Assessment of Healthcare Service Quality: Tertiary Care Hospitals of Dhaka City

Assessment of Healthcare Service Quality: Tertiary Care Hospitals of Dhaka City

Segufta Dilshad (North South University, Bangladesh), Afsana Akhtar (BRAC University, Bangladesh), S. S. M. Sadrul Huda (East West University, Bangladesh), and Nandeeta Samad (North South University, Bangladesh)
DOI: 10.4018/978-1-7998-3576-9.ch014
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The service quality measurement of healthcare services is always a big concern for the hospitals, patient rights activists, regulators, and general patients. This study deals with quality assessment of healthcare facilities concerning the private and public health facilities of Dhaka, Bangladesh. This study follows the survey research approach. Using the purposive sampling method, the individuals have been selected from households who have received healthcare services from public or private hospitals of Dhaka city in last year. The study collected data among 410 respondents. Standard statistical software (i.e., SPSS and STATA) have been used to analyze the data. This study confirms existing evidence that Bangladeshi patients have a growing concern with lower level of satisfaction in public healthcare services. The respondents faced multi-dimensional problems, characterized by a low level of overall service quality, interpersonal service quality, and technical or treatment-related quality at public hospitals. Further research is recommended to analyze the issues further.
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Healthcare System Profile

The health system of Bangladesh exists with pluralistic governance i.e. different stakeholders with their respective roles are working in various competitive and collaborative combinations. There are four such stakeholders working in this field of Bangladesh. The government sector playing a dominant role with a mandate to not only set policy and regulations, but also providing comprehensive health services. Almost two-thirds of total health expenditure is household expenditure in the private including formal and informal sectors. In addition, the vibrant and large non-government organization (NGO) sector that focuses on the health needs of the poor, often as part of a broad array of development interventions. Finally, the donor community that exercises disproportionate influences in determining policy and programmatic priorities, with technical assistance, and directs delivery strategies.

Bangladesh has low ratios of credentialed professionals- only 0.5 doctors and 0.2 nurses per 1000 people, far less than the minimum standard of 2.28 per 1000 recommended by WHO (Bangladesh Health System Review, 2015). Bangladesh also has a shortage of skilled health workers, with twice as many doctors as nurses clustered disproportionately in urban areas. At present there are 64,434 registered doctors, 6,034 registered dentists, 30,516 registered nurses, (MoHFW, 2013) and 27,000 midwives (MoHFW, 2012). There are high levels of out-of-pocket and informal payments for health services and medicines that are exhausting millions of households. Despite these endemic shortfalls in key areas of the health system, pronounced and rapid progress in the most important health measurements - e.g. infant and child mortality, maternal mortality, fertility, and contraceptive prevalence- are remarkable.

In Bangladesh, depending upon the type of services patients required, the level of health care divided into three broader categories: primary care - where basic and general healthcare traditionally provided by community workers, family health practitioners, occasionally gynecologist; secondary care - the medical care provided by a physician who acts as a consultant at the request of the primary physician; tertiary care - specialized curative care, usually on referral from primary and secondary medical care personnel by specialists working in a center that has personnel and facilities for special investigation and treatment.

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