Choice Of Health Care Provider Research Articles

Is the quality of public health facilities always worse compared to private health facilities: Association between birthplace on neonatal deaths in the Indian states.

The role of place of delivery on the neonatal health outcomes are very crucial. Although the quality of care is being improved, there is no consensus about who is the better healthcare provider in low and middle-income countries (LMICs), public or private facilities. The aim of this study is to assess the differentials in neonatal mortality by the type of healthcare providers in India and its states. We used the data from the fourth wave of the National Family Health Survey 2015-16 (NFHS-4). Information on 259,627 live births to women within the five years preceding the survey was examined. Neonatal mortality rates for state and national levels were calculated using DHS methodology. Multi-variate logistics regression was performed to find the effect of birthplace on neonatal deaths. Propensity score matching (PSM) was used to evaluate the relationship between place of delivery and neonatal deaths to account for the bias attributable to observable covariates. The rise in parity of the women and purchasing power influences the choice of healthcare providers. Increased neonatal mortality was found in private hospital delivery compared to public hospitals in Punjab, Rajasthan, Chhattisgarh, Madhya Pradesh, Bihar, Jharkhand, Odisha, Goa, Maharashtra, Andhra Pradesh and Karnataka states using propensity score matching analysis. However, analysis on the standard of pre-natal and post-natal care indicates that private hospitals generally outperformed public hospitals. The study observed a significant variation in neonatal mortality among public and private health care systems in India. Findings of the study urges that more attention be paid to the improve care at the place of delivery to improve neonatal health. There is a need of strengthened national health policy and public-private partnerships in order to improve maternal and child health care in both private and public health facilities.

Patient preferences, referral process, and access to specialized care. Is patient choice constrained?

ABSTRACT In most developed countries, patients have been encouraged to elect their preferred choice of health care provider. However, this is different for specialized care, where the patient’s referral could be defined as a two-stage decision process and their options are pre-selected by their general practitioner (GP). In this study, we estimate patient preferences while controlling for the pre-selection procedure, and we investigate whether patients are actively choosing their provider for cancer care. The French national hospital discharge database (Programme de Médicalisation des Systèmes d’Information, PMSI – MCO 2017) has been used for investigation. We estimated a multinomial choice model when choice sets are in fact unobserved, which is assumed to identify patient preferences, in a revealed preferences framework. Our findings provide evidence that patients consider factors other than distance to select their provider. The patient – hospital distance as well as the specialization profile of providers appears to be internalized in the pre-selection process, while patients rather consider waiting times, hospital quality, and other provider attributes to make their final choice. We also found that patients would be treated in higher-quality hospitals if they had the opportunity to choose among all available providers.

Effect of public-funded health insurances in financial protection for hospitalisation in Rajasthan state, India: Evidence from a national sample survey

BackgroundThe high burden of out-of-pocket expenditure (OOPE) in India has led to introduction of several public-funded health insurance (PFHI) programmes. This study examined the impact of PFHI on hospitalisation-related OOPE in the Rajasthan state. MethodsData from the National Sample Survey 75th round on Social Consumption (Health), were utilized for this study. The sample of Rajasthan state, consisting of 5045 households and 28,020 individuals, was analysed to determine factors associated to PFHI coverage, choice of healthcare provider and OOPE. ResultsOne third of the population was covered by PFHI. In the private facility, although PFHI reduced OOPE (INR 17000 vs 14,700), it did not reduce catastrophic health expenditure (CHE), i.e., CHE 10% (47.1% vs 47.2%), CHE 25% (19.2 vs 23.4%). In government hospitals, PFHI reduced OOPE (INR 2500 vs. 2050), CHE 10% (11.1% vs 7.8%), and CHE 25% (3.6% vs. 2.7%). PFHI did not have any significant effect on the choice of healthcare provider in hospitalised patients in Rajasthan (AOR 0.95, P = 0.538). ConclusionThe study suggests that PFHI does not have any effect on OOPE associated with hospitalisation. Government-funded healthcare is more effective in providing financial protection compared to private healthcare with PFHI. Private facilities are still chosen despite lower OOPE in government facilities due to quality and availability concerns. These limitations of PFHIs must be thoroughly examined before switching from subsidised services to purchases from private facilities. A combination of both approaches should be integrated to achieve universal health care and financial protection for all.

