Patient satisfaction with care is associated with personal choice of physician
Introduction
It is argued that a patient list system guarantees better continuity of care, contributes to health promotion and illness prevention activities, as well as helps to avoid duplication of services and create efficient referrals [1]. Among the characteristics of practices which might influence patient satisfaction with care are presence of a list system and practice size [2], [3]. Continuity of care has also been shown to improve patient satisfaction [4], [5]. Patients’ perception of care presents increasing interest, particularly in a situation where major changes have occurred in health care system. Following fundamental changes in society in the countries of Central and Eastern Europe, remarkable reforms in health care were undertaken at the beginning of the 1990s. Most of these countries changed from state-budget-funded centralized systems to insurance based liberal fee-for-service payment systems [6]. In the late 1990s, several of these countries have made attempts to introduce capitation payment system and patient lists in order to restrain soaring health care costs. During the last 7–8 years analogous changes have taken place in Estonian health care: changing of the funding system of health care from the state budget to the health care insurance fund in 1992, and moving from highly specialized medical providers to a primary care oriented system. Family medicine was seen as a possibility to build up a more effective and better coordinated health care system. At the center of primary care reform were: (1) recognition of family medicine as a speciality with its own under- and postgraduate training programs in 1993 (2) change of the contracting and remuneration system of primary care doctors together with introduction of a list system for family doctors in 1998 [7]. Every person was expected to choose their family doctor by registering on a patient list. They could register personally while contacting doctor at his/her office or at the registration desk of the polyclinic (without contacting doctor before registration), or to be included in the list by a medical staff of local polyclinic according territorial principe. An opportunity to contact the physician directly to be entered in the list was seen as a tool for strengthening personal relationship with doctor. There is limited evidence concerning the effects these changes exert on patient satisfaction as an indicator of quality of care. It has been demonstrated that in a large centralized Health Maintenance Organization, whose members reported having chosen their personal physician were substantially more satisfied with their physician than those who reported having been assigned [8]. It has been demonstrated by a recent study that choice is important for mutual trust, because patients have more confidence in physicians whom they themselves select [9]. While the success of medical care depends significantly on patients’ trust in their physician, free choice of a personal doctor seems to be an important precondition for gaining good medical outcomes. However, patients in different cultures and health care systems may have different views on several aspects of primary care, among them also on the possibility to see the same GP at each visit [10], [11].
The aim of this study was: (1) to investigate whether having a personal physician is associated with patient satisfaction with different primary health care aspects (2) to compare satisfaction with primary health care in those who chose their doctor on their own initiative and in those who were directed to the list by the medical staff of a local polyclinic. (3) to assess whether choice of the personal doctor among other factors is related to satisfaction with primary health care.
Section snippets
Method
In October 1998, a random sample of Estonian residents, aged 15–74 years (n=997), were personally interviewed by using a pre-categorized questionnaire which was worked out in cooperation with a study group of the University of Tartu and the market research company EMOR. The sample of this study was formed by self-weighting: a proportional model of the total population aged 15–74 years, where all respondents represent the equal number of respective persons in the population, was used. Two-stage
Results
The survey was completed by 997 patients. The sample represents the Estonian population (Table 1).
Of the respondents 68% (n=675) were entered in the list of their personal physician. There existed some differences in demographics and health status between the patients who had chosen a personal family doctor and those who had not.
Patients who had registered with a personal doctor were more likely to be women and persons who considered their health status poorer compared with the others (P<0.05
Discussion
In January 1998 a list system with mixed remuneration (capitation, fee-for-service, basic practice payment and bonuses) was established in Estonia. All people were asked to register with a regular physician: family doctor, general internist or pediatrician. The right to choose one's own physician and to contact the physician directly to be entered in the list was considered important points in this process. Since this kind of free registration is unique, analysis of its relationship with
Acknowledgements
This study was supported by funding from the Estonian Health Project.
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