The ethical considerations that should be considered when using client satisfaction measures

Sample Answer

Linking client satisfaction measures to financial incentives in healthcare, often through Value-Based Purchasing ($\text{VBP}$) models, raises several critical ethical considerations that must be balanced against the goal of improving the patient experience.

⚖️ Ethical Considerations

1. The Conflict Between Patient Autonomy and Financial Gain

Risk of Undue Influence: Providers facing financial penalties or rewards may feel pressured to manipulate patient behavior. For instance, a provider might be hesitant to deliver unwelcome but medically necessary advice (e.g., severe lifestyle changes, painful procedures) for fear that the patient will rate them poorly.

The "Pleasing" Provider: This system risks shifting the provider's ethical priority from beneficence (doing what is clinically best for the patient) to paternalism or avoidance (doing what is easiest or most desired by the patient to achieve a high score). This undermines the provider's professional obligation to guide the patient toward optimal health outcomes, especially when the patient's preference conflicts with evidence-based practice.

2. Equity and Justice (Fairness)

Bias Against High-Risk Populations: Patient satisfaction scores are often lower among patients with complex chronic conditions, low health literacy, or those receiving care at safety-net hospitals that treat a disproportionate number of uninsured or socioeconomically disadvantaged individuals.

Ethical Concern: Penalizing organizations serving the sickest and most vulnerable populations is fundamentally unjust and creates a financial disincentive for providers to treat these high-need groups.

Language and Cultural Bias: Survey instruments may not be culturally or linguistically appropriate, leading to systematically lower scores from diverse patient populations, which is an ethical issue of inaccurate and unfair representation.