Abstract
BackgroundA principal reason for low use of public health care services is the perception of inferior quality of care. Studying health service user (HSU) experiences with their care and their perception of health service quality is critical to understanding health service utilization. The aim of this study was to define reference points for some aspects of health care quality and to analyze which HSU experiences resulted in perceptions of overall low quality of care.MethodsData from the National Health Survey 2006 were used to compare the experiences of HSUs with their ambulatory care at Ministry of Health and affiliated institutions (MOH), social security institutions (SSI) and private institutions (PrivI). Reference points of quality of care related to waiting time and expenditure were defined for each of the three types of institutions by analyzing HSU experiences rated as 'acceptable'. A multivariable logistic regression model was used to identify the principal factors associated with the general perception of low quality of care.ResultsA total of 11,959 HSUs were included in the analysis, of whom 37.6% (n = 4,500) HSUs received care at MOH facilities; 31.2% (n = 3,730) used SSI and 31.2% (n = 3,729) PrivI. An estimated travel and waiting time of 10 minutes respectively was rated as acceptable by HSUs from all institutions. The differences between the waiting time rated as acceptable and the actual waiting time were the largest for SSI (30 min) in comparison to MoH (20 min) and PrivI (5 min) users. The principal factors associated with an overall perception of low quality of care are type of institution (OR 4.36; 95% CI 2.95-6.44), waiting time (OR 3.20; 95% CI 2.35-4.35), improvement of health after consultation (OR 2.93; CI 2.29-3.76) and consultation length of less than 20 minutes (2.03; 95% CI 1.60-2.57).ConclusionsThe reference points derived by the HSUs' own ratings are useful in identifying where quality improvements are required. Prioritizing the reduction of waiting times and improving health status improvement after consultation would increase overall quality of care ratings.
Highlights
In National Health and Nutrition Survey Edited by: Olaiz G, Rivera J, Shamah T, Rojas R, Villalpando S, Hernández M, Sepúlveda J
Because health service user (HSU) perception of health services quality is a result of two principal factors: first, their experiences with access to care and use and second, the respective ratings or value they assign to these experiences, it has been argued that it is important to analyze both experiences and ratings simultaneously [4,5,6,7]
In total, 11,959 HSUs were included in the analysis of whom 37.6% (n = 4,500) HSUs received care at Ministry of Health and affiliated institutions (MOH), 31.2%; (n = 3,730) used security institutions (SSI) and 31.2% (n = 3,729) private institutions (PrivI)
Summary
In National Health and Nutrition Survey Edited by: Olaiz G, Rivera J, Shamah T, Rojas R, Villalpando S, Hernández M, Sepúlveda J. Because HSU perception of health services quality is a result of two principal factors: first, their experiences with access to care and use and second, the respective ratings or value they assign to these experiences, it has been argued that it is important to analyze both experiences and ratings simultaneously [4,5,6,7]. The evaluation of patient's satisfaction does not necessarily mean measuring of patient's experiences as "satisfaction involves a cognitive evaluation of and emotional reaction to health care" [12] Coulter [7] has argued that that it is central to measure patients' experience in combination with their respective ratings Information on both of these aspects is essential to improving quality in health services, as they can provide important reference points against which HSU experiences can be measured
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