Patient Satisfaction with Outpatient Facilities: A Cross-Cluster Analysis of Health-System Typologies

Abstract Patient satisfaction with outpatient medical care is a key indicator of health system performance. During the COVID-19 pandemic, satisfaction was likely influenced by both systemic healthcare models and individual vulnerabilities. This study compares satisfaction across three European health system clusters-Bismarck, Beveridge, and Mixed/Transitional-and identifies individual-level predictors of satisfaction. Data were drawn from 26,789 respondents in the SHARE Wave 8 COVID-19 Survey (excluding Israel). Countries were grouped into Bismarck (n ≈ 9,000), Beveridge (n ≈ 7,000), and Mixed/Transitional (n ≈ 11,000) clusters. Satisfaction with outpatient care (caq122_) was analyzed using the Kruskal-Wallis test and Bonferroni-adjusted Mann-Whitney U tests. Multinomial logistic regression assessed predictors of satisfaction levels: “very dissatisfied,” “somewhat dissatisfied,” and “very satisfied” (reference: “somewhat satisfied"). Predictors included subjective health, mental health, technology use, social support, income stability, comorbidities, home care, financial support, COVID status, vaccination, age, and sex. Significant differences in satisfaction were found across clusters (χ²(2) = 537.29, p < .001). Bismarck countries showed the highest satisfaction, Beveridge the lowest (all pairwise p < .05). Regression results showed that testing positive for COVID-19 predicted greater dissatisfaction (OR = 1.42, p = .013). Poor subjective or mental health, low technology use, and weak social support also increased dissatisfaction. High satisfaction was linked to good health, income stability, absence of depression, access to care, and vaccination. Outpatient care satisfaction during COVID-19 varied by European health system type. Individual factors-especially health status, mental well-being, and resource access-strongly influenced satisfaction. Findings support the need for context-sensitive reforms and targeted support for vulnerable patients. Key messages • This study compares satisfaction across three European health-system clusters - Bismarck, Beveridge, and Mixed/Transitional - and identifies predictors of satisfaction using individual-level data. • Individual-level factors - particularly health status, mental well-being, and access to resources - strongly influenced perceptions.