Does Healthcare Deliver?

1. Key findings of PaRIS

Abstract

This chapter presents a selection of key findings from this report. It highlights how PaRIS addresses a significant gap in our current understanding of healthcare systems by capturing patient-reported outcomes and experiences. The chapter provides an overview of the scores on ten key indicators across all participating countries and explores the relationship between patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). Additionally, it examines how these measures correlate with other critical indicators such as life expectancy, healthcare spending, and the health workforce.

The chapter also delves into important concepts such as multimorbidity – affecting more than half of the PaRIS population and having a severe impact on an increasing number of people. Other key themes include trust in healthcare systems, inequalities, the importance of a people-centred approach, and the role of care co-ordination in improving healthcare outcomes.

Incorporating patients’ voices to accelerate the transformation of healthcare: The case for the Patient Reported Indicator Surveys (PaRIS)

For far too long, essential information to steer healthcare systems was lacking: the voice of the patient. While patient-reported experience and outcome measures (PREMs and PROMs, respectively) have been implemented in various contexts, their application has often been episodic, focused on specific conditions, and are rarely comparable across countries. The OECD’s Patient Reported Indicator Surveys (PaRIS) fills this knowledge gap by assessing whether patients truly thrive. It shifts the focus of healthcare performance away from traditional metrics such as mortality, morbidity, hospital admissions, consultations and procedures to patient’s health outcomes such as quality of life, well-being, and patients’ experiences of the healthcare that they receive. PaRIS shows how healthcare impacts people’s lives across multiple dimensions, including physical health, mental health and their ability to fulfil social roles. This comprehensive perspective has the potential to revolutionise the assessment and improvement of healthcare system performance globally.

Expanding healthcare’s focus from traditional biomedically-oriented outcomes to how well people live is essential for the sustainability of health and social policies in the long term. Metrics like life expectancy and morbidity statistics are widely used indicators of population health and provide meaningful insights. However, they offer only a partial view of healthcare system performance, emphasising longevity and clinical parameters over lived experience.

PaRIS seeks to complement these conventional metrics by shifting attention to how well people live, not just how long. By prioritising measures of quality of life and well-being, the initiative aims to provide a better understanding of healthcare outcomes, enabling policies that support both individual and societal health sustainability.

Predictable global trends are reshaping the future of healthcare, highlighting the need for urgent, forward-looking policies that prioritise keeping people active and autonomous as they age. Key trends include declining fertility rates, increased longevity, population ageing, rising health expenditures (already surpassing 10% of GDP in many OECD countries), growing shortages of healthcare workers such as doctors and nurses, and the steady increase in the number of people living with chronic conditions.

In this context, enabling people to remain active, productive, and independent as they age is essential. This approach not only supports individual well-being but also ensures the financial sustainability of healthcare and social services across OECD countries for the decades ahead.

PaRIS harnesses the power of patients’ voices as a transformative force in healthcare. To achieve this goal, it matches data collected from patients with information reported by their primary care practices about the provision of healthcare services. This focus on primary care is particularly important because most healthcare globally takes place outside hospitals and within communities, with primary care typically supporting people close to where they live. By integrating these perspectives, the PaRIS survey underscores the critical role of primary care in meeting the needs of populations.

When taken and analysed together, the indicators reported by patients, their primary care practices, and the characteristics of healthcare systems across OECD countries serve as a roadmap to more people‑centred and effective care, tailored to the unique needs of diverse populations.

PaRIS key figures

PaRIS contains the world’s largest international data collection on patient-reported outcomes and experiences of primary care patients.

• 107 011 primary care patients completed the patient questionnaire and have valid data, representing 104 million primary care users who are 45 years and older

• 1 816 primary care practices have filled out the primary care practice questionnaire

• 19 countries participated

PaRIS captures the outcomes that matter most to patients, such as their mental health, physical functioning, and psychological well-being, together with their experiences of care. The survey is the first of its kind to provide harmonised indicators for 19 countries on the experiences and outcomes of people aged 45 years and older living with chronic conditions. It also measured key dimensions of their experiences of healthcare, such as their experience of quality, co‑ordination, and person-centredness of care, and their trust in the healthcare system. These indicators have been selected in close collaboration with patients. Experts and stakeholders agreed on a key set of ten indicators (the PaRIS10) that serve as the backbone for the flagship report, including five PROMs and five PREMs. A detailed explanation of how each of these indicators were constructed is presented in Annex 1.A, and Table 1.1 below presents country-level results of these indicators across the 19 participating countries.

PaRIS results show a relationship between better experience of care by patients and better health outcomes. This is clear in Switzerland and the United States, where people consistently report more positive care experiences and better health results compared to the OECD average. Similar patterns are seen in Australia, Canada, Czechia, France and Norway where people report mostly positive experiences with their care, along with relatively good health outcomes.

