The quality of health care services by health insurance at district hospitals in Thai Nguyen province

n general and assessment about the quality of health care services by health insurance in Thai Nguyen province in particular. Therefore, the dissertation is new and has no overlap with other scientific works. The dissertation uses SERVPERF model as research method. 6 CHAPTER 2: SCIENTIFIC BASIS OF HEALTH CARE SERVICES QUALITY BY HEALTH INSURANCE 2.1. Theoretical basis 2.1.1. Health care services by health insurance 2.1.1.1. The concept of service 2.1.1.2. The concept of medical service Medical service is a particular public goods and services, meeting the basic needs of people and the community, including two groups of services in the expanded public sector: Group of on- demand health care services, health care services by health insurance and groups of public health services such as disease prevention... are undertaken by the State or private. 2.1.1.3. The concept of health care service 2.1.1.4. The concept of health insurance Health insurance is an economic relationship associated with the mobilization of resources from the participants' contributions to the formation of insurance fund and is used to pay the medical costs for the insured when they have illnesses and diseases. 2.1.1.5. The concept and characteristics of health care services by health insurance a. Concept Health care service by health insurance is the service of medical facilities licensed provide medical examination and treatment with the health insurance perform medical examination (asking for disease, exploiting medical history, physical examination, when necessary, indicate subclinical testing, functional exploration to diagnose and prescribe appropriate and recognized treatments) and cure (using recognized professional and technical methods and approved drugs circulation, on the list of health insurance for emergency, treatment, care and rehabilitation) for patients by health insurance (patients with health insurance and using health insurance for medical examination and treatment). b. Characteristics 7 (i) Inseparability; (ii) Heterogeneity of nature; (iii) Invisible; (iv) Cannot archive. 2.1.1.6. Methods of medical payment by health insurance 2.1.2. The quality of health care service by health insurance 2.1.2.1. Service quality a. Concept b. The components of service quality + Quality in terms of technique; + Quality in terms of function. 2.1.2.2. Quality of health care service a. The concept of health care service quality Health care service quality is the quality of the inputs, process and outputs factors of the health care service and is the patient's perceived level, measured by the patient satisfaction when use medical services. Health care service quality includes two separate components: functional quality and professional, technical quality. b. The quality evaluation of health care services (i) Approach from the authorities and health facilities (ii) Approach from the patient 2.1.2.3. The concept and characteristics of health care service quality by health insurance a. Concept The quality of health care services by health insurance is the quality of the inputs, process and outputs factors of health care services covered by health insurance and is the perception of patients, measured by the satisfaction of patients using health care services by health insurance at a medical facility. b. Characteristics of health care service quality by health insurance (i) The quality of health care services by health insurance is measured by the satisfaction of the needs (satisfaction level) of the insured patients. 8 (ii) The quality of health care services by health insurance is inconsistent. (iii) The quality of health care services by health insurance can be quantified or only perceived qualitatively. 2.1.2.4. Theoretical models of health care service quality by health insurance 2.1.2.5. Component factors of health care services quality by health insurance a. Based selection of the quality components of health care services by health insurance included in the model b. Factors contributing to the quality of health care services by health insurance (i) Reliability; (ii) Responsiveness; (iii) Service capacity; (iv) Empathy; (v) Tangibles; (vi) Administrative Procedures for health care services by health insurance. 2.1.2.6. Improve the quality of health care service by health insurance a) The concept of improving the quality of health care service by health insurance Improving the quality of health care service by health insurance is simultaneously improving three aspects of the quality of health care services by health insurance: Quality for patients; professional quality and management quality. b) The content of improving health care service quality by health insurance Improve the quality of the inputs, process and output factors of health care services by health insurance (or quality of technical expertise and quality of functions). It is aimed at improving the quality of the elements of health care service quality by health insurance. c) Theories about improving the quality of health care services by health insurance (1) Improve the quality of health care services by RBF model 9 (2) Improve the quality of health care services by 5S model 2.1.3. Customer satisfaction 2.1.3.1. The concept of customer satisfaction Customer satisfaction is the satisfaction or the level of customer perception about service quality. 2.1.3.2. Patient satisfaction about the quality of healthcare services Patient satisfaction about the health care service quality by health insurance is the level of satisfaction or the level of perception (evaluation) of the patient about the factors of health care services quality by health insurance when using health care service by health insurance at the hospital. 