CHOICE OF A PERSONAL PHYSICIAN AND PATIENT SATISFACTION IN A HEALTH MAINTENANCE ORGANIZATION

Context.-Being able to choose one's health care plan has been shown to increase subsequent patient satisfaction with the plan, but it is not known whether choosing one's own primary care physician affects patie nt satisfaction with the physician. Objective.-To compare satisfaction with care between members of a group-model health maintenance organiz ation (HMO) who chose their primary care physician and members who wer e assigned a physician. Design.-Cross-sectional mailed survey with res ponse rate of 71.4%. Setting.-A large group-model HMO in northern Cali fornia. Main Outcome Measure.-Nine questions on satisfaction with the primary care physician. Subjects.-Random sample of HMO members 35 to 8 5 years of age who were impaneled with a primary care physician. Resul ts.-Among the 10 205 survey respondents, patients who chose their pers onal physician (n=4748) were 16 to 20 percentage points more likely to rate their satisfaction as ''excellent'' or ''very good'' than patien ts who were assigned a physician (n=5457) for 9 satisfaction measures (P<.001 for each comparison). The association of choice with satisfact ion was not due to physicians with higher patient satisfaction being c hosen more often, or to differences in patient demographic or socioeco nomic characteristics, health values, or health beliefs, or to differe nces in physician demographics or specialty. In a logistic regression model that adjusted for all of these characteristics, having chosen on e's physician was the single predictor most strongly related to having high overall satisfaction (odds ratio, 2.18, 95% confidence interval, 1.95-2.42). Conclusion.-These results suggest that even in a setting of limited physician choice, the opportunity to select one's personal physician may influence subsequent satisfaction.