Modelling health care customer satisfaction: evidence from Serbia
Customer loyalty, with satisfaction of customers as its main precondition, has long been regarded as an overarching goal of service businesses. With the proliferation of health care providers, which brought about rising competitive pressures on the market, the issue of how to satisfy and keep patients has been attracting increasing attention of researchers and health care management. Therefore, this study aims to examine the antecedents of patient satisfaction and its direct and mediated impact on patients’ behavioural intentions in thus far under-studied context of emerging economy’s health care system. The study has been conducted in a primary health care setting, on a convenience sample of 300 patients, by means of structured questionnaire. The application of structural equation modelling (SEM) revealed direct impact of health care service quality on patient satisfaction and its mediated impact on satisfaction, via perceived value of health care services. In addition to direct influence of satisfaction on patients’ behavioural intentions, its total effect on positive intentions of patients is increased by the impact of patient commitment to a health care provider, which, as evidenced by this study’s findings, increases with patient’s rising trust into a health care provider. Implications for theory and practice are discussed and further research directions are provided.
Adomah-Afari, A., Mantey, D.D.D., & Awuah-Werekoh, K. (2019). Factors influencing a long-term relationship between healthcare providers and patients – perspectives of patients at a public regional hospital, Ghana. International Journal of Pharmaceutical and Healthcare Marketing, 13 (3), 364-386.
Aljaberi, M.A., Juni, M.H., Al-Maqtari, R.A., Lye, M.S., Saeed, M.A., Al-Dubai, S.A.R., & Shahar, H.K. (2018). Relationships among perceived quality of healthcare services, satisfaction and behavioural intentions of international students in Kuala Lumpur, Malaysia: a cross-sectional study. BMJ Open, 8 (9), 021180.
Alrubaiee, L., & Alkaa'ida, F. (2011). The Mediating Effect of Patient Satisfaction in the Patients' Perceptions of Healthcare Quality – Patient Trust Relationship. International Journal of Marketing Studies, 3 (1), 103-127.
Amin, M., & Nasharuddin, S.Z. (2013). Hospital service quality and its effects on patient satisfaction and behavioural intention. Clinical Governance: An International Journal, 18 (3), 238-254.
Anderson, J.C., & Gerbing, D.W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103 (3), 411–423.
Arasli, H., Ekiz, E.H., & Katircioglu, S.T. (2008). Gearing service quality into public and private hospitals in small islands: Empirical evidence from Cyprus. International Journal of Health Care Quality Assurance, 21 (1), 8-23.
Barile, S., Saviano, M., & Polese, F. (2014). Information asymmetry and co-creation in health care services. Australasian Marketing Journal, 22 (3), 205–217.
Berry, L.L., Turner, P.J., Janakiraman, R., Ogburn-Russell, L., Couchman, G.R., Rayburn, W.L., & Grisel, J. (2008). Patients’ Commitment to Their Primary Physician and Why It Matters. Annals of Family Medicine, 6 (1), 6-13.
Boakye, K.G., Blankson, C., Prybutok, V.R., & Qin, H. (2017). An assessment of national healthcare service delivery: a Ghanaian illustration. International Journal of Quality & Reliability Management, 34 (5), 649–666.
Bonds, D.E., Camacho, F., Bell, R.A., Duren-Winfield, V.T., Anderson, R.T. & Goff, D.C. (2004). The association of patient trust and self-care among patients with diabetes mellitus. BMC Family Practice, 5, 26.
Caceres, R.C., & Paparoidamis, N.G. (2007). Service quality, relationship satisfaction, trust, commitment and business‐to‐business loyalty. European Journal of Marketing, 41 (7/8), 836-867.
Chandra, S., Mohammadnezhad, M., & Ward, P. (2018). Trust and Communication in a Doctor-Patient Relationship: A Literature Review. Journal of Healthcare Communication, 3 (3), 1-6.
Chang, C-S., Chen, S-Y., & Lan, Y-T. (2013). Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters. BMC Health Services Research, 13, 22.
Choi, B.J., & Kim, H.S. (2013). The impact of outcome quality, interaction quality, and peer-to-peer quality on customer satisfaction with a hospital service. Managing Service Quality, 23 (3), 188-204.
