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Journal number 3 ∘ Tamar Butsashvili
Cost-effective primary healthcare and its benefits

Expanded Summary

The complexity of medical services, especially outpatient services, is caused by the circumstances that provided services are not tangible. It is difficult to measure their characteristics, and of course, it requires high qualified, specific (medical) knowledge. Consumers find it difficult to evaluate the quality of healthcare services in advance since it is possible only after receiving them (in some cases it is even impossible). At the same time, the initial visit to a medical establishment does not mean that a patient is not looking for any other service provider, and this applies both to the medical establishment and the treating doctor. The patient’s satisfaction has a significant impact on continuing medical care. And the latter one, apart from cost-effective medical services, determines the adequate utilization of services. For the progress of the patient-oriented healthcare protection service it is important to improve both the accessibility of medical services and their quality.  The medical care market differs fundamentally from any other market. It means that it is practically impossible for a person who has no medical education to define the quality of medical help and, based on this, to choose a more suitable service. Opponents of transition to free market principles of medical services consider that a person who does not have medical education (a patient, as well as a member of his/her family) is not completely qualified to define not only the service of medical care itself, but also whether it is necessary at all for a person to use these services. Consumers (patients) may have an opportunity of free choice. They might choose a specific medical establishment, but they will not be able to choose the scope of the service. The consumer may define the medical institution for its good infrastructure and high-tech equipment, although the definition of the services received is associated with certain difficulties. Free healthcare consumers do not know which type of medical care is more effective for them, what type of medical care they need, or what benefit the proposed medical assistance will bring to them. It is also difficult for patients to assess the quality and outcome of the undergone treatment. It is due to these factors in the field of medical services that it is hard to conduct effective communication.

In the medical field individual decisions are made not in accordance with the awareness and financial possibilities of individual consumers, but based on their health needs. According to the classical model, the decision on the purchase of medical services should be made by the consumer himself.

It is interesting to consider the meaning of reputation criteria during the selection of doctor and clinic. A medical establishment is not a banking service where the existence of standard service parameters can be applied.

The indicator of quality of medical services is the index of patient satisfaction. Two factors contributed to the spreading of the extensive study of patient satisfaction: on the one hand, the growth of protection of patients' rights throughout the world, and on the other hand, the legitimation of the market economy aspects in medicine and the transfer of patients to the rank of consumers. With such a background it becomes clear that the engagement of patients in the decision-making process has increased. According to the developed recommendations from the Parliamentary Assembly of the European Consulate, the guarantee for quality assurance of medical services on the part of the government demonstrates protection of the dignity and rights of patients. And at the same time, it is recognized that every citizen should take an active part in these processes. In addition to rights, patients are assigned a certain kind of responsibility. It is much more difficult to ensure participation of patients at all stages of medical services. To provide these processes while improving the quality of medical services, special initiatives, schemes and opinions are being developed to involve patients. To study the opinions of patients different tools are developed and applied. To study the satisfaction of patients by level and quality, the questionnaires of the European consulate, the Eurobarometer and the standardized international questionnaire of Europep are used. Methodology developed by the European consulate - Eurobarometer - aims to study the patient safety and health care issues, while Europep studies the satisfaction of patients with the services of practicing doctors. In 2009, due to the use of the Eurobarometer, a study was conducted in 27 countries, and the survey included 406,557,138 people. In 1995-1998 the group of scientists developed an international standardized tool for general practice evaluation by patients –Europep (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409606/).

This methodology is already used in more than 20 countries. With this having been taken into consideration, a questionnaire for quantitative research was developed, which consisted of a section on the significance of the patient engagement. The size of the selection (random selection) is 100 patients who used family doctor services in Tbilisi, in three specific outpatient medical establishments. It turned out that there was a high positive correlation between family doctor services and the satisfaction with the clinic - (Spearman) - rs=0.62, p=0.000.