Disparities by Race and Urbanicity in Online Health Care Facility Reviews.

Abstract

Importance: Online review platforms offer valuable insights into patient satisfaction and the quality of health care services, capturing content and trends that traditional metrics might miss. The COVID-19 pandemic has disrupted health care services, influencing patient experiences.

Objective: To examine health care facility numerical ratings and patient experience reported on an online platform by facility type and area demographic characteristics after the COVID-19 pandemic (ie, post-COVID).

Design, setting, and participants: All reviews of US health care facilities posted on one online platform from January 1, 2014, to December 31, 2023, were obtained for this cross-sectional study. Analyses focused on facilities providing essential health benefits, which are service categories that health insurance plans must cover under the Affordable Care Act. Facility zip code tabulation area level demographic data were obtained from US census and rural-urban commuting area codes.

Main outcomes and measures: The primary outcome was the change in the percentage of positive reviews (defined as reviews with ≥4 of 5 stars) before and post-COVID. Secondary outcomes included the association between positive ratings and facility demographic characteristics (race and ethnicity and urbanicity), and thematic analysis of review content using latent Dirichlet allocation.

Results: A total of 1 445 706 reviews across 151 307 facilities were included. The percent of positive reviews decreased from 54.3% to 47.9% (P < .001) after March 2020. Rural areas, areas with a higher proportion of Black residents, and areas with a higher proportion of White residents experienced lower positive ratings post-COVID, while reviews in areas with a higher proportion of Hispanic residents were less negatively impacted (P < .001 for all comparisons). For example, logistic regression showed that rural areas had significantly lower odds of positive reviews post-COVID compared with urban areas (odds ratio, 0.77; 95% CI, 0.72-0.83). Latent Dirichlet allocation identified themes such as billing issues, poor customer service, and insurance handling that increased post-COVID among certain communities. For instance, areas with a higher proportion of Black residents and areas with a higher proportion of Hispanic residents reported increases in insurance and billing issues, while areas with a higher proportion of White residents reported increases in wait time among negative reviews.

Conclusions and relevance: This serial cross-sectional study observed a significant decrease in positive reviews for health care facilities post-COVID. These findings underscore a disparity in patient experience, particularly in rural areas and areas with the highest proportions of Black and White residents.