How does satisfaction with the health care system relate to patient experience?
Published in the Bulletin of the World Health Organization, March 2009
A patient’s satisfaction with the health care system depends more on factors external to the system than the patient’s actual health care experience, research shows. The study, How does satisfaction with the health care system relate to patient experience?, suggests that because patient satisfaction surveys are playing a greater role in evaluating health system performance, it is important to understand discrepancies in the relationship between how patients rate their care and the actual care they receive. The work was done in collaboration with scientists at the Harvard School of Public Health and Johns Hopkins University’s Bloomberg School of Public Health.
Researchers found that patient experience was significantly associated with satisfaction with the health care system, although reported satisfaction varied greatly, even among patients with similar characteristics located in countries with comparable health systems. For example, Austria and Spain have health care systems that are publicly financed, universally accessible, and similar in many substantive ways, however only 10.8% of Spaniards surveyed claimed to be “very satisfied” with the health care system, compared to 70.4% of Austrians.
In exploring the sources of such variation, researchers found that patient experience accounted for only 10.4% of the variation around the concept of satisfaction, while 17.5% of variation was attributed to factors such as age, income, education, personality, and a country’s rate of immunization coverage.
Researchers also found higher satisfaction ratings among those with a higher education, higher income per capita, older patients, inpatients (versus outpatients), people from countries that had lower immunization coverage, and patients receiving care in a public system. Most surprising is that over 70% of the variation remained largely a mystery, and might be explained by societal influences that they were unable to capture in the analysis.
The analysis focused on 21 European Union countries for which data were available in the 2003 World Health Survey. In that survey, patients were asked to rate their health care systems based on how long they waited to receive care, the quality of basic equipment or facilities, respect for privacy, and overall interaction with the health care team. Additive ordinary least-squares regression models were used to assess the extent to which variables commonly associated with satisfaction with the health care system, as recorded in the literature, explain the variation around the concept of satisfaction. A residual analysis was used to identify other predictors of satisfaction with the health care system.
Data on health system responsiveness (i.e., the manner and environment in which people are treated when they seek health care) provides a unique opportunity to understand the determinants of people’s satisfaction with the health care system and how strongly this is influenced by an individual’s experience as a patient. This study attempted to explore what determines people’s satisfaction with the health care system above and beyond their experience as patients. This research is part of ongoing work by IHME to gauge how societies are performing in addressing health challenges locally and internationally.
Recommendations for future work
Contrary to published reports, people’s satisfaction with the health care system depends more on factors external to the health system than on the experience of care as a patient. Thus, measuring patient experience may be of limited use as a basis for quality improvement and health system reform. More research is needed to fully understand the factors influencing patients' satisfaction of the health care system.
Citation: Bleich SN, Özaltin E, Murray CJL. How does satisfaction with the health care system relate to patient experience? Bulletin of the World Health Organization. 2009 Mar 4;87:271–278.