Perceived Quality of Care in Health Centers Affiliated with a Community-Based Health Insurance Scheme in Two Districts of Northeastern Ethiopia: A Multilevel Analysis

ObjectivesThe purpose of this study was to examine how clients perceived about the quality of health care they received and to identify associated factors at the individual and facility-level. DesignA community-based, cross-sectional study SettingHealth centers in two districts Participants1081 rural households who had ever been enrolled in a community-based health insurance and had visited a health center at least once in the previous 12 months, as well as 194 health care providers working in 12 health centers. Outcome measuresThe outcome variable of interest was the perceived quality of care, which was measured using a 17-item scale. Respondents were asked to rate the degree to which they agreed on 5-point response items relating to their experiences with health care in the outpatient departments of nearby health centers. A multilevel linear regression analysis was used to identify predictors of perceived quality of care. ResultsThe mean perceived quality of care was 70.28 (SD=8.39). Five dimensions of perceived quality of care were extracted from the factor analysis, with the patient-provider communication dimension having the highest mean score (M=77.84, SD=10.12), and information provision having the lowest (M=64.67, SD=13.87). Wealth status, current insurance status, perceived health status, presence of chronic illness, time to a recent health center visit, work experience of health care providers and patient volume were the factors significantly associated with perceived quality of care. An interaction term between patient volume and staff job satisfaction also showed significant association. ConclusionsMuch work remains to improve the quality of care, especially on information provision and access to care quality dimensions. A range of individual and cluster-level characteristics influence the perceived quality of care. For a better quality of care, it is vital to optimize the patient-provider ratio, and enhance staff job satisfaction. Strengths and limitations of this study{blacktriangleright} The study tried to assess the quality of care from the clients point of view using a validated multidimensional scale. {blacktriangleright}This is the first cross-sectional study in Ethiopia, which considered health center (cluster) level variables that have association with perceived quality of care. {blacktriangleright}We tested for the existence of endogeneity between current insurance status and quality of care. Although the results indicated no evidence of endogeneity, it is still possible due to omitted variables. Active insurance members may report a higher perception score quality of care as a result of their desire to stay in the scheme. {blacktriangleright}Because of the cross-sectional nature of the study, it is impossible to establish a cause- and-effect relationship.