Factors influencing public and private healthcare utilisation in Uganda.

In Uganda, health care utilisation remains very low despite a number of government reforms that have been implemented in the health sector since the 1990's such as decentralization and removal of user fees in public health facilities among others. To examine the factors influencing public and private health care utilisation in Uganda. The study used cross sectional data from the Uganda National Household Survey collected between July 2016 and June 2017. Anderson's conceptual framework was used to identify explanatory variables associated with choice of health care providers and a multinomial logistic regression model was estimated. Out of the 17,912 individuals who sought care, 36% used a government facility, 60% used private facility while 4% had self- care/treatment. The results show that out of pocket health expenditure, age, level of education, marital status, residence, and type of illness significantly influenced choice of public healthcare providers. Similarly, utilisation of private healthcare providers was associated with household welfare, level of education, residence, marital status, illness days, and type of illness. The findings highlight the need for a national health insurance scheme to reduce out of pocket payments for health care and enable the poor and vulnerable patients visit the modern health facilities.

Construction and Scale Development of Willingness to Utilize Primary Care Services: A Study from China.

The willingness to utilize primary care services is crucial in explaining residents' healthcare-seeking behavior and decision-making in the context of the free choice of healthcare providers. This study examines China's family doctor contracting services system to elucidate the conceptual structure of the willingness to utilize primary care services and develop a reliable measurement tool. The study was conducted in two phases. Firstly, in-depth interviews were conducted with community residents, resulting in 42 qualitative data sets. Subsequently, a measurement scale for the willingness to utilize family doctor contracting services was developed, and the scale was validated through two surveys using exploratory factor analysis (N = 250) and confirmatory factor analysis (N = 278), respectively. By employing a grounded theory approach, this study analyzes the connotation of willingness to utilize family doctor contracting services. It constructs a conceptual framework for the willingness to utilize primary care services. This conceptual framework consists of three dimensions: perceived feasibility, perceived desirability, and perceived initiative. Based on this framework, a measurement scale comprising 14 items was developed and subjected to rigorous validation procedures to ensure its reliability and validity. This study extends prior research on healthcare service utilization willingness by elucidating the internal willingness structure for primary healthcare services. It enhances our understanding of the connotation of healthcare service utilization willingness and develops a scientifically rigorous measurement tool. The findings of this study provide valuable insights into improving both the willingness and behavior of utilizing primary care services in healthcare systems where the hierarchical referral system still needs to be fully developed.

Racial/Ethnic Residential Segregation, Neighborhood Health Care Provision, and Choice of Pediatric Health Care Provider Across the USA.

Much research has been conducted that demonstrates a link between racial/ethnic residential segregation and health care outcomes. We suggest that minority segregated neighborhoods may have diminished access to organizations and that this differential access may contribute to differences in health care outcomes across communities. We analyze this specifically using the case of pediatric health care provider choice. To examine this association, we estimate a series of multinomial logistic regression models using restricted data with ZIP code level geoidentifiers from the 2011-2012 National Survey of Children's Health (NSCH). We find that racial/ethnic residential segregation is related to a greater reliance on non-ideal forms of health care, such asclinics, and hospital outpatient departments, instead of pediatric physician's offices. This association is at least partially attenuated by the distribution of health care facilities in the local area, physician's offices, and health care practitioners in particular. Additionally, families express greater dissatisfaction with these other forms of care compared to physician's offices, demonstrating that the lack of adequate health care provision is meaningful for health care outcomes. This study expands the literature by examining how the siting of health organizations has consequences for individuals residing within these areas.

