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Patients with better health status have often been shown to be more satisfied with their medical care, but the causal factors in this relation have not been determined. In this study, a longitudinal assessment of these two constructs was undertaken in which older patients in a health maintenance organization were interviewed at baseline (N=590) and again 1 year later (N=526) about their health status and satisfaction with their medical care. Structural equation modeling using LISREL procedures revealed that the predominant direction of causation went from earlier self-perceived overall health and functional ability to later levels of satisfaction. There was no evidence for causal paths going from satisfaction to later health. In addition, a test of spuriousness indicated that for self-perceived overall health, the significant longitudinal path was unlikely to be explained by unmeasured confounding variables.