Background In Malaysia, patients are free to choose their own primary care healthcare providers at their own expense. Studies show that patients who choose their own doctor are associated with increased patient satisfaction. Primary care paediatricians realise the need to involve parents as stakeholders in today’s competitive healthcare industry.

Objectives This study aimed to identify what factors matter to parents when choosing a paediatric primary care for their children in a free market setting where they have direct access to paediatricians. It also explored if differences in these perceived factors exists between parental education and household income levels.

Methods An analytical cross-sectional study was conducted at two paediatric primary care centres in urban Malaysia. Parents who brought their child to seek treatment at the centres were invited to participate. A face and content validated questionnaire that includes respondents’ demographics was devised from the literature and a focus group discussion. A 5-point Likert scale was applied to 25 elements that were organised into five major domains: ‘consultations’ (CO), ‘facilities and services’ (FS), ‘fees and charges’ (FC), ‘social media engagement’ (SM) and ‘doctor’s ‘appearance’ (DA). Elements within each domain were ranked according to a mean ratings score. Internal consistency for each domain was yielded through a Cronbach’s alpha (α) value. Independent t-test was used to determine the associations between outcomes and independent variables.

Results 387 parents completed the questionnaires (response rate, 91.3%). The mean age of the parents was 37.7 years. 295 (76.2%) parents attained a tertiary education. 157 (40.6%) parents were bottom tier income earners. Parents rated the provision of FS highest (mean rating score=41.63, α=0.84), followed by ratings on the interaction with healthcare providers during CO (34.73, 0.77). Younger aged parents (p=0.021) and parents from lower household income level (p=0.001) had higher FS rating score compared with older parents and parents of higher income respectively. The top elements in the FS domain were a ‘strategic location of the primary care’ and ‘comfortable and clean waiting room’. The CO ratings have a predilection towards technical quality, interpersonal manners and successful provider-patient communications during clinical encounters. In exchange, for FC (11.80, 0.75), parents appeared to tolerate costlier consultation and treatment, but still appreciate bills that are transparent. While parents with a higher level of education prefer to participate in shared decision-making with the paediatricians (p=0.002), parents from lower household income level rated a significantly higher score in SM (p<0.001) and DA (p=0.019).

Conclusions Where parents are free to choose their children’s paediatric primary care service, convenient accessibility and perceived consultation-related proficiency mattered most to parents when deciding. The extent to what makes a difference, appeared to be influenced by parental age, educational and income level. These perceived differences largely confirm the need to invest in the development of individualised support services in a consumer-driven health care system. These preferred elements can provide clue to determine parental satisfaction towards health services provided and predict complex health seeking behaviours.