The effects of citizenship status on service utilization and general satisfaction with healthcare: a cross-cultural study.

OBJECTIVE

To explore the role of citizenship status as a predictor of general satisfaction with healthcare services in Qatar, including potential interaction with utilization and health insurance coverage type.

DESIGN

A cross-sectional survey conducted in 2012.

SETTING

A household survey in the State of Qatar in the Arab Gulf.

PARTICIPANTS

A nationally representative sample of 2750 citizens and noncitizens aged 18 years and older.

MAIN OUTCOME

General satisfaction status with Qatar's healthcare system.

MEASURES

Citizenship status, healthcare utilization, health insurance type.

RESULTS

Citizens were significantly less likely to be satisfied with Qatar's healthcare system than noncitizens (odds ratio (OR) = 0.30, P < 0.001). The association between private health insurance and overall satisfaction was not significantly different between citizens and noncitizens (P = 0.19). However, the association between utilization of healthcare services and overall satisfaction was moderated by citizenship (P < 0.001). Among citizens, non-users were less likely to be satisfied than recent users (OR = 1.88, P < 0.05), while the opposite pattern was observed among noncitizens (OR = 0.51, P < 0.05). These patterns persisted even after controlling for potential confounders.

CONCLUSIONS

The study revealed significant population differences in satisfaction between recent users and non-users within citizenship groups. These differences may stem from different expectations with respect to healthcare services. Understanding these expectations may have important policy implications for cross-cultural contexts.