Comparing public and private hospital care service quality in Turkey

Public and Private Options in Practice: The Military Health System

Recent debates over health care reform, including in the context of the Military Health System (MHS) and Veterans Administration, highlight the dispute between public and private provision of health care services. Using novel data on childbirth claims from the MHS and drawing on the combination of plausibly exogenous patient moves and heterogeneity across bases in the availability of base hospitals, we identify the impact of receiving obstetrical care on versus off military bases. We find evidence that off-base care is associated with slightly greater resource intensity, but also notably better outcomes, suggesting marginal efficiency gains from care privatization.

Process Evaluation of Health System Responsiveness Level and Associated Factors Among Mothers Gave Birth at Obstetric Ward in a Tertiary Hospital, Southwest of Ethiopia: Mixed Study Methods

Background

The term responsiveness emerged during the World Health Organization (WHO) report in 2000 as new and essential goals of the health systems to meet the needs of people to their expectations from different services being given in healthcare systems. Obstetric violence and childbirth mistreatment are global problems, but the worst obstetric violence usually occurs in underdeveloped countries. Thus, the main objective of this study was to evaluate the responsiveness of obstetric service at Jimma University Medical Center.

Methods

A single-case study design with quantitative and qualitative data collection was employed. Availability with 17 indicators and health system responsiveness with 24 indicators were used. Consecutive sampling technique was used to select the clients and qualitative data were collected from key informants. SPSS version 25 was used for the analysis of quantitative data, whereas thematic analysis was conducted for qualitative data. A multiple linear regression model was fitted after all assumptions were checked and fit to ensure the relation of the dependent variable with independent variables.

Results

The overall evaluation was 75.6% and judged good. The resource availability and health system responsiveness were 85.5% and 69.7%, which were judged very good and fair, respectively. A stethoscope and thermometer were not available, while 40% glucose, dexamethasone, and intravenous fluid were the most frequently stocked-out supplies. Dignity (72.1%), confidentiality (71.4%), and prompt attention (70%) were the top three good scores for the health system's responsiveness. Health system responsiveness significantly associated with the following: Not attending formal education, attending college and above, place of delivery (health center), mode of delivery (cesarean section), and being merchant.

Conclusion & Recommendation

The health system responsiveness of delivery service in study setting was good. All stakeholders should work for improving the health system's responsiveness in delivery service.

Patient engagement behaviors in hospitals: the role of word of mouth and patient helping behaviors

Purpose

The purpose of this study is to investigate patient perceived value as a stimulus of patient engagement behaviors both from the conceptual and empirical perspectives.

Design/methodology/approach

Based on the stimulus–organism–response framework, the authors developed a model to determine the impact of patient perceived value on patient engagement behavior in health care. The data were collected from a sample of 391 patients hospitalized in private hospitals. Structural equation modeling technique was used to test the research hypotheses.

Findings

The findings confirmed relevance of the service quality dimensions reliability, tangibility, responsiveness and empathy as significant antecedents of patient perceived value. Perceived value plays a significant role in shaping word of mouth and patient helping behaviors.

Research limitations/implications

The findings of this study are relevant and applicable to patients in private hospitals.

Practical implications

This study contributes to the literature by providing new evidence on patient perceived value and engagement behaviors as a response to care quality. With adequate focus on perceived value and service quality, service providers can strengthen the relationship with patients and build a sustainable competitive advantage, by stimulating engagement behaviors in patients.

Originality/value

This study is of unique value to the health-care literature, both from the theoretical and managerial point of views. This study proposes a conceptual model of patient perceived value which can be used in the private health sector. Moreover, this study contributes to the health-care literature by introducing patient-helping behavior.

The quality of Syrian healthcare services during COVID-19: A HEALTHQUAL approach

Syria is a developing country that face enormous healthcare challenges that aggravated with the outbreak of COVID-19. In the study, we evaluate the perceived healthcare service quality based on hospital type, public and private, using five HEALTHQUAL dimensions. We find that service quality in Syrian private hospitals is perceived better that in public hospitals. However, neither type of hospitals scores exceptionally high in any of the examined HEALTHQUAL dimensions. On the contrary, both hospitals score extremely low in the Improvement dimension. We argue that crowdedness environment, medical staff availability and their low salaries, pricing policies as well as the health insurance system, are to blame for such low perceived quality.

Direct and indirect costs of acute diarrhea in children under five years of age in Indonesia: Health facilities and community survey

BACKGROUND

Diarrhea remains a major cause of child morbidity and mortality in low- and middle-income countries. Reliable data on the economic burden of diarrhea is required to support the selection of appropriate health intervention programs. This study aimed to estimate the costs of acute diarrhea in children under five years of age in Indonesia, a large middle-income country with a substantial diarrheal burden.

METHODS

Direct medical cost data were extracted retrospectively for 1050 children under five years of age with acute diarrhea receiving inpatient care across 45 health facilities in seven Indonesian provinces during 2017-2020. Direct medical costs for children treated in outpatient settings were estimated by collecting unit costs associated with standard diarrhea case management in children. A structured interview of 240 caregivers of inpatients was also conducted retrospectively to estimate direct non-medical costs as well as indirect costs from caregiver income loss.

RESULTS

The weighted average direct medical cost for treatment of acute diarrhea as an inpatient and outpatient across health facility types was US$99.8 (SD±$56.8)(35% room costs, 29% professional fees, 26% medication costs, 10% diagnostic costs) and US$7.6 (SD±$4.3) (34% diagnostic costs, 28% medication costs, 27% professional fees, 10% registration fees), respectively. The average direct non-medical household cost for an acute diarrheal admission was US$4.90 and the indirect cost was US$9.90.

