People’s satisfaction with the health system, including the coverage provided, has been a concern for some years now but research into the main explanatory factors is in progress. This work focuses on European countries plus Israel, using the SHARE database to find what determines people’s satisfaction with the basic coverage provided by the health system of each country. On top of the usual individual socioeconomic characteristics, other explanatory factors were also considered. These include, at individual level, trust in others, political positioning, and risk aversion; at country level, they include access to specialist care and the type of health system financing. Estimation of an ordered logistic model found that the main predictors for satisfaction with a health system’s basic coverage include trust in others, unmet health needs, self-assessed health, free access to specialists, health system financed through social insurance, and out-of-pocket payments. These results provide the basis for possible policies designed to improve people’s satisfaction.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Ali, F., Nikoloski, Z., & Rekac, H. (2015). Satisfaction and responsiveness with health-care services in Qatar—Evidence from a survey. Health Policy, 119, 1499–1505.
Allison, P. D. (1999). Logistic regression using the SAS system: Theory and application. Cary, NC: SAS Institute.
AlSaud, A. M., Taddese, H. B., & Filippidis, F. T. (2018). Trends and correlates of the public’s perception of health care systems in the EU: A multilevel analysis of Eurobarometer survey data from 2009 to 2013. BMJ Open, 8, e018178.
Bhatia, M., Rannan-Eliya, R., Somanathan, A., Huq, M. N., Pande, B. R., & Chuluunzagd, B. (2009). Public views of health system issues in four Asian countries. Health Affairs, 28, 1067–1077.
Bleich, S. N., Ozaltint, E., & Murray, C. J. L. (2009). How does satisfaction with the health-care system relate to patient experience? Bulletin of World Health Organization, 87, 271–278.
Blendon, R. J, Leitman, R., Morrison, I., & Donelan, K. (1990). Satisfaction with Health Systems in Ten Nations. Health Aff (Millwood), 9(2), 185–192.
Blendon, R. J., Kim, M., & Benson, J. M. (2001). The public versus the World Health Organization on health system performance. Health Affairs, 20, 10–20.
Borisova, L., Martinussen, P. E., Rydland, H. T., Stornes, P., & Eikemo, T. A. (2017). Public evaluation of health services across 21 European countries: The role of culture. Scandinavian Journal of Public Health, 45, 132–139.
Borooah, V. K. (2001). Logit and probit: Ordered and multinomial models: Quantitative applications in social sciences series. Sage University Paper (Vol. 138). Thousand Oaks: Sage Publications Ltd.
Börsch-Supan, A. (2018). Survey of health, ageing and retirement in Europe (SHARE) wave 6. Release version: 6.1.0. SHARE-ERIC. Data set. https://doi.org/10.6103/share.w6.611.
Börsch-Supan, A., Brandt, M., Hunkler, C., Kneip, T., Korbmacher, J., et al. (2013). Data resource profile: The survey of health, ageing and retirement in Europe (SHARE). International Journal of Epidemiology, 42(4), 992–1001.
Brant, R. (1990). Assessing proportionality in the proportional odds model for ordinal logistic regression. Biometrics, 46, 1171–1178.
Buis, M. L. (2013). OPARALLEL: Stata module providing post-estimation command for testing the parallel regression assumption. Statistical Software Components S457720. Boston College Department of Economics.
Busse, R., Valentine, N., Lessof, S., Prasad, A., & van Ginneken, E. (2012). Being responsive to citizens’ expectations: The role of health services in responsiveness and satisfaction. In J. Figueras & M. McKee (Eds.), Health systems, health, wealth and societal well-being: Assessing the case for investing in health systems (pp. 175–208). Maidenhead: Open University Press.
Calnan, M., Stephen, A., & Smith, N. (2003). Ageing and public satisfaction with the health service: An analysis of recent trends. Social Science and Medicine, 57, 757–762.
