Does Descending Resources Reform Improve Patient Satisfaction and Reshape Choice of Care Providers? A Cross-Sectional Study in Zhejiang, China

Patient satisfaction and choice of care providers have been the core concerns of China’s descending resources reform launched in 2013. This health care reform attempts to improve low-level hospitals’ capability and patient satisfaction through compulsory descending of doctors from high-level hospitals, thereby reshaping patients’ behavior (loyalty). The goal of this paper is to explore the determinants of patient satisfaction, and its impact on patient loyalty with an emphasis on low-level hospitals in the reform context. By using a self-made 5-point scale that incorporates socio-demographic variables, reform, and revealed preference into the European Consumer Satisfaction Index model (ECSI), cross-sectional data from 17 hospitals, and 1287 questionnaires in Zhejiang province is collected to conduct empirical research. Satisfaction is measured as ordinary variables with the reform and with the low-level hospitals, respectively. Loyalty is measured by patients’ willingness to choose low-level hospitals when suffering illness or severe illness. Analysis of variance and multiple comparisons are utilized to examine the different level of hospitals. An ordered logit model and ordinary least squares regression are applied to examine the determinants of satisfaction and loyalty. The results indicate that patient satisfaction can be explained by variables of perceived quality, patient expectations, and corporate image. Socio-demographic variable, providers, and the reform also have significant effects. Patients’ satisfaction plays a pronounced role on improving their loyalty. The descending resources reform positively affects low-level hospitals’ capability and patient satisfaction. The cost reduction and convenience significantly increase the reform satisfaction. Capability, medical environment, and accessibility of descending doctors are positively associated with the satisfaction with low-level hospitals. This paper evidences that the descending resources reform is an effective way to reallocate resources in supply side of health service market and reshape patients’ choice of care providers with the accessibility and spillover of descending human capital.

Determinants of Choice of Care Providers During Childbirth in Rural West Bengal, India

The article analyses determinants of choice of care providers during childbirth. Public health facilities provide care for free to all women during childbirth in West Bengal. In addition, a cash incentive is also attached with the service package for poor women who give birth at public health facilities. However, a section of women still prefer to give birth at home and some avail services from private facilities. The article attempts to explore the reasons underlying such difference. This analysis is based on primary data collected from four villages of Jalpaiguri district following multistage sampling method. It involved a survey of 251 households having at least one child below 2 years. Multinomial logistic regression model was used to analyse the data. The results suggest that quality of public health services, rural infrastructure, utilization of antenatal care and conditional cash transfers influenced the choice of care providers. Women who were eligible for and were aware of Janani Suraksha Yojana were less likely to go to private health facilities for childbirth. However, the programme did not seem to be effective in terms of reducing delivery at home.

‘Pathways to choice’ of care setting

ABSTRACTThis article aims to encourage critical reflection about the limitations of the rational choice approach as an explanatory insight to understanding older people's choice-making about their health or social care requirements. It develops an interpretive framework examining how older people engage in the process of choice-making when selecting a care option. Choice-making is conceptualised as a temporal, processual phenomenon, influenced by others, and characterised by an individual's behavioural responses to changing circumstance and lifecourse events. Data are from qualitative interviews with 29 older adults whose choice of care option involved moving to an extra-care setting in Wales (United Kingdom). Transcripts were coded using in-case and constant-comparison approaches, and analysis was undertaken using concepts ofengagementandtemporalityas elements of the choice-making process. Using an inductive approach, a typology of six different ‘pathways to choice’ of care setting was identified; these findings suggest that choosing a care option in later life is a diverse, interactive and time-bound social phenomenon, inadequately captured by the rational choice approach where it is understood more as an individualised, linear and logical process. Recognising that choice-making evolves through time as part of a process shaped by others means service providers will be better positioned to offer opportunities for more preventative-focused interventions which empower older consumers to make planned and informed choices about care options.