Given the frantic pace of emergency departments, it seems that
ER staff wouldn't have time to treat patients differently, but
patients consistently end up with different perceptions according
to their method of payment. Satisfaction with hospital emergency
departments varies significantly by payor type: Medicare patients
-- older patients covered by insurance -- give the highest
satisfaction scores, while self-pay patients -- typically
low-income patients paying out of their own pockets, or not able to
pay for their services at all -- give the lowest scores. (See "ER
Satisfaction Varies With Payment Type" in Related Items.) What is
causing the gap between these two groups in emergency department
satisfaction?
To answer this question, Gallup looked for patterns in the way
Medicare and self-pay patients scored the core emergency department
satisfaction items in Gallup's 2003 healthcare database. Taking the
scores of all the items together, Medicare patients' overall
average is a significant .17 above that of self-pay patients' (each
item is based on a scale of 1 to 4). If the group of core items is
divided into "process" items (those related primarily to hospital
operations) and "people" items (those related primarily to human
interaction), the gap between Medicare and self-pay patients
remains the same for both sets.
Of the eight questions with the largest gaps between Medicare
and self-pay patients, three are process items, four are people
items, and one (quality of emergency department physicians) fits
neither category and is therefore considered "overall evaluation."
It appears that the satisfaction gap between Medicare patients and
self-payors is not limited to "people"- or "process"-related
factors, but reflects of the whole emergency department
experience.
Furthermore, all of the eight items that differ most between the
two payor groups correlate highly with patients' overall rating of
the emergency department. Of the six emergency department items
that correlate most highly with overall emergency department
satisfaction, five are among the key differentiators between
Medicare and self-pay patients.
Why the Difference?
Self-pay patients tend to be more dissatisfied with the basic
aspects of emergency department service, including speed,
efficiency, and interaction with staff members. That areas of
heightened dissatisfaction are not limited to those involving
people suggests that overt discrimination against self-pay patients
by emergency department staff is not necessarily the root of the
problem.
The broad-based nature of the gap between Medicare patients and
self-pay patients suggests instead that self-pay patients may
simply have different expectations than Medicare patients do.
Patients who visit the emergency department with full insurance
coverage may have a different perspective on the ER's function than
do patients with no coverage, who are less likely to have a primary
care physician to treat day-to-day health problems and more
likely to turn to emergency departments in a broader range of
situations. Consequently, both process and people factors may be
geared to more frequently assign these patients a lower priority --
not because of their payment method but because of the nature of
their ailments. Regardless, the first step toward improving
satisfaction among self-pay patients is to better understand the
motivations and unique expectations of this payor group.