Table 1.1. Country scores on ten key indicators (The “PaRIS10”)

Percentage of people reporting positive outcomes or experiences and average scores, for primary care users aged 45+ living with one or more chronic conditions (age‑sex standardised results)

	Patient-Reported Outcome Measures (PROMs)					Patient-Reported Experience Measures (PREMs)
	Physical health	Mental health	Social functioning	Well-being	General health	Confidence to self-manage	Experienced co‑ordination	Person-centred care	Experienced quality	Trust in healthcare system
Positive outcomes	≥ 42	≥ 40	Good, very good, excellent	≥ 50	Good, very good, excellent	Confident, very confident	≥ 7.5	≥ 12.0	Good, very good, excellent	Agree, strongly agree
OECD PaRIS	45 (70%)	47 (83%)	83%	60 (71%)	66%	59%	8.2 (59%)	16.6 (87%)	87%	62%
Australia	47 (74%)	48 (81%)	80%	59 (70%)	74%	61%	9.6 (74%)	18.1 (93%)	94%	64%
Belgium	45 (68%)	46 (83%)	85%	60 (71%)	72%	63%	8.8 (67%)	17.9 (93%)	95%	70%
Canada	47 (77%)	49 (87%)	87%	62 (74%)	83%	59%	9.3 (71%)	17.6 (90%)	94%	61%
Czechia	46 (72%)	48 (87%)	88%	60 (72%)	63%	68%	9.2 (70%)	17.1 (90%)	96%	54%
France	45 (68%)	46 (87%)	91%	58 (67%)	76%	92%	8.4 (61%)	17.1 (91%)	91%	61%
Greece	45 (69%)	45 (78%)	87%	58 (66%)	69%	37%	7.1 (47%)	14.6 (78%)	74%	36%
Iceland	44 (65%)	47 (82%)	78%	63 (74%)	62%	35%	6.2 (34%)	14.9 (77%)	74%	54%
Luxembourg	45 (72%)	47 (86%)	86%	60 (71%)	71%	56%	8.5 (63%)	17.0 (91%)	93%	66%
Netherlands	47 (74%)	47 (85%)	82%	65 (79%)	64%	78%	7.3 (49%)	16.8 (90%)	92%	71%
Norway	47 (75%)	47 (83%)	80%	63 (76%)	63%	47%	7.6 (51%)	16.3 (87%)	92%	73%
Portugal	43 (57%)	43 (67%)	73%	56 (61%)	42%	61%	7.3 (49%)	14.9 (77%)	69%	54%
Romania	41 (52%)	44 (75%)	75%	59 (65%)	43%	42%	10.3 (78%)	17.4 (92%)	80%	52%
Saudi Arabia	46 (68%)	52 (93%)	93%	59 (65%)	93%	73%	6.5 (37%)	15.9 (87%)	89%	74%
Slovenia	46 (74%)	47 (85%)	88%	61 (72%)	62%	61%	8.2 (57%)	16.4 (84%)	89%	63%
Spain	43 (60%)	46 (81%)	79%	60 (69%)	55%	67%	8.5 (65%)	16.4 (85%)	85%	89%
Switzerland	47 (82%)	49 (91%)	90%	65 (80%)	79%	67%	10.3 (81%)	19.1 (97%)	97%	71%
Wales	44 (60%)	46 (75%)	73%	53 (59%)	62%	51%	5.0 (22%)	13.8 (66%)	72%	46%
Italy*	44 (66%)	45 (76%)	78%	56 (62%)	39%	24%	9.5 (72%)	16.3 (87%)	78%	62%
United States**	48 (75%)	51 (89%)	90%	64 (76%)	81%	74%	9.3 (72%)	18.3 (95%)	94%	65%

Better than the OECD PaRIS average (statistically higher, at 1+ comparative interval above).

Close to the OECD PaRIS average (not statistically different, within one comparative interval).

Worse than the OECD PaRIS average (statistically lower, 1+ comparative interval below).

Note: For all indicators, percentage values are shown, measuring the percentage of people reporting a positive outcome or experience (for example, patients reporting being in good, very good or excellent general health). For five indicators, the average respondent scale score is also shown. See Chapter 2, Table 2.1 for more information on the cutoffs for positive responses and the scales used. Cells are colour-coded to show if values are statistically different to the OECD PaRIS average. In all cases, higher numbers indicate better performance. In Spain, the trust measure was asked specifically about trust in the primary care professionals within people's primary care practice. This variation might influence trust levels in Spain and limit comparability with other countries that refer to trust in the healthcare system more broadly. * Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. ** United States sample only includes people aged 65 years or older.

Source: OECD PaRIS 2024 Database.

Healthcare systems are struggling to support health and well-being of a population that is living longer, but not always living better

The demographic transition, evolving health behaviours, and the success of public health and healthcare in extending lives all contribute to the global rise in the number of people with chronic conditions. Addressing the needs of people with chronic conditions is already a key priority for healthcare systems, and the scale of this challenge is set to expand in the coming decades. Chronic conditions are prevalent, costly, and place a considerable burden on patients, caregivers, healthcare professionals, and healthcare systems. This “demographic transition”, a combination of increasing life expectancy, combined with declining fertility rates, increases the proportion of older people in the population both in absolute numbers and as a proportion of the total. This development is expected to intensify the chronic disease burden. As shown in Figure 1.1, the share of the population aged over 65 is expected to grow from 18% in 2022 to 26% in 2060. The ageing of populations and the increasing life expectancy go hand in hand with the rising prevalence of chronic conditions, which now account for 74% of all deaths globally. As individuals age and accumulate multiple chronic conditions, they become more vulnerable to additional chronic conditions, leading to more severe health outcomes (The Lancet Regional Health – Europe, 2023[1]).

