Association between Medical Resource Allocation and Satisfaction with Services of Public Health Management: Evidence from China

Background: People’s satisfaction has been one important indicator to measure the health care quality in health systems. Medial resource allocation issues have also become an important concern affecting the equity and satisfaction of health service. This study aimed to study the factors affecting people's satisfaction with the services of public health management in China. Specically, we examine the association between medical resource allocation and satisfaction with the services of public health management. Methods: To explore the associations between medical resource allocation and satisfaction with services of public health management in China, we derived data from the 2013 wave of the Chinese General Social Survey (CGSS). Models were estimated using multivariable logistic regression analysis. Results: Among factors of evaluation of medical resource allocation, adequacy of medical service resources, market-oriented and insuciently public of public health services, and convenience of access to public health services were all signicantly associated with satisfaction with services of public health management except the balance of medical service resources' distribution. Also, for different service projects and areas, the link between satisfaction with health service and residents’ characteristics also depends on specic service content. Conclusions: There is a link between medical resource allocation and satisfaction with the services of public health management. Medical resource allocation does affect satisfaction with services of public health management. It is necessary to improve the adequacy, publicity of medical services, and convenience of access to public health services in China.

people, men, and the majority of ethnic groups are more likely to be satis ed [12,13] . But some other research ndings seem to be inconsistent [14,15] .
Especially, medial resource allocation issues have also become an important concern affecting health service satisfaction. It has been examined that the factors regarding medical resource allocation have a signi cant impact on health service satisfaction. They fail to access care services that may be connected with barriers in accessing services and lead to the service dissatisfaction [16] . The availability of health services resources affects the satisfaction of the user. So some institutional factors may affect medical service satisfaction. Such as the allocation of medical resources and the availability of medical resources, etc. The availability of highlevel doctors [17] , waiting time [18] , the distance from home, and availability of medicines also has an important impact on health service satisfaction [19] . Based on research from European countries, Kroneman found that the availability of medical resources signi cantly affects health service satisfaction [20].
In China, one of the ve key objectives of China's new healthcare reform, launched in 2009, is to strengthen the basic-level health service delivery system. However, China still faces a series of problems, such as the rapid increase in medical costs, the unfair medical burden, the decline in medical access for low-income people, and the limited improvement in medical standards [21] . Therefore, in China, it is important to strengthen the analysis and investigation of health satisfaction.
No country's people are particularly satis ed with their medical systems [22] . Services of public health management are the important content of health services. In particular, the allocation of medical resources closely illustrates the equity and effectiveness of public health systems. However, contemporary research regarding health service satisfaction in China usually focused on the individual perspective, such as patients' sociodemographic characteristics; or just focus on overall health service satisfaction, with a lack of research on speci c dimensions of health service. The association between medical resource allocation and satisfaction with the services of public health management remains unknown. To extend previous work, this article plans to examine the satisfaction with services of public health management from a national resident perspective, and explore the relationship between the allocation of medical resources and satisfaction with services of public health management, as well as resident sociodemographic characteristics.

