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Construction and application of a revised satisfaction index model for Chinese urban and rural residents basic medical insurance

By Wenwei Cheng, Jin Cheng, Xiaofang Liu, Yanyan Wu, Weichu Sun, Xiaofang Yan, Liai Peng, Xiaoli Liu, Qi Wang, Mingming Luo, Tingting Sha, Jingcheng Shi, Fang Yang

Posted 25 May 2020
medRxiv DOI: 10.1101/2020.05.23.20108779

Background: Quality is the most important factor of satisfaction However, the existing URRBMI index model lacks the decomposition of the connotation of perceived quality and cannot provide a reference for quality improvement and satisfaction promotion. Objective: This study aims to construct a Satisfaction Index Model for Chinese Urban and Rural Residents Basic Medical Insurance (SIM-URRBMI) with accurate and detailed measurement of perceived quality and give a feasible and scientific suggestion for URRBMI or insurance for other countries in the world. Methods: Based on the theoretical framework of The American Customer Satisfaction Index (ACSI), the connotation of perceived quality was refined by literature review and expert consultation to form a pool of alternative measurement variables.A three-stage randomized stratified cluster sampling was adopted to select the main decision makers for pupils' URRBMI in 8 primary schools from Changsha City. Both Classic Test Theory (CTT) and Item Response Theory (IRT) were used for selection of the measurement variables. The model's reliability and validity were tested using partial least square (PLS) related methods. Results: A total of 1909 respondents who had insurance for their children were investigated with the initial questionnaire. The revised SIM-URRBMI consists of 11 latent variables and 28 measurement variables with good reliability and validity. Among the three explanatory variables of public satisfaction, perceived quality had the largest total effect (0.737). The variable with greatest effect among the five first-order latent variables on perceived quality was quality of the medical insurance policy (0.472). Conclusions: The revised SIM-URRBMI consists of 11 latent variables and 28 measurement variables with good reliability and validity. It provides accurate assessment of perceived quality, which will greatly help performance improvement. Perceived quality is crucial to public satisfaction, especially, the most important aspects are policies regarding medical insurance reimbursement (basic coverage scope, coinsurance, deductible).

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