Artículo original
User satisfaction in the affiliation to Seguro Popular
modules
La Satisfacción del usuario en los módulos de afiliación del Seguro
Popular
Satisfação do usuário nos módulos de afiliação do Seguro
Popular
La satisfaction des utilisateurs dans les modules d’affiliation au
SeguroPopular
José Julio López Ronquillo1
Alfonso Rodríguez León2
María Luisa Castillo Orueta3
1Master of Science in Public Health, Contributor
of Quality and Planning Unit of the General Hospital of Cardenas, Ministry of
Health. México
2Masters in Health Services Administration and
Master in Quality Management. Technical Coordinaton of Supervision and State
Evaluation of the Ministry. México
3Doctor of Educational Sciences (PhD). Teaching
and Research Coordinator of the Health Center and Expanded Services of Tierra
Colorada, Ministry of Health. México
Abstract
Objective:
Identify the level of patient satisfaction (user) with respect to the
perception of quality with the services received by the affiliator of Seguro
Popular (SP).
Materials and Methods:
A Prospective and cross-sectional descriptive study was carried out in the
affiliation and orientation modules (MAO) of the municipality of Cárdenas,
Tabasco. A mixed survey instrument was applied, designed based on the State
Health Services Supervision and Monitoring Model (MOSSSES for its initial in
Spanish), the State Regimes of Social Protection in Health at the national
level until 2016, the sections of “attention” and “waiting time” were taken,
adapting the items to the context of the attention process during the user’s
affiliation. The universe was 156,559 affiliated to the SP, the sample was
calculated, using an error rate of 6%, a confidence level of 95% and a p =
0.5, resulting in a sample of 266 beneficiarles.
Results:
From the 266 beneficiaries surveyed, 92% were women, the average age of
users was 32.62 years. 98% responded to be satisfied with the attention
received in the MAO and that they would return to the same module to perform
procedures, the main reasons were location and treatment received. Regarding
the waiting time, 73.7% of the population reported being very satisfied with
the waiting time, 23.3% satisfied, 2.6% perceived it as regular and 0.4% was
dissatisfied.
Conclusions:
The percentages obtained in the degrees of satisfaction for the attention
received and the waiting time, show ample satisfaction with the service
offered by MAOs, mainly for the treatment received and the location of it.
The communication between staff and user was decisive in the satisfaction of
user.
Keywords: Quality of services; Health services; Patient satisfaction
Resumen
Objetivo:
Caracterizar el nivel de satisfacción del paciente (usuario) con respecto a
la percepción de calidad de los servicios recibidos por el afiliador del
Seguro Popular (SP).
Materiales y Métodos:
Se aplicó un instrumento mixto tipo encuesta, diseñado con base al Modelo de
Supervisión y Seguimiento Estatal de Servicios de Salud, operado por los
Regímenes Estatales de Protección Social en Salud a nivel nacional hasta el
año 2016, se tomaron los apartados de “atención” y “tiempo de espera”,
adecuándose los ítems al contexto del proceso de atención durante la
afiliación del usuario. El universo fue de 156,559 afiliados al SP, se
calculó la muestra, utilizando un porcentaje de error del 6%, un nivel de
confianza del 95% y una p=0.5, resultando una muestra de 266
beneficiarios.
Resultados:
El 92% fueron mujeres, la edad media de los usuarios fue de 32.62. El 98%
respondieron estar satisfechos con la atención recibida en el MAO y que
regresarían al mismo módulo a realizar trámites, siendo los principales
motivos la ubicación y el trato recibido. En cuanto al tiempo de espera, el
73.7% de la población refirió estar muy satisfecho con el tiempo de espera,
el 23.3% satisfecho, el 2.6% lo percibió como regular y el 0.4% quedó
insatisfecho.
Conclusiones:
Los porcentajes obtenidos en los grados de satisfacción por la atención
recibida y el tiempo de espera, demuestran amplia satisfacción con el
servicio de los MAO, principalmente por el trato recibido y la ubicación del
mismo. La comunicación entre el personal y el usuario, fue determinante en
la satisfacción del afiliado.
Palabras clave: Calidad de los servicios; servicios de salud; satisfacción del paciente
Resumo
Objetivo:
Caracterizar o nivel de satisfação do paciente (usuário) em relação á
percepção de qualidade dos serviços recebidos pelo afiliado do Seguro
Popular (SP).
