The dimensions of responsiveness of a health system: a Taiwanese perspective.
BACKGROUND
Responsiveness is an indicator used to measure how well a health system performs relative to non-health aspects. This study assessed whether seven dimensions proposed by the World Health Organization (WHO) to measure responsiveness (dignity, autonomy, confidentiality, prompt attention, social support, basic amenities, and choices of providers) are applicable in evaluating the health system of Taiwan.


METHODS
A key informant survey and focus group research were used in this study. The translated WHO proposed questionnaire was sent to 205 nominated key informants by mail, and 132 (64.4%) were returned. We used principal component analysis to extract factors. Linear regression analysis was used to assess the relationship between the total score and the extracted factors. A qualitative content analysis was also carried out in focus group research.


RESULTS
Principal component analysis produced five factors (respect, access, confidentiality, basic amenities, and social support) that explained 63.5% of the total variances. These five factors demonstrated acceptable internal consistency and four of them (except social support) were significantly correlated with the total responsiveness score. The focus group interviews revealed health providers' communication ability and medical ethics were also highly appraised by Taiwanese.


CONCLUSIONS
When the performance of a health system is to be evaluated, elements of responsiveness proposed by WHO may have to be tailored to fit different cultural backgrounds. Four key features illustrate the uniqueness of Taiwanese perspectives: the idea of autonomy may not be conceptualized, prompt attention and choice of providers are on the same track, social support during care is trivially correlated to the total responsiveness score, and accountability of health providers is deemed essential to a health system.
Hsu
Chih-Cheng
CC
Center for Health Policy Research and Development, National Health Research Institutes, Zhunan Town, Miaoli County 350, Taiwan. cch@nhri.org.tw
Chen
Likwang
L
Hu
Yu-Whuei
YW
Yip
Winnie
W
Shu
Chen-Chun
CC
D000328:Adult; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D003142:Communication; D003219:Confidentiality; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D025341:Principal Component Analysis; D011369:Professional-Patient Relations / Q000941:ethics; D011594:Psychometrics / Q000295:instrumentation* / Q000379:methods; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D012941:Social Responsibility; D012944:Social Support; D012945:Social Values / Q000208:ethnology; D011795:Surveys and Questionnaires; D013624:Taiwan; D014944:World Health Organization