What drives patient discontent? The effect of individual and market determinants

Background. User´s satisfaction is an important tool to evaluate the performance of healthcare services. Measures of satisfaction are important tools for research, administration and planning. Objectives. (i) Study patient satisfaction as a multidimensional concept including organizational issues, professional competence, human characteristics, and status of facilities as dimensions determining the relation between patients and healthcare providers; and (ii) Investigate the contribution of each dimension to overall patient satisfaction, their determinants so as to examine individual and market characteristics which affect overall patient satisfaction, and their mechanisms of operation. Design. Our dataset is based on results from a survey undertaken in health centres to patients visiting their physician. We use information on: (i) Individual variables -demographic, socioeconomic and psychological-; (ii) Market variables –scheduling, centre type, habitat-. The four dimensions included are: organizational issues, professional competence, human characteristics and status of facilities. Main Measures. Patient overall satisfaction is measured as recommendation of the service (dichotomous variable which allows focus on patient’s discontent). Satisfaction defined over the four dimensions are measured as ordinal variables (5-point Likert’s scale). Results. Although individual and market characteristics affect satisfaction with each dimension and overall satisfaction, they operate differently. The characteristics of the provided service determine dramatically, but not only, satisfaction with organisational issues. Since the later is the relatively more important component of overall quality assessment, policy-makers should keep track of these control variables. Conclusions. We have provided a tool for health policy management to be aimed towards ameliorating patient’s discontent, since we have identified patients’ “value chain”.