Determinants of Multidimensional Patient Wellbeing in Private Healthcare Institutions: Evidence From Azerbaijan

Determinants of Multidimensional Patient Wellbeing in Private Healthcare Institutions: Evidence From Azerbaijan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of Multidimensional Patient Wellbeing in Private Healthcare Institutions: Evidence From Azerbaijan Musa Alakbarov, Yaqut Hajiyeva, Nargiz Hajiyeva, Kamran Babaev, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8730678/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Patient wellbeing is increasingly recognised as a key outcome of health system performance, extending beyond traditional indicators of patient satisfaction and clinical effectiveness.In health systems with expanding private sectors, understanding how service delivery processes and institutional factors shape patient wellbeing is particularly important. However, empirical evidence from middle-income countries remains limited. This study aimed to assess multidimensional patient wellbeing in private healthcare institutions in Azerbaijan and to identify its key determinants. Methods A cross-sectional survey was conducted among 300 adult patients receiving care in private healthcare institutions in Azerbaijan. A structured questionnaire measured six wellbeing-related domains: emotional, relational, experiential, financial, informational, and institutional wellbeing, using a five-point Likert scale. An Overall Wellbeing Index (OWI) was constructed by aggregating domain scores. Descriptive statistics, subgroup analyses, Pearson correlation analysis, and multiple linear regression were used to examine determinants of patient wellbeing. Results Overall patient wellbeing was high (OWI = 4.09 on a 5-point scale). Relational and emotional wellbeing demonstrated the strongest performance, highlighting the importance of trust, empathy, and communication quality in private healthcare settings. In contrast, financial and institutional wellbeing scored comparatively lower, reflecting concerns related to pricing transparency, administrative coordination, and service consistency. Regression analysis identified service quality, communication, timeliness of care, and pricing transparency as the strongest predictors of overall wellbeing. Subgroup analyses revealed significantly higher wellbeing among urban residents, individuals with higher socioeconomic status, and patients covered by the Mandatory Health Insurance system. Conclusions Private healthcare institutions in Azerbaijan perform strongly in interpersonal and experiential aspects of care but face persistent system-level challenges related to administrative efficiency, digital readiness, and financial transparency. Strengthening service organisation, pricing transparency, and digital integration may substantially enhance multidimensional patient wellbeing and reduce socioeconomic and geographic disparities. These findings provide policy-relevant evidence for improving patient-centred performance in mixed public–private healthcare systems Patient wellbeing health services research private healthcare patient experience service quality 1. Background: Patient wellbeing has increasingly emerged as a central outcome of healthcare system performance, extending beyond traditional indicators of patient satisfaction and clinical effectiveness. Contemporary wellbeing frameworks promoted by the World Health Organization and the Organisation for Economic Co-operation and Development emphasize the multidimensional nature of wellbeing, encompassing emotional, relational, experiential, financial, informational, and institutional dimensions. In healthcare settings, subjective wellbeing is closely linked to perceptions of trust, service responsiveness, communication quality, and financial security. Despite growing international evidence, empirical research examining multidimensional patient wellbeing in private healthcare systems—particularly in middle-income and transitional contexts—remains limited. Over the past two decades, wellbeing has emerged as a central concept in health policy, public health research, and healthcare performance evaluation. Moving beyond traditional indicators such as mortality, morbidity, and patient satisfaction, contemporary frameworks conceptualize wellbeing as a multidimensional construct encompassing emotional, relational, experiential, and institutional dimensions of individuals’ interactions with health systems (Dodge et al., 2012; VanderWeele, 2017). This shift reflects growing recognition that healthcare systems should be evaluated not only by clinical outcomes, but also by how effectively they support patients’ lived experiences, psychological security, trust, and sense of agency. Patient wellbeing is closely linked to patient experience, quality of care, and system performance. A substantial body of international evidence demonstrates that positive patient experiences are associated with improved adherence, better clinical outcomes, enhanced safety, and greater trust in healthcare institutions (Doyle et al., 2013; Manary et al., 2013; Figueroa et al., 2018). Interpersonal communication, empathy, and respectful treatment have consistently been identified as among the most powerful determinants of wellbeing across diverse healthcare settings (Al-Abri & Al-Balushi, 2014; Anhang Price et al., 2014). Consequently, patient wellbeing has become a key outcome within people-centred care models promoted by the World Health Organization and the Organisation for Economic Co-operation and Development (WHO, 2022; OECD, 2023a). Global wellbeing assessments further suggest that subjective wellbeing in healthcare settings is closely linked to perceptions of trust, service responsiveness, and financial security, underscoring the relevance of multidimensional wellbeing frameworks in health system evaluation (Gallup, 2023). At the system level, wellbeing is increasingly understood as a product of both service delivery processes and broader institutional arrangements. Administrative efficiency, pricing transparency, digital integration, and financial protection mechanisms all shape patients’ perceptions of fairness, predictability, and security when accessing healthcare services (Donabedian, 1988; Bleich et al., 2019). In mixed public–private health systems, these factors become particularly salient, as patients often navigate fragmented financing arrangements, variable governance structures, and heterogeneous service standards. The private healthcare sector plays an expanding role in many upper-middle-income and transitional economies. In countries across Eastern Europe, the Caucasus, and Central Asia, private providers increasingly supply outpatient care, diagnostics, and specialized services, often complementing public systems characterized by resource constraints and capacity limitations (OECD & European Observatory, 2020; World Bank, 2023). While private healthcare is frequently associated with shorter waiting times, better infrastructure, and stronger interpersonal care, concerns persist regarding cost predictability, equity, and regulatory oversight. Azerbaijan represents a particularly relevant context for examining patient wellbeing in private healthcare. The country has undergone significant health system reforms, including the gradual expansion of the MHI system and increased engagement of private providers within a mixed financing model. Private medical institutions have become prominent providers of diagnostic, consultative, and specialized services, especially in urban areas. However, empirical evidence on how patients experience and evaluate wellbeing within Azerbaijan’s private healthcare sector remains limited. Existing studies in Azerbaijan and comparable settings have largely focused on patient satisfaction or service utilization, offering only a partial understanding of patient experience. Satisfaction-based approaches, while informative, do not fully capture the multidimensional nature of wellbeing, nor do they adequately reflect emotional security, institutional trust, financial predictability, and informational clarity (Dodge et al., 2012; VanderWeele et al., 2019). As a result, there is a clear need for research that adopts a broader wellbeing framework and systematically examines how different dimensions interact within private healthcare environments. International evidence suggests that wellbeing profiles in private healthcare settings are shaped by both individual and structural factors. Socioeconomic status, geographic location, and insurance coverage have been shown to influence access, affordability, and perceived quality of care (Kollamparambil, 2020; OECD, 2023b). Urban–rural disparities, in particular, remain a persistent challenge in transitional health systems, where advanced infrastructure and digital health tools are often concentrated in metropolitan areas (World Health Organization Regional Office for Europe, 2023). Understanding how these determinants operate within Azerbaijan’s private healthcare sector is essential for informing equitable and patient-centred policy interventions. Against this background, the present study aims to provide a comprehensive assessment of patient wellbeing in private healthcare institutions in Azerbaijan using a multidimensional framework. By examining emotional, relational, experiential, financial, informational, and institutional domains of wellbeing and integrating them into an Overall Wellbeing Index (OWI), the study seeks to move beyond narrow satisfaction metrics and offer a holistic evaluation of patient experience. In doing so, it contributes to the growing international literature on wellbeing-oriented health system assessment and provides evidence to support more transparent, efficient, and equitable healthcare delivery in mixed public–private systems. 2. Materials and Methods A cross-sectional quantitative study was conducted to assess multidimensional patient wellbeing among users of private healthcare services in Azerbaijan. The study focused exclusively on private medical institutions providing outpatient, diagnostic, and specialized services within a mixed public–private healthcare system. Data collection was carried out between January–December 2025 across multiple private healthcare facilities located in both urban and regional settings. The cross-sectional design was selected to capture patient-reported wellbeing at a single point in time and to examine associations between wellbeing dimensions, service-related characteristics, and socioeconomic factors. 2.1Study Population and Sampling The study population consisted of adult patients (≥ 18 years) who had received medical services in private healthcare institutions in Azerbaijan within the previous 12 months. Inclusion criteria were: (1) age 18 years or older; (2) direct experience with private healthcare services; and (3) ability to provide informed consent and complete the questionnaire independently. Patients receiving exclusively emergency care or those unable to provide informed consent were excluded. A total of 300 respondents were included in the final analysis. This sample size is consistent with prior patient-reported outcome and wellbeing studies and provides sufficient statistical power for descriptive analysis, subgroup comparisons, and multivariate regression modelling involving multiple wellbeing domains. Participants were recruited using a non-probability, facility-based sampling approach designed to capture heterogeneity in patient experiences across different private healthcare settings. Data collection targeted both urban (including Baku) and regional locations, as well as patients with varying socioeconomic status and insurance coverage, in order to enhance diversity within the sample. 2.2Data Collection Instrument Data were collected using a structured, self-administered questionnaire developed for this study based on established wellbeing and patient experience frameworks. The instrument was designed within a structured sociological research program and subsequently adapted to assess multidimensional patient wellbeing in private healthcare institutions. The questionnaire comprised four sections: Sociodemographic characteristics Healthcare utilization patterns Multidimensional wellbeing domains Overall service evaluation All wellbeing-related items were measured using a standardized five-point Likert scale ranging from 1 (“very poor/strongly disagree”) to 5 (“very good/strongly agree”). The English-language version of the questionnaire is provided as Supplementary File 1 . 2.3Wellbeing Framework and Measures Patient wellbeing was conceptualized as a multidimensional construct encompassing six interrelated domains reflecting key service delivery and patient experience dimensions: waiting times; communication quality; facility environment; diagnostic accuracy; treatment effectiveness; pricing transparency. Questionnaire items were grouped into these six analytical domains based on conceptual similarity and healthcare service delivery frameworks. Domain scores were calculated as the arithmetic mean of item responses within each domain, with higher scores indicating higher perceived wellbeing. An Overall Wellbeing Index (OWI) was constructed to provide an integrated measure of patient wellbeing. The OWI was calculated as the mean of the six domain scores, yielding a composite index ranging from 1 to 5. This composite approach enabled multidimensional assessment while preserving interpretability across population subgroups 2.4Statistical Analysis Statistical analysis was performed using SPSS version 25.0. Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarize sociodemographic characteristics, healthcare utilization patterns, and wellbeing domain scores. Bivariate analyses were conducted to examine differences in wellbeing across key subgroups, including place of residence (urban vs. regional), socioeconomic status, and insurance coverage. Pearson correlation coefficients were calculated to assess associations between wellbeing domains and the Overall Wellbeing Index. To identify independent predictors of overall wellbeing, multiple linear regression analysis was performed. The Overall Wellbeing Index served as the dependent variable, while service-related characteristics (service quality, communication, timeliness of care, and pricing transparency) and demographic variables were included as independent predictors. Statistical significance was set at p < 0.05. 2.5Ethical Considerations Participation was voluntary, and all respondents provided informed consent prior to inclusion in the study. Data were collected anonymously, and no personally identifiable information was recorded. The study protocol was reviewed by the Ethics Committee of Azerbaijan Medical University. As the research involved an anonymous sociological survey and did not include identifiable personal or clinical data, formal ethical approval and protocol number were not required. In addition, the research program was approved at the meeting of the Department of Public Health and Healthcare Organization (Protocol № 6, January 8, 2026). 