Figure 1.1. The number of people aged 65 years and older will continue to rise in OECD countries in the coming decades

Share of the OECD population between 65 years and 85 years old and aged 85 years and older; 2022 and expected development till 2060

Source: OECD Data Explorer (2024). Population Projections.

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Most people will spend decades of their lives managing one or more chronic conditions

Over 80% of people aged 45 and older who had a primary care consultation in the previous six months have at least one chronic condition, more than 50% have two or more, and more than 25% have three or more. The interplay between chronic conditions can lead to compounded effects, resulting in a diminished quality of life. People often face not only the physical limitations imposed by their health issues but also psychological and emotional challenges, as these conditions may affect social relationships, employment opportunities, and overall well-being. Furthermore, managing multiple conditions can create complex healthcare needs, leading to difficulties in accessing appropriate care and navigating treatment regimens.

The remarkable increase in life expectancy over the past century is partly due to significant advances in living conditions, public health, and healthcare. However, longer lives also mean that many people spend additional years managing chronic conditions – a phenomenon often referred to as the “failure of success”. As more people navigate the complexities of managing several health conditions simultaneously, the need for effective disease management and well-co‑ordinated care becomes paramount, and so is measurement that captures these aspects of care.

When put together with life expectancy data, PaRIS results highlight that people are living longer but not necessarily better

When PaRIS results are compared with life expectancy data, the link between life expectancy and PROMs is weak which suggests that people are living longer but not necessarily better. Figure 1.2 illustrates this, showing life expectancy alongside general health above and well-being below. The countries in the quadrants at the left have a life expectancy at age 45 that is below the average of the participating countries, on the right are the countries with above average life expectancy at age 45. The upper two quadrants include the countries where patients report respectively above OECD PaRIS average scores for being in good general health and well-being, the lower two quadrants the countries with patients in good general health and well-being below the OECD PaRIS average. No clear patterns or correlations emerge from these figures. This confirms that just because people are living longer, they are not necessarily living better.

Figure 1.2. Life expectancy at age 45 says little about health and well-being

Note: Values on both axes were divided by the OECD PaRIS average, meaning that 1 equals the OECD PaRIS average and values above and under 1 respectively for above and under the OECD PaRIS average. * Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. AU: Australia, BE: Belgium, CA: Canada, CZ: Czechia, FR: France, GR: Greece, IS: Iceland, LU: Luxembourg, NL: Netherlands, NO: Norway, PT: Portugal, SA: Saudi Arabia, SI: Slovenia, ES: Spain, CH: Switzerland, GB-WLS: Wales, IT: Italy, US: United States.

Source: UN World Population Prospects 2023; OECD PaRIS 2024 Database.

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The disconnect between higher longevity and worse quality of life is particularly true for women

Women live longer than men, but they often report poorer physical and mental health. This is illustrated in Figure 1.3. For all people with chronic conditions, 74% of men and 65% of women have good physical health, and 86% of men and 81% of women have good mental health. Also women’s well-being scores are typically 3% to 5% lower than men’s, and in some countries, the gap reaches as high as 9%. Socio‑economic status, age, and living with multiple chronic conditions explain part of the difference, but even when these factors are considered, PaRIS data show that women’s well-being is still worse than men’s.

Figure 1.3. Men may live shorter lives but report better physical and mental health than women

Absolute differences in average scores per country for men and women with at least one chronic condition on physical and mental health

Note: People with one or more chronic conditions. Physical health: PROMIS® Scale v1.2 – Global Health component for physical health and mental are T-score metrics, higher values represent better physical health. * Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. ** United States sample: only includes people of 65 years and older. Physical health: all gaps statistically significant (p<0.05) except for Canada and the United States. Mental health: all gaps statistically significant (p<0.05) except for Australia, Iceland, Luxembourg, Romania and the United States.

Source: OECD PaRIS 2024 Database.

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Healthcare systems must do more to address the needs of a population that increasingly lives with multiple chronic conditions

More than half of primary care users who are 45 years or older have two or more chronic conditions

PaRIS data show that 82% of people aged 45 years or older who had a primary care consultation in the six months preceding the survey live with at least one chronic condition and 52% lives with two or more, as shown in Figure 1.4. Managing these conditions is usually far more complex and resource‑intensive than dealing with a single condition, and this is putting pressure on healthcare systems and healthcare professionals to deliver high-quality, well-co‑ordinated care. It’s not about doing “more of the same” – healthcare systems must shift their focus from individual diseases to how people can live better lives and manage their conditions effectively over the long term.

Figure 1.4. Eight out of ten primary care users live with a chronic condition, more than half with multiple chronic conditions

Note: Results not age‑sex standardised.

Source: OECD PaRIS 2024 Database.

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High blood pressure is the most frequently reported condition, affecting nearly 60% of men and 50% of women with at least one chronic condition, as indicated in Figure 1.5. Arthritis or an ongoing problem with back or joints comes next, affecting 43% of women and 29% men. Men are more likely to report cardiovascular conditions and diabetes than women; while women more often than men report depression, anxiety or other mental health conditions, as well as neurological conditions. While gender differences in prevalence may be partly attributed to biological factors, these may also reflect gender-related diagnostic and treatment biases or differences in propensity to seek care for certain conditions.

