Satisfaction with primary health care in Ukraine in 2016–2020: A difference-in-differences analysis on repeated cross-sectional data

The aim of this study is to examine the general satisfaction with primary health care services in Ukraine among service users and nonusers before and after the implementation of the capitation reform in 2017-2020. Data from a repeated cross-sectional household survey 'Health Index. Ukraine' in 2016-2020 were used. The survey had a sample size of over 10 000 participants per survey round. Effects were estimated using difference-in-differences methods based on matched samples. Our findings show that in general, respondents are 'rather satisfied' with the services of district/family doctors and pediatricians. Satisfaction with family doctors comprised 72.1 % (users) and 69.2 % (nonusers) in 2016; and 75.3 % and 71.9 % in 2020. For pediatrician services, these shares were 73.6 % (users) and 71.1 % (nonusers) in 2016; 74.7 % and 70.2 % in 2020. Our study also revealed an increase in satisfaction with the district/family doctor over time. However, this does not seem to be due to the reform. The results for pediatrician services were mixed. Why satisfaction with primary care is fairly high and slightly increasing over time is unclear. However, we offer several possible explanations, such as low expectations of primary health care, subjective perception of quality of health care services, improved access and affordability, and general improvements in primary health care settings not directly linked to the reform.