Patients’ Satisfaction with the NHS: A Novel Indicator for Portugal

Eleonora Santos, Shahed Khan


This paper analyzes the impact of service quality on patients’ satisfaction with the Portuguese National Health Service, through a novel indicator the Index of Satisfaction with the NHS that measures the share of children delivered in the NHS hospitals to total number of children delivered, in 2000–2016. We assume that families choose private health institutions if they are not satisfied with the National Health Service. Previous literature relies on questionnaires and surveys about patients’ satisfaction, introducing some subjectivity on the analysis since the concept of satisfaction is, itself, debatable, and does not compare the evolution of satisfaction over time. Our study is innovative in this regard. The results indicate that the weaknesses of the Portuguese NHS led public to choose private health institutions. In a context of economic difficulties and the loss of purchasing power, such results have clear implications on the evaluation of the
quality of service provided by the NHS in Portugal.


National Health Service, Patients’ satisfaction, Quality of service

Full Text:



Biscaia AR, Martins JN, Carreira MF et al. Cuidados de

saúde primários em Portugal, reformar para novos

sucessos. Lisboa, Padrões Culturais Editora, 2ª Edição.

Miguel L, e Sá AB. Cuidados de saúde primários em

-2016: reforçar, expandir. Lisboa: Ministério da

Saúde 2010.

Barbosa PAA. O impacto das políticas de saúde na

satisfação de utentes e no acesso aos cuidados de

saúde primários: Estudo de caso na unidade de saúde

familiar Marginal. Dissertação apresentada ao Instituto

Superior de Ciências Socias e Políticas, Universidade

Técnica de Lisboa, para a obtenção do grau de Mestre

em. Política Social 2009.

Enquist B,. Edvardsson B. Corporate service

responsibility as a driving force for service brand

cultivation. Working paper, Karlstad University, Karlstad

Gordon D, Straw M, Dorling D et al. Inequalities in

Health: The Evidence Presented to the Independent

Inquiry into Inequalities in Health, Chaired by Sir Donald

Acheson, Bristol: Policy 1999.

Santos O, Biscaia A, Antunes AR et al. Os Centros de

Saúde em Portugal - A satisfação dos utentes e dos

profissionais 2007.

Williams B. Patient satisfaction: A valid concept? Social

Science & Medicine 1994; 384: 509-16.

Fitzsimmons JA, Fitzsimmons MJ. Service Management,

rd Edition. New York: McGraw-Hill 2001.

Woodruff R, Gardial SF. Know Your Customer.

Cambridge, MA: Blackwell 1996.

Nordgren L. Value creation in health care services

– developing service productivity: Experiences

from Sweden. International Journal of Public Sector

Management 2009; 22(2): 114-27.

Thom D, Hall MA, Pawlson LG. Measuring patients’

trust in physicians when assessing quality of care.

Health Affairs (Millwood) 2004; 23: 124-32.

Alrubaiee L, Alkaa’ida F. The mediating effect of patient

satisfaction in the patients’ perceptions of health

care quality – Patient trust relationship. International

Journal of Marketing Studies 2011; 3(1); 103-21.

Amin M, Nasharuddin SZ. Hospital service quality

and its effects on patient satisfaction and behavioural

intention. Clinical Governance: An International Journal

: 18(3): 238-54.14. Aagja JP, Garg R. Measuring perceived service quality

for public hospitals (PubHosQual) in the Indian context.

International Journal of Pharmaceutical and Healthcare

Marketing 2010: 4(1): 60-83.

Astuti HJ, Nagase K. Patient loyalty to health care

organizations: Relationship marketing and satisfaction.

International Journal of Management and Marketing

Research 2014; 7(2): 39-56.

Dabholkar P, Shepard De, Thorpe D. Assessing the

effects of quality, value and customer satisfaction on

behavioral intention in service environments. Journal

of Retailing 2000; 76(2): 193-218.

Bei L, e Chiao Y. An integrated model for the effects

of perceived product, perceived service quality and

perceived price fairness on consumer satisfaction

and loyalties. Journal of Consumer Satisfaction,

Dissatisfaction and Complaining Behavior 2001; 14:


Tehrani AB, Feldman SR, Camacho FT et al. Patient

satisfaction with outpatient medical care in the United

States. Health Outcomes Research in Medicine 2011;

(4): 197-202.