Snakebite care through the first two waves of COVID-19 in West Bengal, India: a qualitative study

Snakebite is a public health problem in many countries, with India having the highest number of deaths. Not much is known about the effect of the COVID-19 pandemic on snakebite care. We conducted 20 in-depth interviews with those bitten by venomous snakes through the two waves of COVID-19 (March-May 2020; May-November 2021), their caregivers, health care workers and social workers in two areas (Sundarbans and Hooghly) of West Bengal, India. We used a constructivist approach and conducted a thematic analysis. We identified the following themes: 1. Snakebite continued to be recognised as an acute emergency during successive waves of COVID-19; 2. COVID-19 magnified the financial woes of communities with high snakebite burden; 3. The choice of health care provider was driven by multiple factors and consideration of trade-offs, many of which leaned toward use of traditional providers during COVID-19; 4. Rurality, financial and social disadvantage and cultural safety, in and beyond the health system, affected snakebite care; 5. There is strong and shared felt need for multi-faceted community programs on snakebite. We mapped factors affecting snakebite care in the three-delay model (decision to seek care, reaching appropriate health facility, receiving appropriate care), originally developed for maternal mortality. The result of our study contextualises and brings forth evidence on impact of COVID-19 on snakebite care in West Bengal, India. Multi-faceted community programs, are needed for addressing factors affecting snakebite care, including during disease outbreaks - thus improving health systems resilience. Community programs for increasing formal health service usage, should be accompanied by health systems strengthening, instead of an exclusive focus on awareness against traditional providers.

UTILIZATION AND CHOICE OF HEALTH CARE: EMPIRICAL EVIDENCE FROM INDIA

Utilization and choice of health care services are two important decision-making issues once an individual perceives or realizes illness. Identifying and measuring the factors that influence health care utilization and choice are important concern for policy makers, to reduce health system inequality. Both demand and supply side factors influence the above-mentioned choice decisions. However, the nature and severity of illness can also affect the above choice decisions. This study has identified and measured the role of disease specification as an important determinant of choice decision along with its influence on other factors. This study also explored the regional and socio-economic variation of factors which hinder the utilization of government-provided health care services. Analyzing the data of women and child household members, the study found that disease specification affects the choice of health care provider and even influences the role of other important factors.

Choosing not to choose—Patients' justification of a disengaged choice of primary care provider

AbstractA key underpinning of choice of health care provider is that patients make active and informed decisions which stimulate quality competition. By imitating the principles of a market in the steering of health care, patients thus assume the role of consumers. Few patients however neither consider alternative providers nor seek information about quality. The aim of this study was to investigate if and how patients engage in the role of being active and informed consumers in the setting of primary care, and how they argue for their choice. The study was based on semi‐structured interviews with 18 respondents in a municipality in mid‐Sweden. Respondents were purposefully sampled and interviews were analysed using an inductive thematic approach. Findings demonstrated that patients disengaged from choice by arguing, for instance, that they were satisfied with their current provider or because they perceived no differences in quality. Overall, results were in line with previous studies performed in US and European hospital settings, indicating that patients present some similar arguments regarding disengagement from choice irrespective of level of care or geographical setting. Arguments specifically related to the primary care level were that patients found it more important to achieve continuity in the patient‐doctor relationship than ‘shopping around’ for the best provider, or that they desired more profiled services to actively make a choice. In contrast to previous literature, patients refuted the ‘patient‐consumer’ role by referring to, for instance, the belief that care should be of equal quality independent of what choice they made.

What influences slum residents' choices of healthcare providers for common illnesses? Findings of a Discrete Choice Experiment in Ibadan, Nigeria.

