Diabetes mellitus is a costly chronic disease related to medication, physician consultation and laboratory investigation. The main means of financing healthcare include direct out-of-pocket (OOP) payment and government subsidisation in some countries, or public/private health insurance schemes, or a mix of all. Patient satisfaction is critical in ensuring the use of healthcare services, continuity of care and treatment adherence. In this study, we determined the satisfaction of type 2 diabetes mellitus (T2DM) patients regarding the healthcare services and payment methods at Universiti Kebangsaan Malaysia (UKM) Teaching Hospital, Malaysia. This cross-sectional study involved 313 T2DM patients aged ≥18 years who were included after clinical consultations. We used convenience sampling at the outpatient and inpatient medical centres of Hospital Canselor Tuanku Muhriz and UKM Specialist Centre. A survey consisting of sociodemographic, socioeconomic and payment method types as well as a validated patient satisfaction questionnaire scale were used. The mean age was 59.6 years (SD=13.151), 53.0% of the patients were female, 78.3% were Malay, 76.4% were uninsured, 39.6% were covered by government subsidies, while 36.7% paid OOP. Around 86% were generally satisfied with the overall services. Patients were most satisfied with technical quality (84%), communication skills (83%) and accessibility (80%), but satisfaction was lower in doctors’ service orientation, particularly the interpersonal manner (73%), financial aspect (73%) and time spent with the doctor (70%). Over 86% of patients were satisfied with healthcare services and payment methods; however, patients who paid OOP reported low satisfaction. Full insurance and extending benefits to partially cover both inpatients and outpatients with low co-payment is recommended to increase satisfaction.
Payment Methods and Patient Satisfaction among Type-2 Diabetes Patient at a Teaching Hospital in Malaysia
Abstrak
Diabetes melitus ialah penyakit kronik dengan kos tinggi yang dikaitkan dengan ubat-ubatan, perundingan pakar dan ujian makmal. Kaedah utama pembiayaan untuk rawatan penyakit ini ialah biaya sendiri (OOP) dan subsidi kerajaan di beberapa negara, atau skim insurans kesihatan awam/swasta, atau gabungan antaranya. Kepuasan pesakit sangat penting dalam memastikan penggunaan perkhidmatan kesihatan serta kepatuhan penjagaan dan rawatan yang berterusan. Dalam kajian ini, kami mengenal pasti kepuasan pesakit diabetes melitus jenis 2 (T2DM) berkenaan perkhidmatan penjagaan kesihatan dan kaedah pembayaran di hospital pengajar Universiti Kebangsaan Malaysia (UKM). Kajian ini melibatkan 313 pesakit T2DM berusia ≥18 tahun yang terlibat selepas rundingan klinikal dijalankan. Kami menggunakan kaedah persampelan mudah di pusat rawatan pesakit luar dan pesakit di dalam Hospital Canselor Tuanku Muhriz dan Pusat Pakar UKM. Satu tinjauan yang terdiri daripada sosiodemografi, sosioekonomi dan jenis kaedah pembayaran serta skala soal selidik kepuasan pesakit yang sah telah digunakan. Purata umur pesakit ialah 59.6 tahun (SD=13.151), 53.0% pesakit ialah wanita, 78.3% Melayu, 76.4% tidak diinsuranskan, 39.6% dilindungi oleh subsidi kerajaan sementara 36.7% OOP. Secara umumnya, 86% pesakit berpuas hati dengan keseluruhan perkhidmatan. Pesakit paling berpuas hati dengan kualiti teknikal (84%), kemahiran komunikasi (83%) dan kebolehcapaian (80%), namun kepuasan lebih rendah dalam aspek perkhidmatan oleh doktor, terutama kaedah interpersonal (73%), aspek kewangan (73%) dan masa yang dihabiskan bersama doktor (70%). Lebih 86% pesakit berpuas hati dengan perkhidmatan kesihatan dan kaedah pembayaran; namun, pesakit OOP merekodkan kepuasan yang rendah. Insurans penuh dan faedah tambahan untuk separuh perlindungan kepada pesakit dalam dan luar dengan pembayaran bersama yang lebih rendah disyorkan untuk meningkatkan kepuasan mereka.
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