Data
Data in this study were derived from the 2013 wave of the Chinese General Social Survey (CGSS). Generally, CGSS, which is conducted by the National Survey Research Center at the Renmin University of China, is a nationally representative continuous cross-sectional survey on more than 10,000 households in provinces, municipalities, and autonomous regions in mainland China. Information of the respondents, including socioeconomic status, demographic characteristics, health-related behaviors and lifestyles, health status (such as health insurance, health conditions, and health services use) were collected, through a face-to-face interview.
The CGSS data could be downloaded on the o cial website (http://cgss.ruc.edu.cn/). Evaluation of Medical Resource Allocation. This article assumes that people's perception and evaluation of medical resource allocation affects the Satisfaction with Services of Public Health Management of the survey respondents. A 5-point Likert scale was used to measure people's perceived evaluation towards resource allocation, that is, adequacy of service resources provided by public health services, the balance of service resources' distribution across different regions, market-oriented and insu ciently public of public health services, and convenience of access to public health services. Measures Satisfaction with Services of Public Health Management. The dependent variable in this study was the Satisfaction with Services of Public Health Management of the survey respondents in CGSS. A total of 6 items measure the respondents' satisfaction with public health management which can be divided into two groups through factor analysis: Health Regulation (Hygiene supervision management (food, drinking water, public places, etc.), Essential drug regime and Drug Safety Management), and Health Management(Urban and rural residents' health le service, Chronic disease management, and Severe mental illness management). They were evaluated by the question"How satis ed are you with each of the following aspects of public health services". The responses were measured using a 5-point Likert scale ranging from strongly dissatis ed to strongly satis ed. As the dependent variables of our analysis, the answer for each item was dichotomized into two groups: High Satisfaction Levels, where the answer was either satis ed or very satis ed; and Low Satisfaction Levels, where the answer was very dissatis ed, dissatis ed or average. Sociodemographic factors. Similar to prior studies, some of the sociodemographic factors were selected for the analysis based on prior literature on the satisfaction of public health services. These selected factors are sex, age, education level, hukou (household registration), perceived household income, access to medical insurance, and access to a pension.
Hukou is a variable unique to China. In China, a person should register in one and only one place of regular residence in the hukou system, which is an institutional arrangement to control the population mobility, such as migration. Hukou in China usually has two categorizes, rural hukou and urban hukou [23] . According to the questionnaire setting, hukou is divided into rural residents and non-rural residents in this article.
Evaluation of Medical Resource Allocation. Evaluation of Medical Resource Allocation was measured by questions 'Do you think the current health care resources are adequate?", "Is the service resources' distribution across different regions balanced?", "Is it serious that public health services are market-oriented and insu ciently public?", "Is it convenient to get public health services?". The answers were measured using a 5point Likert scale ranging from Level 1 to Level 5. Respectively, adequacy of medical service resources, ranging from most adequate to least adequate; the balance of medical service resources' distribution, ranging from most balanced to most uneven; market-oriented and insu ciently public of public health services, ranging from most serious to not serious at all; the convenience of access to public health services, ranging from most convenient to not convenient at all.

Statistical analysis
Descriptive statistical methods were used to illustrate the distribution of sociodemographic factors, Evaluation of Resource Allocation, and High Satisfaction with Services of Public Health Management based on different speci c dimensions.
The associations between Sociodemographic factors, Evaluation of Resource Allocation, and High Satisfaction with Services of Public Health Management based on different speci c dimensions were accessed using multivariate analyses, and models were estimated using multivariable logistic regression analysis using R 3.6.3. Odds Ratio (OR) and its 95% con dence interval (95%CI) were calculated. All statistical tests were 2-sided, and P-values of < 0.05 were considered as statistically signi cant.

