title: Patient dissatisfaction in China: What matters.
abstract: Patient satisfaction is a focal concern of health-care delivery and an expected outcome of medical care. Recently, the violent conflict between doctors and patients in China has intensified. Patient dissatisfaction has been recognized as an important concern and an urgent issue in the reform of China's health care. The objectives of this study are to investigate the determinants of patient dissatisfaction attributed to patient, hospital, and health-care market characteristics, as well as to explore the major determinants in the context of China. Data from 2007 to 2010 Urban Resident Basic Medical Insurance Survey (URBMIS) are used in this study. A total of 13,336 patients are selected conditional on health-care utilization. Analysis of satisfaction is based on outpatient utilization (last 2 weeks' reference, 6393 individuals) and inpatient utilization (last 1-year reference, 6943 individuals). Satisfaction was measured as ordinal variables (scales 1-5). Ordinary least squares (OLS) regression and an ordered probit model are applied to investigate the determinants. Blinder-Oaxaca decomposition is further employed to detect the proportion each predictor's contribution. The results indicate that patients' gender, education, and insurance status are significantly related to patient satisfaction. Higher-level hospitals are found to negatively correlate with patient satisfaction. Lower competition in providers' market and a higher market share of private hospitals are found to positively correlate with patient dissatisfaction. Meanwhile, the survey indicates that "medical charges too expensive" is chiefly responsible for patient dissatisfaction. Our study provides empirical evidence on the determinants of patient dissatisfaction in China. In particular, the results indicate that establishing a high competition among various providers in the health-care market will act as a "double-edged sword," with great policy implications.
authors.affiliation: West China School of Public Health, Sichuan University, Chengdu, China; West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
authors.forename: Jay
authors.initials: J
authors.lastname: Pan
authors.affiliation: Institute of Regional Economics and Finance, College of Economics, Sichuan Agricultural University, Chengdu, China; Mannheim Institute of Public Health, Social and Prevention Medicine, University of Heidelberg, Mannheim, Germany. Electronic address: liudanren@googlemail.com.
authors.forename: Dan
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Health Science, University of York, York, UK.
authors.forename: Shehzad
authors.initials: S
authors.lastname: Ali
mesh_terms: D000328:Adult; D002681:China; D004522:Educational Status; D005260:Female; D018166:Health Care Reform; D016304:Hospitals, Private / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D008962:Models, Theoretical; D017060:Patient Satisfaction / Q000191:economics*; D012737:Sex Factors
keywords: China; Determinant; Inpatient; Outpatient; Patient satisfaction