2.1.4. The relationship between service quality and customer satisfaction Service quality is the factor greatly affecting customer satisfaction. Service quality and customer satisfaction have a close relationship with each other, in which service quality is created first and determines customer satisfaction. In other words, service quality is the premise of satisfaction, so service quality should not be measured without evaluating customer satisfaction. 2.1.5. Functions and duties of district hospitals in the medical facility system 2.2. Practical basis 2.2.1. Experience in improving the quality of health care services by health insurance in some domestic medical facilities 2.2.1.1. Applying the pilot RBF model in district hospitals and district health centers in Nghe An province 2.2.1.2. The process of 5S implementation in some hospitals 2.2.1.3. Experiences of some other hospitals in improving the quality of health care services by health insurance a. Quality of health care services by health insurance at Bach Mai hospital b. Quality of health care services by health insurance at Hospital K 10 c. Quality of health care services by health insurance in Ho Chi Minh City 2.2.2. Lessons to improve health care service quality by health insurance for district general hospitals in Thai Nguyen province Lesson 1: Applying the RBF model Lesson 2: Implementing the "5S" quality management model Lesson 3: Implement the program "Improving the quality of health care service in medical facilities for the purpose of meeting the satisfaction of insured patients". CHAPTER 3: RESEARCH METHODS 3.1. Research questions of dissertation 1 - What is the quality of health care services by health insurance? What are the components of the quality of health care services by health insurance? What factors affecting patient satisfaction about the quality of health care services by health insurance? 2 - What is the reality of the situation of health care service by health insurance at district hospitals in Thai Nguyen province in the past years? How was health care quality assurance by health insurance carried out in district hospitals in Thai Nguyen province? 3 - What factors affecting patient satisfaction about the quality of health care services by health insurance at district hospitals in Thai Nguyen province? 4 - What solutions should be taken to further improve the quality of health care services by health insurance at district hospitals in Thai Nguyen province? 3.2. Approach method 3.2.1. Approach from the authorities and medical facilities 3.2.2. Approach from the patient 3.3. Analytical framework 3.3.1. The basis of the analytical framework 3.3.2. Analytical framework 11 12 3.4. Research hypothesis (i) Hypothesis 1 (H1): Component factors of health care service quality by health insurance positively affect patient satisfaction about the quality of health care services by health insurance. (ii) Hypothesis 2 (H2): There is no significant difference between the patient satisfaction about the quality of health care services by health insurance according to their socio-demographic characteristics. 3.5. Defining variables 3.5.1. The independent variables 3.5.1.1. Factors belonging to the patient's socio-demographic characteristics (Gender; Age; Education level; Ethnicity; Occupation; Income; Objects participating in health insurance; Beneficiaries of health care costs covered by health insurance) 3.5.1.2. The component elements of health care services quality by health insurance (Reliability; Responsiveness; Service Capacities; Empathy; Tangibles; Administrative Procedures for Health care service by Health Insurance) 3.5.2. Dependent variable Patient satisfaction about the quality of health care services by health insurance. 3.6. Research Methods 3.6.1. Methods of data collection 3.6.1.1. Collect secondary data 3.6.1.2. Collect primary data  Select a study point  Sample selection: (i) Determine the object surveyed (ii) Determine the number of sample units (iii) Content of the surveyed + Scale of health care service quality 13 + Scale of patient satisfaction about the quality of health care services by health insurance + Mean of average value in the interval scale (iv) Methods of survey (v) Characteristics of the overall sample 3.6.2. Methods of processing and synthesizing information 3.6.2.1. Check the information 3.6.2.2. Arrange the information 3.6.3. Information analysis method 3.6.3.1. Secondary data analysis method a) Descriptive statistical method b) Method of comparison 3.6.3.2. Primary data analysis method a) Research process b) Qualitative analysis method c) Quantitative analysis method - Methods of testing the reliability of the scale - Cronbach's Alpha - Exploratory factor analysis method - Multi-variable regression analysis method - Verify the difference between patient satisfaction about the quality of health care services by health insurance according to the individual characteristics of the patient 3.7. Research indicator system 3.7.1. Indicators reflect the quality of health care services by health insurance approaching from managers and medical facilities 3.7.1.1. Indicators reflect the quality of the input factors 3.7.1.2. Indicators reflect the quality of the process and output factors 3.7.1.3. Indicators reflect hospital quality 3.7.2. Indicators reflect the quality of health care services by health insurance approaching from the patient 14 3.7.3. Indicators reflect patient satisfaction about the quality of health care services by health insurance 3.7.4. Indicators reflect the patient's creditworthiness for health care services by health insurance provided by medical facilities 3.7.5. Indicators reflect the demographic - sociological characteristics of the patient CHAPTER 4: THE SITUATION OF HEALTH CARE SERVICES WITH HEALTH INSURANCE AT DISTRICT HOSPITALS IN THAI NGUYEN PROVINCE 4.1. Overview of research site characteristics 4.1.1. overview of Thai Nguyen province 4.1.1.1. Natural condition 4.1.1.2. Socio-economic characteristics 4.1.2. General information about research hospitals 4.2. Situation of health care service quality by health insurance at district hospitals in Thai Nguyen province approaching from managers and medical facilities 4.2.1. Situation of input factors 4.2.1.1. Professional human resources situation 4.2.1.2. Situation of medical facilities and equipment for the patient 4.2.1.3. Situation of health care service cost by health insurance 4.2.1.4. Policies related to health care care by health insurance 4.2.1.5. Administrative procedures for health care services by health insurance 4.2.2. Situation of process and output factors 4.2.2.1 Situation of health care services quality by health insurance according to professional and technical quality Actual health insurance beds and hospital bed occupancy rate; The structure of patients with health insurance; Results of treatment for insured patients; General assessment. 