Results
Bivariate Associations between factors and high satisfaction with the services of public health management In a preliminary bivariate analysis of the data, bivariate associations between sociodemographic characteristics, factors of evaluation of medical resource allocation, and high satisfaction levels in items of health regulation and health management can be seen in Table 1 and Table 2. For all the 6 items that measure the satisfaction with services of public health management, factors of evaluation of medical resource allocation (adequacy of service resources, the balance of service resources' distribution, market-oriented and insu ciently public of public health services, and convenience of access to public health services) were all signi cantly associated with high satisfaction levels.  (18) 20.16%(25) † P for Chi-square test. * P < 0.05, ** P < 0.01, *** P < 0.001 High Satisfaction Levels in Health Management † P for Chi-square test. *P < 0.05, **P < 0.01, ***P < 0.001 ‡ include urban medical insurance, new cooperative medical insurance, and public medical insurance. § include rural pension, urban residents' pension.
For satisfaction in health regulation items (Table 1), nearly 30.25% reported high satisfaction levels with essential drug regime, and sociodemographic characteristics (i.e. access to medical insurance and pension) were also signi cantly associated with high satisfaction levels. Nearly 29.18% reported high satisfaction levels with drug safety management service, which is also associated with education level, hukou, access to medical insurance, and pension. Approximately 28.73% reported high satisfaction levels with hygiene supervision management service (food, drinking water, etc.), which is also associated with sociodemographic factors including age, education level, and access to a pension.
For satisfaction in health management items (Table 2), nearly35.13% reported high satisfaction levels with urban and rural residents' health le service, and sociodemographic characteristics, such as age, education level, hukou, perceived household income, access to medical insurance and pension were also signi cantly associated with high satisfaction levels. About 27.47% reported high satisfaction levels with chronic disease management service, which is also associated with age, education level, perceived household income, access to medical insurance, and pension. The least, 23.36% reported high satisfaction levels with severe mental illness management service, which is also associated with sociodemographic factors like perceived household income, access to medical insurance, and pension.
Multivariable logistic regression models of factors and high satisfaction with services of public health management Table 3 and Table 4 displays multivariable logistic regression models of sociodemographic characteristics and factors of evaluation of medical resource allocation associated with high satisfaction with the services of public health management. .594 † P for logistic regression.*P < 0.05, **P < 0.01, ***P < 0.001 ‡ include urban medical insurance, new cooperative medical insurance, and public medical insurance. § include rural pension, urban residents' pension, .273 † P for logistic regression.*P < 0.05, **P < 0.01, ***P < 0.001 ‡ include urban medical insurance, new cooperative medical insurance, and public medical insurance. § include rural pension, urban residents' pension, For sociodemographic characteristics associated with satisfaction in health regulation items (Table 3), people with average perceived household income were not likely to report high satisfaction levels with essential drug regimes compared with those with below-average income. Those with non-rural resident hukou (compared with rural residents) were not likely to report high satisfaction levels with drug safety management service, while people having medical insurance (compared with no medical insurance) were more likely to report it.
For sociodemographic characteristics associated with satisfaction in health management items (Table 4), people with secondary school education level (compared with elementary school level or below), above-average perceived household income (compared with below-average income), having the medical insurance (compared with no medical insurance) and pension (compared with no pension) were more likely to report high satisfaction levels with urban and rural residents' health le service. People with age above 30 and having a pension (compared with no pension) were more likely to report high satisfaction levels with chronic disease management service. Lastly, people with above-average perceived household income (compared with belowaverage income) and having a pension (compared with no pension) were more likely to report high satisfaction levels with severe mental illness management service.
Concerning the factors about the evaluation of medical resource allocation, for all the 6 items that measure the satisfaction with services of public health management, adequacy of service resources, market-oriented and insu ciently public of public health services, convenience of access to public health services were all signi cantly associated with them (only except the association between market-oriented and insu ciently public of public health services and severe mental illness management service). Besides, the balance of medical service resources' distribution was not signi cantly associated with high satisfaction levels with all the 6 items.
As shown in Table 3 and Table 4, People with the lower evaluation of the adequacy towards medical service resources and convenience of access to public health services were not likely to report high satisfaction levels with services of public health management for all the 6 items. However, people who believed that the marketoriented and insu ciently public of public health services were less serious were all more likely to report high satisfaction levels for all the items except severe mental illness management service. In addition, the balance of medical service resources' distribution is also not signi cantly associated with severe mental illness management service based on evidence from China.

