The patient's view of the acceptability of the primary care in Poland

OBJECTIVE: The aim of the study was to determine how the time factor affected the patients' perception of the acceptability of the primary health care system and to assess their satisfaction with family physician care. DESIGN: A series of cross-sectional studies was conducted in 1998, 2002 and 2006, using face-to-face interviews with structured questionnaires. SETTING: The study was performed in Gizycko, Poland, where family physician services were introduced in 1995. STUDY PARTICIPANTS: Three surveys were conducted, each involving 1000 subjects. Every time, random sample was taken, after selecting a subgroup of patients using medical service within the previous week. MAIN MEASURES: Acceptability of the primary health care system (accessibility, the patient-practitioner relationship, the amenities of care, patient's preferences), perception of the changes in primary care and overall satisfaction with family physician care. RESULTS: Between 1998 and 2002, an improvement was noted, lasting till 2006, in such accessibility components as the possibility of making an appointment by phone or at a definite hour. Some aspects of the patient-doctor relationship indicate that family physician care is directed at illness rather than health-oriented. The level of patient satisfaction was high. CONCLUSIONS: Generally, patients are satisfied with primary care reform and implementation of the family physician system. However, it is easier to improve accessibility of services than physician's personal qualities and the patient-practitioner relationship. Expressive functions of a physician (listening and reassuring) and activities regarding health promotion require special attention in the process of education of family physicians.     

Patient satisfaction with care is associated with personal choice of physician

OBJECTIVE: To evaluate whether choosing one's own primary care doctor is associated with patient satisfaction with primary health care. To evaluate factors related to population's satisfaction with primary health care. POPULATION: A random sample of Estonian adult population (N=997). STUDY DESIGN: Cross-sectional study using a pre-categorized questionnaire which was compiled by the research group of the University of Tartu and the research provider EMOR. RESULTS: Altogether 68% of the respondents had been listed in their personal physician. Their overall satisfaction with the physician as well as satisfaction with several aspects of primary health care were significantly higher compared with those of unregistered respondents. Although some other factors (practice size, patient age, health status) also influenced patient satisfaction, presence of a personal physician appeared the most important predictor of high satisfaction with physician's punctuality and understanding, effectiveness of prescribed therapy, clarity of explanations given by the physician as well as with overall satisfaction with the physician. CONCLUSION: Personal doctor system is associated with patient satisfaction with different aspects of care.     

Patients' views on the professional behaviour of family physicians

BACKGROUND: Patient satisfaction is an important part and a measure of the quality of health care. Patient satisfaction with family physicians was studied within the project 'Analysis of Transition of Health Care System in Croatia'. OBJECTIVES: The aim of this study was to explore patient satisfaction with family physicians through evaluation of some characteristics of physician behaviour. The specific goals of this study were to determine whether there were differences in the evaluation of patient satisfaction with physician behaviour with regard to some sociodemographic characteristics of the respondents. METHODS: The study group consisted of 1217 respondents: 479 (39.4%) men and 738 (60.6%) women. Medical students interviewed the respondents 'face-to-face' immediately after their consultation with the physician. An anonymous questionnaire was created providing answers to 10 questions on patient satisfaction. Data on sociodemographic characteristics and the reason for encounter of the respondents were also collected. RESULTS: The average positive rating over 10 questions on patient satisfaction was 85.3%. There was a statistically significant difference in age distribution between geographic areas (P < 0.001). Differences in answers were found regarding sex, age, educational level (P < 0.001) and reason for encounter (P < 0.01). Two factors were obtained by factor analysis: the first could be called physician's competence/expertise estimated by respondents, and the other physician's empathy evaluated by respondents. The respondents were divided into two groups based on the reason for encounter as a criterion for discriminant analysis: acute (symptoms and complaints, injuries; n = 553) and other reasons (n = 664). The discriminant function obtained was statistically significant (P < 0.01). Younger respondents, regardless of sex, whose reason for encounter was an acute condition, were less satisfied with the physician's expertise, agreeableness during the consultation, physician's interest in what they were saying and physician's friendliness. CONCLUSION: Considering the difficulties present in the health systems of countries in transition, the results of our study were surprisingly encouraging, showing that the respondents were satisfied with the physician's behaviour and that the physicians fulfilled the basic elements of professional behaviour.     

An evaluation of patient satisfaction with family practice care in Slovenia.

