Does Healthcare Deliver? Results from the Patient‑Reported Indicator Surveys (PaRIS): Wales, United Kingdom
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 or 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 Wales (United Kingdom). 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 Welsh 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.
Nearly two‑thirds of people with chronic conditions in Wales (60%) report good physical health, measuring physical function, pain and fatigue, which is lower than the OECD PaRIS average (70%) (lowest-highest: 52‑82%).
While more than half of people (59%) with chronic conditions report good well-being, which refers to how positive a person feels in terms of mood, vitality, and fulfilment, this percentage is below the OECD PaRIS average (71%). Wales is the lowest performing country on this measurement.
One out of five people (22%) with chronic conditions report good experiences of care co‑ordination, which is below the OECD PaRIS average of 59%.
Less than half of people (46%) with chronic conditions trust their healthcare system in Wales compared to the 62% in the OECD PaRIS average.
Slightly more than four out of ten (43%) people with chronic conditions in Wales receive enough support to manage their own health, below the OECD PaRIS average of 63%.
Four out of five (83%) people with chronic conditions are managed in primary care practices that report being well-prepared to co‑ordinate care compared to the OECD PaRIS average of 56%.
Almost all (94%) people with chronic conditions are managed in practices that can exchange medical records electronically, above the OECD PaRIS average of 57%.
In Wales people with chronic conditions have generally poorer health outcomes and experiences of healthcare, compared to other PaRIS countries. 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 Wales, people living with chronic conditions are less likely to have good health outcomes compared to the OECD PaRIS average (Figure 1):
Nearly two‑thirds (60%) of people with chronic conditions report good physical health, measuring physical function, pain and fatigue, which is lower than the OECD PaRIS average (70%) (lowest-highest: 52‑82%).
Three out of four (75%) people with chronic conditions report good mental health, referring to quality of life, emotional distress and social health, and social functioning, showing how well people carry out their usual social activities and roles. While this is above the OECD PaRIS average (83%), there is almost a 20 percentage point difference between Wales and the highest performing country.
While almost six out of ten (59%) people with chronic conditions report good well-being, which refers to how positive a person feels in terms of mood, vitality, and fulfilment, this percentage is much lower than the average of OECD countries in PaRIS (71%). While Wales is the lowest performing country on this measurement, up to 80% of people report good well-being in the highest performing country.
In general, about three out five (62%) people with chronic conditions report good general health, which is comparable to the OECD PaRIS average (66%). Yet, there is more than 30 percentage points difference between Wales and the highest performing country.
The percentage of people with chronic conditions having good experiences of healthcare in Wales is also lower than the OECD PaRIS average (Figure 1):
About half (51%) of people with chronic conditions are confident that they can manage their own health and well-being, compared to the 59% OECD PaRIS average. While this is 16 percentage points higher than the lowest performing country, it is about 40 percentage points lower than the highest performing country.
One out of five (22%) people with chronic conditions report good experiences of care co‑ordination, which is below the OECD PaRIS average of 59%. In some countries, this number goes up to four out of five people (81%) reporting good experiences of care co‑ordination.
More than half (66%) of people with chronic conditions have good experiences of person-centred care, which is organised around the needs of the patients, compared to the OECD PaRIS average of 87%. This places Wales as one of the lowest performing countries in PaRIS.
While seven out of ten (72%) people with chronic conditions report good experiences of quality of care, this remains lower than the OECD PaRIS average of 87%.
Less than half (46%) of people with chronic conditions trust their healthcare system in Wales, below the 62% OECD PaRIS average.
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). This pattern is consistent with the OECD PaRIS average and Wales. Specifically:
In Wales, 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 well-being.
People living with multiple chronic conditions in Wales have poorer physical health compared to those living with one chronic condition (11‑point difference gap), a gap wider than the OECD PaRIS average (8‑point difference). The physical health scores for people with one or two chronic conditions in Wales are slightly below the OECD PaRIS average although, both, above the good-fair cutoff of 42. However, people with three or more chronic conditions in Wales are 4‑points below the good-fair cutoff, while the OECD PaRIS average for this group is only 1‑point below this cutoff (Figure 2).
Similarly, Wales performs slightly below the OECD PaRIS average regarding the mental health of people living with one or two chronic conditions. People with three or more chronic conditions in Wales report poorer mental health than those with one chronic condition with a seven‑point difference, a lower score than the OECD PaRIS average (Figure 3).
