Document Type : Original Article
Authors
1 Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
2 Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
3 Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
4 Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Background: Health system responsiveness (HSR), the extent to which health services meet people’s legitimate expectations regarding the non-clinical aspects of care, is essential for patient-centered care and institutional trust, particularly during crises such as the COVID-19 pandemic. This study aimed to assess inpatient HSR in public referral hospitals in southern Iran during the COVID-19 pandemic.
Methods: In 2023, we conducted a cross-sectional telephone survey of 573 recently discharged patients from two major public COVID-19 referral hospitals in Kerman and Fars provinces. The WHO HSR questionnaire assessed eight domains: dignity, communication, autonomy, confidentiality, prompt attention, choice of provider, quality of basic amenities, and social support. Logistic regression was used to identify predictors of rating each domain as good/very good.
Results: The highest-rated domain was prompt attention (69.3%), followed by social support (69.1%), dignity (65.5%), and confidentiality (63.0%). Lower ratings were observed for communication (42.9%), autonomy (48.2%), and choice of provider (48.3%). In multiple logistic regression, males reported more favorable responsiveness (AOR=1.77). Rural residence (AOR=0.25) and lower income (no income AOR=0.22; <10 million tomans: AOR = 0.51) were associated with less favorable experience.
Conclusion: Public hospitals maintained acceptable performance in several non-clinical domains during COVID-19 but underperformed in communication, autonomy, and provider choice—particularly among socioeconomically disadvantaged groups. Targeted strategies to strengthen staff communication skills and to address the needs of rural and low-income patients are warranted to advance equity and patient-centered care during health emergencies.
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