Is satisfaction with healthcare indeed satisfaction with healthcare?
Is satisfaction with healthcare indeed satisfaction with healthcare?

Summary/Abstract: Background: There is a growing need for healthcare services and system performance assessment due to the population ageing and limited resources in Europe. Therefore, it is not surprising that the measurement of the healthcare system performance with public or user satisfaction (Bleich et al., 2009) is considered important. Public satisfaction with a healthcare system is an important dimension of healthcare legitimacy; referring to the citizens’ evaluations of how their government has actually implemented healthcare services in regards to what it had promised (Rothstein 2001). It is proposed that in contrast to expert opinion and other objective performance measures, subjective evaluations directly echo the experiences and perceptions of the public (Blendon & Benson, 2001) and provide an assessment of healthcare systems that is often described as more accurate, legitimate, and sensitive (Aharony & Strasser, 1993; Fitzpatrik, 1991; Park, Park, Kwon, Kang, & Noh, 2016). However, previous studies (Bleich et al., 2009; Footman et al., 2013) argue that public satisfaction with the healthcare system might depend more on external factors outside the health system. For example, Footman et al. (2013) have found that trust in political institutions was the strongest determinant of healthcare system satisfaction in former Soviet Union countries. One such factor outside the healthcare system might be general satisfaction with a government's actions and general life satisfaction of people which frame the overall satisfaction level. Aim: The aim of the paper is to compare public satisfaction with healthcare systems in four types of European healthcare systems and test the hypothesis that healthcare satisfaction is partially a product of the factors outside the healthcare system. Method: Four countries in our analyses represent four different healthcare systems in Europe. Slovakia presents a low-supply and low-performance mixed system, Germany a supply-and-choice oriented public system, The United Kingdom a regulation-oriented public system and Sweden a performance- and primary care-oriented public system. We used data from the European Social Survey round 6 for analyses of healthcare satisfaction, and link healthcare satisfaction with other institutions in the country and individual level life satisfaction. The European Social Survey meets the high standards of quality of comparative social surveys. The survey is representative of 15+ non-institutionalised populations in the country, and guarantees the best solutions for multi-ethnic data collection. Face to face interviews were used in data collection. In addition to correlation and linear regression analyses, we use structural equation model to distinguish the structure of the satisfaction formation. We investigate mainly the link between satisfaction with healthcare, satisfaction with government, satisfaction with democracy, trust in institutions, overall satisfaction with the individual life, health status and household income situation. Findings: Among different countries and healthcare systems, public satisfaction with healthcare was lowest in the low-supply, low-performance mixed system represented by Slovakia. The structural equation modelling analysis suggested that in all countries satisfaction with the healthcare system belongs to the same set with other institutional satisfaction and trust indicators, rather than being an independent healthcare indicator. Healthcare satisfaction was strongly influenced by the overall satisfaction with other different institutions in society. A comparison of two alternative models proved that the model fit was much better in the model including the latent institutional satisfaction variable (Latent Satisfaction) compared to the model with the independent healthcare satisfaction variable. Latent Satisfaction is also associated with individual life satisfaction. In all countries people who were more pleased with the government and democracy in their country and trusted more national institutions were also more satisfied with the healthcare system. Regression analysis revealed that institutional satisfaction with government, democracy and institutional trust influenced the satisfaction with healthcare more than the individual background situation of people, including the economic situation and subjective health in all healthcare systems. Summary and implications: The structural equation model showed that the overall latent institutional satisfaction component was linked universally with healthcare satisfaction in all countries, regardless of the healthcare system. Moreover, the results demonstrated that latent components of satisfaction with different national institutions was one of the most powerful factors related to formation of satisfaction with the healthcare system. This can be taken into account in the healthcare system assessments in the future.

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