Exploring Value in Healthcare: Patient Satisfaction in Spain Before and After the Pandemic
Author(s)
Carlos Sanchez-Piedra, Dr1, Francisco-Javier Prado-Galbarro, Dr2, Montserrat Carmona, BSc, MSPH, PhD1, Esther-Elena Garcia-Carpintero, Dr1, Lucía Pedrosa Pérez, Dr1, Tasmania del Pino Sedeno, Dr3, Carlos Martin-Saborido, PhD4.
1Instituto de Salud Carlos III- Health Technology Assessment Agency (AETS), Madrid, Spain, 2Hospital Infantil de México Federico Gómez, México DF, Mexico, 3Servicio de Evaluación del Servicio Canario de la Salud (SESCS), La Laguna, Spain, 4Instituto de Salud Carlos III- National School of Public Health, San Sebastián de los Reyes, Spain.
1Instituto de Salud Carlos III- Health Technology Assessment Agency (AETS), Madrid, Spain, 2Hospital Infantil de México Federico Gómez, México DF, Mexico, 3Servicio de Evaluación del Servicio Canario de la Salud (SESCS), La Laguna, Spain, 4Instituto de Salud Carlos III- National School of Public Health, San Sebastián de los Reyes, Spain.
OBJECTIVES: To examine individual and regional factors associated with high satisfaction with the Spanish National Health Service (NHS), and to assess whether these determinants changed following the COVID-19 pandemic.
METHODS: A cross-sectional analysis was conducted using data from the Spanish Healthcare Barometer (2018, 2019, 2022, 2023), including 29,146 adult respondents. Satisfaction was categorized into low, moderate, and high levels. Multinomial logistic regression models assessed associations with sociodemographic, health, and healthcare utilization variables, and regional indicators such as healthcare expenditure, physician density, poverty rate, and life expectancy. Variables were selected based on theoretical relevance and model fit using the Akaike Information Criterion (AIC). Final models were assessed for multicollinearity.
RESULTS: Good self-rated health was positively associated with high satisfaction (OR=1.194, 95% CI=1.027-1.388), while poor (OR=0.649, 95% CI=0.348-0.705) and very poor health (OR=0.539, 95% CI=0.147-0.560) were negatively associated. Women (OR=1.147, 95% CI=1.032-1.274) and foreign-born individuals (OR=1.351, 95% CI=1.448-2.287) were more likely to report high satisfaction. Use of public hospitals (OR=1.148), primary care (OR=1.177), specialist care (OR=1.236), and emergency services were positively associated with satisfaction, while more frequent use was negatively associated (OR=0.971, 95% CI=0.921-0.985). Age showed a modest negative association (OR=0.994, 95% CI=0.990-0.998). No significant associations were observed for education, social class, or most regional variables. Healthcare expenditure showed a marginal positive association (OR=1.308, 95% CI=0.894-1.882). Respondents surveyed during the pandemic were less likely to report high satisfaction (OR=0.829, 95% CI=0.690-0.985). All estimates derive from the final adjusted model, which showed acceptable overall fit.
CONCLUSIONS: High satisfaction with the Spanish NHS is driven primarily by individual health status and use of public services. Regional investment levels appear less influential. These findings highlight the need to strengthen system responsiveness and patient-centered care, particularly in times of crisis.
METHODS: A cross-sectional analysis was conducted using data from the Spanish Healthcare Barometer (2018, 2019, 2022, 2023), including 29,146 adult respondents. Satisfaction was categorized into low, moderate, and high levels. Multinomial logistic regression models assessed associations with sociodemographic, health, and healthcare utilization variables, and regional indicators such as healthcare expenditure, physician density, poverty rate, and life expectancy. Variables were selected based on theoretical relevance and model fit using the Akaike Information Criterion (AIC). Final models were assessed for multicollinearity.
RESULTS: Good self-rated health was positively associated with high satisfaction (OR=1.194, 95% CI=1.027-1.388), while poor (OR=0.649, 95% CI=0.348-0.705) and very poor health (OR=0.539, 95% CI=0.147-0.560) were negatively associated. Women (OR=1.147, 95% CI=1.032-1.274) and foreign-born individuals (OR=1.351, 95% CI=1.448-2.287) were more likely to report high satisfaction. Use of public hospitals (OR=1.148), primary care (OR=1.177), specialist care (OR=1.236), and emergency services were positively associated with satisfaction, while more frequent use was negatively associated (OR=0.971, 95% CI=0.921-0.985). Age showed a modest negative association (OR=0.994, 95% CI=0.990-0.998). No significant associations were observed for education, social class, or most regional variables. Healthcare expenditure showed a marginal positive association (OR=1.308, 95% CI=0.894-1.882). Respondents surveyed during the pandemic were less likely to report high satisfaction (OR=0.829, 95% CI=0.690-0.985). All estimates derive from the final adjusted model, which showed acceptable overall fit.
CONCLUSIONS: High satisfaction with the Spanish NHS is driven primarily by individual health status and use of public services. Regional investment levels appear less influential. These findings highlight the need to strengthen system responsiveness and patient-centered care, particularly in times of crisis.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
OP7
Topic
Health Service Delivery & Process of Care, Organizational Practices, Patient-Centered Research
Disease
No Additional Disease & Conditions/Specialized Treatment Areas