person-centred care and experienced quality of care for people 65 years and older.
Nearly two‑thirds of people living with chronic conditions (67%) trust their healthcare system, this puts the United States slightly above the OECD PaRIS average (65%).
In the United States, 67.5% of men and 64.7% of women report good well-being. This represents a smaller gap between men and women (2.8 points) compared to the OECD PaRIS average (5.1 points). The percentage of women in the United States who report good well-being is higher than the OECD PaRIS average (64.7% vs. 60.4%), while men also perform better than average, though by a smaller margin (67.5% vs. 65.5%).
In the United States, people aged 65 and older with chronic conditions report higher well-being scores than the OECD PaRIS average in higher (68 vs. 66) and middle‑education groups (66 vs. 63), while the low-education group matches the average (60). Nevertheless, the well-being gap between higher and lower education is slightly larger in the United States (7.5 points) compared to the OECD PaRIS average (6.3 points).
In the United States, people 65 years and older with chronic conditions3 have better care experiences and health outcomes compared to the OECD PaRIS average. 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).
People aged 65 and older living in the community with chronic conditions in the United States are more likely to have good health outcomes compared to those in other PaRIS countries (Figure 1):
Three out of four (75%) people in the United States report good physical health, referring to physical function, pain and fatigue. This is above the OECD PaRIS average (69%). The United States is one of the highest performing countries in physical health, with about 10 percentage point difference with the highest score.
Nine out of ten (91%) people report good mental health, and a comparable percentage of people (88%) report positive social functioning, which refers to the extent to which a person can carry out their usual social activities and roles. This places the United States among the highest performing countries in these areas with less than 5 percentage point difference with the highest scores.
Nearly four out of five (79%) people report good well-being – a measure of how positive a person feels in terms of mood, vitality, and fulfilment. In comparison, the OECD PaRIS average for people aged 65 and older with chronic conditions reporting good well-being is slightly lower at 75%.
Nearly four out of five (79%) people report good general health, which is above the OECD PaRIS average of 63% for people 65 years and older. Yet, there is still about a 20 percentage point difference between the United States and the highest performing country.
In the United States, elderly people living in the community with chronic conditions are more likely to have experiences of good quality of care, person-centred care, and co‑ordination of care – this places the United States as one of the best performers in the PaRIS results for the subgroup of people 65 years and older.
Three out of four (74%) people with chronic conditions in the United States are confident that they can manage their own health and well-being. This is above the OECD PaRIS average (59%). However, in the highest performing country, up to 93% of the population feels confident to manage their own health, which is about 20 percentage points higher than the United States.
Three out of four people (74%) with chronic conditions in the United States experience good care co‑ordination (cross-country range: 25‑85), more than 10 percentage points above the OECD PaRIS average (63%).
More than nine out of ten people with chronic conditions in the United States experience good person-centred care, which is care organised around the needs of the patients, and good quality of care (96% and 94%, respectively). The United States stands out as one of the highest performing countries on person-centred care and experienced quality of care for people 65 years and older.
Nearly two‑thirds (67%) of people living with chronic conditions trust their healthcare system, this puts the United States slightly above the OECD PaRIS average (65%).
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. This pattern is consistent with the PaRIS average for people of 65 years and older. Nevertheless, the average United States scores for people with multiple chronic conditions, for example on physical health and mental health, are better than the OECD PaRIS average, and above what is considered as a cutoff for good-fair health. Specifically:
In the United States, people 65 years and older with three or more chronic conditions are more likely to report worse 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 well-being.
People living with multiple chronic conditions in the United States score nine points lower in physical health compared to those living with one chronic condition, a pattern consistent with the OECD PaRIS average. However, the physical health scores for people with one, two, or three or more chronic conditions in the United States are all slightly higher than the OECD PaRIS average for people 65 years and older. For example, while the average physical health score of people aged 65 and older with three or more chronic conditions is above the good-fair cutoff point (42) in the United States, the OECD average goes below the cutoff for this population.
Similarly, the mental health scores of people 65 and older living with one, two, and three or more chronic conditions the United States are above the OECD PaRIS average. People with three or more chronic conditions in the United States report poorer mental health than those with one chronic condition with a six‑point difference, yet it remains above the OECD PaRIS average (Figure 3).
