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Educational inequalities in patient-centred care: patients' preferences and experiences

Jany Rademakers1*, Diana Delnoij23, Jessica Nijman1 and Dolf de Boer12

Author Affiliations

1 NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500, BN, Utrecht, The Netherlands

2 CKZ (Centre for Consumer Experiences in Healthcare), Utrecht, the Netherlands

3 Scientific Centre for Transformation in Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands

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BMC Health Services Research 2012, 12:261  doi:10.1186/1472-6963-12-261

Published: 17 August 2012



Educational attainment is strongly related to specific health outcomes. The pathway in which individual patient-provider interactions contribute to (re)producing these inequalities has yet to be studied. In this article, the focus is on differences between less and more highly educated patients in their preferences for and experiences with patient-centred care., e.g. shared decision making, receiving understandable explanations and being able to ask questions.


Data are derived from several Consumer Quality-index (CQ-index) studies. The CQ-index is a family of standardized instruments which are used in the Netherlands to measure quality of care from the patient’s perspective.


The educational level of patients is directly related to the degree of importance patients attribute to specific aspects of patient-centred care. It has a minor influence on the experienced level of shared decision making, but not on experiences regarding other aspects of patient-centred care.


All patients regard patient-centred care as important and report positive experiences. However, there is a discrepancy between patient preferences for patient-centred care on one hand and the care received on the other. Less educated patients might receive ‘too much’, and more highly educated patients ‘too little’ in the domains of communication, information and shared decision making.

Patient preferences; Patient experiences; Communication; Information; Shared decision making; Education; Inequalities; Patient-centred care