With the desire to study the factors affecting the satisfaction of the quality of health insurance services, thereby proposing solutions to improve the quality of health insurance servic
Trang 1INTRODUCTION
1 Rationale
According to the Health Sector Overview Report, 3.9% of households
(3.5 million citizens) face financial difficulties due to medical expenses In
addition, the increasing cost of medical examination and treatment becomes a
burden on the budget of numerous households, especially families with people
suffering from serious and chronic diseases that require long-term treatment
Therefore, in order to reduce people's out-of-pocket medical expenses, it
is necessary to increase the coverage of health insurance Successfully
implementing universal health insurance would ensure the sustainability of the
health insurance fund and reduces out-of-pocket medical expenses According to
Vietnamese Social Security, by the end of December 2019, the coverage rate of
health insurance reached nearly 90% (nearly 87 million people) Although the
current rate of participation in health insurance is high, at approximately 90%,
the coverage rates of easily-convinced participants are close to 100% The
coverage rates of other groups are significantly low and it is difficult to convince
these people because they have to pay the premiums for health insurance by
themselves
In order to increase the coverage of health insurance, it is extremely
important to study the factors affecting the satisfaction of health insurance
service quality The satisfaction of health insurance participants about the
quality of health insurance services is their satisfaction with health insurance
services on the basis of comparison between results and their own expectations
If people are satisfied with the quality of health insurance services, even if
participating in health insurance is not compulsory, almost all citizens will still
participate in health insurance Determining which factors affect satisfaction
with the quality of health insurance services is not only essential for improving
the quality of health insurance services, but also is the key for giving specific
solutions to increase the coverage rate for different groups of people, especially
those that are partly supported by the State and those that pay the premiums by
themselves With the desire to study the factors affecting the satisfaction of the
quality of health insurance services, thereby proposing solutions to improve the
quality of health insurance services and achieve the universal health insurance that was set by the Prime Minister, the author decides to choose the research topic: "Factors affecting the satisfaction level of health insurance participants about the quality of health insurance services in Vietnam”
2 Research objectives, research subject and scope of research
2.1 Research objectives
The overall objective of the thesis is to study the factors affecting the satisfaction level of health insurance participants about the quality of health insurance services
Specific goals are:
+ Systematize basic theoretical issues about health insurance and factors affecting the satisfaction of health insurance participants about the quality of health insurance services
+ Analyze the influence of factors on the satisfaction of health insurance participants on the quality of health insurance services in Vietnam
+ By analyzing the influence of factors on the satisfaction of health insurance participants on the quality of health insurance services in Vietnam today, the author proposes solutions to improve the organization and the implementation of health insurance policy in Vietnam
2.2 Scope of research
+ The research focuses on clarifying the factors affecting the satisfaction
of health insurance participants about the quality of health insurance services through the organization and the implementation of health insurance policy in Vietnam
+ Time: secondary data was collected from 2015 to 2019, primary data was collected from May 2019 to July 2019
+ Location: Hanoi city, Hue city and Ho Chi Minh city
Trang 22.3 Research subject
The research object of the thesis is the theories and empirical analysis of
the factors affecting the satisfaction level of health insurance participants about
the quality of health insurance services in Vietnam
3 Methodology
3.1 Research design
+ Qualitative research: through the synthesis and analysis of theoretical
models of satisfaction, the author builds research model and research
hypotheses
+ Quantitative research: conducting surveys with large samples (N=1500)
Based on the collected data, the author analyzes the significance and influence
of the factors, analyze the correlation among variables, conduct model testing
and research hypotheses
3.2 Reseach model and research hypotheses
There are there independent variables and one dependent variable:
Figure 1: Research model
Table 1: Research hypotheses
Research hypotheses
H1 Responsiveness has a positive effect on satisfaction with health
insurance service quality
H2 Assurance has a positive effect on satisfaction with health insurance
service quality
H3 Reliability has a positive effect on satisfaction with health insurance
service quality
the satisfaction level about the quality of health insurance services
