Patient Satisfaction

As Nobel laureate Kenneth Arrow famously observed, health care doesn't behave like a normal market in which both buyers and sellers have the information they need to make a decision. In the health care market, sellers (physicians, hospitals, health plans) have the advantage because they usually know far more about the product (medical care) than buyers (patients) do. So consumers have played a limited role in the market.

However, there is one dimension of health care about which only consumers have accurate information: their own experiences with care. Only patients know whether their pain was adequately controlled in the hospital. Patients can observe and reliably report whether health care providers communicated clearly with them, whether they experienced long waiting times, or whether they were treated respectfully. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of surveys is designed to capture these and similar observations in a systematic way that facilitates reporting the results publicly to help other consumers make care decisions. The assumption is that reporting consumer experiences can shape the market by helping other consumers make more savvy decisions. In addition, consumer choices may influence providers and purchasers to improve the care they offer so that they can effectively compete in the market.

This Letter to the Editor appeared in The New York Times on March 22, 2012.

Theresa Brown's critique of patient experience surveys notes the value of multiple measures of patient care. We agree. Unfortunately, she also repeats two common misconceptions about the Hospital Consumer Assessments of Healthcare Providers and Systems survey, which we helped develop.

One is that there are necessarily tradeoffs between good patient experiences and good clinical care. The preponderance of the evidence (at least four recent studies) suggests the opposite: hospitals that perform better on the survey tend to do better on clinical measures, have fewer readmissions within 30 days and have lower risk-adjusted mortality.