4.2.2.2. Situation of health care services quality by health insurance according to functional quality 15 4.2.2.3. Assessment results of The hospital quality inspection team 4.3 Situation of health care service quality by health insurance at district hospitals in Thai Nguyen province approaching from patients 4.3.1 Assessment of health care service quality by health insurance according to the actual perception of the patient 4.3.2. Evaluate the impact of health care service quality by health insurance on patient satisfaction 4.3.2.1. Test reliability with confidence coefficients Cronbach's Alpha There are 6 observed variables removed, while 30 variables in the scale constitute factors of health care service quality by health insurance and 9 variables in the scale "Patient satisfaction about the quality of health care services by health insurance" are retained and used in factor analysis to explore EFA. 4.3.2.2. Exploratory factor analysis EFA a. EFA factor analysis for independent factors i) Test KMO and Barlett's KMO coefficient = 0.840> 0.5; Sig. = 0.000 <0.05: The observed variables are correlated with each other in the whole, the data used for factor analysis is completely appropriate. ii) Analysis of Eigenvalues and Average variance extracted The 30 original observed variables were grouped into 06 groups; Total average variance extracted = 62.94%> 50%: qualilfied; Eigenvalues coefficients of all factors are high (> 1), we extracted 6 independent factors. iii) Factor analysis according to Principal components with Varimax rotation The results of factor analysis are quite good, indicators of "Visible", "reliability", "Empathy", "Administrative procedures for health care examination by health insurance", "Responsiveness" and "Service capacity", have factor loading > 0.5. Therefore, these indicators converge on only one of its common factors, which are 16 eligible for use in the next analysis. The original model is kept unchanged. b. Analysis of the EFA factor for the dependent factor i) Test KMO and Barlett's KMO coefficient = 0.930> 0.5; Sig. = 0.000 <0.05, so the observed variables are correlated in the whole, the data used for factor analysis is completely appropriate. ii) Analysis of Eigenvalues and average variance extracted The 9 original observed variables were grouped into 1 group; Total average variance extracted = 51,052> 50%; qualified; The value of the factor's Eigenvalues coefficient is greater than 1. iii) Factor analysis according to Principal components with Varimax rotation Factor loading is quite good (equally> 0.5), so the factor is of practical significance, we can extract a dependent factor for the next research steps. c. Affirm the research model The original model is kept unchanged. 4.3.2.3. Test research model a. Pearson test of correlation coefficient The independent variables have Sig. <0.05, demonstrating that the satisfaction of patients about the quality of health care services by health insurance is correlated with all independent variables. Therefore, all independent variables are included in regression analysis. b. Hypothesis test - Regression results: - Adjusted R2 = 0.604 (60.4%)> 50%: The independent variables can explain 60.4% of the variation of the dependent variable. - F = 151,041 with Sig. = 0.000: The linear regression model is consistent with the overall. 17 - VIF magnification coefficient <2: There is no multicollinearity phenomenon between the independent variables in the model, does not affect the regression results. - Analytical results: All 6 factors are statistically significant, accept all 6 hypotheses of the research at the 5% significance level. The results of the standardized regression model are: HL = 0.233 * TC + 0.167 * DU + 0.289 * NL + 0.169 * DC + 0.166 * HH + 0.176 * TTHC Conclusion: The final results show that all 6 independent factors affecting patient satisfaction about the quality of health care services by health insurance. In which, the factor " Service capacity - NL" has the strongest impact, followed by the factors: "Reliability - TC" "Administrative procedures for health care service by health insurance - TTHC" "Empathy - DC "Responsiveness - DU", "Tangibles - HH". 4.3.2.4. Check for violation of assumptions in linear regression 4.3.3. Verifying the difference between the satisfaction of health care services quality by health insurance according to the individual characteristics of the patient 4.3.3.1. Test the difference between patient satisfaction about the quality of health care services by health insurance according to academic level 4.3.3.2. Test the difference between patient satisfaction about the quality of health care services by health insurance according to ethnicity 4.3.3.3. Test the difference between patient satisfaction about the quality of health care services by health insurance according to main occupation 4.3.3.4. Test the difference between patient satisfaction about the quality of health care services by health insurance according to income 18 4.3.3.5. Test the difference between patient satisfaction about the quality of health care services by health insurance according to the group of subjects participating in health insurance 4.3.3.6. Test the difference