Performance evaluation of medical services in nine urban public hospitals based on patient reported experience: a cross-sectional survey

Background

The public hospital reform in China was launched in April 2009. Whether patients are satisfied with medical services or not is an important index to measure the effectiveness of the public hospital reform. We aimed to explore whether patients experience improved medical service under the public hospital reform.

Methods

Patient-reported experience measures (PREMs) were used to evaluate medical service performance. We designed a questionnaire to collect patient-reported experiences, using a scoring method based on a scale of one to ten, with one being very poor and ten being excellent. A total of nine urban public hospitals from four provinces (Fujian, Jiangsu, Anhui, and Shanxi) were selected for a field survey in August 2016. We chose two cities as sample sites in each province; one city that had undergone reform and one that had not. In addition, we chose Maanshan city from Anhui province (which underwent public hospital reform well from 2009) as our ‘typical’ sample city. In each city, the biggest general hospital was selected to participate in the study. We ran face-to-face interviews with 2633 patients (we planned to collect data from 200 outpatients and 100 inpatients in each hospital for a sample size 15 times the number of independent variables (20) from nine hospitals. Data were collected from outpatient and emergency patients who had just completed their treatment, inpatients who were being prepared for discharge, or patients who remained in hospital for more than one week. The age of participants was from 0 to 93 (surveys for children under the age of 15 were completed by their parents or guardians), 1199 (45·5%) were male, 1434 (54·5%) were female. We explored factors that might influence performance rating using single-factor analysis of variance and correlation analysis (for example, type of medical insurance, disease diagnosis, disease type, disease severity, and the public hospital reforming policy).

Findings

A total of 2633 participants (a minimum of 268 participants from each hospital) were interviewed, including 1703 outpatients (64·68%) and 930 inpatients (35·32%). Overall, the evaluation of medical services was positive. Question relating to the relationship between doctors and patients had the highest score (7·986), whereas the lowest score was given for question relating to medical service quality and effectiveness (4·917). Question relating to medical costs had a lower score (6·882). The total performance scores differed significantly by patient type, age, sex, marital status, educational level, occupation, type of medical insurance, disease diagnosis, disease type, and disease severity.

Interpretation

The patient–doctor relationship seems to have improved greatly since the initiation of the public hospital reform, but patients' experience of service quality and efficiency, and medical costs remain unsatisfactory. PREMs could reflect improvements to medical services as a result of the urban public hospital reform, and the public hospital reforming policy might improve the service efficiency and medical costs.

Funding

The project is funded by the National Science Foundation of China (number 71473129).