Scandinavian Journal of Psychology, 2008, 49, 385–392 DOI: 10.1111/j.1467-9450.2008.00658.x © 2008 The Authors. Journal compilation © 2008 The Scandinavian Psychological Associations. Published by Blackwell Publishing Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA. ISSN 0036-5564. Blackwell Publishing Ltd Health and Disability Patient experiences with treatment in private practice compared with public mental health services JOHAN HÅKON BJØRNGAARD, 1 ANDREW GARRATT, 2,3 ROLF W. GRÅWE, 1 ØYVIND ANDRESEN BJERTNÆS 3 and TORLEIF RUUD 4,5 1 SINTEF Health Research, Trondheim, Norway 2 Institute of Health Management and Health Economics, University of Oslo, Norway 3 Norwegian Knowledge Centre for the Health Services, Oslo, Norway 4 Division of Mental Health Services, Akershus University Hospital, Norway 5 Faculty Division Akershus University Hospital, Faculty of Medicine, University of Oslo, Norway Bjørngaard, J. H., Garratt, A., Gråwe, R. W., Bjertnæs, Ø. A. & Ruud, T. (2008). Patient experiences with treatment in private practice compared with public mental health services. Scandinavian Journal of Psychology, 49, 385–392. The study compared patient experiences with psychiatric treatment provided by private practitioners and public outpatient clinics. Question- naires were completed by 642 outpatients in private practice and 6,677 outpatients in public clinics. The questionnaire included a measure of patient experiences comprising six items: treatment outcome, enough time for contact and dialogue with clinician, clinicians’ understanding of patient’s situation, suitability of therapy and treatment, clinician follow-up of planned actions, and influence on treatment. Patients in private practice had generally better experiences than patients in public outpatient treatment. The difference between private and public patients was largest for patients with poor self-evaluated mental health or those who had just one consultation in the previous three months. Private practi- tioners appear to have an important role in mental health services delivery, and patients have relatively good experiences with services. Further studies that assess the patient – clinician interaction in different mental health services may give further insights into potential service improvements. Key words: Patient satisfaction, private practice, quality of health care, psychiatry. Johan Håkon Bjørngaard, SINTEF Health Research, 7465 Trondheim, Norway. Tel: +47 922 42 734; fax: +47 932 70 800; e-mail: jhb@sintef.no INTRODUCTION Public health delivery systems are increasingly compared with private systems as policymakers continue to focus on the effectiveness and costs of care. Although mental health treatment is provided by many private practitioners, patient experiences with these services are not well understood. The aim of this study was to describe user experiences among patients of private practitioners in Norway and to compare these with experiences of patients in public out- patient clinics. In particular we wanted to assess the experi- ences of outcome of treatment and different aspects of the relationship with the therapist, both of which are assumed to be important for patients (Crow, Gage, Hampson et al., 2002; Hansson, Bjorkman & Berglund, 1993; Johansson & Eklund, 2003). We are not aware of any studies comparing experiences or satisfaction between patients receiving treat- ment from private practitioners and those receiving treat- ment from public mental health services. Patient satisfaction and experiences with mental health services The measurement of patient perceptions of health services quality is an important component in the assessment of healthcare interventions and service quality (Crow et al., 2002). Patients’ ratings of their experiences or satisfaction with health care are now used widely in the evaluation and monitoring of mental health services (Henderson, Phelan, Loftus, Dall’Agnola & Ruggeri, 1999; Powell, Holloway, Lee & Sitzia, 2004; Shipley, Hilborn, Hansell, Tyrer & Tyrer, 2000; Thornicroft & Tansella, 2005). The information pro- duced by questionnaires assessing patient experiences have been found to be associated with concordance to treatment regimens and health outcomes (Priebe & Gruyters, 1995) and can provide important feedback on services (Pilgrim & Rogers, 1997). However, the link between patient satisfaction and organizational aspects of care is less well understood (Druss, Rosenheck & Stolar, 1999). Patient satisfaction measurement has been criticized for not having a clear definition (Crawford & Kessel, 1999; Williams, 1994). Moreover, questionnaire surveys usually produce a very high satisfaction rating, which may under- estimate dissatisfaction because patients are unwilling to appear ungrateful or because they accept the limitations of healthcare delivery (Crawford & Kessel, 1999; Fitzpatrick, 2002). An alternative approach involves asking patients to rate their experiences of various aspects of healthcare (Crow et al., 2002). This form of measurement involves the collec- tion of more objective information relating to whether