Perceived quality of care among households ever enrolled in a community-based health insurance scheme in two districts of northeast Ethiopia: A community-based, cross-sectional study

Objectives: The purpose of this study was to examine how clients perceived
the quality of health care they received and to identify
associated factors both at the individual and facility levels.
Design: A community-based, cross-sectional study.  Setting: Two
rural districts of northeast Ethiopia, Tehulederie and Kallu.
Participants: 1081 rural households who had ever been enrolled in
community-based health insurance and visited a health center at least once
in the previous 12 months.  Furthermore, 194 health care
providers participated in the study to provide cluster-level data. Outcome
measures: The 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. Results: The 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, and time to a recent health center
visit were individual level variables that showed a significant
association with the perceived quality of care. At the cluster level, the
work experience of health care providers, patient volume, and an
interaction term between patient volume and staff job satisfaction also
showed a significant association.   Conclusions: Much 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.