Background:
Countries, including India, were quick to adopt telemedicine for delivering primary care in response to the widespread disruptions due to the coronavirus disease 2019 (COVID-19) pandemic. This expeditious adoption was critical and the challenges faced during this exigency could guide the design and delivery of future telemedicine applications toward strengthening primary healthcare services.
Methods:
To identify the challenges in delivering primary care via telemedicine technology in the Indian context, a scoping review was conducted. Drawing from the systems approach in healthcare delivery, the review findings are summarized at four levels, patient, provider, healthcare organizations, and policy.
Results:
The initial search yielded 247 articles and 13 met our inclusion criteria. This review highlighted that telemedicine facilitated the continuity of care during COVID-19 but not without challenges. Low levels of education and computer literacy along with the language barriers posed the predominant challenges at the patient level. Providers had concerns related to digital literacy, clinical process flows, legal liabilities, and unethical behavior of the patients. The policy-level challenges include data privacy and security, reimbursement models, unethical behavior by the patient, or provider, and regulating prescriptions of psychotropic drugs. A lack of an integrated telehealthcare model covering diagnostics, prescriptions, and medication supply mirrored the existing fragmentation of care delivery.
Conclusion:
Telemedicine has the potential to improve primary healthcare delivery even beyond COVID-19. Currently, telemedicine applications in India are only facilitating a remote consultation wherein an integrated person-centered care is lacking. There is a need to acknowledge and factor in the inter-connectedness of health system elements for ensuring an effective and efficient healthcare delivery via telemedicine.
Background: The purpose of this study is to propose and test for the moderating role of insurance status on the relationship between service quality (SQ) and service satisfaction (SS) in a hospital setting. The study focuses on the state-run health insurance (SHI) provided to economically deprived families in India.
Methodology: Using a reliable and validated structured questionnaire adapted from Dagger’s hierarchical model of health service quality, exit interviews were conducted with 279 respondents. 310 study participants were randomly recruited (response rate = 90%) from the discharge list of general surgery ward of a private hospital in the Thane district of Maharashtra, India. Multi-group Structural Equation Modelling (SEM) in AMOS v.22 was used to test for the hypothesized model.
Findings: The study finds that patients’ perceptions of different service quality dimensions, including inter-personal, administrative and technical are affected by the insurance status. The analysis identified technical quality as the key determinant of overall perceived service quality for patients insured under SHI. Results support our proposed moderating effect of insurance status on the relationship between service quality and service satisfaction.
Conclusion: The study findings indicate that patients receiving free treatment under SHIs may not have higher expectations of inter-personal and/or administrative quality, but are concerned about technical quality. For paid patients all the dimensions of service quality determine overall perceived service quality and service satisfaction. The study findings have implications for market segmentation strategies based on the insurance status. The study provides insights to SHI implementers for improving the program in the long run and also help hospital administrators identify the quality dimensions to focus upon and ensure patient satisfaction and loyalty.
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