Objective: This study examines whether health system affiliation influences hospital patient experience during the COVID-19 pandemic, focusing on differences between system-affiliated and independent hospitals.

Methods: We conducted a three-level multilevel linear panel analysis using multiple nationwide datasets from 2020 to 2022, with a total of 5,583 year-observations nested within hospitals and hospitals nested within health systems. Seven patient experience domains were analyzed, adjusting for hospital organizational, financial, and market characteristics.

Results: Independent hospitals consistently reported lower patient experience ratings compared with system-affiliated hospitals, with significant differences in doctor communication, nurse communication, discharge information, care transitions, and overall rating. Hospital size was a strong negative predictor across all domains, and the interaction between independence and size showed that larger independent hospitals experienced disproportionately lower ratings. Financial capacity mattered: higher Medicare and commercial payer mixer and stronger net profit margins were associated with better patient experience. Patient experience declined in 2021 compared to 2020 and rebounded in 2022. Additionally, we found that more than 20% of the variation in patient experience was attributable to differences between health systems.

Conclusions: Hospital system affiliation significant shaped patient experience during COVID-19 pandemic. The structural supports, resource depth, and coordinated practices available in health systems likely helped sustain patient-centered care during a period of exceptional operational strain, while independent hospitals, particularly larger ones, faced greater challenges. These findings highlight the need for strategies that enhance the organizational capacity of independent hospitals to maintain high quality care in both routine and crisis conditions.