Urban slum residents have access to a broad range of facilities of varying quality. The choices they make can significantly influence their health outcomes. Discrete Choice Experiments (DCEs) are a widely-used health economic methodology for understanding how individuals make trade-offs between attributes of goods or services when choosing between them. We carried out a DCE to understand these trade-offs for residents of an urban slum in Ibadan, Nigeria. We conducted 48 in-depth interviews with slum residents to identify key attributes influencing their decision to access health care. We also developed three symptom scenarios worded to be consistent with, but not pathegonian of, malaria, cholera, and depression. This led to the design of a DCE involving eight attributes with 2-4 levels for each. A D-efficient design was created, and data was collected from 557 residents between May 2021 and July 2021. Conditional-logit models were fitted to these data initially. Mixed logit and latent class models were also fitted to explore preference heterogeneity. Conditional logit results suggested a substantial Willingness-to-pay (WTP) for attributes associated with quality. WTP estimates across scenarios 1/2/3 were N5282 / N6080 / N3715 for the government over private ownership, N2599 / N5827 / N2020 for seeing a doctor rather than an informal provider and N2196 / N5421 /N4987 for full drug availability over none. Mixed logit and latent class models indicated considerable preference heterogeneity, with the latter suggesting a substantial minority valuing private over government facilities. Higher income and educational attainment were predictive of membership of this minority. Our study suggests that slum residents value and are willing to pay for high-quality care regarding staff qualifications and drug availability. It further suggests substantial variation in the perception of private providers. Therefore, improved access to government facilities and initiatives to improve the quality of private providers are complementary strategies for improving overall care received.

Perceived quality of care and choice of healthcare providerin informal settlements.

When a person chooses a healthcare provider, they are trading off cost, convenience, and a latent third factor: "perceived quality". In urban areas of lower- and middle-income countries (LMICs), including slums, individuals have a wide range of choice in healthcare provider, and we hypothesised that people do not choose the nearest and cheapest provider. This would mean that people are willing to incur additional cost to visit a provider they would perceive to be offering better healthcare. In this article, we aim to develop a method towards quantifying this notion of "perceived quality" by using a generalised access cost calculation to combine monetary and time costs relating to a visit, and then using this calculated access cost to observe facilities that have been bypassed. The data to support this analysis comes from detailed survey data in four slums, where residents were questioned on their interactions with healthcare services, and providers were surveyed by our team. We find that people tend to bypass more informal local services to access more formal providers, especially public hospitals. This implies that public hospitals, which tend to incur higher access costs, have the highest perceived quality (i.e., people are more willing to trade cost and convenience to visit these services). Our findings therefore provide evidence that can support the 'crowding out' hypothesis first suggested in a 2016 Lancet Series on healthcare provision in LMICs.

A comparison of patient-reported quality between inpatient services for mental and physical health: A tertiary-hospital-based survey in China.

It is widely acknowledged that quality of mental health services is routinely worse than physical health services across countries. However, studies separately investigating mental health services often report high-level satisfaction, even comparing with physical health services. Therefore, this study aimed to compare patient-reported quality between inpatient services for mental and physical health in China. An inpatient survey was conducted among service users of mental and physical health services. Patient-reported quality was measured by the responsiveness performance questionnaire after patient discharge and based on patients' multiple experiences of hospitalization in the past 3 years. Chi-square tests were performed to compare the two patient groups' ratings on inpatient services for mental and physical health, and multivariate logistic regression was performed to adjust covariates in the group comparison. Inpatient services for mental health were rated better than those for physical health on "treating with respect" (AOR = 3.083, 95% CI = 1.102-8.629) and "choosing a healthcare provider" (AOR = 2.441, 95% CI = 1.263-4.717). However, mental health services had poorer ratings on "asking patient's opinions" (AOR = 0.485, 95% CI = 0.259-0.910). For other responsiveness items, no significant difference was detected between the two types of inpatient services. Mental health inpatient services provided by China's tertiary hospitals could perform as well as physical health inpatient services in most aspects and even better perform regarding dignity and choice of healthcare providers. However, neglecting patients' voices is more severe in inpatient services for mental health.