Control variables
Responsiveness
Assurance
Reliability
CHAPTER 1: RESEARCH OVERVIEW AND METHODOLOGY 1.1 Research overview
1.1.1 Overview of foreign studies
According to the author's research, there are numerous research studies and papers related to this topic:
+ From 1985, the SERVQUAL model developed by Parasuraman et al has been widely used by scholars and researchers to assess customer satisfaction about services in different sectors in many different markets SERVQUAL is a multi-objective scale built to assess customers' perception of service quality There are five factors affecting service quality: Tangibles; Reliability; Responsiveness; Empathy; Assurance
+ In the field of health services, there are several studies applying SERVQUAL model to assess patient satisfaction such as Yogesh and Satyanarayana (2012); Lee (2016); Toni Lupo (2016)
+ In the field of insurance, there are several studies on satisfaction and quality of insurance services such as the study of Siddiqui and Sharma (2010); Ramamoorthy et al (2018) on life insurance; research by Borda and Jedrzychowska (2012) and Przybytniowski (2015) on vehicle insurance Studies
on satisfaction and quality of insurance services often apply the SERVQUAL model However, the factors affecting the level of satisfaction might be different
to the original SERVQUAL
+ According to Abd and Izham (2016), health insurance is a special service with unique characteristics Therefore, the factors affecting the satisfaction of health insurance service quality are different from other business services Hence, in the research on health insurance service quality, the SERVQUAL might be adapted
+ In the US, Fitzgerald and Bias (2016) show that Responsiveness has a positive impact on satisfaction with health insurance service quality Saad et al (2012) analyze the satisfaction of households with public health insurance in Turkey Only 53.3% of households are satisfied with the public health insurance service, most of them are not satisfied with the Assurance Using the original SERVQUAL model, Stanisław et al (2016) analyze the factors affecting the satisfaction of patients covered by health insurance in the Netherlands
Trang 3According to the exploratory factor analysis, the Tangibility factor is not
statistically significant The remaining four factors are statistically significant
and the Assurance and Empathy have the highest average satisfaction
+ In Africa, satisfaction with health insurance services has been studied in
several countries Shafiu et al (2011) investigate factors affecting the level of
customer satisfaction with health insurance services in Nigeria They find that
Assurance has the greatest impact on the satisfaction level of customers
participating in health insurance Kindie and Sharew (2019) use a regression
model to analyze the factors affecting household satisfaction with community
health insurance services in Sheko district, Ethiopia The benefit packages have
the greatest impact on satisfaction with health insurance services with a
standardized beta value of 0.92 Nsiah-Boateng et al (2017) evaluate customer
satisfaction with health insurance service quality at district hospitals in Ghana
The authors point out 6 factors that affect customer satisfaction about health
insurance services In which, Assurance the highest impact, with a beta
coefficient of 0.874 Based on survey data from 152 national health insurance
participants in Tanzania, Kiyoya (2019) reveal that Reliability and Assurance
have the greatest impact on participant satisfaction
+ In Asia, there are several studies on satisfaction in the field of health
insurance, especially in some countries with many similarities in
socio-economic and cultural aspects to Vietnam such as Indonesia, Taiwan According
to Devadasan et al (2011); Vijay and Krishnaveni (2018), Responsiveness is the
most important factor affecting satisfaction with health insurance service quality
in India Liu (2014) shows that Reliability is an important factor affecting the
satisfaction of national health insurance participants in Taiwan Astiena and
Adila (2017) investigate patient satisfaction with national health insurance in
some medical centers in Padang, Indonesia There are four factors affecting
patient satisfaction: Reliability, Assurance, Responsiveness and Empathy
1.1.2 Overview of domestic studies
There are several paper of satisfaction in the field of health services and
health insurance in Vietnam:
+ Theoretical studies on health insurance and factors affecting participation
in health insurance: Tran Quang Lam (2016) and Le Minh Tuyen (2017)
+ Several studies analyze the satisfaction of health services and health insurance services, but they do not run exploratory factor analysis For example,
Vu Hong Thai et al (2006) examine the satisfaction of people who come for medical examination at Ho Chi Minh City dermatology hospital Research carried by Pham Thi Tan My et al (2011) on the satisfaction of patients and their family members at Van Ninh hospital, Khanh Hoa Research carried by Phan Thi Thuy Vien et al (2011) on patient satisfaction at Tu Du hospital, Ho Chi Minh City
+ Some studies use descriptive statistical methods to measure satisfaction with different factors Hong Ha and Thu Hien (2012) assess customer satisfaction using medical services at hospitals in Vietnam - Cuba, Dong Hoi - Quang Binh A study carried by Nguyen Thi Nhu Quynh and Neera Dhar (2014)
