Association for Public Policy Analysis & Management

Ruhm’s paper “Are Recessions Good For Your Health?” (2000) ignited a resurgence of literature investigating the relationship between macroeconomic shocks and individuals’ health production function. I extend this literature by exploring the impact of macroeconomic conditions on patient satisfaction, an unexplored determinant of cyclical changes in health outcomes. This paper presents evidence that patient satisfaction, as measured by patient reports of having enough time with their health care providers, is increasing from 2000 to 2013. Further, I find that increases in patient satisfaction are larger when the unemployment rate is high. The results suggest a counter-cyclical pattern in patient satisfaction, suggesting that changes in patient behavior may explain a part of the relationship between economic conditions and health outcomes.

Linear fixed effect models estimate the change in patient satisfaction with changes in unemployment rates for the years 2000 to 2013. Within-person variation in county-level unemployment rates and county-level health care variables are used to identify changes in patient satisfaction. The models also include individual characteristics and time and state fixed effects. The results estimate a positive relationship between patients reporting always having enough time with a health care provider and the county-level unemployment rate. This relationship is particularly large for those expected to have the most stringent constraints on their time with their providers, such as the elderly, those in poor health, and those with high medical needs. Further, changes in individual characteristics do not explain much of the variation in satisfaction once an individual fixed effect is included.

I explore four potential mechanism connecting unemployment rates and patient satisfaction: changes in local employment of non-physician health care providers, access to care, relocation of patients, and changes in individual’s employment. I reject the hypothesis that local changes in employment is the main driver of changes in patient satisfaction, despite being a commonly proposed pathway between economic conditions and health outcomes in the literature. Patients moving to new regions and changes in employment status do no affect the relationship between unemployment rates and patient satisfaction. However, improvements in access to care is strongly related to increases in patient satisfaction.

This paper contributes to our understanding of the pathways connecting the macroeconomy and patient satisfaction. The results highlight the heterogeneity in response of patient satisfaction to economic conditions among individuals. In particular, patients most in need of care experience the largest increase in satisfaction when unemployment rates rise. As patient satisfaction is strongly linked to patient behaviors, such as treatment compliance, patients’ demand for health inputs may also experience cyclical trends; exploring this relationship is important for improving health care service delivery.