Meina Li

Factors influencing inpatients' satisfaction with hospitalization service in public hospitals in Shanghai, People's Republic of China.

Objective The aim of this study was to observe the current status of inpatient satisfaction and analyze the possible factors influencing patient satisfaction during hospitalization. Methods A cross-sectional investigation was conducted to obtain basic information about inpatient satisfaction, and statistical methods were used to describe and analyze the data. A total of 878 questionnaires were included in this study. A 5-point Likert scale rating was employed to assess items related to hospitalization care. Nonparametric tests and ordinal logistic analysis were used to explore the relationship between predictors and the patients’ overall satisfaction. Results Among the respondents, 89.75% were satisfied overall with the service they received during hospitalization, while 0.57% reported dissatisfaction. Inpatient demographic characteristics such as sex of the patients, occupation, age, and residence had significant associations with satisfaction, while monthly income and marital status did not. Additionally, the statistical outcome indicated that doctors’ and nurses’ service attitudes, and expenditure and environment were found to have an impact on the inpatient satisfaction ratings, with odds ratio of 2.43, 3.19, and 2.72, respectively. Conclusion This study emphasizes the influence of sex of the patients, the service attitudes of the doctors and nurses, and expenditure and environment on inpatient satisfaction. An increase in satisfaction ratings concerning the areas of doctors’ and nurses’ service attitudes, and expenditure and environment can improve the overall satisfaction levels. Responsible health management departments should pay attention to patient satisfaction and improve the quality of relevant health services, thus ultimately enhancing inpatients’ hospitalization experiences.

Determinants and influencing mechanism of outpatient satisfaction: a survey on tertiary hospitals in the People’s Republic of China

Objective Most patients in the People’s Republic of China prefer tertiary hospitals when seeking medical services. The aim of this study was to assess outpatient satisfaction with tertiary hospitals in the People’s Republic of China, test overall and subscale satisfaction, and explore whether sociodemographic characteristics lead to different degrees of satisfaction and whether subscale outpatient satisfaction contributes to overall satisfaction. Methods A closed questionnaire was given out to investigate outpatients’ sociodemographic characteristics, overall satisfaction, and various subtypes of satisfaction, and a 5-point Likert scale was employed to measure the degree of outpatient satisfaction. Descriptive analysis, Kruskal–Wallis test, Spearman’s rank correlation coefficient, and logistic regression analysis were employed for statistical analysis. Results Response rate was 92.48% (971/1,050). Outpatients’ sociodemographic characteristics (including sex, age, occupation, monthly income, residence, and marital status) were related to various subtypes of satisfaction to varying degrees. Outpatients who were male, older, married, with low or middle incomes, living in Shanghai or other areas of the People’s Republic of China, medical staff, or students were more satisfied with various subtypes of satisfaction than those without these characteristics. In further analyses, satisfaction with their medical needs being met by doctors had the strongest relation to overall satisfaction, followed by satisfaction with doctors’ service attitudes, medical costs, waiting time, prescription, and diagnosis and treatment time. Satisfaction with environment had the weakest contribution to overall satisfaction. Conclusion This study gave some suggestions for tertiary hospitals in advanced areas of the People’s Republic of China. Outpatient sociodemographic characteristics should be paid more attention by medical staff to improve the degree of satisfaction. Tertiary hospitals in the People’s Republic of China should provide more support on the management of doctors, medical costs, and time.

The problem of unreasonably high pharmaceutical fees for patients in Chinese hospitals

The social problem of unreasonably high pharmaceutical costs for patients in Chinese hospitals damages the interests of patients and it has a highly negative impact on the long-term development of the Chinese health service. We constructed a system dynamics model to address two problems, i.e., the unreasonably high prices of drugs and the high level of pharmaceutical fees relative to the medical costs of patients, and we suggest countermeasures and possible solutions. The program Vensim DSS was used to construct a system dynamics model to represent the problem of high pharmaceutical fees for patients in Chinese hospitals. If hospital and medical staff receive a higher kickback rate, they are more likely to prescribe unnecessary expensive drugs to make greater profits, which results in unnecessary drug consumption and irrational drug use, eventually leading to unreasonably high pharmaceutical fees. The benefit chain of the main drug suppliers should be cut off. It is necessary to break the link between the profits from pharmaceutical sales and the prescribing behavior of physicians, and hospital incomes, to avoid any conflicts of interest over how medicines are prescribed. Thus, cost-containment measures and a reformed pharmaceutical distribution system are needed to regulate physicians and hospital interaction.

