Patient satisfaction in the spanish national health system: temporal trends and associated factors from 2018 to 2023.

Publication date: Dec 10, 2025

Patient satisfaction is a key indicator of healthcare system performance and legitimacy. Understanding its determinants provides valuable insights for policy design. To identify healthcare-related and socioeconomic determinants at both the individual and contextual levels (including regional indicators such as healthcare expenditure, physician density, life expectancy, and poverty rate) associated with satisfaction with the Spanish public healthcare system, and to assess changes in satisfaction levels before and after the COVID-19 pandemic. We conducted a cross-sectional analysis using nationally representative data from the Spanish Healthcare Barometer for the years 2018, 2019, 2022, and 2023. Individual-level data were linked with regional-level indicators, aggregated at the level of Spain’s autonomous communities, including public healthcare expenditure, physician density, life expectancy, and poverty rate. Descriptive statistics were used to examine temporal trends. For descriptive purposes, overall satisfaction was analyzed using the original 1-10 scale. For multivariate analysis, satisfaction was operationalized as a three-category ordinal outcome (low, moderate, and high satisfaction). Additional models included interaction terms with the pandemic period, defined as surveys conducted from March 2020 onwards, to assess changes in determinants over time. The final sample included 29,146 adult respondents. Based on the original 1-10 scale, overall satisfaction declined significantly following the pandemic (from 6. 66 to 6. 26; p 

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Original Article