title: The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality.
abstract: BACKGROUND
  Patient satisfaction is a widely used health care quality metric. However, the relationship between patient satisfaction and health care utilization, expenditures, and outcomes remains ill defined.
  
  
  METHODS
  We conducted a prospective cohort study of adult respondents (N = 51,946) to the 2000 through 2007 national Medical Expenditure Panel Survey, including 2 years of panel data for each patient and mortality follow-up data through December 31, 2006, for the 2000 through 2005 subsample (n = 36,428). Year 1 patient satisfaction was assessed using 5 items from the Consumer Assessment of Health Plans Survey. We estimated the adjusted associations between year 1 patient satisfaction and year 2 health care utilization (any emergency department visits and any inpatient admissions), year 2 health care expenditures (total and for prescription drugs), and mortality during a mean follow-up duration of 3.9 years.
  
  
  RESULTS
  Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).
  
  
  CONCLUSIONS
  In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.
authors.affiliation: Department of Family and Community Medicine and Center for Healthcare Policy and Research, University of California-Davis, 4860 Y St, Ambulatory Care Center, Ste 2300, Sacramento, CA 95817, USA. joshua.fenton@ucdmc.ucdavis.edu
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Fenton
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Jerant
authors.forename: Klea D
authors.initials: KD
authors.lastname: Bertakis
authors.forename: Peter
authors.initials: P
authors.lastname: Franks
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States