Research On Public Welfare Evaluation Of Public Medical Institutions Based On Patient Angle

[Background]Public medical institution is an important part of health care system in China, and it is also the main providers of medical service. When the health care reform is continuing to proceed, it has become a social consensus that public health institutions should take social responsibility. For patients, as the users of medical services, they have the most direct feeling and the appropriate evaluator to assess social responsibility level of the public medical institution. Thus discussion and evaluation of public medical institution’s social responsibility is of theoretical and practical significance from the perspective of patients.[Objective]Based on qualitative and quantitative methods, this research is to establish assessment tools for evaluating social responsibility of public medical institutions with high reliability, validity and operability from patients’perspectives, to analyze the main factors affecting the social responsibility evaluation of public medical institutions through on-site investigation, and to provide policy advice to enhance social responsibility of the public medical institutions.[Methods]1) The literature review was applied to analyze the importance, the contents and methods of social responsibility evaluation of public medical institutions from the patient’s point of view.2) Literature review and analysis, personal interviews and focus group discussions were used to establish social responsibility evaluation index system of public medical institutions from the patient’s perspective, further to develop the evaluation questionnaire.3) Pilot and formal field investigation of social responsibility evaluation questionnaire were conducted from the patient’s point of view.4) Collection and analysis of field survey data, and calculating the general Cronbach coefficient and clausal Cronbach coefficient, to detect the internal consistency of the questionnaire. Spearman-Brown related analysis was used to test and evaluate the split half-reliability and test-retest reliability of the questionnaire for patients. The correlation analysis and factor analysis method was applied to test the content validity and structural validity of the questionnaire.5) Logistic regression was used for analysis of the influencing factors of patients’evaluation outcomes in different regions at different levels of public hospitals’social responsibility. [Results]1)The assessment tool for evaluating social responsibility of public medical institution from patients’perspective was established, and the final assessment tool can be divided into two parts, three dimensions,12indicators and one open-ended questions. The first dimension was named quality of service dimension which consists of4secondary indicators, including treatment outcome, waiting time, the overall environment and the treatment process. The second dimension was named service suitability dimension, consists of5secondary indicators, including the treatment costs, privacy protection, and the number of free clinic, moderate checking and rational prescribing. The third dimension was named ethics dimension, and it consists of3secondary indicators, including three rejections of red envelope (under table bonus by patients), possibility of charges afterthe treatment and equal treatment of Medicare and non-Medicare patients. Open-ended questions are comments and suggestions for patients to improve the social responsibility of the public medical institutions.2) Evaluation tools in the pilot and investigation are reflected in high reliability and validity, using pilot as an example, general Cronbach coefficient was0.853, and the standardized Cronbach coefficient was0.877, which could explain higher internal consistency reliability of the questionnaire. The Cronbach coefficient of service quality was0.845, service suitability was0.845, and professional morality was0.752. There are12secondary indicators for the corresponding12problems; delete the highest indicator, the Cronbach coefficient was0.829to0.851, which showed that questionnaire reliability was good. Factor analysis was used to evaluate structural validity, in addition to "reject red envelope"; the other main factors of each option could map pre-set dimension which designed atthe beginning.3) By analyzing the results of the evaluation of the different parts of the different levels of public medical institutions, influencing factors for social responsibility evaluation of the tertiary hospitals are the appropriateness of the medical services, the main factors affecting the social responsibility evaluation of the secondary hospitals are fairness and accessibility of health care services, factors affecting the social responsibility of township hospitals and community health service centers are not the same.4) The influencing factors of patient satisfaction includes waiting time, the overall environment, the treatment process, treatment costs, privacy protection, the number of free cli nic, rational prescribing and rejection of red envelopes, while the main factors for social responsibility evaluation includes the overall environment, treatment costs, free clinic frequency, moderate examination, rational prescribing, rejection of red envelopes, possibility of charges afterthe treatment and equal treatment of medicare and non-medicare patients. [Conclusion]1) Social responsibility evaluation questionnaire has good reliability and validity, and can be used for different patients to evaluate social responsibility of all levels of public medical institutions.2) Social responsibility evaluation and satisfaction evaluation was influenced by different factors.3) Influencing factors of patients evaluating different levels of public medical institutions are not the same, suggesting that different strategies should be applied to improve and enhance social responsibility.