title: Understanding What Makes Americans Dissatisfied With Their Health Care System: An International Comparison.
abstract: For decades, public satisfaction with the health care system has been lower in the United States than in other high-income countries. To better understand the distinctive nature of US health system satisfaction, we compared the determinants of satisfaction with the health system in the United States to those in seventeen other high-income countries by applying regression decomposition methods to survey data collected in the period 2011-13. We found that concerns related to "accessing most-preferred care" (the extent to which people feel that they can access their top preferences at a time of need) were more important to satisfaction in the United States than in other high-income countries, while the reverse was true for satisfaction with recent interactions with the health system. Differences among US socioeconomic groups in survey responses regarding access to most-preferred care suggest that wide variation in insurance coverage and generosity may play a role in these differences. While reductions in the uninsured population and the movement toward minimum health plan standards could help address some concerns about access to preferred care, our results raise the possibility of public backlash as market forces push plans toward more restricted access and higher cost sharing.
authors.affiliation: Joachim O. Hero (hero@fas.harvard.edu) is a doctoral candidate in health policy at Harvard University, in Cambridge, Massachusetts.
authors.forename: Joachim O
authors.initials: JO
authors.lastname: Hero
authors.affiliation: Robert J. Blendon is the Richard L. Menschel Professor of Health Policy and Political Analysis in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Blendon
authors.affiliation: Alan M. Zaslavsky is a professor of health care policy (statistics) in the Department of Health Care Policy, Harvard Medical School, in Boston.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.affiliation: Andrea L. Campbell is the Arthur and Ruth Sloan Professor of Political Science, Department of Political Science, Massachusetts Institute of Technology, in Cambridge.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Campbell
mesh_terms: D032882:Comprehension; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods; D005260:Female; D014943:Global Health; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics*; D054625:Healthcare Disparities / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D038622:Internationality; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States
keywords: Access To Care; Insurance Coverage < Insurance; Public Opinion; Satisfaction