CONCLUSION

There is a significant economic burden associated with acute diarrhea in children in Indonesia. This study, based on a wide variety of health care settings and geographical regions, provides data to inform the economic evaluation of rotavirus vaccines and other diarrheal prevention programs.

FUNDING

This work was supported by a research grant from the Murdoch Children's Research Institute (MCRI) and PATH; and the Indonesian Technical Advisory Group on Immunization (ITAGI).

Differences in health literacy level of patients from public and private hospitals: a cross-sectional study in Turkey

OBJECTIVES

Policy-making based on a health literacy approach makes it a priority to develop people-centered public health strategies and programs, particularly in the time of COVID-19 across the world. This is the first study to assess health literacy levels of patients visiting public and private hospitals in Turkey and also compares these levels with sociodemographic and health-related variables by hospital type to suggest health policies aimed at improving the health literacy skills for patients with different socio-economic backgrounds.

STUDY DESIGN

This is a cross-sectional study.

METHODS

The study was conducted on 948 outpatients from both hospital types in 2018. Health literacy was assessed using the validated Turkish version of the European Health Literacy Survey Questionnaire with 47 items. The level of health literacy and sociodemographic factors influencing it were analyzed using correlation and binary logistic regression tests. Patients from private hospital had better health literacy index score compared with the public hospital.

RESULTS

The health-related variables, such as self-reported health and the presence of long-term illness, and sociodemographic characteristics, including education, age, and gender, were associated with health literacy for both public and private hospitals. Age and education were important predictors, whereas gender, long-term disease condition, self-reported health, and perceived income status were statistically significant variables for adequate health literacy in both hospital types.

CONCLUSIONS

Participants from private hospital had better health literacy than that of public hospital. These findings could be used to help health policy makers to improve the current health literacy policy for patients and develop strategies by stakeholders for reducing barriers to obtaining health-related information.

SERVQUAL Method as an "Old New" Tool for Improving the Quality of Medical Services: A Literature Review

The second half of the 20th century saw the development of a new trend in the management of medical services across Europe. Those shifts were associated with the transformation of various spheres of human life, both on professional and private levels. The service market then turned back to "quality", already known in antiquity. According to Aristotle, "quality" is one of the basic categories of thought and reality of the human population. The research material was obtained from literature databases, including Scopus, Cochrane, Medline, and PubMed, as well as from literature reports, including monographs, research papers (e.g., doctoral dissertations), and others. The available literature was assessed with regards to the abovementioned objectives of our study and considering possible advantages from its implementation. Therefore, the applied research method was based on a bibliographic query and desktop data analysis. The adopted research methodology hinged on exploration, compilation, analysis, and processing of data and information from available sources, resulting in drawing up of summary conclusions. The obtained data were subjected to reciprocal confrontation with an attempt to evaluate new possibilities of using the method in other medical specialties. The Servqual method enables us to learn the patient's expectations, while the service provider can identify irregularities and implement corrections. It allows the executive staff of medical facilities to change elements of medical procedures, which improves the quality of the service provided and thus increases the satisfaction and compliance of patients.

A new service quality scale for hospital emergency rooms

Purpose

Service quality and patient satisfaction have a significant impact in healthcare. Health organizations have also begun to put the customer at the center and meet his or her needs. This study aims to indicate the need to develop a simple and appropriate scale for measuring quality of service in hospital emergency rooms.

Design/methodology/approach

The validity and reliability of the scale were established by three separated and independent studies that used exploratory factor analysis, confirmatory factor analysis and correlation analysis to test the nomological network validity of the scale. The data was collected randomly from an internet panel that comprises more than 50,000 people over the age of 18. The research is based on 1,002 Israelis who accompanied a patient to a hospital emergency room.

Findings

In total, 23 items comprised the new scale of emergency room service quality with three dimensions: “staff professionalism”, “staff caring” and “tangibles”. The internal reliability for the total scale was high with Cronbach'sαof 0.97.

Research limitations/implications

In Israel, there is a state health system, and therefore, it is necessary to check the scale elsewhere in the world.

Originality/value

The measurement of service quality for emergency room needed to be focused on the unique charters of the service provided in hospitals’ emergency room. The findings show that a client may assesses the service their loved one has received to decides whether to return to the same hospital and recommend it to his or her friends.

Assessment of the Quality of Public Hospital Healthcare Services by using SERVQUAL

Hospital healthcare service quality measurement represents an important approach for advancing healthcare systems. This paper presents preliminary results of a research on the quality of healthcare services provided by a large, public, university hospital centre in Croatia, based on the Gaps Model of Service Quality and the SERVQUAL instrument. The importance of particular service quality dimensions was analyzed, as well as the gaps between patient perceptions and expectations of healthcare services provided by 18 departments of the university hospital centre. Results revealed the gaps that exist at the level of the university hospital centre as a whole, showing the size variations in different service quality dimensions. The management of the university hospital centre should improve healthcare service quality in all dimensions by paying particular attention to the 'responsiveness' and 'tangibility', where the largest gap was identified.

Comparing public and private hospitals’ service quality

Background

Saudi Arabia’s health care system has undergone major changes in recent years to enhance the quality of the services it renders to the community. This study is designed to measure the quality of health care services from the patients’ perspective and to compare the service quality of public and private hospitals in the eastern region of Saudi Arabia.

Methods

The study has a quantitative cross-sectional design, with a questionnaire based on the SERVQUAL dimensional model. It was a random sample of 258 inpatients at private and public hospitals in Eastern Saudi Arabia.

