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Low-income Californians are increasingly satisfied with the health care they receive, underscoring the impact of changes made by clinics and providers since the Affordable Care Act went into effect, according to a report released Wednesday.

More than half of low-income patients – 53 percent — rated their quality of care as excellent or very good in 2014, up five percentage points from 2011, according to the survey by the Blue Shield of California Foundation. That means that about 400,000 patients were happier with their care, the report said. (Kaiser Health News receives funding from the foundation.)

Compared with patients who were uninsured in 2011, low-income residents who in 2014 had coverage through the state’s insurance exchange, Covered California, reported much higher satisfaction with their care. Low-income Californians were defined in the survey as having household incomes less than 200 percent of the federal poverty level, or $48,000 for a family of four.

Some of the biggest gains in satisfaction were at community health centers, which see the largest share of the low-income population and received billions of dollars underthe health law to improve their services. Patients there gave higher scores to courtesy and cleanliness than in 2011, and more said somebody at their facility knew them well.

Community clinics have undergone a culture shift because of the Affordable Care Act and started to focus more on patient satisfaction, said Peter V. Long, president of the foundation.

“They realized, ‘We have to do things differently or it’s going to be a challenging world for us,’” he said. “They have prioritized this and actually made a difference.”

Many, for example, began assigning patients to a specific doctor. That continuity of care makes a big difference to patients and helps them develop a relationship with the community clinics,  Long said. “Having the same doctor and having someone who knows me and cares about me builds that level of trust,” he said.

There is still room for improvement, the report said. Just 34 percent of patients at clinics serving low-income patients gave high marks for wait times. And low-income patients in general said it was difficult to get a night or weekend appointment and to access specialists.

Carmela Castellano-Garcia, president of the California Primary Care Association,  said there was an understanding among clinics that the environment would be more competitive after the health law took fuller effect. Under Obamacare, many uninsured patients became eligible for free coverage through Medi-Cal or subsidized plans through

Covered California, the insurance exchange. As a result, they had more choices about where to seek care.

To retain patients, Castellano-Garcia said they devoted significant resources to improving both care and customer service. The survey showed that the changes made a difference, she said.

“This is a great shot in the arm and shows the clinics that their efforts and investments are paying off,” she said.

Researchers surveyed more than 1,500 Californians between August and October of 2014. The margin of error was plus or minus 4 percentage points for the low-income sample. The survey included patients at community clinics, public  and private clinics, as well as doctors’ offices and other settings.

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