3. Results 3.1. Demographic Profile of Respondents A total of 300 adults participated in the wellbeing survey examining patient experiences in private healthcare institutions in Azerbaijan. The sample reflected a balanced and diverse demographic structure, consistent with patterns typically observed in upper–middle-income countries, where private healthcare services are predominantly utilized by urban, middle-income, and well-educated populations. Overall, 56.3% of respondents were women (n = 169) and 43.7% were men (n = 131), indicating a slightly higher utilization of private healthcare services among female patients (Table 1 ). Table 1 Distribution of respondents by gender and self-reported health status (n = 300) Health Status Men (n; %) Women (n; %) Total (n; %) Healthy 51 (38.9%) 60 (35.5%) 111 (37.0%) Practically healthy 31 (23.7%) 63 (37.3%) 94 (31.3%) Ill (acute/chronic) 49 (37.4%) 46 (27.2%) 95 (31.7%) Total 131 (43.7%) 169 (56.3%) 300 (100%) The mean age of respondents was 38.6 ± 12.4 years, with the majority (61.7%) falling within the 25–45-year age range—an age group internationally associated with greater reliance on private healthcare services due to employment-related insurance coverage, time-sensitive care needs, and a preference for faster appointment scheduling. A substantial proportion of respondents (24.7%) were aged 50–59 years, exceeding the younger 18–29-year cohort (20.3%). Women represented a slightly higher share of the 50–59 age group (26.0% compared with 23.0% among men), although this difference was not statistically significant ( t = 0.6, p > 0.05). Educational attainment was notably high: 74.3% of respondents reported having completed higher education, while 25.7% reported secondary or vocational education (Table 2 ). Table 2 Socioeconomic, educational, and age characteristics of respondents (n = 300) Characteristic Category n % Education Higher 223 74.3 Secondary/Vocational 77 25.7 Socioeconomic High 49 16.3 status Medium 188 62.7 Low 63 21.0 Residence Urban 192 64.0 Rural 108 36.0 Age Group 18–29 61 20.3 30–39 37 12.3 40–49 52 17.3 50–59 74 24.7 60–69 54 18.0 ≥ 70 22 7.3 This distribution aligns with global evidence demonstrating that private healthcare services are more frequently utilized by individuals with higher educational attainment and greater awareness of service quality (OECD, 2023a). Socioeconomic status was self-reported as medium by 62.7% of respondents, low by 21.0%, and high by 16.3%. With respect to geographic distribution, 64.0% of participants resided in urban areas—primarily Baku—while 36.0% lived in rural regions. This urban predominance reflects the concentration of private healthcare infrastructure, digital appointment systems, and specialized medical services in metropolitan centers. Overall, the demographic profile of the sample closely aligns with patterns reported in analyses of the WHO European Region and OECD healthcare utilization studies, which consistently highlight the predominance of well-educated, middle-income, and urban populations among users of private healthcare services. This alignment enhances the generalizability of the study’s findings and provides a solid foundation for interpreting wellbeing outcomes across different population subgroups. 3.2. Healthcare Utilization Patterns Overall, private healthcare services (72.0%) were most frequently used for specialist consultations and 48.3% - diagnostic or laboratory services (Table 3 .). Table 3 Healthcare utilization patterns among respondents (n = 300) Type of Service n % Specialist consultation 216 72.0 Diagnostic/laboratory services 145 48.3 Acute illness treatment 95 31.7 Chronic disease management 55 18.3 Routine check-up/screening 126 42.0 Emergency care 19 6.3 Note: Percentages exceed 100% because multiple responses were allowed. Preventive check-ups and screening services were also commonly reported (42.0%). A smaller proportion of respondents reported seeking private care for acute conditions (31.7%) and for the ongoing management of chronic diseases (18.3%). Utilization of private healthcare for emergency services was relatively limited (6.3%). In terms of payment modality, most respondents reported using out-of-pocket payment when accessing private healthcare services (58.7%), while 41.3% received services covered under the Mandatory Health Insurance (MHI) system. This distribution reflects the dual financing structure of private healthcare in Azerbaijan, where insured and uninsured service pathways coexist. Overall, these utilization patterns indicate that private healthcare institutions in Azerbaijan are primarily used for specialist consultations, diagnostics, and preventive services, with a substantial share of patients relying on direct out-of-pocket payments alongside expanding MHI coverage. 3.3. Wellbeing Dimension Scores The assessment of patient wellbeing across six core dimensions—emotional, relational, experiential, informational, institutional, and financial wellbeing—revealed a differentiated profile among users of private healthcare services in Azerbaijan. Overall wellbeing levels ranged from moderate to high across domains, with notable variation reflecting differences in patients’ emotional experiences, interpersonal interactions, service processes, and financial perceptions. Emotional wellbeing demonstrated a relatively high mean score of 4.18 ± 0.66, indicating that most respondents reported positive emotional experiences and reduced anxiety during their interactions with private healthcare institutions (Table 4 ). Relational wellbeing recorded the highest score among all dimensions (4.26 ± 0.63), reflecting patients’ evaluations of interpersonal communication, empathy, trust, and perceived professional competence of clinicians. Indicators related to professional competence and respectful communication were rated positively by the majority of respondents. Experiential wellbeing , encompassing waiting times, physical comfort, cleanliness, and the overall service environment, demonstrated a mean score of 4.11 ± 0.69. A substantial proportion of respondents reported short waiting times and positive assessments of facility hygiene and physical conditions. Table 4 Ranking of patient wellbeing dimensions among private healthcare users (n = 300) Wellbeing Dimension Mean SD Descriptive interpretation Emotional Wellbeing 4.18 0.66 High (positive emotional experience, reduced anxiety) Relational Wellbeing 4.26 0.63 High (strong interaction with clinicians, trust) Experiential Wellbeing 4.11 0.69 High-moderate (comfort, waiting time, environment) Informational Wellbeing 4.02 0.72 Moderate-high (clarity of explanations, guidance) Institutional Wellbeing 3.88 0.71 Moderate (management, system trust, consistency) Financial Wellbeing 3.56 0.86 Low-moderate (pricing clarity, perceived fairness) Informational wellbeing , reflecting the clarity of explanations, quality of guidance, and communication during the care process, showed a mean score of 4.02 ± 0.72. While most respondents reported satisfaction with clinical explanations, some variability was observed in perceptions of administrative communication. Institutional wellbeing , associated with organizational transparency, efficiency, managerial consistency, and trust in healthcare institutions, yielded a moderate mean score of 3.88 ± 0.71. Respondents generally evaluated clinical infrastructure positively, while administrative coordination and feedback mechanisms showed more variability. Financial wellbeing emerged as the lowest-scoring dimension (3.56 ± 0.86). A proportion of respondents reported concerns related to pricing transparency and the predictability of costs, including unexpected additional charges and unclear package pricing. Collectively, the results demonstrate that relational, emotional, and experiential wellbeing domains received higher evaluations, while institutional and financial dimensions were rated comparatively lower, highlighting heterogeneity in patient-reported wellbeing across different aspects of private healthcare services. 3.4. Regression Analysis of Determinants of Overall Wellbeing A multiple linear regression analysis was conducted to identify the key determinants of subjective patient wellbeing among users of private healthcare services in Azerbaijan. The OWI—constructed exclusively from six subjective wellbeing dimensions (emotional, relational, experiential, financial, informational, and institutional wellbeing)—served as the dependent variable. The regression model included a set of service-related and system-level explanatory variables, namely service quality, communication quality, timeliness of care, treatment effectiveness, facility environment, and pricing transparency, alongside selected sociodemographic characteristics (age, gender, education level, and socioeconomic status). These variables were conceptualized as determinants shaping patient wellbeing, rather than as components of the wellbeing construct itself. The final model demonstrated strong explanatory power, accounting for 62.4% of the variance in overall wellbeing scores (Adjusted R² = 0.624, p < 0.001). Four service-related factors—service quality, communication quality, timeliness of care, and pricing transparency—emerged as statistically significant predictors of the OWI (Table 5 ). Table 5 Multiple linear regression analysis of determinants of overall wellbeing Predictor β coefficient SE t-value p-value Signifi-cance Service quality 0.354 0.047 7.51 < 0.001 ** Communication 0.281 0.052 5.41 < 0.001 ** Timeliness 0.229 0.049 4.67 < 0.001 ** Pricing transparency 0.163 0.044 3.70 < 0.001 ** Treatment effectiveness 0.097 0.051 1.89 0.059 (ns) Facility environment 0.083 0.048 1.72 0.086 (ns) Age –0.031 0.015 2.01 0.045 * Gender 0.028 0.042 0.66 0.510 ns Education level 0.041 0.039 1.05 0.294 ns Socioeconomic status 0.056 0.044 1.27 0.207 ns ** p < 0.001; * p < 0.05; ns = not significant Service quality was the strongest determinant of wellbeing (β = 0.354, p < 0.001), indicating that perceptions of clinical competence, diagnostic accuracy, and professional conduct exert a substantial influence on patients’ emotional security, relational trust, and institutional confidence. This finding underscores the central role of perceived clinical excellence in shaping subjective wellbeing outcomes. Communication quality was also a highly significant predictor (β = 0.281, p < 0.001). Patients who reported clearer explanations, respectful interactions, and meaningful engagement with healthcare professionals demonstrated higher levels of emotional and relational wellbeing, which translated into higher overall wellbeing scores. Timeliness of care showed a strong positive association with wellbeing (β = 0.229, p < 0.001). Shorter waiting times, efficient appointment scheduling, and smooth service flow significantly enhanced experiential and emotional wellbeing, reinforcing the importance of responsiveness in private healthcare settings. Pricing transparency exerted a significant independent effect on wellbeing (β = 0.163, p < 0.001). Respondents who perceived healthcare costs as predictable and clearly communicated reported higher levels of financial wellbeing and institutional trust, highlighting the role of transparent pricing as a key determinant of subjective wellbeing rather than as a wellbeing component. By contrast, treatment effectiveness (β = 0.097, p = 0.059) and facility environment (β = 0.083, p = 0.086) did not retain statistical significance after controlling for other service-related factors. Although both variables contribute indirectly to experiential and cognitive aspects of wellbeing, their independent effects appear to be mediated through stronger determinants such as service quality and communication. Among sociodemographic variables, age exhibited a small but statistically significant negative association with wellbeing (β = − 0.031, p = 0.045), suggesting slightly lower wellbeing perceptions among older respondents. Gender, education level, and socioeconomic status were not significant predictors in the multivariate model, indicating that differences in wellbeing were driven primarily by service characteristics rather than by demographic attributes. Overall, the regression analysis confirms that subjective patient wellbeing in private healthcare settings is predominantly shaped by service quality, interpersonal communication, system responsiveness, and financial transparency. By clearly distinguishing determinants of wellbeing from the wellbeing construct itself, the model provides a methodologically robust and conceptually coherent explanation of wellbeing formation, fully aligned with the OWI framework employed in this study. 3.5. Comparative Perceptions of Private and Public Healthcare Respondents were asked to compare their experiences in private medical institutions (PMIs) and public healthcare facilities across six wellbeing-relevant domains: waiting times, communication quality, facility environment, diagnostic capacity, treatment effectiveness, and pricing transparency. Overall, 78.3% of respondents reported that private healthcare services were superior to public services across the assessed domains. In contrast, 9.0% perceived public healthcare services as superior, while 12.7% reported no substantial difference between the two sectors (Table 6 ). Table 6 Comparison of private and public healthcare services across wellbeing-related domains Domain Private better (%) Public better (%) No difference (%) Waiting times 84.0 6.0 10.0 Communication quality 79.7 7.3 13.0 Facility environment 88.3 4.7 7.0 Diagnostic capacity 74.3 10.3 15.4 Treatment effectiveness 58.0 18.0 24.0 Pricing transparency 42.0 27.3 30.7 Across all domains, waiting times showed the most pronounced difference, with 84.0% of respondents indicating that private healthcare facilities provided faster and more responsive care. A substantial majority of respondents also rated private institutions as superior in terms of facility environment (88.3%) and communication quality (79.7%). Differences were less pronounced for treatment effectiveness, where 58.0% of respondents perceived private institutions as superior, 18.0% favored public facilities, and 24.0% reported no difference. Pricing transparency demonstrated the smallest gap between sectors, with 42.0% favoring private facilities and 27.3% favoring public institutions (Table 7 ). Table 7 Subgroup comparison of perceptions of private versus public healthcare services Domain Private better – Urban (%) Private better – Rural (%) χ² / p-value Waiting times 88.1 77.4 P = 0.012 Communication quality 82.5 74.0 P = 0.041 Facility environment 91.3 82.4 P = 0.018 Diagnostic accuracy 78.6 68.5 P = 0.027 Treatment effectiveness 61.9 52.8 P = 0.064 Pricing transparency 45.8 35.2 P = 0.033 Note: Percentages represent respondents indicating that private healthcare services perform better than public services within each domain. p-values are based on χ² tests. 3.6. Overall Wellbeing Index (OWI) An OWI was constructed to provide an integrated measure of respondents’ subjective patient wellbeing in private healthcare settings. In line with international wellbeing frameworks and to avoid conceptual overlap between outcomes and service determinants, the index was based exclusively on subjective wellbeing domains, rather than on specific service characteristics. Accordingly, the OWI aggregated six core dimensions of patient wellbeing: emotional wellbeing, relational wellbeing, experiential wellbeing, financial wellbeing, informational wellbeing, and institutional wellbeing. Each dimension was measured using multiple questionnaire items rated on a five-point Likert scale (1 = very low to 5 = very high). Dimension scores were calculated as the mean of their respective items. The Overall Wellbeing Index was operationalized as the arithmetic mean of the six wellbeing dimensions and calculated using the following formula: \(\:\) \(\:\text{O}\text{W}\text{I}=\frac{1}{6}\sum\:_{i=1}^{6}{\text{W}}_{\mathfrak{i}}\) where \(\:{\text{W}}_{\mathfrak{i}}\) - represents the mean score of each wellbeing dimension (range: 1–5), and 6 represents the total number of wellbeing dimensions included in the index. Across the full sample (N = 300), the resulting OWI score was 4.09 on the 1–5 scale, indicating a generally high level of subjective wellbeing among users of private healthcare services in Azerbaijan. Mean values of the individual wellbeing dimensions ranged from 3.88 (institutional wellbeing) to 4.26 (relational wellbeing), reflecting strong interpersonal experiences alongside comparatively weaker perceptions of organizational and systemic performance. Importantly, service-related characteristics such as service quality, timeliness, treatment effectiveness, facility environment, and pricing transparency were analyzed separately as determinants of wellbeing and were therefore excluded from the OWI construction to prevent circularity between predictors and outcomes. 