Explaining public satisfaction with health‐care systems: findings from a nationwide survey in China

Abstract

ObjectiveTo identify factors associated with health‐care system satisfaction in China.ContextRecent research suggests that socio‐demographic characteristics, self‐reported health, income and insurance, ideological beliefs, health‐care utilization, media use and perceptions of services may affect health‐care system satisfaction, but the relative importance of these factors is poorly understood. New data from China offer the opportunity to test theories about the sources of health‐care system satisfaction.DesignStratified nationwide survey sample analysed using multilevel logistic regression. Setting and participants: 3680 Chinese adults residing in family dwellings between 1 November 2012 and 17 January 2013.Main outcome measureSatisfaction with the way the health‐care system in China is run.ResultsWe find only weak associations between satisfaction and socio‐demographic characteristics, self‐reported health and income. We do, however, find that satisfaction is strongly associated with having insurance and belief in personal responsibility for meeting health‐care costs. We also find it is negatively associated with utilization, social media use, perceptions of access as unequal and perceptions of service providers as unethical.ConclusionsTo improve satisfaction, Chinese policymakers – and their counterparts in countries with similar health‐care system characteristics – should improve insurance coverage and the quality of health services, and tackle unethical medical practices.

Economic inequality in satisfaction with healthcare in the Baltic countries during and after the economic crisis (2008–2014)

“…3 Although public satisfaction with healthcare systems has been previously measured by directly asking about satisfaction with a country's healthcare system (Footman et al 2013;Wendt et al 2009), other measures have been used as well. For example, it is also measured by asking about the way healthcare is run (Bleich, Özaltin, and Murray 2009;Kotzian 2009;Munro and Duckett 2016), the need for changes in the healthcare system (Blendon et al 2002;Wendt et al 2009), the overall state of health services (Ainsaar and Nahkur 2017; Missinne, Meuleman, and Bracke 2013), and the efficiency of healthcare provision (Missinne, Meuleman, and Bracke 2013) in a respondent's country. 4 Our methodology corresponds to this list well.…”

“…Thus, satisfaction refers to people's evaluation of the performance of an existing healthcare system (Wendt et al 2009). Public satisfaction with healthcare systems is influenced by many different factors, for example, experiences in healthcare (Missinne, Meuleman, and Bracke 2013;Wendt et al 2009;Bleich, Özaltin, and Murray 2009;Footman et al 2013), expectations about the organization of healthcare (Rothstein 2001;Missinne, Meuleman, and Bracke 2013), economic factors (Missinne, Meuleman, and Bracke 2013), the historical background of the country, as well as the wider political and institutional context (Footman et al 2013;Aidukaite 2009), personal health, wellbeing, and socioeconomic status (Bleich, Özaltin, and Murray 2009;Footman et al 2013;Missinne, Meuleman, and Bracke 2013;Wendt et al 2009;Munro and Duckett 2016;Ainsaar and Nahkur 2017). In the following section, we provide an overview of the factors that influence public satisfaction with healthcare systems and focus on socioeconomic factors.…”

“…Several studies have found that economic factors are related to public satisfaction with healthcare systems. People who are less satisfied with their household economic situation (Footman et al 2013) or for whom it is difficult to get by with their household income (Wendt et al 2009), those who have below average income (Blendon et al 2002), and those who do not have health insurance (Munro and Duckett 2016), tend to be less satisfied with healthcare systems. In contrast to the impact of income, people with lower education tend to be more satisfied with healthcare because they might have lower expectations (Bleich, Özaltin, and Murray 2009;Footman et al 2013;Missinne, Meuleman, and Bracke 2013).…”

“…In contrast to the impact of income, people with lower education tend to be more satisfied with healthcare because they might have lower expectations (Bleich, Özaltin, and Murray 2009;Footman et al 2013;Missinne, Meuleman, and Bracke 2013). Moreover, there is some evidence that men (Missinne, Meuleman, and Bracke 2013), older people (Bleich, Özaltin, and Murray 2009;Munro and Duckett 2016) and people living in rural areas (Footman et al 2013) are, in some countries, more satisfied with healthcare systems, due to lower expectations of healthcare. In contrast to Western countries, in countries of the former Soviet Union, younger people were more satisfied with healthcare systems compared to older people (Footman et al 2013).…”

“…Another important factor is self-rated health. People with better health tend to be more satisfied with the healthcare system (Ainsaar and Nahkur 2017;Bleich, Özaltin, and Murray 2009;Footman et al 2013;Missinne, Meuleman, and Bracke 2013;Munro and Duckett 2016;Wendt et al 2009). In a recent study, Ainsaar and Nahkur (2017) found that lower satisfaction with healthcare among less healthy people was mainly explained by the lower incomes of the same group in Estonia.…”