Social Control as a Catalyst for Perceived Quality in Public Health: An Empirical Study in Bolivia
Abstract
In the Bolivian context, marked by the ineffectiveness of traditional control mechanisms in the social security system, this study examines the impact of social control as an innovative approach. The research focuses on an empirical analysis conducted in 2010 at Hospital Materno Infantil of Caja Nacional de Salud in La Paz, Bolivia, to determine whether this strategy had improved the quality of care perceived by outpatients since its implementation in 2004. The study used a non-experimental, cross-sectional design with retrospective assessment of perceived change and a mixed-methods approach integrating a quantitative phase—a survey of 57 insured patients affiliated with Caja Nacional de Salud and treated at Hospital Materno Infantil before 2004—and a qualitative phase—a two-session interview with one representative of the mechanism. The study tested the hypothesis that perceived quality had improved significantly since 2004. Perceived quality was modeled in two components—medical and non-medical/administrative—each comprising its respective dimensions, with the models of Avedis Donabedian (1987) and Parasuraman et al. (1985) serving as the principal conceptual references. This approach and the definition of healthcare-quality dimensions align with the recommendations of the Council of Europe for Quality of Care (1997). The evaluation measured and weighted these dimensions and contrasted the results with a control question. Quantitative results showed notable and statistically significant improvements in dimensions such as personal treatment, equity, and respect. However, perceived efficiency and adequacy deteriorated, attributed to system overload. The difference between the negative weighted sum of the dimensions and the positive control-question result reinforces existing literature describing service quality as a subjective and prioritized construct in which users do not value all attributes equally. The qualitative interview contextualized the observed patterns and related them to the activities of the Social Control Mechanism at the hospital. The mechanism can contribute to quality improvement in complex environments by acting as a communication bridge and catalyst for co-responsibility, promoting timely information, feedback, and consensual solutions.