How do Chronically Ill Patients Rate Medical Care by their GPs and Specialists? Results of a Germany-wide Survey.

Abstract

Introduction: The ability of health systems to respond to the legitimate expectations of the population regarding interpersonal and organizational aspects of healthcare - the so-called Health System Responsiveness - is considered a key competence of health systems. While various studies have assessed the responsiveness of ambulatory care, information on differences between care provided by general practitioners (GP) and specialists is still scarce. Methods: By means of a postal survey, 51 998 chronically ill persons (type 2 diabetes and/or coronary heart disease) insured by a statutory health insurance body (Techniker Krankenkasse) were surveyed regarding their experiences with GP and specialist care. An adapted version of the WHO Health System Responsiveness questionnaires was used for assessing data. Differences in the rating of specialist and GP care were analyzed using McNemar's test. Results: Responses from 13 685 patients were included in data analyses. Overall, ambulatory care was rated mostly as positive. Across all dimensions of health system responsiveness, GP care was rated statistically significantly as more positive than specialist care. Considerable differences were found in the evaluation of waiting times, involvement in decision-making and coordination of care. Conclusion: Overall, the surveyed persons were mostly satisfied with their GP and specialist care. However, some aspects of specialist care need to be optimized.