Patient satisfaction refers to their belief and an expression of attitude about the health care service they received. It depends on a number of components including expectations, service consumption experience, and experience-based emotional or cognitive response after consumption and choice. Hence it is a subjective evaluation of the patients' cognitive and emotional reactions resulting from the interaction between their expectations and perception of actual care received (1). Patient satisfaction has become an important indicator of the quality of care provided by health care facilities (2, 3). It is an essential component of convenient patient-centered care and plays a significant role in the health care delivery system. Dissatisfaction with healthcare services often results in a poor treatment outcome as these patients have an increased chance of missing appointments, non-adherence to treatment plans, and leaving hospitals against their advice (4). Despite this fact, it is reported that more than one-third of the patients are dissatisfied with the service they receive from different health care facilities (5).

A number of personal, socioeconomic, and facility-related factors are associated with the satisfaction of patients regarding health care delivery. Patients' characteristics like older age, higher educational and economic attainment, previous experience of hospital visit or admission, having multiple comorbidities, behavioral factors like higher expectations and negative attitude toward hospital service, and hospital-related factors like hospital size, location, environment, patient-staff ratio, communication with hospital staffs, etc. might shape the level of satisfaction of the patients (6–8).

Bangladesh, a developing country in the Southeast Asian region is well recognized for its shortage of a healthy workforce (9, 10). The quality of care provided in different health facilities is not satisfactory to the patients (11–13). The patient-centered communication behavior of the health care providers which plays the most vital role in patient satisfaction is often overlooked in this country (14). It was reported that almost one-third of the patients were dissatisfied with the healthcare service they receive especially those who attend public primary care facilities (13, 15). The quality of communication with the health care provider and the environment of the facility plays the most vital role in this regard (13). However, these scattered pieces of evidence mostly reflect the situation of the outpatient service of the health care facilities of the country as the majority of the study was conducted in outpatient settings. There is hardly any evidence regarding the satisfaction level of the patients admitted to the inpatient department of different public and private healthcare facilities in the country. Hence, the objective of this study was to investigate the level of satisfaction and its associated factors among admitted patients in tertiary care public and private hospitals in Bangladesh.

This study provided an overview of the satisfaction level with the service provided to the patients admitted to the selected tertiary care hospitals of Bangladesh. Here, almost 65% of patients were satisfied with the service they received. Moreover, patients admitted to private hospitals had a higher satisfaction level 76.5%) compared to those in government hospitals (51%). Almost 67% and 63% of the patients were satisfied with the care from physicians and hospital staff respectively and 56% were satisfied with the hospital environment.

There is little evidence on the satisfaction level of hospital-admitted patients in Bangladesh. A study conducted through outdoor patients' exit interviews reported that almost 63% of the patients were satisfied with the service provided (13). Other studies conducted in rural health facilities reported that almost 75% of patients were satisfied; however, this was also an outdoor-based study (20). Some other studies also reported average levels of patient satisfaction though these reported levels of satisfaction levels on a continuous scale which is hard to compare with the findings of this study (12, 15). However, one of these studies reported a similar satisfaction score in both private and public hospitals in contrast to our findings (12). A study from neighboring India reported a higher level of satisfaction with an overall satisfaction rate of almost 93% (21). However, this study was conducted in patients admitted to a private nursing home, where the quality of service might be better compared to the public hospitals. Satisfaction levels in different government hospitals ranged from 60 to 77% which is comparable to our findings (22, 23). A similar level of patient satisfaction was reported in other developing countries like Nepal (24), Pakistan (25), China (26), Fiji (6), Nigeria (18) and Ethiopia (4), etc.

We found treatment cost was a significant predictor of patients' satisfaction in both public and private facilities. Higher health care cost was identified as a predictor of patients' dissatisfaction in several studies before (27–30). However, it is a vicious cycle. It was reported that patient satisfaction often results from increased health care expenditure, increased hospital admission, and increased number of drugs in prescription (27). One possible cause of being high treatment costs associated with patients' dissatisfaction might be the lack of insurance coverage for health expenditure in Bangladesh (31). Health insurance coverage is found to have a positive impact on overall patient satisfaction levels as it minimizes the patients' concerns about healthcare costs and increases positive perceptions of the care providers (26, 30). However, despite higher healthcare costs, patients admitted to private hospitals reported a higher rate of satisfaction compared to public hospitals. A higher level of satisfaction was also reported in patients from private hospitals in other studies from both Bangladesh and other countries (11, 21, 24, 25). Studies reported that service quality, the environment of health care facilities, and responsiveness of care providers like physicians and nurses play a significant role in shaping patients' perception of the facility and their overall satisfaction (25–27). Private hospitals often attempt to provide a better experience to their patients considering the competitive marketplace. On the other hand, public hospitals have the responsibility to ensure health care for the mass population and remain burdened with an overwhelming number of patients and a limited number of care providers which constrains their ability to provide quality care for every patient. For example, in our study, almost 23% of patients in public hospitals were treated on the floor and it was associated with a high level of dissatisfaction. Hence, satisfaction level often falls among the patients in these hospitals.

Patients' treatment modality often affects their satisfaction level. In our study, patients receiving conservative management had a higher satisfaction rate compared to those who received surgical management. A similar finding was reported in a number of previous studies (16, 32, 33). However, it is an ambiguous phenomenon. Surgical management also reported a higher satisfaction rate in some cases (34). Treatment outcome has an influence in this regard. Patients with better treatment outcome and shorter hospital stay often report a higher satisfaction level as found in our study, as well as in previous ones (5, 27). Besides these hospitals and treatment-related factors, patients' sociodemographic characteristics are also associated with satisfaction levels. Older patients with previous experience of hospital visits as patients from lower socioeconomic conditions often reported a higher rate of satisfaction (4, 13, 16, 24). However, patients' education level showed an ambiguous relationship with satisfaction. Educated patients often have a high expectation level from the health care facilities which decreases their satisfaction level with the service they are provided. In contrast, these patients sometimes reported higher satisfaction levels considering the limitations of the hospitals, especially in public settings (5, 13, 16).

This study has several limitations. First of all, the satisfaction level is a perceived idea of the patients which is crafted through the interaction of their expectations, attitudes, and quality of service they receive. Hence, a qualitative exploration could provide a better picture of the influencing factors of their satisfaction level. Moreover, there might be some confounding variables that we did not include in the data collection tool that could have an effect on patient satisfaction, including patients' detailed sociodemographic characteristics, patients' overall disease profile, clinical presentation, and time of hospital admission. Moreover, the question used for patient-reported outcomes in our study was not validated. Finally, the study only included tertiary care hospitals; hence, findings might not be generalizable to all levels of health care facilities in the country.

In summary, almost two-thirds of the patients admitted to tertiary care hospitals were satisfied with the inpatient service they received with a higher satisfaction rate in private hospitals. The lowest satisfaction level was found in the case of the hospital environment and patients' family care. Lower treatment cost, shorter hospital stay, conservative management, and perceived improvement after treatment were associated with the satisfaction level of the patients. More patient-centered care at the lowest possible cost, as well as improvement of the hospital environment, might increase the satisfaction level of the patients.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by Ethical Review Board of University of Rajshahi. The patients/participants provided their written informed consent to participate in this study.

FB: conceptualization, study design, writing-original draft preparation, data collection, methodology, and formal analysis. JS, SH, and MA: editing, supervision, and reviewing. All authors have read and agreed to the published version of the approved manuscript.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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