Abstract
As violent clashes between doctors and patients in China intensify, patient dissatisfaction has been identified as a major concern in the current healthcare reform in China. This study aims to investigate the main determinants of dissatisfaction with local medical services attributable to middle-aged and elderly characteristics and identify areas for improvement. A total of 14,263 rural participants and 4898 urban participants were drawn from the China Health and Retirement Longitudinal Study in 2018. Dissatisfaction was measured by two methods: binary outcome (1 = Dissatisfaction; 0 = No) demonstrated the risk of occurring dissatisfaction among various characteristics, and continuous outcome (ranges from score 1 to 5) showed the degree. The mean score of dissatisfaction was 2.73 ± 1.08. Sixteen percent of rural participants and 19% of urban participants reported dissatisfaction with local medical services, respectively. The multilevel analyses demonstrated that participants’ utilization of paid family doctor services decreased the risk of occurring dissatisfaction; dissatisfaction was less focused on females; having chronic diseases increased the risk of dissatisfaction. This study suggests promotion of family doctor services can effectively reduce middle-aged and elderly dissatisfaction with the local medical services. In addition, more attention should be focused on males and middle-aged and elderly with chronic diseases in order to decrease dissatisfaction.
Highlights
Model 1 showed the participants’ utilization of paid family doctor services decreased the risk of occurring dissatisfaction (OR: 0.58, 95% confidence limits (CLs): 0.45, 0.76); compared with males, the risk of occurring dissatisfaction decreased by 25% for females (OR: 0.75, 95% CL: 0.67, 0.83); the risk of occurring dissatisfaction decreased with the increasing of economic status, and the risk decreased by 16% for participants having middle economic status (OR: 0.84, 95% CL: 0.75, 0.94) and 27% for participants having high economic status (OR: 0.73, 95% CL: 0.63, 0.85), respectively; the risk of dissatisfaction was nearly
The utilization of outpatient in the past month, education of more than elementary school and having chronic diseases were positively associated with the increasing dissatisfaction score (p < 0.05), while utilization of paid family doctor services, aged more than 51 years old and higher economic status were negatively associated with the increasing dissatisfaction score (p < 0.05)
We believe that the results measured by this nationally representative sample will provide useful insights into improving the quality and efficiency of local medical services in China. This pooled analysis of 14,263 rural and 4898 urban populations suggests that dissatisfaction with the local medical services was more focused on males, participants not utilizing the paid family doctor services and participants with chronic diseases
Summary
Patient dissatisfaction refers to the attitude or feeling of being unsatisfied, displeased or disappointed when using healthcare services [3]. It is a measure of the level of content of care they receive from medical institutions and is a significant performance dimension that provides healthcare managers and professionals with useful insights for improving the quality and effectiveness of care [2,4,5,6]. In China, despite a range of health policies to provide greater health benefits to citizens, patient dissatisfaction with medical services continues to rise and can even escalate into serious incidents of violence against doctors.
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