on the satisfaction of the poor with health care services covered by public health insurance in Vietnam A study carried by Pham Van Hung et al (2016) on an early survey serving the development of a package of basic health services paid for health insurance
+ Several studies analyze the factors affecting patient satisfaction These studies use the exploratory factor analysis and multivariate regression models Truong Ngoc Hai et al (2011) investigate the satisfaction of patients treated at the general internal medicine department of Cho Ray hospital Multivariable regression analysis identifies 5 factors related to patient satisfaction score: (1) Duration of treatment, (2) Self-assessment of their health after treatment, (3) Patient's age, (4) Treatment outcome and (5) Patient's quality of life before admission Tang Thi Luu (2012) apply the SERVQUAL to assess the factors affecting patient satisfaction with Da Nang General Hospital After testing the reliability of the scale and analyzing EFA factors, the author proposes 5 factors affecting patient satisfaction including: (1) Impression and reputation of the hospital, (2) Suitability, (3) Responsiveness, (4) Care and attention, (5) Assurance All 5 explanatory variables are statistically significant at the significance level of 5% Le Thi Kim Ngan and Le Thi Thu Trang (2014) examine satisfaction of inpatients about service quality at Can Tho central general hospital There are four statistically significant factors including:
Trang 4Tangibility, Responsiveness, Quality of examination and treatment, Quality of
care and services
1.1.3 Research gap
+ Most of the studies on satisfaction in health and health insurance fields
use the SERVQUAL model as a theoretical basis to build the model To study
the satisfaction level of health insurance service quality of health insurance
participants, the author decides to use SERVQUAL model as the theoretical
basis Although there are some disadvantages, this model is widely applied in
both domestic and foreign studies to analyze the factors affecting the satisfaction
of service users Health insurance is a public service with special characteristics,
moreover, the policy as well as the implement of health insurance is very
different among countries Therefore, it is impossible to build a common model
to assess satisfaction with the quality of health insurance for all nations Based
on studies on service satisfaction and quality in the health service sector and the
characteristics of the health insurance policy in Vietnam, the author would make
adjustments in the SERVQUAL
+ According to the author's knowledge, the number of studies on
satisfaction in health insurance in Vietnam is very limited Most of these few
studies only focus on a certain health facility, which does not represent the
Vietnamese population Moreover, these studies only analyze and assess
satisfaction with health services and hospitals The quality of health insurance
services includes not only medical and hospital services but also some aspects of
health insurance payment, coverage of drugs and medical supplies covered,
access to health insurance, complaints about health insurance, etc It is the
research gap
1.2 Methodology
1.2.1 Analyzing secondary data
1.2.2 Analyzing primary data
1.2.2.1 Research model and hypotheses
1.2.2.2 Measure of variables
1.2.2.3 Data collection
Primary data is collected in the form of questionnaires Variables are
measured using the Likert scale (1932) with a rating scale from 1 to 5 including:
Completely dissatisfied, Unsatisfied, Satisfied, Relatively satisfied and Very satisfied
The population is all insureds who have experience of medical examination and treatment with health insurance However, due to the limitation
of time and resources, the sample is collected in three cities: Hanoi, Hue and Ho Chi Minh with geographical locations in both the North, the Central and the South The sample consists of 1500 insureds who have experience of medical examination and treatment with health insurance in Hanoi, Hue and Ho Chi Minh City
1.2.2.4 Analyzing data
The author converts questionnaires into quantitative variables and uses Excel software for descriptive statistics Then, the author uses SPSS software to test the reliability of the scale and build a linear regression model with the dependent variable being Satisfaction of the health insurance participants about the quality of health insurance services Then, the author examines the impact of factors on the satisfaction of health insurance participants about the quality of health insurance services as well as the correlation among factors
CHAPTER 2: THEORIES OF HEALTH INSURANCE AND FACTORS EFFECTING ON SATISFACTION ABOUT THE QUALITY OF
HEALTH INSURANCE SERVICES 2.1 Overview of health insurance
2.1.1 The definition and types of health insurance
Health insurance includes two types: social health insurance and private health insurance Social health insurance is organized by the State in accordance with the provisions of law, while private health insurance is organized and implemented by insurance companies