3.7. Correlation Analysis of Wellbeing Dimensions A correlation analysis was conducted to examine associations between key service-related dimensions of private healthcare and overall wellbeing. Pearson correlation coefficients were calculated for six domains—service quality, communication, timeliness, facility environment, treatment effectiveness, and pricing transparency—and the OWİ. The strongest correlations with overall wellbeing were observed for service quality (r = 0.72, p < 0.001), communication (r = 0.68, p < 0.001), and timeliness (r = 0.61, p < 0.001). Treatment effectiveness (r = 0.59, p < 0.001) and facility environment (r = 0.54, p < 0.001) showed moderate positive correlations with overall wellbeing. Pricing transparency exhibited the weakest, though still statistically significant, correlation with overall wellbeing (r = 0.46, p < 0.001). Pairwise correlations among the service-related domains indicated moderate to strong associations, reflecting interrelationships between clinical, interpersonal, experiential, and financial aspects of care. All correlation coefficients were positive and statistically significant (Table 8 ). Table 8 Correlation matrix of wellbeing domains and the Overall Wellbeing Index (OWI) Variable Overall Service Quality Commu nication Timeli ness Envi ronment Pricing Effecti veness Overall 1 0.72 0.68 0.61 0.54 0.46 0.59 Service Quality 0.72 1 0.63 0.57 0.48 0.39 0.55 Communication 0.68 0.63 1 0.52 0.44 0.36 0.48 Timeliness 0.61 0.57 0.52 1 0.43 0.31 0.40 Environment 0.54 0.48 0.44 0.43 1 0.29 0.42 Pricing 0.46 0.39 0.36 0.31 0.29 1 0.28 Effectiveness 0.59 0.55 0.48 0.40 0.42 0.28 1 Subgroup analyses were conducted to examine differences in overall wellbeing across gender, age group, education level, income status, and place of residence. No statistically significant difference in overall wellbeing was observed between men and women. Mean wellbeing scores were 4.21 for men and 4.18 for women ( p = 0.68). Overall wellbeing differed significantly across age groups ( p = 0.017). Respondents aged 55 years and above reported higher wellbeing scores compared with younger adults aged 18–34 years, with a mean difference of 0.24. A statistically significant difference in overall wellbeing was observed across education levels ( p = 0.002). Respondents with postgraduate education reported lower wellbeing scores compared with those with secondary education, with a mean difference of − 0.27. Income status was significantly associated with overall wellbeing ( p = 0.005). High-income respondents reported the highest wellbeing scores, while low-income respondents reported lower scores, particularly within the financial wellbeing dimension. A significant difference in wellbeing was observed between urban and rural residents ( p = 0.004) 4. Discussion 4.1. Interpretation of Key Findings The findings of this study demonstrate that subjective patient wellbeing, as captured by the OWI, is shaped by a combination of interpersonal experiences, emotional responses, and system-level conditions within private healthcare institutions in Azerbaijan. Importantly, the OWI reflects patients’ perceived wellbeing outcomes, whereas service-related characteristics function as determinants influencing these outcomes. Among the six wellbeing dimensions comprising the OWI, relational and emotional wellbeing emerged as the strongest components. This indicates that patients place particular value on trust, empathy, respectful communication, and confidence in healthcare professionals. These dimensions capture how patients feel and relate within the care encounter, rather than how services are technically organized. This pattern is consistent with international evidence showing that interpersonal quality is a central driver of subjective wellbeing in healthcare settings (Doyle et al., 2013; Al-Abri & Al-Balushi, 2014). By contrast, financial and institutional wellbeing were comparatively weaker components of the OWI. These dimensions reflect patients’ perceptions of financial security, predictability, organizational consistency, and institutional trust. Their lower scores suggest that, despite strong interpersonal experiences, system-level features such as administrative coordination and cost predictability continue to moderate overall wellbeing outcomes. Regression analysis further clarified this distinction by showing that service quality, communication quality, timeliness of care, and pricing transparency function as key determinants of the OWI, rather than as components of wellbeing itself. Together, these findings confirm that patient wellbeing in private healthcare is not solely a function of clinical competence but emerges from the interaction between interpersonal care and broader system performance. 4.2. Wellbeing Dimensions in the Context of International Evidence The multidimensional wellbeing framework applied in this study—encompassing emotional, relational, experiential, financial, informational, and institutional wellbeing—aligns closely with international models proposed by the WHO, OECD, and contemporary wellbeing theorists. These frameworks emphasize that wellbeing represents a subjective outcome state, shaped by but conceptually distinct from service delivery mechanisms. Consistent with findings from upper-middle-income and OECD countries, emotional and relational wellbeing were the strongest dimensions of the OWI. Patients consistently reported feeling emotionally reassured, respected, and supported through interpersonal interactions with healthcare providers. International research similarly highlights that trust, empathy, and communication quality are foundational to subjective wellbeing across diverse healthcare systems (Busse et al., 2017; Çelik et al., 2021). In contrast, financial and institutional wellbeing demonstrated more moderate scores, reflecting persistent challenges related to perceived affordability, administrative consistency, and institutional reliability. Importantly, these dimensions capture patients’ felt sense of financial security and organizational trust, rather than objective pricing mechanisms. This distinction is supported by OECD and WHO analyses, which differentiate between financial wellbeing outcomes and pricing transparency or financing arrangements as system-level determinants (OECD, 2023; WHO, 2022). Informational wellbeing occupied an intermediate position, suggesting that while patients generally perceived diagnostic explanations and guidance as adequate, variability remained in the clarity and consistency of information provision. This pattern mirrors international evidence indicating that informational wellbeing improves with digital health integration but remains sensitive to workflow pressures and provider communication styles. Overall, Azerbaijan’s wellbeing profile reflects a pattern observed internationally: strong interpersonal foundations coexist with systemic constraints that limit financial and institutional wellbeing outcomes. 4.3. Structural and Socioeconomic Determinants of Patient Wellbeing The subgroup analyses indicate that variation in subjective patient wellbeing, as measured by the OWI, is driven primarily by structural and socioeconomic conditions, rather than by demographic characteristics alone. Geographic location, socioeconomic status, and system-level accessibility emerged as the most influential contextual factors shaping wellbeing outcomes. Urban residents consistently reported higher OWI scores than rural residents, particularly in experiential, informational, and institutional wellbeing dimensions. These differences reflect disparities in service density, diagnostic availability, digital infrastructure, and administrative capacity, all of which function as determinants influencing patients’ wellbeing experiences rather than as wellbeing components themselves. Socioeconomic status also exerted a significant influence on wellbeing, especially within the financial wellbeing dimension. Lower-income respondents reported reduced financial security and greater sensitivity to cost unpredictability, which translated into lower overall wellbeing scores. This finding aligns with international evidence demonstrating that financial vulnerability directly undermines subjective wellbeing, even when interpersonal care quality is perceived as high (OECD, 2023; World Bank, 2023). Importantly, demographic variables such as gender and education level showed minimal independent effects on the OWI after accounting for service-related and structural factors. This suggests that wellbeing inequalities are primarily system-driven, reinforcing the need for organizational and policy-level interventions rather than narrowly targeted demographic strategies. Taken together, these findings emphasize that patient wellbeing in private healthcare is shaped by the interaction between individual experiences and broader structural conditions, underscoring the importance of addressing accessibility, financial predictability, and institutional capacity to improve wellbeing outcomes across population groups. 4.4. Cross-Country Implications for Patient Wellbeing Cross-country evidence provides an important contextual framework for interpreting the wellbeing outcomes observed in Azerbaijan’s private healthcare sector. When examined through the lens of the Overall Wellbeing Index (OWI), international comparisons consistently demonstrate that subjective patient wellbeing is shaped by system-level determinants, rather than by clinical performance alone. Across diverse health systems, private healthcare institutions tend to perform strongly in interpersonal and experiential domains, while financial and institutional wellbeing outcomes remain highly sensitive to governance structures, regulatory oversight, and financing arrangements. Evidence from OECD and WHO countries shows that communication quality, service responsiveness, and perceived clinical competence function as universal determinants of emotional and relational wellbeing, regardless of national income level or system design (Doyle et al., 2013; OECD, 2023; WHO Europe, 2023). Studies from Turkey and Germany, for example, demonstrate that strong interpersonal care and efficient service organization substantially enhance patients’ emotional reassurance and trust, which translate into higher overall wellbeing outcomes (Busse et al., 2017; Çelik et al., 2021). These patterns closely mirror the Azerbaijani findings, where relational and emotional wellbeing emerged as the strongest OWI components. At the same time, cross-country comparisons highlight persistent challenges related to financial and institutional wellbeing, particularly in middle-income health systems with mixed public–private financing models. Research from Brazil, India, and Eastern Europe indicates that reliance on out-of-pocket payments and variability in pricing structures undermine patients’ perceived financial security, even when interpersonal care quality is high (OECD, 2023; PAHO, 2022; World Bank, 2023). Importantly, these studies distinguish between pricing transparency as a system determinant and financial wellbeing as a subjective outcome, reinforcing the conceptual approach adopted in the present study. Digital health maturity and governance strength further differentiate wellbeing outcomes across countries. Systems with advanced digital integration—such as Germany’s electronic patient record infrastructure and Turkey’s national e-health platforms—demonstrate higher levels of informational and institutional wellbeing by improving continuity, predictability, and administrative coordination (WHO, 2022; OECD, 2024). Conversely, countries with fragmented digital infrastructure and weaker regulatory enforcement exhibit lower institutional trust and greater experiential uncertainty, particularly among rural and lower-income populations (WHO Europe, 2023). Within this international context, Azerbaijan’s private healthcare sector exhibits a wellbeing profile that aligns closely with regional and global patterns. Strong interpersonal determinants contribute to high emotional and relational wellbeing, while systemic constraints—particularly in pricing predictability, administrative coordination, and regional accessibility—moderate financial and institutional wellbeing outcomes. These similarities suggest that improvements observed in other health systems are achievable through targeted policy interventions focused on governance strengthening, digitalization, and financial transparency. Overall, the cross-country evidence reinforces the central conclusion of this study: private healthcare can contribute positively to patient wellbeing when service-related determinants are aligned with robust institutional frameworks. For Azerbaijan, aligning private healthcare governance with international best practices—particularly those emphasized by WHO and OECD—offers a clear pathway for enhancing multidimensional wellbeing outcomes while reducing socioeconomic and geographic disparities. 4.5. Strengths and Limitations of the Study This study has several notable strengths. First, it represents one of the first empirical investigations to examine multidimensional subjective patient wellbeing within the private healthcare sector of Azerbaijan. By constructing and applying the Overall Wellbeing Index (OWI), the study moves beyond traditional satisfaction metrics and captures a broader spectrum of emotional, relational, experiential, financial, informational, and institutional wellbeing outcomes. Second, the study is based on a robust and diverse sample (N = 300), enabling meaningful subgroup analyses and multivariate modelling. The clear conceptual separation between wellbeing outcomes and service-related determinants strengthens the methodological rigor of the analysis and reduces the risk of circularity between predictors and outcomes. This study has several limitations that should be acknowledged. First, the cross-sectional design does not allow for causal inference; however, it provides a robust snapshot of multidimensional patient wellbeing within private healthcare institutions and identifies key associations relevant for health services research and policy development. Future longitudinal studies could further explore how wellbeing evolves over time in response to changes in service organization, financing mechanisms, and patient health status. Second, wellbeing was assessed using self-reported measures, which are widely accepted in wellbeing research but may be influenced by subjective perceptions. Nevertheless, subjective wellbeing is a central outcome in patient-centred care frameworks, and self-reported measures remain essential for capturing patients’ lived experiences. Future research may complement these measures with objective service performance indicators or clinical outcomes to provide a more comprehensive assessment. Finally, although the sample included both urban and rural respondents, it reflects the current concentration of private healthcare services in metropolitan areas. Future studies could extend this research by incorporating public healthcare institutions and comparative public–private analyses, which would enable a more comprehensive understanding of patient wellbeing across the entire healthcare system and inform more integrated and equitable health policy interventions. 4.6. Policy and Practice Implications The findings of this study have important implications for healthcare policy and management within Azerbaijan’s private healthcare sector. By clearly distinguishing determinants of wellbeing from wellbeing outcomes, the results provide a focused roadmap for targeted interventions. Policies aimed at strengthening communication quality, service responsiveness, and pricing transparency are likely to yield substantial improvements in emotional, relational, experiential, and financial wellbeing outcomes. In particular, improving cost predictability through standardized pricing frameworks and clearer pre-service cost communication can directly enhance patients’ perceived financial security and institutional trust. Investments in digital health infrastructure—such as electronic medical records, digital appointment systems, and patient-facing information platforms—can further strengthen informational and institutional wellbeing by reducing administrative uncertainty and improving continuity of care. Addressing urban–rural disparities through targeted incentives for regional service expansion and telemedicine deployment is also essential for reducing wellbeing inequalities. Importantly, these findings suggest that private healthcare institutions are well positioned to contribute to national wellbeing goals, provided that system-level determinants are aligned with patient-centred governance and transparency standards. 