Choi, K., Cho, W., Lee, S., Lee, H., & Kim, C. (2004). The relationships among quality, value, satisfaction and behavioral intention in health care provider choice: A South Korean study. Journal of Business Research, 57, 913-921.
Chung, K.-H., & Shin, J.-I. (2010). The antecedents and consequents of relationship quality in internet shopping. Asia Pacific Journal of Marketing and Logistics, 22 (4), 473-491.
Crits-Christoph, P., Rieger, A., Gaines, A., & Gibbons, M.B.C. (2019). Trust and respect in the patient-clinician relationship: preliminary development of a new scale. BMC Psychology, 7, 91.
Dang, B.N., Westbrook, R.A., Black, W.C., Rodriguez-Barradas, M.C., & Giordano, T.P. (2013). Examining the Link between Patient Satisfaction and Adherence to HIV Care: A Structural Equation Model. PLoS ONE 8(1), 54729
Drury, A., Payne, S., & Brady, A. (2020). Identifying associations between quality of life outcomes and healthcare-related variables among colorectal cancer survivors: A cross-sectional survey study. International Journal of Nursing Studies, 101, 103434.
Folland, S., Goodman, A.C., & Stano, M., (2017).The Economics of Health and Health Care, International Edition, 8th Edition, Routledge, London and New York.
Grøndahl, V.A., Kirchhoff, J.W., Andersen, K.L., Sørby, L.A., Andreassen, H.M., Skaug, E., Roos, A.K., Tvete, L.S., & Helgesen, A.K. (2018), Health care quality from the patients’ perspective: a comparative study between an old and a new, high-tech hospital. Journal of Multidisciplinary Healthcare, 11, 591–600.
Gupta, S., Brenner, A.T., Ratanawongsa, N., & Inadomi, J.M. (2014). Patient Trust in Physician Influences Colorectal Cancer Screening in Low-Income Patients. American Journal of Preventive Medicine, 47 (4), 417-423.
Hair, J.F., Anderson, R.E., Tatham, R.L., & Black, W.C. (2010). Multivariate Data Analysis: A Global Perspective (7th Edition). Pearson Prentice Hall. NY.
Hillen, M.A., Koning, C.C.E., Wilmink, J.W., Klinkenbijl, J.H.G., Eddes, E.H., Kallimanis-King, B.L., de Haes, J.C.J.M., & Smets, E.M.A. (2012). Assessing cancer patients' trust in their oncologist: development and validation of the Trust in Oncologist Scale (TiOS). Support Care Cancer, 20 (8), 1787–1795.
Hillen, M.A., Butow, P.N., Tattersall, M.H.N., Hruby, G., Boyle, F.M., Vardy, J., Kallimanis-King, B.L., de Haes, H.C.J.M., & Smets, E.M.A. (2013). Validation of the English version of the Trust in Oncologist Scale (TiOS). Patient Education and Counseling, 91 (1), 25–28.
Hillen, M.A., de Haes, H.C.J M., Stalpers, L.J.A., Klinkenbijl, J.H.G., Eddes, E.H., Butow, P.N., van der Vloodt, J., van Laarhoven, H.W.M., & Smets E.M.A. (2014). How can communication by oncologists enhance patients’ trust?, An experimental study. Annals of Oncology, 25 (4), 896–901.
Huynh, H.P., & Dicke-Bohmann, A. (2020). Humble doctors, healthy patients? Exploring the relationships between clinician humility and patient satisfaction, trust, and health status. Patient Education and Counseling, 103 (1), 173–179.
Jabnoun, N., & Chaker, M. (2003). Comparing the quality of private and public hospitals. Managing Service Quality, 13 (4), 290–299.
Jameel, A., Asif, M., Hussain, A., Hwang, J., Bukhari, M.H., Mubeen, S., & Kim, I. (2019). Improving Patient behavioral Consent through Different Service Quality Dimensions: Assessing the Mediating Role of Patient Satisfaction. International Journal of Environmental Research and Public Health, 16 (23), 4736.
Kim, W.G., Lee, Y.-K., & Yoo, Y.-J. (2006). Predictors of relationship quality and relationship outcomes in luxury restaurants. Journal of Hospitality & Tourism Research, 30 (2), 143-169.