Bogner HR, de Vries McClintock H, Hennessy S et al.

Patient satisfaction and perceived quality of care among

older adults according to activity limitation stages.

Archives of Physical Medicine and Rehabilitation 2015;

(10): 1810-19.

Van de Walle S, Marien S. Choice in public health

services: A multilevel analysis of perceived primary

care doctor choice in 22 countries. Administration and

Society 2017; 49(10): 1471-93.

Leggat SG, Karimi L, Bartram T. A path analysis study of

factors influencing hospital staff perceptions of quality

of care factors associated with patient satisfaction and

patient experience. BMC Health Services Research

; 17(1): 739-46.

Huang ECH, Pu C, Chou YJ et al. Public trust in

physicians—Health care commodification as a

possible deteriorating factor: Cross-sectional analysis

of 23 countries. INQUIRY: The Journal of Health Care

Organization, Provision, and Financing 2018; 55.

Krupchanka D, Khalifeh H, Abdulmalik J et al. Satisfaction

with psychiatric in-patient care as rated by patients

at discharge from hospitals in 11 countries. Social

psychiatry and Psychiatric Epidemiology 2017; 52(8):


Petrosyan V, Patel K, Ameerally PJ. Are patients

satisfied with the head and neck skin cancer service?

An evaluation of outpatient services with a review

of published reports. British Journal of Oral and

Maxillofacial Surgery 2017; 55(10): 1018-23.

Nymberg P, Drevenhorn E. Patients’ experience of a

nurse‐led lifestyle clinic at a Swedish health centre.

Scandinavian Journal of Caring Sciences 2016; 30(2):


Ward PR, Rokkas P, Cenko C et al. ‘Waiting for’ and

‘waiting in’ public and private hospitals: a qualitative

study of patient trust in South Australia. BMC Health

Services Research 2017; 17(1): 333-43.

Brookes G, Baker P. What does patient feedback reveal

about the NHS? A mixed methods study of comments

posted to the NHS Choices online service. BMJ Open

; 7(4): 1-12.

Ziebland S, Coulter A, Calbrese JD, et al. (Eds.).

Understanding and using health experiences: improving

patient care. Oxford: Oxford University Press 2013: 1-5.

Xesfingi S, Vozikis A. Patient satisfaction with the health

care system: Assessing the impact of socio-economic

and health care provision factors. BMC Health Services

Research 2016; 16(1): 94-100.

Oliveira A, Albuquerque C, Cunha M et al. Satisfação

dos utentes numa unidade de cuidados de saúde

primários do interior. Servir (Lisbon, Portugal). 2016;

(3): 62-67.

Esquerdo T. O impacto da qualidade na satisfação

do utente e nas dimensões da confiança pública nos

serviços de saúde. Doctoral Thesis. Universidade do

Minho 2015.

Schoenfelder T, Klewer J, Kugler J. Determinants of

patient satisfaction: a study among 39 hospitals in an

in-patient setting in Germany. International Journal for

Quality in Health Care 2011; 23(5): 503-09.

Ali N, May S. A qualitative study into Egyptian patients’

satisfaction with physiotherapy management of low

back pain. Physiotherapy Research International 2017;


Woodside AG, Frey LL, Daly RT. Linking service quality,

customer satisfaction, and behavioral intention: from

general to applied frameworks of the service encounter.

Journal of Health Care Marketing 1989; 9(4): 5-17.

Lim PC, Tang NKH. A study of patients’ expectations

and satisfaction in Singapore hospitals. International

Journal of Health Care Quality Assurance 2000; 13(7):


Van Der Schee E, Braun B, Calnan M et al. Public

trust in health care: A comparison of Germany, the

Netherlands, and England and Wales. Health Policy

; 81(1): 56-67.

Chaniotakis I, e Lymperopoulos C. Service quality effect

on satisfaction and word of mouth in the health care

industry. Managing Service Quality 2009; 19(2): 229-42.


  • There are currently no refbacks.

Comments on this article

View all comments

Copyright (c) 2018 International Journal of Healthcare Education & Medical Informatics (ISSN: 2455-9199)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.