Satisfaction and Quality:

Patient and Physician Perspectives

Data Bulletin No. 03
Fall 1997
Marie C. Reed, Robert F. St. Peter

ow satisfied are Americans today with their health care? How strongly do physicians believe they are able to provide high-quality care? Because of a lack of objective, systematic and reliable measures of quality of care, patients’ and physicians’ perspectives on these questions can serve as important barometers of quality. These issues are of particular interest because of the many changes in the health care system over the past several years.

FAMILIES’ PERSPECTIVES

he great majority of American families are either very satisfied (61 percent) or somewhat satisfied (28 percent) with the health care they received in the last 12 months, but more than 1 out of 10 are not satisfied with this care, according to the Household Survey conducted by the Center for Studying Health System Change.

The proportion of families not satisfied with their health care varies across the communities studied. A larger proportion of families in Miami (16 percent) and a smaller proportion of families in Lansing (10 percent) and Syracuse (8 percent) report that they are not satisfied with their health care. (See table below.)

Many factors may be responsible for community-level variation. These include: differences across communities in patients’ medical needs and expectations; availability of medical services, particularly to the uninsured; cost of care borne directly by patients; quality of interpersonal relationships with physicians and other providers; extent and nature of managed care; and patterns, effectiveness and outcomes of treatment.

PHYSICIANS’ PERSPECTIVES

he Center’s Physician Survey found that the majority of doctors either agree strongly (45 percent) or agree somewhat (31 percent) with the statement: "It is possible to provide high-quality care to all of my patients." Almost one in four (24 percent) physicians, however, do not agree that it is possible to provide high-quality care to all of their patients. Specialists (27 percent) are more likely than primary care physicians (18 percent) to express this view.

Physicians’ assessments of their ability to provide high-quality care vary by community. Fewer physicians in Syracuse (18 percent), Lansing (18 percent) and Greenville, S.C. (19 percent), do not agree that it is possible to provide high-quality care to all of their patients. Factors explaining this variation in physicians’ assessments may include differences across communities in: characteristics of patient populations; specific training and expectations of the physicians; degree of autonomy physicians have in making clinical decisions; availability of specialists and other medical services for treating complex medical problems; and the general attitude of physicians about changes in the health care environment, including the nature and extent of managed care.

SHARED PERSPECTIVES

striking finding from both surveys is that communities with a higher (or lower) proportion of families not satisfied with their health care tend to have a higher (or lower) proportion of physicians who do not agree that it is possible to provide high-quality care to all of their patients. The correlation between families’ and physicians’ views in the communities studied is high (0.81). Understanding the factors leading to such variation across communities and how these findings may change over time are objectives of the Center’s ongoing research.

This Data Bulletin presents preliminary findings from the Household and Physician Surveys conducted in 1996 and 1997 as part of the Community Tracking Study. The Household Survey is a nationally representative telephone survey of the civilian, non-institutionalized population; it included 43,771 persons in 23,554 families. The Physician Survey is a nationally representative telephone survey of non-federal, patient care physicians (excluding certain specialities -- e.g., radiology, anesthesiology, pathology); it included 9,264 physicians, of whom 5,160 are primary care physicians. All comparisons and differences described in the text are statistically significant at the p<0.05 level.