Clients’ Experience and Satisfaction of Utilizing Healthcare Services in a Community Based Health Insurance Program in Bangladesh
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Settings and Sample
2.2. Research Design
2.3. Data Collection
2.4. Data Analysis
2.5. Ethical Approval
3. Results
3.1. Background Characteristics
3.2. Distribution of Health Services Provision-Related Satisfaction on Health Scheme
3.3. Standardized Satisfaction Items Test Scale
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Name of Services | Description of Services |
---|---|
Health benefits | |
Qualified medical doctors consultation | 30 BDT (US$0.39)—Market price 300 BDT (US$3.86) |
Medicine/Drugs | 20% discount on all medicines |
Diagnostic tests | Up to 50% discount on all diagnostic tests |
Specialist doctor consultation (e.g., gynaecologists, cardiologists) | 100 BDT (US$1.29) (Market price = 500 BDT or US$6.44) |
Inpatient care | Maximum 4000 BDT (US$51.45) per household per year |
Periodic satellite clinics | Free of charge is LASP surveillance area |
Non-health benefits | |
Savings Opportunity | Up to 500 BDT (US$6.44) per month per household. Member can withdraw any saved amount with 10% interest after one year period |
Low cost Computer Training Programs (CTP) | For all beneficiaries of LASP, with a cost 1200 BDT (US$15.44), Length of training was three months; market price 4500 BDT (US$58.0) |
Sewing Training (ST) | For all female CBHI beneficiaries; Length of training was three months with free of charge |
Variables | Observation (n) | Percentage (%) |
---|---|---|
Sex | ||
Male | 151 | 64.81 |
Female | 82 | 35.19 |
Age | ||
18–44 | 160 | 68.67 |
45–64 | 64 | 27.47 |
≥65 | 9 | 3.86 |
Education background | ||
No education | 23 | 9.87 |
Primary | 87 | 37.34 |
Secondary | 96 | 41.20 |
Higher secondary | 20 | 8.58 |
Higher | 7 | 3.00 |
Marital status | ||
Unmarried | 16 | 6.87 |
Married | 211 | 90.56 |
Widowed/divorced/Separated | 6 | 2.58 |
Family size | ||
<4 | 11 | 4.72 |
4–5 | 99 | 42.49 |
>5 | 123 | 52.79 |
Occupations | ||
Worker | 52 | 22.32 |
Business | 40 | 17.17 |
Housewife | 72 | 30.9 |
Farmer | 14 | 6.01 |
Services | 28 | 12.02 |
Other | 27 | 11.59 |
Self-reported health states | ||
No problem | 92 | 39.48 |
Some problems | 103 | 44.21 |
Extreme problems | 38 | 16.31 |
Income quintile (BDT) | ||
Q1 (≤8000 BDT) | 48 | 20.61 |
Q2 (8001–12,000 BDT) | 62 | 26.61 |
Q3 (12,001–15,000 BDT) | 34 | 14.59 |
Q4 (15,001–24,000 BDT) | 43 | 18.45 |
Q5 (>24,000 BDT) | 46 | 19.74 |
Total observation, N | 233 | 100.00 |
Domain | Likert 5 Scale of Patient Satisfaction | n (%) | Score | |
---|---|---|---|---|
Mean ± SD | 95% CI | |||
Satisfied with reception of services (N = 233) | (1) Not good | 11 (4.72) | 3.88 ± 1.10 | 3.74 to 4.02 |
(2) A little bit | 13 (5.58) | |||
(3) Quite good | 51 (21.89) | |||
(4) Welcomed nicely | 76 (32.62) | |||
(5) Welcomed greatly | 82 (35.19) | |||
Satisfied with service providers’ attitude towards explaining health problem (N = 233) | (1) Strongly disagree | 3 (1.29) | 4.08 ± 0.93 | 3.96 to 4.20 |
(2) Disagree | 10 (4.29) | |||
(3) Neutral | 44 (18.88) | |||
(4) Agree | 84 (36.05) | |||
(5) Strongly agree | 92 (39.48) | |||
Services providers friendly (N = 233) | (1) Strongly disagree | 2 (0.86) | 4.18 ± 0.79 | 4.08 to 4.28 |