OBJECTIVE: To describe the level of patient satisfaction with family practice in Slovenia. DESIGN: An internationally developed instrument for patients' evaluations of general practice care was used in a postal survey. SETTING: A representative sample of 36 family practices in Slovenia. STUDY PARTICIPANTS: Sixty consecutive patients in every practice were approached and offered a self-administered questionnaire. A total of 2160 questionnaires were handed out. MAIN OUTCOME MEASURE: Percentages of patients reporting level of satisfaction on a 5-point Likert scale for the items in the questionnaire. RESULTS: On average 58.2% of respondents rated the level of care received as excellent. Waiting in the waiting room was the item rated poorest (26.0%). Participants were also less satisfied with perceived time during the consultation (51.6%) and with connectional aspects of care: the feeling that family practitioners showed interest in their personal situation (46.5%); the feeling that family practitioners made it easy to explain problems (49.1%). On the other hand patients praised many other aspects of family practice care in Slovenia: confidentiality of medical records (77.0%); listening capacity of their family physicians (69.4%); being able to speak to the family practitioner on the 'phone (72%). CONCLUSIONS: Patient satisfaction with family practice care in Slovenia was shown to be relatively high and can be compared to other European countries. The results showed areas in which quality improvement is required: organizational changes to shorten the waiting time in the waiting room and greater emphasis on communication skills.     

Family physicians' observations of their practice, well being, and health care in the United States.

OBJECTIVE: Our goal was to characterize how family physicians perceive recent changes in the health care system and how content they are with various factors. STUDY DESIGN: We performed a cross-sectional mailed survey. POPULATION: The survey was completed by a random sample of 361 family physicians practicing in the United States. OUTCOME MEASURES: The survey evaluated attitudes about corporate managed care, health care reform, career satisfaction, compensation, personal life satisfaction, workload stress, personal well-being, and residency training. We reported percentages for Likert-rated survey items, factor analysis of the survey, and a regression model for statistical prediction of the 4 major factors. RESULTS: Relative to survey data gathered in 1996, fewer family physicians in our survey reported that they were satisfied with their careers (59% vs 82%); fewer were satisfied with their compensation (55% vs 65%); and fewer would again choose family practice as their specialty (66% vs 75%). Thirty-one percent worried that they were "burning out" as physicians, and 48% reported that they had experienced more stress-related symptoms in the past year. Only 7% agreed that corporate managed care is the best way to provide the health care America needs at a cost society can afford, but only 36% unequivocally endorsed the concept of a national health plan. Forty-two percent of the respondents reported that they had witnessed bad patient outcomes they perceived to be attributable to managed care business processes. CONCLUSIONS: The morale and career satisfaction of family physicians seems to have eroded in recent years, and discontent is common. As a group, family physicians are unhappy with the current health care system and quite unified about certain specific reforms, yet they are far from such consensus about more sweeping reform.     

Physician satisfaction with Medicaid managed care: the Missouri experience

BACKGROUND: Medicaid managed care is important to health reform at the state level. However, little is known about physician satisfaction with these programs. We sought to measure this satisfaction in Missouri and determine its predictors. METHODS: We surveyed a random sample of primary care physicians participating in Medicaid managed care (n = 670) or traditional Medicaid (n = 670). Primary outcomes measured were physicians' satisfaction Medicaid managed care, traditional Medicaid and commercial managed care. Satisfaction was measured on a 5-point Likert-type scale. RESULTS: The response rate was 52%. Physicians participating in Medicaid managed care were less likely to be satisfied or very satisfied with Medicaid managed care (28.6%) than with commercial managed care (40%) or their previous experience with traditional Medicaid (39.7%). Among physicians participating in traditional Medicaid, 29.8% were satisfied or very satisfied with traditional Medicaid. Physicians participating in Medicaid managed care were less satisfied with clinical autonomy under that system in comparison with their previous experience with traditional Medicaid (relative difference = 10.8%, P =.001). In multiple linear regression analyses, clinical autonomy (R2 = 0.40) was a strong predictor of overall satisfaction with Medicaid managed care. CONCLUSIONS: Enhancing physicians' clinical autonomy may result in improved satisfaction with Medicaid managed care. State Medicaid agencies should include physician satisfaction as a measure of Medicaid managed care plans' quality.     

Primary health care system in transition: the patient's experience.

