Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care

Abstract

ObjectiveDeteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers.MethodsWe adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships.FindingsAbout 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736–1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215–0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust—the most significant predictor of patient satisfaction—is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care.ConclusionAt the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders.

Patient Satisfaction with Psychiatric Services: A Survey at a Nigerian Federal Teaching Hospital

“…At the time of this study (data collection), the country was at the peak of her economic recession, which contributed to the upward review of the bills of the hospital almost shortly before the onset of this study. Recessions are known to cause contractions in economic growth, leading to fiscal crises for governments, compromising their ability to fund medical care and eventually causing employers and hospital managements to alter their service charges to sustain the hospital expenditure and service provision [25]; and patient satisfaction has been reported to be negatively associated with higher levels of hospital medical expenditure [26]. Other major factor responsible for the relative low satisfaction in this area is the fact that almost all the patients sampled have their bills paid directly by themselves or their family members; majority were not under the national health insurance scheme.…”

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“…Özlü and Uzun ( 2015) found that there were differences in patient satisfaction with nursing care in surgery clinics in different hospitals in turkey related to educational background, profession, the hospital in which the patients stay and previous hospital experience . Shan (2016) found that lack of trust was behind patient dissatisfaction with hospital inpatient care in Heilongjiang in China.…”

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