Mixed Methods Research on Satisfaction with Basic Medical Insurance for Urban and Rural Residents in China

Abstract

Background: There are few studies on satisfaction with integrated basic medical insurance for urban and rural residents (URRBMI), and satisfaction with URRBMI is not very high due to the complexity of its policies and differences among the insured. The aim of the present study was to explore the factors that influence satisfaction with URRBMI in China and to provide scientific suggestions for the government to effectively manage and improve the policy.Methods: An explanatory sequential design in mixed method research was used. Quantitative study adopted a three-stage stratified cluster sampling method to randomly select the guardians of pupils who had participated in the URRBMI (n=1335). A quantitative study was conducted to calculate latent variables’ score and path coefficient between latent variables by SmartPLS3. 0. With public trust, public satisfaction and perceived quality as the target variables, the important-performance analysis (IPA) was used to explore the important but insufficient performance factors, which were the key elements to improve satisfaction of URRBMI. A purposeful sampling strategy was used to get qualitative research subjects from quantitative research subjects according to satisfaction level. A qualitative study was conducted using semi-structured interviews and the thematic analysis method was used to summarize the interview data.Results: Perceived quality to public satisfaction with a total effect of 0.737 (t=41.270, P<0.001), perceived quality to perceived value with a total effect of 0.676 (t=31.964, P<0.001), and public satisfaction to public trust with a total effect of 0.634 (t=31.305, P<0.001) were three strongest paths. IPA showed that public satisfaction and perceived quality were key factors for public trust and that perceived quality was of high importance and low performance for public satisfaction. The policy quality was a determining factor for perceived quality. Qualitative research showed that the most unsatisfactory aspect for the insured was the policy quality. Conclusions: This study found that improving quality is key to improving public satisfaction and public trust of URRBMI. The government should improve the compensation level by broadening the channel of financing for URRBMI fund, rationally formulating reimbursement standards and broadening the scope of the drug catalogue and the medical treatment projects. The government should establish a stable financing growth mechanism and effective ways of health education so as to improve public satisfaction and public trust.