Complaints As Indicators of Health Care Shortcomings: Which Groups of Patients Are Affected?

Objective: Patient complaints about the health care system and medical services are regarded as indicators of shortcomings in health care systems. This article examines the topics of complaint raised most frequently and analyzes which groups of persons were most affected.

Design: Quantitative content analysis using a category system. Logistic regression was used for statistical analysis.

Setting And Participants: 13 505 letters of complaint directed to the Federal Commissioner for Patient Issues in Germany between 2004 and 2007.

Main Outcome Measures: Letters of complaint covering at least one topic were categorized to a total of 20 topics.

Results: The issues most frequently raised were unjust policies (23.8%), refusal or restriction of drugs (23.8%) and refusal or restriction of non-drug treatments (23.9%). The relative proportion of complaints about the physician-patient relationship increased over the period of analysis (over all 4 years: 9.3%). Multivariate analysis showed that complaints about the topics under examination were more likely to be lodged by people with statutory health insurance, people in a precarious financial situation, people with chronic disease or multimorbidity and women.

Conclusions: These results provide important insights into shortcomings in the German health care system that should be seen in the context of recent reform measures. Policy makers should be made aware that certain groups of the population are particularly affected by these changes and take steps to ensure that inequalities in the health care system are not exacerbated.