title: Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries.
abstract: The measurement of consumer satisfaction is an essential part of the assessment of health care services in terms of service quality and health care system responsiveness. Studies across Europe have described various strategies health care users employ to secure services with good quality and quick access. In Central and Eastern European countries, such strategies also include informal payments to health care providers. This paper analyzes the satisfaction of health care users with the quality of and access to health care services. The study focuses on six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine).
  
  
  
  We use data on past experience with health care use collected in 2010 through uniform national surveys in these countries. Based on these data, we carry out a multi-country analysis to investigate factors associated with the satisfaction of health care users in the six countries.
  
  
  
  The results indicate that about 10-14 % of the service users are not satisfied with the quality of, or access to health care services they used in the preceding year. However, significant differences across countries and services are observed, e.g. the highest level of dissatisfaction with access to outpatient services (16.4 %) is observed among patients in Lithuania, while in Poland, the level of dissatisfaction with quality of outpatient and inpatient services are much lower than dissatisfaction with access. The study also analyses the association of users' satisfaction with factors such as making informal payments, inability to pay and relative importance of service attributes stated by the service users.
  
  
  
  These multi-country findings provide evidence for health policy making in the Central and Eastern European countries. Although the average rates of satisfactions per country are relatively high, the results suggest that there is ample room for improvements. Specifically, many service-users still report dissatisfaction especially those who pay informally and those unable to pay. The high shares of informal payments and inability of users to deal with the health expenditures lead to doubts about the fairness of the health care provision in Central and Eastern Europe. There is an urgent need for policy makers in the region to not only acknowledge but also to effectively address this key problem.
authors.affiliation: School of Public Health, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine. chernysh@ukma.kiev.ua.
authors.forename: Tetiana
authors.initials: T
authors.lastname: Stepurko
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Milena
authors.initials: M
authors.lastname: Pavlova
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.|Topinstitute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Groot
mesh_terms: D000288:Administrative Personnel; D000328:Adult; D003430:Cross-Sectional Studies; D005061:Europe, Eastern; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008097:Lithuania; D008297:Male; D010549:Personal Satisfaction; D011787:Quality of Health Care; D044469:Racial Groups; D055815:Young Adult
keywords: Central and Eastern Europe; Consumer satisfaction; Hospitalization; Informal patient payments; Outpatient service