Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China.
Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
Front Public Health. 2022 May 2;10:800612. doi: 10.3389/fpubh.2022.800612. eCollection 2022.
China is attempting to establish a voluntary contracting system in primary care. This study aimed to determine the degree of consumer satisfaction with the entitlements of contract arrangements and its associated factors.
A stratified cluster sampling strategy was adopted to recruit study participants from three administrative districts of Hangzhou municipality, each containing six residential communities. In each community, 50 households were recruited. A questionnaire was administered through face-to-face interviews with members of the households who signed a contract with community health centers, to collect data regarding their sociodemographic characteristics, health conditions, and knowledge of and attitudes toward the contract entitlements. Consumer satisfaction was measured using six items rated on a five-point Likert scale ranging from "1=very dissatisfied" to "5=very satisfied" and a summed score was calculated. A mixed linear regression model was established to identify individual predictors of consumer satisfaction after adjustment of the random (intercept) effect of household clusters.
Overall, the respondents reported low levels of awareness and understanding of the contract entitlements, with an average knowledge score of 8.21 (SD = 3.74) out of a maximum possible of 19. The respondents had relatively lower levels of satisfaction (satisfied or very satisfied) with their prioritized entitlements (51.5%) and hospitals at home and telemedicine services (31.3%), compared with the contract and insurance policies (85.5%) and medical services provided (87.0%). Female gender, older age, chronic conditions, and perceived better health were associated with higher levels of satisfaction, while poor awareness and knowledge were associated with lower levels of satisfaction.
The study participants perceived limited benefits from the contract arrangements in primary care, which may jeopardize the policy purpose of the arrangements to encourage patients to use primary care as the first contact point in accessing health care services. It is evident that consumer satisfaction with the contract entitlements varies by healthcare needs. Lower levels of satisfaction are associated with poor awareness and knowledge of the entitlements.
中国正试图在基层医疗保健中建立自愿签约制度。本研究旨在确定消费者对合同安排的权益的满意度程度及其相关因素。
采用分层聚类抽样策略，从杭州市三个行政区招募研究参与者，每个行政区包含六个居民区。在每个社区，招募 50 户家庭。通过与与社区卫生中心签订合同的家庭成员进行面对面访谈，使用问卷收集他们的社会人口统计学特征、健康状况、以及对合同权益的了解和态度等数据。使用六点李克特量表（1=非常不满意，5=非常满意）对六项消费者满意度进行评分，并计算总分。建立混合线性回归模型，在调整家庭聚类的随机（截距）效应后，确定消费者满意度的个体预测因素。
总体而言，受访者对合同权益的认知和理解程度较低，19 分制下平均知识得分 8.21（SD=3.74）。受访者对其优先权益（51.5%）和家庭医院和远程医疗服务（31.3%）的满意度相对较低，而对合同和保险政策（85.5%）和提供的医疗服务（87.0%）的满意度较高。女性、年龄较大、慢性病和自我感知健康状况较好与较高的满意度相关，而较差的认知和知识与较低的满意度相关。
研究参与者认为从初级保健中的合同安排中获得的收益有限，这可能危及安排的政策目的，即鼓励患者将初级保健作为获得医疗服务的第一联系点。显然，消费者对合同权益的满意度因医疗保健需求而异。较低的满意度与对权益的认知和知识不足有关。
