PHC is imperative for the establishment of a strong healthcare system that ensures better health outcomes, effectiveness and efficiency, as well as health equity [32]. As the first-contact, continuous, comprehensive, and coordinated care providers, CHCs are increasingly valued in chronic disease management [33, 34]. There are a wide range of factors determining the service satisfaction among visitors seeking medical treatment from CHCs. According to literature review, the success of a health facility largely depends on client perception of healthcare quality because client satisfaction reflects the perception to its services provided. Furthermore, client satisfaction could also influence the utilization of PHC facilities in some degree.
This paper, from the perspective of subjective perception, endeavored to identify the factors influencing public satisfaction with CHC services in Banan district of Chongqing, China, and explore the influence paths associated with the satisfaction. Several perception related variables serving as potential drivers to public satisfaction were selected based on literature review. Through influence path analysis, we found that service expectation, service quality and value recognition were the main factors affecting service satisfaction of CHCs. In addition, both perceived quality and service expectation could affect public satisfaction through perception or judgment on value of CHC services.
Service expectation as a direct influence factor
The influence coefficient of service expectation was -0.191. Service expectation has a negative impact on the satisfaction with CHC services. It is necessary to adjust the public expectation, or even reduce it to achieve increase in service satisfaction. Excessive service expectation in certain time has no positive significance to the evaluation of service satisfaction. CHCs should show their actual presentation without exaggeration to the public. CHCs and relevant government agencies should inform the public by providing real information and policies to the public through face-to-face communication or social media. It is necessary to promote public participation and guide the public to have rational expectation on present services CHCs can provide at its healthcare level. As service receivers, the public tend to exaggerate their needs and raise their expectations. Once their roles turn to service providers and regulators, the public would have more rational considerations in not just service satisfaction. Rational expectation for healthcare services based on the function positioning and value orientation of CHCs among the public may present a positive impact on service satisfaction.
Perceived value as a direct influence factor
The influence coefficient of perceived value of CHC services was 0.441. Perceived value has a direct, positive impact on the satisfaction with CHC services. In addition, the influence coefficients of the two indirect paths were 0.224 and -0.087 in Table 6, respectively. We can conclude that value recognition of CHC services is an important driver to public satisfaction. Both perceived quality of care and service expectation could affect public value recognition and further the satisfaction with CHC services. Thus, the present CHCs starve for dynamic health publicity to cultivate existing sources and foster appropriate incentives to enhance value recognition. Various means of publicity should be leveraged to ensure that the public stays informed with healthcare knowledge and government’s policies provided by CHCs and its staff. For example, mass media can serve as a forum for health education among young generations, while on-the-spot or face-to-face demonstration or interpretation would be efficient among older adults. Health education should concentrate on imparting health-related knowledge and attitudes, and focus on function positioning and value orientation of CHCs. In addition, incorrect and improper knowledge should be prevented or reduced at PHC level when carrying out health education activities, which could in some degree dispel mistrust and disrespectfulness towards CHCs. Furthermore, CHCs should show their crucial and irreplaceable role in protecting public health and addressing health crisis. Undoubtedly, for instance, Chinese health care system including CHCs has done a great job in quelling COVID-19 pandemic and further defending in China. Taken together, public value recognition could be reached and enhanced among different communities from many aspects.
Table 6
The effect of indirect influencing paths
Influencing path | Specific indirect effect |
Quality → Value → Satisfaction | 0.224 |
Expectation → Value → Satisfaction | -0.087 |
Perceived quality as a direct influence factor
We found through path analysis that perceived quality of CHC services could directly (influence coefficient: 0.508) or indirectly (through influence on perceived value of CHC services) affect the satisfaction towards CHC services. Policy and financial inputs, and the introduction of well-trained health providers especially general practitioners are of great importance. Governments and relevant authorities have to lean forward and fast-track resources to PHC in terms of, for example, training of medical staffs, medical equipment and instruments, and financial protection. In some degree, improvement on the quality of CHC services can serve as a means to help gain value recognition, which is consistent with the indirect influence path (perceived quality → perceived value → public satisfaction) we found in the study. Thus, for instance, professional performance in the basic medical service and accessibility [8], and job satisfaction of PHC providers [35, 36] can affect the public value recognition towards CHCs. In terms of site location, we should take into account the distribution density of CHCs, floor space, and accessibility (topography, transportation, etc.). CHCs should be allowed to provide paid services within their capabilities. Service items can be adjusted or established according to public needs to increase the income of CHCs. It is necessary to form a virtuous cycle between government funding, service providing and social evaluation, which could further restore the status of or reinforce the role of a CHC.
Lack of fairness and trust towards CHC services
Path analysis has shown that there are direct connections between perceived fairness, perceived trust, perceived quality, and perceived value. This indicates that perceived quality and perceived value of CHC services could further affect public evaluation or judgment on fairness and trust in CHCs and the staff. But perceived fairness and trust have neither direct nor indirect influence on final satisfaction with the help of other variables. These suggest that lack of trust and fairness in CHC services does exist among older adults or their families in Banan district of Chongqing, China. Low awareness to and low utilization of CHC services, and low appraisals from the public could contribute to the lack. There is still a great disparity between urban and rural CHCs as well as between areas in service quality and care efficiency [37, 38]. In regards to the existing lack of trust and fairness, CHCs should first and foremost ensure the availability of basic health services including children's health care and chronic disease management, and increase awareness to and utilization of CHC services especially among older adults. In addition, we can take health equity as the breakthrough point. CHCs should narrow the gaps in basic health service items and service quality between areas, and adhere to principle of equal treatment, so as to enhance positive public perception to fairness and trust.