Source of care selection and health care quality perceptions: Does health insurance matter in patient satisfaction?

Micro health insurance (MHI) was designed to protect the poor from iatrogenic poverty by providing them with financial protection and improving their access to healthcare. These schemes are also expected to improve quality of care through strategic purchasing decisions. Empirical evidence on the perception of quality of healthcare by MHI enrolees is limited in India. This paper explains the relationship between perceived quality of care and patient satisfaction among insured and uninsured individuals. A cross-sectional survey was conducted to collect data from 416 insureds, 366 newly insured and 364 uninsured self-help group members in 84 villages in Karnataka, India. Regression analysis shows that financial and physical accessibility to healthcare and membership in MHI significantly influences patient satisfaction. Insured individuals perceived better quality of healthcare delivery care and sought care at private facilities more than at public hospitals. Perceived quality of supplies, providers, and physical resources dramatically influence patient satisfaction. The MHI scheme managers should design contracts with hospitals that have the good physical infrastructure, adequate supplies of drugs, equipment, and qualified medical professionals to enhance patient satisfaction. Since MHI facilitates accessibility and affordability of care, enrolment should, therefore, be encouraged among the uninsured to improve access to care. Awareness on seeking care from the formal system than self- treatment needs to be fostered among all the self-help group members, especially the uninsured population.