Institute of Public Health, Medical Faculty, Heidelberg University, Heidelberg, Germany.
BMC Health Serv Res. 2013 Dec 1;13:502. doi: 10.1186/1472-6963-13-502.
Responsiveness of health care services in low and middle income countries has been given little attention. Despite being introduced over a decade ago in many developing countries, national health insurance schemes have yet to be evaluated in terms of responsiveness of health care services. Although this responsiveness has been evaluated in many developed countries, it has rarely been done in developing countries. The concept of responsiveness is multi-dimensional and can be measured across various domains including prompt attention, dignity, communication, autonomy, choice of provider, quality of facilities, confidentiality and access to family support. This study examines the insured users' perspectives of their health care services' responsiveness.
This retrospective, cross-sectional survey took place between October 2010 and March 2011. The study used a modified out-patient questionnaire from a responsiveness survey designed by the World Health Organization (WHO). Seven hundred and ninety six (796) enrolees, insured for more than one year in Kaduna State-Nigeria, were interviewed. Generalized ordered logistic regression was used to identify factors that influenced the users' perspectives on responsiveness to health services and quantify their effects.
Communication (55.4%), dignity (54.1%), and quality of facilities (52.0%) were rated as "extremely important" responsiveness domains. Users were particularly contented with quality of facilities (42.8%), dignity (42.3%), and choice of provider (40.7%). Enrolees indicated lower contentment on all other domains. Type of facility, gender, referral, duration of enrolment, educational status, income level, and type of marital status were most related with responsiveness domains.
Assessing the responsiveness of health care services within the NHIS is valuable in investigating the scheme's implementation. The domains of autonomy, communication and prompt attention were identified as priority areas for action to improve this responsiveness. For the Nigerian context, we suggest that health care providers in the NHIS should pay attention to these domains, and the associated characteristics of users, when delivering health care services to their clients. Policy makers, and the insurance regulatory agency, should consider the reform strategies of monitoring and quality assurance which focus on the domains of responsiveness to lessen the gap between users' expectations and their experiences with health services.
中低收入国家的医疗服务响应性一直没有得到太多关注。尽管在许多发展中国家十多年前就引入了国家医疗保险计划，但尚未根据医疗服务的响应性对其进行评估。尽管在许多发达国家已经评估了这种响应性，但在发展中国家很少这样做。响应性的概念是多维度的，可以通过各种领域进行衡量，包括及时关注、尊严、沟通、自主权、提供者选择、设施质量、保密性和获得家庭支持。本研究考察了参保用户对其医疗服务响应性的看法。
这是一项回顾性、横断面调查，于 2010 年 10 月至 2011 年 3 月进行。研究使用了世界卫生组织（WHO）设计的响应性调查的修改后的门诊问卷。对在尼日利亚卡杜纳州参保一年以上的 796 名参保人进行了访谈。使用广义有序逻辑回归来确定影响用户对卫生服务响应性看法的因素，并量化其影响。
沟通（55.4%）、尊严（54.1%）和设施质量（52.0%）被评为“极其重要”的响应性领域。用户对设施质量（42.8%）、尊严（42.3%）和提供者选择（40.7%）特别满意。在所有其他领域，参保人表示满意度较低。设施类型、性别、转诊、参保时间、教育程度、收入水平和婚姻状况类型与响应性领域最相关。
在 NHIS 中评估医疗服务的响应性，对于调查该计划的实施情况是有价值的。自主、沟通和及时关注领域被确定为改善这种响应性的优先领域。就尼日利亚的情况而言，我们建议 NHIS 中的医疗保健提供者在向客户提供医疗保健服务时，应关注这些领域以及与用户相关的特征。政策制定者和保险监管机构应考虑关注响应性领域的监测和质量保证改革策略，以缩小用户期望与他们对卫生服务的体验之间的差距。
