Weichu Sun

Background: There have been few studies on satisfaction with integrated basic medical insurance for urban and rural residents (URRBMI), and satisfaction with URRBMI is not very high because of the complexity of its policies and differences among the insured. The aim of the present study was to explore the factors that influence satisfaction with URRBMI in China and to provide scientific suggestions to the government for how to effectively manage and improve the policy. Methods: An explanatory sequential design of mixed methods research was used. A quantitative research using a three-stage stratified cluster sampling method was used to randomly select the guardians of pupils who participated in URRBMI (n = 1335). The quantitative research was conducted to calculate the latent variables’ scores and path coefficients between latent variables using SmartPLS3.0. With public trust, public satisfaction, and perceived quality as the target variables, important-performance analysis (IPA) was used to explore the important but underperforming factors, which were the key elements to improving satisfaction with URRBMI. A purposeful sampling strategy according to satisfaction level was used to obtain qualitative research subjects from among the quantitative research subjects. A qualitative research was conducted using semi-structured interviews, and the thematic analysis method was used to summarize the interview data. Results: The three strongest paths were perceived quality to public satisfaction, with a total effect of 0.737 (t = 41.270, P < 0.001); perceived quality to perceived value, with a total effect of 0.676 (t = 31.964, P < 0.001); and public satisfaction to public trust, with a total effect of 0.634 (t = 31.305, P < 0.001). IPA revealed that public satisfaction and perceived quality were key factors for public trust and that perceived quality was of high importance for public satisfaction but had low performance. The policy quality was a determining factor for perceived quality. The qualitative research results showed that the most unsatisfactory aspect for the insured was the policy quality. Conclusions: This study found that improving quality is key to improving public satisfaction with and public trust in URRBMI. The government should improve the compensation level by broadening the channel of financing for the URRBMI fund, rationally formulating reimbursement standards, and broadening the scope of the drug catalog and the medical treatment projects. The government should establish a stable financing growth mechanism and effective methods of providing health education to improve public satisfaction and public trust.

Background: Quality is the most important factor of satisfaction However, the existing URRBMI index model lacks the decomposition of the connotation of perceived quality and cannot provide a reference for quality improvement and satisfaction promotion.Objective: This study aims to construct a Satisfaction Index Model for Chinese Urban and Rural Residents Basic Medical Insurance (SIM-URRBMI) with accurate and detailed measurement of perceived quality and give a feasible and scientific suggestion for URRBMI or insurance for other countries in the world.Methods: Based on the theoretical framework of The American Customer Satisfaction Index (ACSI), the connotation of perceived quality was refined by literature review and expert consultation to form a pool of alternative measurement variables. A three-stage randomized stratified cluster sampling was adopted to select the main decision makers for pupils’ URRBMI in 8 primary schools from Changsha City. Both Classic Test Theory (CTT) and Item Response Theory (IRT) were used for selection of the measurement variables. The model’s reliability and validity were tested using partial least square (PLS) related methods.Results: A total of 1909 respondents who had insurance for their children were investigated with the initial questionnaire. The revised SIM-URRBMI consists of 11 latent variables and 28 measurement variables with good reliability and validity. Among the three explanatory variables of public satisfaction, perceived quality had the largest total effect (0.737). The variable with greatest effect among the five first-order latent variables on perceived quality was quality of the medical insurance policy (0.472).Conclusions: The revised SIM-URRBMI consists of 11 latent variables and 28 measurement variables with good reliability and validity. It provides accurate assessment of perceived quality, which will greatly help performance improvement. Perceived quality is crucial to public satisfaction, especially, the most important aspects are policies regarding medical insurance reimbursement (basic coverage scope, coinsurance, deductible).

The era of big data in healthcare is here, and this era will significantly improve medicine and especially oncology. However, traditional machine learning