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Patient satisfaction doesn't necessarily mean better care

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March 31, 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, according to a new study published in the WHO Bulletin by Dr. Christopher Murray from the Institute for Health Metrics and Evaluation at the University of Washington and colleagues from the Harvard School of Public Health and Johns Hopkins University’s Bloomberg School of Public Health.

"Patient satisfaction surveys are playing a greater role in evaluating health system performance and therefore understanding the relationship between how patients rate their care and the actual care they receive is crucial,” says Dr. Murray. “What our study shows is that the relationship is murky.”
  
The analysis focused on 21 European Union countries in the 2003 World Heath Survey for which data were available. 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. Researchers found that reported satisfaction varied greatly, even amongst 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 even a country’s rate of immunization coverage.

Researchers found higher satisfaction ratings among those with a higher education, higher income per capita, older patients, inpatients (vs. 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.

The authors believe the remainder of the variation could be explained by societal influences that they were unable to capture in the analysis. “The media’s portrayal of the health care system, war, even the performance of national football teams may be partly responsible for the remaining variation in satisfaction with the health care system,” says Dr. Murray.

Murray suggests more research is needed to fully understand the factors influencing patients' satisfaction of the health care system.

Read the article: 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;87:271–278. (pdf*)
Technical Appendices (pdf*)

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