Mixed methods research on satisfaction with basic medical insurance for urban and rural residents in China.

BACKGROUND: There have been few studies on satisfaction with integrated basic medical insurance for urban and rural residents (URRBMI), and satisfaction with URRBMI is not very high because of the complexity of its policies and differences among the insured. The aim of the present study was to explore the factors that influence satisfaction with URRBMI in China and to provide scientific suggestions to the government for how to effectively manage and improve the policy. METHODS: An explanatory sequential design of mixed methods research was used. A quantitative research using a three-stage stratified cluster sampling method was used to randomly select the guardians of pupils who participated in URRBMI (n = 1335). The quantitative research was conducted to calculate the latent variables' scores and path coefficients between latent variables using SmartPLS3.0. With public trust, public satisfaction, and perceived quality as the target variables, important-performance analysis (IPA) was used to explore the important but underperforming factors, which were the key elements to improving satisfaction with URRBMI. A purposeful sampling strategy according to satisfaction level was used to obtain qualitative research subjects from among the quantitative research subjects. A qualitative research was conducted using semi-structured interviews, and the thematic analysis method was used to summarize the interview data. RESULTS: The three strongest paths were perceived quality to public satisfaction, with a total effect of 0.737 (t = 41.270, P < 0.001); perceived quality to perceived value, with a total effect of 0.676 (t = 31.964, P < 0.001); and public satisfaction to public trust, with a total effect of 0.634 (t = 31.305, P < 0.001). IPA revealed that public satisfaction and perceived quality were key factors for public trust and that perceived quality was of high importance for public satisfaction but had low performance. The policy quality was a determining factor for perceived quality. The qualitative research results showed that the most unsatisfactory aspect for the insured was the policy quality. CONCLUSIONS: This study found that improving quality is key to improving public satisfaction with and public trust in URRBMI. The government should improve the compensation level by broadening the channel of financing for the URRBMI fund, rationally formulating reimbursement standards, and broadening the scope of the drug catalog and the medical treatment projects. The government should establish a stable financing growth mechanism and effective methods of providing health education to improve public satisfaction and public trust.

[Study on out-of-pocket expenditure and related factors among cancer inpatients with Hunan Provincial Urban Employee Basic Medical Insurance].

OBJECTIVE: To explore the level and influential factors for out-of-pocket (OOP) expenditure regarding Hunan Provincial Urban Employee Basic Medical Insurance (UEBMI) and to provide evidence for improvement of medical insurance payment system.
 METHODS: Stratified random sampling method was used to obtain 10 527 records of cancer inpatients from January 2011 to December 2014. Social demographic and expenditure information were collected from UEBMI information system. The proportion of OOP expenditure for inpatient and each part of the cost was described. Multiple linear regression was used to analyze main related factors of OOP expenditure.
 RESULTS: The median proportion of OOP for inpatients costs was 20.11%, and remained stable from 2011 to 2014. The main related factors for OOP expenditure were age, civil servant, retirment status, hospital level, cost of hospitalization, hospitalization duration, medicine cost, proportion of general medical service charges, treatment cost, expenses of examination and laboratory test, and cancer type.
 CONCLUSION: OOP expenditure among UEBMI cancer inpatients was under control and stable. The level can well reflect the policy preferences. It could be further improved through the control of related factors, particularly the hospital level.

[Content validity index in scale development].

Content validity is the degree to which an instrument has an appropriate sample of items for the construct being measured and is an important procedure in scale development. Content validity index (CVI) is the most widely used index in quantitative evaluation. There are 2 kinds of CVI: I-CVI and S-CVI. A method to compute a modified kappa statistic (K*) can be used to adjust I-CVI for chance agreement. S-CVI/UA and S-CVI/Ave are both scale level CVI with different formulas. Researchers recommend that a scale with excellent content validity should be composed of I-CVIs of 0.78 or higher and S-CVI/UA and S-CVI/Ave of 0.8 and 0.9 or higher, respectively. The characteristics and qualifications of the experts, process and main results of content validity evaluation should be reported in scale-related manuscript.