A survey measuring patient satisfaction in 21 European countries has investigated what determines people's satisfaction with the health-care system above and beyond their experience as patients.

Austria and Spain, for example, have universally accessible, publicly financed health systems, characterized by hospitals with salaried physicians, yet only 10.8% of Spaniards claimed to be very satisfied with the health care that they receive, compared with 70.4% of Austrians.

According to co-author Emre Ozaltin, from the Harvard School of Public Health in the United States of America, a patient's actual experience (measured by health system responsiveness), while significant, determines just 10% of their degree of satisfaction…