Perceived Quality of Health Services and Related Factors among ICHF Insured and Uninsured Community Members Attending Pangani District Hospital

Abstract

Background: Community Health Fund (CHF) was established in 1996, targeting about 85% of the population in rural areas engaged in the informal sector, to improve their access to health care services from the accredited health care facilities. Improved CHF (iCHF) was introduced in 2016 with the aim of providing access to quality health services to its members through healthcare providers in its network nationally. Quality of healthcare is one of many important determinants of health service utilization by clients. Empirical evidence in some African countries has raised concerns on experiences of poor quality of services among insured clients. This study assessed the perceived quality of health services and related factors among iCHF insured and uninsured community members attending Pangani district hospital. Objective: To determine perceived quality of health services and associated factors among iCHF insured and uninsured community members attending Pangani District Hospital. Methodology: This study adopted a quantitative approach and cross-sectional analytic research design. Data was collected by using structured questionnaires. Analysis was done descriptively whereby frequency, standard deviation and mean were used to describe socio-economic characteristics of respondents. Mean score for perceived quality of care was set such that a score of 1.0-2.9 indicate positive perception and a score of 3.0-5.0 indicate negative perception. Perceived quality of care was gauged by comparing perceptions of the insured and uninsured patients. Mean quality score was calculated separately for insured and uninsured patients, t-test was used to test the differences in quality perceptions between the insured and uninsured patients. The study also applied logistic regression to establish the association between perceived quality of care, health insurance status and socio-demographic characteristics of patients. Results: A total of 452 respondents were included in the study whereby more than half were females (62.8%). Majority of the respondents were aged between 28-38 (31.2%), 250 respondents (55.3%) had primary level of education, and 271 respondents (60.0%) were self-employed. The general findings on dimensions of perceived quality of care found that; patient-centeredness scored a mean of 2.17 for insured and 2.38 for uninsured; timeliness shows a mean score of 2.66 for insured and 3.43 for uninsured; and the accessibility of healthcare service illustrates a mean score of 3.00 for insured and 3.32 for uninsured. The comparison of insured and uninsured in perceived quality of care show statistically significant difference in perceived patient-centeredness, and no statistically significant difference in perceived timeliness and accessibility of healthcare services. Results from logistic regression indicate statistically significant association between perceived quality health care and age (aOR;0.92895% CI 0.907-0.949:p=0.000), sex (aOR;1.903:95% CI 1.201-3.014:p=0.006), marital status (aOR;0.418:95% CI 0.217-0.805:p=0.009), occupation (aOR;3.284:95% CI 1.409-7.664:p=0.006) and education level (aOR;0.532:95% CI 0.302-0.939:p=0.0360). Conclusion: This study concludes that there is better perception of health care quality among iCHF insured compared to uninsured community members in all quality of healthcare dimensions among users of Pangani district hospital. The study also concludes that the socio-demographic characteristics (age, sex, marital status, and occupation and education level) influence the perceived quality care.