4.7. Directions for Future Research Future research should build on the present findings by further examining the dynamic relationship between service-related determinants and subjective wellbeing outcomes in private healthcare settings. Longitudinal study designs would be particularly valuable for assessing how changes in service orga-nization, digital health integration, and financing arrangements shape wellbeing trajectories over time. Mixed-methods approaches incorporating qualitative interviews could provide deeper insight into how patients interpret financial security, institutional trust, and interpersonal care—dimensions that are central to the Overall Wellbeing Index framework. In addition, integrating objective institutional indicators, such as accreditation status, staffing profiles, or digital maturity scores, would enable more robust multi-level analyses linking organizational performance to patient wellbeing outcomes. Importantly, future studies should extend this line of inquiry to public healthcare institutions and conduct comparative public–private analyses. Such research would allow for a more comprehensive understanding of how governance models, financing mechanisms, and service delivery structures influence patient wellbeing across the entire healthcare system. Finally, future research should explore the development and validation of context-specific wellbeing measurement instruments tailored to national healthcare environments. This would enable more precise and culturally sensitive assessment of wellbeing outcomes while maintaining comparability with established international wellbeing frameworks 5. Conclusion This study provides one of the first comprehensive evaluations of multidimensional patient wellbeing within Azerbaijan’s private healthcare sector, offering valuable insight into how interpersonal, experiential, financial, informational, and institutional factors jointly shape patient experiences. The findings demonstrate that while relational and emotional wellbeing—reflecting trust, empathy, and communication quality—are consistently strong across private medical institutions, overall wellbeing is moderated by systemic limitations in management efficiency, service accessibility, and pricing transparency. The mean OWI score of 4.09 on a 1–5 scale (approximately 81.8 on a 0–100 scale) indicates a generally high level of patient wellbeing. Nevertheless, meaningful disparities persist across socioeconomic and geographic groups. Urban residents, higher-income individuals, and patients covered by the MHI system reported substantially higher wellbeing, whereas regional and low–socioeconomic status populations experienced lower scores, particularly in experiential, financial, and institutional domains. These differences highlight the continuing influence of structural inequalities in access, affordability, and institutional capacity within the private healthcare landscape. Multivariate analyses further revealed that service quality, communication, timeliness, and pricing transparency are the strongest predictors of overall wellbeing. These findings underscore that meaningful improvements in patient wellbeing require more than strong clinical competence and interpersonal care. They also depend on reliable administrative processes, transparent financial practices, and efficient service organization. Strengthening digital health integration, standardizing appointment and workflow systems, and improving pricing transparency are therefore likely to generate substantial gains in experiential, informational, and financial wellbeing. Taken together, the study emphasizes that improving patient wellbeing in private healthcare requires a balanced dual strategy: preserving the strong interpersonal and clinical foundations already present in many institutions, while simultaneously addressing systemic weaknesses related to organizational capacity, digital readiness, cost predictability, and equity. For policymakers and healthcare leaders, these findings offer a clear, evidence-based framework for aligning private healthcare delivery with international standards of patient-centred wellbeing. Integrating wellbeing as a core performance metric is essential for ensuring accessible, high-quality, and equitable care across all population groups within evolving healthcare systems. Declarations Ethics approval and consent to participate The study protocol was reviewed by the Ethics Committee of Azerbaijan Medical University. The research was conducted in accordance with the ethical principles of the Declaration of Helsinki. As the study involved an anonymous sociological survey and did not include identifiable personal or clinical data, formal ethical approval and a protocol number were not required. In addition, the research program was approved at the meeting of the Department of Public Health and Healthcare Organization (Protocol № 6, January 8, 2025). Participation was voluntary, and written informed consent was obtained from all respondents prior to inclusion in the study. Confidentiality and anonymity of the participants were fully ensured throughout the research process. Consent for publication Not applicable. The manuscript does not contain any individual person’s data, images, or identifiable information. Availability of data and materials The authors confirm that the data supporting the findings of this study are available within the article. Additional datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no external funding. Authors' contributions Musa Alekberov — Conceptualization, study design, methodology development, supervision, statistical analysis oversight, interpretation of findings, manuscript drafting, and critical revision. Yaqut Hajiyeva — Data collection, survey administration, database development, preliminary data analysis, manuscript editing. Nargiz Hajiyeva — Methodological support, socio-analytical framework development, interpretation of social wellbeing indicators, manuscript review. Kamran Babayev — Literature review, data validation, visualization, and preparation of tables . Mahira Sariyeva — Institutional coordination, data acquisition support, policy context analysis, manuscript proofreading. Shamil Aydamirov — Clinical context interpretation, healthcare system expertise input, results evaluation, and final manuscript review. All authors read and approved the final manuscript. References Anhang Price, R., Elliott, M. N., Zaslavsky, A. M., Hays, R. D., Lehrman, W. G., Rybowski, L., … Cleary, P. D. (2014). Examining the role of patient experience surveys in measuring health care quality. Medical Care, 52 (2), 93–100. https://doi.org/10.1097/MLR.0000000000000024 Batbaatar, E., Dorjdagva, J., Luvsannyam, A., Savino, M. M., & Amenta, P. (2017). Determinants of patient satisfaction: A systematic review. Perspectives in Public Health, 137 (2), 89–101. https://doi.org/10.1177/1757913916634136 Bleich, S. N., Özaltin, E., & Murray, C. J. (2019). How does satisfaction with the health-care system relate to patient experience? Bulletin of the World Health Organization, 97 (1), 18–28. https://doi.org/10.2471/BLT.18.219626 Busse, R., Blümel, M., Knieps, F., & Bärnighausen, T. (2017). Statutory health insurance in Germany: A health system shaped by 135 years of solidarity, self-governance, and competition. The Lancet, 390 (10097), 882–897. https://doi.org/10.1016/S0140-6736(17)31280-1 Çelik, Y., Şahin, B., & Üner, S. (2021). Patient satisfaction in private hospitals in Turkey. BMC Health Services Research, 21 , 119. https://doi.org/10.1186/s12913-021-06133-7 Cramm, J. M., Møller, V., & Nieboer, A. P. (2012). Individual- and neighbourhood-level indicators of subjective well-being in a small and heterogeneous country. Social Indicators Research, 105 (3), 581–593. https://doi.org/10.1007/s11205-011-9790-0 Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260 (12), 1743–1748. https://doi.org/10.1001/jama.260.12.1743 Doyle, C., Lennox, L., & Bell, D. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open, 3 , e001570. https://doi.org/10.1136/bmjopen-2012-001570 Gallup. (2023). Global wellbeing index report . https://www.gallup.com Helliwell, J. F., Huang, H., Wang, S., & Norton, M. (2021). World happiness report 2021 . https://worldhappiness.report Helliwell, J. F., Huang, H., Norton, M., et al. (2023). World happiness report 2023 . https://worldhappiness.report Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century . National Academies Press. https://doi.org/10.17226/10027 Kaya, S., & Öztürk, Y. (2020). Service quality perceptions in private hospitals. The International Journal of Health Planning and Management, 35 (2), 456–470. https://doi.org/10.1002/hpm.2926 Kollamparambil, U. (2020). Happiness, happiness inequality and income dynamics in South Africa. Journal of Happiness Studies, 21 (1), 201–222. https://doi.org/10.1007/s10902-019-00075-0 Lomas, T., & VanderWeele, T. J. (2022). The garden and the orchestra: Metaphors for wellbeing. International Journal of Environmental Research and Public Health, 19 (21), 14544. https://doi.org/10.3390/ijerph192114544 Luxford, K., Safran, D. G., & Delbanco, T. (2011). Promoting patient-centered care: A qualitative study. International Journal for Quality in Health Care, 23 (1), 2–9. https://doi.org/10.1093/intqhc/mzq069 Manary, M. P., Boulding, W., Staelin, R., & Glickman, S. W. (2013). The patient experience and health outcomes. New England Journal of Medicine, 368 , 201–203. https://doi.org/10.1056/NEJMp1211775 Nilsson, A. H., et al. (2024). Interpreting the Cantril ladder as a measure of wellbeing. Scientific Reports, 14 , 2642. https://doi.org/10.1038/s41598-024-52939-y OECD. (2022). Measuring what matters for child wellbeing . https://www.oecd.org/wise/measuring-child-well-being/ OECD. (2023a). Trust in health systems . https://www.oecd.org/gov/trust/ OECD. (2023b). Patient-reported indicators surveys (PaRIS): Results from the baseline survey . https://www.oecd.org/health/paris/ OECD. (2024). Health at a glance 2024 . https://www.oecd.org/health/health-at-a-glance/ OECD & European Observatory on Health Systems and Policies. (2020). Health systems in transition: Azerbaijan . https://eurohealthobservatory.who.int PAHO. (2022). Health systems and financial protection in Latin America . https://www.paho.org VanderWeele, T. J. (2017). On the promotion of human flourishing. Proceedings of the National Academy of Sciences, 114 (31), 8148–8156. https://doi.org/10.1073/pnas.1702996114 VanderWeele, T. J., McNeely, E., & Koh, H. K. (2019). Reimagining health—Flourishing. JAMA, 321 (17), 1667–1668. https://doi.org/10.1001/jama.2019.3035 Weziak-Bialowolska, D., VanderWeele, T. J., & McNeely, E. (2021). Human flourishing in organizations. International Journal of Environmental Research and Public Health, 18 (16), 8359. https://doi.org/10.3390/ijerph18168359 WHO. (2022a). Quality of care framework for people-centred health services . https://www.who.int WHO. (2022b). Global strategy on digital health 2020–2025 . https://www.who.int/publications/i/item/9789240020924 WHO Europe. (2023). People-centred care in the WHO European Region . https://www.who.int/europe/publications World Bank. (2023). Azerbaijan health system review . https://www.worldbank.org/en/country/azerbaijan Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.MultidimensionalPatientWellbeingQuestionnaireEnglishVersion.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 15 Mar, 2026 Reviewers agreed at journal 11 Mar, 2026 Reviewers invited by journal 11 Mar, 2026 Editor assigned by journal 16 Feb, 2026 Editor invited by journal 10 Feb, 2026 Submission checks completed at journal 10 Feb, 2026 First submitted to journal 10 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8730678","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":604571695,"identity":"bdc256e7-636f-4870-9fd4-39c5a86fa92d","order_by":0,"name":"Musa Alakbarov","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYPACCwYJCTDDhoGBmbmBGC0SMC1pQC2MpGk5DMQEtOjOSH/4gaFGQk5ydvOxDx/bzkfztzM2MFe24dZidiPHWILhmISxtMyx5Jkz227nzjjM2MB4Fr8WoKvYJBLnSeQYM/OcuZ3bANLSiFdL+uMfDP8k6udJ5H8GajmXO5+wlgQzCcY2iQRpiRxmZp6KA7kbCGo588bMgrFPwnDmnGPGjDMqknM3ArUcbDiHR8vx9Mc3GL7ZyEvcbn7M8MHALnfe+cMHHzaU4dYCAsx/0EUO4NcwCkbBKBgFo4AQAAD+EVBnsp/jygAAAABJRU5ErkJggg==","orcid":"","institution":"Azerbaijan Medical University","correspondingAuthor":true,"prefix":"","firstName":"Musa","middleName":"","lastName":"Alakbarov","suffix":""},{"id":604571696,"identity":"f4daa3ac-5f24-4395-b9f3-e8d834649181","order_by":1,"name":"Yaqut Hajiyeva","email":"","orcid":"","institution":"Azerbaijan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yaqut","middleName":"","lastName":"Hajiyeva","suffix":""},{"id":604571697,"identity":"cc5767c0-5a48-4ec7-89f4-618d0dd8ddfd","order_by":2,"name":"Nargiz Hajiyeva","email":"","orcid":"","institution":"Ministry of Labor and Social Protection of the Population of the Republic of Azerbaijano","correspondingAuthor":false,"prefix":"","firstName":"Nargiz","middleName":"","lastName":"Hajiyeva","suffix":""},{"id":604571698,"identity":"ee06c43e-f114-4c93-9462-5c78a2986c9f","order_by":3,"name":"Kamran Babaev","email":"","orcid":"","institution":"Azerbaijan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Kamran","middleName":"","lastName":"Babaev","suffix":""},{"id":604571700,"identity":"7f6aef46-cdfc-44e5-9f2c-bff17364e6b3","order_by":4,"name":"Mahira Sariyeva","email":"","orcid":"","institution":"Ministry of Healthcare","correspondingAuthor":false,"prefix":"","firstName":"Mahira","middleName":"","lastName":"Sariyeva","suffix":""},{"id":604571702,"identity":"17d86e19-2f9e-4279-b7a3-60bc22199b8f","order_by":5,"name":"Shamil Aydemirov","email":"","orcid":"","institution":"Ministry of Healthcare","correspondingAuthor":false,"prefix":"","firstName":"Shamil","middleName":"","lastName":"Aydemirov","suffix":""}],"badges":[],"createdAt":"2026-01-29 11:09:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8730678/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8730678/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104579394,"identity":"ff961561-b4b9-4fe2-b761-96ec8b6dbe64","added_by":"auto","created_at":"2026-03-13 14:41:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1330304,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8730678/v1/ad836625-2c38-4948-864c-4894275d7324.pdf"},{"id":104579380,"identity":"7dee835d-86ed-4674-9f3c-8112faf6e254","added_by":"auto","created_at":"2026-03-13 14:41:44","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16893,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.MultidimensionalPatientWellbeingQuestionnaireEnglishVersion.docx","url":"https://assets-eu.researchsquare.com/files/rs-8730678/v1/3d6143c58c5d93818a163163.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDeterminants of Multidimensional Patient Wellbeing in Private Healthcare Institutions: Evidence From Azerbaijan\u003c/p\u003e","fulltext":[{"header":"1. Background:","content":"\u003cp\u003ePatient wellbeing has increasingly emerged as a central outcome of healthcare system performance, extending beyond traditional indicators of patient satisfaction and clinical effectiveness. Contemporary wellbeing frameworks promoted by the World Health Organization and the Organisation for Economic Co-operation and Development emphasize the multidimensional nature of wellbeing, encompassing emotional, relational, experiential, financial, informational, and institutional dimensions. In healthcare settings, subjective wellbeing is closely linked to perceptions of trust, service responsiveness, communication quality, and financial security. Despite growing international evidence, empirical research examining multidimensional patient wellbeing in private healthcare systems\u0026mdash;particularly in middle-income and transitional contexts\u0026mdash;remains limited.\u003c/p\u003e \u003cp\u003eOver the past two decades, wellbeing has emerged as a central concept in health policy, public health research, and healthcare performance evaluation. Moving beyond traditional indicators such as mortality, morbidity, and patient satisfaction, contemporary frameworks conceptualize wellbeing as a multidimensional construct encompassing emotional, relational, experiential, and institutional dimensions of individuals\u0026rsquo; interactions with health systems (Dodge et al., 2012; VanderWeele, 2017). This shift reflects growing recognition that healthcare systems should be evaluated not only by clinical outcomes, but also by how effectively they support patients\u0026rsquo; lived experiences, psychological security, trust, and sense of agency.