OBJECTIVE: To find out how Estonian people evaluate the changes in primary health care (PHC), how they perceive the acceptability of the new PHC system, and to assess patients' satisfaction with their primary care doctor. DESIGN: Face-to-face interviews using structured questionnaires. SETTING: Estonia. STUDY PARTICIPANTS: A random sample of Estonian residents aged 15-74 years (n = 997). MAIN MEASURES: Acceptability of PHC system (accessibility, the patient-practitioner relations, amenities, and patient's preferences) and patients' satisfaction with primary care doctor. RESULTS: Of the 997 respondents, 46% were sufficiently informed about the transition to the general practitioner (GP)-based PHC system; however, 45% of respondents had not personally experienced any changes. Of the 997 persons interviewed, 68% were registered on the patient list of a GCP, and 62% of those who had health problems preferred to consult the primary care doctor first. The waiting time for an outpatient appointment was brief (0-2 days). Of the 997 respondents, 68% were satisfied with their primary care doctor. Satisfaction was dependent on: (i) how patients evaluated the competence of the physician; (ii) comprehensibility of doctor's explanations; and (iii) comfort of the clinic. The right of patients to choose their own primary care doctor and having sufficient information about the changes in PHC system had a positive influence on the level of satisfaction. CONCLUSIONS: Patients' opinions are important in the evaluation of PHC. To increase the level of satisfaction, people need to understand the nature and intent of the primary care reforms. Personal choice of primary care doctor and good patient-doctor relationships are important factors too.     

Satisfaction with organizational aspects of health care provision among Lithuanian physicians

BACKGROUND: Physician satisfaction is considered an important factor influencing quality of health care provision, patient compliance, and costs to health care systems. Dissatisfaction leads to an increase in turnover of physicians and early retirement, which has a negative impact on continuity and quality of health care. Physician dissatisfaction with certain aspects of health care provision may also help to identify potential weaknesses in satisfactory functioning of health care systems. The aim of the current research project is to study the satisfaction with different organizational aspects of health care provision in Lithuania as judged by a selection of physicians. METHOD: The study was conducted in Lithuania in June 2004. Physicians in randomly selected health care centers were invited to take part in the survey, 505 primary and secondary care physicians were interviewed by external interviewers during the study period. Physicians were asked to express their satisfaction on items presented in a questionnaire. The questionnaire consisted of 22 questions, evaluating different aspects of health care services - working conditions, workload, financial remuneration, organization of health care infrastructure and availability of laboratory services. Answers were presented by the 5 point Likert type scale, ranging from "very satisfied" (5) to "very dissatisfied" (1). RESULTS: Physicians who were most satisfied with their working conditions were working in private primary health care practices (91.1% satisfied or very satisfied), as compared with 54% of physicians working in state-owned primary care institutions and 49.7% in hospitals. Physicians working in cities and regional centers or towns were more satisfied with organizational aspects of health care services than physicians working in rural health care centers. Satisfaction with their financial remuneration showed that 74% of respondents stated they were "dissatisfied" or "very dissatisfied". While asked about potential deficiencies in their health care institutions, the most important identified by respondents in all localities was a perceived lack of financial support for these institutions. CONCLUSIONS: There is a significant difference in the perception of physicians in private and state health care institutions with regard to financial remuneration as well as availability of laboratory diagnostic and treatment equipment and working conditions. Based on the study findings, possibilities to increase Primary Care financing should be considered in order to improve the quality of the delivery of health care services as well as retain physicians within the health care system. Results of this study demonstrate a need of further research to quantify what could be reasonably expected from diagnostic and investigative resources to support health care in Lithuania in current economic situation.     

Satisfaction with primary medical care: population determinants

OBJECTIVES: To study the level of satisfaction with the family physician in the general population, and to evaluate the influence of characteristics of the individual and the available health care services. METHODS: Cross-sectional survey with a representative sample of 1,505 beneficiaries of the Social Security, older than one year, from the city of Matar?o (Barcelona). A questionnaire, administered by home interview, examined the socio-demographic situation, health status, health care organizations and services used and the preferences and knowledge in relation to them. Satisfaction was measured on the scale of Hulka BS et al. developed at Andalusian primary care centres. RESULTS: Satisfaction with the family physician had, on a scale from 0 to 100, a mean score of 61.3 (standard deviation, 13.5) points. The main determinant of satisfaction was the model of primary care, users of non-reformed centres being less satisfied. It was followed by better knowledge of ambulatory services, age and better attitudes towards primary care, which were positively related to satisfaction. Indicators of health care accessibility and continuity, as well as the number of medical visits fulfilled, the subject's main activity and their level of health were also independent determinants of satisfaction. The explained satisfaction's variation was 38.98%. CONCLUSIONS: Satisfaction with family physician is a complex and multifactorial behaviour which is under constant change due to the interrelation of the individual with his social and health care environment.     

