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Perceived quality of care among households ever enrolled in a community-based health insurance scheme in two districts of northeast Ethiopia: A community-based, cross-sectional study

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Sep 23, 2022 version files 702.74 KB

Abstract

Objectives: The purpose of this study was to examine how clients perceived the quality of health care they received and to identify associated factors both at the individual and facility levels.

Design: A community-based, cross-sectional study. 

Setting: Two rural districts of northeast Ethiopia, Tehulederie and Kallu.

Participants: 1081 rural households who had ever been enrolled in community-based health insurance and visited a health center at least once in the previous 12 months.  Furthermore, 194 health care providers participated in the study to provide cluster-level data.

Outcome measures: The outcome variable of interest was the perceived quality of care, which was measured using a 17-item scale. Respondents were asked to rate the degree to which they agreed on 5-point response items relating to their experiences with health care in the outpatient departments of nearby health centers. A multilevel linear regression analysis was used to identify predictors of perceived quality of care.

Results: The mean perceived quality of care was 70.28 (SD=8.39). Five dimensions of perceived quality of care were extracted from the factor analysis, with the patient-provider communication dimension having the highest mean score (M=77.84, SD=10.12), and information provision having the lowest (M=64.67, SD=13.87). Wealth status, current insurance status, perceived health status, presence of chronic illness, and time to a recent health center visit were individual level variables that showed a significant association with the perceived quality of care. At the cluster level, the work experience of health care providers, patient volume, and an interaction term between patient volume and staff job satisfaction also showed a significant association.  

Conclusions: Much work remains to improve the quality of care, especially on information provision and access to care quality dimensions. A range of individual and cluster-level characteristics influence the perceived quality of care. For a better quality of care, it is vital to optimize the patient-provider ratio and enhance staff job satisfaction.