Explaining public satisfaction with health care systems: findings from a nationwide survey in China

Objective: To identify factors and covariates associated with health care system satisfaction in China. Context: Recent research suggests that socio-demographic characteristics, self-reported health, income and insurance, ideological beliefs, health care utilization, media use and perceptions of services may affect health care system satisfaction, but the relationships between these factors are poorly understood. New data from China offers the opportunity to test theories about the sources of health care system satisfaction. Design: Stratified nationwide survey sample analysed using multilevel logistic regression. Setting and participants: 3,680 Chinese adults residing in family dwellings between 1 November 2012 and 17 January 2013. Main outcome measure: Satisfaction with the way the health care system in China is run. Results: We find only weak associations between satisfaction and socio-demographic characteristics, income and self-reported health. We do, however, find that satisfaction is strongly associated with having insurance and belief in personal responsibility for meeting health care costs. We also find it is negatively associated with utilization, social media use, perceptions of access as unequal and perceptions of service providers as unethical. Conclusions: To improve satisfaction, Chinese policy makers – and their counterparts in countries with similar health care system characteristics – should improve insurance coverage and the quality of health services, and tackle unethical medical practices