Mixed methods research on satisfaction with basic medical insurance for urban and rural residents in China

Abstract

Background: There have been few studies on satisfaction with integrated basic medical insurance for urban and rural residents (URRBMI), and satisfaction with URRBMI is not very high because of 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 to the government for how to effectively manage and improve the policy. Methods: An explanatory sequential design of mixed methods research was used. A quantitative research using a three-stage stratified cluster sampling method was used to randomly select the guardians of pupils who participated in URRBMI (n = 1335). The quantitative research was conducted to calculate the latent variables' scores and path coefficients between latent variables using SmartPLS3.0. With public trust, public satisfaction, and perceived quality as the target variables, important-performance analysis (IPA) was used to explore the important but underperforming factors, which were the key elements to improving satisfaction with URRBMI. A purposeful sampling strategy according to satisfaction level was used to obtain qualitative research subjects from among the quantitative research subjects. A qualitative research was conducted using semi-structured interviews, and the thematic analysis method was used to summarize the interview data. Results: The three strongest paths were 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). IPA revealed that public satisfaction and perceived quality were key factors for public trust and that perceived quality was of high importance for public satisfaction but had low performance. The policy quality was a determining factor for perceived quality. The qualitative research results showed that the most unsatisfactory aspect for the insured was the policy quality.

Assessment of the satisfaction with public health insurance programs by patients with chronic diseases in China: a structural equation modeling approach

“…Although different variables, participants, and models were used by prior health insurance studies [20,22] as compared with our analysis, similar conclusions were drawn in terms of key factors influencing patient satisfaction, such as reimbursement ratio, the scope of healthcare services, and technologies listed in the insurance catalog. On the other hand, we identified several new findings that had not been reported by prior research.…”

“…Recent studies [68][69][70] also proved that increase in patient satisfaction could have a positive impact on patients' trust. Another SEM research on URRBMI enrollees suggested that the perception of policy quality was a decisive factor in the perceived quality of URRBMI [20]. Given our results that patients' awareness of their insurance policies was very limited, it seemed to be a little bit difficult for patients to make a non-biased assessment of the policy quality.…”

“…The SEM allowed us to test several relationships simultaneously within a conceptual model, which is important for patient satisfaction research where many mediating variables are suspected to have complex intercorrelations. Unlike other studies [20,22], the participants in our SEM were patients with chronic diseases who had actual experiences of getting reimbursed for their outpatient and/or inpatient care. Consequently, their views can truly reflect the real-world performance of insurance programs.…”

“…We provided a brief review of the literature below before presenting our theoretical framework. Several studies have applied the SEM approach to assess residents' satisfaction with health insurance in China [16][17][18][19][20][21][22]. However, none of the studies focused on patients with chronic diseases.…”

“…However, none of the studies focused on patients with chronic diseases. While the participants varied substantially across the studies, such as elementary students, rural and urban residents [18,20,21]. Many of the participants had no experience of getting reimbursement from insurance programs, and consequently what they reported in the studies were not their actual satisfaction with insurance programs, but their expectations of the programs.…”