Evaluation of primary health care reform in Estonia from patients' perspective: acceptability and satisfaction.

AIM To analyze the population's view of the primary health care reform five years after the formal implementation of the reform investigating the acceptability of the primary health care system, patients' preferences, and satisfaction with their family doctors. METHODS Face-to-face interviews using structured questionnaires were preformed with a random sample of the Estonian residents aged 15-74 years (n=999). RESULTS Out of 999 respondents, 35% prefer to first see their family doctor and if necessary to get a referral or a recommendation to see a specialist. The referral to the specialist by the family doctor is more preferred by older respondents, rural people, by the respondents with a lower level of education and income as well as by people who were more satisfied with their family doctor. The people who were more satisfied with their family doctor found that the whole health care system was functioning better than the previous primary health care system. Out of all the respondents who have had a contact with their family doctor during the last 12 months 87% (n=585) were satisfied with his work. The overall satisfaction with the family doctor depended on 1) perceived competence of the physician (OR=0.624, 95% confidence interval (CI)=0.419-0.933); 2) understanding the patient's problem (OR=0.699, 95%CI=0.496-0.984); 3) punctuality of the physician (OR=1.533, 95%CI=1.075-2.186); and 4) the location of the primary health care center/clinic (OR=0.751, 95%CI=0.574-0.983). CONCLUSION During the five-year-period most of the Estonian population has accepted the new primary health care system and the satisfaction rate has increased. Family doctors are in the center of the primary health care systems and their professional competence plays a great role in making the system acceptable for the patients.