Exploring Disparities in Satisfaction with Obstetric-Gynecological Care Among Insured and Uninsured Women in Almaty, Kazakhstan: A Comparative Cross-Sectional Study

Sholpan Aliyeva^1,2Vyacheslav Lokshin³Maksut Kamaliev⁴Sholpan Sarmuldayeva⁵Gani Kaldybayev⁶Oxana Tsigengagel^7*

• ¹Department of Clinical Disciplines, Kazakhstan’s Medical University “Kazakhstan School of Public Health,”, Almaty, Kazakhstan
• ²Department of Gynecological, JSC Central Clinical Hospital,, Almaty, Kazakhstan
• ³Department of Assisted Reproductive Technologies, International Clinical Centre of Reproduction “PERSONA,”, Almaty, Kazakhstan
• ⁴Department of Health Management, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty, Kazakhstan
• ⁵Department of Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
• ⁶Birth Center, Karasay Clinical Multidisciplinary Central District Hospital, Karasay, Kazakhstan
• ⁷Department of Biostatistics, Bioinformatics, and Information Technologies, Astana Medical University, Astana, Kazakhstan

Abstract BackgroundPatient satisfaction is a key indicator of healthcare quality. Although crucial, limited research has explored factors contributing to satisfaction disparities in outpatient obstetric-gynecological care, particularly in Kazakhstan. The objective of the study is to explore disparities in satisfaction with obstetric-gynecological care between insured and uninsured women in Almaty, Kazakhstan, and to identify the key determinants of patient satisfaction.MethodsA cross-sectional survey was conducted among 107 insured and uninsured patients over three months in early 2024 at a hospital in the Almaty region, Kazakhstan. Using a five-point Likert scale, a structured questionnaire assessed socio-demographics, patient-reported experiences with the care process, and overall satisfaction across 16 dimensions. The survey instrument was pilot-tested and demonstrated strong internal consistency (Cronbach’s alpha = 0.83). Chi-square tests examined associations, and multivariable logistic regression identified key predictors of patient satisfaction.ResultsA multivariable analysis revealed a "satisfaction paradox": insured patients had lower odds of being satisfied compared to uninsured patients (AOR = 0.15, 95% CI: 0.03–0.81). Specifically, a lack of insurance was associated with higher reported satisfaction in doctor-patient communication (OR = 1.8) and nursing care (OR = 2.1). Other significant predictors of satisfaction included having kidney disease and a shorter hospital stay.ConclusionsOur findings suggest that expanding insurance coverage is necessary for access but insufficient for ensuring patient satisfaction. The observed "satisfaction paradox" highlights that policy must adopt a dual focus: promoting enrolment while simultaneously improving the quality of patient-provider interactions to meet the higher expectations of insured patients.Keywords: Health insurance; patient satisfaction; socioeconomic factors; outpatients, health equity; healthcare disparities; obstetrics and gynecology; Kazakhstan.