How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links
Abstract
:1. Introduction
2. Literature Review
2.1. Overconsumption of Health Care and Patient Moral Hazard
2.2. Patient Satisfaction and Patient Adherence
2.3. Trust in Health Care
3. Materials and Methods
3.1. Research Model and Hypotheses
3.2. Variables and Scale Development
3.3. Sample and Method
4. Results
5. Discussion
- It is an attempt at taking a new and two-dimensional look at overconsumption of health care. On the one hand, overuse is a macroeconomic problem, and it has been the subject of extensive research. On the other hand, it can be viewed as patient behavior that is subject to modification through appropriate management by the service provider (patient satisfaction) and by the health system (public trust in health care).
- It identifies factors influencing overconsumption of health care, both on the macro (trust in the health system) and micro (patient satisfaction, non-adherence) scales. It also points to the mediating role of patient satisfaction and emphasizes the importance of patient non-adherence in stimulating overuse of medical services.
- It focuses on Poland, a country in transition, where no research into the degree of overuse has been conducted before. Interestingly, Poland’s health system has been undergoing major transformations, and patients are not yet treated as clients.
- Finally, it improves the understanding of how public trust operates within both macro- and micro-relationships in the health system, which may provide an insight into interpersonal trust. This research is sufficiently novel in that few studies have emphasized the role of patient satisfaction and patient non-adherence in shaping overconsumption of health care before.
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Concept | Meaning | Source |
---|---|---|
Overuse | A situation when health care service is provided under circumstances in which its potential for harm exceeds the possible benefit | [13] |
Moral hazard | Excessive expenditure due to eligibility for insurance benefits | [18] |
Patient satisfaction | A patients’ overall evaluation of the performance of a service offering after experiencing it | [30] |
Patient adherence | The extent to which a person’s behavior (such as taking medication, modifying lifestyle, following a diet) corresponds with agreed recommendations from a health care professional | [36] |
Interpersonal trust | Characterizes a relationship between two individuals, such as a specific doctor–patient relationship. | [51] |
Public/system trust | Characterizes attitudes toward collective entities or social organizations. | [10] |
Variable | Source | Cronbach Alpha |
---|---|---|
Public trust in health care (5 items) | [63,64] | 0.68 |
Patient satisfaction (8 items) | [64,73,74] | 0.86 |
Patient non-adherence (3 itmes) | [39] | 0.64 |
Income | Sex | ||||
---|---|---|---|---|---|
N | % | N. | % | ||
up to PLN 1.000 * | 84 | 9.3 | female | 572 | 58.2 |
from PLN 1.001 to 1.400 | 95 | 10.5 | male | 411 | 41.8 |
from PLN 1.401 to 1.800 | 108 | 12.0 | Age | ||
from PLN 1.801 to 2.000 | 113 | 12.5 | 18–24 | 103 | 10.5 |
from PLN 2.001 to 2.500 | 76 | 8.4 | 25–34 | 182 | 18.5 |
from PLN 2.501 to 3.000 | 120 | 13.3 | 35–44 | 163 | 16.6 |
from PLN 3.001 to 5.000 | 139 | 15.4 | 45–59 | 252 | 25.6 |
over PLN 5.000 | 118 | 13.1 | over 60 | 283 | 28.8 |
hard to say | 49 | 5.4 | |||
Place of residence | Level of education | ||||
village | 356 | 36.2 | elementary | 148 | 15.0 |
up to 100 thous. | 335 | 34.1 | basic vocational | 213 | 21.7 |
100–499 thous. | 164 | 16.7 | secondary | 345 | 35.2 |
500+ thous. | 127 | 13.0 | college/university | 276 | 28.1 |
Mean | SD | Patient Satisfaction | Patient Non-Adherence | Public Trust in Health Care | |
---|---|---|---|---|---|
Correlation Coefficient | |||||
Patient satisfaction | 3.62 | 0.77 | |||
Patient non-adherence | 2.31 | 1.02 | −0.19 | ||
Public trust in health care | 2.97 | 0.76 | 0.47 | −0.14 | |
Overconsumption of health care by patients | 3.54 | 1.22 | −0.19 | 0.16 | −0.15 |
Index | Score |
---|---|
CMIN/DF | 1.78 |
GFI | 0.97 |
CFI | 0.97 |
RMSA | 0.028 |
Holter | 691 |
Estimate | p Value | ||||
---|---|---|---|---|---|
H1: Overconsumption of health care by patients | ← | Public trust in health system | −0.10 | 0.002 | Supported |
H2: Patient satisfaction | ← | Public trust in health system | 0.57 | 0.000 | Supported |
H3: Patient non-adherence | ← | Public trust in health system | −0.12 | 0.05 | Supported |
H4: Patient non-adherence | ← | Patient satisfaction | −0.16 | 0.003 | Supported |
H5: Overconsumption of health care by patients | ← | Patient satisfaction | −0.11 | 0.000 | Supported |
H6: Overconsumption of health care by patients | ← | Patient non-adherence | 0.15 | 0.001 | Supported |
Public Trust in Health Care | Patient Satisfaction | Patient Non-Adherence | |
---|---|---|---|
Standardized total effects | |||
Public trust in health care | - | - | - |
Patient satisfaction | 0.57 | - | - |
Patient non-adherence | −0.21 | −0.16 | - |
Overconsumption of health care by patients | −0.19 | −0.13 | 0.14 |
Standardized direct effects | |||
Public trust in health care | - | - | - |
Patient satisfaction | 0.57 | - | - |
Patient non-adherence | −0.12 | −0.16 | - |
Overconsumption of health care by patients | −0.10 | −0.11 | 0.14 |
Standardized indirect effects | |||
Public trust in health care | - | - | - |
Patient satisfaction | - | - | - |
Patient non-adherence | −0.09 | - | - |
Overconsumption of health care by patients | −0.09 | −0.02 | - |
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Krot, K.; Rudawska, I. How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links. Int. J. Environ. Res. Public Health 2021, 18, 3860. https://doi.org/10.3390/ijerph18083860
Krot K, Rudawska I. How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links. International Journal of Environmental Research and Public Health. 2021; 18(8):3860. https://doi.org/10.3390/ijerph18083860
Chicago/Turabian StyleKrot, Katarzyna, and Iga Rudawska. 2021. "How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links" International Journal of Environmental Research and Public Health 18, no. 8: 3860. https://doi.org/10.3390/ijerph18083860
APA StyleKrot, K., & Rudawska, I. (2021). How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links. International Journal of Environmental Research and Public Health, 18(8), 3860. https://doi.org/10.3390/ijerph18083860