\u003c/p\u003e \u003cp\u003ePatient wellbeing is closely linked to patient experience, quality of care, and system performance. A substantial body of international evidence demonstrates that positive patient experiences are associated with improved adherence, better clinical outcomes, enhanced safety, and greater trust in healthcare institutions (Doyle et al., 2013; Manary et al., 2013; Figueroa et al., 2018). Interpersonal communication, empathy, and respectful treatment have consistently been identified as among the most powerful determinants of wellbeing across diverse healthcare settings (Al-Abri \u0026amp; Al-Balushi, 2014; Anhang Price et al., 2014). Consequently, patient wellbeing has become a key outcome within people-centred care models promoted by the World Health Organization and the Organisation for Economic Co-operation and Development (WHO, 2022; OECD, 2023a). Global wellbeing assessments further suggest that subjective wellbeing in healthcare settings is closely linked to perceptions of trust, service responsiveness, and financial security, underscoring the relevance of multidimensional wellbeing frameworks in health system evaluation (Gallup, 2023).\u003c/p\u003e \u003cp\u003eAt the system level, wellbeing is increasingly understood as a product of both service delivery processes and broader institutional arrangements. Administrative efficiency, pricing transparency, digital integration, and financial protection mechanisms all shape patients\u0026rsquo; perceptions of fairness, predictability, and security when accessing healthcare services (Donabedian, 1988; Bleich et al., 2019). In mixed public\u0026ndash;private health systems, these factors become particularly salient, as patients often navigate fragmented financing arrangements, variable governance structures, and heterogeneous service standards.\u003c/p\u003e \u003cp\u003eThe private healthcare sector plays an expanding role in many upper-middle-income and transitional economies. In countries across Eastern Europe, the Caucasus, and Central Asia, private providers increasingly supply outpatient care, diagnostics, and specialized services, often complementing public systems characterized by resource constraints and capacity limitations (OECD \u0026amp; European Observatory, 2020; World Bank, 2023). While private healthcare is frequently associated with shorter waiting times, better infrastructure, and stronger interpersonal care, concerns persist regarding cost predictability, equity, and regulatory oversight.\u003c/p\u003e \u003cp\u003eAzerbaijan represents a particularly relevant context for examining patient wellbeing in private healthcare. The country has undergone significant health system reforms, including the gradual expansion of the MHI system and increased engagement of private providers within a mixed financing model. Private medical institutions have become prominent providers of diagnostic, consultative, and specialized services, especially in urban areas. However, empirical evidence on how patients experience and evaluate wellbeing within Azerbaijan\u0026rsquo;s private healthcare sector remains limited.\u003c/p\u003e \u003cp\u003eExisting studies in Azerbaijan and comparable settings have largely focused on patient satisfaction or service utilization, offering only a partial understanding of patient experience. Satisfaction-based approaches, while informative, do not fully capture the multidimensional nature of wellbeing, nor do they adequately reflect emotional security, institutional trust, financial predictability, and informational clarity (Dodge et al., 2012; VanderWeele et al., 2019). As a result, there is a clear need for research that adopts a broader wellbeing framework and systematically examines how different dimensions interact within private healthcare environments.\u003c/p\u003e \u003cp\u003eInternational evidence suggests that wellbeing profiles in private healthcare settings are shaped by both individual and structural factors. Socioeconomic status, geographic location, and insurance coverage have been shown to influence access, affordability, and perceived quality of care (Kollamparambil, 2020; OECD, 2023b). Urban\u0026ndash;rural disparities, in particular, remain a persistent challenge in transitional health systems, where advanced infrastructure and digital health tools are often concentrated in metropolitan areas (World Health Organization Regional Office for Europe, 2023). Understanding how these determinants operate within Azerbaijan\u0026rsquo;s private healthcare sector is essential for informing equitable and patient-centred policy interventions.\u003c/p\u003e \u003cp\u003eAgainst this background, the present study aims to provide a comprehensive assessment of patient wellbeing in private healthcare institutions in Azerbaijan using a multidimensional framework. By examining emotional, relational, experiential, financial, informational, and institutional domains of wellbeing and integrating them into an Overall Wellbeing Index (OWI), the study seeks to move beyond narrow satisfaction metrics and offer a holistic evaluation of patient experience. In doing so, it contributes to the growing international literature on wellbeing-oriented health system assessment and provides evidence to support more transparent, efficient, and equitable healthcare delivery in mixed public\u0026ndash;private systems.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003eA cross-sectional quantitative study was conducted to assess multidimensional patient wellbeing among users of private healthcare services in Azerbaijan. The study focused exclusively on private medical institutions providing outpatient, diagnostic, and specialized services within a mixed public\u0026ndash;private healthcare system. Data collection was carried out between January\u0026ndash;December 2025 across multiple private healthcare facilities located in both urban and regional settings. The cross-sectional design was selected to capture patient-reported wellbeing at a single point in time and to examine associations between wellbeing dimensions, service-related characteristics, and socioeconomic factors.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1Study Population and Sampling\u003c/h2\u003e \u003cp\u003eThe study population consisted of adult patients (\u0026ge;\u0026thinsp;18 years) who had received medical services in private healthcare institutions in Azerbaijan within the previous 12 months. Inclusion criteria were: (1) age 18 years or older; (2) direct experience with private healthcare services; and (3) ability to provide informed consent and complete the questionnaire independently. Patients receiving exclusively emergency care or those unable to provide informed consent were excluded. A total of 300 respondents were included in the final analysis. This sample size is consistent with prior patient-reported outcome and wellbeing studies and provides sufficient statistical power for descriptive analysis, subgroup comparisons, and multivariate regression modelling involving multiple wellbeing domains. Participants were recruited using a non-probability, facility-based sampling approach designed to capture heterogeneity in patient experiences across different private healthcare settings. Data collection targeted both urban (including Baku) and regional locations, as well as patients with varying socioeconomic status and insurance coverage, in order to enhance diversity within the sample.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2Data Collection Instrument\u003c/h2\u003e \u003cp\u003eData were collected using a structured, self-administered questionnaire developed for this study based on established wellbeing and patient experience frameworks. The instrument was designed within a structured sociological research program and subsequently adapted to assess multidimensional patient wellbeing in private healthcare institutions.\u003c/p\u003e \u003cp\u003eThe questionnaire comprised four sections:\u003c/p\u003e \u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eSociodemographic characteristics\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHealthcare utilization patterns\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eMultidimensional wellbeing domains\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eOverall service evaluation\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e All wellbeing-related items were measured using a standardized five-point Likert scale ranging from 1 (\u0026ldquo;very poor/strongly disagree\u0026rdquo;) to 5 (\u0026ldquo;very good/strongly agree\u0026rdquo;).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe English-language version of the questionnaire is provided as \u003cb\u003eSupplementary File 1\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3Wellbeing Framework and Measures\u003c/h2\u003e \u003cp\u003ePatient wellbeing was conceptualized as a multidimensional construct encompassing six interrelated domains reflecting key service delivery and patient experience dimensions: waiting times; communication quality; facility environment; diagnostic accuracy; treatment effectiveness; pricing transparency. Questionnaire items were grouped into these six analytical domains based on conceptual similarity and healthcare service delivery frameworks. Domain scores were calculated as the arithmetic mean of item responses within each domain, with higher scores indicating higher perceived wellbeing. An \u003cb\u003eOverall Wellbeing Index (OWI)\u003c/b\u003e was constructed to provide an integrated measure of patient wellbeing. The OWI was calculated as the mean of the six domain scores, yielding a composite index ranging from 1 to 5. This composite approach enabled multidimensional assessment while preserving interpretability across population subgroups\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4Statistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS version 25.0. Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarize sociodemographic characteristics, healthcare utilization patterns, and wellbeing domain scores. Bivariate analyses were conducted to examine differences in wellbeing across key subgroups, including place of residence (urban vs. regional), socioeconomic status, and insurance coverage. Pearson correlation coefficients were calculated to assess associations between wellbeing domains and the Overall Wellbeing Index. To identify independent predictors of overall wellbeing, multiple linear regression analysis was performed. The Overall Wellbeing Index served as the dependent variable, while service-related characteristics (service quality, communication, timeliness of care, and pricing transparency) and demographic variables were included as independent predictors. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5Ethical Considerations\u003c/h2\u003e \u003cp\u003e Participation was voluntary, and all respondents provided informed consent prior to inclusion in the study. Data were collected anonymously, and no personally identifiable information was recorded. The study protocol was reviewed by the Ethics Committee of Azerbaijan Medical University. As the research involved an anonymous sociological survey and did not include identifiable personal or clinical data, formal ethical approval and protocol number were not required. In addition, the research program was approved at the meeting of the Department of Public Health and Healthcare Organization (Protocol № 6, January 8, 2026).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Demographic Profile of Respondents\u003c/h2\u003e \u003cp\u003eA total of 300 adults participated in the wellbeing survey examining patient experiences in private healthcare institutions in Azerbaijan. The sample reflected a balanced and diverse demographic structure, consistent with patterns typically observed in upper\u0026ndash;middle-income countries, where private healthcare services are predominantly utilized by urban, middle-income, and well-educated populations. Overall, 56.3% of respondents were women (n\u0026thinsp;=\u0026thinsp;169) and 43.7% were men (n\u0026thinsp;=\u0026thinsp;131), indicating a slightly higher utilization of private healthcare services among female patients (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of respondents by gender and self-reported health status (n\u0026thinsp;=\u0026thinsp;300)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHealth Status\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMen (n; %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen (n; %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal (n; %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (38.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60 (35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111 (37.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractically healthy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (23.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63 (37.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94 (31.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIll (acute/chronic)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49 (37.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (27.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e131 (43.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e300 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe mean age of respondents was 38.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4 years, with the majority (61.7%) falling within the 25\u0026ndash;45-year age range\u0026mdash;an age group internationally associated with greater reliance on private healthcare services due to employment-related insurance coverage, time-sensitive care needs, and a preference for faster appointment scheduling. A substantial proportion of respondents (24.7%) were aged 50\u0026ndash;59 years, exceeding the younger 18\u0026ndash;29-year cohort (20.3%). Women represented a slightly higher share of the 50\u0026ndash;59 age group (26.0% compared with 23.0% among men), although this difference was not statistically significant (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.6, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eEducational attainment was notably high: 74.3% of respondents reported having completed higher education, while 25.7% reported secondary or vocational education (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocioeconomic, educational, and age characteristics of respondents (n\u0026thinsp;=\u0026thinsp;300)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCharacteristic\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEducation\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary/Vocational\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSocioeconomic\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003estatus\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eResidence\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAge Group\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis distribution aligns with global evidence demonstrating that private healthcare services are more frequently utilized by individuals with higher educational attainment and greater awareness of service quality (OECD, 2023a). Socioeconomic status was self-reported as medium by 62.7% of respondents, low by 21.0%, and high by 16.3%. With respect to geographic distribution, 64.0% of participants resided in urban areas\u0026mdash;primarily Baku\u0026mdash;while 36.0% lived in rural regions. This urban predominance reflects the concentration of private healthcare infrastructure, digital appointment systems, and specialized medical services in metropolitan centers.\u003c/p\u003e \u003cp\u003eOverall, the demographic profile of the sample closely aligns with patterns reported in analyses of the WHO European Region and OECD healthcare utilization studies, which consistently highlight the predominance of well-educated, middle-income, and urban populations among users of private healthcare services. This alignment enhances the generalizability of the study\u0026rsquo;s findings and provides a solid foundation for interpreting wellbeing outcomes across different population subgroups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Healthcare Utilization Patterns\u003c/h2\u003e \u003cp\u003eOverall, private healthcare services (72.0%) were most frequently used for specialist consultations and 48.3% - diagnostic or laboratory services (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHealthcare utilization patterns among respondents (n\u0026thinsp;=\u0026thinsp;300)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eType of Service\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialist consultation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnostic/laboratory services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute illness treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic disease management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoutine check-up/screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eNote: Percentages exceed 100% because multiple responses were allowed.