Figure 1.5. The most often reported condition was high blood pressure, followed by arthritis or ongoing problems with back or joints and cardiovascular or heart conditions

Note: 21.9% of men and 27.5% of women indicated having another chronic condition that was not in the list. Denominator: people who reported at least one chronic condition.

Source: OECD PaRIS 2024 Database.

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People with lower education and incomes develop chronic conditions earlier and accumulate them faster

People with lower education and incomes face a double disadvantage: not only do they fall ill earlier in life, they experience worse outcomes once sick compared to their higher earning or higher educated counterparts. For example, Figure 1.6 shows that there is a significant 5 to 10 percentage point difference in mental health scores between the highest and lowest income groups, which persists even when age and the number of chronic conditions is accounted for.

Figure 1.6. People with higher incomes report better physical and mental health score than people with lower incomes

Absolute differences in average scale scores for mental and physical health between highest and lowest income groups

Note: People with one or more chronic conditions. Results are additionally controlled for education. PROMIS® Scale v1.2 – Global Health component for physical health and mental are T-score metrics, higher values represent better physical health. Countries are sorted by gap in mental health. * Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. All differences are statistically significant (p<0.05).

Source: OECD PaRIS 2024 Database.

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It is not only “how many”, but also which combinations of chronic conditions people live with that matter for health outcomes

The PaRIS data reveal the high prevalence of chronic conditions that commonly occur together, particularly high blood pressure (hypertension), arthritis, cardiovascular disease, and mental health conditions. This underscores the need for integrated care models to address these overlapping health concerns. Among people with chronic conditions, the most common combination is arthritis with hypertension, affecting 27% of the population. This pairing is particularly important to address, as arthritis and other musculoskeletal problems might associate with worse physical functioning and well-being than other chronic conditions, thus less participation in social activities (Cheng et al., 2019[2]). This is followed by the combination cardiovascular disease with hypertension at 20% and diabetes mellitus with hypertension, at 18%, as indicated in Figure 1.7.

Figure 1.7. Most people with chronic conditions reported having hypertension, along with arthritis, cardiovascular disease, and breathing or mental health conditions

Percentage of most common combinations of chronic conditions among people with two or more conditions

Source: OECD PaRIS 2024 Database. See https://stat.link/xvp4e3.

Mental health is a critical component in the management of multiple chronic conditions

Addressing mental health needs is critical for the successful management of multiple chronic conditions. Sixteen percent of the patients with chronic conditions in the survey live with at least one mental health condition. People with multiple chronic conditions report worse physical health and are less confident that they can manage their own health when one of their conditions is a mental health condition. While fewer people with multiple chronic conditions in general report good social functioning compared to people with one chronic condition, this negative relation is amplified when one of these conditions is a mental health condition.

PaRIS results show that mental ill-health takes a particularly important toll on the social functioning of people living with multiple chronic conditions. As shown in Figure 1.8, among people with two or more chronic conditions, the lowest percentage reporting good social functioning is observed when at least one of their conditions is a mental health condition: only 64% of respondents of people in this group reported good social functioning. In contrast, among people with two or more chronic conditions without a mental health condition, 83% report good social functioning when the conditions are discordant (i.e. conditions that do not share a common causal mechanism) and 91% report good social functioning when the conditions are concordant ones (i.e. conditions that frequently occur together and share common causal mechanisms).

These results highlight two critical messages. First, patients with multiple chronic conditions, of which one involves a mental health condition, have significantly higher needs. Addressing these needs requires healthcare systems to adopt integrated care models that co‑ordinate seamlessly with social care services, ensuring simultaneous support for both mental and physical health.

Second, patients with discordant chronic conditions also demand specific policy attention. Unlike concordant conditions, where shared causal mechanisms can enable more effective management and coping strategies, discordant conditions often lack such commonalities. This can lead to fragmented care and greater challenges in maintaining social functioning, underscoring the need for tailored approaches to their care.

Figure 1.8. Among people with multiple chronic conditions, those who have a mental health condition are more likely to report poor social functioning

Note: PROMIS® Scale v1.2 – Global Health. Answer to the question: “In general, please rate how well you carry out your usual social activities and roles [further specified in questionnaire]”, “good, very good or excellent” versus “fair or poor”. * Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. ** United States sample only includes people aged 65 years or older. Differences between groups are statistically significant (p<0.05) for all countries except for Czechia, Greece, the Netherlands, Slovenia, Switzerland and the United States between concordant and discordant groups.

Source: OECD PaRIS 2024 Database.

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Doing more for people with chronic conditions does not necessarily mean spending more, but a larger health workforce is associated with better outcomes

Higher health spending is significantly associated with better results for only four out of the ten PaRIS indicators of health outcomes and experiences of care

There is a positive correlation between health spending and measures such as good physical health, well‑being, person-centred care, and experienced quality of care, as confirmed by multivariate regression analyses that account for GDP per capita and core patient characteristics (age, sex, education, and chronic conditions). However, this correlation is moderate, with values below 0.50 for most indicators, except for physical health, which reaches 0.64. Furthermore, no significant correlation is observed for the remaining six PROMs or PREMs (Figure 1.9).

