Identifying Patient Perceptions of Inequality in Public Health Care Services: Evidence From a Single Indian Administrative District.

Purpose: Assessment of patient experiences is an essential step to revamp patient-centered care and identify systemic effectiveness as part of universal health coverage. This paper analyzes the variation of health care at different levels of the public health care system in India by measuring patients' experience with the care they have received in the Alipurduar district of India. Methods: From May 2021 to April 2022, stratified sampling technique was applied to collect primary data from 450 patients having different health problems from different levels of the public health care system. In addition, Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results were used to evaluate patient experience, with the reliability of questions measured by Cronbach's alpha. Collected data were categorized with the help of exploratory factor analysis; after which, analysis of variance and post-hoc tests were applied to understand specific variations in patient experiences. Results: This study identified that the services delivered in the health centers were not suitable (6.160 out of 10) to fulfill the needs of the patients. Among the three domains of health care services - namely, proficiency, tangibility, and information - the experience of patients significantly varied (P<0.001) when comparing primary, secondary, and tertiary levels of the public health care system. Conclusions: Patients receiving services from the centers under the tertiary level have expressed lesser satisfaction than those patients who have received care at primary or secondary levels because of excessive patient load, inadequate manpower, and other infrastructure deficits at the tertiary level.