Vaccines are a cost-effective tool for protecting against infectious diseases. There is broad agreement within the global scientific community that the most effective way to defeat infectious diseases such as diphtheria, tetanus and pertussis (DTP), measles, hepatitis B, and influenza is through the mass vaccination of populations around the world. High national coverage rates, however, may not be sufficient to stop disease spreading if vaccination rates are uneven within the country, or if take‑up is low in specific population groups. Hence, government action to garner trust and public confidence in the safety and efficacy of vaccination across all population groups is essential for the success of vaccination programmes (OECD, 2021[1]).

Early diagnosis, together with healthy lifestyles (see Chapter 4 “Risk factors for health”), is key to tackling cancer. Screening is considered a cost-effective way to reduce the burden of breast, cervical and colorectal cancer. Most OECD countries have programmes for breast, cervical and colorectal cancer screening in place for target populations, but for each cancer type, the target population, screening frequency and methods can vary across countries.

Safe prescribing of medicines can be used as an indicator of healthcare quality, complementing information on consumption and expenditure on pharmaceuticals (see Chapter 9). The overuse, underuse or misuse of prescription medicines can lead to serious consequences for the health of the patient and wasteful expenditure. This is the case for opioids and antibiotics, for example.

Asthma, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are widely prevalent long-term conditions. Common to all three conditions is that the evidence base for effective treatment is well established, and much of it can be delivered by primary care. A high-performing primary care system, where accessible and high-quality services are provided, can reduce acute deterioration in people living with asthma, COPD or CHF. Hospital admissions for these conditions are largely avoidable and are therefore used as a marker of quality and access to primary care, with the proviso that very low admissions rates may also partly reflect reduced access to acute care.

Effective management of diabetes is a public health priority, with about 537 million adults estimated to be living with the condition worldwide. The significance of prevention and management of diabetes was also highlighted during the COVID‑19 pandemic, as the infection is associated with high risks of hospitalisation and mortality among people with diabetes. Deaths due to diabetes continue to increase globally, reaching 6.7 million deaths in 2021. It is projected that by 2045 approximately 783 million adults will have the condition, and taking into account the impact of COVID‑19, the burden of diabetes is likely to become even higher (IDF, 2021[1]).

Given the importance of incorporating people’s voices into the development of health systems and improving quality of care, national efforts to develop and monitor patient-reported measures have been intensified in recent years. In many countries, specific organisations have been established, or existing institutions identified, and made responsible for measuring, monitoring and reporting patient experiences of healthcare. This has resulted in more regular collection of patient experience data and standardised procedures for analysis and reporting.

Measures of patient safety culture from the perspective of health workers can be used – along with patient-reported experiences of safety and traditional patient safety indicators (see section on “Safe acute care – surgical complications and obstetric trauma”) – to give a holistic perspective of the state of safety in health systems.

Patient safety, relating to prevention of harm during healthcare activities, remains a pressing issue with substantial social and economic costs in OECD countries. It is estimated that up to 13% of healthcare spending goes towards treatment of patients harmed during care, the majority of which could be avoided if appropriate safety protocols and clinical guidelines were adhered to (Slawomirski and Klazinga, 2022[1]). To achieve sustainable progress towards safe care and the goals of WHO’s Global Patient Safety Action Plan 2021‑30, a focus on the promotion of patient safety cultures (see section on “Safe acute care – workplace culture and patient experiences”) and improvement in both processes and outcomes (see section on “Patient-reported outcomes in acute care”) is vital (WHO, 2021[2]).

Mortality due to coronary heart disease has declined substantially over recent decades (see section on “Mortality from circulatory diseases” in Chapter 3). Reductions in smoking (see section on “Smoking” in Chapter 4) and improvements in treatment for heart diseases have contributed to this decline (OECD, 2015[1]). Despite this progress, AMI (heart attack) remains one of the leading causes of death and the main cause of cardiovascular death in many OECD countries, highlighting the need for further reductions in risk factors and care quality improvements (OECD/The King's Fund, 2020[2]).

Stroke is a leading cause of death, accounting for 6% of all deaths across OECD countries in 2021 (see sections on “Main causes of mortality” and “Mortality from circulatory diseases” in Chapter 3). A stroke occurs when the blood supply to a part of the brain is interrupted, leading to necrosis (cell death) of the affected part. Of the two types of stroke, about 85% are ischaemic (caused by clotting) and 15% are haemorrhagic (caused by bleeding).

Patient-reported measures have become essential tools to improve healthcare quality and ensure people‑centred care. Patient-reported outcome measures (PROMs) are often used as an indicator of the quality of care, including acute care such as hip and knee replacement surgery. They are used to monitor and promote delivery of patient-centred care as they provide information about patients’ perception of the quality of healthcare, such as whether the care they received met their individual goals and needs. Given the increasing importance of measuring PROMs to assess the quality of care in recent years, the number of people responding to PROMs requests in relation to hip and knee replacement surgery has increased across countries, even during the COVID‑19 pandemic when the volume of surgeries declined (OECD, forthcoming[1]).

The burden of mental illness is substantial, affecting one in two people at some point in their lives. During the COVID‑19 pandemic, levels of mental distress increased (see section on “Mental health” in Chapter 3), and the prevalence of anxiety and depression doubled in some countries (OECD, 2021[1]). The economic costs due to mental ill health have been estimated to be more than 4.2% of gross domestic product (GDP), covering both the direct costs of treatment and the indirect costs related to lower employment rates and reduced productivity (OECD, 2021[2]). High-quality, timely care has the potential to improve outcomes, and to reduce suicide and excess mortality for individuals with mental disorders.

When patients with chronic conditions require care from multiple providers across different healthcare settings, fragmented care can lead to poor health outcomes, unmet needs, and excessive service utilisation and costs. Recognising the need for care integration, countries are developing new models of care, aiming to enhance population health, improve patient experiences, reduce healthcare costs, support the well-being of healthcare professionals and promote health equity (OECD, 2023[1]).