Perceived Quality and Users’ Satisfaction with Public–Private Partnerships in Health Sector
Abstract
:1. Introduction
- How satisfied is the Portuguese population with the quality of service provided by PPP hospitals?
- Is there any difference in the users’ satisfaction between PPP hospitals and PMH?
- Is the proposed model adjusted to data collected among the Portuguese population?
- Are literacy level, age, education, and income moderator variables of the relationship between quality perceived by the users and their satisfaction?
2. Methods
2.1. Sampling
2.2. Variable Measures and Measurement Model
2.3. Data Collection Process
2.4. Ethical Issues
3. Results and Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Hospitals | Frequency | Percentage | Test Sample * |
---|---|---|---|
Braga PPP | 233 | 10.1 | 43 |
Cascais PPP | 222 | 9.6 | 41 |
Loures PPP | 304 | 13.2 | 56 |
Vila Franca de Xira PPP | 274 | 11.9 | 51 |
Sub-total | 1033 | 44.8 | 191 |
Figueira da Foz PMH | 212 | 9.2 | 39 |
Setúbal PMH | 210 | 9.1 | 39 |
Leiria PMH | 372 | 16.1 | 69 |
Évora PMH | 250 | 10.9 | 46 |
Sub-total | 1044 | 55.2 | 193 |
Total | 2077 | 100 | 384 |
Quality Perceived by the User | ID | Questionnaire Items |
---|---|---|
Empathy | Em1 | The clinical staff is polite and friendly. |
Em2 | The clinical staff listens and understands the users. | |
Em3 | The clinical staff easily understands my health situation. | |
Em4 | The clinical staff quickly understands my needs. | |
Em5 | The clinical staff knows how to put themselves in my place and understand my problems. | |
Space and environment | EA1 | The facilities of this hospital seem to me to be adequate to the needs of the county’s population. |
EA2 | The hospital’s physical facilities are visually appealing. | |
EA3 | The overall cleanliness level of the hospital is adequate. | |
EA4 | The Hospital provides a comfortable and safe environment for users. | |
EA5 | Mobility within the hospital is relatively easy. | |
Effectiveness | Eca1 | The clinical staff was rigorous in hygiene care and protection. |
Eca2 | The doctors made an accurate diagnosis of my pathologies. | |
Eca3 | The nurses did not make mistakes in their work. | |
Eca4 | I felt confident about the professional performance of the entire clinical staff. | |
Eca5 | I have great confidence in the ability of the doctors in this hospital. | |
Efficiency | Eci1 | I feel that the clinical staff avoids unnecessary use of medications. |
Eci2 | I feel that the clinical staff strives to apply only those methods of treatment that are strictly necessary. | |
Eci3 | I feel that the hospital’s work processes are clear and concise. | |
Eci4 | I feel that the number of employees is adequate for the needs of the users. | |
Eci5 | The hospital efficiently manages the time I spend in the hospital (e.g., conducts appointments/exams on time). | |
Results of the use of hospital services | R1 | I feel that the health care was appropriate for my medical situation. |
R2 | My health has improved after the treatment in this hospital. | |
R3 | I feel that I have improved a lot because of being treated in this hospital. | |
R4 | The clinical staff gave me all the explanations to prevent other related diseases. | |
R5 | The degree of effort and willingness of the clinical staff to prevent disease is high. |
Clinical Staff Effectiveness | Em1 | Em2 | Eca1 | Eca2 | Eca3 | Eca5 | Eci2 | R3 | R4 | R5 |
0.759 | 0.795 | 0.626 | 0.807 | 0.621 | 0.867 | 0.684 | 0.821 | 0.771 | 0.724 | |
Space and environment | EA1 | EA2 | EA3 | EA4 | EA5 | |||||
0.771 | 0.814 | 0.643 | 0.708 | 0.645 |
Literacy Level | ID | Questionnaire Items |
---|---|---|
Access competence | GLA1 | I have already looked for information about the hospital management model applied in the health care unit in my area of residence. |
GLA2 | I consider that the information made available by the government regarding hospital management models is enough. | |
Understanding competence | GLC1 | I know well what a public–private partnership model in hospital management is. |
GLC2 | I know well the differences between a public–private partnership management model and an exclusively public management model. | |
Evaluate and apply information competence | GLI1 | The management model applied influences my choice, concerning the health unit (Hospital). |
GLI2 | I have a positive opinion about the involvement of the private sector in the management of Public Hospitals. |
