My good – and newly married – friend Sara Bleich recently published, along with her co-authors Emre Ozaltin and Chris Murray, a paper that explores the determinants of health care satisfaction using data from the World Health Survey. Basically they find that patient satisfaction and other factors are predictors of overall satisfaction but together actually explain only a small fraction of the variation in satisfaction reported by patients across European countries.

In recent years the concept of “health system responsiveness” has been developed and advanced by the World Health Organization to capture some of the aspects of health systems performance above and beyond the more objective measures related to health outcomes. It refers to “… the manner and environment in which people are treated when they seek health care” and it is subjective by nature. While we think it is important, enough so that it receives a great deal of emphasis in the overall health system performance exercises, but yet we know little of what drives it or even really agree how to define it.

The reasons for focusing on European countries exclusively was purposeful it order to assume that there were not major differences in health outcomes, which is debatable, but perhaps a reasonable approach. Although most of the countries in the sample have nearly universal access to health services, modes of financing do vary among the countries.

What I found to be the most interesting was that although there were not major differences in health outcomes, and people generally had access, there were still relatively large differences in overall measures of satisfaction among countries. What explains the fact that only 10% of Spaniards were very satisfied with their health system while over 70% of Austrian were. Culture? History? Expectations? How well their soccer team did at the world cup? National wine consumption? Who knows. If we don’t know, then to what extent are the factors that drive these differences factors that can be influenced by public policy? If not, to what extent should health system performance be based on these types of measures? Lots of unanswered questions.

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