Kim, K.H., Kim, K.S., Kim, D.Y., Kim, J.H., & Kang, S.H. (2008). Brand equity in hospital marketing , Journal of Business Research, 61 (1), 75-82.
Lai, I.K.W. (2014). The Role of Service Quality, Perceived Value, and Relationship Quality in Enhancing Customer Loyalty in the Travel Agency Sector. Journal of Travel & Tourism Marketing, 31 (3), 417-442.
Lee, Y.-Y., & Lin, J.L. (2011). How much does trust really matter? A study of the longitudinal effects of trust and decision-making preferences on diabetic patient outcomes. Patient Education and Counseling, 85 (3), 406–412.
Marković, S., Lončarić, D., & Lončarić, D. (2014). Service quality and customer satisfaction in the health care industry - Towards health tourism market, Tourism and Hospitality Management, 20 (2), 155-170.
Martin, L.R., Feig, C., Maksoudian, C.R., Wysong, K., & Faasse, K. (2018). A perspective on nonadherence to drug therapy: psychological barriers and strategies to overcome nonadherence. Patient Preference and Adherence, 12, 1527–1535.
Materla, T., Cudney, E.A., & Hopen, D. (2019). Evaluating factors affecting patient satisfaction using the Kano model. International Journal of Health Care Quality Assurance, 32 (1), 137-151.
Mečev, D., & Kardum Goleš, I. (2015) Primary healthcare service quality measurement: Servqual scale. Ekonomski Vjesnik, 28, 161-177.
Meesala, A., & Paul, J. (2018). Service quality, consumer satisfaction and loyalty in hospitals: Thinking for the future. Journal of Retailing and Consumer Services, 40, 261–269.
Milošević, I., Mihajlović, I., & Stojanović, A. (2019). Dominant factors of SMEs failure - multigroup confirmatory factor analysis. Serbian Journal of Management, 14 (2), 345 - 360.
Moliner, M.A. (2009). Loyalty, perceived value and relationship quality in healthcare services. Journal of Service Management, 20 (1), 76-97.
Moreira, A.C., & Silva, P.M. (2015). The trust-commitment challenge in service quality-loyalty relationships. International Journal of Health Care Quality Assurance, 28 (3), 253-266.
Morgan, R.M. & Hunt, S.D. (1994). The commitment-trust theory of relationship marketing. Journal of Marketing, 58 (3), 20-38.
Naidu, A. (2009). Factors affecting patient satisfaction and healthcare quality. International Journal of Health Care Quality Assurance, 22 (4), 366-381.
Naik Jandavath, R.K., & Byram, A. (2016). Healthcare service quality effect on patient satisfaction and behavioural intentions in corporate hospitals in India. International Journal of Pharmaceutical and Healthcare Marketing, 10 (1), 48-74.
Ng, J.H.Y., & Luk B.H.K. (2020). Patient satisfaction: Concept analysis in the healthcare context. Patient Education and Counseling, 102 (4), 790–796.
Oliver, R L. (1997). Satisfaction: A Behavioral Perspective on the Consumer. The McGraw-Hill Companies, Inc. New York.
Otani, K.A. & Kurz, R.S. (2004). The impact of nursing care and other healthcare attributes on hospitalized patient satisfaction and behavioral intentions. Journal of Healthcare Management, 49 (3), 181-197.
Padma, P., Rajendran, C., & Prakash, S.L. (2010). Service quality and its impact on customer satisfaction in Indian hospitals. Benchmarking: An International Journal, 17 (6), 807-841.
Parasuraman, A., Zeithaml, V.A., & Berry, L.L. (1988). SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. Journal of Retailing, 64 (1), 12-40.
Pevec, T., & Pisnik, A. (2017). The development and validation of an evaluation system for patients’ assessment of health services. Economic Thought and Practice, 2, 611-635.
Pevec, T., & Pisnik, A. (2018). Empirical evaluation of a conceptual model for the perceived value of health services, Slovenian Journal of Public Health, 57 (4), 175-182.
Podsakoff, P.M., MacKenzie, S.B., & Podsakoff, N.P. (2012). Sources of Method Bias in Social Science Research and Recommendations on How to Control It. Annual Review of Psychology, 63 (1), 539-569.
