Liu Xiaofang, Yang Fang, Cheng Wenwei, Wu Yanyan, Cheng Jin, Sun Weichu, Yan Xiaofang, Luo Mingming, Mo Xiankun, Hu Mi, Lin Qian, Shi Jingcheng
Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, 410078, China.
The Third Xiangya Hospital of Central South University, Changsha, China.
BMC Public Health. 2020 Aug 5;20(1):1201. doi: 10.1186/s12889-020-09277-1.
There have been few studies on satisfaction with integrated basic medical insurance for urban and rural residents (URRBMI), and satisfaction with URRBMI is not very high because of the complexity of its policies and differences among the insured. The aim of the present study was to explore the factors that influence satisfaction with URRBMI in China and to provide scientific suggestions to the government for how to effectively manage and improve the policy.
An explanatory sequential design of mixed methods research was used. A quantitative research using a three-stage stratified cluster sampling method was used to randomly select the guardians of pupils who participated in URRBMI (n = 1335). The quantitative research was conducted to calculate the latent variables' scores and path coefficients between latent variables using SmartPLS3.0. With public trust, public satisfaction, and perceived quality as the target variables, important-performance analysis (IPA) was used to explore the important but underperforming factors, which were the key elements to improving satisfaction with URRBMI. A purposeful sampling strategy according to satisfaction level was used to obtain qualitative research subjects from among the quantitative research subjects. A qualitative research was conducted using semi-structured interviews, and the thematic analysis method was used to summarize the interview data.
The three strongest paths were perceived quality to public satisfaction, with a total effect of 0.737 (t = 41.270, P < 0.001); perceived quality to perceived value, with a total effect of 0.676 (t = 31.964, P < 0.001); and public satisfaction to public trust, with a total effect of 0.634 (t = 31.305, P < 0.001). IPA revealed that public satisfaction and perceived quality were key factors for public trust and that perceived quality was of high importance for public satisfaction but had low performance. The policy quality was a determining factor for perceived quality. The qualitative research results showed that the most unsatisfactory aspect for the insured was the policy quality.
This study found that improving quality is key to improving public satisfaction with and public trust in URRBMI. The government should improve the compensation level by broadening the channel of financing for the URRBMI fund, rationally formulating reimbursement standards, and broadening the scope of the drug catalog and the medical treatment projects. The government should establish a stable financing growth mechanism and effective methods of providing health education to improve public satisfaction and public trust.
关于城乡居民基本医疗保险（URRBMI）满意度的研究较少，由于其政策复杂且参保人员存在差异，URRBMI的满意度不是很高。本研究的目的是探讨影响中国URRBMI满意度的因素，并为政府如何有效管理和改进该政策提供科学建议。
采用混合方法研究的解释性序列设计。定量研究使用三阶段分层整群抽样方法，随机选取参加URRBMI的小学生监护人（n = 1335）。定量研究使用SmartPLS3.0计算潜变量得分和潜变量之间的路径系数。以公众信任、公众满意度和感知质量为目标变量，采用重要性-绩效分析（IPA）来探索重要但表现不佳的因素，这些因素是提高URRBMI满意度的关键要素。根据满意度水平采用有目的抽样策略，从定量研究对象中获取定性研究对象。采用半结构化访谈进行定性研究，并使用主题分析法总结访谈数据。
三条最强路径分别是感知质量对公众满意度，总效应为0.737（t = 41.270，P < 0.001）；感知质量对感知价值，总效应为0.676（t = 31.964，P < 0.001）；公众满意度对公众信任，总效应为0.634（t = 31.305，P < 0.001）。IPA显示，公众满意度和感知质量是公众信任的关键因素，感知质量对公众满意度非常重要但表现较差。政策质量是感知质量的决定因素。定性研究结果表明，参保人员最不满意的方面是政策质量。
本研究发现，提高质量是提高公众对URRBMI满意度和公众信任的关键。政府应通过拓宽URRBMI基金筹资渠道、合理制定报销标准、扩大药品目录和医疗服务项目范围来提高补偿水平。政府应建立稳定的筹资增长机制和有效的健康教育提供方式，以提高公众满意度和公众信任。