Results

Patients at private hospitals perceived a higher level of quality of the health care services (t = 3.390, p < 0.01).

Conclusions

Further research on the financial and leadership dimensions of health care quality will contribute to improved planning for health care services.

Factors Affecting the Choice of National and Public Hospitals Among Outpatient Service Users in South Korea

The present study analyzed factors underlying outpatient service users' choice of national and public (rather than private) hospitals. Based on Andersen's Behavioral Model, we developed a framework that covered needs, enabling, and personal factors. Data of outpatient service usage were obtained from the Korean medical panel survey during 2008 to 2013. Logistic regression analyses were conducted, and results revealed that the rate of national and public hospital use was very low (5.57%), and our model adequately explained variance in service use. Specifically, several demographic factors-older age, low income, national merit and medical care, being chronically ill, and having a disability-were predictive of whether an individual is likely to choose national and public hospitals. We discuss the need to strengthen national and public hospitals' medical services in order to better manage care for low-income vulnerable groups.

Dimensions of service quality in healthcare: a systematic review of literature

PURPOSE

Various dimensions of healthcare service quality were used and discussed in literature across the globe. This study presents an updated meaningful review of the extensive research that has been conducted on measuring dimensions of healthcare service quality.

DATA SOURCES

Systematic review method in current study is based on PRISMA guidelines. We searched for literature using databases such as Google, Google Scholar, PubMed and Social Science, Citation Index.

STUDY SELECTION

In this study, we screened 1921 identified papers using search terms/phrases. Snowball strategies were adopted to extract published articles from January 1997 till December 2016.

DATA EXTRACTION

Two-hundred and fourteen papers were identified as relevant for data extraction; completed by two researchers, double checked by the other two to develop agreement in discrepancies. In total, 74 studies fulfilled our pre-defined inclusion and exclusion criteria for data analysis.

DATA SYNTHESIS

Service quality is mainly measured as technical and functional, incorporating many sub-dimensions. We synthesized the information about dimensions of healthcare service quality with reference to developed and developing countries. 'Tangibility' is found to be the most common contributing factor whereas 'SERVQUAL' as the most commonly used model to measure healthcare service quality.

CONCLUSION

There are core dimensions of healthcare service quality that are commonly found in all models used in current reviewed studies. We found a little difference in these core dimensions while focusing dimensions in both developed and developing countries, as mostly SERVQUAL is being used as the basic model to either generate a new one or to add further contextual dimensions. The current study ranked the contributing factors based on their frequency in literature. Based on these priorities, if factors are addressed irrespective of any context, may lead to contribute to improve healthcare quality and may provide an important information for evidence-informed decision-making.

Service quality: A subliminal pathway to service differentiation and competitive advantage in private healthcare marketing in Ghana

The study investigates the role of service quality in Ghana's private hospitals and its effect on patients' satisfaction and loyalty. A sample of 622 respondents was drawn using convenience sampling. Structural equation modeling using smart PLS was used to test the measures. The study found a significant positive relationship between service quality and patient satisfaction and also a significant positive relationship between patients' satisfaction and loyalty and that patients' satisfaction mediates the relationship between service quality and patients' loyalty. The study provides a useful guide to policy formulation for private healthcare practitioners.

Do patients really perceive better quality of service in private hospitals than public hospitals in India?

Purpose

The purpose of this paper is to compare perceived service quality of public/government and private medical college hospitals.

Design/methodology/approach

This study adopts a descriptive, cross-sectional and research design. The research sample includes 340 in patients from six medical college hospitals located in the state of Odisha, India. Primary data are collected through a structured closed ended questionnaire containing 66 items on 1–7 point Likert scale. Statistical tools like factor analysis and ANOVA are performed with the help of SPSS-17 software to analyze the collected data.

Findings

This study identifies 13 dimensions of perceived hospital service quality. The comparative study indicates better performance of public/government hospitals across the technical dimensions of perceived service quality, whereas private hospitals report better performance across majority of the functional dimensions.

Originality/value

In the Indian healthcare system, public hospitals provide low-cost healthcare targeted toward low to middle socio-economic population whereas, large corporate private hospitals provide high-cost healthcare targeted toward high-income group. So the comparison between them produces an obvious result indicating better service quality in private hospitals. Present study minimizes this gap by comparing the service quality of public and private medical college hospitals. Medical colleges ensure access to health services for a larger group of people. Thus, similarity in the segment of population receiving medical services in public and private medical colleges is higher, making the comparison of perceived service quality fairer.

Understanding health care service quality in developing Latin America

Researchers have overlooked how poor consumers judge service quality in health care settings in Latin America. This research addresses this void by exploring how vulnerable consumers evaluate quality in a public hospital. The results show that vulnerable consumers evaluate hospitals on service delivery process, physician-patient relationship, and medical service reliability. Vulnerable consumers judge health care quality foremost on a provider's ability to provide them with fairness. The results also show that vulnerable consumers view the quality of their relationship with a physician just as important as reliability. Hospitals that serve vulnerable patients should strive to emphasize fairness and empathy.

