Background
Methods
Study setting
Sampling
Questionnaire
Domain name | Definition (also provided in the interview manual) |
---|---|
Prompt attention | This meant patients have short travel times and convenient access to health care facilities. They obtain fast care in emergencies and have short waiting times for appointments and consultations. Tests get done quickly. |
Dignity | This is termed patients are shown respect by greetings before talking to them. Physical examinations are conducted in privacy and in a way that respects their cultural norms. |
Communication | This meant the provider listens carefully to patients and explains things so patients can understand. Patients have time to ask questions, if they don’t understand something. |
Autonomy | This is termed patients are involved in deciding on their treatment if they want to. The provider asks patients for permission before starting treatments or tests. |
Choice | This meant patients are able to choose their health care provider (place or person) and allowed to consult for a second opinion or with a specialist, if so desired. |
Quality of facilities | This refers to having enough space, seating places and fresh air in the waiting and examination rooms as well as hospital wards. It includes a clean facility and clean toilets in the hospital. |
Statistical analysis
Independent variables | Categories | Frequency | Percentage |
---|---|---|---|
Type of facility visited | Public | 435 | 54.7 |
Private | 361 | 45.3 | |
Age | <40 years | 387 | 48.6 |
≥40 years | 409 | 51.4 | |
Sex | Male | 431 | 54.2 |
Female | 365 | 45.8 | |
Educational status1
| Lower education | 247 | 31.0 |
Higher education | 549 | 69.0 | |
Monthly income level (US$)2
| ≤187 dollars | 239 | 30.0 |
>187 dollars | 557 | 70.0 | |
Type of marital status | Polygamy | 187 | 23.5 |
Others3
| 609 | 76.5 | |
Duration of enrolment | ≤2 years | 282 | 35.4 |
>2 years | 514 | 64.6 | |
12 months visits to HCPs*
| 1–3 visits | 231 | 29.0 |
>3 visits | 565 | 71.0 | |
Referral after enrolment4
| Yes | 363 | 45.6 |
No | 433 | 54.4 | |
Total N (%) | 796 | 100 |
Results
Health insurance users’ (respondents) characteristics, expectations and experience related to responsiveness of health care services
Domains responses | Prompt attention travel and short waiting times (%) | Dignity respectful treatment (%) | Communication clarity of communication (%) | Autonomy involvement in decision making (%) | Choice of provider patient choice of providers’ (%) | Quality of facilities good quality of surroundings (%) |
---|---|---|---|---|---|---|
Extremely important | 307 (38.6) | 431 (54.1) | 441 (55.4) | 278 (34.9) | 319 (40.1) | 414 (52.0) |
Very important | 365 (45.9) | 312 (39.2) | 319 (40.1) | 366 (46.0) | 372 (46.7) | 296 (37.2) |
Moderately important | 99 (12.4) | 35 (4.4) | 19 (2.4) | 111 (13.9) | 83 (10.4) | 66 (8.3) |
Slightly important | 16 (2.0) | 10 (1.3) | 9 (1.1) | 29 (3.7) | 11 (1.4) | 11 (1.4) |
Not important | 9 (1.1) | 8 (1.0) | 8 (1.0) | 12 (1.5) | 11 (1.4) | 9 (1.1) |
Total | 796 (100) | 796 (100) | 796 (100) | 796 (100) | 796 (100) | 796 (100) |
Domains responses | Prompt attention travel and short waiting times (%) | Dignity respectful treatment (%) | Communication clarity of communication (%) | Autonomy involvement in decision making (%) | Choice of provider patient choice of providers’ (%) | Quality of facilities good quality of surroundings (%) |