This indicates that while higher health spending is associated with better outcomes for some PaRIS10 indicators, it does not guarantee improved patient outcomes or experiences across the board. Notably, it is possible to achieve comparatively strong performance at lower levels of health spending.

Figure 1.9. Higher health spending per capita is significantly associated with better physical health, well-being, person-centred care, and experienced quality of care, but not with the other six PaRIS10 indicators

Note: An asterisk indicates a statistically significant correlation (p<0.05). In multivariate regressions which controlled for GDP per capita and patient characteristics (age, sex, education, chronic conditions), health spending per capita had a statistically significant coefficient for all the PaRIS10 indicators except “Experienced Quality”.

Source: OECD Data Explorer, WHO Global Health Observatory, OECD PaRIS 2024 Database.

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Strong outcomes and experiences of care are achievable even with lower-than-average health spending per capita

While higher health spending per capita is often linked to better patient-reported outcomes and experiences for certain indicators, high performance is not solely reliant on expenditure. For example, as shown in Figure 1.10, Czechia, Belgium and Switzerland achieve the highest scores for “Experienced Quality” while having very different levels of health spending per capita. Similarly, Iceland and Slovenia achieve well-being scores that are higher than the OECD PaRIS average whilst spending comparatively little per capita. Indeed, Czechia and Slovenia both score well across most of the PaRIS10 indicators, while having relatively low health spending per capita. Later chapters explore policies that can help drive strong results without substantial increases in health spending.

Figure 1.10. While patients often report better well-being and better quality of care in countries with higher health spending, some countries with relatively low levels of spending also have positive outcomes and experiences

Note: Values on both axes were divided by the OECD PaRIS average, meaning that 1 equals the OECD PaRIS average and values above and under 1 respectively for above and under the OECD PaRIS average. For GB-WLS, aggregate UK health spending values are used. * Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. ** United States sample only includes people of 65 years and older. AU: Australia, BE: Belgium, CA: Canada, CZ: Czechia, FR: France, GR: Greece, IS: Iceland, LU: Luxembourg, NL: Netherlands, NO: Norway, PT: Portugal, RO: Romania, SA: Saudi Arabia, SI: Slovenia, ES: Spain, CH: Switzerland, GB-WLS: Wales, IT: Italy, US: United States.

Source: OECD Data Explorer, WHO Global Health Observatory, OECD PaRIS 2024 Database.

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In countries with a higher availability of healthcare workers, people report better physical health, mental health, and well-being on average

Similarly to the analysis of health spending, greater availability of health workforce is significantly associated with three of the ten PaRIS key indicators. Interestingly, these associations are observed for three PROMs within the health workforce, while none are found for PREMs. Figure 1.11 compares the density of the healthcare workforce – measured as the number of doctors and nurses per 1 000 people – with the proportion of the population reporting good well-being, relative to the OECD PaRIS average. Similar patterns emerge for physical health and mental health scores. While this analysis does not establish causality, it highlights the potential benefits of investing in healthcare staffing to improve patient-reported health outcomes, particularly in areas where workforce availability can directly enhance the effectiveness of care.

Figure 1.11. Countries with a larger health workforce also report higher levels of well-being

Note: Values on both axes were divided by the OECD PaRIS average, meaning that 1 stands for the OECD PaRIS average and values above and under 1 respectively for above and under the OECD PaRIS average. * Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. AU: Australia, BE: Belgium, CA: Canada, CZ: Czechia, FR: France, IS: Iceland, LU: Luxembourg, NL: Netherlands, NO: Norway, RO: Romania, SI: Slovenia, ES: Spain, CH: Switzerland, IT: Italy.

Source: OECD Stat; OECD PaRIS 2024 Database.

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Better experiences of care are associated with better health outcomes and greater trust in the healthcare system

Patients with chronic conditions who report that their care is more person-centred are more likely to report higher levels of well-being

While people‑centredness of healthcare systems is an important goal by itself, the PaRIS data show that people who rate their care as more person-centred also have better physical and mental health, and better well-being (Figure 1.12). In all countries, people with chronic conditions who are in the top quartile of person-centredness of care (which corresponds to a person-centred care score of 20 or more) feel healthier and report better well-being that the people in the bottom quartile of person-centred care (score of 13 or less).

Figure 1.12. People who report that their care is person-centred also report higher levels of well-being

Well-being scores: average and separate for people who report person-centredness scores in the top quartile (PC score greater than or equal to 20) and in the bottom quartile (PC less than 13)

Note: The figure compares health outcomes of people with low-medium person-centred care (score below 13 points out of 24) and the group with high person-centred care (score above or equal to 20 points out of 24). P3CEQ Questionnaire. Response to eight questions measuring if care is person-centred. Scale ranges from 0 to 24, higher scores represent better person-centred care. WHO‑5 well-being index. Response to five questions measuring well-being. raw scale 0‑25 converted to 0‑100 scale, higher scores represent higher well-being. * Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. ** United States sample only includes people of 65 years and older.

Differences between groups are statistically significant (p<0.05) for all countries.

Source: OECD PaRIS 2024 Database.

