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Client perceptions of the performance of public and independent not-for-profit primary healthcare

Department of Public Health, University of Helsinki, Finland, ritva.laamanen{at}kolumbus.fi, Folkhälsan Research Centre, Finland

John Øvretveit

Karolinska Institute Medical Management Centre, Stockholm, Sweden, Bergen University, Faculty of Medicine, Norway

Jari Sundell

National Institute of Public Health, Finland

Nina Simonsen-Rehn

Department of Public Health, University of Helsinki, Finland

Sakari Suominen

Provincial State Office of Western Finland Social Welfare and Health Department, Finland, University of Turku, Finland

Mats Brommels

Karolinska Institute Medical Management Centre, Stockholm, Sweden, Department of Public Health, University of Helsinki, Finland

Aims: To compare primary healthcare (PHC) provided by an independent not-for-profit organization (INPO) with that provided by two public municipal organizations (MO1 and MO2), in terms of clients' perceptions of performance, acceptance, and trust. Methods: A survey using a pre-tested questionnaire to all clients visiting a health centre (HC) doctor or nurse during one week in 2000 (n=511, 51% response rate) and 2002 (n=275, 47%). The data were analysed by descriptive statistics and cumulative logistic regression analysis. Results: The INPO differed from both publicly provided services in accessibility, consistency of service, and outcomes. Clients reported lower trust in HC provided by public organizations compared with the INPO. Trust was higher if clients also reported experiencing ``very good'' or ``moderate'' organizational access — or if general satisfaction was ``very high'' or ``moderate'' or if they experienced outcomes as ``very good'' or ``moderate'' compared with the ``very poor or low'' situation. Women reported lower trust in HC than men. When the family doctor was included in the same logistic regression model with the service provider, only the family doctor was a significant explanatory variable. Reported acceptance of private alternative service providers among clients was similar between the study organizations. Conclusions: Clients of the INPO generally rated the service more positively than clients of publicly provided services. The results indicate that trust in HC depends more on a family doctor system than a service provider.

Key Words: Acceptance • independent not-for-profit organization • performance • primary health care • trust

Scandinavian Journal of Public Health, Vol. 34, No. 6, 598-608 (2006)
DOI: 10.1080/14034940600585820


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