Quality of life and patient satisfaction cohabit more and more in the same paradigm through the notion that patient satisfaction with care and treatment can lead to positive outcomes which in turn adds to the overall clinical effectiveness. Yet, patient satisfaction is often used without a clear understanding of the concept. The objective was to test a model of patient satisfaction that would identify the antecedents of the satisfaction judgment. METHOD: Self-administered questionnaire to 532 inpatients of two acute-care hospitals in Montreal (Canada). The questionnaire consisted of six Likert scales measuring: Expectations (3 items), Perceived quality (17 items), Conformity to expectations (3 items), Needs (6 items), Fairness (2 items) and Satisfaction (10 items). Scales reliability and construct validity where assessed with Cronbach alpha coefficient of internal consistency and confirmatory factorial analysis. The model was tested with causal modeling (LISREL 8). RESULTS: All scales alpha ranged from 0.70 to 0.91. The model provides satisfactory fit to the data (?2=26.44, dl=28, p=0.55) and explains 61% of the variation in satisfaction. Examination of total effects (sum of direct and indirect effects of one variable on another) reveals that Perceived quality has the greatest influence on satisfaction (total effect of 0.62), followed by Conformity to expectation (total effect of 0.44), Fairness (total effect of 0.44), Needs (total effect of 0.16), and Expectations (total effect of 0.11). In conclusion, the utilization of satisfaction information to it's full potential not only requires reliable and valid instruments, but also relevant concepts such as Perceived quality and Conformity to expectations, to take into account the complexity of the satisfaction judgment.