Public satisfaction with the healthcare system in China during 2013-2015: a cross-sectional survey of the associated factors

Objective: We explore how public satisfaction with the healthcare system in China varies with social and economic factors, especially regional variations and changes during 2013-2015.

Design: Population-based, cross-sectional survey performed between July 2013 and July 2015.

Setting: General population of China during 2013-2015.

Participants: A total of 15 969 participants (women=49.4%, sample-weighted average age=51.9).

Primary outcome measure: Public satisfaction with the healthcare system, defined as 'being satisfied' if a respondent's satisfaction score is ≥70 points.

Results: The 2-year mean of the satisfaction score of the sample is 68.5 out of 100 points and the score in 2015 is higher than 2013 by 3.5 points. Senior respondents (OR=1.19, p<0.001), rural respondents (OR=1.23, p=0.009) and those with higher socioeconomic status are more likely to report being satisfied. Internal migrants (OR=0.75, p<0.001) and those with a higher level of education are less likely to report being satisfied. Total health expenditure as percentage of gross domestic product and density of hospital beds have a significantly positive association with satisfaction (OR=1.13, p<0.001). Meanwhile, the government's share in total healthcare expenditures has a moderately negative association with satisfaction (OR=0.97, p<0.001). In rural areas, the density of hospital beds has a positive association with satisfaction (OR=1.26, p=0.002). The Northeast region and Shanghai (OR=0.49, p<0.001; OR=0.71, p=0.034) are less likely to report being satisfied and this remained unchanged in 2015.

Conclusion: There are considerable disparities in public satisfaction with the healthcare system in China, associated with demographic and socioeconomic characteristics, regional locations, urban-rural environment, and regional health resource abundance. Actions are recommended to improve satisfaction with the public healthcare system, especially in the Northeast region of China.