Abstract
BackgroundWith the objective of the national health services systems reform to move care to the community, community health services (CHS) are becoming the gateways of the health system in China. This study aims to evaluate the levels and distributions of the responsiveness of CHS in urban China and identify the relevant features to provide the government with policy advice on the improvement of CHS responsiveness.MethodsA total of 872 face-to-face interviews were conducted in community health centers (CHCs) from 2007 to 2009. Indicators of responsiveness that were recommended by the World Health Organization were adopted, and non-conditional logistic regression analysis was performed to explore the factors associated with the levels and distributions of the responsiveness of CHS.ResultsThe responsiveness scored at a fairly ‘good’ level of 7.45, 7.45, and 7.46 for CHS in years 2007, 2008, and 2009, respectively. The representative responsiveness inequality indexes were 0.097, 0.101, and 0.109, respectively, indicating the moderately balanced distributions of responsiveness in these three years. During this period, the scores of responsiveness elements were highest at 7.44 to 8.34 in “dignity”, “communication”, and “social support”, while lowest at 6.76 to 7.54 in “autonomy”, “confidentiality”, and “basic amenities”. The results of the logistic regression analysis suggested that five elements (OR value), namely, “dignity” (1.414–3.345), “communication” (1.218–3.655), “basic amenities” (1.251–2.362), “prompt attention” (1.098–1.590), and “autonomy” (1.416–2.173), had significant associations with CHS responsiveness.ConclusionsThe responsiveness of CHS in Wuhan City was fairly good but still requires further improvement, particularly on the working conditions of CHCs and communication skills trainings among CHS workers.
Highlights
The framework put forward by the World Health Organization (WHO) in 2000 highlight health, responsiveness, and fairness of financing as the three main targets in the assessment of health system performance [1]
The concept of customer satisfaction was introduced into the field of marketing by Cardozo (1965). Hulka and her colleagues initiated the conceptualization of patient satisfaction [4,5], a mature concept with an accepted international standard called Customer Satisfaction Index (CSI)
Patient satisfaction is a complicated mixture of expectant expectations and experiences of medical care, whereas responsiveness evaluation assesses the extent by which the health system meets the individuals’ general expectations for health services [6,7]
Summary
The framework put forward by the World Health Organization (WHO) in 2000 highlight health, responsiveness, and fairness of financing as the three main targets in the assessment of health system performance [1]. Despite being a new concept that was introduced by WHO in 2000, responsiveness is becoming a hot spot for evaluating the health service system. Patient satisfaction is a complicated mixture of expectant expectations and experiences of medical care, whereas responsiveness evaluation assesses the extent by which the health system meets the individuals’ general expectations for health services [6,7]. The elements of responsiveness are steadier than those of patient satisfaction because responsiveness does not evaluate medical technology. Health service responsiveness is recognized as one of the basic human rights. Considering the interaction between the health system and residents as well as the importance of the basic human rights maintained by the health system, WHO recommends responsiveness as one of the three main goals [2,9,10]. This study aims to evaluate the levels and distributions of the responsiveness of CHS in urban China and identify the relevant features to provide the government with policy advice on the improvement of CHS responsiveness
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