Patient satisfaction with hospital inpatient care: Effects of trust, medical insurance and perceived quality of care

Linghan Shan, Ye Li, Ding Ding, Qunhong Wu, Chaojie Liu, Mingli Jiao, Yanhua Hao, Yuzhen Han, Lijun Gao, Jiejing Hao, Lan Wang, Weilan Xu, Jiaojiao Ren

Research output: Contribution to journalArticlepeer-review

49 Scopus citations

Abstract

Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736-1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215-0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust the most significant predictor of patient satisfaction is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders.

Original languageEnglish (US)
Article numbere0164366
JournalPLoS One
Volume11
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine
  • General Biochemistry, Genetics and Molecular Biology
  • General Agricultural and Biological Sciences

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