Choice, Continuity, and Competence: A Longitudinal and Multilevel Study of Satisfaction with General Practitioner Service Supply

Abstract

Is satisfaction with municipal general practitioner (GP) service provision related to objective characteristics of the local service supply? We argue that objective features of public services will be more significant for citizen satisfaction when most users have first-hand experience with a service, as is the case with GP services. The study combines elements from two theoretical approaches: a) Hirscman’s Exit, voice, loyalty (EVL), and b) the Expectancy-Disconfirmation Model (EDM). We employ a novel dataset that combines individual-level data from five waves of the Norwegian Citizens Survey (2010, 2013, 2015, 2016 and 2019) with municipal-level panel data on GP service characteristics. We focus on three crucial aspects of municipal-level GP services: choice options, continuity, and competence. All major municipal-level GP service characteristics are positively related to satisfaction. Related to our theoretical framework, this implies that services that are used frequently and are familiar to users will be less susceptible to expectation management because prior performance and objective features will play a more prominent role than for services that are less well-known.