The influence of the type of health service on communication between physicians and patients
Filipa Costa Couto, Ana Margarida Barreto · Observatorio (OBS*) · 2025
This study aims to carry out an exploratory assessment of whether the type of health service can mediate the effect of physicians' age and gender on their communication with patients. A cross-sectional, quantitative survey was conducted with 144 adult patients with atopic dermatitis in Portugal and treated in public or private healthcare centers. Participants were recruited via the national patient association ADERMAP and completed an online questionnaire between December 2022 and August 2023. The instrument assessed patients’ perceptions of physician communication across multiple dimensions, including clarity, emotional responsiveness, shared decision-making, and availability. Data were analyzed using descriptive statistics, Spearman’s correlation, and Mann-Whitney U tests. Findings support all three hypotheses. Regarding H1, the type of healthcare service influenced communication perceptions: physicians in the public sector were rated more positively on aspects such as the use of accessible language and responsiveness outside consultation hours. H2 was supported by the interaction between physician gender and service type: male physicians were rated more favorably in private care, whereas female physicians received higher ratings in public care. Finally, H3 was partially supported: in the private sector, older physicians were consistently associated with more favorable communication, while in the public sector, age effects were weaker and more mixed. The results show that the type of health system in which the patient is followed (public or private) appears to influence the perception of communication, and that this effect is mediated by demographic factors such as the physician’s age and gender. These findings emphasize the importance of healthcare organizations and training programs in addressing the interaction between individual characteristics and institutional context. Despite limitations such as a non-representative, diagnosis-specific sample and reliance on patient perceptions, the study contributes to a more comprehensive understanding of physician-patient interaction and offers guidance for equitable, context-sensitive communication practices.