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Patients’ trust goes hand-in-hand with high-quality healthcare and is closely linked to personal experience of healthcare

Trust in healthcare systems is a key indicator of their quality and performance. PaRIS data show that trust in the healthcare system goes hand in hand with better health; respondents who report high levels of general health are almost 20% more likely to trust the healthcare system than those who report poor health (66 and 56% in each group trust the healthcare system, respectively). Likewise, the average mental health scores of those who trust the healthcare system are 6% higher than those who do not.

Trust in the healthcare system varies by a factor of two across countries and is – to some extent – linked to national perceptions on trust in institutions, such as national government, as shown in Figure 1.13. Within countries, trust in the healthcare system also varies across demographic groups, with men, people with higher incomes, older people, and those with higher education levels generally expressing greater trust.

Figure 1.13. In countries with higher trust in the national government, people have also more trust in the healthcare system

Percentage of people who says they trust the national government and percentage who trust the healthcare system

Note: Data from the OECD Trust in Public institutions relates within-country distributions of responses to the question “On a scale of 0 to 10, where 0 is not at all and 10 is completely, how much do you trust the national government?”. A 6‑10 to “ high or moderately high trust“. “OECD” presents the unweighted average across countries. OECD Trust Survey Data is for the United Kingdom. Data from the OECD PaRIS: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. * Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions.

Source: OECD Trust Survey 2023 and OECD PaRIS 2024 Database.

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However, trust in healthcare is impacted by more than a general trust in government and related institutions; individual experiences with healthcare have a major impact on trust. As seen in Figure 1.14, people who experience adverse events, don’t receive enough health information from their healthcare professional, have to repeat information that should be in their health record, or experience problematic waiting times are less likely to trust the healthcare system. This is illustrated in Figure 1.14, which shows that people who have experienced an event or circumstance that could potentially cause them harm in primary care – such as, not getting an appointment when needed, receiving a wrong or delayed diagnosis or treatment, or experiencing problems with communications between healthcare professionals – are 1.6 times less likely to trust the healthcare system than those who have not experienced such an adverse event (45% compared to 70%).

Figure 1.14. People who have experienced an adverse event in primary care are much less likely to trust the healthcare system

Percentage of people that trust in the healthcare system according to having experienced an adverse event

Note: Examples of adverse events include not getting an appointment when needed, receiving a wrong or delayed diagnosis or treatment, or experiencing problems with communications between healthcare professionals. Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. * Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. ** United States sample only includes people of 65 years and older. All differences for Trust in the healthcare system are statistically significant (p<0.05).

Source: OECD PaRIS 2024 Database.

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The connection between the individual experience of high-quality care and trust is evident. Across countries, patient perceptions of high-quality care and having a central point of contact for health problems positively impact trust. People who felt that their primary care professional spent enough time with them are almost 90% more likely to trust the healthcare system compared to those who did not feel this was the case (64% compared to 34%). Likewise, people who feel as though their healthcare professional encourages them to raise concerns are 1.3 times more likely to trust their healthcare professional, compared to those who did not (90% compared to 71%). Policies to promote patient safety, better care co‑ordination and continuity, and higher-quality care interactions can result in outcomes that influence higher levels of trust for people living with chronic conditions.

PaRIS data highlights policies and approaches to more person-centred, co‑ordinated, and safer care for people with chronic conditions

People feel more confident about managing their health when they receive support from their primary care professionals and are involved in decisions about their care

People are more confident in managing their health when doctors involve them in decision making and support them in taking a more active role in managing their health conditions. Although most people with chronic conditions regularly see healthcare professionals, they live with their conditions 24/7, requiring ongoing self-management within their own environments. Supporting these patients in managing their health and well-being is therefore essential. This support may include guidance on making healthy lifestyle choices and effective medication management. Such self-management support, understood as empowering patients with the knowledge and skills to manage their conditions effectively, is more effective when patients are actively involved in decisions about their own care. For example, people are on average 10 percentage points more confident in self-management when doctors involve them in decisions about their care, and 14 percentage points more confident when they receive strong self-management support from their primary care professionals.

Structured approaches to self-management support, such as referrals to self-management classes (used by primary care practices serving 39% of patients with chronic conditions) or explicit goal setting and action planning (used by practices serving 34% of patients), remain less common compared to simpler strategies like providing verbal information during consultations. Notably, 89% of patients are with primary care practices that report offering verbal guidance, highlighting a gap between the widespread use of basic informational support and the less frequent adoption of more comprehensive, structured interventions.

Patients who have long-standing relationships with their primary care practice more often experience a high quality of care

Time with primary care professionals is invaluable for people with multiple chronic conditions. People who live with multiple chronic conditions and spent more time with primary care professionals are more likely to report better quality of care. Results indicate that having a long-standing relationship with a primary care professional (longer than five years) increases the odds of experiencing quality care by 30%. Patients benefit from the trust, rapport, and deep understanding that develop over time. On average, 58% of people with multiple chronic conditions have been with the same primary care professional for five years or more, ensuring long-term continuity of care. About 40% have been with their primary care professional for over 10 years. The highest proportions of patients with such long-term continuity were observed in Romania, Czechia and the Netherlands, where over half of patients indicated being with their primary care professional over a decade.

