ReviewSatisfaction of patients: A right to health indicator?
Introduction
Are there links between the right to health and patient satisfaction? We tried to explore the issue in comparing the right to health constituents to commonly admitted patient satisfaction items having in mind that patient satisfaction might be a useful right to health indicator.
Indeed, the former UN Special Rapporteur on the Right to Health has recently stressed the importance of appropriate indicators in this field and the need for adequate monitoring [1].
He has proposed 72 human rights indicators applied to the health sectors that can/could/should be monitored in each state. Let us mention several indicators to show the extent of expected monitoring: i.e. infant mortality rates, percentage of 1-year-old children immunized against major infant diseases, maternal mortality ratio, prevalence rate of violence against women, percentage of the population (urban and rural) having access to drinking water, existing national heath workforce strategy, proportion of national health budget allocated to mental health, health data protection laws, protection of freedom of expression by the constitution, number of ratified international human rights treaties, etc. Critical voices have underlined that 18 proposed indicators are not monitored by any of the 194 states and even basic indicators such as maternal mortality rates are monitored by less than 50% of the states [2]. Furthermore, it has been reported that the ratification of an international human-rights treaty is no guarantee to the implementation of the right to health [3].
There is a growing concern about monitoring the accountability of states in meeting their human rights obligations. Indeed the concept of progressive realization of the right to health expects states to implement health policies and programs improving the health of the population while considering available resources. This implies that states have a data collection system that allows the monitoring of sensitive, specific and valid indicators of the progress achieved [4], which certainly is of interest for the protection and promotion of human rights, and more specifically the right to health, in a community.
The concept of right to health, as mentioned in article 25 of the Universal Declaration of Human Rights [5] and in article 12 of the International Convention of Cultural, Economic and Social Rights [6] has been a matter of debate: can it be a right to good health or is it rather a right to access to health care services and health promotion programs of any individual, since an absolute right to good health can not be granted by the authorities [7]?
But the concept of the right to health has been on the scene for a long time: Aristoles already has given some thoughts to it: “it is evident that the best is that arrangement according to which anyone whatsoever might do best and live a flourishing life”; Amaryta Sen almost 2500 years later pushes in favour of health being intimately linked to the capability of the individuals and the communities [8].
The General Comment 14/2000 of the Committee on economic, cultural and social rights [9] considers that basic constituents of the right to health are:
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The availability of health services, health infrastructure and public health programs,
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The non-discriminatory (physical, economic, information) access for all to health care and prevention programs,
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The acceptability (ethical, gender-related, cultural) of health services and programs,
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The quality of care, i.e. health procedures and programs must be scientifically and medically sound which in turn implies competent health professionals, adequate medication and appropriate infrastructure.
Patient satisfaction studies are frequently implemented in health services throughout the world [10], [11], [12], [13], [14], [15], [16]. Controversial since considered subjective, yet they are reported as having some impact on the management of health services as well as on the behavior of health professionals [17], [18]. Indeed, patient satisfaction studies allow the integration of the patients view into the functioning of the health sector. They also allow identifying problems and difficulties encountered in the health services as well as gaps in the quality of care [19].
Our article presents a comparative analysis of key-concepts in the field of patient satisfaction and in the field of human rights.
Section snippets
Methods
The concept analysis based on the model developed by Rodgers [20] served as a methodological approach. We identified, clarified, classified and compared key-concepts of the right to health as mentioned in the General Comment 14/2000 [9] and in a selected set of surveys/reviews on patient satisfaction.
The patient satisfaction papers were selected on the frequency citation by Scholar Google for papers I and II. The remaining papers were selected on Medline according to specific care settings
Results
Table 1 shows the correspondence between patient satisfaction items as reported in the various studies and reviews and the right to health essential elements as defined by the General Comment 14/2000 when analyzed through the concept analysis approach of Rodgers [20]:
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Availability of services is identified as a patient satisfaction element in several articles (III, IV, VI, VIII, IX, XI),
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Accessibility to care is reported by all the studies, in various forms (financial, physical, information),
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Discussion
The comparative analysis of the constituents of the right to health as described in the General Comment 14/2000 shows close links between the right to health and patient satisfaction. Indeed, there seems to be straight forward correspondence between the patient satisfaction concepts and the right to health constituents such as availability, accessibility, acceptability and quality of care.
In our study we had selected 11 articles of different socio-cultural backgrounds, of different health
Conclusion
The indicators of the achievement of the right to health cannot in our view be limited to the national and international mechanisms of human rights protection. There must be some integration of a large number of actors of the health sector and related sectors, including patients.
But the integration of patient satisfaction into a pool of indicators monitoring the achievement of the right to health as we propose will need
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establishing an international consensus on the concept of patient
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2020, Journal of Communication DisordersCitation Excerpt :Therefore, measurements of satisfaction can provide useful information for clinical practice (Adhikary et al., 2018; Vargo & Lusch, 2004). Studies which measured parent and patient satisfaction yielded insight into their demands and needs, with the aim of improving service delivery and resource distribution (Bleich, Ozaltin, & Murray, 2009; Mpinga & Chastonay, 2011). Increased satisfaction results in a higher commitment and compliance to care enhancing the envisioned health outcomes (Adhikary et al., 2018; Bleich et al., 2009).