The result of an analysis of the latest round of the British Social Attitudes survey in the UK highlights what I think is one of the key challenges in health system reform. Over the past seven years, the National Health Service (NHS) has undergone extensive reforms, including major changes to the organization of the system and massive increases in public expenditure on the system. The general thinking is that these reforms have done much to improve the quality of services provided and it seems to be showing up in public opinion surveys.

More than half of surveyed Brits report now being satisfied with the NHS, a substantial improvement over the past 25 years, and even a major improvement over the past decade. What is interesting, those who have had recent contact with the system are much more likely to report being satisfied than those who have not, somewhat suggesting that the new improvements are driving this change in public opinion. The highest level of satisfaction was reported about services received from physicians.

However, satisfaction with inpatient services has been falling. It could be that the quality of these services is actually declining, or more likely, linked in part to the increase perception of quality of other health services, expectations of these services are likely rising faster than actual improvements.

You really can’t make everyone happy all of the time…so health reform, even the really well planned and well executed ones, will never be easy.

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