This study aims at measuring the level of quality of health services and the problem of access to public health institutions in Morocco from the viewpoint of patients, This study is part of the health geography. The study shows that this quality is related to the geographical distribution of health services and the extent of their accessibility (especially the pair distance and time), as well as to the cultural, social and moral characteristics of the local population, which leads to their evaluation of either satisfaction (quality) or dissatisfaction (mediocrity).
The study aims to test the problem of research, by adopting a case study from the small cities in Morocco (the city of Kasbah Tadla) within the framework of its borders (Beni Mellal) and regional (Beni Mellal - Khenifra). The data collection was based on two methods: the first is an approach theoretical: (administrative and documentary data), the second one, based on the field, by selecting a random sample by proportional stratification (20%) for a total of 103 patients, it was extracted by the average of patients turning to health institutions. The questionnaires were distributed according to the importance of the institutions
The study is primarily based on two types of analysis: quantitative and qualitative, based on measurable and verifiable statistical hypotheses. Subject to review specific measurements and tests. This explains the adoption of the statistical hypothesis: There is no statistically significant difference (H0 in satisfaction with the quality of the health services dimensions of reliability, response, confidence, empathy and tangibles aspects, according to socio-demographic variables (age, gender, educational level, marital status, profession and geographical origin) and the physical components of access (distance, time, and the type of the means of transport). The study aims to answer the following problematic question: How can able to assess the dimensions of the quality of health services from the point of view of the beneficiaries? and what is the relationship of this evaluation with the physical components of access and their individual and demographic characteristics?
1. Examination of hypotheses
If we look at the realization and satisfaction of respondents of the quality of health services represented in reliability, response, confidence, empathy and tangible aspects, there are statistically significant differences, which means the importance of respondents' perceptions of the quality of health services provided to them, as all aspects related to it were positive evaluation We, therefore, reject the hypothesis that "there are no statistically significant differences in assessing the quality dimensions of health services represented in reliability, response, confidence, empathy and tangible aspects from the respondents' point of view" and we accept the alternative hypothesis.
If we look at the relationship between sociological variables and the physical components of access and satisfaction with the health services provided, we emphasize the acceptance of the following alternative hypotheses:
There are statistically significant differences between the distance and time taken to reach, as well as the type of the means of transport and some aspects of reliability in the quality of health services represented in the provision of health services on appointments fixed and the provision of health services with a high degree of accuracy. There is a relationship between the same aspects and variables of sex, profession and educational level, in addition to the geographical origin and its relationship with the institution's response quickly to the problems and inquiries of patients.
There is a statistically significant relationship between the distance and time required to access and one component of the response in the quality of health services, which is the commitment of staff to meet patients' requests immediately. There is a relationship between the same component, as well as the willingness of employees to cooperate with patients with the gender variable.
There is an effective relationship between the distance and time it takes for patients to reach and one aspect of confidence in the quality of health services, which is patient confidence in the knowledge, skills and experience of medical frameworks. We also record the same relationship between the same aspect and the variables of sex and profession, as well as the effect of the latter on the patient's sense of safety when dealing with medical frameworks.
There are statistically significant differences between the distance and time taken to access, according to variables empathy in the quality of health services represented in the employees of the institution having acknowledgement of the needs of patients, as well as clarifying health problems in the way they understand. There are also differences between these two aspects with the variables of gender, occupation and geographical origin, in addition to the effect of the latter on the convenient medical examination for patients.
There is a statistical relationship between three aspects of the tangibles dimension in the quality of health services, namely: The presence of the health institution in a convenient location that is easily accessible, and the presence of the medications needed by patients, as well as the presence of accompanying services (ambulance, pharmacy). There are also differences between the same aspects with the variables of sex and occupation.
The degree of satisfaction with the quality of health services is influenced more by the physical components of access (distance and time) compared to demographic variables (sexual structure, age structure, family status, educational level, geographical origin and profession). The geographical context, especially the distance and time it takes for patients to reach health institutions, are important factors in assessing the quality of health services, especially in terms of reliability, response and tangible aspects.
2. Review the results:
The first result: Health establishments are focused in the centre-city, which makes the distance people tour to attain them vary from one region to another in the city, and the farther we move far from the centre, the greater the distance and time to access the nearest health care institution. Although there is no full-size get entry to problems because the extensive majority of the population Does not move extra than 2 km to attain the nearest health institution. Also, defining buffer zones around the area of health institutions with a distance of 1,5 which's a reasonable distance on arrival, highlighting that maximum residential neighbourhoods inside the city benefit from the service variety and within a duration of no more than 30 minutes. As for the network analysis, it was shown that the farthest point from the health facility, which is estimated at extra than 4,500 meters, shows that human beings who live in these areas be afflicted by marginalization in obtaining health care services.
The second result: The dimensions of the quality of health services related to confidence and reliability are more satisfied by patients, and these elements constitute strengths in providing the health service, perhaps the most important of them: is that health institutions have the confidence of the beneficiaries, in addition to the commitment to provide the service on appointments specified, in addition to confidence in skill and experience medical of doctors and nurses.
The third result: The dimensions of quality of health services, which are evinced in empathy, response and tangible aspects, have less impact on patient satisfaction , especially the staff desire in the institution and their constant willingness to cooperate with patients, as well as the inconsistency of medical examination times with the requirements of beneficiaries, and the lack of consideration of social customs and traditions, as well as insufficient equipment medical devices and medicines available in health institutions.
Fourth result: the distance and time variables affect patients' satisfaction with the quality of the health services provided (reliability, response, confidence, empathy and tangibles), as proximity is an important factor in their realization of these dimensions. While owning private transportation means affect less to satisfaction of the customer.
Fifth result: variables of geographical origin, profession and educational level more affect patients' satisfaction with the quality of health services compared to the variables of sexual structure and family status, which are secondary variables that do not significantly affect trend of respondents.
Finally, the study presented a number of suggestions and alternatives to solve the research problem in the future, in addition to that, it recommended the creation of health facilities required devices and equipment, the provision of medical staff and qualified personnel assistance and the provision of appropriate physical evaluation of their effectiveness to ensure it continues to work out, to plant the trust and confidence in the hearts of patients and their auditors.
Keywords:
Health services, Quality, Quality of health services, The physical components of Access, Satisfaction/ dissatisfaction