---|---|---|---|---|---|---|
Very good | 230 (28.9) | 308 (38.7) | 254 (31.9) | 172 (21.6) | 222 (27.9) | 320 (40.2) |
Good | 314 (39.5) | 337 (42.3) | 304 (38.2) | 299 (37.6) | 324 (40.7) | 341 (42.8) |
Moderate | 199 (25.0) | 96 (12.1) | 165 (20.7) | 221 (27.7) | 189 (23.8) | 92 (11.6) |
Bad | 36 (4.5) | 31 (3.9) | 53 (6.7) | 71 (8.9) | 32 (4.0) | 19 (2.4) |
Very bad | 17 (2.1) | 24 (3.0) | 20 (2.5) | 33 (4.2) | 29 (3.6) | 24 (3.0) |
Total | 796 (100) | 796 (100) | 796 (100) | 796 (100) | 796 (100) | 796 (100) |
Health insurance users’ factors that influences responsiveness domains
Independent variables | Prompt attention1
| Dignity1
| Communication1
| |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Coef. | SE | p-value | Impact | Coef. | SE | p-value | Impact | Coef. | SE | p-value | Impact | |
Type of facility visited | ||||||||||||
Private (ref.) | ||||||||||||
Public | −0.68 | 0.14 | <0.001 | 0.51 | −0.67 | 0.14 | <0.001 | 0.51 | −1.31a
| 0.63 | 0.039 | 0.27 |
−0.02b
| 0.25 | 0.923 | 1.02 | |||||||||
0.56c
| 0.17 | <0.001 | 1.55 | |||||||||
0.60d
| 0.16 | <0.001 | 1.57 | |||||||||
Age | ||||||||||||
≥40 years (ref.) | ||||||||||||
<40 years | −0.06 | 0.14 | 0.693 | 0.94 | −0.01 | 0.15 | 0.968 | 0.99 | 0.02 | 0.15 | 0.895 | 1.02 |
Sex | ||||||||||||
Female (ref.) | ||||||||||||
Male | 0.38 | 0.13 | 0.004 | 1.47 | 0.27 | 0.13 | 0.042 | 1.32 | 0.21 | 0.13 | 0.123 | 1.23 |
Educational Status | ||||||||||||
Higher education (ref.) | ||||||||||||
Lower education | 0.20 | 0.15 | 0.217 | 1.22 | −0.33 | 0.16 | 0.033 | 0.71 | −0.05 | 0.16 | 0.759 | 0.95 |
Monthly income level | ||||||||||||
>187 US dollars (ref.) | ||||||||||||
≤187 US dollars | 0.24 | 0.16 | 0.140 | 1.27 | 0.06 | 0.16 | 0.691 | 1.06 | 0.36 | 0.16 | 0.029 | 1.43 |
Type of marital status | ||||||||||||
Others (ref.) | ||||||||||||
Polygamy | −0.07 | 0.15 | 0.678 | 0.94 | 0.04 | 0.17 | 0.818 | 1.04 | −0.30 | 0.16 | 0.063 | 0.74 |
Enrolment duration | ||||||||||||
>2 years (ref.) | ||||||||||||
≤2 years | 0.54a
| 0.59 | 0.365 | 1.71 | 0.18 | 0.14 | 0.216 | 1.19 | 0.24a
| 0.55 | 0.665 | 0.99 |
0.06b
| 0.30 | 0.837 | 1.06 | 0.31b
| 0.26 | 0.964 | 1.27 | |||||
0.44c
| 0.17 | 0.012 | 1.55 | 0.35c
| 0.18 | <0.001 | 1.42 | |||||
−0.07d
| 0.17 | 0.684 | 0.93 | 0.63d
| 0.16 | 0.033 | 1.89 | |||||
12 months visits to HCPs*
| ||||||||||||
>3 visits (ref.) | ||||||||||||
1–3 visits | −0.55a
| 0.55 | 0.320 | 0.58 | 0.23 | 0.14 | 0.110 | 1.26 | −0.32a
| 0.46 | 0.484 | 0.73 |
−1.12b
| 0.37 | 0.003 | 0.33 | −0.05b
| 0.26 | 0.849 | 0.95 | |||||
−0.45c
| 0.17 | 0.008 | 0.63 | −0.66c
| 0.18 | <0.001 | 0.51 | |||||
−0.16d
| 0.17 | 0.360 | 0.85 | 0.12d
| 0.17 | 0.489 | 1.13 | |||||
Referral after enrolment | ||||||||||||
No (ref.) | ||||||||||||
Yes | −0.05a
| 0.49 | 0.918 | 0.95 | 0.88a
| 0.46 | 0.053 | 2.42 | −1.28a
| 0.52 | 0.013 | 0.28 |
0.28b
| 0.29 | 0.329 | 1.33 | 0.39b
| 0.29 | 0.170 | 1.48 | −0.31b
| 0.25 | 0.220 | 0.74 | |
0.49c
| 0.16 | 0.002 | 1.57 | −0.06c
| 0.18 | 0.729 | 0.94 | −0.73c
| 0.16 | <0.001 | 0.48 | |
0.55d
| 0.17 | 0.001 | 1.61 | −0.42d
| 0.15 | 0.006 | 0.66 | −0.84d
| 0.16 | <0.001 | 0.43 | |
Constant | 4.17a
| 0.59 | <0.001 | 64.72 | 3.27a
| 0.31 | <0.001 | 26.31 | 5.28a
