Patient Preference and Adherence (Aug 2022)
Quality Perceptions and Choice of Public Health Facilities: A Mediation Effect Analysis of Outpatient Experience in Rural China
Abstract
Shuying Yin,1,2 Min Hu,1 Wen Chen1 1Department of Health Economics, School of Public Health, Fudan University, Shanghai, People’s Republic of China; 2Research Department I, Shenzhen Health Development Research and Data Management Center, Shenzhen, People’s Republic of ChinaCorrespondence: Wen Chen; Min Hu, The Department of Health Economics, School of Public Health, Fudan University, No. 187 Box, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, People’s Republic of China, Tel +86 13818325486 ; +86 17717031079, Email [email protected]; [email protected]: Outpatients have choices of providers in the hierarchical health service delivery system of China. Understanding how quality perceptions and outpatient experience affect the choice of health facility would help inform decisions about priorities for action aimed at guiding the use of primary care. This study examines how quality perceptions of outpatient service affect the facility level choice in rural China.Methods: Household surveys were conducted in 2011, 2012 and 2015 in Ningxia Hui Autonomous Region, China. We selected 968 respondents as the study sample, who had at least two outpatient visits to the public health facilities during each survey period. Prior quality perceptions of the outpatient service at the village clinics, township centers, and county hospitals were reported on an 8-item Quality Indicator questionnaire. Experienced quality perception from the first outpatient visit was also reported. The outcome of interest was outpatients’ facility level choices. We used regression and mediation analysis to explore whether and how outpatient experience at a specific health facility would mediate the relationship between prior quality perceptions and the facility level choice.Results: Overall, the quality perception was positively and significantly associated with outpatients’ staying at the same or lower levels of care (β=0.265, P=0.007). This effect was fully mediated by experienced quality perception (z=2.985, P=0.003). The indirect effect was significant for three particular dimensions, including quality perceptions of the environment (β=0.075, P=0.025), doctor-patient communication (β=0.065, P=0.022), and physician ability (β=0.062, P=0.021).Conclusion: Outpatient quality perceptions—especially positive perceptions regarding environment, doctor-patient communication, and physician ability—could contribute to minimizing upward referral via improvement in outpatient experience. Policymakers and health care providers may need to therefore optimize outpatient experience as they push to develop a more locally responsive primary care system.Keywords: perceived quality, choice of provider, outpatient care, questionnaire, China