Service quality and satisfaction in healthcare sector of Pakistan- the patients' expectations

Purpose The purpose of this paper is to assess the influence of patients' expectations from healthcare service quality on their satisfaction with nursing in public and private hospitals of Pakistan. Design/methodology/approach Data ( n=456) were collected from three public sector hospitals and three private sector hospitals of Lahore, the capital of Pakistan's most populous province. Male and female patients who have experience of both sectors were surveyed using a self-administered questionnaire developed using the original SERVQUAL approach. Data were analyzed using the statistical techniques and the Laplace criterion. Findings This paper attempts to explain degree of influences of five service quality constructs (empathy, responsiveness, tangibility, reliability and assurance) on Pakistani patients' expectations from the private and public sector hospitals and thus patient satisfaction. Further, this work can offer several intuitions into the effect of five constructs of service quality on patients' expectations of healthcare service quality and patient satisfaction with the service providers/nursing. The results reveal that the patient satisfaction is most strongly related to empathy in public sector and to responsiveness in private sector. Research limitations/implications In light of the previous studies and the current research findings, the study anticipates no apparently significant improvement in healthcare sector of Pakistan in near future considering various factors discussed in the study. The study will also help the service providers and the policy makers in understanding the deteriorating situation of the Pakistani healthcare sector and will guide them in identifying the areas by improving which not only the healthcare service quality in the country can be improved but also the image of healthcare sector among the masses and competitiveness of the healthcare sector can be enhanced. Originality/value The value of the study rests in its critical analysis of the current status of the healthcare sector of Pakistan with a view to suggest the areas that need to be worked on by the service providers and policy makers. Also, the study tries to settle a controversy within Pakistani healthcare literature concerning the question that who is producing more satisfied patients: private hospitals or their public counterparts?

Patients' satisfaction and public and private sectors' health care service quality in Pakistan: Application of grey decision analysis approaches

PURPOSE

The study aims to evaluate the comprehensive relationship between patient satisfaction and five dimensions of health care service quality in Pakistani public/private health care sectors, using a novel grey relational analysis (GRA) models and the Hurwicz criteria of decision making under uncertainty.

DESIGN/METHODOLOGY/APPROACH

Data were collected from private and public health care facilities of Pakistan through an improved SERVQUAL instrument. Deng's GRA, absolute GRA, and the second synthetic GRA models were applied to address the problem under study.

FINDINGS

Grey relational analysis models revealed that reliability and responsiveness are most strongly predicting patient satisfaction in public and private health care sectors, respectively. The Hurwicz criteria showed that patients are more likely to be satisfied from private health care facilities.

LIMITATIONS/IMPLICATIONS

Limitations of SERVQUAL model are also the limitations of the study; eg, the study suggests that because of the absence of "cost," which is a key quality indicator of Pakistani public sector health care facilities, the model was unable to comprehensively evaluate the health care situation in light of the observations of price-focused Pakistani patients. The study recommends tailoring of SERVQUAL model for the resource-scant and underdeveloped countries where people's evaluation of the quality of the hospitals is likely to be influenced by the price of services.

ORIGINALITY/VALUE

The study is a pioneer in health care evaluation of public and private sectors of Lahore and Rawalpindi while using GRA models, in general, and the second synthetic GRA model, in particular. It presents an alternative method to the statistical way of analyzing data by successfully demonstrating the use of grey methods, which can make reasonable decisions even through small samples.

Service quality in Iranian hospitals: A systematic review and meta-analysis

Background: This study aimed to explore service quality in Iranian hospitals by a systematic review and meta-analysis of the existing literature.

Methods: The literature search in the international (PubMed, Scopus, and the ISI) and Iranian (SID, Iranmedex, and Magiran) scientific databases was conducted to identify studies (published in English and Persian) used the service quality gap (SERVQUAL) model to examine service quality in Iranian hospitals between 2000 and 2016. The databases were searched using a combination of the following keywords: "hospital service quality", or "healthcare service quality", and "SERVQUAL model", or "gap model", and "Iran". A random-effects meta-analysis model was used to investigate the quality of hospital care in Iran.

Results: A total of 13 articles with 4,217 patients were included in the study. Results indicate that there are negative gap values between patients' expectations and perceptions in six SERVQUAL dimensions namely. tangibility, reliability, responsiveness, assurance, empathy, and access. The overall mean score of patients’ expectations and perceptions of quality of hospital care in Iran were estimated 4.59 and 3.69, respectively (i.e., quality score gap= -0.9). The highest and lowest quality score gap values were related to the reliability and responsiveness dimensions, correspondingly.

Conclusion: The study found that expectations of patients from hospital care have not been met in Iran. Thus, improving service quality in Iranian hospitals warrants further attention by health professionals, health policy-makers, and hospital managers.

Healthcare service failure: how dissatisfied patients respond to poor service quality

Purpose

Few scholars have so far explored how healthcare service quality affects patient dissatisfaction, leading to negative behavior responses when a healthcare service fails. The purpose of this paper is to examine how different service quality attributes affect patient dissatisfaction leading to a variety of asymmetric negative behavior responses.

Design/methodology/approach

Following a survey of 453 dissatisfied outpatients in Korea, structural equation modeling with a series of post hoc analyses is used to test the research model. It consists of five hypotheses.

Findings

Outcome quality is found to be the most significant variable affecting patient dissatisfaction, followed by administrative quality, interactive quality, and environmental quality. Dissatisfied patients tend to engage more in active behaviors (e.g. negative word-of-mouth, switching, and complaining) than in remaining passive in a non-linear way. Also, the mediating role of dissatisfaction is found to be significant.

Research limitations/implications

This paper has empirically identified the most significant service quality attributes that lead to dissatisfied patients and negative behaviors on their part. These findings indicate that different quality attributes of service failure lead to different actions. However, this study has suffered from a few limitations as a result of its research context and scope.

Originality/value

This paper is one of the very few empirical studies examining the relationships among the output and process quality attributes, patient dissatisfaction, and actual behaviors in a healthcare service failure context.

