Effect of social health insurance on quality of care : a case study of Mahosoth Hospital in Vientiane, Lao PDR

Abstract

To examine factors affecting quality of care, and to compare the quality of care between insured and uninsured patient under the social security health insurance organization at Mahosoth hospital in Vientiane Capital City of Lao PDR. The process of care was assessed by analyzing the medical prescription records at the inpatient care and outpatient care department of the hospital. The quality of care was assessed by the process and outcome approaches. Considering about quality of outpatient care, the prescription records in practicing of doctors were used. At the inpatient care, the medical procedures and length of stay were used as indicators for assessing the quality of care and interviewed patient satisfaction was used to evaluate the outcome of care provided by the hospital at both inpatient care department and outpatient care department. In term of percentage of conformed standard procedure (PCSP) for inpatient, there were statistically significant with showing the correlation between level of PCSP and insurance status with [superscript 2] = 16.46; mean of PCSP of insured patients was higher than that of uninsured with 75.821 and 69.179, respectively. The length of stay (LOS) of the insured was shorter than the uninsured with t = 28.88; mean of LOS of insured patient was less than that of uninsured with 8.02 and 9.94, respectively. Besides the income of patient, insurance enrollment, cost of treatment, PCSP and percentage of conforming standard drug (PCSD) were negative related to LOS. The higher level of compliance to the standard treatment was correlated with the shorter LOS. The study also found that there were correlation between satisfaction and insurance status with [superscript 2] = 30.37. The result from model showed that on average the LOS for patients who got malaria disease were 6.420 days and pneumonia disease were 5.816 days with very statistic significance. With income of patient, insurance enrollment, cost of treatment, PCSP and PCSD were negative related with LOS. For outpatient care, the number of the insured was greater than the uninsured. The insured were more satisfied than uninsured patient with [superscript 2] = 59.60. The results showed that, insurance enrollment and gender were statistically significant and positively related to the satisfaction. The insured patient was more satisfied higher than that uninsured patient. Waiting time for consultation from doctors was one factor that patients were complaining about satisfaction. The payment method for the care was also affecting the satisfactory of the patients. In term of the level of PCSP of outpatient, the insured patients received proper procedures following the standard treatment guidelines higher than the uninsured with t = -56.22. Similarly, the score of PCSD at excellence level was highest percentage for the insured; mean of PCSD of insured was higher than that of uninsured with 84.434 and 81.337, respectively. It means that the insurance status has influence on the qualityof care provided from the doctors. This research provides information about quality of care under the health insurance scheme from different perspectives, the quality of care was statistically significant different between the insured and uninsured patients at both department, from the professional perspective. Therefore, the quality of care of services in hospital must be improved by following the national standard treatment guideline, because the higher level of compliance to the standard treatment, the better the quality of care.