Bypassing Primary Care in Sri Lanka: A Comparative Study on Reasons and Satisfaction

Abstract

The absence of well demarcated draining areas and lack of clear referral policies have allowed patients in rural Sri Lanka to bypass primary care facilities. This study explored the reasons for bypassing and patient satisfaction of bypassed versus others patients. This was a cross sectional study in a referral and two miner hospitals using an interviewer administered questionnaire. Patients bypassed were mostly married, permanently employed and had a higher monthly income. The most common reason for bypassing was perception of availability of better facilities in the major hospital. Patients by-passed were significantly more satisfied with the cleanliness, seating arrangements and availability of medicine. Patients who did not bypass were significantly more satisfied on accessibility, kindness of health workers and information received. Patients with better social support and stable income tend to bypass the closest facility more often. Improvement of basic facilities at miner hospital and referral policies could reverse the bypassing phenomenon.