Patient preference and choice of healthcare providers in Shanghai, China: a cross-sectional study

Objectives This study aimed to assess patients’ healthcare-seeking preferences in mild, chronic, and serious illness; identify influential factors; and examine the reasons underlying patients’ healthcare-seeking preference. Design A retrospective study. Setting The study was conducted in 14 tertiary hospitals in Shanghai, China. Participants Questionnaires were distributed to 1519 patients, and 1114 were completed and returned. All patients participated in the study voluntarily, provided written informed consent, and possessed the ability to complete the questionnaire. Main outcome measures We measured and compared preferences and choice of healthcare providers in patients if they had experienced mild, chronic, or serious illness. Results More than 50% of participants, including those who were >60 years of age, had consulted a doctor more than three times during the preceding year, were single, and were most likely to decide not to seek medical treatment. Community health facilities were the most frequently selected healthcare provider in mild illness. In addition, patients who had no personal preference, did not express a preference for a good environment or first-class medical technology, were concerned about close proximity and short waiting times, and pursued low medical costs were most likely to choose a community health facility. General hospitals were the most frequently selected healthcare provider in chronic and serious illness. In addition, patients who earned higher monthly incomes, did not pursue low medical costs, were not concerned about short waiting times or close proximity, and expressed a preference for first-class medical technology, were most likely to choose general hospitals. Conclusion Patients’ healthcare-seeking preference was influenced mainly by healthcare providers’ characteristics, illness severity, and sociodemographic characteristics. These findings indicate that patients’ current healthcare-seeking preference was not ideal and requires optimisation.

Factors influencing two-way referral between hospitals and the community in China: A system dynamics simulation model:

Background: Two-way referrals between hospitals and community healthcare systems (CHSs) are important for optimizing the distribution of medical resources and enabling resource sharing, but referrals are always from CHSs to hospitals. A referral from the hospital to the community is rare in China; this has a highly negative impact on the long-term development of the Chinese health services. The aim of this study was to address influence factors in hospital–community referrals. Methods: We constructed a system dynamics model to address the problem of the two-way referral between hospitals and CHSs and identified potential countermeasures and possible solutions. The Vensim DSS program was used to construct a system dynamics model to represent the problem through model description, causal loop diagrams, and stock and flow diagrams. Results: The model was used to perform intervention experiments, in which the influence on all the sectors of referrals could be observed by changing the system parameters. The experimental results showed a greater difference in medical costs between hospitals and CHSs, more investments to CHSs, higher levels of medical insurance of CHSs, and more referrals from hospitals to CHSs. Conclusions: The system can widen the price gap between hospitals and CHSs, increase information flow, improve medical insurance level of CHSs, and elevate the current level of CHSs through enabling two-way referral between hospitals and CHSs.

Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People's Republic of China.

Objective Dual practice is defined as a physician’s performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people’s perception. Methods A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis. Results The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals’ human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients. Conclusion This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals’ human resource would promote physicians’ willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics.

Survey on Two-Way Referrals Between Large Public Hospitals and Community Health Service Centers

We examined doctors’ and patients’ cognitions and satisfaction with community health and two-way referral in order to understand reasons for the poor referral rate. By identifying these influencing factors, we might ensure that the two-way referral system in Shanghai runs normally, thereby helping to achieve patients’ initial options in the community health system.

Basic Information Survey for Large Public Hospital Reform

We conducted a large-scale investigation of the public welfare of public hospitals in Shanghai and Beijing. The research participants covered four levels: hospitals, hospital administrators, medical staffs, and patients.

Survey on Translational Medicine in Large Public Hospitals

We aimed to understand the current development of translational medicine in large public hospitals as well as medical staff’s attitudes towards and awareness of translational medicine (Keramaris et al. 2008; Krontiris and Rubenson 2008; Szalma et al. 2010; Littman and Marincola 2011).

Survey of Outpatient Satisfaction with Large Public Hospitals

This chapter presents a survey on outpatients’ satisfaction with large public hospitals. Specifically, we looked at their satisfaction with waiting time, medical services, diagnosis and treatment quality, medical expenses, and hospital environment.