Patient satisfaction with health services in Bangladesh

Concern over the quality of health care services in Bangladesh has led to loss of faith in public and private hospitals, low utilization of public health facilities, and increasing outflow of Bangladeshi patients to hospitals in neighbouring countries. Under the circumstances, assessment of the country's quality of health care service has become imperative, in which the patient's voice must begin to play a greater role. This study attempts to identify the determinants of patient satisfaction with public, private and foreign hospitals. A survey was conducted involving inpatients in public and private hospitals in Dhaka City and patients who have experienced hospital services in a foreign country. Their views were obtained through exit polls using probability and non-probability (for foreign hospital patients) sampling procedures. Regression models were derived to identify key factors influencing patient satisfaction in the different types of hospitals. Doctors' service orientation, a composite of 13 measures, is the most important factor explaining patient satisfaction. Policy implications are discussed.     

Public and private hospitals in Bangladesh: service quality and predictors of hospital choice

This study compares the quality of services provided by publicand private hospitals in Bangladesh. The premise of the paperwas that the quality of hospital services would be contingenton the incentive structure under which these institutions operate.Since private hospitals are not subsidized and depend on incomefrom clients (i.e. market incentives), they would be more motivatedthan public hospitals to provide quality services to patientsto meet their needs more effectively and efficiently. This premisewas supported. Patient perceptions of service quality and keydemographic characteristics were also used to predict choiceof public or private hospitals. The model, based on discriminantanalysis, demonstrated satisfactory predictive power.     

Service quality in public and private hospitals in urban Bangladesh: a comparative study

This study compared the quality of services provided by private and public hospitals in urban Bangladesh. Using twenty-four scale items, patient perceptions were sought on five aspects of service quality including responsiveness, assurance, communication, discipline and baksheesh. Because private hospitals are not subsidized, it was felt that the incentive structure would induce them to provide better services than public hospitals on the measures of service quality. This contention was largely supported. The results also indicated that both groups have room for improvement.     

Gearing service quality into public and private hospitals in small islands: empirical evidence from Cyprus

PURPOSE: The purpose of this research is to develop and compare some determinants of service quality in both the public and private hospitals of Northern Cyprus. There is considerable lack of literature with respect to service quality in public and private hospitals. DESIGN/METHOD/APPROACH: Randomly, 454 respondents, who have recently benefited from hospital services in Famagusta, were selected to answer a modified version of the SERVQUAL Instrument. The instrument contained both service expectations and perceptions questions. FINDINGS: This study identifies six factors regarding the service quality as perceived in both public and private Northern Cyprus hospitals. These are: empathy, giving priority to the inpatients needs, relationships between staff and patients, professionalism of staff, food and the physical environment. Research results revealed that the various expectations of inpatients have not been met in either the public or the private hospitals RESEARCH IMPLICATIONS/LIMITATIONS: At the micro level, the lack of management commitment to service quality in both hospital settings leads doctors and nurses to expend less effort increasing or improving inpatient satisfaction. Hospital managers should also satisfy their employees, since job satisfaction leads to customer satisfaction and loyalty. Additionally, hospital administrations need to gather systematic feedback from their inpatients, establish visible and transparent complaint procedures so that inpatients' complaints can be addressed effectively and efficiently. ORIGINALITY/VALUE: The hospitals need to organize training sessions based on the critical importance of service quality and the crucial role of inpatient satisfaction in the health care industry. Future studies should include the remaining regions in Cyprus in order to increase research findings' generalizability. Additionally, including other dimensions such as hospital processes and discharge management and co-ordination may provide further insights into understanding inpatients' perceptions and intentions.     

Choice and evaluation of hospitals in Bangladesh: insights from patients and policy implications

This paper attempts to gain insights into the health care system of Bangladesh from the perspectives of hospital patients. The study is based on survey data obtained from 207 recipients of health care services from 57 hospitals in Dhaka City. Patients' choice of hospital is influenced by referrals of doctors (28.7%), reputation of the hospital (23.7%), referral by family and friends (17.4%), closeness to home (14.9%), cost (7.4%) and other miscellaneous factors (7.9%). The major reason for selecting a particular hospital is for treatment (86%). Only few choose preventive or health maintenance services. Demographic trends indicate that better educated and more affluent people are more likely to seek private hospital care, while those who are less educated and less affluent are more inclined to seek public hospital care. The average length of hospital stay, both for private and public hospitals, was 9.9 days. Longer hospital stays are positively associated with nonavailability of needed medicines, poor upkeep of facilities, need to provide "tips" for services, lack of prompt services, a suffocating environment, and unexplained hospital costs. Average satisfaction rate was 4.85, with private hospitals earning higher average ratings than public facilities. The highest income groups gave the highest quality ratings (5.26) compared to other income groups. Implications of findings for health policy are outlined.     

