A Comparative Analysis of Satisfaction among Clients on the Kisiizi Hospital Community Insurance Scheme and Non-Insured Clients at Kisiizi Hospital, Rukungiri District

Abstract

Introduction: Patients’ satisfaction is considered core to quality of health care. In the developed world, patients’ satisfaction surveys have improved quality of healthcare delivery and have become a mandatory issue in almost all French hospitals. In Germany, it is measured annually to help improve quality of healthcare delivery. However, the surveys have received scanty attention in sub Saharan Africa. In Uganda particularly, there is an imbalance of power between providers and users of health services. Studies in Kabale reported lack of patients’ satisfaction with healthcare services. Similarly another report also showed dissatisfaction leading to Health workers attrition from Bushenyi District. Although it is assumed that insured patients are more satisfied with the care that they receive, this has not been comprehensively studied in Kisizi hospital. Aim: This study sought to compare patient satisfaction with health care among insured versus uninsured patients and the factors associated with health satisfaction among the two groups. Methods: The study was a cross-sectional comparative analysis of patient satisfaction levels among insured and uninsured patients at Kisiizi Hospital. Data was collected using an interviewer administered questionnaire with a validated and standardized satisfaction measurement tool. A total of 700 respondents, 350 in each financing option were interviewed at the outpatient department. Modified Poisson regression was used to assess the strength of association between selected factors and satisfaction. Analysis was conducted using Stata® software version 13 to determine the factors most strongly associated with perceptions of quality and satisfaction with health care among the insured and uninsured. Results: The percentage of satisfied patients in the uninsured group was 64% compared to 53.71% of the insured patients who reported being generally satisfied with health care (p=0.002). The factors that were significantly associated with satisfaction for the uninsured were education, interpersonal aspects, communication and access. For the insured, income, interpersonal aspects, financial aspects and access were the factors most strongly associated with satisfaction. Conclusion: Paying patients are happier with their care than those on insurance. We recommend that insured patient expectations are studied and managed for better satisfaction outcomes.