Health Systems Assessment Session 4: Citizen Satisfaction as a Measure of Health System Performance | Anuska Kalita


One of the key goals of a health system, citizen satisfaction is the degree to which citizens or the public are satisfied with the health system. Measuring citizen satisfaction is important because members of the public are beneficiaries and actors in a health system, capable of providing feedback on the quality and responsiveness of services. Their opinions can be important in shaping health policies and bringing legitimacy and accountability to the policymaking process.

Citizen satisfaction research remains undertheorized, and there are very few data sets that include variables needed to assess it, especially in low- and middle-income countries like India. Understanding the determinants of citizens’ satisfaction with a country’s or state’s health system has merit beyond its political and strategic value to reformers. More broadly, high public satisfaction with specific services such as health care is linked with higher trust in public institutions, which is an important element in the effective functioning of democratic governments.

This session will introduce the concept of citizen satisfaction and its importance in India. The session will cover the different data sets and survey items that have been used to measure citizen satisfaction worldwide. Drawing on primary research from India and other countries, the session will discuss the key correlates of citizen satisfaction, as well as some pitfalls of common measurement indices.

The session is designed for participants interested in health, health systems, and health policy. Some familiarity with the Indian health system, health policies, and programs is desired.

Suggested Reading

  • Bhatia, M., Rannan-Eliya, R., Somanathan, A., Huq, M. N., Pande, B. R., & Chuluunzagd, B. (2009). Public Views Of Health System Issues In Four Asian Countries. Health Affairs, 28(4), 1067–1077.
  • Blendon, R. J., Benson, J., Donelan, K., Leitman, R., Taylor, H., Koeck, C., & Gitterman, D. (1995). Who Has The Best Health Care System? A Second Look. Health Affairs, 14(4), 220–230.
  • Blendon, R. J., Kim, M., & Benson, J. M. (2001). The Public Versus The World Health Organization On Health System Performance. Health Affairs, 20(3), 10–20.

Optional Reading

  • Munro, N., & Duckett, J. (2016). Explaining public satisfaction with health-care systems: Findings from a nationwide survey in China. Health Expectations, 19(3), 654–666.
  • Papanicolas, I., Cylus, J., & Smith, P. C. (2013). An Analysis Of Survey Data From Eleven Countries Finds That ‘Satisfaction’ With Health System Performance Means Many Things. Health Affairs, 32(4), 734–742.

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