People have better experiences of care when the scheduled time for consultations is longer. More time scheduled for regular or follow up consultations (more than 15 minutes) significantly improve the odds of experiencing quality-of-care by 21% among people with multiple chronic conditions, underlining the importance of giving patients adequate time to address their concerns and ensure thorough care.

Yet, on average, only 38% of primary care practices participating in PaRIS reported that the time scheduled for regular and follow up consultations was 15 minutes or more, ranging from 80% or more in Norway, Portugal and Iceland to less than 10% in the Netherlands, Spain and Wales.

People with multiple chronic conditions often have more complex needs, which might not be covered in healthcare systems designed for single diseases with limited time. The time spent on consultations, meeting the same primary care professionals, follow-up and relationship are perceived as more important among people with multiple chronic conditions than patients with no chronic conditions (Norman, Jelin and Bjertnaes, 2024[3]).

Medication reviews and care plans can contribute to better co‑ordination of care

Over 70% of people who live with multiple chronic conditions take at least three medications, and more than a third take four or more medications. An example of an intervention that could contribute to better medication management is the use of systematic medication reviews, where a healthcare professional discusses with the patient all the medication that the patient is taking. This helps ensure that all the medications are necessary and safe when taken together, giving the patient an opportunity to signal any issues and enhance self-management. A medication review can prevent harmful interactions, reduce side effects, and improve overall treatment outcomes. It also helps identify any outdated or unnecessary prescriptions, reducing costs to both patients and healthcare systems, and ensures that patients understand their medication regimen. This good practice varies from more than 85% of people with multiple chronic conditions in Switzerland, the United States and Czechia to less than 45% in Iceland and Slovenia.

Care plans help improve co‑ordination of care, but they are rarely used. A care plan is a written agreement between the patient and the healthcare professionals detailing the type of care the patient receives over an extended period and how this care will be given, including what the patient will do. While a care plan can be a useful tool to structure and co‑ordinate care, only 25% of the people in the survey with chronic conditions reported having a care plan available to them and 26% of their primary care practices report that they use care plans for all their patients with chronic conditions at least once a year. However, there seems to be a breakdown in communication between what is reported by patients and their primary care practices. For example, in Australia, Saudi Arabia and Spain, physicians report around 50% usage of care plans for all patients with chronic conditions while only between 25% and 35% of their patients reports having such a plan.

Sufficient consultation time, effective and accessible doctor-patient communication, and use of digital tools can contribute to more person-centred care

When healthcare is “person-centred”, it is tailored to the individual needs of the patient. In the often‑complex care for people with (multiple) chronic conditions, there is usually no “one‑size fits all” solution. PaRIS shows that care can be made more person-centred when professionals spend enough time with patients, explain things in a way that is easy to understand, provide written instructions about how to manage care at home, and when they offer patients remote options to contact and consult healthcare professionals, such as video consultations, e‑mail, text message or messaging through remote platforms.

Figure 1.15 shows the size of the regression effects of several factors. Spending enough time and the provision of easy-to‑understand instructions were particularly important for more person-centred care, but several aspects of health digitalisation matter too, including availability of digital consultations, patient’s access to their electronic medical records, and the possibility of ordering repeated prescriptions online. Women are significantly less likely to receive person-centred care, and having more chronic conditions is associated with a lower person-centred care score.

Figure 1.15. Sufficient consultation time, effective and accessible communication, and use of digital tools are all associated with more person-centred care

Estimated effects and 95% confidence intervals of practices’ and patients’ characteristics on person-centred care

Note: Analysis includes 52 729 patients in 18 countries, only those with at least one chronic condition were included. The United States was excluded for not having information at the practice level. Statistical significance: *** p<0.001;** p<0.01;* p< 0.05. Video consultations and remote options compared to having telephone only. Female compared to Male; Age groups compared to people from 45 to 54 years old; Education high and middle compared to people with low education. Random intercept models with patient, practice and country level.

Source: Author’s estimations with data form the OECD PaRIS 2024 Database. See https://stat.link/hk67ng.

Patients with chronic conditions face limited access to digital services in primary care

PaRIS data further show that there is need for improvement in the digitalisation of the primary care experience. For example, the availability of videoconference services in primary care practices is not only low, but there also seems to be a breakdown in communication between practices and their patients about availability of such services. Considering the information reported by practices, 28.3% of patients with chronic conditions are with practices that offer videoconference services, while only 10.8% of patients with chronic conditions report that their primary care practice offers videoconference services.

Given the low availability of video consultations in primary care, it is unsurprising that their usage reported by patients is even lower. Approximately 7% of patients with chronic conditions report having used video consultation in primary care, as shown in Figure 1.16.

Figure 1.16. Fewer than one in ten patients with chronic conditions reports having used video consultation services with their primary care practices

Note: * Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. ** United States sample only includes people aged 65 years or older. Standardised results are adjusted for age and sex across countries.

Source: OECD PaRIS 2024 Database.

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Other findings confirm opportunities for improving digitalisation of primary care. On average across countries, only 54% of patients with chronic conditions have booked primary care appointments online and 43% have ordered repeated prescriptions with their primary care practice online. The number for accessed to primary care medical records online are even lower: only 17% of patients with chronic conditions report having done so.

