Impacts of the referral system on outpatient satisfaction: an analysis of propensity score analysis

Abstract

Objective To analyze impacts of the referral system on outpatient satisfaction with the background of developing a hierarchical medical system, and to provide recommendations for further improvements of the referral system. Methods Based on the outpatient satisfaction survey results of the National Healthcare Improvement Initiative Third Party Assessment (2016-2017), the propensity matching method was used to analyze the satisfaction of outpatients who were referred and not referred. Results Compared with the overall satisfaction score of the non-referred outpatients, that of the referred outpatients was 0.11 points lower (P<0.01, 95%CI=-0.17, -0.06). The patient experience satisfaction score of the referred outpatients was 0.06 points lower than that of the non-referred(P=0.03, 95%CI=-0.11, -0.01). Conclusions Under the policy background of the hierarchical medical system in China, the current referral system has failed to positively improve patient satisfaction. To further improve the referral system and to raise patient satisfaction, there is a need to take following actions, to link the referral system construction with the public hospital reforms, in order to motivate the tertiary hospitals to be more actively involved in the strengthening of the referral system, to strengthen the medical capacity of the primary health care institutions, to standardize the referral criteria and procedure, and to formulate a more rational and effective health insurance payment method and reimbursement system. In addition, it is critical to further regulate and optimize the referral procedures, so as to set up reasonable and effective insurance payment and reimbursement for the referred patients, to promote the dissemination and to raise public awareness of the referral policy. Finally, it is necessary to enhance the diagnostic and treatment skills of the primary level of the health care delivery system. Key words: Patient transfer; Hierarchical medical system; Propensity matching method; Outpatients; Satisfaction