People with multiple chronic conditions less often report good social functioning than people with one chronic condition in Wales, a pattern that was also found in other countries (Figure 4). While 86% of people with one chronic condition in Wales have good social functioning, this goes down to 54% of people with three or more chronic conditions, which is 20 percentage points below the OECD PaRIS average.
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.
In general, Wales performs near-average in most primary care features assessed:
Less than 6% of people with two or more chronic conditions in Wales are managed in primary care practices scheduling follow-up and regular consultations of more than 15 minutes; this is 41 percentage points lower compared to the OECD PaRIS average of 47% (Figure 5).
In Wales, all people with two or more chronic conditions are managed in primary care practices where non-physician staff is involved in chronic disease management; this is 17 percentage points higher than the OECD PaRIS average of 83% (Figure 5).
More than three out of five people (65%) with three or more chronic conditions in Wales report that their medication was reviewed by a healthcare professional over the past 12 months (Figure 5); this is 10 percentage points lower than the OECD PaRIS average of 75%.
Almost six in ten people with two or more chronic conditions (59%) in Wales report being with the same primary care professional for more than five years; this is close to the OECD PaRIS average (58%) (Figure 5).
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, Wales demonstrates a mixed performance compared to the OECD PaRIS average:
Around 43% of people with chronic conditions in Wales receive enough support to manage their own health, significantly below the OECD PaRIS average of 63% (Figure 6).
Wales performs strongly in digital health literacy, with 34% 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%) (Figure 6).
A much higher proportion (83%) of people with chronic conditions are managed in primary care practices that report being well-prepared to co‑ordinate care, which is far above the OECD PaRIS average of 56% (Figure 6).
Around 94% of people with chronic conditions are managed in practices that can exchange medical records electronically, significantly exceeding the OECD PaRIS average of 57% (Figure 6).
These results highlight Wales’ strong infrastructure for care co‑ordination and electronic medical record adoption, with particular success in digital health literacy, but reveal challenges in providing sufficient support for patients with chronic conditions.
There are differences in well-being and trust in the healthcare systems across genders among people with chronic conditions in Wales, both indicators being lower for women.
The gender gap in well-being in Wales is similar to the OECD PaRIS average (5 points). This gender gap mirrors results for other countries; however, Wales performs worse than the OECD PaRIS average in terms of well-being for both men and women (Figure 7).
While about 51% of men in Wales have trust in the healthcare system, only 43% of women have trust in healthcare (Figure 8). These trust levels are much lower than the OECD PaRIS average for men (67%) and women (58%).
The gender gap in trust in Wales (9 percentage points) is similar to the OECD PaRIS average gap (9 percentage points).
As in other OECD countries, people with chronic conditions and higher incomes report higher well-being and trust in the healthcare system in Wales:
Across OECD PaRIS countries, people with higher incomes report better well-being than those with lower incomes with 13 points difference. Wales’ well-being levels across income groups are lower than the OECD PaRIS average, particularly for people with low and middle incomes (Figure 9).
Among people living with chronic conditions in Wales, almost six out of ten people (56%) with higher incomes trust the healthcare system, compared to 47% 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 (Figure 10).
The gap in healthcare system between high- and low-income groups in Wales is not statistically significant and is in line with the OECD PaRIS average (11%).
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 Wales are based on 7 706 patients and 75 primary care practices. Patients were sampled by probability sampling from the Welsh Demographic Service and Master Patient Index. Primary care practices were sampled by probability sampling from the administrative data for analysis and performance assessment of primary care practices.
In Wales, primary care practices responded to the questionnaire online. Patients responded to the questionnaire online, via paper-and-pencil surveys, and via telephone.
Wales has demonstrated a high level of maturity within the country in collecting and using patient reported measures at scale. The nation’s implementation model has been very successful in reaching primary care practices and patients from across the country, meeting all standards and processes required by OECD and achieving one of the largest and most comprehensive datasets across all participating countries, despite its small population size. Wales’ strategic and well thought out approach to PaRIS is further evidence of the innovative and creative policy approach to health and care adopted in Wales, with a well-established and recognised value-based healthcare mission for which the country is already internationally recognised.
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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