The PaRIS initiative: Helping healthcare policies to do better for patients

Director, OECD Directorate for Employment, Labour and Social Affairs

When is healthcare successful? All too often, the answer is that we don’t really know. Although healthcare consumes almost a tenth of GDP in the OECD, our understanding of the value and outcomes that this large and often growing spending achieves remains limited. 

Health systems collect vast amounts of data—how many patients were treated, what services were delivered, whether clinicians followed guidelines, and how much was spent.  We typically measure survival rates, or rates of cure after treatment, as a marker of success. But these indicators do not tell us enough about people’s recovery and ability to get back to their usual activities which, ultimately, is what we expect from healthcare. In the last decade, for example, knee replacements have doubled from 60 per 100,000 people to 120 on average in OECD countries. But not all these interventions may be justified if a patient’s ability to work, look after their family, or do whatever matters to them, is no better after the operation compared to before.

Collecting data on clinical outcomes, like mortality and complications, is essential, and the OECD is contributing in providing comparable indicators on them. But we also need to know about the outcomes that matter from a patient’s point of view if we are to strengthen the capacity of clinicians and policymakers to provide health services shaped around patients’ needs. And this can only be done by asking the patients themselves what they think of healthcare quality.

Progress has recently been made on this front and a number of health systems, particularly at local level, are starting to collect “patient-reported outcome measures” (PROMs) and “patient-reported experience measures” (PREMs). PROMs systematically ask people to report back on outcomes that matter to them, whether treatment reduced their pain, for example, or helped them live more independently. PREMs complement this information by asking people about their experience of being treated, for instance, whether the treatment was properly explained to them, or if they felt involved in decisions about their care.

However, work in this area faces hurdles. For instance, although validated data sets of the most important outcomes by disease have been developed by the International Consortium for Health Outcomes Measurement (ICHOM), each health system continues to pursue its own path, leading to fragmentation which greatly narrows the scope for cross-country comparative analysis of outcomes. This means that opportunities to identify excellence, support poor performers and drive improvements across the board will inevitably be missed. Moreover, there is a glaring gap to fill, too, in that the biggest users of healthcare–people with multiple, long-term conditions–are typically not included in PROMs and PREMs initiatives at all.

The OECD can play an important role in addressing these issues. In particular, by emphasising the substantial benefit from standardising PROMs and PREMs across countries, and recognising the OECD’s leadership in reporting health system performance measures, the OECD is well placed to take forward international work to extend and deepen the benchmarking of health system performance through patient-reported indicators.

Indeed, after in-depth discussions with a high-level reflection group, involving leading experts in measuring and driving health performance improvement, and with member countries, the OECD requested a mandate from health ministers at their meeting on 17 January 2017 to develop an exciting new global initiative, the Patient-Reported Indicators Survey, or PaRIS for short. PaRIS aims to devise new tools to improve healthcare policy and practice, and build a people-centred view of health system performance. It will be done in two ways. First, in conditions where patient reported indicators are already used, such as in care after a stroke or heart attack, in cancer care, and in hip and knee surgery, PaRIS will work with countries to accelerate the international monitoring of standardised PROMs and PREMs. Second, in conditions where PROMs and PREMs are rarely used, PaRIS will develop new patient-reported indicators. Priority groups in this case are patients with chronic conditions such as diabetes and dementia and, in particular, patients with several conditions at once, as these require complex care. PaRIS will survey both patients and carers directly, and issue new state of the art indicators on health system performance.

This is a challenging, multi-year project that will depend on close collaboration with international partners such as the European Commission, the World Health Organization, the Commonwealth Fund and the International Consortium for Health Outcomes Measurement. All stakeholders stand to benefit, particularly patients, by helping them assessing what treatments are the most likely to benefit them, and clinicians who will have critical data on how to improve the care they provide. Policymakers will also benefit from PaRIS, by having better information on where to focus quality improvement efforts and prioritise spending.

So, to return to my opening question, when is healthcare successful?  For me, the answer is clear: when patients state that their well-being is better as a result. Through PaRIS, we will capture the vital information required to build successful healthcare systems that are truly responsive to patients everywhere.

For further information contact: and visit

©OECD Observer No 309 Q1 2017

Read Ministerial Statement: The next generation of health reforms

Article updated 21/02/2017

Economic data


Stay up-to-date with the latest news from the OECD by signing up for our e-newsletter :

Twitter feed

Suscribe now

<b>Subscribe now!</b>

To receive your exclusive paper editions delivered to you directly

Online edition
Previous editions

Don't miss

  • How do the largest community of British expats living in Spain feel about Brexit? Britons living in Orihuela Costa, Alicante give their views.
  • Brexit is taking up Europe's energy and focus, according to OECD Secretary-General Angel Gurría. Watch video.
  • OECD Chief Economist Catherine Mann and former Bank of England Governor Mervyn King discuss the economic merits of a US border adjustment tax and the outlook for US economic growth.
  • Africa's cities at the forefront of progress: Africa is urbanising at a historically rapid pace coupled with an unprecedented demographic boom. By 2050, about 56% of Africans are expected to live in cities. This poses major policy challenges, but make no mistake: Africa’s cities and towns are engines of progress that, if harnessed correctly, can fuel the entire continent’s sustainable development.
  • OECD Observer i-Sheet Series: OECD Observer i-Sheets are smart contents pages on major issues and events. Use them to find current or recent articles, video, books and working papers. To browse on paper and read on line, or simply download.
  • How sustainable is the ocean as a source of economic development? The Ocean Economy in 2030 examines the risks and uncertainties surrounding the future development of ocean industries, the innovations required in science and technology to support their progress, their potential contribution to green growth and some of the implications for ocean management.
  • The OECD Gender Initiative examines existing barriers to gender equality in education, employment, and entrepreneurship. The gender portal monitors the progress made by governments to promote gender equality in both OECD and non-OECD countries and provides good practices based on analytical tools and reliable data.
  • They are green and local --It’s a new generation of entrepreneurs in Kenya with big dreams of sustainable energy and the drive to see their innovative technologies throughout Africa.
  • Interested in a career in Paris at the OECD? The OECD is a major international organisation, with a mission to build better policies for better lives. With our hub based in one of the world's global cities and offices across continents, find out more at .

Most Popular Articles

OECD Insights Blog

NOTE: All signed articles in the OECD Observer express the opinions of the authors
and do not necessarily represent the official views of OECD member countries.

All rights reserved. OECD 2017