Hong Zhuang, Lu Jing, Chen Gang, Tang Qi, Sun Heqi, Wei Ting, Zhao Sitang, Lu Jun
School of Public Health, Fudan University, Shanghai, China.
Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China.
Ann Med. 2025 Dec;57(1):2446693. doi: 10.1080/07853890.2024.2446693. Epub 2025 Jan 4.
Evaluation of health system responsiveness (HSR) can improve patient satisfaction, promote health equity and enhance the quality of health services.
To explore the differences in HSR among medical institutions at different levels and in various domains.
A multi-stage stratified sampling method was used to select 820 participants aged 18 years and older from Kunshan City, China. Analysis of variance was used for univariate analysis. Linear regression and ordinal logistics were applied to explore the relationship between different hospital levels and HSR. Forest plots were used to illustrate the relationship between each domain and the hospital level.
The relationship between hospital level and HSR remained significant ( < 0.05). Compared with primary healthcare institutions, secondary hospitals had lower HSR scores (β = -1.47, 95%CI = [-2.15, -0.79], < 0.001). Similarly, tertiary hospitals had lower HSR scores compared with primary healthcare institutions (β = -1.54, 95%CI = [-2.39, -0.70], < 0.001). The study found that attention, communication, basic amenities, social support, and the choice of healthcare providers were lower in secondary hospitals compared to primary healthcare institutions (OR < 1; < 0.05). In tertiary hospitals, attention, communication, autonomy, basic amenities, social support, and the choice of healthcare provider were lower compared to primary healthcare institutions (OR < 1; < 0.05).
By comparing the HSR of hospitals at different levels, the study identified areas for improvement. Particularly, urgent improvements are needed in prompt attention, communication, basic amenities, social support and the choice of healthcare providers.
卫生系统响应性（HSR）评估可提高患者满意度、促进卫生公平并提升卫生服务质量。
探讨不同级别医疗机构及各领域HSR的差异。
采用多阶段分层抽样方法，从中国昆山市选取820名18岁及以上的参与者。采用方差分析进行单因素分析。应用线性回归和有序逻辑回归探讨不同医院级别与HSR之间的关系。森林图用于说明各领域与医院级别之间的关系。
医院级别与HSR之间的关系仍然显著（<0.05）。与基层医疗机构相比，二级医院的HSR得分较低（β = -1.47，95%CI = [-2.15, -0.79]，<0.001）。同样，与基层医疗机构相比，三级医院的HSR得分较低（β = -1.54，95%CI = [-2.39, -0.70]，<0.001）。研究发现，与基层医疗机构相比，二级医院在关注、沟通、基本设施、社会支持和医疗服务提供者选择方面较低（OR < 1；<0.05）。在三级医院中，与基层医疗机构相比，关注、沟通、自主性、基本设施、社会支持和医疗服务提供者选择较低（OR < 1；<0.05）。
通过比较不同级别医院的HSR，该研究确定了改进领域。特别是，在及时关注、沟通、基本设施、社会支持和医疗服务提供者选择方面迫切需要改进。
