A Study On Perceived Quality Of Medical Service Based On Patients' View

Quality of medical services relates to the vital interests and health safety of people. With the continuous development of society and economy, the living standard and demands for medical services of people both have enhanced. Medical services include not only technical services, but also non-technical services, such as hospital environment, care attitude, medical processes, and medical expenses and so on. What people require is the superb medical technology, as well as the good health services. In recent years, the health sector has attached great importance to improving the working of medical services and repeatedly issued the hospital management programs as the theme of "patient-centered, improving the quality of medical service", which requires medical institutions to focus on the quality and efficiency of medical services, make more convenience for patients to see a doctor by optimizing processes, and improve the treatment feeling of patients. With the deepening health care reform and the growing popularity of the homogenization of medical technology, medical institutions have being facing an unprecedented competition. It is the improving the quality of medical services that provides an opportunity and a way for medical institutions. Therefore, the quality of medical services becomes a core element for maintaining market competitiveness of medical institutions, as well as an important part of healthy development and construction of health care, and an important research area of the hospital management.Perceived quality of medical services is a result of the comparison between the expecting medical services and the actual experience of patients in the medical service process. It is a perceived outcome. How is the quality of medical services? As a direct object of care, Patients'feelings and experiences are more convincing. Recently, although many scholars and managers affirm the need to assess the quality of health services based on patient-centered, their research views are still based on the supply-side. It has been proved that there is a big difference between the medical services provided by medical institutions and what patient's demand for. To evaluate the quality of medical services based on patients'view, it will be more directly and deeply to reflect the needs of them, and also expose the medical services weaknesses and disadvantages. Thus, the patient's subjective perception should be the evaluation criteria of quality of medical service.The country throughout speed up the development of health care, people's health care needs steadily rise, with the intense competition in the medical market and the deterioration of the doctor-patient relationship. Thus, under this background, to carry out the study of perceived quality of medical service based on patients'view is extremely urgent.ObjectiveThis study aimed to construct a questionnaire about perceived quality of medical service based on patient'view, investigate the status and characteristics of perceived quality of medical service of inpatients and determine the interaction among perceived quality of medical service, satisfaction and loyalty. To analyze the current problems about quality of medical service in hospitals, and make suggestions to augment medical service, enforce competition between hospitals and so well as the relationship between hospital and patient.MethodThis study used 4 methods to analyze questions step by step.1. Literature analysis. To collect the literatures about perceived quality of service, quality of service, perceived quality of medical service, satisfaction and loyalty in healthcare industry during recent years and summarize new trend, views, and creativities about investigation.2. Interview. Deep interview was done to patients and several doctors, nurses and nursing works (a total of 20) to understand what and how did patients feel, after studying the documents. Useful information was obtained to design the primary questionnaire.3. Questionnaire. Firstly,306 patients were selected to answer the questionnaire that leaded to an immediate consequence of the formal scale. And then, 706 inpatients were asked to accomplish the perceived quality of medical service, satisfaction and loyalty scales according to the stratified random sampling method in several hospitals.4. Mathematical statistical analysis. In order to get better explains of the findings, draw conclusions and make recommendations, using SPSS21.0 and AMOS21.0 software for statistical analysis, including the reliability and validity examination, descriptive statistics, independent samples T-test, ANOVA, correlation analysis, and path analysis.Result1. The perceived quality of medical service questionnaire based on inpatients'view showed:The final formal scale of perceived quality of medical service involved 4 dimensions, which were reliability (5 items), empathy (4 items), economy (3 items), and tangibility (3 items). The internal consistency was good with the Cronbach'a coefficients in the range of 0.861±0.921. The adaptive test of exploratory factor analysis showed the sample data was suitable for factor analysis with which the KMO was 0.923, and