Roosevelt Institute | Cornell University

Do Online Reviews Provide a Clearer Picture of Patient Satisfaction?

By Andjela CirkoPublished September 29, 2016

Hospitals and insurance carriers care about patient satisfaction surveys because insurance payments can be influenced not only by patient health outcomes, but by how they rate their care as well.

Currently, hospitals use the Hospital Consumer Assessment of Healthcare Providers and Systems (H.C.A.H.P.S) to measure patient satisfaction. Collecting this information is costly, however, and some people argue how effective it is in assessing patients' experiences.
A 2012 study from the Journal of General Internal Medicine examined online patient reviews from Yelp and and found many of them were positive. The online reviews assessed factors such as convenience, staff friendliness, and access to the hospital, in addition to doctor-patient interactions.
The hospital consumer assessment survey assumes that it has the best system for measuring patient satisfaction, yet it ignores many of the most popular topics discussed on Yelp reviews. This creates an issue. The cost of a visit, insurance and billings, and perceptions of family members are often the most commented about on Yelp, yet the H.C.A.H.P.S. does not address these topics at all. In fact, 9 of the 15 most talked about topics on online reviews are not even asked about in hospital surveys.  
H.C.A.H.P.S. believe that patients' opinions and their medical records tell the whole tale, but we know that is not the case. In the real world, patients care not only about themselves, but about how their family feels and is treated during their stay, and other topics not addressed by the survey. They care little about numbers produced by the hospital, and more about hearing other experiences.
In the U.S. healthcare market, patients shift to hospitals with higher quality care. How they decide what determines quality care is very personal to the individual patient. This study looked at Medicare patients only, who have little choice in insurance, but a lot of choice in provider. Unlike the privately insured, who are restricted to facilities and providers within their insurers' networks, Medicare enrollees have the option to choose which hospital and provider to see. These patients often choose higher quality hospitals, but how do they come to this decision? It is likely that they receive their information online.
The question is whether the health care system needs to spend money measuring satisfaction, or whether public reviews like those on Yelp are sufficient. If patients are trusting these reviews anyway, is there a point in wasting money on conducting hospital surveys? Could online reviews be used to assess services and incentivize providers to improve quality care? Why are patients basing their decisions off online reviews in the first place?
These are difficult questions to answer. Maybe it is just the lack of words behind the numbers that leads patients to prefer online reviews over hospital survey statistics. Perhaps if the hospital surveys allowed for more anecdotes and "words behind the numbers," patients would refer to them more often. It is likely that the convenience of online reviews leads more people to use it. Despite the convenience, it is questionable how reliable online reviews are.  Many times, people who take the time to comment on online review forums have had either great experiences or awful experiences. It is few and far between that one writes a review about their mediocre visit to the doctor's office. How biased are these patient opinions? If online reviews such as Yelp and RateYourMD are going to take the place of expensive hospital surveys, we, as consumers, have to be cautious about how we interpret these reviews and use them to make decisions about our health outcomes.