This is because they are both important in a keenly competitive health care service market. Internationally, many scholars [ 6 , 9 , 14 — 19 , 33 ] agree that patient satisfaction investigation and consultation experience investigation can be helpful in making sustainable improvements to medical services. Currently a number of scholars have been exploring disease-based satisfaction indices by which medical service quality can be evaluated through a set of patient satisfaction indicator systems. Items to be evaluated include consultation environment, waiting time, medical staff attitude, medical technique, and therapeutic effect and medical cost among others.
After repeated examination for health service delivery programs, both the Patient Satisfaction Questionnaire Ware, PSQ and the Quality of Care Monitors Carey were chosen as the basis for developing similar questionnaire [ 37 ]. Also, anchoring vignettes short descriptions of hypothetical situations are being used to adjust patient expectation for the purpose of achieving effective comparison among populations [ 38 — 40 ].
Finally, most investigations were done by a third-party using different questionnaires for different types of patient in order to ensure validity and effectiveness of the result. Thus, bias caused by complex interests of different stake-holders could be eliminated. PROMs measure quality of care from the patient perspective and calculate the health gain from a certain intervention. PROMs are measures of a patient health status or health-related quality of life and are typically short, self-completed questionnaires providing measurements at a single point in time.
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The health status information collected from patients before and after an intervention provides an indication of the quality of care delivered. Since PROMs have been made mandatory, the health gain reported from these four interventions has increased i. Fitzpatrick et al. However, weaknesses remain in existing satisfaction investigations.
Patient satisfaction is highly related to patient expectations as patient satisfaction may change, even though the health service is itself unchanged. Patients have different expectations or reference criteria with regard to their health care service [ 42 — 45 ]. It was analyzed from qualitative and quantitative view. One of the goals of this study was to identify the dimensions or items with which residents may or may not be satisfied. Thus, the key parts of the questionnaire included:. Through a stratified sampling method, eighteen districts of Shanghai were divided into three groups according to their location and level of economic development.
Subsequently, one district was randomly selected from each group. These included one center district Luwan District , one inner suburban district Changning District and one outer suburban district Qingpu District. In each sampled district, three community health service centers were randomly sampled, and respondents from each service center were selected to respond to questionnaires.
The sample size is determined by:. Trained investigators randomly distributed surveys and received effective responses. After website and email responses were included, the survey accumulated an additional completed questionnaires. The online survey was also limited in the same three districts, and its proportion was similar with the field research. In total, responses were collected through field and online survey. The study has several limitations. First, the influence of responses expectations and individual subjective factors was not considered when we designed investigation questionnaire and the email respondents were more well off and educated.
Second, the selection of the respondents focused on only one city, Shanghai. Thus the results may not be generalizable to the entire country due to differences between cities and urban and rural distinctions. Third, the reform process has started relatively recently and, as a result, more time may be needed for these policies to take full effect. Data were analyzed using an SAS computer statistical package, Version 9. The respondents were grouped by sex, age, education, place of residence the capital city, urban or rural populations and annual income.
The Spearman correlation test was used to estimate the association between variables. We conducted a multivariate analysis of logistic regression to determine the independent effects on the level of satisfaction.
The respondents were grouped by sex, age, job status, education, income and whether or not they suffered illness in the two weeks prior to being surveyed. The education distribution showed that Of the respondents, or Table 2 shows the items and corresponding score of each dimension.
As seen in Table 2 , after calculated the average scores of the subareas for each of the four categories, we found that the residents were generally satisfied to a relatively high degree with the clinical service, the next highest level was with the public health service; and the results showed less satisfaction with the essential drug system and the health insurance system.
The highest satisfaction was with staff attitude 3. Residents were least satisfied with the drug prices 3. The overall satisfaction related to the health care system was just above the median score 3 3. Satisfaction scores for different dimensions and groups are shown in Table 3.