| 0.78 | <0.001 | 196.18 |
3.39b
| 0.40 | <0.001 | 29.62 | 2.56b
| 0.26 | <0.001 | 12.95 | 2.22b
| 0.32 | <0.001 | 9.24 | |
1.18c
| 0.23 | <0.001 | 3.27 | 1.60c
| 0.22 | <0.001 | 4.94 | 1.54c
| 0.24 | <0.001 | 4.67 | |
−0.58d
| 0.21 | 0.007 | 0.55 | −0.24d
| 0.21 | 0.024 | 0.78 | −0.60d
| 0.22 | 0.005 | 0.54 |
Independent variables | Autonomy1
| Choice of provider1
| Quality of facilities1
| |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Coef. | SE | p-value | Impact | Coef. | SE | p-value | Impact | Coef. | SE | p-value | Impact | |
Type of facility visited | ||||||||||||
Private (ref.) | ||||||||||||
Public | 1.16a
| 0.43 | 0.006 | 3.20 | −0.36 | 0.13 | 0.008 | 0.70 | −0.92 | 0.14 | <0.001 | 0.40 |
0.85b
| 0.22 | <0.001 | 2.34 | |||||||||
−0.34c
| 0.15 | 0.025 | 0.71 | |||||||||
−0.41d
| 0.17 | 0.020 | 0.66 | |||||||||
Age | ||||||||||||
≥40 years (ref.) | ||||||||||||
<40 years | 0.69a
| 0.39 | 0.074 | 1.99 | −0.23 | 0.14 | 0.107 | 0.79 | 0.04 | 0.15 | 0.765 | 1.05 |
0.41b
| 0.22 | 0.067 | 1.51 | |||||||||
−0.15c
| 0.16 | 0.367 | 0.86 | |||||||||
−0.17d
| 0.18 | 0.361 | 1.19 | |||||||||
Sex | ||||||||||||
Female (ref.) | ||||||||||||
Male | 0.25 | 0.13 | 0.057 | 1.28 | −0.14a
| 0.37 | 0.708 | 0.87 | 0.09 | 0.14 | 0.522 | 1.09 |
−0.08b
| 0.27 | 0.764 | 0.92 | |||||||||
0.02c
| 0.16 | <0.001 | 2.04 | |||||||||
0.17d
| 0.16 | 0.883 | 1.02 | |||||||||
Educational Status | ||||||||||||
Higher education (ref.) | ||||||||||||
Lower education | 0.33a
| 0.44 | 0.453 | 1.39 | 0.14 | 0.15 | 0.363 | 1.16 | −0.37 | 0.16 | 0.025 | 0.69 |
−0.21b
| 0.24 | 0.378 | 0.81 | |||||||||
−0.36c
| 0.17 | 0.041 | 0.44 | |||||||||
−0.06d
| 0.20 | 0.754 | 0.93 | |||||||||
Monthly income level | ||||||||||||
>187 US dollars (ref.) | ||||||||||||
≤187 US dollars | 0.20 | 0.16 | 0.220 | 1.21 | 0.29 | 0.16 | 0.073 | 1.34 | 0.69 | 0.17 | <0.001 | 1.70 |
Type of marital status | ||||||||||||
Others (ref.) | ||||||||||||
Polygamy | −0.39 | 0.16 | 0.014 | 0.68 | −0.32 | 0.16 | 0.044 | 0.72 | −0.11 | 0.16 | 0.505 | 0.90 |
Duration of enrolment | ||||||||||||
>2 years (ref.) | ||||||||||||
≤2 years | 0.33 | 0.14 | 0.019 | 1.39 | 0.49 | 0.14 | 0.001 | 1.62 | 0.03 | 0.15 | 0.836 | 1.03 |
12 months visits to HCPs*
| ||||||||||||
>3 visits (ref.) | ||||||||||||
1–3 visits | −0.14 | 0.14 | 0.315 | 0.87 | 0.61a
| 0.37 | 0.106 | 1.83 | 0.23a
| 0.42 | 0.578 | 1.26 |
1.06b
| 0.27 | <0.001 | 2.90 | 0.37b
| 0.32 | 0.241 | 1.45 | |||||
0.16c
| 0.17 | 0.343 | 1.17 | −0.47c
| 0.21 | 0.028 | 0.63 | |||||
0.32d
| 0.18 | 0.074 | 1.38 | −0.25d
| 0.17 | 0.128 | 0.77 | |||||
Referral after enrolment | ||||||||||||
No (ref.) | ||||||||||||
Yes | 0.28a
| 0.41 | 0.501 | 1.32 | 1.03a
| 0.44 | 0.019 | 2.81 | −0.81 | 0.14 | <0.001 | 0.44 |
0.18b
| 0.22 | 0.408 | 1.20 | 0.47b
| 0.27 | 0.081 | 1.60 | |||||
−0.34c
| 0.15 | 0.023 | 0.71 | −0.39c
| 0.16 | 0.014 | 0.67 | |||||
−0.57d
| 0.18 | 0.002 | 0.56 | −0.65d
| 0.17 | <0.001 | 0.52 | |||||
Constant | 1.98a
| 0.35 | <0.001 | 7.26 | 2.71a
| 0.41 | <0.001 | 15.09 | 4.10a
| 0.36 | <0.001 | 60.34 |
1.12b
| 0.24 | <0.001 | 3.09 | 1.84b
| 0.29 | <0.001 | 6.30 | 3.40b
| 0.29 | <0.001 | 30.11 | |
0.50c
| 0.21 | 0.015 | 1.66 | 0.51c
| 0.22 | 0.020 | 1.66 | 2.58c
| 0.25 | <0.001 | 13.17 | |
−1.12d
| 0.23 | <0.001 | 0.32 | −0.96d
| 0.23 | <0.001 | 0.38 | 0.22d
| 0.21 | 0.029 | 1.25 |