References

[2] Cheng, A. et al. (2019), “PROMIS Physical and Emotional Health Scores Are Worse in Musculoskeletal Patients Presenting to Physiatrists than to Other Orthopedic Specialists”, PM&R, Vol. 11/6, pp. 604-612, https://doi.org/10.1002/pmrj.12068.

[3] Norman, R., E. Jelin and O. Bjertnaes (2024), “Multimorbidity and patient experience with general practice: A national cross-sectional survey in Norway”, BMC Primary Care, Vol. 25/1, https://doi.org/10.1186/s12875-024-02495-1.

[1] The Lancet Regional Health – Europe (2023), “Securing the future of Europe’s ageing population by 2050”, The Lancet Regional Health - Europe, Vol. 35, p. 100807, https://doi.org/10.1016/j.lanepe.2023.100807.

Annex 1.A. The PaRIS 10 key indicators

The ten key indicators in the PaRIS flagship report, the “PaRIS 10” include five PROMs and five PREMs. All indicators are based on validated and tested instruments and were selected after discussions with the Working Party of PaRIS, the Health Committee and other experts and stakeholders. The table below describes how these ten indicators were measured.

 

Patient-Reported Outcome Measures (PROMs)
Physical health	Response to four questions measuring physical function, pain and fatigue, response options scale of 1‑5. Average score of patients. Raw scale 4‑20 converted to T-score metric in which 50 is the mean and 10 the standard deviation of the PROMIS reference population. T-score range of 16.2‑67.7. Percentage of patients reporting positive outcome (T-score of 42 or more, equivalent to being in “good” physical health or better, as compared to “fair” or “poor” health, based on PROMIS reference population), shown in Table 1.1. Data instrument: PROMIS® Scale v1.2 – Global Health scale.
Mental health	Response to four questions on quality of life, emotional distress and social health, response options scale of 1‑5. Average score of patients. Raw scale 4‑20 converted to T-score metric in which 50 is the mean and 10 the standard deviation of the PROMIS reference population. T-score range of 21.2‑67.6. Percentage of patients reporting positive outcome (T-score of 40 or more, equivalent to being in ”good” mental health or better, as compared to ”fair” or “poor” health, based on PROMIS reference population) , shown in Table 1.1. Data instrument: PROMIS® Scale v1.2 – Global Health scale.
Social functioning	Response to question: “In general, please rate how well you carry out your usual social activities and roles [further specified in questionnaire]”, response options range from poor (1) to excellent (5). Percentage of patients that responded good, very good or excellent (compared to fair or poor). Data instrument: PROMIS® Scale v1.2 – Global Health scale.
Well-being	Response to five questions measuring well-being (have felt cheerful and in good spirits, calm and relaxed, active and vigorous, fulfilled in daily life, fresh and rested), response options scale of 0‑5. Average score of patients (raw scale 0‑25 converted to 0‑100 scale) Percentage of patients reporting positive outcome (score >=50, indicating not at risk of clinical depression), shown in Table 1.1. Data instrument: WHO‑5 Well-being Index.
General health	Response to question: “In general, would you say your health is …” where response options range from poor (1) to excellent (5). Percentage of patients that responded good, very good or excellent (as compared to fair or poor) Data instrument: PROMIS® Scale v1.2 – Global Health scale.
Patient-Reported Experience Measures (PREMs)
Confidence to self-manage	Response to question: “How confident are you that you can manage your own health and well-being?”, response options range from not confident at all (0) to very confident (3). Percentage of patients that are confident or very confident (compared to somewhat confident or not confident at all). Data instrument: P3CEQ Questionnaire.
Experienced co‑ordination	Response to five questions measuring care co‑ordination (care joined up, single named contact, overall care plan, support to self-manage, information to self-manage). Response options scale of 0‑3. Average score of patients (on a scale of 0‑15). Percentage of patients reporting positive experience (scored 50% or more across 5 questions, i.e. scale score >=7.5), shown in Table 1.1. Data instrument: P3CEQ Questionnaire, data available only for people with chronic condition/s.
Person-centred care	Response to eight questions measuring if care is person-centred (discussed what is important, involved in decisions, considered “whole person”, no need to repeat information, care joined up, support to self-manage, information to self-manage, confidence to self-manage). Response options scale of 0‑3. Average score of patients (on a scale of 0‑24). Percentage of patients reporting positive experience (scored 50% or more across 8 questions, i.e. scale score >=12), shown in Table 1.1. Data instrument: P3CEQ Questionnaire, data available only for people with chronic condition/s.
Experienced quality	Response to question: “When taking all things into consideration in relation to the care you have received, overall, how do you rate the medical care that you have received in the past 12 months from your primary care centre?”, response options range from poor (1) to excellent (5). Percentage of patients that responded good, very good or excellent (compared to fair, poor, and not sure). Data instrument: Adapted from Commonwealth Fund International Health Policy Survey.
Trust in healthcare system	Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, response options range from strongly disagree (1) to strongly agree (5). Percentage of patients that agree or strongly agree (compared to neither agree nor disagree, disagree, strongly disagree). Data instrument: Based on OECD Guidelines on Measuring Trust and similar to questions in selected national surveys.