社会办医发展趋势研究:基于四川省的分析

新医改以来,中央和地方不断出台促进社会办医的有利政策,推动了社会办医迅速发展。本文以四川省为例,利用2002—2014年医院层面的总体数据,从数量、规模、选址及所提供的服务种类4个方面分析社会办医发展趋势,从而为相关政策的制定和完善提供决策依据。研究发现,13年间社会办医发展迅速,非公立医院数量年增幅19.2%;非公立医院规模较小,尽管社会办医提供的诊疗服务占比逐年上升,但截至2014年仍仅占14.5%;社会办医选址集中在经济相对发达的地区,但欠发达地区新增非公立医院的比例逐年提高;提供的服务种类方面,非公立医院与公立医院存在一定差异,由社会办医提供的专科医疗服务构成比更高,主要集中在耳鼻喉、美容整形、心血管等领域。     

不同所有权性质医院住院患者就医体验比较分析-以重庆市为例

目的 比较不同所有权性质医院住院患者就医体验差异。方法 2015年10月利用二阶段随机抽样方法对重庆市主城区不同所有权性质的8家公立医院和8家民营医院共640名住院患者进行问卷调查,采用Likert5级量表进行就医体验满意度评分。结果 2组医院住院患者在年龄、患病首选上的差异具有统计学意义（P＜0.05)。民营医院总体就医体验满意度得分显著高于公立医院（P＜0.05)。主成分回归分析显示,显著影响公立医院住院患者就医体验满意度的因素依次为医疗服务质量、医疗服务可及性、有形性;医疗服务质量、态度和医学伦理、医疗服务可及性、有形性为民营医院的显著影响因素。结论 不同所有权性质医院住院患者就医体验存在显著差异。强化医疗服务的能力建设是提高不同所有权性质医院住院患者就医体验满意度的优先措施。     

Comparing public and private hospital care service quality in Turkey

PURPOSE: The aim of this article is to examine the differences in service quality between public and private hospitals in Turkey. DESIGN/METHODOLOGY/APPROACH: This study applies the principles behind the SERVQUAL model and compares Turkey's public and private hospital care service quality. The study sample contains a total of 200 outpatients. Through the identification of 40 service quality indicators and the use of a Likert-type scale, two questionnaires containing 80-items was developed. The former measured patients' expectations prior to admission to public and private hospital service quality. The latter measured patient perceptions of provided service quality. FINDINGS: The results indicate that inpatients in the private hospitals were more satisfied with service quality than those in the public hospitals. The results also suggest that inpatients in the private hospitals were more satisfied with doctors, nurses and supportive services than their counterparts in the public hospitals. Finally, the results show that satisfaction with doctors and reasonable costs is the biggest determinants of service quality in the public hospitals. ORIGINALITY/VALUE: Consequently, SERVQUAL, as a standard instrument for measuring functional service quality, is reliable and valid in a hospital environment.     

Service quality in the public sector hospitals: a study in India

Most studies on service quality have been conducted in the context of the private sector of the economy. In fact, in the healthcare setting, for a long time, public-sector hospitals were not expected to excel in the provision of service quality. In a country such as India, even now, public-sector hospital staffs enjoy relatively higher salaries, flexible work schedules, and secure employment until retirement. Because patients do not pay for most services, normally they are concerned only about the quality of the core product. The authors indicate that, even in the public sector context, the quality of the physician and that of the clinical support staff significantly impact patient satisfaction. However, the quality of nonclinical support staff is not found to have any significant effect on patient satisfaction.     

Health technology assessment in Belgium

The Belgian healthcare system has a Bismarck-type compulsory health insurance, covering almost the entire population, combined with private provision of care. Providers are public health services, independent pharmacists, independent ambulatory care professionals, and hospitals and geriatric care facilities. Healthcare responsibilities are shared between the national Ministries of Public Health and Social Affairs, and the Dutch-, French-, and German-speaking Community Ministries of Health. The national ministries are responsible for sickness and disability insurance, financing, determination of accreditation criteria for hospitals and heavy medical care units, and construction of new hospitals. The six sickness and disability insurance funds are responsible for reimbursing health service benefits and paying disability benefits. The system's strength is that care is highly accessible and responsive to patients. However, the healthcare system's size remained relatively uncontrolled until recently, there is an excess supply of certain types of care, and there is a large number of small hospitals. The national government created a legal framework to modernize the insurance system to control budgetary deficits. Measures for reducing healthcare expenditures include regulating healthcare supply, healthcare evaluation, medical practice organization, and hospital budgets. The need to control healthcare facilities and quality of care in hospitals led to formal procedures for opening hospitals, acquiring expensive medical equipment, and developing highly specialized services. Reforms in payment and regulation are being considered. Health technology assessment (HTA) has played little part in the reforms so far. Belgium has no formal national program for HTA. The future of HTA in Belgium depends on a changing perception by providers and policy makers that health care needs a stronger scientific base.     

