Does Healthcare Deliver? Results from the Patient-Reported Indicator Surveys (PaRIS): Switzerland

The OECD Patient-Reported Indicator Surveys (PaRIS) is a groundbreaking initiative that fills a critical gap in health data by measuring the health outcomes and care experiences of people. This is an essential piece of information still lacking: the views of those directly concerned by health services – the patients – about their experience with the healthcare system and the outcomes as reported by them. By capturing the perspectives of over 107 000 people across 1 800 primary care practices in 19 countries, PaRIS provides an internationally comparable assessment of how outcomes and experiences of primary care users aged 45 years and older vary across countries and how healthcare systems deliver the care people with chronic conditions need.

As the global population of people living with chronic conditions continues to grow, the need for healthcare systems to adapt to their needs has never been more urgent. PaRIS plays a crucial role in informing this shift by offering data that supports the reorganisation of healthcare around the care experiences and health outcomes that matter most to people. Unlike disease‑specific assessments, PaRIS takes a broader approach, measuring how healthcare impacts people’s lives across various dimensions. This comprehensive perspective has the potential to revolutionise the way we assess the performance of healthcare systems on a global scale.

PaRIS findings emphasise the need for more people‑centred and co‑ordinated care, especially for the 80% of primary care users aged 45 years and older that live with at least one chronic condition and the 50% that live with multiple (two or more) chronic conditions. Targeted policies are essential to address inequalities, enhance care co‑ordination, and build trust in healthcare systems. Encouraging patient involvement in care decisions and fostering strong relationships with healthcare professionals can lead to better health outcomes, greater trust in the system, and increased confidence in managing their own health. At the same time, a well-staffed healthcare workforce and primary care practices organised around people’s needs are key to achieving improved patient outcomes and experiences.

This country note leverages the main findings of the publication, Does Healthcare Deliver: Results from the Patient-Reported Indicator Surveys (PaRIS), to provide a focused assessment for Switzerland. 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 Swiss 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.

In Switzerland people with chronic conditions have better health outcomes and experiences of healthcare, compared to most PaRIS countries (Chapter 2). This assessment is based on the 10 key patient-reported outcome measures (PROMs) – physical health, mental health, social functioning, well-being and general health and patient-reported experience measures (PREMs) – confidence to self-manage, experienced co‑ordination of care, experienced person-centred care, experienced quality of care and trust in healthcare system (Figure 1).

In Switzerland, people living with chronic conditions are more likely to have good health outcomes compared to other countries in PaRIS – this places Switzerland as one of the best performers in the PaRIS survey results (Figure 1).

• More than four out of five (82%) people with chronic conditions in Switzerland report good physical health, as measured by physical function, pain, and fatigue. This is above the OECD PaRIS average of 70% and the highest among participating countries.

• More than nine out of ten (91%) people with chronic conditions in Switzerland report good mental health, referring to quality of life, emotional distress, and social health. This is above the OECD PaRIS average of 83% and only 2 percentage points below the highest-performing country (93%).

• Nine out of ten (90%) people with chronic conditions in Switzerland report good social functioning, which measures how well people carry out their usual social activities and roles. This is above the OECD PaRIS average of 83% and only 3 percentage points below the highest-performing country (93%).

• Four out of five (80%) people with chronic conditions in Switzerland report positive well-being, which reflects mood, vitality, and fulfilment. This is the highest performance among participating countries and is 9 percentage points above the OECD PaRIS average of 71%.

• Nearly four out of five (79%) people with chronic conditions in Switzerland report good general health, which is significantly above the OECD PaRIS average of 66% but 14 percentage points below the highest-performing country (93%).

More people living with chronic conditions in Switzerland have good care experiences compared to other countries in PaRIS (Figure 1).

• Two-thirds (67%) of people with chronic conditions in Switzerland feel confident managing their own health, which is above the OECD PaRIS average of 59% but the 25 percentage point difference with the highest-performing country (92%) shows room for improvement.

• More than four out of five (81%) people with chronic conditions in Switzerland report good care co‑ordination, which is the highest performance among participating countries and well above the OECD PaRIS average of 59%.

• Nearly all people (97%) with chronic conditions in Switzerland report good person-centred care, care focusing on patient’s needs, and experiencing good quality of care, which is the highest among participating countries and considerably above the OECD PaRIS average of 85% and 87%, respectively.

