In their article, Jha, associate professor for health policy and management at Harvard School of Public Health, and colleague Paula Chatterjee postulated two explanations for the disparity in how patients answered the HCAHPS survey.
"One is that patients (in safety net hospitals) have very different expectations (than do patients in other hospitals). And the alternative is that these hospitals have not done as good of a job focusing on these patient issues," he says.
"You can tell a story for either one. But my personal feeling is that these hospitals have not done as good of a job focusing on the patient experience aspects of healthcare. And it's not totally surprising. They're very financially stressed. The reimbursement they get from a large chunk of their patient population is so low they're chronically underfunded. So it's not totally surprising."
In their paper, Jha and Chatterjee found that the greatest differences were seen in how patients responded to the question about overall hospital rating. Only 63.9% of safety net hospital patients gave the hospital the highest score of 9 or 10 while 69.5% of patients at non-safety net hospitals gave their caregivers the high score.
The one sole exception was that safety net hospitals in the southern part of the United States gave their hospitals scores as high as patients in their non-safety net counterparts.
Jha's report mentioned other possible explanations for the variation between safety net and non-safety net hospital responses. Safety net hospitals had substantially fewer nurses per 1,000 patient days than non-safety net hospitals, and had more patients covered by Medicaid and fewer patients covered by Medicare, and more black patients, than their non-safety net counterparts.