Patient Satisfaction with Primary Health Care Services between Insured and Non-insured patients under Community-Based Health Insurance Scheme: A Comparative Cross-Sectional Facility Based Study in North East Ethiopia

Abstract

Background: Universal Health Coverage is a situation where all people can access the health services they need without incurring financial hardship. The aim of the study was to compare the overall satisfaction with primary health care among insured and non-insured outpatient service beneficiaries in five Community-Based Health Insurance (CBHI) contracted health centers in North Eastern Ethiopia. Methods: facility-based cross sectional comparative study design was conducted from March through April 2017 among 311 insured and 301 non-insured outpatients. All statistical analysis was done using Statistical Package for Social Sciences research IBM version 20.0. Multi-variable linear regression analysis was employed to control confounders in determining predictors of patient satisfaction by insurance status. Chi-Square test, unstandardized coefficient (Uβ), standardized coefficient (Sβ) Standard error, with 95% Confidence Interval (CI) and P < 0.05 was used to claim statistical significance. Results: Out of 624 outpatients, 612 respondents with a response rate of 98% were enrolled in this study. The overall, insured and non-insured patient satisfaction was 475 (77.6%), 247 (79.4%) and 228 (75.7%), respectively. The mean score with Standard Deviation of the satisfaction score was 86.14 ± 14.99 among insured and 83.85 ± 17.16 among noninsured under CBHI scheme, respectively. An independent sample t-test showed statistically significant difference where insured patients have a higher mean satisfaction score than their counterpart noninsured with t= 2.031, df=610, P=0.043. And the consultation and diagnosis service are much more performed among noninsured than insured patients on the use of a stethoscope, proper examination, taking the history of past illnesses, asked history treatment taken before arrival at the health facility and explained diagnosis to patients by health care providers with X2= 4,509 to 14.664, P-value < 0.05. Conclusions: The study finding shows that insured patients perceived with a higher level of quality of care and satisfaction score. However, non-insured patients received high proportion score on objective quality of care measurements. Therefore, to improve patient experiences at health centers and achieve financial risk protection through CBHI, program managers and health care providers should ensure quality of services to the standards at the health facility to insured and noninsured community members.