While recent studies of citizen satisfaction focus almost exclusively on expectations and performance information as drivers of satisfaction, there is good reason to believe that interpersonal encounters with bureaucrats are fundamental to how citizens view public organizations.

The authors examine this issue in the context of the U.S. healthcare system, a setting where attention has been growing in recent years to the importance of the user experience and where there is growing recognition of longstanding social inequities that users encounter.

Drawing on a cross-sectional dataset of 2,005 U.S. hospitals, the authors find that overall satisfaction is strongly linked to perceptions of the quality of interaction with the frontline staff and less so with medical and environmental coordination. However, in hospitals serving low socioeconomic patients, overall satisfaction is more strongly associated with perceptions of environmental coordination (e.g., quietness).

Policymakers should acknowledge the importance of user experience and heterogeneous preferences underlying citizen satisfaction.