Rajić, T., Milošević, I., & Rakić, A. (2020). The Influential Factors of Health Care Customer Loyalty: Evidence from Serbia. Management: Journal Of Sustainable Business And Management Solutions In Emerging Economies, 25 (2), 77-87.
Roy, P.J., Choib, S., Bernsteinc, E., & Walleye, A. Y., (2020). Appointment wait-times and arrival for patients at a low-barrier access addiction clinic. Journal of Substance Abuse Treatment, 114, 108011
Satsanguan, L., Fongsuwan, W., & Trimetsoontorn, J. (2015). Structural Equation Modelling of Service Quality and Corporate Image that affect Customer Satisfaction in Private Nursing Homes in the Bangkok Metropolitan Region. Research Journal of Business Management, 9 (1), 68-87.
Senic, V., & Marinkovic, V. (2013). Patient care, satisfaction and service quality in health care. International Journal of Consumer Studies, 37 (3), 312-319.
Sheppard, V.B., Wang, J., Yi, B., Harrison, T.M., Feng, S., Huerta, E.E., & Mandelblatt, J.S. (2008). Are Health-care Relationships Important for Mammography Adherence in Latinas?. Journal of General Internal Medicine, 23 (12), 2024–2030.
Sousa, B.M., & Alves, G.M. (2019). The role of relationship marketing in behavioural intentions of medical tourism services and guest experiences. Journal of Hospitality and Tourism Insights, 2 (3), 224-240.
Sumaedi, S., Bakti, I.G.M.Y., Rakhmawati, T., Astrini, N.J., Widianti, T., & Yarmen M. (2016). Indonesian public healthcare service institution’s patient satisfaction barometer (IPHSI-PSB), A new public healthcare patient satisfaction index. International Journal of Productivity and Performance Management, 65 (1), 25-41.
Tsai, T.C., Orav, E.J., & Jha, A.H. (2015). Patient Satisfaction and Quality of Surgical Care in US Hospitals. Annals of Surgery, 261 (1), 2-8.
Upadhyai, R., Kumar, J.A., Roy, H., & Pant, V. (2019). A Review of Healthcare Service Quality Dimensions and their Measurement. Journal of Health Management, 21 (1), 102–127.
Woodside, A,G., Frey, L.L., & Daly, R.T. (1989). Linking service quality, customer satisfaction, and behavioural intention. Journal of Healthcare Marketing, 9 (4), 5-17.
Zeithaml, V.A. (1988). Consumer perceptions of price, quality, and value: a means – end model and synthesis of evidence. Journal of Marketing, 52 (3), 2–22.
The Author wishes to submit the Work to SJM for publication. To enable SJM to publish the Work and to give effect to the parties’ intention set forth herein, they have agreed to cede the first right to publication and republication in the SJM Journal.
The Author hereby cedes to SJM, who accepts the cession, to the copyright in and to the paper.
The purpose of the cession is to enable SJM to publish the Work, as first publisher world-wide, and for republication in the SJM Journal, and to grant the right to others to publish the Work world-wide, for so long as such copyright subsists;
SJM shall be entitled to edit the work before publication, as it deems fit, subject to the Authors approval
The Author warrants to SJM that:
- the Author is the owner of the copyright in the Work, whether as author or as reassigned from the Author’s employee and that the Author is entitled to cede the copyright to SJM;
- the paper (or any of its part) is not submitted or accepted for publication in any other Journal;
- the Work is an original work created by the Author;
- the Author has not transferred, ceded, or assigned the copyright, or any part thereof, to any third party; or granted any third party a licence or other right to the copyright, which may affect or detract from the rights granted to SJM in terms of this agreement.
The Author hereby indemnifies the SJM as a body and its individual members, to the fullest extent permitted in law, against all or any claims which may arise consequent to the warranties set forth.
No monetary consideration shall be payable by SJM to the Author for the cession, but SJM shall clearly identify the Author as having produced the Work and ensure that due recognition is given to the Author in any publication of the Work.
Should SJM, in its sole discretion, elect not to publish the Work within 1 year after the date of this agreement, the cession shall lapse and be of no further effect. In such event the copyright shall revert to the Author and SJM shall not publish the Work, or any part thereof, without the Author’s prior written consent.