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePreventive check-ups and screening services were also commonly reported (42.0%). A smaller proportion of respondents reported seeking private care for acute conditions (31.7%) and for the ongoing management of chronic diseases (18.3%). Utilization of private healthcare for emergency services was relatively limited (6.3%).\u003c/p\u003e \u003cp\u003eIn terms of payment modality, most respondents reported using out-of-pocket payment when accessing private healthcare services (58.7%), while 41.3% received services covered under the Mandatory Health Insurance (MHI) system. This distribution reflects the dual financing structure of private healthcare in Azerbaijan, where insured and uninsured service pathways coexist.\u003c/p\u003e \u003cp\u003eOverall, these utilization patterns indicate that private healthcare institutions in Azerbaijan are primarily used for specialist consultations, diagnostics, and preventive services, with a substantial share of patients relying on direct out-of-pocket payments alongside expanding MHI coverage.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Wellbeing Dimension Scores\u003c/h2\u003e \u003cp\u003eThe assessment of patient wellbeing across six core dimensions\u0026mdash;emotional, relational, experiential, informational, institutional, and financial wellbeing\u0026mdash;revealed a differentiated profile among users of private healthcare services in Azerbaijan. Overall wellbeing levels ranged from moderate to high across domains, with notable variation reflecting differences in patients\u0026rsquo; emotional experiences, interpersonal interactions, service processes, and financial perceptions.\u003c/p\u003e \u003cp\u003eEmotional wellbeing demonstrated a relatively high mean score of 4.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66, indicating that most respondents reported positive emotional experiences and reduced anxiety during their interactions with private healthcare institutions (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eRelational wellbeing\u003c/em\u003e recorded the highest score among all dimensions (4.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63), reflecting patients\u0026rsquo; evaluations of interpersonal communication, empathy, trust, and perceived professional competence of clinicians. Indicators related to professional competence and respectful communication were rated positively by the majority of respondents.\u003c/p\u003e \u003cp\u003e \u003cem\u003eExperiential wellbeing\u003c/em\u003e, encompassing waiting times, physical comfort, cleanliness, and the overall service environment, demonstrated a mean score of 4.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69. A substantial proportion of respondents reported short waiting times and positive assessments of facility hygiene and physical conditions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRanking of patient wellbeing dimensions among private healthcare users (n\u0026thinsp;=\u0026thinsp;300)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWellbeing Dimension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDescriptive interpretation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional Wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh (positive emotional experience, reduced anxiety)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelational Wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh (strong interaction with clinicians, trust)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperiential Wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh-moderate (comfort, waiting time, environment)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformational Wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate-high (clarity of explanations, guidance)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstitutional Wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate (management, system trust, consistency)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinancial Wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow-moderate (pricing clarity, perceived fairness)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eInformational wellbeing\u003c/em\u003e, reflecting the clarity of explanations, quality of guidance, and communication during the care process, showed a mean score of 4.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72. While most respondents reported satisfaction with clinical explanations, some variability was observed in perceptions of administrative communication.\u003c/p\u003e \u003cp\u003e \u003cem\u003eInstitutional wellbeing\u003c/em\u003e, associated with organizational transparency, efficiency, managerial consistency, and trust in healthcare institutions, yielded a moderate mean score of 3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71. Respondents generally evaluated clinical infrastructure positively, while administrative coordination and feedback mechanisms showed more variability.\u003c/p\u003e \u003cp\u003e \u003cem\u003eFinancial wellbeing\u003c/em\u003e emerged as the lowest-scoring dimension (3.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86). A proportion of respondents reported concerns related to pricing transparency and the predictability of costs, including unexpected additional charges and unclear package pricing.\u003c/p\u003e \u003cp\u003eCollectively, the results demonstrate that relational, emotional, and experiential wellbeing domains received higher evaluations, while institutional and financial dimensions were rated comparatively lower, highlighting heterogeneity in patient-reported wellbeing across different aspects of private healthcare services.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Regression Analysis of Determinants of Overall Wellbeing\u003c/h2\u003e \u003cp\u003eA multiple linear regression analysis was conducted to identify the key determinants of subjective patient wellbeing among users of private healthcare services in Azerbaijan. The OWI\u0026mdash;constructed exclusively from six subjective wellbeing dimensions (emotional, relational, experiential, financial, informational, and institutional wellbeing)\u0026mdash;served as the dependent variable.\u003c/p\u003e \u003cp\u003e The regression model included a set of service-related and system-level explanatory variables, namely service quality, communication quality, timeliness of care, treatment effectiveness, facility environment, and pricing transparency, alongside selected sociodemographic characteristics (age, gender, education level, and socioeconomic status). These variables were conceptualized as determinants shaping patient wellbeing, rather than as components of the wellbeing construct itself.\u003c/p\u003e \u003cp\u003eThe final model demonstrated strong explanatory power, accounting for 62.4% of the variance in overall wellbeing scores (Adjusted R\u0026sup2; = 0.624, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Four service-related factors\u0026mdash;service quality, communication quality, timeliness of care, and pricing transparency\u0026mdash;emerged as statistically significant predictors of the OWI (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple linear regression analysis of determinants of overall wellbeing\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSignifi-cance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eService quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.354\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.281\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTimeliness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.229\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePricing transparency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.163\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment effectiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(ns)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(ns)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026ndash;0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocioeconomic status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e**\u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001; * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; ns\u0026thinsp;=\u0026thinsp;not significant\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eService quality was the strongest determinant of wellbeing (β\u0026thinsp;=\u0026thinsp;0.354, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that perceptions of clinical competence, diagnostic accuracy, and professional conduct exert a substantial influence on patients\u0026rsquo; emotional security, relational trust, and institutional confidence. This finding underscores the central role of perceived clinical excellence in shaping subjective wellbeing outcomes.\u003c/p\u003e \u003cp\u003eCommunication quality was also a highly significant predictor (β\u0026thinsp;=\u0026thinsp;0.281, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Patients who reported clearer explanations, respectful interactions, and meaningful engagement with healthcare professionals demonstrated higher levels of emotional and relational wellbeing, which translated into higher overall wellbeing scores.\u003c/p\u003e \u003cp\u003eTimeliness of care showed a strong positive association with wellbeing (β\u0026thinsp;=\u0026thinsp;0.229, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Shorter waiting times, efficient appointment scheduling, and smooth service flow significantly enhanced experiential and emotional wellbeing, reinforcing the importance of responsiveness in private healthcare settings.\u003c/p\u003e \u003cp\u003ePricing transparency exerted a significant independent effect on wellbeing (β\u0026thinsp;=\u0026thinsp;0.163, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Respondents who perceived healthcare costs as predictable and clearly communicated reported higher levels of financial wellbeing and institutional trust, highlighting the role of transparent pricing as a key determinant of subjective wellbeing rather than as a wellbeing component.\u003c/p\u003e \u003cp\u003eBy contrast, treatment effectiveness (β\u0026thinsp;=\u0026thinsp;0.097, p\u0026thinsp;=\u0026thinsp;0.059) and facility environment (β\u0026thinsp;=\u0026thinsp;0.083, p\u0026thinsp;=\u0026thinsp;0.086) did not retain statistical significance after controlling for other service-related factors. Although both variables contribute indirectly to experiential and cognitive aspects of wellbeing, their independent effects appear to be mediated through stronger determinants such as service quality and communication.\u003c/p\u003e \u003cp\u003eAmong sociodemographic variables, age exhibited a small but statistically significant negative association with wellbeing (β = \u0026minus;\u0026thinsp;0.031, p\u0026thinsp;=\u0026thinsp;0.045), suggesting slightly lower wellbeing perceptions among older respondents. Gender, education level, and socioeconomic status were not significant predictors in the multivariate model, indicating that differences in wellbeing were driven primarily by service characteristics rather than by demographic attributes.\u003c/p\u003e \u003cp\u003eOverall, the regression analysis confirms that subjective patient wellbeing in private healthcare settings is predominantly shaped by service quality, interpersonal communication, system responsiveness, and financial transparency. By clearly distinguishing determinants of wellbeing from the wellbeing construct itself, the model provides a methodologically robust and conceptually coherent explanation of wellbeing formation, fully aligned with the OWI framework employed in this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.5. Comparative Perceptions of Private and Public Healthcare\u003c/h2\u003e \u003cp\u003eRespondents were asked to compare their experiences in private medical institutions (PMIs) and public healthcare facilities across six wellbeing-relevant domains: waiting times, communication quality, facility environment, diagnostic capacity, treatment effectiveness, and pricing transparency.\u003c/p\u003e \u003cp\u003eOverall, 78.3% of respondents reported that private healthcare services were superior to public services across the assessed domains. In contrast, 9.0% perceived public healthcare services as superior, while 12.7% reported no substantial difference between the two sectors (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eComparison of private and public healthcare services across wellbeing-related domains\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate better\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePublic better\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo difference\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaiting times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnostic capacity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment effectiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePricing transparency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAcross all domains, waiting times showed the most pronounced difference, with 84.0% of respondents indicating that private healthcare facilities provided faster and more responsive care. A substantial majority of respondents also rated private institutions as superior in terms of facility environment (88.3%) and communication quality (79.7%).\u003c/p\u003e \u003cp\u003eDifferences were less pronounced for treatment effectiveness, where 58.0% of respondents perceived private institutions as superior, 18.0% favored public facilities, and 24.0% reported no difference. Pricing transparency demonstrated the smallest gap between sectors, with 42.0% favoring private facilities and 27.3% favoring public institutions (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSubgroup comparison of perceptions of private versus public healthcare services\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate better \u0026ndash; Urban (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrivate better \u0026ndash; Rural (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2; / p-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaiting times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnostic accuracy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment effectiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePricing transparency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote: Percentages represent respondents indicating that private healthcare services perform better than public services within each domain. p-values are based on χ\u0026sup2; tests.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.6. Overall Wellbeing Index (OWI)\u003c/h2\u003e \u003cp\u003eAn OWI was constructed to provide an integrated measure of respondents\u0026rsquo; subjective patient wellbeing in private healthcare settings. In line with international wellbeing frameworks and to avoid conceptual overlap between outcomes and service determinants, the index was based exclusively on subjective wellbeing domains, rather than on specific service characteristics.\u003c/p\u003e \u003cp\u003eAccordingly, the OWI aggregated six core dimensions of patient wellbeing: emotional wellbeing, relational wellbeing, experiential wellbeing, financial wellbeing, informational wellbeing, and institutional wellbeing. Each dimension was measured using multiple questionnaire items rated on a five-point Likert scale (1\u0026thinsp;=\u0026thinsp;very low to 5\u0026thinsp;=\u0026thinsp;very high). Dimension scores were calculated as the mean of their respective items.