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Perceived Quality of Care in Health Centers Affiliated with a Community-Based Health Insurance Scheme in Two Districts of Northeastern Ethiopia: A Multilevel Analysis

Objectives: The purpose of this study was to examine how clients perceived the quality of health care, and to identify related individual and facility-level factors. Design: Community-based, cross-sectional Setting: Health centers affiliated with community-based health insurance scheme Participants: 1081 rural households that had ever been enrolled in community-based health insurance and had visited a health center at least once in the previous 12 months, as well as 194 health care providers working in 12 health centers. Outcome measures: The outcome variable of interest was the overall perceived quality of score, which was measured using a 17-item scale. Respondents were asked to rate the degree to which they agreed on 5-point response items relating to their experiences with health care in the outpatient departments of nearby health centers. A multilevel linear regression analysis was used to identify predictors of quality of care. Results: The mean perceived quality of care score was 62.85 (SD=10.49). Five quality of care dimensions were extracted from the factor analysis, with patient-provider communication dimension having the highest mean score (M=72.29, SD=12.66) and information provision having the lowest (M=55.83, SD=17.34). Wealth status, current insurance status, perceived health status, presence of chronic illness, time since the most recent visit to a health center, patient volume and health care providers' work experience were significantly associated with the perceived quality of care. An interaction term between patient volume and staff job satisfaction also showed significant association. Conclusions: Much work remains to be done to improve the quality of care, in particular, on information provision and access to care quality dimensions. People's perceptions of the quality of care differed depending on a variety of individual and health center-level factors. For better quality of care, it is vital to determine an appropriate patient volume per care provider, and improve staff job satisfaction.