Materiais e Métodos:
Estudo prospectivo e transversal descritivo realizado nos módulos de
afiliação e orientação (MAO) do municipio de Cárdenas, Tabasco, foi aplicado
um levantamento de tipo de instrumento misto, elaborado com base no Modelo
de Supervisão e Acompanhamento Estatal de Serviços de Saúde, operado pelos
Regimes Estatais de Proteção Social em Saúde a nivel nacional até 2016,
foram tomadas as seções de “atenção” e “tempo de espera”, adaptando os itens
ao contexto do processo de atendimento durante a filiação do usuário. O
universo foi 156,559 afiliado ao SP, a amostra foi calculada, usando uma
taxa de erro de 6%, um nivel de confiança de 95% e p = 0,5, resultandem uma
mostra de 266 beneficiários.
Resultados:
92% eram mulheres, a idade média dos usuários era de 32,62. 98% responderam
estar satisfeitos com a atenção recebida na MAO e que retornariam ao mesmo
módulo para realizar procedimentos, sendo os principais motivos de
localização e tratamento recebido. Em relação ao tempo de espera, 73,7% da
população relataram ser muito Satisfeito com o tempo de espera, 23,3%
satisfeito, 2,6% o percebeu como regular e 0,4% estava insatisfeito.
Conclusões:
As porcentagensobtidas nos graus de satisfação pela atenção recebida e o
tempo de esperamos tramam pla satisfação com o serviço da MAO,
principalmente para o tratamento recebido e a localização do mesmo. A
comunicação entre o pessoal e o usuário foi decisiva na satisfação do
afiliado.
Palavras-chave: Qualidade dos serviços; servinos de saúde; Satisfação do paciente
Résumé
Objectif:
Identifier le niveau de satisfaction du patient (utilisateur) par rapport á
la perception de la qualitédes services rejus par l’affilié de Seguro
Popular (SP).
Matériaux et méthodes:
Étude descriptive prospective et transversale réalisée dans les modules
d’affiliation et d’orientation (MAO) de la municipalité de Cárdenas á
Tabasco., Une instrument mixte de type enquete a été appliquée, conju sur la
base du Modéle de Supervision et de suivi de l’État des Services de Santé,
gérépar les Régimes de Protection Sociale de l’État en Santé au niveau
national jusqu’en 2016, les sections “attention” et “temps d’attente” ont
été prises, adaptant les éléments au contexte du processus d’attention
pendant l’affiliation de l’utilisateur. L’univers était composé par 156,559
membres du SP, l’échantillon a été calculé en utilisant un taux d’erreur de
6%, un niveau de confiance de 95% et un p = 0,5, résultant en un échantillon
de 266 bénéficiaires.
Résultats:
Le 92% étaient des femmes, dont l’age moyen des utilisateurs était de 32,62
ans. 98% ont répondu qu’ils étaient satisfaits des soins rejus au MAO et
qu’ils retourneraient au meme module pour effectuer des procédures, les
principales raisons étant l’emplacement et le traitement reju..En ce qui
concerne le temps d’attente, 73,7% de la population ont déclaré etre trés
satisfaits du temps d’attente, 23,3% satisfaits, 2,6% perjus comme étant
réguliers et 0,4% insatisfaits.
Conclusions:
Les pourcentages obtenus dans les degrés de satisfaction pour l’attention
rejue et le temps d’attente, montrent une grande satisfaction avec le
service proportionné par les MAOs, principalement pour le traitement renu et
son emplacement. La communication entre le personnel et l’utilisateur a été
déterminante pour la satisfaction de l’affilié.
Mots-clés: Qualité des services; services de santé; Satisfaction des patients
Introduction
The Social Protection in Health System (SPSS for its initials in Spanish) is a scheme
of public and voluntary insurance to all Mexicans not covered by any of the social
security schemes existing in the country, which offers financial coverage in health
services, trying to satisfy in a comprehensive manner the needs of the insured
population, without affecting the family economy. The study of satisfaction, allows
to identify users’perception, among other things, regarding the medical attention
received in the different phases that determine it; the opportunity and the results
of the attention; kindness, relationships with the staff and information regarding
the health problem1.
