What is important in evaluating health care quality? An international comparison of user views

Data were used from different studies that all used a version of the QUOTE-questionnaire that measures user views of health care quality in two dimensions: the importance that users attach to aspects of care and their actual experience. Data from 12 European countries and 5133 individuals were used. They were analysed using multi-level analysis.Although most of the variations in importance people attach to aspects of health care is located at the individual level, there are also differences between countries. The ranking of aspects shows similarities. 'My GP should always take me seriously' was in nearly all countries ranked first, while an item about waiting time in the GP's office was always ranked lowest.Differences between countries in how health care users value different aspects of care are difficult to explain. Further theorising should take into account that importance and performance ratings are positively related, that people compare their experiences with those of others, and that general and instrumental values might be related through the institutions of the health care system.Large differences between countries exist in the use, costs, quality, and accessibility of health services [1]. Also large differences exist between countries in health care performance and in people's evaluations of their health care system [2-7]. But do these differences also exist in what people from different countries view as important in evaluating health care quality? The World Health Report 2000 has been criticized on its assumption of a universal value base to all health care systems; values such as responsiveness may be valued differently in different countries [8]. In this article we address this issue by comparing what people find important in general practice care in different countries. Grol et al studied patients' priorities in general practice [9]. They found both many similarities and differences between countries. Particularly, doctor-patient communication and ac