Perceived quality of out- and in-patient services in Ukraine: health care users' perspective

Abstract

Quality is perhaps the most ambiguous concept in health care service provision though number of studies suggest and use a list of attributes assessed by health care users for identifying perceived quality of the service. This study is aimed to assess perceived quality of health care services through the health care users’ angle measuring quality-related attributes of health care services and compare its importance with the access-related ones. The paper presents empirical study results focused on health care service quality. We use the data originated within a wider study «Health Index. Ukraine» on knowledge, attitudes and behavior of people that is linked to health and care services. The data has been collected in May-July 2016 in Ukraine with the use of nationally and regionally representative sample of adults 18+ years old. It appears that health care users assess both ambulatory services and hospitalizations as good and acceptable: 37% and 53% of out-patients and in-patients respectively. Perceived treatment effectiveness is the most important service attribute for both out- and in-patient service users (which has got positive enough assessment), while second important attribute for out-patient service users is «opportunity to receive free-of-charge treatment and test» and for in-patient care – «provision of pharmaceuticals». Two later access-related attributes have got mostly negative assessment by health care users. We conclude that chronic underfunding of health care services impacted the provision of pharmaceuticals and accessibility of the services, while self-coping strategies of physicians and health care users (also seen in informal patient payments) allowed maintain adequate service wrapping, or perceived quality. Moreover, there is a great lack of information about health care users’ needs and expectations in Ukraine. That is why the studies employing health care users’ opinion, perspective are important both for the facility which work is assessed and for the healthcare governance in general. Health care users’ assessment of service quality adds lacking dimension for analysis and further decisions connected with fulfilment of the requirements (expectations). Further cross-sectional studies on perceived quality are necessary to monitor progress in health care service provision, and especially its quality and access attributes.