Chan, D. (2009). So why ask me? Are self report data really that bad? In C. E. Lance & R. J. Vandenberg (Eds.), Statistical and methodological myths and urban legends: Doctrine, verity and fable in the organizational and social sciences (pp. 309–335). New York, NY: Routledge.
Christelis, D., Jappelli, T., Paccagnella, O., & Weber, G. (2006). Socio-economic status, income, and wealth. SHARE working papers. Retrieved February 20, 2018, from http://www.share-project.org.
Crow, R., Gage, H., Hampson, S., Hart, J., Kimber, A., Storey, L., et al. (2002). The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature. Health Technology Assessment, 6(32), 1–244.
Cylus, J., Nolte, E., Figueras, J., & McKee, M. (2016). What, if anything does, the EuroHealth Consumer Index actually tells us? The BMJ Opinion. Retrieved February 20, 2018, from http://blogs.bmj.com/bmj/2016/02/09/what-if-anything-does-the-eurohealth-consumer-index-actually-tell-us/.
De Almeida, R., Bourliataux-Lajoinie, S., & Martins, M. (2015). Satisfaction measurement instruments for healthcare service users: A systematic review. Cadernos de Saúde Pública, 31(1), 11–25.
de Silva, A. (1999). A framework for measuring responsiveness. GPE Discussion Paper Series: 32 EIP/GPE/EBD, WHO.
Donelan, K., Blendon, R. J., Schoen, C., Davis, K., & Binns, K. (1999). The cost of health system change: Public discontent in five nations. Health Affairs, 18, 206–216.
European Observatory on Health Systems and Policies. (2018). The health systems and policy. Monitor. Retrieved January 20, 2018, from http://www.hspm.org/searchandcompare.aspx.
Eurostat. Database. Retrieved February 8, 2018, from http://ec.europa.eu/eurostat/data/database.
Fitzpatrick, R. (1991). Surveys of patients satisfaction: Important general considerations. BMJ, 302(6781), 887–889.
Footman, K., Roberts, B., Mills, A., Richardson, E., & McKee, M. (2013). Public satisfaction as a measure of health system performance: A study of nine countries in the former Soviet Union. Health Policy, 112, 62–69.
Gill, L., & White, L. (2009). A critical review of patient satisfaction. Leadership in Health Services, 22(1), 8–19.
Giordano, G. N., & Lindstrom, M. (2015). Trust and health: Testing the reverse causality hypothesis. Journal of Epidemiology and Community Health, 70(1), 10–16.
Goodwin, J. S., Black, S. A., & Satish, S. (1999). Aging versus disease: The opinions of older Black, Hispanic, and non-Hispanic white Americans about the causes and treatment of common medical conditions. Journal of American Geriatrics Society, 47, 973–979.
Greifeneder, R., Scheibehenne, B., & Kleber, N. (2010). Less may be more when choosing is difficult: Choice complexity and too much choice. Acta Psychologica, 133(1), 45–50.
Grossman, M. (1972). On the concept of health capital and the demand for health. Journal of Political Economy, 80, 223–255.
Hall, J., & Dornan, M. (1990). Patient sociodemographic characteristics as predictors of satisfaction with medical care: A meta-analysis. Social Science and Medicine, 30(7), 811–818.
Ham, C. (2005). Money can’t buy you satisfaction. British Medical Journal, 330, 597–599.
Health Consumer Powerhouse (HCP). (2018). Available at https://healthpowerhouse.com/publications/. Retrieved January 5, 2018.
Hekkert, K. D., Cihangir, S., Kleefstra, S. M., & Berg, B. (2009). Patient satisfaction revisited: A multilevel approach. Social Science and Medicine, 69, 68–75.
Jenkinson, C., Coulter, A., Bruster, S., Richards, N., & Chandola, T. (2002). Patients’ experiences and satisfaction with health care: Results of a questionnaire study of specific aspects of care. Quality and Safety Health Care, 11, 335–339.
