Hospital Management and Patient Satisfaction in Bangladesh: A Comparative Study between Private and Public Sectors

Abstract

Health is a basic prerequisite for improving the quality of life. Socio-economic development of a nation mostly depends on the state of health. A large number of Bangladeshi people, particularly in rural areas, remain with no or little access to health care facilities. Their lack of participation in health service is a problem that has many dimensions and complexities. Patient satisfaction with health care is seen as a dimension of quality of care. Expectations of service recipients are increasing day by day due to rapid development of science, technology and management. The quality of care that satisfied patients yesterday or day before yesterday may not satisfy them tomorrow or day after tomorrow. Moreover, satisfaction and utilization of services go hand in hand, which is the rationale behind thousands of satisfaction research being published in the developed world per year. But unfortunately there is hardly any study on patient satisfaction using large series of field level data in Bangladesh. Finding clue from this gap this study has been done in order to evaluate patient satisfaction in Bangladesh. A cross-sectional comparative study has been conducted with the aim of identifying differences in the level of satisfaction among patients in private and public hospitals. We have purposively selected six hospitals- three from public and three from private. Dhaka Medical College Hospital, Mitford Hospital and Sher- E Bangla Medical College Hospital are among the public hospitals and Central Hospital, Bangladesh Medical College Hospital and Ibn Sina Hospital are from private hospital. Primary data has been collected through a structured pre-tested questionnaire from 299 respondent inpatients 150 from public hospitals and 149 from private hospitals. Male patients are 161 and female patients are 138. Half of the patients have been selected from medical wards and the other half from surgical wards. The list of patients ready to be released on a particular date has been obtained from the respective Ward-in-Charge of the respective hospitals. Satisfaction score has been assessed with services of doctors, nurses, aya and ward boy, cleanliness, laboratory and reception. Satisfaction has been categorized into five levels- not at all satisfactory, somewhat satisfactory , more or less satisfactory, appreciable, and excellent, where 1 meant for `'not at all satisfactory' and 5 for 'excellent', 'somewhat satisfactory' 2, 'more or less satisfactory' 3 and 'appreciable' 4 in between them. Dependent variable is satisfaction score. Satisfaction has been further assessed with a close question of future return to the same hospital. Inter personal perceptual variation has been taken into consideration to avoid confounding effect. Age, sex, occupation, educational status, socioeconomic condition, marital status, outcome of treatment, types of treatment and expenditure of treatment have also analyzed to measure the impact of these demographic characteristics on patient satisfaction. Data has been analyzed using SPSS version 20. Hypotheses have been tested using Independent t test. Binary Logistic Regression Model has been built to explore maximum effect of independent variables on dependent variable. Qualitative data has been analyzed with Chi-square test, while one way ANOVA has been done to compare more than two groups. In this study mean age of the public group was 39.01  18.84 years and that of private group was 47.32  20.47 years. However, age and sex have no association with any of the satisfaction scores given to the doctor’s service, nurse’s service, provision of medicine supply, service given at the reception, aya/ ward-boy and cleaner’s service, laboratory service and maintenance of cleanliness. So, age and sex have got no significant effect on total satisfaction score. Satisfaction score does differ between married and unmarried population also. Socioeconomic conditions of this series are dominantly from middle class followed by poor class and a small from (nearly 10 percent) affluent segment of the society. Most of the middle class and rich people are served by the private hospitals and the poor people are served by public hospitals. Most of the patients in this study are primary educated. Higher educated people like private hospitals than that of public hospitals. A handsome number of illiterate people have participated in the study who have been treated both in private and public hospitals. One way ANOVA discovers that occupation and educational status of the study population have no influence on satisfaction. The rich people are more satisfied than the poor people. But age, sex, educational status, occupation, marital status and type of treatment has got no significant influence on satisfaction and future return to the same hospital. Even the amount of expenditure has not considered by the patients in determining their satisfaction in the same type of hospital. Out of 299 patients nearly two thirds have been either completely cured or improved, one third either not improved or deteriorated and a negligible portion that is around 1 percent unfortunately died during the course of hospital admission. Outcome of treatment have logically influenced the satisfaction score. Those patients are more satisfied who are cured or improved than those who are deteriorated or died. Overall satisfaction is higher in private hospitals than that of public hospitals in respect of all services - doctor, nurse, aya/ward boy and cleaner, laboratory services, reception and medicine supply. Availability of essential service, politeness and sympathy of staff, cleanliness, and use of modern equipment has positive influence on patient satisfaction in private hospitals. It is surprising that expenditure of treatment does not influence the satisfaction rather the services of doctor, nurse, aya/ward boy and cleaner, reception, laboratory and cleanliness have influenced the satisfaction score. It indicates patients require service even if it requires reasonable costs. Around 30 percent of the respondents are disappointed with the services. They will not return to the same hospital for consuming service if they would become ill unluckily. It is only the services provided by the hospital that could influence the patient significantly in making decision of future return to the same hospital. But, binary logistic regression analysis explores that future return depends on doctor’s service, aya/ ward boy and cleaner’s service, regular and timely supply of medicines only. Nurse’s service, reception, laboratory service, cleanliness and outcome of treatment do not influence the decision significantly. Most of the people of Bangladesh are of poor socio-economic status and they have to avail themselves of the services from public sector. But it is frustrating that most of the services provide by public providers are not at all satisfactory to a good number of the patients. It gives a red signal for the health system of the country. Till now public sector is the only active system at the doorstep level of the poor and middle class people. Most of the people cannot buy the health services of private sector as they are costly. So it is urgently needed to identify the loopholes of the public sector and fix accountability of the service providers. Besides, the cost of services of the private providers should be reasonable to all segments of the society and the Directorate of Health should influence the price fixing mechanism of the private hospitals.