Groenewegen Peter P, Kerssens Jan J, Sixma Herman J, van der Eijk Ingrid, Boerma Wienke G W
NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, The Netherlands.
BMC Health Serv Res. 2005 Feb 21;5(1):16. doi: 10.1186/1472-6963-5-16.
Quality of care from the perspective of users is increasingly used in evaluating health care performance. Going beyond satisfaction studies, quality of care from the users' perspective is conceptualised in two dimensions: the importance users attach to aspects of care and their actual experience with these aspects. It is well established that health care systems differ in performance. The question in this article is whether there are also differences in what people in different health care systems view as important aspects of health care quality. The aim is to describe and explain international differences in the importance that health care users attach to different aspects of health care.
Data were used from different studies that all used a version of the QUOTE-questionnaire that measures user views of health care quality in two dimensions: the importance that users attach to aspects of care and their actual experience. Data from 12 European countries and 5133 individuals were used. They were analysed using multi-level analysis.
Although most of the variations in importance people attach to aspects of health care is located at the individual level, there are also differences between countries. The ranking of aspects shows similarities. 'My GP should always take me seriously' was in nearly all countries ranked first, while an item about waiting time in the GP's office was always ranked lowest.
Differences between countries in how health care users value different aspects of care are difficult to explain. Further theorising should take into account that importance and performance ratings are positively related, that people compare their experiences with those of others, and that general and instrumental values might be related through the institutions of the health care system.
从用户角度评估医疗保健质量在评估医疗保健绩效方面的应用越来越广泛。除满意度研究外，从用户角度来看，医疗保健质量在两个维度上被概念化：用户对医疗保健各方面的重视程度以及他们在这些方面的实际体验。众所周知，医疗保健系统在绩效方面存在差异。本文探讨的问题是，不同医疗保健系统中的人们对医疗保健质量重要方面的看法是否也存在差异。目的是描述并解释医疗保健用户对医疗保健不同方面重视程度的国际差异。
使用来自不同研究的数据，所有研究均采用了QUOTE问卷的一个版本，该问卷从两个维度衡量用户对医疗保健质量的看法：用户对医疗保健各方面的重视程度以及他们的实际体验。使用了来自12个欧洲国家的5133个人的数据。采用多层次分析进行分析。
尽管人们对医疗保健各方面重视程度的大部分差异存在于个体层面，但国家之间也存在差异。各方面的排名显示出相似性。“我的全科医生应该始终认真对待我”在几乎所有国家都排名第一，而关于在全科医生办公室等待时间的一项内容总是排名最低。
各国医疗保健用户对不同医疗保健方面的重视程度差异难以解释。进一步的理论化应考虑到重视程度和绩效评级呈正相关，人们会将自己的经历与他人的经历进行比较，以及一般价值和工具价值可能通过医疗保健系统的制度联系起来。
