Choice and evaluation of hospitals in Bangladesh: insights from patients and policy implications.

This paper attempts to gain insights into the health care system of Bangladesh from the perspectives of hospital patients. The study is based on survey data obtained from 207 recipients of health care services from 57 hospitals in Dhaka City. Patients' choice of hospital is influenced by referrals of doctors (28.7%), reputation of the hospital (23.7%), referral by family and friends (17.4%), closeness to home (14.9%), cost (7.4%) and other miscellaneous factors (7.9%). The major reason for selecting a particular hospital is for treatment (86%). Only few choose preventive or health maintenance services. Demographic trends indicate that better educated and more affluent people are more likely to seek private hospital care, while those who are less educated and less affluent are more inclined to seek public hospital care. The average length of hospital stay, both for private and public hospitals, was 9.9 days. Longer hospital stays are positively associated with nonavailability of needed medicines, poor upkeep of facilities, need to provide "tips" for services, lack of prompt services, a suffocating environment, and unexplained hospital costs. Average satisfaction rate was 4.85, with private hospitals earning higher average ratings than public facilities. The highest income groups gave the highest quality ratings (5.26) compared to other income groups. Implications of findings for health policy are outlined.