Comparative analysis of healthcare responsiveness between insured and uninsured patients: A cross-sectional study in a tertiary hospital of Nepal

Background: The responsiveness of a health system is considered to be an intrinsic goal of health systems and an essential aspect in performance assessment. This highlights the non-medical aspects of patients depend upon how health care facilities acknowledge patients’ demands. Objectives: This study assesses perceptions of insured and uninsured patients regarding the responsiveness of inpatient services at a tertiary hospital in Nepal. Methods: Using a cross-sectional, hospital-based design, quantitative research was conducted at the National Academy of Medical Sciences, Bir Hospital. A total of 228 participants were selected through simple random sampling. Data were collected via interviews. Associations between variables were identified through bivariate and multivariable logistic regression. Results: The mean age of patients was 46.63 years with standard deviation (SD) of 16.33 years. Most patients perceived their health status as poor (93.9%), and 74.1% reported insufficient availability of medicines. Both insured and uninsured patient groups experienced poor responsiveness for three out of eight domains. Based on inpatient’s importance and experience, responsive domain can be classified into three priority groups to enhance responsiveness: 1st priority: Prompt attention and clarity of communication; 2nd priority: dignity, choice and quality of amenities; and 3rd priority: autonomy, confidentiality and social support. Conclusion: The hospital should improve the degree of responsiveness in all domains, with priority given to prompt attention and clarity of communication. More attention should be given to patients who stay for longer durations in the hospital as Nepal expands national health insurance coverage.