Factors Determining the Choice of Healthcare Providers in Uganda

Since early 1990s, the government of Uganda has implemented a number of reforms in the health sector, such as decentralization of health service delivery and removal of user fees in public health facilities aimed at achieving equitable access to quality healthcare. Despite these reforms, low levels of healthcare utilisation has remained a serious challenge in Uganda; and out-of-pocket health expenditure remains very high: at 41% of total health expenditure. This study seeks to examine factors that influence patients’ choice of healthcare providers in Uganda. A multinomial logistic model was estimated using data from the 2019/20 Uganda National Household Survey. The results showed that cost of healthcare, household welfare, level of education insurance, and region were significant in determining the choice of a healthcare provider. Duration of illness, distance to a health facility and type of illness were also significant determinants. The findings highlight the need for the government to introduce a national health insurance scheme to reduce out-of-pocket payments for healthcare, which will enable vulnerable individuals visit health facilities. It should also increase investments in the health sector by constructing and equipping more health facilities.
 JEL Classification: C25, I11, I12, I18

Does Health System Responsiveness Differ between Insured and Uninsured Outpatients in Primary Health Care Facilities in Asagirt District, Ethiopia? A Cross-Sectional Study

Background. An effective designation of health facilities improves the facility’s ability to respond to patients’ legitimate expectations. Limited evidence exists regarding the association between health system responsiveness and financial fairness in Sub-Saharan Africa, particularly in Ethiopia. The purpose of the study was, therefore to evaluate the health system responsiveness among insured and uninsured outpatients in primary healthcare facilities and determine the association between health insurance and health system responsiveness among outpatients. Methods. A facility-based cross-sectional study was conducted between March 30 and April 30,2021. The study sampled 423 participants using a systematic random sampling technique, and the data was collected with structured and pretested questionnaires administered by interviewers. Responsiveness was measured using the short version of the World Health Organization’s multicountry responsiveness survey, which has seven dimensions including autonomy, communication, confidentiality, attention, dignity, choice, and amenities. Using quantile regression, a specific association between health insurance and the health system responsiveness index was examined, adjusting for sociodemographic, quality, and satisfaction-related factors. Results. Of a total of 417 outpatients, 70.74% had health insurance. There was no statistical difference in health system responsiveness among insured and uninsured outpatients. Possession of health insurance was not associated with responsiveness (−0.67; 95%CI: −1.59, 0.25). There was a statistically significant negative relationship between age and responsiveness (−1.33; 95% CI: −2.47, −0.19) among 30–39 year olds and (−1.66; 95% CI: −3.02, −0.32) among 40–49 year olds. However, there was a positive statistical association between responsiveness with urban residence (+1.33; 95%CI: 0.37, 2.29), perceived quality of healthcare (+2.96; 95%CI: 1.95, 4.05), and patient satisfaction (3; 95%CI: 1.94, 4.07). Conclusions. There was no difference in the responsiveness of the health system between insured and uninsured outpatients. All domains need further improvement, particularly those more closely related to patients’ concerns, such as waiting time to get service and choices of healthcare providers. Furthermore, health facility administrators and the government should enhance responsive healthcare services in parallel with quality improvement and patient satisfaction, based on feedback from service users for better performance.

A time-frame comparison study of surgical volume shifts on female primary stress urinary incontinence surgery.

