Political debates on the reform of health systems are stimulated by dissatisfaction of citizens with their health
system. To adapt health systems in order to achieve more satisfaction, policy makers must know what citizens expect
from it, in particular, what actually determines the citizen’s satisfaction.
The paper will analyze the topic of satisfaction with health systems under three aspects: What properties and outputs of
the health system are most important for citizens satisfaction? What properties of the individuals and the society affect the
individual’s satisfaction? Moreover, is there a systematic interaction among individual and societal factors in the sense,
that societal features determine what is most relevant for individual satisfaction? In particular, does this interaction operate
by the mechanism that overall societal development changes the expectations of citizens regarding the health system?
At the theoretical level, the paper provides an explanation of why in particular wealth and economic development might
change the criteria by which citizens evaluate their health system. The paper empirically analyzes the impact of individual-
level attitudes and features located at the health system level on an individual’s satisfaction with the health system using
Eurobarometer survey data. The findings indicate that of the different types of health system output, the restoration of
physiological health is no longer crucial for satisfaction. While not irrelevant, this output is taken for granted. Instead,
“beyond-health outputs”, like responsiveness, are the main determinants of satisfaction in developed countries.