User satisfaction has been measured from doctor-patient relationship and not
fromuser-affiliator perspective, as indicated by Mexico’s Ministry of Health (SSA
for its initials in Spanish) 2which
places this relationship as: “the dimension resulting from the fulfillment of needs
and expectations in the schemes of measurement of quality from the user’s
perspective”. On the other hand, Palacios-Gómez refers that it is “the main
indicator of the of service quality and is the best predictor of customer loyalty
with respect to the service (use and / or later purchase thereof)...understanding
this as a global perception of service which is constructed on the addition of
“partial” perceptions that generate greater or lower satisfaction“3.
In turn, the Mexico’s Ministry of Health, the SPSS and the National Institute of
Public Health (INSP for its initials in Spanish) have implemented from 2009 to 2015,
studies in order to measure the users’ satisfaction with the social protection
system in health under the same approach1, 4and5.
The affiliator is the user’s first contact with health services, its work consist
into incorporate users to SPSS. During the affiliation process, the staff follows a
model of standardized user care at a national level by the National Commission for
the Social Protection in Health (CNPSS for its initials in Spanish) and this model
is universal, it is applied throughout the country 6
7and8.However, in the literature reviewed
no research was found that measures user satisfaction in relation to the attention
received in the affiliation modules, those examined are related to the service
provider(medical consultations, medicine supply, among others) 9
10u’ 12
13
14
15>16
17and18.
Therefore, this study aims to identify the level of users’ satisfaction with respect
to the perception of quality in the service received by the Seguro Popular (SP)
affiliator.
Materials and methods
A descriptive, prospective and cross-sectional study was carried out from October to
November 2017 in the Affiliation and Orientation Modules (MAO in Spanish) of the
municipality of Cárdenas, Tabasco. During this period of time, a mixed survey
instrument was applied, designed based on the State Health Services Supervision and
Monitoring Model (MOSSSES for its initial in Spanish),operated by the State Regimes
of Social Protection in Health (REPSS in Spanish) nationally until 2016 and applied
by the Seguro Popular managers in order to know users’ satisfaction in relation to
the service provided by health personnel.From the model, the sections of “attention”
and “waiting time” were taken, adapting the items to the context of the attention
process during the user’s affiliation.
The adequacy of the model resulted in a two-part instrument. The first consists of
seven items that intégrate the general user data and location of the MAO, such
statements present dichotomous (Yes/No) and polytomous response options (Very
Satisfied, Satisfied, Regular, Dissatisfied) following Likert scales, designed
according to the questions. The second section integrates two questions related to
the waiting time and the degree of satisfaction during the service, adapting the
scale options of the previous section. The study’s population is represented by all
those people who are beneficiaries of the Seguro Popular (SP), 156,559 affiliates16.
The sample was calculated, by the TheSurveySystem sample calculator available at
http://www.surveysoftware.net/sscalce. htm,using an error rate of 6%, a confidence
level of 95% and a p = 0.5, resulting in a sample of 266 beneficiaries of the SP,
which was stratified for each of the MAOs, leaving the number of surveys as shown in
table 1.
Table 1 Sample stratified by MAO
| Affiliation and Orientation Modules (MAO) |
Universe |
Sample |
| Cárdenas |
45,491 |
77 |
| Villa Benito Juárez |
30,346 |
52 |
| C-16 |
30,843 |
52 |
| Cárdenas - Centro |
23,276 |
40 |
| Azucena 2da. sección |
26,603 |
45 |
| Total |
156,559 |
266 |
Source: REPSS (2017)19
Results
From the 266 beneficiaries surveyed, 92% were women and 8% were men, the average age
of users was 32.62 years with a maximum of 84 years and a minimum of 15 years of
age. Figure 1 presents the frequency of the
responses given to each of the items that make up satisfaction with the attention
received in the MAO. , 98% of respondents answered tobe satisfied with the service,
only one user responded not to be satisfied. It is important to note that the most
frequent degree of satisfaction indicated was “very satisfied”, as illustrated
below.
We questioned the users about returning to do the procedure at the same MAO, it was
obtained that 98% of them answered affirmatively and only 2% gave a negative
response. Among the main reasons identified, four were more frequent: the attention
given (62%), rapid attention (17%), location of the MAO (12%) and necessity (9%),
the rest presented lower frequencies. Figure 2
illustrate the distribution of these results.