Brand equity and the role of emergency medical care service quality of private cardiac institutes

Purpose

The purpose of this paper is to investigate the impact of health-care quality of emergency medical services on brand equity of cardiac institutes by using industry-specific measure, 5Qs model of health-care service quality (HCSQ).

Design/methodology/approach

Survey method technique has been used to collect data from the patients availing emergency medical services from 12 cardiac institutes. Effective responses have been received from 393 patients from four localities. Systematic sampling technique has been used to collect data from the respondents. Partial least square structural equation modeling using smartPLS 2.0 has been used to analyze the results.

Findings

Findings of the study reveal that HCSQ has weak relationship with hospital brand loyalty but strong relationship with brand image and brand awareness. Furthermore, brand awareness and brand image have strong relationship with brand loyalty. Furthermore, brand image and brand loyalty have strong relationship with overall hospital brand equity but found nonsignificant relationship of brad awareness with overall hospital brand equity.

Originality/value

The principal contribution of the paper is to provide the insight on the impact of emergency HCSQ on brand equity of the private cardiac hospitals. Second, this study is first in branding literature that has used industry-specific scale 5Qs model to measure the service quality of emergency medical care and its impact on private sector cardiac hospital’s brand equity. Previously researchers used generic scales that were insufficient to measure the service quality of specialized industries (Babakus and Mangold, 1992; Carman, 1990; Caro and Garcia, 2007).

A new approach in exploring satisfaction with nursing care by nurses themselves

AIMS AND OBJECTIVES

To examine the level of satisfaction with nursing care from nurses' perspectives, as patients and/or as caregivers for hospitalised relatives.

BACKGROUND

Many studies that have examined patients' satisfaction with nursing care in Jordan and worldwide found high ratings of satisfaction with nursing care among patients. These ratings may be inflated because patients, as the recipients of care, are often unequipped to judge specific aspects of care, unless the patient is also a nurse.

METHODS

A descriptive cross-sectional design was used. Data were collected using the Patients Satisfaction with Nursing Care Quality Questionnaire. The total sample size was 231 registered nurses from eight hospitals in Jordan. All participating nurses had either experienced hospitalisation for a minimum of 24 hr for themselves or as caregivers for one of their close relatives, currently or within the last year.

RESULTS

The average age of participants was 31.7 (SD = 0.40) years. Most of the participants were female with <10 years of work experience. The average score for the level of satisfaction was 2.96 of 5, which reflects a moderate level of satisfaction with nursing care. None of the 19 items of the satisfaction scale exceeded the moderate level. The highest mean score of satisfaction level was 3.20 (SD = 1.17) for the skills and competence of nurses, while the lowest mean score was 2.68 (1.22) for the coordination of care after discharge.

CONCLUSION

Nurses as patients and/or caregivers evaluated the nursing care during their hospitalisation differently in comparison with public patients. The findings indicated that nurses perceived only moderate levels of satisfaction when undergoing experiences of hospitalisation.

RELEVANCE TO CLINICAL PRACTICE

The findings from this study may help nurses to become more alert for meeting the patients' needs as desired under the best practice.

Comparison of Responsiveness Level in Iranian Public and Private Physiotherapy Clinics: a Cross-Sectional Multi-center Study

Introduction:

Responsiveness is a main goal of health systems. Responsiveness focus on the non-medical aspects of health services delivery. This study was aimed to assess responsiveness level in public and private physiography clinics.

Methods:

In this multicenter cross sectional study, 403 patients refers to 16 public and 64 private physical therapy clinics were studied randomly in Ahvaz, Iran, from 2013 to 2014. Data were collected based on a valid health system responsiveness questionnaire that was developed by WHO. Health system responsiveness questionnaire for outpatients care includes seven components and 25 questions. Statistical relationship between responsiveness level of centers and patients characteristics was analyzed using Pearson coefficient, Independent t-test and one-way ANOVA.

Results:

Out of 403 patients, 299 (74.19%) patients were women. The mean (±SD) age of the patients was 42(±14.18) years and 92.1% of patients were 65> years. Responsiveness status in private and public physiotherapy clinics was assessed excellent (26.93±5.2) and very well (21.08±5.8) respectively. In private clinics, the mean score of communication dimension (3.96±1) and autonomy dimension (3.95±0.9) was higher than other dimensions. In public clinics the mean score of dignity (3.30±0.8), autonomy (3.16±0.9), and prompt attention (3.12±1) was higher than other areas respectively. In public and private clinics, quality of basic amenities area had the lowest score.

Conclusions:

The results showed that the some patients and center characteristics such as gender and work shift were factors affecting assessment of responsiveness. Responsiveness level in private centers was better than publics.

Equating the expected and perceived service quality

Purpose

The purpose of this paper is to investigate patients’ views toward the perceived service quality of public and private healthcare service providers. Determinants of healthcare service quality were compared by carrying out a GAP analysis to equate perceived and expected services and examined differences in the service quality.

Design/methodology/approach

The study sample comprises 310 inpatients of public and private healthcare service providers. Self-administered questionnaires were used along a five-point Likert scale and analyzed through the Statistical Package for Social Sciences. GAP analysis was used to observe the difference between expectations and perceived service quality.

Findings

A cross-sectional study revealed significant quality gaps between the expected and perceived services of public and private healthcare service providers; conversely patients’ expectations are not fully met in both types of hospitals. Private hospitals surpassed in terms of overall perceived service quality from their counterparts. Perceived services were found better in terms of physician medical services in public sector hospitals, while rooms and housekeeping services were found better in terms of private sector hospitals.

Practical implications

The result can be used by both public and private healthcare service providers to restructure their quality management practices which could only be possible through effective management commitment, regular patients’ feedback and translucent complaint procedures.

