Consumers have gotten happier with their cable TV providers and their cellphone companies, but they re not so pleased with their local hospitals, according to the latest American Customer Satisfaction Index. The index, released Tuesday, offers a quarterly look at customer satisfaction for major businesses, including cable and satellite television, wireless and fixed-line phone services, utilities, computer software and health care.

The overall Customer Satisfaction Index was unchanged at 75.9 (out of 100) from the previous quarter, but results improved for all industries except health care and energy utilities. A sharp 5% drop in satisfaction for the hospital industry dragged on the overall index. The health care sector also fell 1.9% year-over-year.

That index is a telling indicator of consumer spending, because when people have positive experiences with a particular company or industry, they re likely to spend more in the future, says Claes Fornell, the founder of the ACSI and the director of the National Quality Research Center at the University of Michigan. Typically, customer satisfaction will suffer in a recession as companies cut back on services, but in the recent downturn, businesses have been able to reduce costs while actually improving customer satisfaction, Fornell says.

Health care is far less affected by economic cycles than other businesses, of course people still get sick and need to see their doctors -- and even a six-year low for patient satisfaction with the hospital industry doesn t mean spending will slow. But it may demonstrate the impact of a long-term shift within the industry to focus more on outpatient care, Fornell says. Patient satisfaction with outpatient care (hospital treatment without an overnight stay) held steady in the first quarter compared previous quarter, but satisfaction with inpatient services (at least one night stay in the hospital) fell 5%, to its lowest level in five years. Satisfaction with emergency room services plunged 12%. In response to the survey, a spokesperson for the American Hospital Association says hospitals have made and continue to make tremendous improvements in the quality of care.

Patient satisfaction isn t just a customer relations issue, it s a health issue, says Dr. John Santa, the director of the Consumer Reports Health Ratings Center. How a person experiences their care is an outcome all by itself, Santa says, and good communication means it s less likely that errors are going to occur.

Patients can compare hospitals on both patient satisfaction and health outcome measures at HospitalCompare.gov. Generally, patients tend to be happier with smaller hospitals or hospitals that specialize in one or two types of care than in larger, more complex institutions where more doctors are involved in working with each patient, Santa says.

Over the past decade, hospitals have worked to improve doctors and nurses communication with patients, and patients experiences have improved as a result, Santa says. According to the latest data available from the Department of Health and Human Services, 75% of patients at the average U.S. hospital said nurses always communicated well, and 80% of patients said the same of doctors.

However, there are still some thorny points for hospitals. Clear communication about new medications and instructions when patients are discharged remain areas of weakness for hospitals nationwide, Santa says. People are taking more medications now than they did in the past, and communication hasn t kept pace with the increasing complexity of treatment, Santa says. Efforts to shorten hospital stays and shift to outpatient care whenever possible also mean the process of discharging patients requires coordination among more people, he says.

How can consumers make sure their hospital stays go smoothly? Patients entering a hospital should be prepared to speak up and ask questions about everything from whether a given treatment is necessary to whether caregivers have washed their hands, Santa says. Patients should bring a friend or family member to help monitor their treatment. Hospitals have all kinds of checklists, and so should patients, Santa says. Patients should also start planning for their discharge, including follow-up with a primary-care physician and help with daily tasks, as soon as possible, he says.