\u003c/p\u003e \u003cp\u003eThe Overall Wellbeing Index was operationalized as the arithmetic mean of the six wellbeing dimensions and calculated using the following formula:\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\(\\:\\)\u003c/span\u003e \u003c/span\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\(\\:\\text{O}\\text{W}\\text{I}=\\frac{1}{6}\\sum\\:_{i=1}^{6}{\\text{W}}_{\\mathfrak{i}}\\)\u003c/span\u003e \u003c/span\u003e \u003c/p\u003e \u003cp\u003ewhere\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{W}}_{\\mathfrak{i}}\\)\u003c/span\u003e \u003c/span\u003e - represents the mean score of each wellbeing dimension (range: 1\u0026ndash;5), and\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e6 represents the total number of wellbeing dimensions included in the index.\u003c/h3\u003e\n\u003cp\u003eAcross the full sample (N\u0026thinsp;=\u0026thinsp;300), the resulting OWI score was 4.09 on the 1\u0026ndash;5 scale, indicating a generally high level of subjective wellbeing among users of private healthcare services in Azerbaijan. Mean values of the individual wellbeing dimensions ranged from 3.88 (institutional wellbeing) to 4.26 (relational wellbeing), reflecting strong interpersonal experiences alongside comparatively weaker perceptions of organizational and systemic performance.\u003c/p\u003e \u003cp\u003eImportantly, service-related characteristics such as service quality, timeliness, treatment effectiveness, facility environment, and pricing transparency were analyzed separately as determinants of wellbeing and were therefore excluded from the OWI construction to prevent circularity between predictors and outcomes.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.7. Correlation Analysis of Wellbeing Dimensions\u003c/h2\u003e \u003cp\u003eA correlation analysis was conducted to examine associations between key service-related dimensions of private healthcare and overall wellbeing. Pearson correlation coefficients were calculated for six domains\u0026mdash;service quality, communication, timeliness, facility environment, treatment effectiveness, and pricing transparency\u0026mdash;and the OWİ.\u003c/p\u003e \u003cp\u003eThe strongest correlations with overall wellbeing were observed for service quality (r\u0026thinsp;=\u0026thinsp;0.72, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), communication (r\u0026thinsp;=\u0026thinsp;0.68, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and timeliness (r\u0026thinsp;=\u0026thinsp;0.61, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Treatment effectiveness (r\u0026thinsp;=\u0026thinsp;0.59, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and facility environment (r\u0026thinsp;=\u0026thinsp;0.54, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) showed moderate positive correlations with overall wellbeing. Pricing transparency exhibited the weakest, though still statistically significant, correlation with overall wellbeing (r\u0026thinsp;=\u0026thinsp;0.46, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003ePairwise correlations among the service-related domains indicated moderate to strong associations, reflecting interrelationships between clinical, interpersonal, experiential, and financial aspects of care. All correlation coefficients were positive and statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation matrix of wellbeing domains and the Overall Wellbeing Index (OWI)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eService Quality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCommu\u003c/p\u003e \u003cp\u003enication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTimeli\u003c/p\u003e \u003cp\u003eness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEnvi\u003c/p\u003e \u003cp\u003eronment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePricing\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEffecti\u003c/p\u003e \u003cp\u003eveness\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eService Quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTimeliness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnvironment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePricing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffectiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSubgroup analyses were conducted to examine differences in overall wellbeing across gender, age group, education level, income status, and place of residence. No statistically significant difference in overall wellbeing was observed between men and women. Mean wellbeing scores were 4.21 for men and 4.18 for women (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.68). Overall wellbeing differed significantly across age groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.017). Respondents aged 55 years and above reported higher wellbeing scores compared with younger adults aged 18\u0026ndash;34 years, with a mean difference of 0.24. A statistically significant difference in overall wellbeing was observed across education levels (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002). Respondents with postgraduate education reported lower wellbeing scores compared with those with secondary education, with a mean difference of \u0026minus;\u0026thinsp;0.27. Income status was significantly associated with overall wellbeing (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005). High-income respondents reported the highest wellbeing scores, while low-income respondents reported lower scores, particularly within the financial wellbeing dimension. A significant difference in wellbeing was observed between urban and rural residents (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004)\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Interpretation of Key Findings\u003c/h2\u003e \u003cp\u003eThe findings of this study demonstrate that subjective patient wellbeing, as captured by the OWI, is shaped by a combination of interpersonal experiences, emotional responses, and system-level conditions within private healthcare institutions in Azerbaijan. Importantly, the OWI reflects patients\u0026rsquo; perceived wellbeing outcomes, whereas service-related characteristics function as determinants influencing these outcomes.\u003c/p\u003e \u003cp\u003eAmong the six wellbeing dimensions comprising the OWI, relational and emotional wellbeing emerged as the strongest components. This indicates that patients place particular value on trust, empathy, respectful communication, and confidence in healthcare professionals. These dimensions capture how patients feel and relate within the care encounter, rather than how services are technically organized. This pattern is consistent with international evidence showing that interpersonal quality is a central driver of subjective wellbeing in healthcare settings (Doyle et al., 2013; Al-Abri \u0026amp; Al-Balushi, 2014).\u003c/p\u003e \u003cp\u003eBy contrast, financial and institutional wellbeing were comparatively weaker components of the OWI. These dimensions reflect patients\u0026rsquo; perceptions of financial security, predictability, organizational consistency, and institutional trust. Their lower scores suggest that, despite strong interpersonal experiences, system-level features such as administrative coordination and cost predictability continue to moderate overall wellbeing outcomes.\u003c/p\u003e \u003cp\u003e Regression analysis further clarified this distinction by showing that service quality, communication quality, timeliness of care, and pricing transparency function as key determinants of the OWI, rather than as components of wellbeing itself. Together, these findings confirm that patient wellbeing in private healthcare is not solely a function of clinical competence but emerges from the interaction between interpersonal care and broader system performance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Wellbeing Dimensions in the Context of International Evidence\u003c/h2\u003e \u003cp\u003eThe multidimensional wellbeing framework applied in this study\u0026mdash;encompassing emotional, relational, experiential, financial, informational, and institutional wellbeing\u0026mdash;aligns closely with international models proposed by the WHO, OECD, and contemporary wellbeing theorists. These frameworks emphasize that wellbeing represents a subjective outcome state, shaped by but conceptually distinct from service delivery mechanisms.\u003c/p\u003e \u003cp\u003eConsistent with findings from upper-middle-income and OECD countries, emotional and relational wellbeing were the strongest dimensions of the OWI. Patients consistently reported feeling emotionally reassured, respected, and supported through interpersonal interactions with healthcare providers. International research similarly highlights that trust, empathy, and communication quality are foundational to subjective wellbeing across diverse healthcare systems (Busse et al., 2017; \u0026Ccedil;elik et al., 2021).\u003c/p\u003e \u003cp\u003eIn contrast, financial and institutional wellbeing demonstrated more moderate scores, reflecting persistent challenges related to perceived affordability, administrative consistency, and institutional reliability. Importantly, these dimensions capture patients\u0026rsquo; felt sense of financial security and organizational trust, rather than objective pricing mechanisms. This distinction is supported by OECD and WHO analyses, which differentiate between financial wellbeing outcomes and pricing transparency or financing arrangements as system-level determinants (OECD, 2023; WHO, 2022).\u003c/p\u003e \u003cp\u003eInformational wellbeing occupied an intermediate position, suggesting that while patients generally perceived diagnostic explanations and guidance as adequate, variability remained in the clarity and consistency of information provision. This pattern mirrors international evidence indicating that informational wellbeing improves with digital health integration but remains sensitive to workflow pressures and provider communication styles.\u003c/p\u003e \u003cp\u003eOverall, Azerbaijan\u0026rsquo;s wellbeing profile reflects a pattern observed internationally: strong interpersonal foundations coexist with systemic constraints that limit financial and institutional wellbeing outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Structural and Socioeconomic Determinants of Patient Wellbeing\u003c/h2\u003e \u003cp\u003eThe subgroup analyses indicate that variation in subjective patient wellbeing, as measured by the OWI, is driven primarily by structural and socioeconomic conditions, rather than by demographic characteristics alone. Geographic location, socioeconomic status, and system-level accessibility emerged as the most influential contextual factors shaping wellbeing outcomes.\u003c/p\u003e \u003cp\u003eUrban residents consistently reported higher OWI scores than rural residents, particularly in experiential, informational, and institutional wellbeing dimensions. These differences reflect disparities in service density, diagnostic availability, digital infrastructure, and administrative capacity, all of which function as determinants influencing patients\u0026rsquo; wellbeing experiences rather than as wellbeing components themselves.\u003c/p\u003e \u003cp\u003eSocioeconomic status also exerted a significant influence on wellbeing, especially within the financial wellbeing dimension. Lower-income respondents reported reduced financial security and greater sensitivity to cost unpredictability, which translated into lower overall wellbeing scores. This finding aligns with international evidence demonstrating that financial vulnerability directly undermines subjective wellbeing, even when interpersonal care quality is perceived as high (OECD, 2023; World Bank, 2023).\u003c/p\u003e \u003cp\u003eImportantly, demographic variables such as gender and education level showed minimal independent effects on the OWI after accounting for service-related and structural factors. This suggests that wellbeing inequalities are primarily system-driven, reinforcing the need for organizational and policy-level interventions rather than narrowly targeted demographic strategies.\u003c/p\u003e \u003cp\u003eTaken together, these findings emphasize that patient wellbeing in private healthcare is shaped by the interaction between individual experiences and broader structural conditions, underscoring the importance of addressing accessibility, financial predictability, and institutional capacity to improve wellbeing outcomes across population groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.4. Cross-Country Implications for Patient Wellbeing\u003c/h2\u003e \u003cp\u003eCross-country evidence provides an important contextual framework for interpreting the wellbeing outcomes observed in Azerbaijan\u0026rsquo;s private healthcare sector. When examined through the lens of the Overall Wellbeing Index (OWI), international comparisons consistently demonstrate that subjective patient wellbeing is shaped by system-level determinants, rather than by clinical performance alone. Across diverse health systems, private healthcare institutions tend to perform strongly in interpersonal and experiential domains, while financial and institutional wellbeing outcomes remain highly sensitive to governance structures, regulatory oversight, and financing arrangements.\u003c/p\u003e \u003cp\u003eEvidence from OECD and WHO countries shows that communication quality, service responsiveness, and perceived clinical competence function as universal determinants of emotional and relational wellbeing, regardless of national income level or system design (Doyle et al., 2013; OECD, 2023; WHO Europe, 2023). Studies from Turkey and Germany, for example, demonstrate that strong interpersonal care and efficient service organization substantially enhance patients\u0026rsquo; emotional reassurance and trust, which translate into higher overall wellbeing outcomes (Busse et al., 2017; \u0026Ccedil;elik et al., 2021). These patterns closely mirror the Azerbaijani findings, where relational and emotional wellbeing emerged as the strongest OWI components.\u003c/p\u003e \u003cp\u003eAt the same time, cross-country comparisons highlight persistent challenges related to financial and institutional wellbeing, particularly in middle-income health systems with mixed public\u0026ndash;private financing models. Research from Brazil, India, and Eastern Europe indicates that reliance on out-of-pocket payments and variability in pricing structures undermine patients\u0026rsquo; perceived financial security, even when interpersonal care quality is high (OECD, 2023; PAHO, 2022; World Bank, 2023). Importantly, these studies distinguish between pricing transparency as a system determinant and financial wellbeing as a subjective outcome, reinforcing the conceptual approach adopted in the present study.\u003c/p\u003e \u003cp\u003eDigital health maturity and governance strength further differentiate wellbeing outcomes across countries. Systems with advanced digital integration\u0026mdash;such as Germany\u0026rsquo;s electronic patient record infrastructure and Turkey\u0026rsquo;s national e-health platforms\u0026mdash;demonstrate higher levels of informational and institutional wellbeing by improving continuity, predictability, and administrative coordination (WHO, 2022; OECD, 2024). Conversely, countries with fragmented digital infrastructure and weaker regulatory enforcement exhibit lower institutional trust and greater experiential uncertainty, particularly among rural and lower-income populations (WHO Europe, 2023).\u003c/p\u003e \u003cp\u003eWithin this international context, Azerbaijan\u0026rsquo;s private healthcare sector exhibits a wellbeing profile that aligns closely with regional and global patterns. Strong interpersonal determinants contribute to high emotional and relational wellbeing, while systemic constraints\u0026mdash;particularly in pricing predictability, administrative coordination, and regional accessibility\u0026mdash;moderate financial and institutional wellbeing outcomes. These similarities suggest that improvements observed in other health systems are achievable through targeted policy interventions focused on governance strengthening, digitalization, and financial transparency.