Originality/value

The study conceptualizes the expected and perceived hospital service quality dimensions as an eight-dimensional framework. A comparison between public and private sector hospitals is made to get a better understanding about the differences in the perceived healthcare services among two sectors. Consequences of the study will aid hospital managers and policy makers to get a fuller picture of healthcare services in order to contrive enhancement practices.

Comparison Quality of Health Services between Public and Private Providers: The Iranian People's Perspective

INTRODUCTION

Health services quality has been the most important criteria of judging, and its improvement causes people's satisfaction of health systems. In a health system, public and private sectors provide services and typically have been effective in promoting health services quality of community. The aim of this study was to compare the quality of health services in both public and private sectors from the perspective of residents in Qazvin (Iran).

METHODS

This cross-sectional study was conducted in 2014. The study population included all residents of Qazvin Province, and the sample size was estimated to 1002. The research tool was a perceptions of services quality standard questionnaire. Data were collected by trained interviewers visiting homes and were analyzed by IBM-SPSS software version 22 and t-test and linear regression. Cronbach's alpha coefficient was 0.91 and test-re-test coefficient was 83%.

RESULTS

741 people (74%) in their last visit to receive services were referred to the public sector. Between the perception of people participating in the study about medical equipment and supplies, welfare facilities, competence and experience of doctor, waiting time, rapid reception, and access to doctor in public and private sectors, significant differences were observed (p < 0.05). In the tangible realm in perception of health services, there was a significant difference in quality between the public and private sectors (p < 0.05). In addition, place of receiving services, waiting time, education, occupation, and type of received services were affecting factors in regards to perceptions of health services from the perspective of Iran's population (p < 0.05).

CONCLUSION

The results showed the importance of a tangible realm on people's satisfaction of health services. It seems that the public sector should pay more attention to this issue.

How patients think about social responsibility of public hospitals in China?

BACKGROUND

Hospital social responsibility is receiving increasing attention, especially in China where major changes to the healthcare system have taken place. This study examines how patients viewed hospital social responsibility in China and explore the factors that influenced patients' perception of hospital social responsibility.

METHODS

A cross-sectional survey was conducted, using a structured questionnaire, on a sample of 5385 patients from 48 public hospitals in three regions of China: Shanghai, Hainan, and Shaanxi. A multilevel regression model was employed to examine factors influencing patients' assessments of hospital social responsibility. Intra-class correlation coefficients (ICCs) were calculated to estimate the proportion of variance in the dependent variables determined at the hospital level.

RESULTS

The scores for service quality, appropriateness, accessibility and professional ethics were positively associated with patients' assessments of hospital social responsibility. Older outpatients tended to give lower assessments, while inpatients in larger hospitals scored higher. After adjusted for the independent variables, the ICC rose from 0.182 to 0.313 for inpatients and from 0.162 to 0.263 for outpatients. The variance at the patient level was reduced by 51.5 and 48.6 %, respectively, for inpatients and outpatients. And the variance at the hospital level was reduced by 16.7 % for both groups.

CONCLUSIONS

Some hospital and patient characteristics and their perceptions of service quality, appropriateness, accessibility and professional ethics were associated with their assessments of public hospital social responsibility. The differences were mainly determined at the patient level. More attention to law-abiding behaviors, cost-effective health services, and charitable works could improve perceptions of hospitals' adherence to social responsibility.

Measuring patients’ healthcare service quality perceptions, satisfaction, and loyalty in public and private sector hospitals in Pakistan

Purpose

This study aims to explore the relationship between healthcare perceived service quality (HCSQ) and patient loyalty. Mediating role of patient satisfaction is also assessed between HCSQ and patient loyalty.

Design/methodology/approach

A sample of 600 was gathered using stratified random sampling technique from inpatients of public and private sector hospitals of Pakistan through self-administered questionnaire, and was analyzed through regression analysis.

Findings

Findings indicate that healthcare perceived service quality has a significant positive effect on patients’ loyalty. Patient satisfaction also mediates the relationship between HCSQ and patient loyalty. Findings state that there is a significant difference between HCSQ which is perceived by the patients of both public and private sector hospitals. Differences suggest that the patients of private sector hospitals were found more satisfied than their counterparts.

Practical implications

The results indicate that hospital managers should have knowledge about the perceptions and satisfaction of patients as it leads to a step towards introducing reforms in the quality of healthcare sector.

Originality/value

No such particular research in literature has been made earlier in Pakistan’s context which has assessed the perceptions of patients in terms of HCSQ dimensions as being addressed in this study. Thus, this study endeavors to fill that gap in terms of measuring healthcare services provided by both public and private sector hospitals. Outcomes of this study will enable hospitals’ managers to get a better understanding towards stronger as well as weaker aspects of service quality, and will help in observing factors which contribute towards patients’ satisfaction and patient loyalty in building long term relationships between hospital and patients.

Measuring patient-perceived hospital service quality: a conceptual framework

Purpose

Although measuring healthcare service quality is not a new phenomenon, the instruments used to measure are timeworn. With the shift in focus to patient centric processes in hospitals and recognising healthcare to be different compared to other services, service quality measurement needs to be tuned specifically to healthcare. The study’s purpose is to design a conceptual framework for measuring patient perceived hospital service quality, based on existing service quality literature

Design/methodology/approach

Using hospital service quality theories, expanding existing healthcare service models and literature, a conceptual framework is proposed to measure hospital service quality. The article outlines inpatient perceived service quality dimensions

Findings

An instrument for measuring hospital service quality dimensions is developed and compared with other service quality measuring instruments. The latest dimensions are in line with previous studies, but a relationship dimension is added.