Joshi, V. D., Chen, Y. M., & Lim, J. F. Y. (2009). Public perceptions of the factors that constitute a good healthcare system. Singapore Medical Journal, 50(10), 982–989.
Judge, K., & Solomon, M. (1993). Public-opinion and the national-health-service patterns and perspectives in consumer satisfaction. Journal of Social Policy, 22, 299–327.
Kersnik, J. (2001). Determinants of customer satisfaction with the health care system, with the possibility to choose a personal physician and with a family doctor in a transition country. Health Policy, 57(2), 155–164.
Kotzian, P. (2009). Determinants of satisfaction with health care system. Open Political Science Journal, 2, 47–58.
Malter, F., & Borrsch-Supan, A. (2013). Share wave 4: Innovations and methodology. Munich: Max Planck Institute for Social Law and Social Policy.
Manning, W. G., & Marquis, M. S. (1996). Health insurance: The trade-off between risk pooling and moral hazard. Journal of Health Economics, 15(5), 609–639.
Missine, S., Meuleman, B., & Brack, P. (2013). The popular legitimacy of European healthcare systems: A multilevel analysis of 24 countries. Journal of European Social Policy, 23(3), 231–247.
Mossialos, E. (1997). Citizens’ views on health care systems in the 15 member states of the European Union. Health Economics, 6, 109–116.
Mossialos, E., & Dixon, A. (2002). Funding health care: An introduction. In E. Mossialos, A. Dixon, J. Figueras, & J. Kutzin (Eds.), Funding health care: Options for Europe (pp. 1–30). Buckingham: Open University Press.
Munro, N., & Duckett, J. (2015). Explaining public satisfaction with health-care systems: Findings from a nationwide survey in China. Health Expectations, 19, 654–666.
Nutting, P. A., Goodwin, M. A., Flocke, S. A., et al. (2003). Continuity of primary care: To whom does it matter and when? Annals of Family Medicine, 1, 149–155.
O’Connell, A. (2006). Logistic regression models for ordinal response variables. Thousand Oaks: Sage Publications.
OECD. (2012). Health at a glance: Europe. Paris: OECD Publishing.
OECD. (2015). Country note: How does health spending in Israel compare. OECD Health Statistics.
OECD. (2016a). Health at a glance: State of health in the EU cycle. Retrieved January 20, 2018, from http://www.oecd.org/health/health-at-a-glance-europe-23056088.htm.
OECD. (2016b). Health policy in Israel. OECD health policy overview. Retrieved January 20, 2018, from http://www.oecd.org/eco/surveys/economic-survey-israel.htm.
OECD. (2016c). Health at a glance: Europe. Paris: OECD Publishing.
Papanicolas, I., Cylus, J., & Smith, P. C. (2013). An analysis of survey data from eleven countries finds that satisfaction with health system performance means many things. Health Affairs, 4, 734–742.
Plous, S. (1993). The psychology of judgment and decision making. New York: McGraw-Hill.
Prohaska, T. R., Keller, M. L., Leventhal, E. A., & Leventhal, H. (1987). Impact of symptoms and aging attribution on emotions and coping. Health Psychology, 6, 495–514.
Rivkin, M., & Bush, P. (1974). The satisfaction continuum in health care: Consumer and provider preferences. In S. Mushkin (Ed.), Consumer incentives for health care (pp. 304–332). New York: Milbank Memorial Fund.
Saltman, R. B., & Figueras, J. (1998). Analyzing the evidence on European health care reform. Health Affairs, 2, 85–108.
Sarkisian, C. A., Hays, R. D., & Mangione, C. M. (2002). Do older adults expect to age successfully? The association between expectations regarding aging and beliefs regarding healthcare seeking among older adults. Journal of American Geriatrics Society, 50, 1837–1843.
