Peng XinXin, Zhang Jing Hua
School of Business, Macao University of Science and Technology, Macao S.A.R., China.
School of Business, Jiangsu University of Technology, Changzhou, China.
Arch Public Health. 2022 Jul 8;80(1):165. doi: 10.1186/s13690-022-00925-z.
As China pursues better social equality and improvement in public services (healthcare), public satisfaction has been considered as a key performance indicator. There is a great need to better understand the disparities and inequalities in the public satisfaction with its healthcare system.
Based on Chinese General Social Survey (CGSS) 2015 ( a set of nationally representative survey data, the most recent wave containing information about public satisfaction with the healthcare system), this study utilizes the quantile regression method to analyze how the public satisfaction at high or low quantile of the score distribution varies according to the socio-economic status and healthcare system performance indicators, especially in rural areas.
This study found that, at the highest percentile, better Self-Reported-Health (SRH) is associated significantly with a lower satisfaction score (coefficient -4.10, P < 0.01). High socioeconomic status (especially "above average" group) has higher satisfaction scores at both mean (coefficient 3.74, P<0.01) and median (coefficient 3.83, P<0.01). This effect is also significant across the lower quantiles of the satisfaction levels. West and Middle region (the less developed regions) tended to be more satisfied, whereas those in Northeast reported a large negative effect (coefficient -7.07, P < 0.01) at the median. While rural residents generally reported higher levels of satisfaction, rural residents' preference regarding hospital beds and primary care access seems generally to be opposite to that of urban residents.
Our findings suggest that the ongoing healthcare reform needs to integrate more preventive care to meet the healthy residents' expectation and demands. More attention should be guided to the vulnerable healthcare system in the Northeast region, which has a stagnant local economy. Outcome-based quality care is especially preferred in rural healthcare, in addition to improvement of utilization and access. In addition, the "pro-rich" inequality is an ongoing concern about the system.
随着中国追求更好的社会平等和公共服务（医疗保健）改善，公众满意度被视为一项关键绩效指标。非常有必要更好地了解公众对其医疗保健系统满意度方面的差异和不平等情况。
基于2015年中国综合社会调查（CGSS）（一组具有全国代表性的调查数据，最新一轮包含有关公众对医疗保健系统满意度的信息），本研究采用分位数回归方法来分析得分分布的高或低分位数处的公众满意度如何根据社会经济地位和医疗保健系统绩效指标而变化，特别是在农村地区。
本研究发现，在最高百分位数处，更好的自我报告健康状况（SRH）与较低的满意度得分显著相关（系数为-4.10，P < 0.01）。高社会经济地位（特别是“高于平均水平”组）在均值（系数为3.74，P < 0.01）和中位数（系数为3.83，P < 0.01）处均有较高的满意度得分。这种影响在满意度水平的较低分位数处也很显著。西部和中部地区（较不发达地区）往往更满意，而东北地区的受访者在中位数处报告有较大的负面影响（系数为-7.07，P < 0.01）。虽然农村居民总体上报告的满意度较高，但农村居民对病床和基层医疗服务可及性的偏好似乎总体上与城市居民相反。
我们的研究结果表明，正在进行的医疗改革需要整合更多的预防保健措施，以满足健康居民的期望和需求。应更多关注东北地区脆弱的医疗保健系统，该地区当地经济停滞不前。除了提高利用率和可及性外，农村医疗保健尤其需要基于结果的优质护理。此外，该系统中“有利于富人”的不平等现象一直令人担忧。
