Factores de insatisfacción con la asistencia sanitaria. Un estudio Delphi

OBJECTIVE: To study the causes of the disagreement between the general atmosphere of insatisfaction inherent in the assistance offered by the health care system and the favourable evaluation that the public shows in the questionnaires carried out in the field of primary health care. The less satisfactory issues of the health service offert are also identified. DESIGN: A Delphi thecnique has been used as consensus method. SETTING: Community setting: Salamanca urban area. PARTICIPANTS: The Delphi group is made up of people working in jobs with a pronounced social character: members of neighbour associations, educators, social workers, etc. Three consecutive questionnaires were distributed among fifty people. Twenty-seven of them completed the three rounds. MEASUREMENTS AND MAIN RESULTS: The score of the reasons of disagreement perceived as the most important were: the difficulties of access at a specialised level, 8.3 points; the inequality of the services offered by the two organizative models that coexist in the primary health care, 7.1; the lack of discrimination between the primary and the specialized level, 6.8. The highest scores were for the following complaints: excessive waiting lists at the second care level (8.5), delay in solving the problems (7.8) and masification at the consultancy (7.1). The most satisfactory aspects are the possibility of free choice of doctor, 7.9 points; the previous appointement system, 7.6; and a reliable relationship with the doctor, 7.3. CONCLUSIONS: To take into account these factors in the future design and interpretation of inquiries will increase their information validity and usefulness.