Patient satisfaction and the use of health services. Explorations in causality.

Little research exists that examines the causal relationship between patient satisfaction and the use of health services. This study of a representative sample of low income families suggests that a relationship does exist. Furthermore, results reported indicate it is bidirectional and reciprocal in nature, and that it is highly related to the provider from which patients seek care. Analysis according to the five major area clinics that were main sources of medical care for an upstate New York community (two HMOs, two hospital-affiliated teaching clinics, and one continuity-of-care clinic) revealed that, in some providers, the association between use and satisfaction is positive, in others negative. Further evidence for a "patient provider" interaction hypothesis was found, suggesting that background characteristics, including health status and race, are related to use and satisfaction in different ways in different clinics. The findings provide evidence for the existence of a causal relationship between use and satisfaction, which is dependent on the context in which medical care is given, and also suggest structural characteristics that might be responsible for these effects. A final conceptual model of satisfaction is offered, permitting reciprocal causation with use and satisfaction with emphasis on patient provider interactions, and this model provides an identification of short- and long-term processes. Progress in this area might require a shift in perspective upward toward structural and systems variables or a shift downward toward "microanalytic" processes, which detail patient-provider interactions.