• More than seven out of ten (71%) people with chronic conditions in Switzerland trust their healthcare system, which is above the OECD PaRIS average of 62% but 18 percentage points below the highest-performing country (89%).

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 Switzerland and the OECD PaRIS average, yet Switzerland scores higher than the OECD PaRIS average in health outcomes and above the good-fair cutoff for physical health. Specifically:

• In Switzerland, people with three or more chronic conditions are less likely to report better health compared to those with two chronic conditions. This pattern is consistent with other countries’ results.

• People living with several chronic conditions in Switzerland have poorer physical health compared to those living with only one chronic condition with a 7‑point difference, 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 Switzerland are slightly higher than the OECD PaRIS average (Figure 2). For example, while the average physical health score of people with three or more chronic conditions in Switzerland is above the good-fair cutoff point (42), the OECD PaRIS average is below the cutoff.

• Similarly, Switzerland performs better than the OECD PaRIS average regarding the mental health of people living with one, two, and three or more chronic conditions. People with three or more chronic conditions in Switzerland report poorer mental health than those with one chronic condition, a 4‑point difference gap, a slightly narrower gap compared to OECD PaRIS average (5‑point difference) (Figure 3).

• People with multiple chronic conditions less often report good social functioning than people with one chronic condition in Switzerland, as elsewhere (Figure 4). While 95% of people with one chronic condition in Switzerland have good social functioning, this goes down to 82% of people with three or more chronic conditions, which is above 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, Switzerland is above average in most primary care consultation features (Figure 5):

• Almost four out of five people (78%) with two or more chronic conditions in Switzerland are managed in primary care practices that offer follow-up and regular consultations of more than 15 minutes; this is 31 percentage points higher compared to the OECD PaRIS average of 47%.

• In Switzerland, four out of five people (80%) with two or more chronic conditions are managed in primary care practices where non-physician staff is involved in chronic disease management; this is similar to the OECD PaRIS average of 83%.

• More than nine out of ten people (91%) with three or more chronic conditions in Switzerland report that their medication was reviewed by a healthcare professional over the past 12 months; this is 16 percentage points higher than the OECD PaRIS average of 75%.

• More than three out of five people (63%) with two or more chronic conditions in Switzerland report being with the same primary care professional for more than five years; this represents 5 percentage points above the OECD PaRIS average (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, Switzerland demonstrates strong performance compared to the OECD PaRIS average (Figure 6):

• Around 82% of people with chronic conditions in Switzerland receive enough support to manage their own health, significantly above the OECD PaRIS average of 63%.

• Switzerland’s digital health literacy equals OECD PaRIS average, with 19% of people with chronic conditions reporting confidence in using health information from the internet (range of 5‑34%).

• A very high percentage (88%) 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%.

• However, only 55% of people with chronic conditions are managed in practices that can exchange medical records electronically, slightly below the OECD PaRIS average of 57%.

These results highlight Switzerland’s strong infrastructure for supporting patients with chronic conditions and co‑ordinating care but point to potential areas of improvement in digital health literacy and electronic medical record adoption.

Among people with chronic conditions, there are differences in well-being and trust in the healthcare systems across genders in Switzerland, both indicators being lower for women (Figure 7 and Figure 8).

• The gender gap in well-being in Switzerland is smaller compared to the OECD PaRIS average (5‑points). This gender gap mirrors results for other countries; however, Switzerland performs slightly better than the OECD PaRIS average in terms of well-being, particularly for women.

• While about 74% of men with chronic conditions in Switzerland have trust in healthcare, only 68% of women with chronic conditions have trust in the healthcare system. These trust levels are much higher than the OECD PaRIS average for men (67%) and women (58%) with chronic conditions. The gender gap in trust in Switzerland (7 percentage points) is slightly smaller than 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 (Figure 9 and Figure 10):

• Across OECD PaRIS countries, people with chronic conditions and higher incomes report better well-being on average than those with lower incomes (seven point difference). Switzerland well-being levels are higher than the OECD PaRIS average.

• In Switzerland, among people living with chronic conditions, almost eight out of ten people (78%) with higher income trust the healthcare system, compared to 67% of people with lower income. The trust levels in the healthcare system across income groups are much higher than the OECD PaRIS average for high (70%) and low (59%) income groups. The gap between high- and low-income groups in Switzerland is comparable to the OECD PaRIS average (11%).