As in other countries, people with multiple chronic conditions in the United States less often report good social functioning than people with one chronic condition. While 93% of people 65 and older with one chronic condition in the United States have good social functioning, this goes down to 81% of people with three or more chronic conditions, yet this is above the OECD PaRIS average.
Systematic medication reviews in people with multiple chronic conditions can enhance medication safety and efficacy while also increasing care co‑ordination. In the same line, the duration of the relationship with the same primary care professional is associated with higher likelihood of experiencing good quality care (Chapter 3).
The United States performs above the OECD PaRIS average in medication revisions, and close to the average in terms of the duration of the relationship with primary care professionals (Figure 5):
More than four out of five people (87%) 65 years or older with three or more chronic conditions in the United States report that their medication was reviewed by a healthcare professional over the past 12 months; this is more than 10 percentage points higher than the OECD PaRIS average of 75%.
Almost six out of ten people 65 years or older with two or more chronic conditions (59%) in the United States report being with the same primary care professional for more than five years; this is similar 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.
On the indicators of people‑centred care, the United States performs better than the OECD PaRIS average:
Almost three‑quarters (74%) of people 65 years and older with chronic conditions in the United States receive enough support to manage their own health, significantly above the OECD PaRIS average of 66%.
Also, digital health literacy in the United States is generally better than the OECD PaRIS average, with 25% of people 65 years and older with chronic conditions reporting confidence in using health information from the internet, above the OECD PaRIS average of 15%.
These results highlight the United States’ strong performance in both patient support and digital health literacy, suggesting effective engagement with patients and resources to enhance health management.
There are differences in well-being and trust in the healthcare system between men and women for people 65 years and older with chronic conditions in the United States, with both indicators being lower for women:
The gap between men and women on measures of well-being is smaller in the United States (3 points) compared to the OECD PaRIS average (5 points). However, while the United States performs above the OECD PaRIS average for well-being in women (65% vs. 60%), the figure for men is closer to the OECD PaRIS average (68 vs. 66%).
In terms of trust, 73% of men in the United States trust the healthcare system, compared to 65% of women, resulting in a gap of 7.5 percentage points. This is slightly narrower than the OECD PaRIS average gap between men and women of 8.4 percentage points, though trust levels for both men and women are higher than the OECD PaRIS averages (70% for men and 61% for women).
These findings highlight the need to reduce health disparities between men and women while maintaining and building upon the relatively high levels of well-being and trust seen in the United States.
People 65 years and older with chronic conditions in the higher education group in the United States score 68 on average in the well-being index. This is slightly higher than the OECD PaRIS average of 66. In the middle‑education group, the level is comparable with a 3‑point difference in favour of the United States (66 vs. 63). For the low-education group, the average score in the United States is comparable to the OECD PaRIS average (60).
Across OECD PaRIS countries, people 65 years and older with chronic conditions in the higher education group report about 6 points better well-being than those with lower education. In the United States, this difference is slightly higher at 8 points.
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 for this country note span 46 847 primary care users (aged 65 years and older) and 1 815 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. For detailed information on national sampling procedures and other methodological details, see Chapter 7 of the report.
Results for the United States are based on 4 216 patients. The United States used a pre‑existing sample of patients from the Medicare Current Beneficiary Survey (MCBS). MCBS follows a stratified random selection of participants according to their geographical area, age, sex and ethnicity. For the PaRIS sample, only patients living in a private household and over 65 years old were invited to participate. No primary care practices were invited to participate in the survey.
In the United States, patients responded to the questionnaire with computer assisted personal interviewing, or computer assisted telephone interviewing.
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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← 1. US results reflect the population of Medicare beneficiaries aged 65 and over and living in the community.
← 2. US joined PaRIS by leveraging an existing survey infrastructure – the Medicare Current Beneficiary Survey (MCBS). This approach allowed the U.S. to align with the international framework while drawing on a well-established national data source.
← 3. Respondents were asked if they have ever been told by a doctor that they have any of the following health problems: high blood pressure; cardiovascular or heart condition; diabetes (type 1 or 2); arthritis or ongoing problem with back or joints; ongoing depression, anxiety or other mental health condition; breathing condition; chronic kidney disease; chronic liver disease; cancer (diagnosis or treatment in the last 5 years); Alzheimer’s disease or other cause of dementia; neurological condition; other long-term problem(s).