Regular readers of Asia Healthcare Blog may be aware that Benjamin Shobert is currently in Myanmar, where he is conducting a health care survey in two major cities. The survey work is part of a project that Rubicon Strategy Group is carrying out for a client with operations in Myanmar to determine how mature of a market Myanmar's health care space is for foreign capital.
The survey Benjamin is using was designed in-house based on a data bank of validated survey questions designed for deducing a variety of information about patient care preferences and patient attitudes towards health care providers. Adapting validated survey question is the standard method for designing surveys in much of epidemiological research. Because questions have been tested and validated beforehand, it is much more likely that a survey will yield useable data, and that the data collected will be useable for cross-area studies. For example, it is much more likely that a survey conducted in Myanmar will yield data that can be analyzed in relation to survey data from Hong Kong if the surveys used in both studies originated from the same validated set of questions.
Rubicon Strategy Group's Myanmar Healthcare Questionnaire was constructed using two primary sources of validated questions: a questionnaire used for the Commonwealth Fund to survey healthcare systems in developed countries used by Harris Interactive, and the Picker Patient Experience Questionnaire (PPE-15) adapted for use in Hong Kong. The PPE-15 core set is an international standard set of core questions used to measure patient experience with healthcare. We looked for a PPE-15 set that had been deployed in an Asia health care system, and we further adapted it to the needs of our survey.
Recognizing the need to both make the survey accessible to respondents and to collect as much information as possible from a country where data is scant, the survey Benjamin is employing in the field is a balanced mix of closed-ended and open-ended questions.
Closed-ended questions are ones where the choices available to respondents are defined, or "closed". A question where the respondent can only answer "yes" or "no" is a very simple closed-ended question. The sorts of closed-ended questions we employed in our study are much more complicated. For example, we have the following question:
1) Which of the following statements comes closest to expressing your overall view of the health care system in this country?
a) On the whole, the system works pretty well and only minor changes are necessary to make it work better.
b) There are some good things in our health care system, but fundamental changes are needed to make it work better.
c) Our health care system has so much wrong with it that we need to completely rebuild it.
d) Not sure.
e) Decline to answer.
You'll notice that in addition to have more than just a binary Yes/No option, we have several choices, including a "Not sure" and a "Decline to answer" response. The "Not sure" and "Decline to answer" responses are important to include because capturing the absence of an opinion and a refusal to answer is important for statistical purposes, and because it can actually help the surveyor identify possible gaps in knowledge, which can be addressed with future questions and surveys.
Open-ended questions, on the other hand, are ones where the respondent is allowed to answer in basically any way they wish. The upside of these questions is that the surveyor can capture responses she couldn't otherwise think to catch. In a country like Myanmar the open-ended question can be very powerful because so little data on health in the country exists, as Benjamin recently explained. The downside, however, is that open-ended questions can be impossible to quantify, and they make the respondent work much harder. The fact that a respondent has to work hard to answer the question, and the absence of any triggers, like in a closed-ended question (where each choice is a trigger of sorts), can result in answers that are hard to verify with much certainty. In our survey we tended to employ open-ended questions in tandem with a closed-ended question designed to capture similar information, like the following:
32) [Global rating of the quality of healthcare] Using any score from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, how many score would you give for your last inpatient care episode in the past 12 months?
33) [Open ended question to capture responses we can't think of] What are your biggest frustrations about health care in Myanmar?
Of course, a survey is useless unless it can be administered in a language understandable to the locals. Translators trained in health care research have been employed to help Benjamin carry out the survey. Here is one of the translators, with our survey in hand, administering a question.Translator administering Rubicon's survey in Myanmar
The survey will take place over two weeks. We hope to come back from Myanmar with several hundred interviews that fit certain screening criteria we've come up with. Our survey includes six basic categories that we feel touches on information where little or no information is otherwise available:
- Overall views of the health care system
- Access to health care
- Patient/Physician relationship
- Prescription and prescription brand use
- Out-of-pocket Costs and Ability to pay
- IT Access
We will share with you some of the results of this research in the months to come, to the point that we're able to do so, since a lot of the information will be proprietary. For now please follow along with Benjamin on Asia Healthcare Blog as he snakes his way through Myanmar, and follow me her on Seeking Alpha for more coverage of health care in Asia.