Two-factor theory – at the intersection of health care management and patient satisfaction

Figures & data

Table 1 Variables differentiating Canadian from US respondents in logistic analysis 1

Variable	P level	Synopsis
Overall quality	<0.001	US participants report higher levels of excellence in health quality (43% US versus 38% Canada). The remaining standards of good, fair, and poor were similar regardless of the country of origin of participants (46% ± 1.5%, 10% ± 1%, and 2.5% ± 0.5%), respectively. For each country, satisfaction with physician care was rated as excellent at 59%. US respondents reported greater levels of excellence in hospital care (56% versus 46% for Canadians).
Overall satisfaction	0.06	Statistically similar; however, US participants reported higher levels at the scale’s “very satisfied” endpoint and lower levels for the “somewhat dissatisfied” and “very dissatisfied” levels. Canadians reported higher levels for the remaining endpoints of “somewhat satisfied” or “neutral”.
Unmet medical needs	0.012	Twelve and a half percent of US participants reported the presence of unmet medical needs versus 11.2% of Canadians.
Health status	0.005	US participants reported higher levels of “excellent” health status (25% US versus 22% Canadian). Canadians reported marginally higher levels for very good and good levels and lower levels for substandard health (13.6% versus 15.4% for US participants).
Type of insurance coverage	<0.001 (US population only)	US participants reported the highest levels of satisfaction for the US government Medicare program (elderly patients), followed by private employer-based coverage (general working population) and government veteran care. Ranked lowest was the US government Medicaid program for financially indigent patients. Levels of satisfaction for Canadian participants demonstrated a statistically similar pattern to that of the US Medicaid program.

Table 2 Variables forming either a positive or negative opinion of overall satisfaction with health care in logistic analysis 2

	Unmet medical needs		Overall quality of health care
	Yes	No	Poor	Fair	Good	Excellent
US Medicare	8%	92%	2%	6%	41%	51%
Private/employer	8.5%	91.5%	1%	8%	47%	44%
Medicaid	19%	81%	5%	12%	47%	36%
Veterans Administration/Indian Health Services	13%	81%	5%	12%	44%	41%
Canada	11%	89%	3%	12%	47%	38%

Table 3 Satisfaction levels (as percentages) for individual factors and the survey population as a whole

Full survey: self reported, opinion for overall satisfaction with health care received		Self reported, unavailability of needed health care (All survey respondents)		Self reported, presence of insurance coverage (American respondents)		Self reported, health status (All survey respondents)			Self reported, opinion on the quality of the care received (All persons who have received health care within the last 12 months)
	Overall satisfaction with health care received	Factor: presence of un-met medical need	Factor: absence of un-met medical need	Factor: presence of insurance coverage	Factor: absence of insurance coverage	Factor: reporting better levels of health	Reporting good health (inflection point)	Factor: reporting poorer levels of health	Factor: perceiving high quality care	Perceiving neither high or low quality care (inflection point)	Factor: perceiving low quality of care
Positive opinion (satisfaction)	81.64%	60.66%	84.66%	87.65%	71.85%	82.71%	85.31%	74.96%	94.10%	55.95%	4.42%
Neutral opinion	3.72%	8.38%	3.07%	2.63%	6.29%	3.27%	3.16%	5.38%	2.54%	16.07%	1.63%
Negative opinion (dissatisfaction)	14.64%	30.95%	12.27%	9.71%	21.85%	14.02%	11.53%	19.66%	3.37%	27.98%	93.95%
	n = 8688	n = 1037	n = 7626	n = 4252	n = 302	n = 2082	n = 2914	n = 1282	n = 7013	n = 315	n = 860

Table 4 Criteria assessment for two-factor model

Factor	Criteria	Relative change in satisfaction
Presence of un-met medical need	When present increased satisfaction	FALSE	−20.98%	Motivator
	When absent did not significantly increase dissatisfaction	TRUE	−2.37%	No
	When absent increased dissatisfaction	FALSE	−2.37%	Hygiene
	When present did not significantly increase satisfaction	TRUE	−20.98	No
Absence of un-met med need	When present increased satisfaction	TRUE	3.02%	Motivator
	When absent did not significantly increase dissatisfaction	FALSE	16.31%	No
	When absent increased dissatisfaction	TRUE	16.31%	Hygiene
	When present did not significantly increase satisfaction	TRUE	3.02%	Yes
Presence of insurance coverage	When present increased satisfaction	TRUE	6.02%	Motivator
	When absent did not significantly increase dissatisfaction	FALSE	7.21%	No
	When absent increased dissatisfaction	TRUE	7.21%	Hygiene
	When present did not significantly increase satisfaction	FALSE	6.02%	No
Absence of insurance coverage	When present increased satisfaction	FALSE	−9.79%	Motivator
	When absent did not significantly increase dissatisfaction	TRUE	−4.93%	No
	When absent increased dissatisfaction	FALSE	−4.93%	Hygiene
	When present did not significantly increase satisfaction	TRUE	−9.79%	No
Reporting higher levels of health	When present increased satisfaction	TRUE	1.07%	Motivator
	When absent did not significantly increase dissatisfaction	TRUE	−3.11%	Yes
	When absent increased dissatisfaction	FALSE	−3.11%	Hygiene
	When present did not significantly increase satisfaction	TRUE	1.07%	No
Reporting poorer levels of health	When present increased satisfaction	FALSE	−6.68%	Motivator
	When absent did not significantly increase dissatisfaction	TRUE	−3.11%	No
	When absent increased dissatisfaction	FALSE	−3.11%	Hygiene
	When present did not significantly increase satisfaction	TRUE	−6.68%	No
Perception of high quality care	When present increased satisfaction	TRUE	12.46%	Motivator
	When absent did not significantly increase dissatisfaction	FALSE	13.34%	No
	When absent increased dissatisfaction	TRUE	13.34%	Hygiene
	When present did not significantly increase satisfaction	FALSE	12.46%	No
Perception of low quality care	When present increased satisfaction	FALSE	−77.22%	Motivator
	When absent did not significantly increase dissatisfaction	FALSE	13.34%	No
	When absent increased dissatisfaction	TRUE	13.34%	Hygiene
	When present did not significantly increase satisfaction	TRUE	−77.22%	Yes