The Association of Patient Satisfaction and Quality of Care: Theory, Evidence, and Application

Health care providers and policy makers measure and report patient-satisfaction (PSAT) scores as an implicit proxy for quality of care (QOC), a metric used to reimburse physicians and determine bonus or penalties for Medicare payments. These practices assume i) a strong and positive association of subjective PSAT judgments and objective QOC outcomes (e.g., mortality, recovery time), and ii) accurate consumer beliefs about the PSAT–QOC association. Study 1 (a national survey of 9,449 respondents) shows that consumer belief about the PSAT–QOC correlation is .69. However, Study 2 reveals that the objective PSAT–QOC correlation is .24 based on a meta-analysis of 198 studies. Study 3, a choice-based conjoint analysis, shows that as consumer beliefs diverge from the objective correlation, they are more likely to choose hospitals producing worse clinical outcomes. Study 4 shows that interventions informing consumers of the objective correlation can increase the accuracy of consumer beliefs about it. For executives and regulators, the results elucidate the financial and consumer well-being risks of assuming high correspondence of consumer beliefs with objective reality, while suggesting interventions that can engender accurate consumer beliefs. Theoretically, the results suggest reimagining and evaluating the potential unintended consequences of information environments in health care.