Bartlett test was significant (?2=5016.809, P=0.000). The cumulative explained rate of variance reached 67.451% by using PCA (principal component analysis) under the condition of characteristic root was more than 1 and then with the varimax rotation. Factor loadings of all items were above 0.5, and there was no common factor loading. The outcomes of model fitting were good by using CFA (confirmatory factor analysis) via AMOS. The fit indexes were;?2/df=3.875, RMSEA=0.064,GFI=0.943, AGFI=0.918, NFI=0.934, CFI=0.951, CN=254.2. Status of perceived quality of medical service of inpatients showed:Generally, the perceived quality of medical service of inpatients were in a high level, the dimension from high to low was empathy, reliability, economy, and tangibility.Perceived quality of medical service of patients in third-class hospital were significantly lower than that of patients in secondary hospitals in terms of reliability, empathy, economy and total scores (P<0.01).Perceived quality of medical services of male patients was significantly lower than that of female patients in the dimension of reliability (P<0.05).Perceived quality of medical service of patients living in cities was significantly higher than that of patients in rural on economic dimension (P<0.05).Perceived quality of medical service of patients with a high school or college degree was significantly higher than that of patients with an undergraduate education on reliability dimension (P<0.05).Perceived level of quality of medical service of elderly patients were higher than those of in adolescence and middle age patients on reliability dimension and total scores (P<0.05); patients perceived level of quality of medical services performed as the elderly> middle age> adolescence in the dimension of empathy (P<0.05).Perceived quality of medical service of patients with low-income and high-income were higher than that of patients with low-middle-income on tangible dimension (P <0.05).Perceived quality of medical service of patients paying at free and medical insurance were higher than that of patients at self-paying and other forms on empathy dimension(P<0.05).Perceived quality of medical services of patients with feelings about diseases of serious and general were higher than that of patients with mild disease on the dimension of empathy (P<0.01).Perceived quality of medical service of passive patients were higher than that of median and proactive patients on reliability dimension (P<0.01); and passive and mediate patients were higher than that of proactive patients on empathy dimension (P <0.01); passive patient was higher than that of proactive patients on total scores (P <0.01). 3. The relationship research between perceived quality of medical service and satisfaction, behavioral intention showed that:Reliability, empathy, economic, tangibility, satisfaction, intension to recommend, and willingness to re-diagnosis presented a positive correlation between each other (r =0.402?0.779, P<0.001).Perceived quality of medical services had a direct effect on satisfaction (?=0.872, C.R.=17.109, P<0.001). Perceived quality of medical services had a direct impact on behavioral intention(?=0.829, C.R.= 15.858, P<0.001). Perceived quality of medical services had an indirect effect on behavioral intention through satisfaction, and could construct a structural equation model with satisfaction as a medium. Mediation model fitting indices were ?2/df=3.828, RMSEA=0.063, RMR= 0.014, GFI=0.982, AGFI=0.957, NFI=0.986, TLI=0.981, CN=403. Using SOBEL test method to obtain Z=5.689, P<0.001. Satisfaction as the role of mediating variables was significant, and the intermediary rata was 41.654%.Conclusions and recommendationsThe results show that it's reasonable of the questionnaire structure of perceived quality of medical services constituted by reliability, empathy, economy, and tangible. The study found that although the overall level of perceived quality of medical services was high, there were still differences in a different hospital grade, gender, age, place of residence, education level, monthly income, medical department, self-feeling about disease, the modes of doctor-patient cooperation and other aspects of the patient perceived quality of medical services. This suggested that the hospitals could provide targeted and appropriate medical services according to the specific circumstances of different patients. Perceived quality of medical service could positively predict satisfaction and behavior intention, and also had an indirect effect on behavioral intention through satisfaction. Therefore, if the hospital wants to increase patients' satisfaction and behavioral intention, it will have to take practical measures to improve the quality of medical services of the hospital. Such as putting emphasis on perceived quality of medical service, as the purpose of to enhance patient behavioral intentions;constantly improve the quality of medical service standards and provide personalized medical service; focusing on medical humanism to meet the emotional needs of the patients; provide more convenient channels to improve the patient's perceived quality of medical service on the dimension of services tangibility and economy.