Differences in quality of primary and secondary care experienced by the insured and the uninsured : a case study of Kupang municipality, capital of East Nusa Tenggara, Indonesia

Abstract

To analyze the differences in quality of primary and secondary care experienced by the insured and uninsured. The specific objectives are to analyze the differences in quality of care between different type of health insurance and to analyze factor affecting quality of care in primary and secondary care. The quality of care was assessed by the input, process and outcome approach of outpatient care in primary and secondary health facilities. Input of care was assessed by analyzing physician characteristic and perception of patient on the capacity of the physician. The medical procedures, standard treatment and prescribing pattern were used to access the process of care. To evaluate outcome of care patient satisfaction was used as the indicator. For secondary care there were some significant differences between insured and insured. In term of input aspect uninsured patient get service more from specialty physician and cost form provider perspective for uninsured is higher than insured. Regarding process aspect, the percentage conforming to standard therapy of insured patient is higher than the uninsured, the percentage of essential drugs and generic drugs of uninsured are higher than the insured. For outcome aspect the uninsured patients were more satisfied than the insured but the result is not significant. There are five significant variables affecting satisfaction of patient which are cost from provider perspective, waiting time, consultation time, and capacity of physician from perspective of patient and medical procedures. For public primary care there were some differences between insured and uninsured patient. The differences which identified s on private. For private all the respondents are satisfied with the services. In term of process prescribing pattern (such as no of drugs, percentage of generic drugs and antibiotic) and standard treatment have significant different between insured and uninsured. Factor affecting patient satisfaction for public primary care is there are no significant differences between uninsured and insured group for all variable of process. Only one significant variable affecting satisfaction of patient which is percentage conforming standard treatment. This research provides information regarding quality of care under health insurance scheme from different perspectives. Factor affecting the quality of care which have significant result is related with services directly receive by the patients. It means that Government of East Nusa Tenggara province should focus on that matter for improving quality of care and health status.