Family caregiver satisfaction with care at end of life: report from the cultural variations study (CVAS)

The objective of this study was to examine differences in family caregiver satisfaction with care at end of life based on site of death, in an observational study involving advanced cancer patients and their family caregivers. The study was based on follow-up interviews with 28 family caregivers of 28 patients who died during a two-year prospective study involving 68 patients and 68 family caregivers. Telephone interviews addressed the circumstances of the patients 'death, their satisfaction with the care provided to the patient, and their satisfaction with how well they were attended to by health providers. There were no associations between site of death (died at home vs. did not die at home) and family caregiver satisfaction with the overall care provided to the patient. However family caregivers of patients who died at home responded that they thought the patient was more at peace (with respect to spiritual and religious matters) than did family caregivers of patients who did not die at home (p = 0.003). Family caregivers of patients who died at home appeared to feel less satisfied with the attention paid to their own wishes regarding the patient's care (p = 0. 13), less satisfied with the emotional support provided to them by healthcare personnel taking care of the patient (p = 0. 08), and less satisfied with communication from health providers (p = 0. 11). Findings indicate that although dying at home appears to provide a more peaceful death for the patient, it may also distance family caregivers from health professionals and leave them feeling less supported during the patient's last days of life.     

The relationship between primary care physicians' adherence to guidelines for the treatment of diabetes and patient satisfaction: findings from a pilot study

BACKGROUND: Adherence to clinical guidelines improves health care outcomes, reduces expenditure and prevents the complication of unnecessary interventions. It is uncertain what effect the adherence to guidelines for treating diabetes has on patient satisfaction. Some authors have reported that the use of guidelines does not affect patient satisfaction with care, and have concluded that satisfaction is related to a physician's interpersonal skills, rather than to the quality of care. Others have reported that structured intervention programmes improve patient satisfaction with care. OBJECTIVE: The purpose of our study was to explore the association between adherence to clinical guidelines and satisfaction with care among diabetics. METHODS: The study population included 135 randomly sampled diabetes patients listed with 12 primary care physicians at two health plans in Israel, which together insure >80% of the population. Telephone interviews were conducted with the patients between August and November 2000, using structured questionnaires. Patients were asked to report on the extent to which their primary care physician treated them as indicated by the clinical guidelines of these health plans. They were also asked to rate their satisfaction with their primary care physician and the treatment of their disease. Bi-variate analysis was conducted using the chi-square statistical significance test. Multivariate analysis was conducted using logistic regression models. RESULTS: Adherence to guidelines for diabetes was associated with patient satisfaction with care, independently of the patient's ethnicity (first language), age, gender, education, medication (insulin versus other) and health plan affiliation. CONCLUSION: Patients who report being treated as recommended in practice guidelines were more likely to be satisfied with their care. This finding may encourage primary care physicians to adhere to clinical practice guidelines.     

End-of-life care: perspectives of family members of deceased patients

This study was undertaken to determine the opinions of family members of deceased patients regarding end-of-life care. This multisite cross-sectional survey was administered to 969 volunteer participants during 1997 to 2000. Eligible participants included immediate family members of deceased patients at five local institutions in a regional health system. Among 969 respondents, most (84.4 percent) indicated that the care for their family member was excellent. Reasons cited for satisfaction included overall care (40.2 percent), staff effort (23.2 percent), and communication (16.4 percent). Reasons cited for dissatisfaction included perceived incompetence (9.7 percent), perceived uncaring attitude (8.4 percent), and perceived understaffing (3.7 percent). Respondents were more satisfied with communication from nursing staff (88 percent) than physicians' communication (78 percent, p < 0.001, Bowker's test). Respondents indicated higher overall satisfaction with nursing (90 percent) and pastoral care (87 percent), than with physician care (81 percent, p < 0.001 and p = 0.006, Bowker's test). A unique survey instrument can be used to measure family perceptions and opinions regarding end-of-life care.     