Scales | Cronbach α | Minimum of the Corrected Item–Total Correlations | Average of the Inter-Item Correlations | Compositive Reliability | Average Variance Extracted | R2 |
---|---|---|---|---|---|---|
Clinical staff effectiveness (CSE) | 0.948 | 0.668 | 0.647 | 0.966 | 0.738 | CSE-SE (0.676) LL-SE (0.095) LL-CSE (0.107) |
Space and Environment (SE) | 0.880 | 0.661 | 0.594 | 0.936 | 0.746 | |
Service quality | 0.946 | 0.548 | 0.539 | 0.976 | 0.733 | |
Literacy Level (LL) | 0.757 | 0.387 | 0.509 | 0.834 | 0.643 |
Indicators | N = 384 | N = 2077 | Criteria | Indicators | N = 384 | N = 2077 | Criteria |
---|---|---|---|---|---|---|---|
CMIN | 162.391 | 365.963 | Smaller | NFI | 0.796 | 0.897 | >0.9 |
df | 90 | 90 | ----- | RFI | 0.728 | 0.862 | >0.9 |
p-value | 0.000 | 0.000 | >0.05 | TLI | 0.857 | 0.892 | >0.9 |
CMIN/df | 1.804 | 4.066 | <2 (5) | CFI | 0.893 | 0.919 | >0.9 |
RMR | 0.111 | 0.067 | Smaller | PNFI | 0.597 | 0.672 | >0.6 (0.8) |
SRMR | 0.096 | 0.052 | Smaller | PCFI | 0.670 | 0.689 | >0.6 (0.8) |
GFI | 0.914 | 0.960 | >0.9 | FMIN | 0.424 | 0.159 | Smaller |
AGFI | 0.871 | 0.940 | >0.9 | RMSEA | 0.046 | 0.036 | <0.05 |
PGFI | 0.605 | 0.635 | >0.6 (0.8) | PCLOSE | 0.718 | 1.000 | >0.05 |
Modelo | χ2 | df | χ2/df | RMSEA (p-Value) | SRMR | CFI | RFI | GFI | Δdf | Δχ2 | LR of Δχ2 | Comparison Model |
---|---|---|---|---|---|---|---|---|---|---|---|---|
CFA with Marker | 468.696 | 132 | 3.551 | 0.082 | 0.057 | 0.932 | 0.893 | 0.873 | ||||
Baseline preparation | 468.696 | 138 | 3.396 | 0.079 | 0.057 | 0.933 | 0.898 | 0.873 | 6 | 0.000 | 1.000 | |
Baseline | 482.700 | 140 | 3.448 | 0.080 | 0.074 | 0.931 | 0.896 | 0.870 | 2 | 14.004 | 0.001 | |
Method-C | 477.793 | 139 | 3.437 | 0.080 | 0.061 | 0.931 | 0.897 | 0.871 | 1 | 4.907 | 0.027 | Baseline |
Method-U | 444.684 | 125 | 3.557 | 0.082 | 0.054 | 0.935 | 0.893 | 0.880 | 14 | 33.109 | 0.003 | Method-C |
Method-R | 444.687 | 126 | 3.529 | 0.081 | 0.054 | 0.935 | 0.894 | 0.880 | 1 | 0.003 | 0.956 | Method U |
Relationships | Loadings |
---|---|
Perceived quality → Space and Environment | 0.842 |
Perceived quality → Clinical staff effectiveness | 0.924 |
Perceived quality → Users’ satisfaction | 0.946 |
Models | Chi-Square | Degrees of Freedom | p-Value | Invariant? |
---|---|---|---|---|
Not restricted | 502.993 | 180 | ||
Restricted | 533.928 | 195 | ||
Difference | 30.935 | 15 | 0.009 | No |
All hospitals | PPP hospitals | PMH | ||
Loadings of Perceived quality on Users’ satisfaction | Below average | 0.968 | 0.951 | 0.982 |
Above average | 0.943 | 0.921 | 0.938 |
Models (Age) | Chi-Square | Df | p-Value | Invariant? |
---|---|---|---|---|
Not restricted | 478.819 | 180 | ||
Restricted | 480.056 | 181 | ||
Difference | 1.237 | 1 | 0.266 | Yes |
Models (Income) | Chi-Square | Df | p-value | Invariant? |
Not restricted | 488.747 | 180 | ||
Restricted | 491.686 | 181 | ||
Difference | 2.939 | 1 | 0.086 | Yes |
Models (Education) | Chi-Square | Df | p-value | Invariant? |
Not restricted | 655.323 | 270 | ||
Restricted | 660.480 | 272 | ||
Difference | 5.157 | 2 | 0.076 | Yes |
Loadings of perceived qualityon users’ satisfaction | Age | All hospitals | PPP hospitals | PMH |
Below 45 years | 0.957 | 0.933 | 0.971 | |
Above 45 years | 0.948 | 0.946 | 0.937 | |
Loadings of perceived quality on users’ satisfaction | Income | All hospitals | PPP hospitals | PMH |
Below 1452€ | 0.955 | 0.948 | 0.957 | |
Above 1452€ | 0.959 | 0.923 | 0.967 | |
Loadings of perceived quality on users’ satisfaction | Education | All hospitals | PPP hospitals | PMH |
Basic | 0.964 | 0.963 | 0.937 | |
Secondary | 0.942 | 0.944 | 0.930 | |
High | 0.971 | 0.921 | 0.971 |
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Carvalho, J.M.S.; Rodrigues, N. Perceived Quality and Users’ Satisfaction with Public–Private Partnerships in Health Sector. Int. J. Environ. Res. Public Health 2022, 19, 8188. https://doi.org/10.3390/ijerph19138188
Carvalho JMS, Rodrigues N. Perceived Quality and Users’ Satisfaction with Public–Private Partnerships in Health Sector. International Journal of Environmental Research and Public Health. 2022; 19(13):8188. https://doi.org/10.3390/ijerph19138188
Chicago/Turabian StyleCarvalho, João M. S., and Nuno Rodrigues. 2022. "Perceived Quality and Users’ Satisfaction with Public–Private Partnerships in Health Sector" International Journal of Environmental Research and Public Health 19, no. 13: 8188. https://doi.org/10.3390/ijerph19138188