The thesis focuses on social health insurance, because in Vietnam by the end of 2019, the coverage rate of social health insurance has reached about 90%
of the population Although the private health insurance has developed rapidly,
it only covers a small part of the population with high incomes Health insurance is defined as a social security policy implemented by the State, based on the contributions of participants and support from the State
Trang 5Budget, in order to pay for medical examination and treatment costs for
participants when they encounter health risks
2.1.2 Nature of health insurance
- Health insurance is an objective demand of citizens, especially in the
market economy
- Health insurance is always considered as a pillar policy in the system of
social security, along with social insurance and social assistance
- Health insurance contributes to the redistribution of income among
participants
- The relationship in health insurance is a complex, multi-party
relationship
- Health insurance is not only a social security policy, but also a public
insurance service organized by the State
- The goal of health insurance is to improve health status, share losses
among participants, reduce out-of-pocket medical expenses, and contribute to
ensuring social security
2.1.3 Principles of health insurance
The health insurance has five basic principles:
(1) Risk pooling
(2) Principles of self-responsibility for their own health
(3) Coverage and participation of health insurance must be prescribed
by law
(4) Several groups of citizens is supported by the State
(5) Each citizen at a time only participates in health insurance according
to a certain group
2.1.4 Roles of health insurance
There are three main roles of health insurance:
+ Provide basic and comprehensive medical services for prevention,
treatment, rehabilitation and health promotion for people
+ Protect people from financial risks due to sickness
+ Ensure equity in accessing health services, Ensure that all citizens can
access basic health services, regardless of their financial status
2.2 Definition of quality of health insurance service
2.2.1 Service quality
2.2.1.1 Definition of service
Service is a non-tangible and purposeful activity of a supplier to meet some human demand Health insurance service is a special type of service In essence, health insurance services include activities carried out by health facilities and agencies implementing health insurance policies
2.2.1.2 Definition of service quality
Quality and service quality are complex concepts that are difficult to define In order to evaluate service quality, it is necessary to consider both the service system of the provider (the supply) and the perceptions, expectations and psychology of service users (the demand)
2.2.2 Quality of health insurance service
Health insurance service is a special public service, because both health insurance agencies and health facilities jointly provide health insurance services Therefore, the quality of health insurance services depends not only on the quality
of health services, but also on the health insurance policy and the implementation
of this policy by the health insurance agency Factors such as the list of drugs and medical supplies, covered medical expenses or settlement of complaints, etc all have an impact on the quality of health insurance services The thesis does not focus on the quality of medical professionals Instead, it focuses on the factors of functional quality of health services, health insurance policies and the implementation of health insurance policy of the social insurance agency
To sum up, quality of health insurance services is the ability of health insurance services to meet the needs of health insurance participants, which is the result of a comparison between the expectations of the insured and their perceptions of using health insurance services
2.2.3 Improving the quality of health insurance services is an objective demand of participants as well as social insurance agencies and medical facilities
Most participants only use health insurance services when they are sick Therefore, the quality of health insurance services has a great impact on the medical examination and treatment process and their health status A high-quality service helps patients reduce time, effort and money in medical
Trang 6examination and treatment Conversely, a poor quality service makes their
medical examination and treatment more difficult, more expensive, and even
dangerous to their lives If citizens are satisfied with the quality of health
insurance services, even if participating in health insurance is not mandatory,
most of them would participate in health insurance One of the reasons why
citizens do not buy health insurance is that they do not really believe in the
quality of health insurance services Therefore, it is necessary to constantly
improve the quality of health insurance services
2.3 The satisfaction of participants with the quality of health insurance
services
2.3.1 The concept and classification of the satisfaction of participants with the
quality of health insurance services
Satisfaction of health insurance participants is an overall attitude or an
emotional response to the difference between their expectations about the
quality of health insurance services and what they receive and experience when