European patients' views on the responsiveness of health systems and healthcare providers

BACKGROUND: Responsiveness to patients is now seen as a key characteristic of effective health systems. This study aimed to learn more about European people's views on the responsiveness of their country's health systems and healthcare providers. METHODS: Telephone survey with random samples of the populations in Germany, Italy, Poland, Slovenia, Spain, Sweden, Switzerland and the UK using random digit dialling. RESULTS: Responses were obtained from 8119 people aged 16 and over. Just over half the respondents said that doctors always listened carefully to them, gave them time for questions and provided clear explanations. Respondents from Switzerland and the UK reported consistently high rates of satisfaction with doctors' communication skills, while respondents from Poland were significantly less satisfied. Younger people were more critical than older people. Expectations of patient involvement in treatment decisions were high, particularly among younger people, with 74% indicating a desire to be actively involved. Most respondents felt they should have a choice of primary care doctor, specialist doctor and hospital, but less than half felt they had sufficient information to make an informed choice. There were significant variations between the countries in reported levels of involvement and in satisfaction with opportunities for choice. CONCLUSIONS: The results suggest that many European patients want a more autonomous role in health care decision-making. Policy-makers and clinicians should consider how to narrow the gap between public expectations and patients' experience.     

A study of patient satisfaction with primary health care services in Saudi Arabia

Patient satisfaction is of value to primary health care providers. The main objective of this study was to estimate patient satisfaction with respect to primary health care services in Riyadh City, Saudi Arabia. Fourteen primary health care centers were chosen randomly to represent various geographic areas of Riyadh. Information was collected through a pre-tested questionnaire used by thirty well-trained final year medical students. Systematic sampling of family files was conducted and the household head was interviewed. Nine hundred respondents were interviewed concerning their satisfaction with the services delivered. The findings were as follows: 40% were dissatisfied. One third of the dissatisfied expressed the view that the center was too far; 19.4% complained that the working hours of the center were not suitable; 38.9% complained of the absence of specialty clinics; 19.4% had language barriers with the physicians; 63.9% complained about delays at the center; 16.7% of the satisfied and 38.9% of the dissatisfied complained that the physicians did not satisfactorily explain their health problems and treatments. In 22.7% of the dissatisfied category, physicians' explanations were neither clear nor understandable. Among the satisfied, 74.6% said that primary health care center was the first choice if they felt sick; 61.1% of the non-satisfied category gave this response. The implications of these findings are discussed, and recommendations are given to rectify certain problems.M. El Shabrawy Ali, Ph.D is Professor and Chairman, Department of Community and Family Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; M. Elisa Ali Mahmoud, M.D. is Consultant in Epidemiology and Statistics, Ministry of Health, Rivadh, Saudi Arabia.     

Inpatients satisfaction in a rheumatology department

MATERIAL AND METHODS: This prospectivve study aiming to evaluate patients satisfaction included 102 patients (42 men and 60 women with a mean age of 49.7 years) admitted in the department of rhumatology of Monastir University hospital, and was based on a validated questionaire. RESULTS: Global satisfaction was 80%. Satisfation as regards administrative proceedings (e.g. admission procedure) reached 84%. As for the degrees of satisfaction concerning care, the environment (accomodation meals, noise) and reception, they were as follows : 79%, 81% and 91% respectively. The prioritis whide were considred as important but partly achieved by health care priveders included in formation of the patient's family (47%), of the family physician (23%), and of the patient (22%). CONCLUSION: Inpatients global satisfaction in a rheumatology department was 80 %. Priorities to improve patient quality of care were family, general practionner and patient information.     

Commitment to a regular physician: how long will patients wait to see their own physician for acute illness?

BACKGROUND: Continuity of care with a physician is associated with better health outcomes and greater patient satisfaction. Having a "regular doctor" could lead to greater continuity of care, but only if the patient consistently seeks care from this physician. How long will a patient wait for care if their usual physician is not available? Our study explored factors related to a patient's decision to seek care from another professional. METHODS: We analyzed the results of a statewide random digit dialing telephone survey of 658 Kentucky adults. Our study focused on the 466 adults who indicated they usually seek care from the same physician. Respondents were asked about seeing an alternate provider if they had an acute, non-life-threatening condition and their usual physician was not available. RESULTS: Of the respondents, 48.6% indicated they would seek care from another professional the same day, 41.6% would wait 1 day or more, and 9.8% would not see another professional. Patients with asthma were significantly more likely to wait for care from their regular physician (P <.05), as were patients who usually visited a physician's office instead of a clinic (P <.05). In a multivariate model, seeking alternate care the same day was significantly more likely among patients who were older, nonwhite, and who would seek alternate care at their usual site of care (P <.05). CONCLUSIONS: Maintaining continuity of care with their usual physician is important to patients. Patient and practice characteristics may influence the decision to wait for care in an effort to maintain continuity.     