The objective was to investigate the surgical volume shifts for primary female stress urinary incontinence (SUI) over a 20-year period (1999-2018) in Taiwan. This was a retrospective cohort study based on Taiwan's National Health Insurance Research Database. We divided the time-frame into four periods: first period (1999-2003), second period (2004-2008), third period (2009-2013), and fourth period (2014-2018). The variables included major surgical types for SUI (retropubic urethropexy, pubovaginal sling, midurethral sling, etc.), surgeon gender, specialty, surgical volume (high ≥30, median 5-29, low <5), and hospital accreditation level. Reoperation rates within 1 year were analyzed as an outcome measurement. A total of 51,018 patients were identified. Major surgical types increased significantly during the first three periods and slightly decreased during the fourth period. The proportion of surgical volume shifted from high- to medium-, and low-volume, but it reversed during the fourth period. The proportion of SUI surgeries decreased in medical centers, whereas it increased in regional and local hospitals. The proportion of SUI surgeries by female surgeons increased. Similar phenomena occurred in MUS. As for surgeon specialty, major surgical types were performed by gynecologists and urologists equally, whereas MUS were performed more by gynecologists than by urologists. Unexpectedly, 1-year reoperation rates were higher in high-volume surgeons. The surgical trend of SUI surgeries shifted from high- to medium-, and low-volume surgeons, medical centers to regional and local hospitals during the study periods. This implied surgical skills and performance spreading, which may have a great influence on patient and healthcare provider choice of treatment.

Is the criminalization of informal payment a good idea? The role of the free choice of physician in the elimination of the phenomenon

In Hungary, the new act on the employment status of health workers aims at the elimination of informal payments by the strict separation of public and private care, by a significant increase of the salary of medical doctors and with the criminalization of giving and accepting informal payments. In this study, which is based on our former research, an analysis of the Hungarian judicial practice and an internet research focused on obstetrics, we examine whether the chosen tools are appropriate to achieve this goal, and if not, how the provisions of law should be modified. Both the theoretical considerations and the empirical evidence suggest that the approach the act took is wrong, because the majority of patients are not paying to compensate the doctors for their low salary. Patients pay because they think that they will not get the necessary care without it. This fee-for-service type informal payment is not corruption and it originates from health system shortages, which is not addressed by the act. On the contrary, the full implementation of the provisions of the act might even increase these shortages, which paradoxically can lead to the amplification of the phenomenon. According to the international experiences, long-term measures aiming at the easing of shortages, in themselves, are not sufficient to roll back this undesirable phenomenon, if they are not coupled with a short-term quick fix intervention, which creates a formal substitution mechanism allowing patients to buy the services associated with informal payments legally. The free choice of doctor is perceived to be an additional service to be paid for by the majority of patients and doctors, despite that, according to the current regulations, it is part of the public benefit package and should be available free of charge. Hence, informal payments could be formalized in the frame of the free choice of doctor and health care provider by making it a chargeable service. Such an approach is not unfamiliar in the Hungarian health policy, judicial practice, and even private obstetric care. Moreover, there is a government-supported obstetric model program in the public system in Hungary, where an explicit goal is to replace informal payments with formal fees to be paid by the patients for the free choice of the obstetrician who attends the delivery. All of these seem to be realistic starting points to introduce a technically and politically feasible pilot project, but the detailed regulations should be designed so that the involved health workers have no financial interest to discriminate against non-paying patients. To achieve this, we recommend that the attending physicians are also paid a fee even if they care for a patient, who did not choose them and pay them out of pocket, but live in the catchment area of the health service delivery organization, which is obliged to care for the local residents. Obviously, the source of this fee, which is eventually a performance-based component of the income of physicians, in this case, has to be the social health insurance scheme.

The effect of the price of time on healthcare provider choice in Ghana

The existing literature confirms that the cost of treatment affects the choice of a particular healthcare provider. The Ghana National Health Insurance Scheme was established in 2003 to reduce the cost of healthcare provision and increase access to healthcare. However, we find that that even when the price is assumed to be “zero”, there remain some economic costs for choosing a particular healthcare provider over the other. This is called the price of time or opportunity cost. The study uses data from the seventh round of the Ghana Living Standards Survey (GLSS 7) conducted in 2016/2017 and employs multinomial probit regression as the technique for the analysis. The study finds that travel time and waiting time have significant effects on the choice of healthcare provider. If travel time and waiting time increase by 1 h, it will decrease the probability of seeking healthcare by 12% and 17%, respectively. Travel cost was not found to have a significant effect. The recommendations are that policymakers should make the effort to decrease travel time and waiting time at the health facilities in the country to improve healthcare delivery.