using the health insurance service
From the above concept, the satisfaction of participants with the quality of
health insurance services is classified into five levels: Very Unsatisfied,
Unsatisfied, Relatively Satisfied, Satisfied, Very Satisfied
2.3.2 Factors affecting the satisfaction level of participants with the quality of
health insurance services
2.3.2.1 Responsivenesss
Responsiveness is the first factor affecting the satisfaction level of
participants with the quality of health insurance services According to
Parasuraman et al (1985), responsiveness represents the desire and willingness
of service staff to provide timely service to customers For health insurance
services, responsiveness is reflected in the easy access of participants to health
insurance and administrative procedures when providing medical care with
health insurance (Fitzgerald and Bias, 2016)
2.3.2.2 Assurance
Assurance is the ability to reliably and accurately deliver the promised
service According to Emel (2014), assurance is the consistent and reliable
provision of services, accurate payment and complete record keeping It includes
the consistency, the stability in the first time providing services Ensuring service commitments is one of the expectations of customers
In the field of health insurance, many studies have shown that Assurance has a positive effect on the satisfaction level of participants with the quality of health insurance services such as the study of Shafiu et al (2011), Yogesh et al Satyanarayana (2012), Nsiah-Boateng et al (2017), Astiena and Adila (2017), Kindie and Sharew (2019)
2.3.2.3 Reliability
Reliability is the provision of services with a polite and respectful attitude
to customers, which is demonstrated through expertise, and effective customer service Parasuraman et al (1988) argue that Reliability is reflected in the professional level, behavior and communication of employees The combination
of attitude and ability creates a sense of trust for customers Customers will feel more satisfied with the service when the reliability of suppliers meets their expectation
In the field of health insurance, many studies have shown that Reliability
is an important factor affecting the satisfaction of health insurance participants: Liu (2014), Lee (2016), Astiena and Adila (2016) 2017), Sarker et al (2018), Kiyoya (2019)
2.4 Health insurance in several nations and lessons for Vietnam
2.4.1 Health insurance in several nations 2.4.2 Lessons for Vietnam
+ The health insurance policy depends on the socio-economic conditions, culture and awareness of people in each country
+ The State always plays an essential role in promulgating and implementing health insurance policy
+ The design of health insurance policy should be done in a long-term perspective
+ The level of contribution of each group of participants, the scope of benefits covered by health insurance, the method of co-payment and the method of payment between health insurance agency and medical facilities should be calculated precisely At the same time, all these factors must be managed in order to balance and stabilize the financial health insurance fund
Trang 7CHAPTER 3: ANALYSIS OF FACTORS INFLUENCING QUALITY
SATISFACTION OF HEALTH INSURANCE SERVICES IN VIETNAM
3.1 Overview of health insurance in Vietnam
3.1.1 Foudation and development
3.1.2 Management organization
3.1.3 The implementation of health insurance services in Vietnam
3.1.3.1 The number of participants
The number of participants in health insurance increases sharply in recent
years In 2019 it reaches 85.6 million people, which equals nearly 22 times the
number in 1993 when the health insurance is introduced The proportion of the
population covered by health insurance in 2019 is about 90% Several groups
such as officials, public employees have the proportions of approximately 100%
3.1.3.2 Health insurance fund management
The revenues and expenditures of health insurance increase continuously
during 1993-2019 The health insurance fund is a stable and sustainable
financial source, serving the people's medical examination and treatment,
contributing to reduce the financial burden on health care for the State budget In
2019, the amount of the health insurance fund increases by nearly 900 times
compared to 1993, with revenues and expenditures of VND 104,538 billion and
VND 104,443 billion, respectively
3.1.3.3 The organization of medical treatment and ensuring the benefits of
medical treatment for participants
a, The number of medical treatments and the medical expenses covered by
health insurance
The number of medical treatments increases rapidly, reaching 184 million
times in 2019, an increase of nearly 90 times compared to 1993 The frequency
of medical examination and treatment with health insurance also increases from
1.84 times/person/year in 2009 to 2.11 times /person/year in 2019 Health
insurance benefits are expanded Thousands of new medical services, including
hundreds of high-tech, high-cost services and a number of new disease groups
are covered by the health insurance By the end of 2019, there are nearly 15,000
health care facilities covered by health insurance throughout the country,
including remote islands and mountainous areas After nearly 30 years of
implementing the health insurance policy, more than 350 million turns of
