The effects of citizenship status on service utilization and general satisfaction with healthcare: a cross-cultural study

Abstract

Objective: To explore the role of citizenship status as a predictor of general satisfaction with healthcare services in Qatar, including potential interaction with utilization and health insurance coverage type.

Design: A cross-sectional survey conducted in 2012.

Setting: A household survey in the State of Qatar in the Arab Gulf.

Participants: A nationally representative sample of 2750 citizens and noncitizens aged 18 years and older.

Main outcome: General satisfaction status with Qatar's healthcare system.

Measures: Citizenship status, healthcare utilization, health insurance type.

Results: Citizens were significantly less likely to be satisfied with Qatar's healthcare system than noncitizens (odds ratio (OR) = 0.30, P < 0.001). The association between private health insurance and overall satisfaction was not significantly different between citizens and noncitizens (P = 0.19). However, the association between utilization of healthcare services and overall satisfaction was moderated by citizenship (P < 0.001). Among citizens, non-users were less likely to be satisfied than recent users (OR = 1.88, P < 0.05), while the opposite pattern was observed among noncitizens (OR = 0.51, P < 0.05). These patterns persisted even after controlling for potential confounders.

Conclusions: The study revealed significant population differences in satisfaction between recent users and non-users within citizenship groups. These differences may stem from different expectations with respect to healthcare services. Understanding these expectations may have important policy implications for cross-cultural contexts.

Keywords: Qatari citizens; White-Collar migrants; expectation-based satisfaction; experience-based satisfaction; general satisfaction; health insurance; healthcare utilization; inpatient; normative expectations.; outpatient.