Practical implications

The framework empowers managers to assess healthcare quality in corporate, public and teaching hospitals.

Originality/value

The article helps academics and practitioners to assess hospital service quality from a patient perspective.

Evaluation of the Quality of Health Service Providers: The Iranian People Perspective 2014

INTRODUCTION

Quality is the center of attention in all service providing organizations that are effective in promoting satisfaction of patients who are referred to medical centers. The aim of this study was to investigate the quality of health service providers in a case study of Qazvin, Iran, in 2014.

METHODS

This descriptive study was conducted on 1,002 people who were residents of Qazvin Province (Iran) in 2014. The people were selected randomly from the population of the study area. The main variables studied were education, perceptions, expectations, and gaps in service quality. The data collection tool was the standard Servequal questionnaire. To determine the reliability of the research tool, we used Cronbach's Alpha coefficient and the test-retest method. Statistical analyses were conducted using SPSS and the ANOVA test.

RESULTS

The mean age of people included in the study was 32 ± 9.9 years, and the average waiting time to receive services was 73 ± 47 minutes. Hospitals and doctors' offices had the highest quality gap of -1.420 ± 0.82 and -1.01 ± 0.75, respectively. The service quality gaps in medical centers, health providers of rural area, and health providers of urban area were -0.883 ± 0.67, -0.882 ± 0.83, and -0.804 ± 0.62, respectively. There was a significant relationship between peoples' perceptions and expectations concerning the quality of health services and their educational levels.

CONCLUSION

The higher gaps in quality in hospitals and in doctors' offices require more attention. Managers and policy makers should consider developing and implementing plans to reduce these gaps in quality and to promote better health services in these two sectors.

An Investigation of Service Quality—Willingness to Recommend Relationship across Patient and Hospital Characteristics

This study investigates onto which dimensions of service quality have more impact on patients’ overall quality perceptions of a hospital and seeks to determine the nature of relationship between service quality and patients’ willingness to recommend a hospital to their friends and family. The study also uncovers if the levels of service quality and recommendation behaviours and the relationship between service quality and recommendation behaviour exhibit similar patterns among male versus female, black versus white patients and small/medium versus large hospitals. Data gathered via mail questionnaires and phone interviews from a large sample of the patients of a hospital system in the Southern United States serve as the study setting. Results are presented and their implications are discussed. Avenues for future research are offered.

Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

INTRODUCTION

Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services.

OBJECTIVES

The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services.

MATERIALS AND METHODS

The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected.

RESULTS

All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel.

CONCLUSION

Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility.

Customer perceived service quality, satisfaction and loyalty in Indian private healthcare

Purpose

– The purpose of this paper is to analyse how perceived service quality and customer satisfaction lead to loyalty towards healthcare service providers.

Design/methodology/approach

– In total, 475 hospital patients participated in a questionnaire survey in five Indian private hospitals. Descriptive statistics, factor analysis, regression and correlation statistics were employed to analyse customer perceived service quality and how it leads to loyalty towards service providers.

Finding

– Results indicate that the service seeker-service provider relationship, quality of facilities and the interaction with supporting staff have a positive effect on customer perception.

Practical implications

– Findings help healthcare managers to formulate effective strategies to ensure a better quality of services to the customers. This study helps healthcare managers to build customer loyalty towards healthcare services, thereby attracting and gaining more customers.

Originality/value

– This paper will help healthcare managers and service providers to analyse customer perceptions and their loyalty towards Indian private healthcare services.

Implementing hospital quality assurance policies in Iran

Purpose

– The purpose of this paper is to provide an overview of applied hospital quality assurance (QA) policies in Iran.

Design/methodology/approach

– A mixed method (quantitative data and qualitative document analysis) study was carried out between 1996 and 2010.

Findings

– The QA policy cycle forms a tight monitoring system to assure hospital quality by combining mandatory and voluntary methods in Iran. The licensing, annual evaluation and grading, and regulatory inspections statutorily implemented by the government as a national package to assure and improve hospital care quality, while implementing quality management systems (QMS) was voluntary for hospitals. The government’s strong QA policy legislation role and support has been an important factor for successful QA implementation in Iran, though it may affected QA assessment independency and validity. Increased hospital evaluation independency and repositioning, updating standards, professional involvement and effectiveness studies could increase QA policy impact and maturity.

Practical implications

– The study highlights the current QA policy implementation cycle in Iranian hospitals. It provides a basis for further quality strategy development in Iranian hospitals and elsewhere. It also raises attention about finding the optimal balance between different QA policies, which is topical for many countries.

Originality/value

– This paper describes experiences when implementing a unique approach, combining mandatory and voluntary QA policies simultaneously in a developing country, which has invested considerably over time to improve hospital quality. The experiences with a mixed obligatory/voluntary approach and comprehensive policies in Iran may contain lessons for policy makers in developing and developed countries.

Measuring the quality of provided services for patients with chronic kidney disease

Background:

The healthcare organizations need to develop and implement quality improvement plans for their survival and success. Measuring quality in the healthcare competitive environment is an undeniable necessity for these organizations and will lead to improved patient satisfaction.

Objectives:

This study aimed to measure the quality of provided services for patients with chronic kidney disease in Kerman in 2014.

Patients and Methods:

This cross-sectional, descriptive-analytic study was performed from 23 January 2014 to 14 February 2014 in four hemodialysis centers in Kerman. All of the patients on chronic hemodialysis (n = 195) who were referred to these four centers were selected and studied using census method. The required data were collected using the SERVQUAL questionnaire, consisting of two parts: questions related to the patients' demographic characteristics, and 28 items to measure the patients' expectations and perceptions of the five dimensions of service quality, including tangibility, reliability, responsiveness, assurance, and empathy. The collected data were analyzed using SPSS 21.0 through some statistical tests, including independent-samples t test, one-way ANOVA, and paired-samples t test.