medical examination and treatment people are paid by health insurance with a total payment of nearly 460,000 billion VND Tens of millions of patients participating in health insurance with incurable diseases and serious diseases requiring long-term treatment are indemnified
b) The professional qualifications of the medical staff
Out of nearly 180,000 medical staff, the percentage of medical staff with degrees and professional qualifications accounts for a very small percentage The proportions of medical specialists II Medicine and Master of Medicine are very low, at 2.92% and 1.81%, respectively The percentage of doctors with a PhD degree or higher is only 0.19% Thus, the number of treating doctors and specialists with high professional qualifications is still small, which does not meet the demand of citizens
c) Equipment of medical facilities covered by health insurance
Health care facilities in Vietnam still have many limitations in terms of physical conditions and infrastructure Even level hospitals still do not meet the needs of patients Most central hospitals face overcrowding, many patients share the same hospital bed, the toilet area is still dirty and does not meet medical hygiene conditions District hospitals and commune health care facilities do not face overcrowding of patients, however, the facilities are still poor and outdated They are unable to perform surgeries, procedures, and subclinical tests requiring complex and intensive techniques
3.1.4 General assessment of the implementation of health insurance services
in Vietnam
3.1.4.1 Achievements
- In 2012, the health insurance coverage rate is below 65% of the population By the end of 2019, this firgure reaches nearly 90% of the population, which is equivalent to 85 million people Thus, Vietnam basically completes the goal of universal health insurance
- The benefits of are expanded, funding sources for medical care at health facilities are guaranteed
- Renovate the financial mechanism in the direction of correct and adequate calculation of health service prices in order to gradually reduce the payment from state budget Health facilities improve the quality of medical
Trang 8examination and treatment Ensure fairness in evaluating the performance of
medical facilities across the country, ensure the benefits of participants
- The assessment of costs of medical care and treatment with health
insurance focuses on improving and renovating management quality, the ability
to monitor and control In line with the direction of administrative reform and
application of information technology in the field of health insurance,
contributing to improving the responsibility and initiative of the social insurance
agency, medical examination and treatment facilities as well as enhancing the
effectiveness of supervision
3.1.4.2 Limiatations
- Several party committees do not extensively disseminate the health
insurance policy to the beneficiaries of the health insurance regime, especially in
remote and isolated areas
- Communication on the health insurance policy has not achieved high
efficiency: the implementation organization is not strategic; sometimes still
passive and unprofessional
- The proportion of citizens participating in the health insurance accounts
for over 90% of the total population, and still nearly 10% of the population has
not yet joined health insurance (equivalent to about 10 million people) The
majority of them live in rural areas and come from households working in
agriculture, forestry, fishery and salt production; individual business households,
etc It is difficult to convince them because they have to pay out of pocket to
participate in health insurance
- The provisions of the Law on Health Insurance and its guiding
documents are not consistent
- Administrative procedures for health insurance are still inadequate
- Health insurance costs tend to increase, leading to an overspending of
the health insurance fund from 2016 to 2019
- Regulations on the list of drugs and medical supplies covered by the
health insurance fund are still inadequate
- The physical facilities of health care facilities covered by health
insurance at the district level are poor and outdated, unable to perform
complicated surgeries, procedures and tests Medical qualifications at these
facilities are also limited People are still not satisfied with the procedures in
medical examination, treatment, health insurance payment such as: complicated paperwork, time consuming procedure, etc
3.2 Analysis of factors affecting the level of satisfaction with the quality of health insurance services in Vietnam
3.2.1 Testing the scales
3.2.1.1 Testing the reliability of measurement scales
Cronbach's Alpha coefficients show that all three scale components have reliability greater than 0.7 Thus, the designed scale is statistically significant
3.2.1.2 Exploratory Factor Analysis
KMO and Bartlett's values show that there is a correlation between the variables; p-value (Sig) of 0.000 is less than the significance level α = 0.05 At the same time, the KMO value = 0.866 is in the statistically significant range (from 0.5 to 1), implying that factor analysis for grouping these variables together is appropriate
