Do Healthy Patients Have Higher Expectations or Do Sicker Patients Have More Unmet Needs? The Relationship between Health Status & Patient Needs

by Deirdre Mylod, PhD, Executive Director, Institute for Innovation | Feb 11, 2015

When patients provide feedback about care quality, they bring a complex mix of needs, expectations and evaluations to the equation. Some believe that a healthier person brings with them higher expectations of speed, convenience and amenities from their healthcare experience. The assumption is that healthier patients are more critical because their relative good health affords them the opportunity to compare their experience to other types of service environments. 

Evidence shows, however, that healthier patients are more likely to offer positive evaluations of care. Following are key insights on this topic from the Institute Findings Library.

Better Self-Report of Health Status = Higher Patient Experience Scores

Not surprisingly, maternity patients are most likely to report excellent (44.1%) or very good (41.7%) health. Medical patients most likely to report fair (28.1) or poor (9.3%) health, with fewer reporting excellent (7.2%) or very good (19.4%) health. Surgical patients fall in between with a fairly large group reporting excellent (12.5%) or very good (34.4) and few (<5%) reporting poor health.


Within each Inpatient service line (maternity, medical and surgical), patients who self-report as being in excellent health are the most likely to recommend the hospital. As health status worsens, evaluations also decline. Similarly, patients with poorer health status are consistently less likely to rate their hospital as a 9 or a 10.


In the Medical Practice setting, it is most common for patients to evaluate their own health as either very good (33.3%) or good (34.3%).

 As in the Inpatient setting, similar patterns occur: patients in poorer health are less likely to recommend their care provider to others; they are also less likely to evaluate their provider as a 9 or a 10.


Patient experience indicators give us insight into which elements of care are consistently meeting patient needs and where unmet needs still remain. It is intuitive that patients with more complex health issues may be less likely to have their needs met. Our health care system has become increasingly specialized in order to treat the sickest of patients from a technical perspective; however we may not be addressing the needs of our patients along the way.

When looking within the inpatient setting at the medical and surgical populations, we find that the attributes of care least influenced by patients’ health status relate to courtesy, amenities and perception of skill. In contrast, the elements of care that are most impacted by health status include discharge preparation, pain control, responsiveness to concerns, emotional support and involvement in decision making. Sicker patients have greater needs related to their care.

By understanding the different needs of sicker patients, providers can more appropriately respond and support them during their care.  In addition to sophisticated clinical quality, these patients need support to navigate the stress of their health issues, control over decisions that matter and education to engage in their own self-care.