between patient satisfaction about the quality of health care services by health insurance according to the group of the beneficiaries of health care costs covered by health insurance 4.3.3.7. Test the difference between patient satisfaction about the quality of health care services by health insurance according to gender 4.3.3.8. Test the difference between patient satisfaction about the quality of health care services by health insurance according to age group 4.3.3.9. Test the difference between patient satisfaction about the quality of health care services by health insurance according to hospital Conclusion: The test results show that 6/8 factors of socio- demographic characteristics have a statistically significant difference in the average score of patient satisfaction about the quality of health care services by health insurance. These are: Academic level, ethnicity, main occupation, income, beneficiaries of health insurance and beneficiaries of health care costs covered by health insurance. 4.3.4. Patient's credibility in healthcare services by health insurance at district hospitals in Thai Nguyen province 4.3.5. General assessment There are 6 factors are statistically significant on patient satisfaction about the quality of health care services by health insurance at district hospitals in Thai Nguyen province and 6 factors in the demographic - social characteristics have different influences on the patient's satisfaction about the quality of health care services by health insurance. Among the 6 above factors, there are 2 new factors: the subjects participating in health insurance and the beneficiary of health care costs covered by health insurance have 19 different effects on patient's satisfaction about the quality of health care services by health insurance. 4.4. Evaluate the implementation of solutions to improve the quality of health care services by health insurance at district hospitals in Thai Nguyen province. 4.4.1. Proposals on priority issues for quality improvement of The hospital quality inspection team 4.4.2. The primary solutions implemented in hospitals 4.4.3. Implementation results of solutions 4.5. General assessment of health care service quality by health insurance 4.5.1. Achievements 4.5.2. Limitations and reasons CHAPTER 5: SOLUTIONS TO IMPROVE QUALITY OF HEALTH CARE SERVICES BY HEALTH INSURANCE AT DISTRICT HOSPITAL IN THAI NGUYEN PROVINCE 5.1. Orientation and perspective on improving health care service quality by health insurance 5.1.1. The direction of the Party's and the State for Health Insurance 5.1.1.1. The Party's direction 5.1.1.2. The State direction for health insurance 5.1.2. Perspectives on improving the quality of health care services by health insurance at district hospitals in Thai Nguyen province Point 1: To improve the quality of health care services by health insurance at district hospitals in Thai Nguyen province, the assignment of autonomy for medical facilities, implementation of health care service costs covered by health insurance includes salary, socialization is very necessary. Point 2: Improving the quality of health care services by health insurance must put the benefits of the people on top. 20 Point 3: In order to improve the quality of health care services by health insurance, hospitals need to consider improving procedures and formalities in health care services by health insurance. Point 4: It is necessary to propagate and advertise the quality of health care services in these hospitals with the support from central and provincial hospitals for people to trust. Point 5: Taking the satisfaction level of insured patients as a measure to evaluate the quality of health care services by health insurance. 5.2. Solutions to improve the quality of health care services by health insurance at district hospitals in Thai Nguyen province 5.2.1. Solutions to develop human resource 5.2.1.1. The basis for proposing the solution 5.2.1.2. Specific solutions Human resource development must be concerned consistently from the beginning to the final stage: Focusing on recruiting; training and developing human resource. 5.2.2. Revolutionize administrative procedures and formalities in health care services by health insurance 5.2.2.1. The basis for proposing the solution 5.2.2.2. Specific solution (i) Administrative procedures should be minimized in a light trend. Computerize stages in the process of instructing, receiving and examining patients with hospital management software systems and interconnect departments in hospital. (ii) Seriously implement the transparency about the benefits of insured patients such as names of drugs, medical services, and techniques used in treatment and reimbursed by health insurance. 5.2.3. Solution to invest in modern medical equipment and upgrade facilities 5.2.3.1. The basis for proposing the solution 5.2.3.2. Specific solutions 21 (i) Upgrade the facilities of hospitals to ensure modernity, science, convenience and synchronization (ii) Realize socialization to have more modern medical equipment 5.2.4. Solution to strengthening the financial management of health care services by health insurance 5.2.4.1. The basis for proposing the solution 5.2.4.2. Specific solutions Complete the health insurance premium; Strengthen the collection management of health insurance fund; Strengthen the spending assessment in medical facilities of health insurance. 5.2.5. Other solutions i) Promote the socialization of medical examination and treatment ii) Strengthen leadership, management and working regulations iv) Do not allow the patient to be inferior with differences in fairness v) Inform patients adequately, properly and promptly vi) Establish a traditional "physician - patient" relationship vii) Strengthen communication activities at medical management and treatment facility 5.3. Recommendations 5.3.1. Recommendations to the Government 5.3.2. Recommendations to the Ministry of Health 5.3.3. Recommendations to the Department of Health of Thai N