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The individual item satisfaction scores were aggregated into total mean scores for each of the four dimensions. The mean score for each dimension was analyzed by sex, age, place of birth, work status, education and income. Scores were 3. The unemployed, those earning low incomes, born in a suburban setting and having received an elementary education or less, were found to have relatively low satisfaction with all four dimensions of the health care system.
Residents, who were men, aged under 60, born in rural settings, possessing an elementary or less education and at the third quarter income level were more satisfied with the essential drug system. Residents, who were under 60 years of age, workers not originally from Shanghai, employed, possessing a secondary education and at the third quarter income level were more satisfied with the health insurance system.
Delivery of Health Care Services
The difference in the overall satisfaction score between groups was smaller, as shown in the last column of Table 3. On all scales, the community health care system earned mean scores of 3. The score was marginally above the midpoint a score below 3 would indicate a negative evaluation. Out of all the respondents, Only one-third believed that it had changed for the better, and The percentage of respondents who thought they changed for the worse in these two aspects were Thus, compared with the price of medicines and the ratio of reimbursement, people have a relative high assessment on the medical environment, medical level and staff attitude; more than half the interviewers reported positive response.
This result is thought to have arisen because the patients pay for the services mostly on a fee-for-service basis, so there was no incentive for the health service provider to control the costs. Although the government took some measures to control medicine and service prices, the result was still unsatisfactory according to the survey results. Indeed, even for the employed respondents, the degree of perception improvement with the essential drug delivery system was obviously lower than with other items.
The details are shown in Table 4. The mean score for each dimension was analyzed by sex, age, place of residence, work status, education and income. In particular, the migrant worker group reported greater satisfaction because they generally have graduated from university and can find stable jobs in cities. The results show that vulnerable groups have less accessibility to community health services, highlighting the need for more attention to be paid to this area during the reform process.
Patient Health Record Systems Scope and Functionalities: Literature Review and Future Directions
The analysis results are shown in Table 5. In order to understand the satisfaction with community health services comprehensively, the questionnaire designed an open ended question.
Compared with the beginning of the reform, the biggest difference is the improvement in terms of convenience, medical environment and staff attitude. Most of the questions focused on access to drugs, the reimbursement rate, out of pocket payment rate and medicine price. The health care system in China has made some progress since the government initiated the reforms.
However, this finding was not inconsistent across all of the four main dimensions of services. Only one-third of respondents found the drug delivery system to have improved, and one-third believed that there was no change. More than half the respondents thought that the health insurance system had undergone no change or worsened.http://nttsystem.xsrv.jp/libraries/89/viqys-ueberwachung-per.php
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The residents report lower satisfaction with the essential drug system. Out of the medicines on the list, only of them are chemical and biological medicines the rest are traditional Chinese medicines. Particularly, demand is unmet for medicines used to treat children and chronic illnesses. The results also demonstrate that disadvantaged groups the elderly, retired, those only with an elementary level of education and those earning a lower level of income expressed poorer response in overall satisfaction across every dimension. This result of vulnerable groups reporting less satisfaction seems logical and consistent with the reality of China.
As most hospitals mainly received payment based on a fee-for-service basis, they have little incentive to control costs, although an increasing number of hospitals are now paid for by other provider payment methods. The government chose a tender system in order to decrease the price of medicines [ 47 ] and to hopefully make the medicine procurement process more transparent and fair. However, there are still many problems with the implementation of the reforms leading to the policies not fully realizing the desired effect.
For example, problems include a single supplier monopoly in one city, collusion between a hospital and pharmaceutical manufacturer and between a supplier and health bureau, and a lack of supervision by the local government [ 48 ]. This is consistent with previous studies [ 31 ]. For this reason, it is recommended that the government should concentrate on improving the service related to the above factors to produce greater satisfaction e.
The government should also promote fairness and accessibility of medical service between different groups. This study also shows that, for the elderly, additional financial subsidization must be supplied by government. But differences of satisfaction level were found among most dimensions and groups.
Disadvantaged groups asserted lower satisfaction levels overall relative to non-disadvantaged groups. This study provides a practical measure of satisfaction with specific dimensions of health care system.
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