(2) Disagree | 4 (1.72) | |||
(3) Neutral | 32 (13.73) | |||
(4) Agree | 107 (45.92) | |||
(5) Strongly agree | 88 (37.77) | |||
Service providers’ explanations about prescribed medicines (N = 233) | (1) Not explained simply | 3 (1.29) | 4.23 ± 0.81 | 4.12 to 4.33 |
(2) Partly explained | 5 (2.15) | |||
(3) Fairly explained | 23 (9.87) | |||
(4) Has been explained | 107 (45.92) | |||
(5) Been fully explained | 95 (40.77) | |||
Service providers’ explanations about diagnostic tests (N = 149) | (1) Not explained simply | 6 (4.03) | 4.46 ± 0.98 | 4.31 to 4.62 |
(2) Partly explained | 2 (1.34) | |||
(3) Fairly explained | 10 (6.71) | |||
(4) Has been explained | 30 (20.13) | |||
(5) Been fully explained | 101 (67.79) | |||
Satisfied with confidentiality (N = 233) | (1) Strongly disagree | 6 (2.58) | 4.09 ± 0.86 | 3.97 to 4.20 |
(2) Disagree | 5 (2.15) | |||
(3) Neutral | 26 (11.16) | |||
(4) Agree | 122 (52.36) | |||
(5) Strongly agree | 74 (31.76) | |||
Satisfied with staff behaviour (N = 233) | (1) Strongly disagree | 2 (0.86) | 4.18 ± 0.73 | 4.09 to 4.28 |
(2) Disagree | 2 (0.86) | |||
(3) Neutral | 27 (11.59) | |||
(4) Agree | 122 (52.36) | |||
(5) Strongly agree | 80 (34.33) | |||
Satisfied with facility environment (N = 233) | (1) Strongly disagree | - | 4.21 ± 0.70 | 4.12 to 4.30 |
(2) Disagree | 1 (0.43) | |||
(3) Neutral | 34 (14.59) | |||
(4) Agree | 114 (48.93) | |||
(5) Strongly agree | 84 (36.05) | |||
Satisfied with the comprehensive services provided by the clinic (N = 233) | (1) Strongly disagree | 3 (1.29) | 4.09 ± 0.85 | 3.98 to 4.20 |
(2) Disagree | 8 (3.43) | |||
(3) Neutral | 32 (13.73) | |||
(4) Agree | 112 (48.07) | |||
(5) Strongly agree | 78 (33.48) | |||
Overall score | 4.17 ± 0.04 (4.08 to 4.26) |
Variables | Mean Satisfaction Score ± SD | Unadjusted Model | Adjusted Model | ||||
---|---|---|---|---|---|---|---|
Cofficient (SE) | 95% CI | p-Value | Coefficient (SE) | 95% CI | p-Value | ||
Sex | |||||||
Male | 4.09 ± 0.67 | Ref | - | - | Ref | - | - |
Female | 4.31 ± 0.65 | 0.22 (0.09) | (0.04, 0.40) | 0.01 | 0.20 (0.24) | (−0.28, 0.68) | 0.41 |
Age | |||||||
18–44 | 4.13 ± 0.68 | Ref | - | - | |||
45–64 | 4.26 ± 0.64 | 0.14 (0.10) | (−0.05, 0.33) | 0.16 | |||
≥65 | 4.24 ± 0.65 | 0.11 (0.21) | (−0.31, 0.53) | 0.62 | |||
Education background | |||||||
No education | 4.21 ± 0.59 | 0.34 (0.43) | (−0.51, 1.19) | 0.43 | |||
Primary | 4.17 ± 0.69 | 0.30 (0.42) | (−0.53, 1.13) | 0.47 | |||
Secondary | 4.19 ± 0.66 | 0.32 (0.42) | (−0.51, 1.14) | 0.45 | |||
Higher secondary | 4.11 ± 0.55 | 0.24 (0.43) | (−0.61, 1.09) | 0.59 | |||
Higher | 3.88 ± 1.17 | Ref | - | - | |||
Marital status | |||||||
Unmarried | 4.21 ± 0.58 | Ref | - | - | |||
Married | 4.15 ± 0.68 | −0.06 (0.17) | (−0.40, 0.29) | 0.74 | |||
Widowed/divorced/Separated | 4.58 ± 0.47 | 0.37 (0.32) | (−0.26, 1.00) | 0.25 | |||
Family size | |||||||
<4 | 4.63 ± 0.75 | Ref | - | - | Ref | - | - |
4–5 | 4.19 ± 0.71 | −0.43 (0.21) | (−0.85, −0.02) | 0.04 | −0.31 (0.26) | (−0.83, 0.2) | 0.23 |
>5 | 4.11 ± 0.62 | −0.51 (0.21) | (−0.93, −0.10) | 0.01 | −0.35 (0.26) | (−0.87, 0.16) | 0.18 |
Occupations | |||||||
Housewife | 4.29 ± 0.66 | Ref | - | - | Ref | - | - |
Worker | 4.23 ± 0.60 | −0.07 (0.12) | (−0.31, 0.17) | 0.59 | 0.11 (0.25) | (−0.38, 0.61) | 0.65 |