Patient satisfaction with family physicians and general internists: is there a difference?

Although general internists and family physicians see similar types of patients, they have been found to have different styles of practice. It is not known whether these differences in practice style are associated with differences in outcomes of care such as patient satisfaction. This study examined whether patients of family physicians and general internists have different perceptions of the care they receive. National samples of recently trained family physicians and general internists were asked to complete questionnaires about their practices and to record information on all patient encounters during a three-day period. Three patients were randomly sampled from among those seen by each physician during the study period and were sent questionnaires that included questions about their satisfaction with the medical care they were receiving from the physician. Two hundred thirteen adult patients who saw 124 family physicians and 218 adult patients who saw 98 general internists participated in this study. Patients of general internists and of family physicians reported similar levels of satisfaction on all four dimensions measured (access, humaneness, quality, and general satisfaction) even after controlling for the effects of a variety of patient, practice, physician, and encounter characteristics. It is concluded that the fundamental differences in practice style that have been reported between family physicians and general internists do not seem to be associated with differences in patient satisfaction.     

Physician, practice, and patient characteristics related to primary care physician physical and mental health: results from the Physician Worklife Study

OBJECTIVE: To study the impact that physician, practice, and patient characteristics have on physician stress, satisfaction, mental, and physical health. DATA SOURCES: Based on a survey of over 5,000 physicians nationwide. Four waves of surveys resulted in 2,325 complete responses. Elimination of ineligibles yielded a 52 percent response rate; 1,411 responses from primary care physicians were used. STUDY DESIGN: A conceptual model was tested by structural equation modeling. Physician job satisfaction and stress mediated the relationship between physician, practice, and patient characteristics as independent variables and physician physical and mental health as dependent variables. PRINCIPLE FINDINGS: The conceptual model was generally supported. Practice and, to a lesser extent, physician characteristics influenced job satisfaction, whereas only practice characteristics influenced job stress. Patient characteristics exerted little influence. Job stress powerfully influenced job satisfaction and physical and mental health among physicians. CONCLUSIONS: These findings support the notion that workplace conditions are a major determinant of physician well-being. Poor practice conditions can result in poor outcomes, which can erode quality of care and prove costly to the physician and health care organization. Fortunately, these conditions are manageable. Organizational settings that are both "physician friendly" and "family friendly" seem to result in greater well-being. These findings are particularly important as physicians are more tightly integrated into the health care system that may be less clearly under their exclusive control.     

Comparison of patient satisfaction with ambulatory visits in competing health care delivery settings in Geneva, Switzerland.

OBJECTIVES: To measure satisfaction with medical visits in various health care settings and to assess the extent to which differences in satisfaction scores between health care settings can be attributed to patients' characteristics. DESIGN: This was a cross sectional survey to measure seven dimensions of patient satisfaction. SETTINGS: Ambulatory visits to 'gatekeepers' or specialists in a newly established managed care organisation, a private group practice, or a university hospital outpatient clinic in Geneva, Switzerland. PATIENTS: There were altogether 1027 adult patients (81% participation rate). RESULTS: Patients who consulted physicians in the private group practice reported higher levels of satisfaction (overall mean 83.2 on a scale between 0 and 100) than university clinic patients (79.7), patients of independent specialists within the managed plan (78.5), and patients of managed plan gatekeepers (69.8, intergroup differences p < 0.001). Differences between settings were reduced after adjustment for sex, age, country of origin, general practitioner versus specialist visit, and scheduled versus urgent visit (adjusted scores: 80.8, 78.8, 77.6, and 72.7 in the four settings, p < 0.001). Intergroup differences were largest for general satisfaction, but small and non-significant for satisfaction with explanations given by the physician and for time spent with the patient. CONCLUSIONS: Patient satisfaction varied widely between health care settings. Differences in satisfaction ratings could be ascribed only partly to disparities in patient populations. Patients of managed plan gatekeepers were least satisfied, presumably because they could not choose their physician freely. Comparison of patient satisfaction across health care settings can provide a basis for targeted quality improvement initiatives.