Schneider, U., Pfarr, C., Schneide, B. S., & Ulrich, V. (2012). I feel good! Gender differences and reporting heterogeneity in self-assessed health. European Journal of Health Economics, 13(3), 251–265.
Shmueli, A. (2003). Israelis evaluate their health care system before and after the introduction of the national health insurance law. Health Policy, 63, 279–287.
Sitzia, J., & Wood, N. (1997). Patient satisfaction: A review of issues and concepts. Social Science and Medicine, 45, 1829–1843.
Strasser, S., Ahorony, L., & Greenberger, D. (1993). The patient satisfaction process: Moving toward a comprehensive model. Medical Care Review, 50, 219–248.
Subramanian, S. V., Huijts, T., & Avendano, M. (2010). Self-reported health assessment in the 2002 World Health Survey: How do they correlate with education? Bulletin of World Health Organization, 88, 131–138.
Subramanian, S. V., Huijts, T., & Perkins, J. M. (2009). Association between political ideology and health in Europe. European Journal of Public Health, 19(5), 455–457.
Tucker, J. L., & Kelley, V. A. (2000). The influence of patient sociodemographic characteristics on patient satisfaction. Military Medicine, 165, 72–76.
Van der Schee, E., Braun, B., Calnan, M., Schnee, M., & Groenewegen, P. P. (2007). Public trust in health care: A comparison of Germany, the Netherlands, and England and Wales. Health Policy, 81, 56–67.
van der Zee, J., & Kroneman, M. W. (2007). Bismarck or Beveridge: A beauty contest between dinosaurs. BMC Health Services Research, 7, 94.
Wendt, C., Kohl, J., Mischke, M., & Pfeifer, M. (2010). How do Europeans perceive their healthcare system? Patterns of satisfaction and preference for state involvement in the field of healthcare. European Sociological Review, 26(2), 177–192.
Williams, R. (2006). Generalized ordered logit/partial proportional odds models for ordinal dependent variables. Stata Journal, 6(1), 58–82.
Williams, R. (2009a). Using heterogeneous choice models to compare logit and probit coefficients across groups. Sociological Methods and Research, 37(4), 531–559.
Williams, R. (2009b). Understanding and interpreting generalized ordered logit models. Journal of Mathematical Sociology, 40(1), 7–20.
Williams, R. (2016). Understanding and Interpreting Generalized Ordered Logit Models. Journal of Mathematical Sociology, 40(1), 7–20.
Williams, R. A. (2005). Gologit2: A program for generalized logistic regression/partial proportional odds models for ordinal dependent variables. Retrieved April 12, 2018 from http://www.stata.com/meeting/4nasug/gologit2.pdf.
Worthington, C. (2005). Patient satisfaction with health care: Recent theoretical developments and implications for evaluation practice. The Canadian Journal of Program Evaluation, 20(3), 41–63.
We thank an anonymous reviewer whose suggestions and helpful comments contributed to the improvement of the earlier draft of this manuscript. This paper uses data from SHARE Waves 1, 2, 3 (SHARELIFE), 4, 5 and 6 (DOIs: https://doi.org/10.6103/share.w1.611, https://doi.org/10.6103/share.w2.611, https://doi.org/10.6103/share.w3.611, https://doi.org/10.6103/share.w4.611, https://doi.org/10.6103/share.w5.611, https://doi.org/10.6103/share.w6.611), see Börsch-Supan et al. (2013) for methodological details.
The SHARE data collection has been primarily funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812) and FP7 (SHARE-PREP: N°211909, SHARE-LEAP: N°227822, SHARE M4: N°261982). Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C) and from various national funding sources is gratefully acknowledged (see www.share-project.org).
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Tavares, A.I., Ferreira, P.L. Public satisfaction with health system coverage, empirical evidence from SHARE data. Int J Health Econ Manag. 20, 229–249 (2020). https://doi.org/10.1007/s10754-020-09279-x
- Health system coverage
- Ordered logistic regression