title: Is Satisfaction with the Acute-Care Experience Higher amongst Consumers Treated in the Private Sector? A Survey of Public and Private Sector Arthroplasty Recipients.
abstract: BACKGROUND
  Consumer satisfaction with the acute-care experience could reasonably be expected to be higher amongst those treated in the private sector compared to those treated in the public sector given the former relies on high-level satisfaction of its consumers and their subsequent recommendations to thrive. The primary aims of this study were to determine, in a knee or hip arthroplasty cohort, if surgery in the private sector predicts greater overall satisfaction with the acute-care experience and greater likelihood to recommend the same hospital. A secondary aim was to determine whether satisfaction across a range of service domains is also higher in the private sector.
  
  
  METHODS
  A telephone survey was conducted 35 days post-surgery. The hospital cohort comprised eight public and seven private high-volume arthroplasty providers. Consumers rated overall satisfaction with care out of 100 and likeliness to recommend their hospital on a 5-point Likert scale. Additional Likert-style questions were asked covering specific service domains. Generalized estimating equation models were used to analyse overall satisfaction (dichotomised as ≥ 90 or < 90) and future recommendations for care (dichotomised as 'definitely recommend' or 'other'), whilst controlling for covariates. The proportions of consumers in each sector reporting the best Likert response for each individual domain were compared using non-parametric tests.
  
  
  RESULTS
  457 survey respondents (n = 210 private) were included. Less patient-reported joint impairment pre-surgery [OR 1.03 (95% CI 1.01-1.05)] and absence of an acute complication (OR 2.13 95% CI 1.41-3.23) significantly predicted higher overall satisfaction. Hip arthroplasty [OR 1.84 (1.1-2.96)] and an absence of an acute complication [OR 2.31 (1.28-4.17] significantly predicted greater likelihood for recommending the hospital. The only care domains where the private out-performed the public sector were hospitality (46.7 vs 35.6%, p <0.01) and frequency of surgeon visitation (76.4 vs 65.8%, p = 0.03).
  
  
  CONCLUSIONS
  Arthroplasty consumers treated in the private sector are not more satisfied with their acute-care experience nor are they more likely to recommend their hospital provider. Rather, avoidance of complications in either sector appears to result in improved satisfaction as well as a greater likelihood that patients would recommend their hospital provider.
authors.affiliation: Orthopaedic Department, Liverpool Hospital, Liverpool, NSW, Australia.|South West Clinical School UNSW, Randwick, NSW, Australia.|Ingham Institute of Applied Medical Health Research, Liverpool, NSW, Australia.
authors.forename: Justine M
authors.initials: JM
authors.lastname: Naylor
authors.affiliation: South West Clinical School UNSW, Randwick, NSW, Australia.|Ingham Institute of Applied Medical Health Research, Liverpool, NSW, Australia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Descallar
authors.affiliation: University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Mechteld
authors.initials: M
authors.lastname: Grootemaat
authors.affiliation: Orthopaedic Department, Liverpool Hospital, Liverpool, NSW, Australia.|South West Clinical School UNSW, Randwick, NSW, Australia.|Ingham Institute of Applied Medical Health Research, Liverpool, NSW, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Badge
authors.affiliation: Orthopaedic Department, Liverpool Hospital, Liverpool, NSW, Australia.|South West Clinical School UNSW, Randwick, NSW, Australia.|Ingham Institute of Applied Medical Health Research, Liverpool, NSW, Australia.
authors.forename: Ian A
authors.initials: IA
authors.lastname: Harris
authors.affiliation: Ingham Institute of Applied Medical Health Research, Liverpool, NSW, Australia.|Brain Injury Rehabilitation Unit, Liverpool Hospital, Liverpool, NSW, Australia.|School of Human Services and Social Work, Griffith University, Gold Coast, Queensland, Australia.|John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, NSW, Australia.
authors.forename: Grahame
authors.initials: G
authors.lastname: Simpson
authors.affiliation: Orthopaedic Department, Liverpool Hospital, Liverpool, NSW, Australia.|South West Clinical School UNSW, Randwick, NSW, Australia.|Ingham Institute of Applied Medical Health Research, Liverpool, NSW, Australia.
authors.forename: Deanne
authors.initials: D
authors.lastname: Jenkin
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011795:Surveys and Questionnaires