Patient Satisfaction as Policy Feedback: Does the ACA Improve Care?

• In Event: Public Opinion and Health Politics: Policy Feedback and Misinformation

Abstract

Has the landmark Affordable Care Act of 2010 (ACA) improved the satisfaction of individuals with their medical care? An important and growing body of research has focused on the impact of the ACA on political attitudes and behavior in support of the law. Neglected in this valuable research on policy feedback is the ACA’s impact on the patient experience.

The ACA is the most comprehensive health care reform since the Johnson Administration. One of its objectives was to improve patient satisfaction with health care through a number of new policies including the following: expanding government health care coverage, enhancing Medicare’s prescription drug benefits for seniors, improving the quality of hospital care by designating patient evaluations as a factor in Medicare payments, reducing the burdens of paperwork on patients, and other steps.

We draw on our original panel study to track the effects of the ACA on the patient experience. We investigate two potential influences on individual patient satisfaction with health care: changes in individual experiences with medical care under the ACA, and changes in the methods of health insurance and health care delivery introduced by the ACA. Specifically, we expect that individuals who experienced the ACA’s benefits – namely, improvements in access to health care, medical coverage, quality of treatment under the ACA, and ease of care – to be more likely to have higher levels of satisfaction than those who did not experience those benefits.

Our empirical analysis draws from a unique panel dataset that tracks a nationally representative sample of adults in five waves from 2010 to 2018. This ten-year panel study provides multiple measures of patient satisfaction relating to the choice of physicians and hospitals, the conduct of insurance providers, the amount of paperwork and number of calls to manage health coverage, the number and kind of medical treatments, out-of-pocket health care costs and the efficiency of health care services covered by their insurance. In addition, our data include a battery of policy variables that track how the ACA impacted the access of individuals to prescriptive drugs, insurance coverage, and medical care, as well as its effect on the source of their health care coverage. Our data also include controls for individuals’ political ideology and social and economic status. We use dynamic panel data models to explore whether changes in policy experiences influence patient satisfaction, controlling for potential confounding factors.

There are two potential implications of the proposed paper to extend research on the ACA’s policy feedback from the study of political attitudes and behavior to the reactions of patients. First, it may identify a new source of increased public support for the ACA that has not been carefully considered in the past. Second, it may identify an important new dimension for evaluating health reform and introduce policy feedback research to the large and significant field of health services research.

Authors

• Ling Zhu, University of Houston

• Lawrence R. Jacobs, University of Minnesota, Twin Cities