Does Descending Resources Reform Improve Patient Satisfaction and Reshape Choice of Care Providers? A Cross-Sectional Study in Zhejiang, China

Patient satisfaction and choice of care providers have been the core concerns of China's descending resources reform launched in 2013. This health care reform attempts to improve low-level hospitals' capability and patient satisfaction through compulsory descending of doctors from high-level hospitals, thereby reshaping patients' behavior (loyalty). The goal of this paper is to explore the determinants of patient satisfaction, and its impact on patient loyalty with an emphasis on low-level hospitals in the reform context. By using a self-made 5-point scale that incorporates socio-demographic variables, reform, and revealed preference into the European Consumer Satisfaction Index model (ECSI), cross-sectional data from 17 hospitals, and 1287 questionnaires in Zhejiang province is collected to conduct empirical research. Satisfaction is measured as ordinary variables with the reform and with the low-level hospitals, respectively. Loyalty is measured by patients' willingness to choose low-level hospitals when suffering illness or severe illness. Analysis of variance and multiple comparisons are utilized to examine the different level of hospitals. An ordered logit model and ordinary least squares regression are applied to examine the determinants of satisfaction and loyalty. The results indicate that patient satisfaction can be explained by variables of perceived quality, patient expectations, and corporate image. Socio-demographic variable, providers, and the reform also have significant effects. Patients' satisfaction plays a pronounced role on improving their loyalty. The descending resources reform positively affects low-level hospitals' capability and patient satisfaction. The cost reduction and convenience significantly increase the reform satisfaction. Capability, medical environment, and accessibility of descending doctors are positively associated with the satisfaction with low-level hospitals. This paper evidences that the descending resources reform is an effective way to reallocate resources in supply side of health service market and reshape patients' choice of care providers with the accessibility and spillover of descending human capital.