\u003c/p\u003e \u003cp\u003eOverall, the cross-country evidence reinforces the central conclusion of this study: private healthcare can contribute positively to patient wellbeing when service-related determinants are aligned with robust institutional frameworks. For Azerbaijan, aligning private healthcare governance with international best practices\u0026mdash;particularly those emphasized by WHO and OECD\u0026mdash;offers a clear pathway for enhancing multidimensional wellbeing outcomes while reducing socioeconomic and geographic disparities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.5. Strengths and Limitations of the Study\u003c/h2\u003e \u003cp\u003eThis study has several notable strengths. First, it represents one of the first empirical investigations to examine multidimensional subjective patient wellbeing within the private healthcare sector of Azerbaijan. By constructing and applying the Overall Wellbeing Index (OWI), the study moves beyond traditional satisfaction metrics and captures a broader spectrum of emotional, relational, experiential, financial, informational, and institutional wellbeing outcomes.\u003c/p\u003e \u003cp\u003eSecond, the study is based on a robust and diverse sample (N\u0026thinsp;=\u0026thinsp;300), enabling meaningful subgroup analyses and multivariate modelling. The clear conceptual separation between wellbeing outcomes and service-related determinants strengthens the methodological rigor of the analysis and reduces the risk of circularity between predictors and outcomes.\u003c/p\u003e \u003cp\u003eThis study has several limitations that should be acknowledged. First, the cross-sectional design does not allow for causal inference; however, it provides a robust snapshot of multidimensional patient wellbeing within private healthcare institutions and identifies key associations relevant for health services research and policy development. Future longitudinal studies could further explore how wellbeing evolves over time in response to changes in service organization, financing mechanisms, and patient health status. Second, wellbeing was assessed using self-reported measures, which are widely accepted in wellbeing research but may be influenced by subjective perceptions. Nevertheless, subjective wellbeing is a central outcome in patient-centred care frameworks, and self-reported measures remain essential for capturing patients\u0026rsquo; lived experiences. Future research may complement these measures with objective service performance indicators or clinical outcomes to provide a more comprehensive assessment. Finally, although the sample included both urban and rural respondents, it reflects the current concentration of private healthcare services in metropolitan areas. Future studies could extend this research by incorporating public healthcare institutions and comparative public\u0026ndash;private analyses, which would enable a more comprehensive understanding of patient wellbeing across the entire healthcare system and inform more integrated and equitable health policy interventions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.6. Policy and Practice Implications\u003c/h2\u003e \u003cp\u003eThe findings of this study have important implications for healthcare policy and management within Azerbaijan\u0026rsquo;s private healthcare sector. By clearly distinguishing determinants of wellbeing from wellbeing outcomes, the results provide a focused roadmap for targeted interventions.\u003c/p\u003e \u003cp\u003ePolicies aimed at strengthening communication quality, service responsiveness, and pricing transparency are likely to yield substantial improvements in emotional, relational, experiential, and financial wellbeing outcomes. In particular, improving cost predictability through standardized pricing frameworks and clearer pre-service cost communication can directly enhance patients\u0026rsquo; perceived financial security and institutional trust.\u003c/p\u003e \u003cp\u003eInvestments in digital health infrastructure\u0026mdash;such as electronic medical records, digital appointment systems, and patient-facing information platforms\u0026mdash;can further strengthen informational and institutional wellbeing by reducing administrative uncertainty and improving continuity of care. Addressing urban\u0026ndash;rural disparities through targeted incentives for regional service expansion and telemedicine deployment is also essential for reducing wellbeing inequalities.\u003c/p\u003e \u003cp\u003e Importantly, these findings suggest that private healthcare institutions are well positioned to contribute to national wellbeing goals, provided that system-level determinants are aligned with patient-centred governance and transparency standards.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.7. Directions for Future Research\u003c/h2\u003e \u003cp\u003eFuture research should build on the present findings by further examining the dynamic relationship between service-related determinants and subjective wellbeing outcomes in private healthcare settings. Longitudinal study designs would be particularly valuable for assessing how changes in service orga-nization, digital health integration, and financing arrangements shape wellbeing trajectories over time.\u003c/p\u003e \u003cp\u003eMixed-methods approaches incorporating qualitative interviews could provide deeper insight into how patients interpret financial security, institutional trust, and interpersonal care\u0026mdash;dimensions that are central to the Overall Wellbeing Index framework. In addition, integrating objective institutional indicators, such as accreditation status, staffing profiles, or digital maturity scores, would enable more robust multi-level analyses linking organizational performance to patient wellbeing outcomes.\u003c/p\u003e \u003cp\u003eImportantly, future studies should extend this line of inquiry to public healthcare institutions and conduct comparative public\u0026ndash;private analyses. Such research would allow for a more comprehensive understanding of how governance models, financing mechanisms, and service delivery structures influence patient wellbeing across the entire healthcare system.\u003c/p\u003e \u003cp\u003eFinally, future research should explore the development and validation of context-specific wellbeing measurement instruments tailored to national healthcare environments. This would enable more precise and culturally sensitive assessment of wellbeing outcomes while maintaining comparability with established international wellbeing frameworks\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study provides one of the first comprehensive evaluations of multidimensional patient wellbeing within Azerbaijan\u0026rsquo;s private healthcare sector, offering valuable insight into how interpersonal, experiential, financial, informational, and institutional factors jointly shape patient experiences. The findings demonstrate that while relational and emotional wellbeing\u0026mdash;reflecting trust, empathy, and communication quality\u0026mdash;are consistently strong across private medical institutions, overall wellbeing is moderated by systemic limitations in management efficiency, service accessibility, and pricing transparency.\u003c/p\u003e \u003cp\u003eThe mean OWI score of 4.09 on a 1\u0026ndash;5 scale (approximately 81.8 on a 0\u0026ndash;100 scale) indicates a generally high level of patient wellbeing. Nevertheless, meaningful disparities persist across socioeconomic and geographic groups. Urban residents, higher-income individuals, and patients covered by the MHI system reported substantially higher wellbeing, whereas regional and low\u0026ndash;socioeconomic status populations experienced lower scores, particularly in experiential, financial, and institutional domains. These differences highlight the continuing influence of structural inequalities in access, affordability, and institutional capacity within the private healthcare landscape.\u003c/p\u003e \u003cp\u003eMultivariate analyses further revealed that service quality, communication, timeliness, and pricing transparency are the strongest predictors of overall wellbeing. These findings underscore that meaningful improvements in patient wellbeing require more than strong clinical competence and interpersonal care. They also depend on reliable administrative processes, transparent financial practices, and efficient service organization. Strengthening digital health integration, standardizing appointment and workflow systems, and improving pricing transparency are therefore likely to generate substantial gains in experiential, informational, and financial wellbeing.\u003c/p\u003e \u003cp\u003eTaken together, the study emphasizes that improving patient wellbeing in private healthcare requires a balanced dual strategy: preserving the strong interpersonal and clinical foundations already present in many institutions, while simultaneously addressing systemic weaknesses related to organizational capacity, digital readiness, cost predictability, and equity. For policymakers and healthcare leaders, these findings offer a clear, evidence-based framework for aligning private healthcare delivery with international standards of patient-centred wellbeing. Integrating wellbeing as a core performance metric is essential for ensuring accessible, high-quality, and equitable care across all population groups within evolving healthcare systems.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed by the Ethics Committee of Azerbaijan Medical University. The research was conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eAs the study involved an anonymous sociological survey and did not include identifiable personal or clinical data, formal ethical approval and a protocol number were not required. In addition, the research program was approved at the meeting of the Department of Public Health and Healthcare Organization (Protocol № 6, January 8, 2025).\u003c/p\u003e\n\u003cp\u003eParticipation was voluntary, and written informed consent was obtained from all respondents prior to inclusion in the study. Confidentiality and anonymity of the participants were fully ensured throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable. The manuscript does not contain any individual person\u0026rsquo;s data, images, or identifiable information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm that the data supporting the findings of this study are available within the article. Additional datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMusa Alekberov \u0026mdash; Conceptualization, study design, methodology development, supervision, statistical analysis oversight, interpretation of findings, manuscript drafting, and critical revision.\u003c/p\u003e\n\u003cp\u003eYaqut Hajiyeva \u0026mdash; Data collection, survey administration, database development, preliminary data analysis, manuscript editing.\u003c/p\u003e\n\u003cp\u003eNargiz Hajiyeva \u0026mdash; Methodological support, socio-analytical framework development, interpretation of social wellbeing indicators, manuscript review.\u003c/p\u003e\n\u003cp\u003eKamran Babayev \u0026mdash; Literature review, data validation, visualization, and preparation of tables .\u003c/p\u003e\n\u003cp\u003eMahira Sariyeva \u0026mdash; Institutional coordination, data acquisition support, policy context analysis, manuscript proofreading.\u003c/p\u003e\n\u003cp\u003eShamil Aydamirov \u0026mdash; Clinical context interpretation, healthcare system expertise input, results evaluation, and final manuscript review.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAnhang Price, R., Elliott, M. 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(2024). \u003cem\u003eHealth at a glance 2024\u003c/em\u003e. https://www.oecd.org/health/health-at-a-glance/\u003c/li\u003e\n\u003cli\u003eOECD \u0026amp; European Observatory on Health Systems and Policies. (2020). \u003cem\u003eHealth systems in transition: Azerbaijan\u003c/em\u003e. https://eurohealthobservatory.who.int\u003c/li\u003e\n\u003cli\u003ePAHO. (2022). \u003cem\u003eHealth systems and financial protection in Latin America\u003c/em\u003e. https://www.paho.org\u003c/li\u003e\n\u003cli\u003eVanderWeele, T. J. (2017). On the promotion of human flourishing. \u003cem\u003eProceedings of the National Academy of Sciences, 114\u003c/em\u003e(31), 8148\u0026ndash;8156. https://doi.org/10.1073/pnas.1702996114\u003c/li\u003e\n\u003cli\u003eVanderWeele, T. J., McNeely, E., \u0026amp; Koh, H. K. (2019). 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(2023). \u003cem\u003eAzerbaijan health system review\u003c/em\u003e. https://www.worldbank.org/en/country/azerbaijan\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Patient wellbeing, health services research, private healthcare, patient experience, service quality","lastPublishedDoi":"10.21203/rs.3.rs-8730678/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8730678/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePatient wellbeing is increasingly recognised as a key outcome of health system performance, extending beyond traditional indicators of patient satisfaction and clinical effectiveness.In health systems with expanding private sectors, understanding how service delivery processes and institutional factors shape patient wellbeing is particularly important. However, empirical evidence from middle-income countries remains limited. This study aimed to assess multidimensional patient wellbeing in private healthcare institutions in Azerbaijan and to identify its key determinants.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was conducted among 300 adult patients receiving care in private healthcare institutions in Azerbaijan. A structured questionnaire measured six wellbeing-related domains: emotional, relational, experiential, financial, informational, and institutional wellbeing, using a five-point Likert scale. An Overall Wellbeing Index (OWI) was constructed by aggregating domain scores. Descriptive statistics, subgroup analyses, Pearson correlation analysis, and multiple linear regression were used to examine determinants of patient wellbeing.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOverall patient wellbeing was high (OWI\u0026thinsp;=\u0026thinsp;4.09 on a 5-point scale). Relational and emotional wellbeing demonstrated the strongest performance, highlighting the importance of trust, empathy, and communication quality in private healthcare settings. In contrast, financial and institutional wellbeing scored comparatively lower, reflecting concerns related to pricing transparency, administrative coordination, and service consistency. Regression analysis identified service quality, communication, timeliness of care, and pricing transparency as the strongest predictors of overall wellbeing. Subgroup analyses revealed significantly higher wellbeing among urban residents, individuals with higher socioeconomic status, and patients covered by the Mandatory Health Insurance system.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePrivate healthcare institutions in Azerbaijan perform strongly in interpersonal and experiential aspects of care but face persistent system-level challenges related to administrative efficiency, digital readiness, and financial transparency. Strengthening service organisation, pricing transparency, and digital integration may substantially enhance multidimensional patient wellbeing and reduce socioeconomic and geographic disparities. These findings provide policy-relevant evidence for improving patient-centred performance in mixed public\u0026ndash;private healthcare systems\u003c/p\u003e","manuscriptTitle":"Determinants of Multidimensional Patient Wellbeing in Private Healthcare Institutions: Evidence From Azerbaijan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-13 14:41:34","doi":"10.21203/rs.3.rs-8730678/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-15T20:52:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199608769865552292239793022443227255990","date":"2026-03-11T07:48:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-11T06:17:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-16T14:21:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-10T22:21:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-10T08:00:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-02-10T07:39:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6bda7f60-caa1-4b2f-9aa2-9a3ac26d4ff5","owner":[],"postedDate":"March 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-13T14:41:34+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-13 14:41:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8730678","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8730678","identity":"rs-8730678","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}