The Factor loading coefficient (multiplier loading) of the observed variables must be greater than 0.5 (Amir and Omidi, 2016) The analysis results show that the multiplier loading of all 12 observed variables is greater than 0.5 Thus, the 12 components of the questionnaire were preserved and extracted into
03 factors in accordance with the original research intention
The percentage of variance explained for all three factors is 69.802%; greater than the 50% criterion Thus, 03 factors explain 69.802% of the variation
of 12 observed variables All Initial Eigenvalues (% of Variance) values are greater than 2%, then all 12 variables are statistically significant
After analyzing exploratory factors, it could be concluded that the research scale is statistically significant
3.2.2 Testing hypotheses
3.2.2.1 Analyzing correlation among independent variables
All correlation coefficients among the independent variables are less than 0.7 Therefore, there is no multicollinearity The relationship between the
dependent and any independent variable is significant
3.2.2.2 Regression analysis and testing hypotheses
Linear regression equation with dependent variable being the satisfaction level of health insurance participants about the quality of health insurance services is:
Trang 9HL = 1.036 + 0.241 * DU + 0.087 * DB + 0.214 * TC
Thus, the impact of Responsiveness to the satisfaction level of health
insurance participants about the quality of health insurance services is the
strongest (DU) The lowest impact belongs to the Assurance (DB)
Explain the slope coefficients b:
+ b1 = 0.241 > 0 indicates that when DU increases by 1 unit, the average
satisfaction level of participants about the quality of health insurance services
increases by 0.241 units The standard regression value of the variable DU
affects 29.7% to the satisfaction level of health insurance service quality Thus,
the research hypothesis H1 is accepted, Responsiveness has a positive effect on
satisfaction with health insurance service quality
+ b2 = 0.087 > 0 when DB increases by 1 unit, the average satisfaction
level of participants about the quality of health insurance services increases by
0.087 units The standard regression value of the variable DB affects 11.6% to
the satisfaction level of health insurance service quality Thus, the research
hypothesis H2 is accepted, Assurance has a positive effect on satisfaction with
health insurance service quality
+ b3 = 0.214 > 0 when TC increases by 1 unit, the average satisfaction
level of participants about the quality of health insurance services increases by
0.214 units The standard regression value of the variable TC affects 27.8% to
the satisfaction level of health insurance service quality Thus, the research
hypothesis H3 is accepted, Reliability has a positive effect on satisfaction with
health insurance service quality
3.3 Assess the satisfaction level of health insurance participants about health
insurance services
3.3.1 General assessment
Of the 1364 survey participants, 433 are dissatisfied and very dissatisfied,
accounting for 31.74% - a large proportion of survey respondents are not
satisfied with the quality of health insurance services
There is a difference in satisfaction with the quality of health insurance
services in three cities The percentage of survey respondents who are satisfied
with the quality of health insurance services in Hue is the highest In contrast, in
Ho Chi Minh City, more than 32% of survey respondents are not satisfied with
the quality of health insurance services, which is the highest percentage of people dissatisfied with health insurance services
The level of satisfaction of survey participants at the three health care levels is very different The number of survey respondents who are dissatisfied and very dissatisfied with the quality of health insurance services at district health care facilities is the highest The cause of this phenomenon is that the facilities and equipment of the district medical facilities are not properly invested and do not meet the medical treatment needs Moreover, the professional qualifications of medical staff and doctors at district health facilities are very limited Therefore, the percentage of survey respondents who are satisfied with the quality of health insurance services at central and provincial and city health care facilities is 31.05% and 23.16%, respectively The rate at district health care facilities is only less than 18%
3.3.2 Factors on the Responsiveness of health insurance services
The average value of satisfaction of health insurance participants about the Responsiveness is 3.498 Among four factors of Responsiveness, factor Dapung4 (Administrative procedures for medical examination and treatment with health insurance) has the lowest average value of satisfaction (3.376) Many participants say that the medical examination and treatment procedures covered by health insurance are complicated and cumbersome, causing time-consuming for patients Moreover, the propaganda and awareness raising of the participants of health insurance is still not good, so patients do not understand the necessary documents and procedures when performing medical examination and treatment with health insurance It is difficult and time consuming for both the patient and the medical staff