Businessman | 4.03 ± 0.62 | −0.26 (0.13) | (−0.52, 0.00) | 0.05 | 0.01 (0.26) | (−0.49, 0.52) | 0.97 |
Farmer | 4.08 ± 0.62 | −0.21 (0.20) | (−0.59, 0.18) | 0.29 | 0.01 (0.3) | (−0.58, 0.59) | 0.99 |
Services | 4.06 ± 0.70 | −0.23 (0.15) | (−0.52, 0.06) | 0.12 | −0.04 (0.28) | (−0.6, 0.51) | 0.88 |
Other | 4.10 ± 0.88 | −0.19 (0.15) | (−0.49, 0.11) | 0.20 | −0.13 (0.23) | (−0.58, 0.33) | 0.58 |
Self-reported health states | |||||||
No problem | 4.03 ± 0.62 | Ref | - | - | Ref | - | - |
Some problems | 4.18 ± 0.65 | 0.14 (0.09) | (−0.04, 0.33) | 0.13 | 0.11 (0.1) | (−0.09, 0.31) | 0.27 |
Extreme problems | 4.49 ± 0.74 | 0.45 (0.13) | (0.2, 0.7) | 0.00 | 0.37 (0.14) | (0.09, 0.65) | 0.01 |
Income quintile (BDT) | |||||||
Q1 (≤8000 BDT) | 4.00 ± 0.56 | 0.24 (0.14) | (−0.03, 0.51) | 0.08 | 0.05 (0.15) | (−0.25, 0.34) | 0.75 |
Q2 (8001–12,000 BDT) | 4.24 ± 0.72 | 0.35 (0.13) | (0.10, 0.61) | 0.01 | 0.23 (0.14) | (−0.06, 0.51) | 0.12 |
Q3 (12,001–15,000 BDT) | 4.35 ± 0.71 | 0.08 (0.15) | (−0.21, 0.38) | 0.59 | 0 (0.15) | (−0.3, 0.3) | 0.99 |
Q4 (15,001–24,000 BDT) | 4.08 ± 0.69 | 0.10 (0.14) | (−0.18, 0.38) | 0.49 | 0.06 (0.14) | (−0.21, 0.33) | 0.68 |
Q5 (>24,000 BDT) | 4.09 ± 0.61 | Ref | - | - | Ref | - | - |
Observation (N) | 233 | ||||||
VIF Mean (Max) | 3.78 (4.16) | ||||||
Ramsey RESET test | 5.49 (<0.001) | ||||||
R-squared | 11.35% | ||||||
F-statistic | 2.38 (<0.004) |
Domain | N | Sign | Item-Test Correlation | Item-Rest Correlation | Inter-Item Correlation | Alpha |
---|---|---|---|---|---|---|
Satisfied with reception of services | 233 | + | 0.8 | 0.74 | 0.61 | 0.93 |
Satisfied with service providers attitude towards explaining health problem | 233 | + | 0.84 | 0.79 | 0.6 | 0.92 |
Services providers friendly | 233 | + | 0.87 | 0.83 | 0.59 | 0.92 |
Service providers explaining about prescribed medicine | 233 | + | 0.84 | 0.79 | 0.6 | 0.92 |
Service providers explanation about diagnostic tests | 149 | + | 0.64 | 0.54 | 0.63 | 0.93 |
Satisfied with confidentiality | 233 | + | 0.8 | 0.74 | 0.61 | 0.92 |
Satisfied with staff behavior | 233 | + | 0.85 | 0.8 | 0.59 | 0.92 |
Satisfied with facility environment | 233 | + | 0.74 | 0.67 | 0.62 | 0.93 |
Satisfied with clinic provides comprehensive services | 233 | + | 0.82 | 0.76 | 0.6 | 0.92 |
Test scale | 0.61 | 0.93 |
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Sarker, A.R.; Sultana, M.; Ahmed, S.; Mahumud, R.A.; Morton, A.; Khan, J.A.M. Clients’ Experience and Satisfaction of Utilizing Healthcare Services in a Community Based Health Insurance Program in Bangladesh. Int. J. Environ. Res. Public Health 2018, 15, 1637. https://doi.org/10.3390/ijerph15081637
Sarker AR, Sultana M, Ahmed S, Mahumud RA, Morton A, Khan JAM. Clients’ Experience and Satisfaction of Utilizing Healthcare Services in a Community Based Health Insurance Program in Bangladesh. International Journal of Environmental Research and Public Health. 2018; 15(8):1637. https://doi.org/10.3390/ijerph15081637
Chicago/Turabian StyleSarker, Abdur Razzaque, Marufa Sultana, Sayem Ahmed, Rashidul Alam Mahumud, Alec Morton, and Jahangir A.M. Khan. 2018. "Clients’ Experience and Satisfaction of Utilizing Healthcare Services in a Community Based Health Insurance Program in Bangladesh" International Journal of Environmental Research and Public Health 15, no. 8: 1637. https://doi.org/10.3390/ijerph15081637