Evaluation of the consumer model: Relationship between patients' expectations, perceptions and satisfaction with care

Objective. To evaluate the consumer model in a health care system, by studying the relationship between four variables: expectations, perceived degree of fulfillment, satisfaction and changing of physicians. Design. Cross-sectional study; telephone interview of patients who had visited a primary care physician 1-2 months previously. Setting. The Maccabi health plan, Israel. Study participants. A random sample of 759 patients, aged 18 and over residing in two towns in Israel. Response rate to telephone interview was 50.7% (n=385). Main outcome measures. Expectation, perceived expectations fulfilled by the physician, satisfaction with the visit to the primary care physician and intention to change physician. Results. The gap between the expectations and their fulfillment showed a low correlation with satisfaction. For attributes where a large difference was found, no correlation was found with patient satisfaction. Attributes such as 'diagnosis', 'preventive health care' and 'answering questions' presented correlation coefficients of 0.3. The correlation between the perceived fulfillment of these attributes and satisfaction presented higher correlation coefficients (between 0.4-0.5). This limits the consumer model as a way to predict satisfaction. Satisfaction correlated highly with intention to change physician. The mean score for the satisfaction of those intending to change doctors was 3.8 compared to 5.5 in the group of consumers not intending to change doctors. Conclusion. The consumer model is able to explain only to a modest extent the variation in satisfaction, but dissatisfaction is a good predictor of the intention to change doctors.