Factor Dapung3 (wide network of health care facilities covered by health insurance) has the highest average value of satisfaction (3.663) The satisfaction level of participants about the network of health care facilities is quite high, because it covers a wide range from the central to local levels, including 04 levels: the central level; provincial and city lines; district and ward lines Patients with health insurance cards could receive medical treatment at all central hospitals and major hospitals of other ministries/sectors On average, each province has nearly 20 hospitals that are health care facilities covered by health insurance Numerous district hospitals across the country signed contracts
Trang 10for health care and treatment with health insurance Thus, the network of health
care facilities covers the whole country, from ward health facilities to central
hospitals in big cities
3.3.3 Factors on the Assurance of health insurance services
Compared with the Responsiveness and Reliability, the average value of
satisfaction of participants about the Assurance is the lowest, at only 3.461 In
which, two factors with the lowest average value of satisfaction are the factor
Dambao3 (3.289) and Dambao2 (3.317) These two factors measure the
satisfaction of participants about the richness in the list of covered health care
services and the list of covered drugs and medical supplies Of the 1364 survey
participants, 117 people (accounting for nearly 8.6%) are completely dissatisfied
and 111 people (accounting for 8.14%) are not satisfied with the list of covered
drugs and medical supplies Similarly, for the list of covered health care
services, there are also 120 people (8.8%) being completely dissatisfied and 119
people (8.72%) being not satisfied Many respondents comment that the list of
covered drugs, medical supplies as well as health care services is incomplete and
does not meet the needs of patients This list also changes frequently, causing
patients to feel that the social insurance agency tends to remove "good,
high-quality, expensive" drugs from the list but only provides drugs " popular, low
quality, cheap” Therefore, the level of satisfaction with the list of drugs,
medical supplies as well as health care services is relatively low
3.3.4 Factors on the Reliability of health insurance services
The average value of satisfaction of participants about the Reliability is
relatively high, at 3.593 The average value of satisfaction of the factor Tincay3
(facilities and equipment of health care facilities) is quite low, at only 3.468
Among 1364 survey participants, 221 people (16.2%) choose the degree of
being very dissatisfied or dissatisfied with the facilities and equipment of health
care facilities Notably, the percentage of survey respondents who are not
satisfied with the facilities of the central health facilities; provincial and city
lines and district lines are nearly the same District hospitals have poor and
outdated equipments that cannot perform complex surgeries, procedures, and
paraclinical tests Recently, provincial and city hospitals invest in modern
equipments, but the qualification of medical staff is far from those of the central
level Therefore, the use of subclinical results in diagnosis and treatment are not
really effective The central line is invested, equipped with modern equipments Furthermore, the qualification of medical staff is very high, many of them are leading experts, but all central hospitals have to face overcrowding Several patients must share a hospital bed The toilet area does not meet medical hygiene conditions Therefore, the facilities and equipment of medical facilities in general still do not meet the needs of patients The issue of upgrading medical facilities and equipment is not only a problem for lower-level medical facilities but also for large hospitals at the central level
CHAPTER 4: PERCEPTION, ORIENTATION, AND SOLUTIONS TO ENHANCE THE QUALITY OF HEALTH INSURANCE SERVICES TO
SATISFY THE PARTICIPANTS IN VIETNAM 4.1 Perception, orientation, and objectives to develop health insurance in Vietnam
4.1.1 Perception to develop the health insurance
The key perception to develop the health insurance is towards universal health insurance, creating a stable financial source in the direction of fairness and efficiency, gradually improving the quality of health care services, ensuring the responsibilities, and satisfaction of participants, ensuring national social security
4.1.2 Orientation to develop the health insurance
Firstly, develop and perfect the health insurance policy Secondly, synchronously implememt solutions to improve the quality of medical examination and treatment covered by health insurance
Third, further innovate the financial mechanism in the direction of direct investment for beneficiaries of health insurance
Fourth, strengthen the state management of health insurance Fifth, for provinces and cities, the implementation of Resolution 21 must
be determined as a political task and a socio-economic target of each locality Sixth, promote propaganda and dissemination of the law on health insurance in the direction of professionalization in both content and method of approaching participants
4.1.3 Objectives to develop the health insurance
- Ensure all citizens can access primary health care services