Rashidian et al. responsiveness aspects in governmental, private and charity hospitals showed that private hospitals per- formed better in all aspects (p-value < 0.001) (Table 3). Comparison of responsiveness domains based on out- patient center type also showed significant differ- ences, in a way that private centers performed better in all aspects (p-value < 0.001) (Table 3). Almost 10% of respondents perceived some sort of discrimi- nation while receiving inpatient services. No differ- ences in this regard were found between public and private centers. No one reported being discriminated against because of their nationality or ethnicity. On the other hand, lack of money and social class were the main reported reasons for discrimination. Principal Component Analysis revealed that three main components explain 61% of the variance for inpatient services responsiveness. First component including communication, autonomy, confidentiality and choice explained 21.9% of variances, 2nd compo- nent included quality of basic amenities and access to social support and 3rd component included prompt attention and dignity domains. PCA for outpatient services responsiveness also found three components explaining 62% of the vari- ances. First component included dignity, communica- tion and autonomy domains, 2nd component included quality of basic amenities and social support and the 3rd component included prompt attention domain. Discussion Except for one article published in Persian on respon- siveness in children care,21 this is the first research paper from Iran about health service responsiveness, while several studies on patient satisfaction and quality of care are available in literature.22-25 It is also of importance that as WHS is valid, comparable in- strument for responsiveness assessment developed by WHO, its use provides a condition to compare the results with the ones of other studies in other coun- tries. On the other hand, results of PCA provide new information for interested researchers of this subject to revise the questionnaire based on it. This study has several important implications. People used governmental health services more de- spite its worse rate in comparison to private sector in terms of responsiveness. Studies in South Africa also indicated that people used governmental health ser- vices more.7 As our study population is in a low in- come district of Tehran, it seems that economic abil- ity of households could be a main factor for using governmental services, especially as the majority of respondents reported that responsiveness aspects were very important to them. This may also demonstrate a geographical access issue, as most private hospitals are located in North, North West and Center of Tehran. Dignity, quality of basic amenities, prompt atten- tion and communication received higher scores in terms of their importance. This is somehow similar to a study of patient expectation in Iran.26 A review of patient expectation study also showed items related to quality and communication that received more im- portance.26 Hospital responsiveness domains scores were lower on autonomy, quality of basic amenities, prompt attention and social support. Autonomy, namely getting information about type of treatment and involving consumer (patients) in decision making about treatment and care options, seems not have been given sufficient attention from health care pro- viders. Hence, training and orientation of medical and Table 3: Percentage of people rated responsiveness domains of outpatient services as "good" or "very good" based on type of center In/Outpatient Type of center Governmental Private Domains Prompt attention 77 80 Dignity b 88 92 Communication b 81 89 Autonomy b 78 87 Confidentiality b 81 88 Quality of basic amenities b 77 83 Choice b 67.5 79 Social support a a a NA. Not applicable for outpatient services, b p- value < 0.001 Charity 58 92 67 66 91 83 75 a 70 75 70 62 78 67 62 70 Inpatient Governmental Private Charity 89 84 78 62 88 72 56 72 50 73 64 60 60 28 50 54 306 WWW.ircmj.com Vol 13 May 2011