Predictors and consequences of rural clients' satisfaction level in the district public-private mixed health system of Bangladesh.

Background: We investigated predictors of the rural clients' satisfaction level (CSL), and interlinks between perceived specific service quality (PSSQ), perceived utility value (PUV), CSL, and clients' reactions (CR) towards current and future utilization of providers and facilities in the public-private mixed health system of Bangladesh.

Methods: A quantitative study using interviewer-administered questionnaire was conducted among 400 rural patients. CSL was measured both directly and indirectly. Clients' opinions of PSSQ relating to healthcare structure and process features were measured for indirectly assessing their satisfaction. PUV and CR were also measured indirectly. 5-point Likert scales were used to measure PSSQ, PUV, CSL and CR. Multiple regression and mediation were the models.

Results: Clients' satisfaction was low in both health sectors with significantly lower in the public than private sector. Accessibility (financial) predicted commonly high variations in CSL both in the public (18.2%) and private sectors (25.0%). Availability predicted incomparably highest variations in CSL in the public sector (34.6%). Structural factors predicted higher variations in clients' satisfaction in the public sector, which in the private sector were service process-features. Clients' reaction was the ultimate outcome of PSSQ mediated through PUV and CSL. PUV mediated the effects of PSSQ on clients' reaction stronger than CSL.

Conclusion: Financial accessibility is a crucial risk of impoverishment in both public and private sectors. Both structural and process features of healthcare are in ample needs for addressing existing low satisfaction in patients in rural Bangladesh.