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.