Exploring disparities in satisfaction with obstetric-gynecological care among insured and uninsured women in Almaty, Kazakhstan: a comparative cross-sectional study
Aliyeva S. Lokshin V. Kamaliev M. Sarmuldayeva S. Kaldybayev G. Tsigengagel O.
2025Frontiers Media SA
Frontiers in Global Womens Health
2025#6
Background: Patient satisfaction is a key indicator of healthcare quality. Although crucial, limited research has explored factors contributing to satisfaction disparities in outpatient obstetric-gynecological care, particularly in Kazakhstan. The objective of the study is to explore disparities in satisfaction with obstetric-gynecological care between insured and uninsured women in Almaty, Kazakhstan, and to identify the key determinants of patient satisfaction. Methods: A cross-sectional survey was conducted among 107 insured and uninsured patients over three months in early 2024 at a hospital in the Almaty region, Kazakhstan. Using a five-point Likert scale, a structured questionnaire assessed socio-demographics, patient-reported experiences with the care process, and overall satisfaction across 16 dimensions. The survey instrument was pilot-tested and demonstrated strong internal consistency (Cronbachs alpha = 0.83). Chi-square tests examined associations, and multivariable logistic regression identified key predictors of patient satisfaction. Results: A multivariable analysis revealed a “satisfaction paradox”: insured patients had lower odds of being satisfied compared to uninsured patients (AOR = 0.15, 95% CI: 0.03–0.81). Specifically, a lack of insurance was associated with higher reported satisfaction in doctor-patient communication (OR = 1.8) and nursing care (OR = 2.1). Other significant predictors of satisfaction included having kidney disease and a shorter hospital stay. Conclusions: Our findings suggest that expanding insurance coverage is necessary for access but insufficient for ensuring patient satisfaction. The observed “satisfaction paradox” highlights that policy must adopt a dual focus: promoting enrolment while simultaneously improving the quality of patient-provider interactions to meet the higher expectations of insured patients. 2025 Aliyeva, Lokshin, Kamaliev, Sarmuldayeva, Kaldybayev and Tsigengagel.
health equity , health insurance , healthcare disparities , Kazakhstan , obstetrics and gynecology , outpatients , patient satisfaction , socioeconomic factors
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Department of Clinical Disciplines, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty, Kazakhstan
Department of Gynecological, JSC Central Clinical Hospital, Almaty, Kazakhstan
Department of Assisted Reproductive Technologies, International Clinical Centre of Reproduction “PERSONA”, Almaty, Kazakhstan
Department of Health Management, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty, Kazakhstan
Department of Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
Birth Center, Karasay Clinical Multidisciplinary Central District Hospital, Kaskelen, Kazakhstan
Department of Biostatistics, Bioinformatics, and Information Technologies, Astana Medical University, Astana, Kazakhstan
Department of Clinical Disciplines
Department of Gynecological
Department of Assisted Reproductive Technologies
Department of Health Management
Department of Medicine
Birth Center
Department of Biostatistics
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