Two stars: Fewer people leave positive reviews for health care facilities post-COVID

Fewer people leaving positive reviews for health care facilities: ©Chinnarach - stock.adobe.com

A study led by researchers at the Perelman School of Medicine at the University of Pennsylvania has found that online reviews of health care facilities significantly declined after the onset of the COVID-19 pandemic, and they have yet to fully recover. The study, published in JAMA Network Open, analyzed Yelp reviews of U.S. health care facilities from 2014 to 2023 and uncovered a notable shift in the public perception of care.

Before the pandemic, positive reviews—those rated four and five stars—accounted for 54.3% of all reviews. However, after March 2020, that percentage dropped to 47.9%, with positive reviews never surpassing 50% after the second half of 2021. In fact, over half of all reviews of health care facilities are now negative, a dramatic reversal from the pre-pandemic landscape.

"Online reviews provide valuable insights into the patient experience that traditional metrics, like hospital-administered surveys, might miss," said Neil Sehgal, the study’s lead author and an associate fellow at the Penn Leonard Davis Institute of Health Economics, in a statement. "These reviews help hospitals better understand what matters most to patients and their support networks in near real time."

What patients are complaining about – and one area they are happy with

The research team utilized language processing techniques to identify the most common themes in Yelp reviews. The analysis found several key areas where public opinion shifted dramatically during the pandemic:

• Insurance and Billing Issues: Complaints about insurance and billing became a dominant theme in negative reviews, with these issues spiking after COVID-19.
• Customer Service and Staff Behavior: Negative mentions of customer service and staff behavior also increased, reflecting heightened patient frustration with these aspects of care.
• Facility Cleanliness: Concerns about facility cleanliness decreased in the negative reviews following COVID, possibly due to the renewed focus on hygiene during the pandemic.

The study also found that geographic and ethnic factors influenced the decline in positive reviews. Rural health care facilities, which historically had lower ratings, saw a more significant drop in positive reviews post-pandemic. Rural facilities were 23% less likely to receive positive reviews after COVID, compared to a 7% decline in urban facilities.

Ethnic demographic data further illuminated disparities in patient experiences. Health facilities in neighborhoods with higher Black or White populations experienced more significant drops in positive ratings than those in predominantly Hispanic areas. The study also highlighted ethnic differences in the types of complaints voiced: reviews from Black and Hispanic communities more often cited “insurance and billing issues,” while White communities were more likely to mention long “wait times.”

While the exact causes of these shifts remain unclear, the study’s authors argue that the findings underscore the need for health care providers to better understand the nuanced concerns of different communities. "The overlap of themes across different populations highlights the importance of delivering care that is tailored to the specific needs and preferences of local communities," said Anish Agarwal, M.D., a co-author of the study and an assistant professor of Emergency Medicine at Penn, in a statement. "This could help health systems address long-standing issues and improve patient satisfaction."

Looking ahead, the researchers hope to dive deeper into the content of these reviews to explore how attitudes and opinions differ across socio-ethnographic lines. Such insights could provide health care professionals with valuable tools for addressing patient concerns and improving the patient experience in a post-pandemic world.