Aliyeva Sholpan, Lokshin Vyacheslav, Kamaliev Maksut, Sarmuldayeva Sholpan, Kaldybayev Gani, Tsigengagel Oxana
Department of Clinical Disciplines, Kazakhstan's Medical University "Kazakhstan School of Public Health", Almaty, Kazakhstan.
Department of Gynecological, JSC Central Clinical Hospital, Almaty, Kazakhstan.
Front Glob Womens Health. 2025 Jul 25;6:1580888. doi: 10.3389/fgwh.2025.1580888. eCollection 2025.
Patient satisfaction is a key indicator of healthcare quality. Although crucial, limited research has explored factors contributing to satisfaction disparities in outpatient obstetric-gynecological care, particularly in Kazakhstan. The objective of the study is to explore disparities in satisfaction with obstetric-gynecological care between insured and uninsured women in Almaty, Kazakhstan, and to identify the key determinants of patient satisfaction.
A cross-sectional survey was conducted among 107 insured and uninsured patients over three months in early 2024 at a hospital in the Almaty region, Kazakhstan. Using a five-point Likert scale, a structured questionnaire assessed socio-demographics, patient-reported experiences with the care process, and overall satisfaction across 16 dimensions. The survey instrument was pilot-tested and demonstrated strong internal consistency (Cronbach's alpha = 0.83). Chi-square tests examined associations, and multivariable logistic regression identified key predictors of patient satisfaction.
A multivariable analysis revealed a "satisfaction paradox": insured patients had lower odds of being satisfied compared to uninsured patients (AOR = 0.15, 95% CI: 0.03-0.81). Specifically, a lack of insurance was associated with higher reported satisfaction in doctor-patient communication (OR = 1.8) and nursing care (OR = 2.1). Other significant predictors of satisfaction included having kidney disease and a shorter hospital stay.
Our findings suggest that expanding insurance coverage is necessary for access but insufficient for ensuring patient satisfaction. The observed "satisfaction paradox" highlights that policy must adopt a dual focus: promoting enrolment while simultaneously improving the quality of patient-provider interactions to meet the higher expectations of insured patients.
患者满意度是医疗质量的关键指标。尽管至关重要，但针对门诊妇产科护理中导致满意度差异的因素，尤其是在哈萨克斯坦，相关研究有限。本研究的目的是探讨哈萨克斯坦阿拉木图有保险和无保险女性在妇产科护理满意度上的差异，并确定患者满意度的关键决定因素。
2024年初，在哈萨克斯坦阿拉木图地区的一家医院，对107名有保险和无保险的患者进行了为期三个月的横断面调查。使用五点李克特量表，一份结构化问卷评估了社会人口统计学特征、患者报告的护理过程体验以及16个维度的总体满意度。该调查问卷进行了预测试，显示出很强的内部一致性（克朗巴哈系数=0.83）。卡方检验用于检验相关性，多变量逻辑回归用于确定患者满意度的关键预测因素。
多变量分析揭示了一个“满意度悖论”：与无保险患者相比，有保险患者满意度较低的几率更高（调整后比值比=0.15，95%置信区间：0.03-0.81）。具体而言，没有保险与在医患沟通（比值比=1.8）和护理（比值比=2.1）方面报告的较高满意度相关。其他满意度的重要预测因素包括患有肾病和住院时间较短。
我们的研究结果表明，扩大保险覆盖范围对于获得医疗服务是必要的，但不足以确保患者满意度。观察到的“满意度悖论”凸显出政策必须采取双重重点：促进参保，同时提高医患互动质量，以满足参保患者更高的期望。
