Satisfaction and Quality:

How satisfied were Americans with their health care during the late 1990s, and how confident were physicians in their ability to deliver high-quality care? In the absence of objective, systematic measures of care quality, the perceptions of patients and doctors served as valuable indicators. These questions took on heightened importance given the rapid changes reshaping the health care system during this period, including the expansion of managed care.

Families' Perspectives on Health Care

The Household Survey conducted by the Center for Studying Health System Change found that the vast majority of American families were either very satisfied (61 percent) or somewhat satisfied (28 percent) with the health care they had received in the preceding 12 months. Still, more than 1 in 10 families expressed dissatisfaction with their care.

The share of families reporting dissatisfaction varied across the communities studied. A higher proportion of families in Miami (16 percent) were not satisfied, while families in Lansing (10 percent) and Syracuse (8 percent) were less likely to report dissatisfaction.

Numerous factors could explain these community-level differences, including variation in patients' medical needs and expectations, the availability of medical services (particularly for the uninsured), the direct costs borne by patients, the quality of relationships between patients and their providers, the extent and character of managed care in each market, and the patterns, effectiveness, and outcomes of treatment.

Physicians' Perspectives on Quality

The Center's Physician Survey found that most doctors either agreed strongly (45 percent) or agreed somewhat (31 percent) with the statement: "It is possible to provide high-quality care to all of my patients." However, nearly one in four physicians -- 24 percent -- did not agree that delivering high-quality care to all their patients was possible. Specialists (27 percent) were more likely than primary care physicians (18 percent) to hold this view.

Physician confidence in their ability to provide high-quality care also varied geographically. Fewer physicians in Syracuse (18 percent), Lansing (18 percent), and Greenville, South Carolina (19 percent), disagreed that they could deliver high-quality care to all patients. The factors behind this variation were likely multiple: differences in patient population characteristics, physician training and expectations, the degree of clinical decision-making autonomy available to doctors, access to specialists and other medical resources for complex cases, and physicians' broader attitudes about the changing health care environment, including managed care.

A Notable Alignment Between Patient and Physician Views

One of the most striking findings from the two surveys was the strong correspondence between family satisfaction and physician confidence at the community level. Communities where a higher proportion of families reported dissatisfaction with their health care also tended to have a higher proportion of physicians who doubted their ability to provide high-quality care to all patients. The statistical correlation between these two measures across the communities studied was notably strong (0.81).

This alignment suggested that the factors driving patient satisfaction and physician confidence were at least partly shared -- whether those factors involved resource availability, local market conditions, or the broader care environment. Understanding what produced such variation across communities, and tracking how these perceptions shifted over time, were central objectives of the Center's ongoing research program.

Community-Level Comparison

The Community Tracking Study provided side-by-side data on family dissatisfaction and physician skepticism about quality across 12 metropolitan areas. The share of families not satisfied and the share of physicians not agreeing they could provide high-quality care, respectively, by community: Boston (10 percent, 23 percent); Cleveland (12 percent, 21 percent); Greenville, S.C. (11 percent, 19 percent, significantly different); Indianapolis (11 percent, 24 percent); Lansing (10 percent, significantly different, 18 percent, significantly different); Little Rock (11 percent, 21 percent); Miami (16 percent, significantly different, 30 percent); Newark (12 percent, 29 percent); Orange County (13 percent, 31 percent); Phoenix (14 percent, 30 percent); Seattle (12 percent, 25 percent); Syracuse (8 percent, significantly different, 18 percent, significantly different). For metropolitan areas over 200,000 population, averages were 12 percent and 25 percent. National averages were 11 percent and 24 percent.

Sources and Further Reading

This Data Bulletin presents findings from the Community Tracking Study, including both the Household Survey and the Physician Survey, conducted by the Center for Studying Health System Change. The surveys covered 12 randomly selected metropolitan areas and a nationally representative sample. Statistical significance is noted where site values differ from the mean for metropolitan areas with populations over 200,000.