The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature.

Is primary care essential

Objectives. We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status.Methods. We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures.Results. In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States.Conclusions. United States residents are less able to access care than are Canadians. Universal coverage appears to reduc...

http://www.pnhp.org/PDF_files/USvCan_AJPH06.pdf

Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673600048261.pdf

World Health Report 2000: a step towards evidence-based health policy.

OBJECTIVE: To explore what determines people's satisfaction with the health-care system above and beyond their experience as patients. METHODS: Data on health system responsiveness, which refers to the manner and environment in which people are treated when they seek health care, provides a unique opportunity to better 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. The data were obtained from 21 European Union countries in the World Health Survey for 2003. 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. FINDINGS: Patient experience was significantly associated with satisfaction with the health-care system and explained 10.4% of the variation around the concept of satisfaction. Other factors such as patient expectations, health status, type of care, and immunization coverage were also significant predictors of health system satisfaction; although together they explained only 17.5% of the observed variation, while broader societal factors may largely account for the unexplained portion of satisfaction with the health-care system. CONCLUSION: 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 the latter may be of limited use as a basis for quality improvement and health system reform.

/pdf/how-does-satisfaction-with-the-health-care-system-relate-to-3x439o83n5.pdf

How does satisfaction with the health-care system relate to patient experience?

Amid growing dissatisfaction with its health care system, the United States is increasingly looking abroad for insights into health system reform. In the Spring 1989 issue of Health Affairs, an analysis of a threenation survey of how Americans, Canadians, and Britons viewed the performance of their health care systems showed that, of citizens of the three countries, Americans expressed the greatest degree of dissatisfaction with their health system and Canadians the least. In addition, only Americans were so dissatisfied that they would consider adopting the type of health system found in another country. The majority of the public (61 percent) stated they would prefer the Canadian system of national health insurance, in which “the government pays most of the cost of care for everyone out of taxes, and the government sets all fees charged by doctors and hospitals” to the current U.S. system. A number of questions were raised about the results of this survey, including the following. (1) Were the findings of this three-nation survey replicable across multiple surveys and time periods, or were they a onetime, random result? (2) Are citizens of other industrialized countries as satisfied with their governments’ national health plans as Canadians or Britons are? Might not other nations with health systems similar to these have populations that are dissatisfied with their government-sponsored programs? (3) Were Canadians’ favorable attitudes toward their health system more a reflection of their optimistic and supportive views regarding their national institutions than an actual measure of their satisfaction with their universal health program? This DataWatch seeks to address these questions with recent findings from a number of international and domestic opinion surveys.

Satisfaction With Health Systems In Ten Nations

Background The United States is considering enacting a national health plan and global health care budget similar to those in other countries There are few data on the effects of such policies on physicians and patients Methods We conducted a telephone survey of 602 physicians in the United States, 507 physicians in Canada, and 519 physicians in the former West Germany from February through May 1991; the response rates were 44 percent, 49 percent, and 41 percent, respectively Among other topics, the questionnaire included measures of satisfaction with the health care system and with medical practice Results In the United States, 23 percent of the physicians surveyed thought the health care system worked well, as compared with 33 percent in Canada and 48 percent in West Germany Seventy-three percent of US physicians reported that patients' inability to afford necessary treatment was a serious problem, as compared with 25 percent in Canada and 15 percent in West Germany Seventy-seven percent of West

Physicians' perspectives on caring for patients in the United States, Canada, and West Germany.

To explore the concerns of practicing physicians as a way to inform the health reform debate, the authors conducted a survey of physicians in the United States, Canada, and Germany. Survey results indicate that U.S. physicians are most likely to view affordability as the greatest barrier to access to care for their patients. However, unavailability of services and long waiting times were cited most often by Canadian physicians. German physicians did not cite access problems as frequently as Canadian physicians did; other measures of satisfaction were closer to U.S. levels, suggesting fewer trade-offs if the United States were to adopt aspects of the German health care system.

Health reform lessons learned from physicians in three nations

Many of the legislative proposals to address the growing problem of uninsured Americans to date have focused on improving access to health insurance for small businesses. This focus is sound for three reasons. First, the impact could be quite large–over 53 percent of the uninsured work for small businesses, and many more are dependents of someone who works for a small firm. Second, these reforms retain our current employment-based system of providing health insurance–a system that is favored by a large number of employers and employees. Third, the reforms expand access to health insurance without requiring that the federal government raise taxes. Proposals targeted at covering employees of small businesses have taken two forms. The first, reforms of the small-group insurance market, attempt to address many of the problems small businesses face in offering health insurance to employees: high costs, rising rates, policy cancellations, lack of access to a policy due to insurance policies such as “redlining” (that is, excluding) specific industries, exclusions of certain individuals or illnesses, and lack of information about rates. Such proposals retain the voluntary nature of health benefits and only attempt to regulate the sale of policies by insurance companies. The second group of proposals focuses on providing access to insurance for small businesses as part of a comprehensive program to cover all of the uninsured. Universal access proposals fall into three categories-employer mandates, “play-or-pay” proposals, and single-payer programs-and the effect of any policy on small businesses will depend on the financing levels set in the legislation. A variety of tax rates and subsidy levels are being considered.

Ian Morrison

Papers

Satisfaction With Health Systems In Ten Nations

Physicians' perspectives on caring for patients in the United States, Canada, and West Germany.

Health reform lessons learned from physicians in three nations

Small business and the national health care reform debate.