Are bad health and pain making us grumpy? An empirical evaluation of reporting heterogeneity in rating health system responsiveness

Abstract

This paper considers the influence of patients' characteristics on their evaluation of a health system's responsiveness, that is, a system's ability to respond to the legitimate expectations of potential users regarding non-health enhancing aspects of care (Valentine et al. 2003a). Since responsiveness is evaluated by patients on a categorical scale, their selfevaluation can be affected by the phenomenon of reporting heterogeneity (Rice et al. 2012). A few studies have investigated how standard socio-demographic characteristics influence the reporting style of health care users with regard to the question of the health system's responsiveness (Sirven et al. 2012, Rice et al. 2012). However, we are not aware of any studies that focus explicitly on the influence that both the patients' state of health and their experiencing of pain have on the way in which they report on system responsiveness. This paper tries to bridge this gap by using data regarding a sample of patients hospitalized in four Local Health Authorities (LHA) in Italy's Emilia-Romagna region between 2010 and 2012. These patients have evaluated 27 different aspects of the quality of care, concerning five domains of responsiveness (communication, social support, privacy, dignity and quality of facilities). Data have been stratified into five sub-samples, according to these domains. We estimate a generalized ordered probit model (Terza, 1985), an extension of the standard ordered probit model which permits the reporting behaviour of respondents to be modelled as a function of certain respondents' characteristics, which in our analysis are represented by the variables "state of health" and "pain". Our results suggest that unhealthier patients are more likely to report a lower level of responsiveness, all other things being equal, while patients experiencing pain are more likely to make use of the extreme categories of responsiveness, that is, to choose the category "completely dissatisfied" or the category "completely satisfied". These results hold across all five domains of responsiveness.

Improving People’s Self-Reported Experience with the Health Services: The Role of Non-Clinical Factors

“…This was the case of age, marital status, employment status, chronic illness, and experience. In line with the literature [33,34], our findings indicated that some individuals' socioeconomic characteristics were correlated with self-reported experience of the health service. For example, gender was statistically significant only for primary care.…”

What is health systems responsiveness? Review of existing knowledge and proposed conceptual framework

“… 6 On the other hand, multiple influences (such as population’s sociodemographic characteristics of) were thought to play greater role in shaping people’s satisfaction, thus making it a less appropriate reflection of real service quality. 44 61 63 In other words, both responsiveness and satisfaction are shaped by characteristics of both people and systems and differences exist in degrees to which these characteristics affect self-assessments.…”

How do hospital‐specialty characteristics influence health system responsiveness? An empirical evaluation of in‐patient care in the Italian region of Emilia‐Romagna

“…Most of previous studies on health system responsiveness have focused on the demand‐side by investigating the association between sociodemographic characteristics of patients and their reported level of responsiveness. Some of these studies have adopted an international comparison perspective (e.g., Rice, Robone, & Smith, ; Sirven, Santos‐Eggimann, & Spagnoli, ; Valentine, Darby, & Bonsel, ), whereas others have adopted a national one (Adesanya et al, ; Ebrahimipour et al, ; Fiorentini, Ragazzi, & Robone, ; Luo, Wang, Lu, & Liu, ; Röttger, Blümel, Fuchs, & Busse, ). However, little is yet known about the influence of supply‐side factors on responsiveness.…”

“…The use of data at disaggregated level has been shown of paramount importance to increase the reliability of analyses about hospital systems, because it allows, for example, to take into account differences in accounting principles and in the definitions in the outcomes of interest, which may exist across different observational units (e.g., health‐care providers) (Gravelle & Backhouse, ; Rice, Robone, & Smith, ). Earlier work has shown that hospital characteristics play an important role in explaining differences in patients' evaluation of healthcare (e.g., Fiorentini et al, ; Robone, Fiorentini, Nicoli, & Rodella, ; Sjetne, Veenstra, & Stavem, ; Young, Meterko, & Desai, ). However, differently from previous studies on responsiveness, which treated hospitals as “black‐boxes,” the present paper investigates which supply factors affect responsiveness not only across hospitals but also within hospitals.…”