Health system responsiveness for delivery care in Southern Thailand.

OBJECTIVE To assess the perception of women who gave birth in a hospital on health system responsiveness and their satisfaction. DESIGN A cross-sectional study. SETTING Four district, one regional and one university hospitals in the Songkhla province, Southern Thailand. PARTICIPANTS All women who delivered in the participating hospitals from November 2007 to December 2008. METHODS All women were interviewed at 24- or 48-h post partum by well-trained interviewers who worked independently outside the hospital. MAIN OUTCOME MEASURES Eight components of health system responsiveness were measured. The factors associated with high rate of health responsiveness and its effect on the women's satisfaction was estimated by multiple logistic regression. RESULTS A total of 2822 women were interviewed and their ages ranged from 12 to 48 years (mean ± SD: 27.6 ± 6.3). The components of health system responsiveness, which influenced the women's decision for delivering in a hospital were, in the order of importance, prompt attention, dignity, clear communication, autonomy, basic amenities, confidentiality, choice of provider and social support. The majority of women (>80%) gave high ratings for dignity, clear communication, prompt attention and autonomy. The type of hospital was a significant factor in all components of health responsiveness. Compared with women with universal coverage, women insured with the social security and civil servant medical benefit schemes gave higher ratings of dignity, confidentiality and choice of provider. Women's satisfaction for delivery care was significantly associated with high rates of all health responsiveness components, except choice of health providers. CONCLUSIONS Prompt attention, dignity, clear communication and autonomy influenced women's decision to deliver in the hospital. High health system responsiveness is important for women's satisfaction.