title: Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care.
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China.
authors.forename: Linghan
authors.initials: L
authors.lastname: Shan
authors.affiliation: Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China.
authors.forename: Ding
authors.initials: D
authors.lastname: Ding
authors.affiliation: Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China.
authors.forename: Qunhong
authors.initials: Q
authors.lastname: Wu
authors.affiliation: School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
authors.forename: Chaojie
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China.
authors.forename: Mingli
authors.initials: M
authors.lastname: Jiao
authors.affiliation: Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China.
authors.forename: Yanhua
authors.initials: Y
authors.lastname: Hao
authors.affiliation: The Forth Affiliated Hospital of Harbin Medical University.
authors.forename: Yuzhen
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China.
authors.forename: Jiejing
authors.initials: J
authors.lastname: Hao
authors.affiliation: Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China.
authors.forename: Weilan
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China.
authors.forename: Jiaojiao
authors.initials: J
authors.lastname: Ren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005251:Fees, Medical; D005260:Female; D006306:Health Surveys; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D019458:Insurance Coverage; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D005791:Patient Care; D017060:Patient Satisfaction; D011787:Quality of Health Care; D035502:Trust; D055815:Young Adult