Socioeconomic inequality in public satisfaction with the healthcare system in China: a quantile regression analysis

Outpatient pooling policy and healthcare satisfaction among middle-aged and older adults: evidence from China

OBJECTIVE

Previous studies have shown that health insurance and financial burden affect satisfaction with healthcare. This study aims to examine the relationship between China's outpatient pooling policies and healthcare satisfaction among middle-aged and older adults. Additionally, it investigates how demographic, socioeconomic, health status, healthcare utilization, and regional healthcare resource variables influence satisfaction levels.

METHODS

Using data from the 2015 and 2018 China Health and Retirement Longitudinal Study, a mixed-effects ordered logit model was employed to assess the relationship between outpatient pooling policies and healthcare satisfaction.

RESULTS

Outpatient pooling policies for Urban Employee Basic Medical Insurance were significantly associated with higher healthcare satisfaction (AOR = 1.29, 95% CI = [1.03, 1.62]), with particularly strong effects observed in the middle (AOR = 2.55, 95% CI = [1.05, 6.18]) and eastern regions of China (AOR = 3.05, 95% CI = [1.46, 6.39]). Higher financial levels of outpatient insurance protection were also associated with greater healthcare satisfaction (AOR = 1.44, 95% CI = [1.11, 1.86]). However, no significant association was observed regarding the outpatient pooling policies for Urban and Rural Residents Basic Medical Insurance. Additionally, demographic, socioeconomic, health, and healthcare utilization variables, along with regional healthcare resources, were significantly associated with healthcare satisfaction.

CONCLUSIONS

This study highlights the role of implementing outpatient pooling policies, especially a higher level of protection under these policies, in improving healthcare satisfaction among middle-aged and elderly individuals in China.

Confidence in China's healthcare system: a focus on lower-middle class

BACKGROUND

During the post-pandemic era, there has been growing anxiety regarding health security, especially among the middle class worldwide. The public's confidence in the healthcare system encompasses their expectations and perceptions of the healthcare system's ability to meet their needs without financial hardship. This study aims to examine the disparities of confidence and to identify potential vulnerable subgroups.

METHODS

Adopting the China General Social Survey (CGSS) 2021, we performed multivariate logistic regression to analyze the associations between confidence level and socioeconomic classes, controlling for demographics.

RESULTS

Among all respondents (n = 2341), 71% reported confidence. However, respondents identified as lower-middle class had the least likelihood of reporting confidence (OR = 0.64, p = 0.006) compared to the lowest social class. De facto married respondents had 21% lower odds of confidence (OR = 0.78, p = 0.046) compared to unpartnered respondents.

CONCLUSIONS

Our findings reveal that, contrary to expectations, the lower-middle class in China-rather than the lowest social strata-exhibits the least confidence in the healthcare system. This low confidence appears closely linked to heightened insecurity about downward social mobility stemming from catastrophic healthcare expenditure. Moreover, married individuals also revealed low level of confidence in the healthcare system. These results underscore the urgent need for universal healthcare policies in China and similar emerging economies that specifically address the unique health security concerns of the lower-middle class and consider the dynamics inherent in marriages and families associated.

Trends and inequalities in health system satisfaction: results from the latest nationally representative surveys in Qatar

BACKGROUND

Health system satisfaction is an important but understudied indicator of health system performance. It has far-reaching implications for sustainability but has been widely understudied particularly for non-European settings. Qatar represents a growing international experience of rapid development requiring steadfast system funding and reorganisation. After decades of unprecedented immigration and nearly free health care, Qatar sought to expand the system by 2016, reorganise it by 2022, and accelerate private funding and health system outcomes by 2030.

AIM

The aim of this study is to conduct a comprehensive assessment of health system satisfaction in Qatar, in anticipation of the 2024-2030 health reforms, with a particular emphasis on detailed policy attribution and the formulation of recommendations. The overarching aim of this study is to contribute to the limited body of international literature on health system satisfaction, particularly in non-European contexts, with a focus on specific populations such as migrants, labourers, and labour camp residents.

METHODS

We analysed the levels of, and individual inequalities in, health system satisfaction in Qatar between 2012 and 2014. Descriptive statistics were employed to assess satisfaction levels, while inequalities were examined using logit analysis. The satisfaction variables encompass the key aspects of health system provision and management, whereas the individual variables are focused on their attributability to Qatar's specific health policy context, including regionally distinct socio-economic groups.

FINDINGS

Health system satisfaction levels in Qatar were relatively high in both 2012 and 2014, particularly regarding service provision, though they did not reach exceptionally high levels. Both satisfaction dimensions-provision and management-improved in 2014, with management showing more rapid progress. However, males, Qatari citizens, individuals with chronic disease, labourers, and residents of the largest labour camps were less likely to express satisfaction with the system.

CONCLUSION

Qatar's satisfaction trends and inequalities between 2012 and 2014 emphasise the significance of both dedicated efforts and effective organisational structures in maintaining high levels of health system satisfaction during periods of rapid development. To ensure continued satisfaction, performance, and sustainability throughout the 2024-2030 reforms, it is essential to address unresolved organisational constraints before eroding dedicated efforts through increased private health funding.

Public satisfaction with health system after healthcare reform in China

BACKGROUND

The Chinese central government launched the third phase of health system reforms in 2009. After a decade since the initiation of the reform, the health system has witnessed noteworthy gains. However, there is no concurrent improvement in public satisfaction with the health system. This study analysed various factors that influence public satisfaction with the system and examined whether perceived quality of care affects public satisfaction.

METHODS

A longitudinal nationally representative survey was used for this study. We used five waves of China Family Panel Studies (CFPS) survey data. The final sample consisted of 145 843 observations. A two-way fixed-effects ordered logistic model was used for the analysis.

RESULTS

The results indicate that perceived good quality of care was positively associated with public satisfaction in health system regardless of rural-urban residence. Older adults and individuals with more than 3 years of college education were less likely to be satisfied with the system in rural areas. Personal income and the density of medical professionals in the geographic area tend to improve public satisfaction in rural areas. Having medical insurance coverage and fair or good self-rated health improved the probability of reporting public satisfaction in urban areas. Married people and individuals who lived in the West region were less likely to be satisfied with the health system in urban areas.

CONCLUSIONS

Knowledge and skills of healthcare providers or physical quality of facilities are not sufficient in improving public satisfaction in the health system. Policymakers need to identify options to influence the important factors that affect public perception of the system. This analysis identified several policy-amenable factors to improve public perception of the health system in rural and urban China.

Exploring Older Adults' Perceived Affordability and Accessibility of the Healthcare System: Empirical Evidence from the Chinese Social Survey 2021

The difficulties in accessibility and affordability of healthcare services have posed persistent challenges to the Chinese government ever since the 1990s. This research aimed to explore the perceived accessibility and affordability of the healthcare system, which is also referred to as the social problem of Kan Bing Nan, Kan Bing Gui among older Chinese adults. The research, based on 2169 sample data points from the Chinese Social Survey (CSS) 2021 database, explored the objective and subjective factors in constructing the public perceptions of accessibility and affordability of the healthcare system among both older adult users and older adult non-users of healthcare services, including healthcare expenditure variables, patient experience variables, financial protection variables, and social evaluation variables. The study utilized binary logistic regression analysis to investigate how four different sets of independent variables impact the perceived affordability and accessibility of the healthcare system by older adults. The research found that Kan Bing Nan, Kan Bing Gui was considered the most pressing issue among the older adults in China. Self-reported medical burdens, the cost of healthcare services, and the perceived fairness of public healthcare services were significantly associated with older adults' perceived affordability and accessibility of the healthcare system.