In the item to identify the reason for choosing the MAO where the procedure was
carried out,users answered the following, 74% chose the MAO for its location, 19%
mentioned for the attention received and 7% for not standing in line; the
above-mentioned, is illustrated in figure 3.
Regarding the information received, 255 of the participants answered that they did
receive it, it was also complete and understandable, 10 did not receive it and one
considered it was incomplete.
With regards to complains about the care received in MAOs, 100% of the population
responded that they had not presented any objection.
In the matter of waiting time, 73.7% of the population reported being very satisfied,
23.3% satisfied, 2.6% regular and 0.4% dissatisfied; in figure 4, the waiting times referred by users are presented.
Discussion
The results obtained in this study showed that 92% of the respondents who carried up
procedures at the MAOs in the municipality of Cárdenas, Tabasco, were women; this
accords with the ownership in the affiliation policies, indicated by the CNPSS
“Currently, 16.8 million women are owners of their SPSS affiliation policy, which
represents 72.5%of the 23.2million affiliate policies registered until June 2017”
20.
In this regard, the CNPSS explains:
This statistic is not comparable to the female head of households in Mexico ... since
for the SPSS the observed data is a measurement of the ownership of the protected
core rights policy, without determining the functional and sociological role of
women in the structure of the home which they belong to “.
According to the results obtained, 98% of users were satisfied with the attention
received in the MAOs, and they did not present any complains during the studied
period. Agreeing with the statement of the 2017 satisfaction survey report of the
REPSS in Tabasco: “With respect to our affiliated users have filed a complaint ...
of the 4370 respondents, 92% report not having submitted it” 21
This finding coincides with the statements made by Saturno- Hernández et al (2016)
who refer “Measuring the satisfaction of SPSS affiliates is a complex but a
necessary process, both to meet with existing regulations and to have solid
foundations to design strategies to improve the services that are financed.”22. Likewise, Priego (2002) mentions
“Intangible services of attention are elements that cannot be measured, however,
they count and influence to determine and define a quality service” 23,in turn, Ross and Infante (2000)
state: “user satisfaction can be measured at least in four areas that would be
comparing, evaluating health systems and services, identify needs for change in
procedures to improve user satisfaction and assist health organizations to access
users with little acceptance of the service “24.
On the other hand, the CNPSS25
through its Call Center, in the first semester of 2017, recorded for Tabasco, 343
calls, of which only three corresponded to complaints related to affiliation
procedures (denial of affiliation and re-affiliation problems, in the municipalities
of Centro and Comalcalco).
Likewise, the INEGI in 2016, states: “in canying out procedures, payments and
requests for public services, in addition to other contacts with public servants,
74.6% of users said they felt satisfied” referring that the surveyed population
declared to be very satisfied or satisfied with the service26.
Regarding the waiting time, the results obtained indicate that 74% of MAO users
responded to be very satisfied with the waiting time, being between 10 and 15
minutes the most frequent indicated, differs from that found in the study of user
satisfaction of SPSS in 2015, in which it is indicated that the 26,991 people
surveyed “... 66.1% consider the affiliation procedures are not fast ...”1.
Another important piece of information was provided by the item of information
received, the 95.9% answered having received complete and understandable information
regarding the affiliation process, however, 73% of users said they did not know
another MAO. In this respect, the CNPSS in 2017 states: “The problems related to
information and the functioning of the services at the time of affiliation to Seguro
Popular are very frequent and relevant “20found in its user satisfaction study that 71% of its
respondents considered the information received insufficient.
Conclusions
The percentages obtained in the degrees of satisfaction for the attention received
and the waiting time during the process of affiliation in the MAO, they show that
the users are satisfied with the service, in such a way, that they will continue
attending that same module for quality and for location.
The information received during the process was a determinant in the satisfaction of
users, a high percentage of users responded having received complete and
understandable information.
Conflict of interests
Authors declare noconflict of personal, social, economic or other interests.
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Instituto Nacional de Estadística y Geografía [INEGI]. p.16. Disponible en:
http://www.inegi.org.mx/saladeprensa/boletines/2016/especiales/especiales2016_05_01.pdf
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