Determinants of healthcare satisfaction and community-proposed service improvements: A study of Phonthong District, rural Laos

Achieving Universal Health Coverage requires understanding the socio-economic and geographic factors that shape rural healthcare experiences. This study identifies the determinants of public health service satisfaction and analyzes community-proposed service improvements in the multi-ethnic Phonthong District, Lao PDR.
Methods: A convergent mixed-methods study was conducted among 377 public health service users. Quantitative data on socio-demographic and geographic variables were analyzed using multiple linear regression to identify predictors of satisfaction. Concurrently, 465 open-ended community comments were analyzed thematically to determine grassroots priorities for health sector reform. The results found that the multiple regression model explained 45.7% of the variance in satisfaction (R2 = 0.457, p < 0.001). Significant predictors included the reason for the visit (p < 0.001), health insurance status (p = 0.004), primary occupation (p = 0.007), distance to the health facility (p = 0.022), personal income (p = 0.026), and marital status (p = 0.033). Qualitatively, the community’s top priorities were accelerating service delivery and improving staff attitudes (23.87%), upgrading basic infrastructure such as water, electricity, and patient rooms (20.43%), and enhancing doctor-patient communication (10.97%). In conclusion, healthcare satisfaction in rural Laos is deeply entangled with economic fragility and geographic isolation. To improve service quality, health policies must move beyond expanding access and prioritize upgrading foundational facility infrastructure, ensuring reliable medical supplies, and cultivating a culturally competent workforce that effectively communicates with multi-ethnic populations.