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Patient satisfaction with their health care is increasingly being scrutinized by insurers and the government. The Centers for Medicare and Medicaid Services (CMS) has been publishing satisfaction scores for the past four years. Future hospital reimbursements are slated to be cut if hospitals do not meet certain satisfaction goals. Yet, studies have not consistently shown patient satisfaction to be related to better care. Many of the factors associated with satisfied patients are not controllable like their age, baseline health status, marriage status, an emergency room’s volume, and patient acuity while others like increased healthcare utilization and spending are contrary to CMS’s goal of reducing healthcare costs.

In a recent study published in the Archives of Internal Medicine, researchers compared patient satisfaction to health care utilization, health care expenditures, cost of prescription drugs, and death rates (mortality) over a nearly four year period.1 51,946 adults were surveyed between 2000 and 2007 using the national Medical Expenditure Panel Survey. Satisfaction was measured using five items from the Consumer Assessment of Health Plans Survey with satisfaction scores divided into fourths (quartiles). It turns out that those patients in the highest quartile of satisfaction were 12% more likely to be admitted to a hospital, had 9% more total expenditures, 9% higher prescription drug expenses, and 26% higher mortality compared to those patients in the lowest quartile of satisfaction.

A summary of some of the factors previously shown to increase patient satisfaction with their healthcare is listed.

  • understandable explanations and instructions of care and discharge from nurses and physicians 2-5
  • more health care utilization like blood tests, X-rays, and advanced imaging 6-10
  • shorter length of stay in an emergency room (ER) or during hospital admission4,11-14
  • more specialist referrals15 and for those requiring neurology second opinions, hospital admission to expedite the time it takes to obtain that second opinion or tertiary referral16
  • length of time to reach an inpatient bed for those admitted through the ER12,17
  • a patient’s final diagnosis and acuity level (sicker patients are more satisfied while those seen in an ER with non-serious illness are less satisfied)18 An exception is that satisfaction with a surgeon is lower in those undergoing emergency surgery compared to elective surgery or those admitted for trauma compared to a non-traumatic disorders.19
  • better baseline health before hospital admission 20,21
  • older patient age 4,20-22
  • married status 20
  • having health insurance 22
  • notes to certify patients were sick to give to employers 15
  • more antibiotic prescriptions in those with respiratory tract infections 23
  • more narcotic prescriptions in those with chronic pain 22
  • food quality, comfortable gurneys, and noise levels in an ER5

In light of the cited Archives of Internal Medicine study, maybe George Bernard Shaw was right when he said “As long as I have a want, I have a reason for living. Satisfaction is death.”


  1. Fenton JJ, Jerant AF, Bertakis, Franks P. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med 2012; 172: 405-411.
  2. Sun BC, Adams J, Orav EJ, et al. Determinants of patient satisfaction and willingness to return with emergency care. Ann Emerg Med 2000; 35: 426-434.
  3. Thompson DA, Yarnold PR, Williams DR, Adams SL. Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Ann Emerg Med 1996; 28: 657-665.
  4. McCarthy ML, Ding R, Zeger SL, et al. A randomized controlled trial of the effect of service delivery information on patient satisfaction in an emergency department fast track. Acad Emerg Med 2011; 18: 674-685.
  5. Walsh M, Knott JC. Satisfaction with the emergency department environment decreases with length of stay. Emerg Med J 2010; 27: 821-828.
  6. Kendrick D, Fielding K, Bentley E, et al. The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomized controlled trial. BMJ 2001; 322: 400-405.
  7. Kravitz RL, Cope DW, Bhrany V, Leake B. Internal medicine patient’s expectations for care during office visits. J Gen Intern Med 1994; 9: 75-81.
  8. Kravitz RL, Bell RA, Azari R, et al. Request fulfillment in office practice: antecedents and relationship to outcomes. Med Care 2002; 40: 38-51.
  9. Miller P, Kendrick D, Bentley E, Fielding KI. Cost effectiveness of lumbar spine radiography in primary care patients with low back pain. Spine (Phila Pa 1976) 2002; 27: 2291-2297.
  10. van Bokhoven MA, Pleunis-van Empel MC, Koch H, et al. Why do patients want to have their blood tested? A qualitative study of patient expectations in general practice. BMC Fam Pract 2006; 7: 75
  11. Hedges JR, Trout A, Magnusson AR. Satisfied patients exiting the emergency department (SPEED) study. Acad Emerg Med 2002; 9: 15-21.
  12. Preyde M, Crawford K, Mullins L. Patients’ satisfaction and wait times at Gudlph General Hospital emergency department before and after implementation of a process improvement project. CJEM 2012;14: 157-168.
  13. Rodi SW, Grau MV, Orsini CM. Evaluation of a fast track unit: alignment of resources and demands improved satisfaction and decreased length of stay for emergency department patients. Qual Manag Health Care 2006; 15: 163-170.
  14. Yarris LM, Frakes B, Magaret N, et al. H ow accurately can emergency department providers estimate patient satisfaction. West J Emerg Med 2012; 13: 351-357.
  15. Verbeek J, Sengers MJ, Riemens L, Haafkens J. Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine (Phila Pa 1976). 2004;29:2309-2318.
  16. Wijers D, Wieske L, Vergouwen MDI, et al. Patient satisfaction in neurological second opinions and tertiary referrals. J Neurol 2012; 257: 1869-1874.
  17. Pines JM, Iyer S, Disbot M, et al. The effect of emergency department crowding on patient satisfaction for admitted patients. Acad Emerg Med 2008; 15: 825-831.
  18. Boudreaux ED, Friedman J, Chansky ME, Baumann BM. Emergency department patient satisfaction: examining the role of acuity. Acad Emerg Med 2004; 11: 162-168.
  19. Rogers FB, Krasne M, Bradburn E, et al. Acute care and trauma surgeons: we can’t get no satisfaction – what do satisfaction surveys measure? Am Surg 2012; 78: 731-734.
  20. Nguyen TP, Briancon S, Empereur F, Guillemin F. Factors determining inpatient satisfaction with care. Soc Sci Med 2002; 54: 493-504.
  21. Wolf A, Olsson LE, Taft C, et al. Impact of patient characteristics on hospital care experience in 34,000 Swedish patients. BMC Nurs 2012; 11: 8.
  22. Wallace AS, Freburger JK, Darter JD, et al. Comfortably numb? Exploring satisfaction with chronic back pain visits. Spine J 2009; 9: 721-728.
  23. Stearns CR, Gonzales R, Camargo CA, et al. Antibiotic prescriptions are associated with increased patient satisfaction with emergency department visits for acute respiratory tract infections. Acad Emerg Med 2009; 16: 934-941.

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