Choice of a personal physician and patient satisfaction in a health maintenance organization.
BACKGROUND
Being able to choose one's health care plan has been shown to increase subsequent patient satisfaction with the plan, but it is not known whether choosing one's own primary care physician affects patient satisfaction with the physician.


OBJECTIVE
To compare satisfaction with care between members of a group-model health maintenance organization (HMO) who chose their primary care physician and members who were assigned a physician.


METHODS
Cross-sectional mailed survey with response rate of 71.4%.


METHODS
A large group-model HMO in northern California.


METHODS
Nine questions on satisfaction with the primary care physician.


METHODS
Random sample of HMO members 35 to 85 years of age who were impaneled with a primary care physician.


RESULTS
Among the 10205 survey respondents, patients who chose their personal physician (n=4748) were 16 to 20 percentage points more likely to rate their satisfaction as "excellent" or "very good" than patients who were assigned a physician (n =5457) for 9 satisfaction measures (P<.001 for each comparison). The association of choice with satisfaction was not due to physicians with higher patient satisfaction being chosen more often, or to differences in patient demographic or socioeconomic characteristics, health values, or health beliefs, or to differences in physician demographics or specialty. In a logistic regression model that adjusted for all of these characteristics, having chosen one's physician was the single predictor most strongly related to having high overall satisfaction (odds ratio, 2.18, 95% confidence interval, 1.95-2.42).


CONCLUSIONS
These results suggest that even in a setting of limited physician choice, the opportunity to select one's personal physician may influence subsequent satisfaction.
Schmittdiel
J
J
Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94611, USA.
Selby
J V
JV
Grumbach
K
K
Quesenberry
C P
CP
D000328:Adult; D000368:Aged; D002140:California; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000145:classification* / Q000592:standards; D011787:Quality of Health Care; D000078329:Workforce