A match made in heaven? A pilot study of patient-therapist match.

The authors report on a study of patient-therapist match in 50 psychodynamic psychotherapy dyads. Sixty-six percent of patients and therapists agreed about the quality of the match, with 58% of patients and 56% of therapists reporting that the match was positive. Positive match correlated with positive patient and therapist assessments about the progress and process of therapy, but not with perceived similarity of personal characteristics. Patients' and therapists' perceptions about their similarities and differences from one another did not correlate. This study suggests it is both possible and important to gather data from both patient and therapist when studying match.

The role of psychographic characteristics as determinants of complaint behavior by elderly consumers of physician health care services.

The authors investigate the influence of various psychographic characteristics in distinguishing between those elderly patients who complain about dissatisfying experiences with health care providers and those who do not. Discriminant analysis results suggest that patients who are low in trust in their physicians and who are younger in terms of cognitive age are more likely to complain than are patients who are high in trust and older in terms of cognitive age. In light of these findings, the authors propose a number of managerially-relevant courses of action for health care providers.

Cultural affiliation and the importance of health care attributes. Marketers can develop segmentation strategies for targeted patient groups.

Culturally based values are known to influence consumer purchase decisions, but little is known about how those values affect health care choices. To rectify that situation and provide health care marketers with a framework for developing culturally based segmentation strategies, the authors undertook an exploratory research project in which Hispanic-, African-, and Anglo-Americans were asked to rate the importance of 16 different health care attributes. Those attributes can be grouped under five categories: quality of physician, quality of nurses and other medical staff, economic issues, access to health care, and nonmedically related experiential aspects. Survey responses identified distinct differences in the importance attached to the various attributes by the three cultural groups. The study also looks at the impact of six demographic and social characteristics on the evaluations made by each cultural group. Those characteristics are educational level, gender, age, health status, marital status, and number of people living in the household.

Elderly patients' satisfaction with the outcome of their health care complaints.

This article profiles the determinants of elderly patients' satisfaction with the outcome of their health care complaints. Type of provider response, severity of complaint, and the individual characteristics of age and cognitive age were found to be significant in effecting satisfaction. Related strategies for managing elderly health care complaints are discussed.

Complaint intensity and health care services.

The author extends his Complaint Intensity Outcome Framework by including a customer-need component and applying the model to a sample of elderly health care consumers. The results indicate that immediate action should be taken to improve complaint mechanisms and performance related to the quality of physicians. Other attributes require less dramatic action, and some require none at all.

Considering the competition in strategy development: an extension of importance-performance analysis.

The author extends importance-performance analysis by including competitors' performance. He demonstrates its value by applying it to a national sample of HMO members. Findings indicate that inappropriate strategies may result if a competition dimension is not included in the analysis.

An assessment of employers' experiences with HMOs: factors that make a difference.

This study investigated those factors that influenced employers' experiences with health maintenance organizations (HMOs). It examined a national cross-sectional sample of chief executive officers (CEOs) and benefits managers. Findings revealed that different administrative issues such as the volume of paperwork, confusion about benefits, and educating employees about HMO benefits were of primary importance in affecting management's experiences with HMOs. Differences were found between CEOs' and benefits managers' responses.

Adding a competitive dimension to importance-performance analysis: an application to traditional health care systems.

This study introduced an extension of importance-performance analysis by further including the performance of competitors. It demonstrated its value by applying it to a national sample of fee-for-service health care users. This study found that inappropriate strategies may result from importance-performance analysis that excludes a dimension of competition. In particular, the two attributes, availability of both physicians and emergency services, were found to be "high" on importance and "good" on fee-for-service performance. From the basic classic importance-performance approach, a relatively passive strategy would be recommended for each of these attributes. When also considering competition, however, a more appropriate, vigorous strategy of head-to-head competition clearly emerges.

HMO viability and the economically disadvantaged.

This study uses data from the 1984 Kaiser Foundation national health care survey to assess the viability of HMOs for the economically disadvantaged in light of important health care attributes. To achieve this, the paper examines their satisfaction with different health care attributes and their preferences for alternative health care systems with respect to these same attributes. These data are used to assess overall health care system preference. This study found that the economically disadvantaged population was largely indifferent between an HMO or traditional fee-for-service health care system. This finding supported the prospect that the economically disadvantaged and Medicaid beneficiaries were somewhat amenable to HMO coverage. A fairly strong preference for fee-for-service health care system was found with respect to the quality of care attribute. This suggests that the economically disadvantaged will view HMOs as the health care system of choice depending on their ability to provide quality care. In light of these findings, several policies are recommended.

The role of health care attributes and demographic characteristics in the determination of health care satisfaction.

The authors investigate the influence of demographic characteristics and health care attributes on overall health care satisfaction. They use a national cross-section sample of HMO members and another of non-HMO members. Demographic characteristics are treated as antecedent to satisfaction with the health care attributes in the determination of overall health care satisfaction. The health care attributes are very similar in impact for both samples, suggesting HMOs should emphasize those attributes both to ensure reenrollment and to encourage new enrollment. Findings also show that satisfaction with several health care attributes varies along a few demographic dimensions, suggesting demographic bases along which the health care market can be segmented.

Uncommon troubles in young people: prevalence estimates of selected psychiatric disorders in a nonreferred adolescent population.

A two-stage epidemiologic strategy was used to estimate the lifetime prevalence of selected DSM-III-defined psychiatric disorders in a county-wide secondary school population (N = 5596). Screening tests used in the first stage included items based on DSM-III criteria for eating disorders and panic disorder, as well as the Leyton Obsessional Inventory-Child Version and the Beck Depression Inventory. Based on interviews (n = 356) by clinicians in the second stage, the lifetime prevalence of anorexia nervosa was 0.2%; bulimia, 2.5%; panic disorder, 0.6%; obsessive-compulsive disorder, 1.9%; major depression, 4.0%; dysthymic disorder, 4.9%; and generalized anxiety disorder, 3.7%. While rates of mental health service utilization varied greatly by diagnosis, only 41% of students who were assigned both a diagnosis and a rating of impairment had received any kind of clinical attention.

Determinants of health care satisfaction: a national study of HMO and fee-for-service consumers.

This study examines the extent to which different health care attributes determine health care satisfaction. It employed two national cross-sectional samples, one of HMO members and the other of NON-HMO health care users. The comparative analysis revealed that the pattern of results for both samples were similar. The two most important attributes for both samples were health care costs and availability of specialists. Results suggest different marketing and related management strategies.

Intentions to join HMOs: perceived relative performance versus satisfaction/dissatisfaction.

This study employed a national sample to investigate the determinants of consumers' intentions to join HMOs by considering different health care attributes. It employed two models, a performance model and a satisfaction model. The study found that the robustness of the performance model was substantially stronger in explaining intentions to join HMOs than the satisfaction model. More specific findings indicated that the health care attributes of cost and quality of care were important in both models, although to a far greater extent in the performance model, and that availability of physicians was also important in the performance model, albeit to a lesser degree. The study also examined demographic characteristics that may serve as a basis for segmenting the health care market. Of those considered, only two, age and urban/rural residence, were found to be significant. Age was considerably the more important of the two and younger respondents were far more interested in joining HMOs than their older counterparts. The pattern of results for the young subsample paralleled those found for the entire sample.