Discussion
This study examined the association between sociodemographic characteristics and factors of evaluation of medical resource allocation associated with high satisfaction with the services of public health management in the China context. Speci cally, we examined the association between medical resource allocation and satisfaction with speci c service content of public health management.
For the link between sociodemographic characteristics and satisfaction with services of public health management, so far, it still remains uncertain. Judging from the relevant conclusions of other scholars, most of the studies have examined the correlation between demographic factors such as age, gender, health status, and level of education with patient satisfaction; however, the ndings from these studies are con icting. Some studies have found that male patients, patients older than 50 years old, are more satis ed with health services [24] . Other studies have found that age, gender, and education do not signi cantly affect health service satisfaction [25] .
However, to summarize the above conclusions, the ndings of this article further show that, for different service projects and areas, the link between satisfaction with health service and residents' characteristics also depends on speci c service content. For example, in health management items, the demographic characteristics that signi cantly affect people's reporting high satisfaction levels with urban and rural residents' health le service are not the same as those that affect that with chronic disease management service.
Besides, in our ndings, the least people reported high satisfaction levels with severe mental illness management service. Maybe this service is only for a small number of groups, and most groups have little to do with this service.
For the association between medical resource allocation and satisfaction with services of public health management, this study shows that medical resource allocation does affect satisfaction with services of public health management based on evidence from China. Among factors of evaluation of medical resource allocation, adequacy of medical service resources, market-oriented and insu ciently public of public health services, and convenience of access to public health services were all signi cantly associated with high satisfaction levels overall except balance of medical service resources' distribution.
These conclusions are also consistent with other relevant research results. Satisfaction with the healthcare system is more strongly related to some institutional arrangements, especially the allocation of medical resources.
That is to say, for the adequacy issue of health service resources, the rapid increase of health care costs, and the insu cient nancial subsidies from the health insurance system may result in the health management dissatisfaction [26] . Also, the health expenditures provided nancial supply importantly shape and positively affect the patient satisfaction [27] . For the publicity issue of health service resources, some scholars believe that market-oriented methods may put those vulnerable patients at great risk [28] . European cases show that dissatisfaction with healthcare systems is related to the co-payments ratio. The fewer general practitioners and higher co-payments contribute to the lower overall level of healthcare service satisfaction [29] . For the convenience of access to public health services, the satisfaction of health services is signi cantly affected by the accessibility of medicine and health services [30] . However, among factors of evaluation of medical resource allocation, people's perception of the balance of service resources' distribution has no statistical correlation with the satisfaction of health management in China. Therefore, the focus of China's policy should be how to improve the adequacy, publicity of medical services, and convenience of access to public health services.

Conclusion
This article nds that there is a link between medical resource allocation and satisfaction with the services of public health management. Among factors of evaluation of medical resource allocation, adequacy of medical service resources, market-oriented and insu ciently public of public health services, and convenience of access to public health services were all signi cantly associated with satisfaction with services of public health management except the balance of medical service resources' distribution.
Our ndings also further show that, the link between satisfaction with health service and residents' characteristics also depends on speci c service content. The link between satisfaction with health service and residents' characteristics should be examined according to speci c medical and health services. That is to say, for different service projects and areas, the link between satisfaction with health service and residents' characteristics is full of differences, and also depend on speci c service content.
Especially, medical resource allocation does affect satisfaction with services of public health management. It is necessary to improve the adequacy, publicity of medical services, and convenience of access to public health services in China. Further research should focus on how interventions could help persons to consume services of public health management, despite progression of the changing environments.

List Of Abbreviations
CGSS: Chinese General Social Survey; OR: Odds Ratio.

Declarations
Ethics approval and consent to participate After ethical approval, the Chinese General Social Survey (CGSS) launched in 2003, is the earliest national representative continuous survey project run by academic institution in China mainland. We used the public data of CGSS, no additional ethics approval was needed.

Consent for publication
Not applicable.

Availability of data and materials
The datasets used and/or analysed during the current study are available on the CGSS o cial website (http://cgss.ruc.edu.cn/).

Competing interests
The authors declare that they have no competing interests. Authors' contributions Shangren Qin conceived the idea and design of this study and wrote the manuscript. Xiaohe Wang guided data analysis work and revised the manuscript. All authors read and approved the nal manuscript.