Bleich Sara N, Ozaltin Emre, Murray Christopher K L
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Bull World Health Organ. 2009 Apr;87(4):271-8. doi: 10.2471/blt.07.050401.
To explore what determines people's satisfaction with the health-care system above and beyond their experience as patients.
Data on health system responsiveness, which refers to the manner and environment in which people are treated when they seek health care, provides a unique opportunity to better understand the determinants of people's satisfaction with the health-care system and how strongly this is influenced by an individual's experience as a patient. The data were obtained from 21 European Union countries in the World Health Survey for 2003. Additive ordinary least-squares regression models were used to assess the extent to which variables commonly associated with satisfaction with the health-care system, as recorded in the literature, explain the variation around the concept of satisfaction. A residual analysis was used to identify other predictors of satisfaction with the health-care system.
Patient experience was significantly associated with satisfaction with the health-care system and explained 10.4% of the variation around the concept of satisfaction. Other factors such as patient expectations, health status, type of care, and immunization coverage were also significant predictors of health system satisfaction; although together they explained only 17.5% of the observed variation, while broader societal factors may largely account for the unexplained portion of satisfaction with the health-care system.
Contrary to published reports, people's satisfaction with the health-care system depends more on factors external to the health system than on the experience of care as a patient. Thus, measuring the latter may be of limited use as a basis for quality improvement and health system reform.
探究除患者就医体验之外,还有哪些因素决定人们对医疗保健系统的满意度。
医疗系统响应性数据指人们寻求医疗服务时接受治疗的方式和环境,它为更好地理解人们对医疗保健系统满意度的决定因素以及个人就医体验对其影响程度提供了独特契机。这些数据取自2003年世界卫生调查中21个欧盟国家的数据。采用加法普通最小二乘回归模型来评估文献中记录的通常与医疗保健系统满意度相关的变量在多大程度上解释了满意度概念周围的差异。使用残差分析来确定医疗保健系统满意度的其他预测因素。
患者就医体验与对医疗保健系统的满意度显著相关,解释了满意度概念周围10.4%的差异。其他因素,如患者期望、健康状况、护理类型和免疫接种覆盖率,也是医疗系统满意度的重要预测因素;尽管它们共同仅解释了观察到的差异的17.5%,而更广泛的社会因素可能在很大程度上解释了医疗保健系统满意度中无法解释的部分。
与已发表的报告相反,人们对医疗保健系统的满意度更多地取决于医疗系统外部的因素,而非患者的就医体验。因此,将后者作为质量改进和医疗系统改革的基础,其作用可能有限。