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An Analysis of Survey Data from 11 Countries Finds That "Satisfaction" with Health System Performance Means Many Things

The Issue

Patient satisfaction surveys are important for assessing health system performance. It is unclear, however, if the scores reflect respondents’ experience of care or other factors outside of a health system’s direct control. A study using data on 11 high-income countries included in the Commonwealth Fund’s 2010 International Health Policy Survey sought to determine whether respondents’ perceptions of affordability and effectiveness, among other factors, influenced satisfaction scores.

What the Study Found

In the 11 countries studied—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the authors found that perceptions of affordability and effectiveness of care, as well as ratings of one’s regular doctor, were important factors in respondents’ overall satisfaction with the health system. There was also some evidence that waiting times for appointments and diagnosis were associated with discontent.

Of any country, the U.K. had the greatest percentage of respondents who said that only minor changes to the health care system were needed (61.3%). The U.S., meanwhile, had the highest percentage of respondents who believed that their health system was in need of complete rebuilding (25.4%).

Compared with the other 10 countries, the U.S. had the highest percentage of respondents who reported being very confident they would receive effective treatment (34.7%) and also the highest percentage saying they were not at all confident they would (9.2%). 


Despite controlling for various socioeconomic factors and experiences related to health service delivery, the authors were unable to explain the differences in overall health system perceptions in the 11 countries. "Overall health system satisfaction ratings were not consistently associated with particular types of patient experiences across countries," they write.

Publication Details



I. Papanicolas, J. Cylus, and P. C. Smith, "An Analysis of Survey Data from Eleven Countries Finds That ‘Satisfaction’ with Health System Performance Means Many Things," Health Affairs, April 2013 32(4):734–42.