Assessment of Food Safety Knowledge,Attitudes and Practices of Food Service Staff in Bangladeshi Hospitals: A Cross-Sectional Study

Food safety knowledge, attitudes and practices among hospital food service staff are crucial in the prevention of foodborne disease outbreaks, as hospitalized patients are more vulnerable to potential hazards. This study, therefore, sought to assess the food safety knowledge, attitudes and practices of food service staff in Bangladeshi hospitals. A cross-sectional study was conducted among 191 food service staff from seven different hospitals in Dhaka and Chattogram from October 2021 to March 2022 using pretested questionnaires. Multiple linear regression was used to identify the factors associated with the food safety knowledge, attitudes and practices. The findings showed moderate knowledge but high levels of attitudes and practices of food safety among hospital food handlers. Food safety knowledge was significantly higher among males, participants from private hospitals and participants working in a hospital that had a food service supervisor and dietitian in charge of food service operations. Moreover, participants from private hospitals and participants working in a hospital that had a food service supervisor and dietitian in charge of food service operations had more positive attitudes and better practices regarding food safety. Hospital management should consider these factors for enhancing food handlers’ knowledge and increase training and supervision on food safety practices to reduce foodborne diseases and outbreaks.     

Insurance status and waiting times for hospital-based services in Ireland

In Ireland long waits for public hospital services are a feature of the healthcare system, with limited evidence that waits for private hospital services (delivered in both public and private hospitals) are shorter. In 2008, in an attempt to ensure more equitable access to hospital-based services, a ‘common waiting list’ for all patients within public hospitals was proposed. The aim of this paper is to analyse waiting times in Ireland for hospital services for patients with and without private health insurance (PHI) and to examine whether the 2008 reform reduced the differential in waiting. The analysis used data from the 2007 and 2010 health module of the Quarterly National Household survey (QNHS). The impact of insurance status on waiting times was analysed for the period before and after the reforms. A higher proportion of those without PHI were waiting more than three months for hospital services relative to those with PHI. There was no evidence that the 2008 reforms reduced the differential. Anecdotal evidence suggests that the proposals were not fully implemented, although expansion of capacity for private patients’ treatment in private hospitals is a possible confounding factor.     

Comparing public and private hospital care service quality

The study applies the principles behind the SERVQUAL model and uses Donabedian's framework to compare and contrast Malta's public and private hospital care service quality. Through the identification of 16 service quality indicators and the use of a Likert-type scale, two questionnaires were developed. The first questionnaire measured patient pre-admission expectations for public and private hospital service quality (in respect of one another). It also determined the weighted importance given to the different service quality indicators. The second questionnaire measured patient perceptions of provided service quality. Results showed that private hospitals are expected to offer a higher quality service, particularly in the "hotel services", but it was the public sector that was exceeding its patients' expectations by the wider margin. A number of implications for public and private hospital management and policy makers were identified.     

Healthcare waste management in Uganda: management and generation rates in public and private hospitals in Kampala

Aim

The aim of this study was to assess the management, characteristics and generation of healthcare waste (HCW) in public and private hospitals in Kampala City, Uganda.

Methods

We employed mainly qualitative methods through the use of a waste inventory, observations, document review and key informant interviews. The HCW inventory was done to determine the rate of generation of infectious waste and general waste in one public and one private hospital. Observations using an observation checklist were done to establish HCW management practices in three hospitals.

Results

The average generation rate for infectious waste from Nsambya hospital (private hospital) was 0.23?kg/patient/day as compared to 0.25?kg/patient/day for Mulago (public hospital). Generation is influenced by type and state of sickness/condition, the level or seriousness of the sickness, the number of people nursing the patient, the visitation rate/number of people visiting a patient and the items they carry to the ward. These factors can be used by health facility managers to minimize the quantities of healthcare waste generated.

Conclusion

The study found no evidence that either public or private ownership is a decisive factor for the successful management of healthcare waste. However, contracting of healthcare waste management services to a private party as was seen in the public hospital had resulted in improved services and this strategy should also be tried in private hospitals.     

Can privatising selected services benefit the public healthcare system?

