Patient satisfaction in the spanish national health system: temporal trends and associated factors from 2018 to 2023.

backgroundPatient satisfaction is a key indicator of healthcare system performance and legitimacy. Understanding its determinants provides valuable insights for policy design. To identify healthcare-related and socioeconomic determinants at both the individual and contextual levels (including regional indicators such as healthcare expenditure, physician density, life expectancy, and poverty rate) associated with satisfaction with the Spanish public healthcare system, and to assess changes in satisfaction levels before and after the COVID-19 pandemic.

methodsWe conducted a cross-sectional analysis using nationally representative data from the Spanish Healthcare Barometer for the years 2018, 2019, 2022, and 2023. Individual-level data were linked with regional-level indicators, aggregated at the level of Spain's autonomous communities, including public healthcare expenditure, physician density, life expectancy, and poverty rate. Descriptive statistics were used to examine temporal trends. For descriptive purposes, overall satisfaction was analyzed using the original 1-10 scale. For multivariate analysis, satisfaction was operationalized as a three-category ordinal outcome (low, moderate, and high satisfaction). Additional models included interaction terms with the pandemic period, defined as surveys conducted from March 2020 onwards, to assess changes in determinants over time.

resultsThe final sample included 29,146 adult respondents. Based on the original 1-10 scale, overall satisfaction declined significantly following the pandemic (from 6.66 to 6.26; p < 0.001), indicating a negative shift in public perception after COVID-19. Higher satisfaction was associated with better self-rated health, lower frequency of healthcare visits, and recent utilization of public healthcare services, including hospital, specialist, and emergency care. Sociodemographic factors such as being female, younger, and born outside of Spain were also positively associated with satisfaction. Lower satisfaction was observed among individuals with chronic conditions, lower socioeconomic status, or limited educational attainment. Contextual variables showed weaker associations, with only life expectancy exhibiting a significant positive relationship.

conclusionsSatisfaction with the Spanish healthcare system is primarily shaped by individual characteristics and experiences, with only limited evidence of associations with broader contextual indicators. The post-pandemic decline in satisfaction highlights the need for targeted policies that improve responsiveness, equity, and user confidence in public healthcare services.