Is patient satisfaction overrated?

You may strive for satisfied patients, but a March study published in the Archives of Internal Medicine indicates that happy patients are more expensive and don’t necessarily live longer.

Researchers hypothesized that patient satisfaction may be linked to increased discretionary healthcare consumption, lead author Joshua Fenton, MD, a family physician with the Department of Family and Community Medicine and Center for Healthcare Policy and Research, University of California–Davis, told Medical Economics eConsult. In previous studies, increased healthcare services use has been associated with adverse effects, he says.

“In our study, higher satisfaction was associated with greater healthcare expenditures and also higher mortality after adjustment for illness burden,” Fenton says. “One possible explanation is that more-satisfied patients are exposed to more unnecessary care, both in and out of the hospital. This care may boost satisfaction but ultimately has no health benefits and increase potential risks.”

Fenton and his colleagues studied adult patient chart data from 2000 through 2007 in the national Medical Expenditure Panel Survey and compared it with satisfaction data from the Consumer Assessment of Health Plans Survey. Both databases are maintained by the Agency for Healthcare Research and Quality.

Adjusting for sociodemographics, insurance status, chronic disease burden, health status, and utilization and expenditures, respondents in the highest patient satisfaction quartile had lower odds of an emergency department visit but greater chances of a hospital admission, greater total expenditures, greater prescription drug expenditures, and increased mortality.

“Patients should be satisfied with the care they receive, but we need to understand better what drives patient satisfaction,” Fenton says. “Ideally, patients would be satisfied because their providers communicate empathically and deliver timely, evidence-based care. But there may be clinical situations where high satisfaction is impossible to achieve without compromising other quality goals.

“At this point, patient satisfaction should not be the sole driver of quality improvement, but because it's relatively easy to measure, it might be overemphasized by many organizations,” Fenton adds. “I am concerned that patient satisfaction is now being wrapped into many schemes for reimbursing providers.”

Fenton’s team did not study a connection between patient satisfaction and treatment adherence.

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