Understanding elderly client satisfaction with primary health care in rural Bangladesh

Objective. To examine the elements of patient satisfaction that affect and influence health care utilisation by elderly people in rural Bangladesh. Methods. Based on the Primary Health Care in Later Life: Improving Services in Bangladesh and Vietnam (PHILL) project’s qualitative baseline study of older individuals and their caregivers in four villages in the southeast region of Bangladesh, this study conducted six focus group discussions and 30 in-depth interviews at village and household levels between February and November 2003, in a sample of elderly individuals and caregivers aged 60 years or older. A non-random strategy of sampling was used to achieve maximum variation for gender and economic status. Both physical and mental abilities of elderly participants were considered while selecting respondents. Results. Mobility, cost and payment flexibility, and cultural perception of medical outcome are primary determinants of satisfaction and utilisation. The private sector is more successful in meeting the particular demands of elderly satisfaction, i.e. better availability and flexible payment systems. Conclusion. The private sector health care system has much to offer the government system as it attempts to address the needs of the elderly. The elderly are highly heterogeneous and vary greatly with regard to socioeconomic status. The user fee structure of the public health care system should reflect this reality. A possible effective strategy would be to provide free health care services for the poorest and most vulnerable elderly, and at full cost for richer patients. Flexibility in the payment system is vital. In rural families ability to pay for the health care is often seasonal, especially for those engaged in agriculture. Credit purchase for medicines and health care therefore appears attractive. There is a critical need to coordinate between these private and public sector primary health care, especially with regard to specific training needs of local village providers, establishing an effective and timely referral system to channel elderly patients to the public sector, and introduce a much-needed preventive health care.