The evaluation of empirical data concerning private physician consultations in public hospitals in Greece suggests that privatisation of selected public services can increase patients' freedom of choice and also improve efficiency and quality of services, thus strengthening the supply side in a mixed healthcare system. The 2001 NHS health reform in Greece provides financial incentives to public hospital physicians to consult patients 'privately' at the outpatient clinics, while remaining restrained by certain provisions regarding fees. Competition between public and private hospitals is centrally regulated, and in this case cumulative data show success for the public sector. At the same time, patient satisfaction with the new arrangement measured in this study was very high. It could be argued that, under certain conditions, attracting private funds into a public health system constitutes an opportunity to reinforce the public provision of the system.     

Perceptions of Quality of Care for Serious Illness at Different Levels of Facilities in a Rural Area of Bangladesh

This study was conducted to explore care-seeking for perceived serious morbidities and users'' perceptions about quality of care at different facilities in Matlab, Bangladesh. This is a secondary analysis of baseline community survey data of the Matlab Essential Obstetric Care Project conducted in 2001. Principal component and factor analysis methods were used for computing summary quality and socioeconomic indicators. During perceived serious morbidity of any household member within the last one year, 88.1% (776/881) used health resource outside home. Of them, 25.6% visited informal care providers, 17.8% peripheral public facilities, 7.9% tertiary hospitals, 7.3% facilities of non-governmental organizations, and 41.4% private facilities as the highest healthcare resources. Socioeconomic status and type of morbidity were significant predictors for choice of the highest level of care. Most (86.1%) of those who sought care outside the home were satisfied with the quality of services provided for their last serious morbidities. Users of organized private-sector and tertiary facilities perceived the quality of services better than users of informal care providers and peripheral public facilities. Behaviour and attitude of the service providers and availability of medicines were significant predictors for perceived quality of care. Peripheral public-health facilities were of poor quality and grossly under-used. Further research should explore the technical aspect of quality of care in different facilities, along with perceptions of service providers to design client-focused interventions to impact the use of healthcare services. There is no reason to overlook informal care providers, they should rather be trained and monitored.Key words: Healthcare, Healthcare-seeking behaviour, Health services, Patients'' satisfaction, Quality of care, Bangladesh     

Hospital ownership and efficiency: a review of studies with particular focus on Germany

The German hospital market has been subject over the past two decades to a variety of healthcare reforms. Particularly the introduction of diagnosis-related groups (DRGs) in 2004 aimed to increase efficiency of hospitals. The objective of the paper is to review recent studies comparing the efficiency of German public, private non-profit and private for-profit hospitals. The results of the studies are quite mixed. However, in line with the evidence found in studies from other countries, especially the US, the evidence from Germany suggests that private ownership (i.e., private non-profit and private for-profit) is not necessarily associated with higher efficiency compared to public ownership. This may be a surprising result to many policy makers as private for-profit hospitals are often perceived the most efficient ownership type by the public.     

医院所有制与效率：以德国为关注重点的研究回顾

德国医院市场在过去20年里进行了一揽子医疗改革,特别是在2004年引进了疾病诊断相关分组——以期提高医院效率。本文旨在回顾近期就比较德国公立医院、私立非营利医院和私立营利医院效率所开展的研究。尽管研究结果错综复杂,但结合其他国家,特别是美国的研究证据,德国方面的研究结果表明:与公立医院相比,私立医院(私立非营利和私立营利医院)的运营效率并不一定就高。由于私立营利医院通常都会被认为是最有效率的所有制形式,因此本研究结果对很多决策者来说也许有些意外。     

Public,private, neither,both? Publicness theory and the analysis of healthcare organisations

In England recent health reforms have resulted in a shift of emphasis from targets to outcomes, and to the provision of healthcare by any willing provider. The outcomes described encompass clinical and public service outcomes such as choice and access. The range of organisations providing healthcare services is large and increasing. Whilst many are clearly located in either the public or private sectors, others have features of both public and private organisations, and are not easily characterised as either one or the other. Analytical frameworks are generally underdeveloped, and have not kept pace with changes in organisation forms. This article reviews how public and private organisations have been compared in organisation theory, describes previous work on dimensional publicness in both non-healthcare and healthcare organisations, and presents a publicness grid for hospitals in England. Publicness is defined as a characteristic of an organisation which reflects the extent to which the organisation is influenced by political authority. In establishing a link between publicness and public service outcomes it is suggested that core publicness, dimensional publicness (consisting of political and economic authority) and normative publicness (public sector values) all have to be taken into account, since all have an impact on these outcomes. A framework is described that can be used to map the relationships between public service outcomes and publicness. How the framework can be applied in practice to healthcare organisations is described through the development of appropriate indicators and measures. Publicness theory can help health administrators and researchers understand and better manage public service outcomes. Some of the research questions that might be addressed using this approach are considered. Further development of the publicness concept in healthcare is advocated.