Patient satisfaction and visiting the doctor: A self-regulating system

In 1974, Aday and Anderson proposed that client satisfaction may affect utilization of physician services, and that utilization, in turn, may affect satisfaction. Since that time, a number of researchers have investigated the issue, adopting increasingly sophisticated approaches. To date, however, the statistical models used to test the hypothesized feedback have not been completely appropriate. We develop and test alternative hypotheses on the reciprocal effects of satisfaction and utilization. Using methods that allow us to specify models with feedback effects, we examine whether satisfaction with the doctor and visits to the doctor form a self-regulating or a self-amplifying system. In both, satisfaction is expected to result in more visits to the doctor, but in a self-regulating system, visits are hypothesized to lead to lower satisfaction while in the self-amplifying system, visits are hypothesized to produce greater satisfaction. We specify and test the feedback model in two data sets: one based on a cross-sectional survey of pediatric practices in New Haven, Connecticut and the other based on Gray's panel survey of the Federal Employees Health Benefits Program. In both cases the results indicate that satisfaction and visits form a self-regulating system.