Abstract
Background and rationale
Despite a global movement toward people-centred care, systematic and comparable data on how populations access, experience, and evaluate their health systems remain scarce. Existing health system performance measurement tends to focus on clinical outcomes and administrative metrics, leaving a critical blind spot: the perspectives of the people the system is meant to serve. Whether populations can access care when needed, how they are treated when they do, whether they trust the system, and whether they feel their voices shape health policy — these questions are rarely answered with rigorous, representative data. This gap is especially pronounced for high-needs groups including adolescents and migrants, whose experiences are rarely captured in national health system assessments. The People’s Voice Survey (PVS), developed by the Harvard-led QuEST Network and validated across 25 countries worldwide, was designed to address this gap. The PVS uses nationally representative samples to measure utilisation, experiences of care, confidence, trust and overall perceived health system quality both among users and non-users of healthcare.
Objectives and methods
With the objective to measure health systems performance, we implemented the PVS in four European countries: Latvia, the Netherlands, Germany, and Switzerland. In each country, surveys were conducted using nationally representative samples. In each country, we also conducted additional sub studies focusing on adolescents (aged 15–19) and selected migrant populations.
Format and added value
The session features four country presentations — from Latvia, the Netherlands, Germany, and Switzerland — each sharing key national findings on access to care, experiences within the health system, and population-level assessments of system quality. Presentations also cover whether people perceive their health system as improving or deteriorating, and the extent to which they feel change is needed. Rather than focusing on direct cross-country comparison, the session draws on diverse learnings from four distinct health system contexts, surfacing experiences that are often invisible in policy debates: unmet need, erosion of trust, perceived worsening of care, and populations who feel the system does not adequately meet their needs. A facilitated discussion follows, exploring what these findings mean for health system governance and how the population perspective can be more systematically heard in policy reform across Europe, while leaving space at the end of the session to reflect on cross-country similarities and differences.
Key messages
• The People’s Voice Survey (PVS), captures how populations access, experience, and rate their health systems, generating evidence to strengthen people-centred care.
• Findings from 4 European countries reveal demand for change, perceived worsening of health systems, and unmet need — offering critical insights for policy makers.