Quality decreases from introducing patient choice in a National Health Service

A view often expressed about patient choice of health care providers is that it will increase competition between providers, which benefits the efficiency of the health system. We address here a patient choice initiative, regarding selection of hospital for specialty consultations, in the Portuguese National Health Service (NHS) that has two specific features. The first feature involves shared decision making between patients and GPs, in the choice of hospital for referral, which should be based on publicly available information on “quality”. The second specific feature is that the patient choice initiative did not involve payment changes to NHS hospitals associated with patients’ movements. We show that explaining initial asymmetries in qualities (waiting times) with systematic differences in hospital characteristics (cost advantages and managerial talent) leads to potential asymmetric responses to the introduction of patient choice in the NHS. This implies that the empirical analysis has to accommodate such asymmetries. Explicitly allowing for asymmetries in responses to the policy measure reveals that reactions were indeed different, with top-performance hospitals reducing their qualities (increasing waiting times) after the patient choice initiative was introduced.

An Assessment of Major Factors Contributing towards Choosing Alternate Healers (Hakeem, Dispenser, Spiritual Healer) over Registered Medical Practitioner (RMP)

Background: Malpractice is characterized as "careless, unsuitable, or illegal activity while performing a professional task" by Oxford Learner's Dictionaries (1). Prevalence of alternate healers is a problem of nearly all less economically underdeveloped countries. Pakistan is also one of the victims of malpractice. Factors that contribute to malpractice are proximity, affordable fee, availability, family pressure, and the strong opinion of the community. The objective of the study was to analyze why people choose alternate healers and to evaluate the misconception and myths regarding registered medical practitioners. Methods: A Descriptive cross-sectional study was conducted on a sample size of 319 with participants from Gujranwala’s rural and urban areas in 2021. Both the male and female population of Gujranwala was included. Data was entered and analyzed in SPSS version 21. Results: The socio-economic and demographic variables considerably effect the choice of health care provider. More people in rural areas visit alternate healers as compared to urban areas. Lack of information and misconceptions about physicians were also the factors effecting health seeking behavior of people. Conclusion: There is a potential to improve the health-seeking behavior and utilization of health facilities by addressing the demand side (community) factors i.e., socio-economic factors, cultural beliefs, by shutting down all unlicensed practitioners and educating the community to avoid visiting them to reduce the probability of exposure to unsafe healthcare practices.

RESPONSIVENESS SISI KESEHATAN DALAM MEMBERIKAN PELAYANAN KESEHATAN

Background: Responsiveness according to WHO is the result that can be achieved when an institution designed so that they areaware of and respond appropriately to the expectations of a legitimate, based on measurements through eight domains are: dignity,attention immediately, autonomy, choice of health care providers, clear communication, confidentiality, quality of basic amenities, andaccess to social support networks.Objective: To analyze the responsiveness of the hospitals and health centers in providing health services.Methods: A descriptive study with qualitative methods. This research uses descriptive type so that the researcher will analyze howresponsiveness in terms of health in providing health services to the community. This research was conducted in Buru Regency with 22 respondents.Results: The experience of respondents to the responsiveness in hospitals that view based on variable dignity officers have notprovided services to the fullest and less maintain patient privacy. Variable attention in hospitals and health center patients are stillwaiting long in getting service especially in emergency situations because the doctor was not in place. The variable access to thenetwork for the distance from home to health facilities is still very far away and unreached by the public outside the city as well as a drugthat is not yet complete. The variable quality of amenities in hospitals on quality very bad environment that makes the patient feelnot comfortable and safe. Variable trust in hospitals and community health centers are still not so sure about health care because theybelieve in the healing traditions.Conclusion: Responsiveness of the health in Hospitals Buru and Air Buaya Health Centers not responsive that in view based on variablesdignity, attention, access to the network, quality of amenities and trust.