Medical School of Nantong University, Nantong, 226001, Jiangsu, China.
Library and Reference Department, The First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China.
BMC Public Health. 2021 Oct 19;21(1):1886. doi: 10.1186/s12889-021-11947-7.
China has successfully sustained its universal health insurance coverage over the past decade. Although patient satisfaction has been recognized as an important indicator to measure the performance of insurance programs in China, there is a lack of evidence on how patients with chronic diseases are satisfied with China's public health insurance programs and whether their satisfaction differs by type of insurance. We aimed to fill the evidence gap.
We established a hypothetical model that comprised patients' awareness of insurance policies, the fulfillment of patients' expectations of insurance benefits, patients' perceived value of health insurance coverage, patients' satisfaction with health insurance programs, patients' complaints, and trust in health insurance programs. We performed a confirmatory factor analysis by using a structural equation modeling (SEM) approach to examine the hypothesized model. A model-testing survey in 10 tertiary hospitals was conducted between June and October 2018, with a valid sample of 922 insured patients with chronic diseases.
The SEM model, with good fit indices, showed that patients' awareness of health insurance policies, insurance program's fulfillment of expectations, and patients' perceived value of insurance coverage, positively predicted patient satisfaction (P < 0.01). The fulfillment of patients' expectations of insurance benefits was the major predictor of satisfaction with health insurance (coefficient = 0.593, P < 0.001), while the patients' perceived value of insurance coverage had the largest impact on their trust in health insurance (coefficient = 0.409, P < 0.01). Compared to patients with Urban-Rural Resident Basic Medical Insurance, Urban Employee Basic Medical Insurance enrollees had a higher degree of satisfaction with insurance on average (P < 0.01). Despite differences in the degree of satisfaction, the main findings from the SEM were also proved by the multi-group analysis.
Our findings highlight the importance of incorporating patients' perceived value as part of the ongoing efforts to increase satisfaction with health insurance by patients, especially those who have chronic diseases. Policymakers are also suggested to formulate evidence-informed reimbursement policies that meet patients' expectations.
中国在过去十年中成功地维持了全民健康保险的覆盖范围。尽管患者满意度已被认为是衡量中国保险计划绩效的一个重要指标，但缺乏有关慢性病患者对中国公共健康保险计划的满意度以及他们的满意度是否因保险类型而异的证据。我们旨在填补这一证据空白。
我们建立了一个假设模型，该模型包括患者对保险政策的认识、患者对保险福利期望的满足程度、患者对健康保险覆盖范围的感知价值、患者对健康保险计划的满意度、患者的投诉和对健康保险计划的信任。我们使用结构方程模型（SEM）方法进行验证性因子分析，以检验假设模型。我们于 2018 年 6 月至 10 月在 10 家三级医院进行了一项模型测试调查，共纳入 922 名患有慢性病的参保患者。
具有良好拟合指数的 SEM 模型表明，患者对健康保险政策的认识、保险计划对期望的满足程度以及患者对保险覆盖范围的感知价值均正向预测患者的满意度（P<0.01）。满足患者对保险福利的期望是影响患者对健康保险满意度的主要因素（系数=0.593，P<0.001），而患者对保险覆盖范围的感知价值对其对健康保险的信任影响最大（系数=0.409，P<0.01）。与参加城乡居民基本医疗保险的患者相比，参加城镇职工基本医疗保险的患者对保险的满意度平均更高（P<0.01）。尽管满意度存在差异，但 SEM 的主要发现也通过多组分析得到了证实。
我们的研究结果强调了将患者的感知价值纳入提高患者对健康保险满意度的持续努力中的重要性，尤其是对患有慢性病的患者。决策者还应制定符合患者期望的基于证据的报销政策。
