Predictors of patients\u2019 choice of hospitals under universal health coverage: a case study of the Nicaraguan capital

Ida G Monfared,Sebastian Vollmer,Jonathan Garcia

doi:10.1186/s12913-021-07333-z

Abstract

BackgroundThis study looks at the factors that can shape patients’ choice of healthcare providers. Understanding this process can help with making high quality healthcare more accessible for all. We focus on distance, patient’s health status, (perceived) quality of healthcare facility, and referrals to investigate how these factors compete in shaping patients’ choice of hospitals.MethodsThis study was carried out in Managua, the capital of Nicaragua. Utilizing an exit-survey, patients were interviewed across five public hospitals in 2017 and then six in 2019 when a new highly-equipped hospital was added to the system. We used a multinomial logit model to investigate patients’ preference of a specific hospital over the rest within each wave.ResultsOur results show that being referred to a hospital is the strongest predictor and in some cases, it can increase the relative risk ratio of choosing a facility by a factor of 49 (p < 0.01; 95% CI: 27.39–87.17). For the remaining factors, the hierarchy of importance was less clear-cut yet all these factors remained significantly important at various levels.ConclusionsOverall, our results highlight the importance of referral systems in making quality healthcare more equitable. Moreover, with distance also being a key predictor and in the absence of an organized referral system, those with low-income would either be further deprived by having to settle with locally available healthcare (regardless of its quality) or face high amounts of out-of-pocket expenditure when seeking help from the private sector.

Highlights

This study looks at the factors that can shape patients’ choice of healthcare providers
This remains a challenge given the scarcity of resources in low- and middle-income countries (LMICs)
It was under the notion of human rights that Latin American countries (LACs) launched a major healthcare system reform aiming to achieve universal health coverage (UHC) [2]

Summary

Introduction

This study looks at the factors that can shape patients’ choice of healthcare providers. Having access to quality healthcare has long been recognized as a basic human right [1] This remains a challenge given the scarcity of resources in low- and middle-income countries (LMICs). In order to mitigate the impact from these reforms, in 2006 the government introduced a new Family and Community Health Care Model to increase healthcare coverage that placed further focus on citizens and community participation [13] These efforts made some services ( child and maternal care) more accessible to rural communities [14], they did not resolve the financial and administrative challenges within the wider system [15]

Methods

Results

Discussion

Conclusion