Results:

The results showed that the means of patients' expectations were more than their perceptions of the quality of provided services in all dimensions, which indicated that there were gaps in all dimensions. The highest and lowest means of negative gaps were related to empathy (-0.52 ± 0.48) and tangibility (-0.29 ± 0.51). In addition, among the studied patients' demographic characteristics and the five dimensions of service quality, only the difference between the patients' income levels and the gap in assurance were statistically significant (P < 0.001).

Conclusions:

Overall, the results of the present study showed that the expectations of patients on hemodialysis were more than their perceptions of provided services. The healthcare providers and employees should pay more attention to the patients' opinions and comments and use their feedback to solve the workplace problems and improve the quality of provided services. In addition, training the health staff to meet the patients' emotional needs and expectations is suggested.

Service Quality and Re-visit Intention

The outcomes of service quality such as customer satisfaction and subsequent re-visit intention are two of the most important indicators of organizational performance in the present competitive health care market. This article provides a holistic overview of customer experience of service quality in private hospitals as well as the implications of the same on the behavioural outcomes (e.g., customer satisfaction and re-visit intention) of customers. In this study, we identify the relative importance of critical service quality dimensions from customers’ perspective and examine the relationship between service quality and re-visit intention. A gap analysis was carried out to compare the service quality of a charitable hospital with that of a corporate hospital. A standard questionnaire covering 26 service quality variables was administered to a sample of 120 respondents in two hospitals in Mumbai. Findings suggest that the major factors that influence service quality are related to direct patient care such as hospital facilities, availability of doctors and the behaviour of staff. We suggest that service providers need to understand the critical role of human interaction in health care. Moreover, it is vital to consider all the stakeholders (including attendants and visitors) in service design and delivery as they act as participants in the service delivery process.

Power and trust in organizational relations: an empirical study in Turkish public hospitals

Given the salience of the interplay between trust and power relations in organizational settings, this paper examines the perceptions of social power and its effects on trust in supervisors within the context of public hospitals. Following the theoretical background from which the study model is developed, the recent situation of hospitals within Turkish healthcare system is discussed to further elucidate the working conditions of physicians. Sample data were collected employing a structured questionnaire that was distributed to physicians working at seven different public hospitals. The statistical analyses indicate that perceptions of supervisors' social power affect subordinates' trust in supervisors. Although coercive power is found to have the greatest impact on trust in supervisors, the influence of the power base is weak. In addition, the results show that perceptions of social power differ between genders. However, the results do not support any of the hypotheses regarding the relations between trust in supervisors and the examined demographic variables.

Considerations in the selection of healthcare providers for mothers and children in Bo, Sierra Leone: reputation, cost and location

The factors that influence the selection of a healthcare provider once the decision to seek care has been made can be summarized using a triad of cost, location and reputation. The goal of this study was to identify which of these factors is the primary consideration when women in urban Bo, Sierra Leone, select a healthcare provider for themselves or their children. We interviewed 1091 mothers during a household census of two neighbourhoods of Bo in April 2010. Reputation was the top consideration for about half of the women, cost was the second most common priority, and the location of the healthcare facility was the primary consideration for less than 7% of the participants. The majority of women said they would select a new provider if cost was not a barrier. Socioeconomic characteristics were not significant predictors of whether cost, location or reputation was selected as the highest-ranked consideration. This evidence for the importance of reputation in healthcare decision-making even in low-resource areas highlights the need for health systems to address issues of quality and responsiveness, and not just cost, in order to increase access to and utilization of health services.

Dimensions of hospital service quality: a critical review: perspective of patients from global studies

PURPOSE

The purpose of this paper is to review the service quality dimensions established in various studies conducted across the world specifically applied to health care.

DESIGN/METHODOLOGY/APPROACH

Studies conducted on quality of care selected from literature databases - Ebsco, Emerald Insight, ABI/Inform - was subjected to a comprehensive in-depth content analysis.

FINDINGS

Service quality has been extensively studied with considerable efforts taken to develop survey instruments for measuring purposes. The number of dimensional structure varies across the studies. Self-administered questionnaire dominates in terms of mode of administration adopted in the studies, with respondents ranging from 18 to 85 years. Target sample size ranged from 84-2,000 respondents in self-administered questionnaires and for mail administration ranged from 300-2,600 respondents. Studies vary in terms of the scores used ranging from four to ten-point scale. A total of 27 of the studies have used EFA, 11 studies have used structural equation modelling and eight studies used gap scores. Cronbach's alpha is the most commonly used measure of scale reliability. There is variation in terms of measuring the content, criteria and construct validation among the studies.

PRACTICAL IMPLICATIONS

The literature offers dimensions used in assessing patient perceived service quality. The review reveals diversity and a plethora of dimensions and methodology to develop the construct discussed.

ORIGINALITY/VALUE

The reported study describes and contrasts a large number of service-quality measurement constructs and highlights the usage of dimensions. The findings are valuable to academics in terms of dimensions and methodology used, approach for analysis; whereas findings are of value to practitioners in terms of the dimensions found in the research and to identify the gap in their setting.

The impact of total quality service (TQS) on healthcare and patient satisfaction: an empirical study of Turkish private and public hospitals

This paper attempts to measure patients' perceptions of the quality of services in public and private healthcare centers in Turkey. The main aim was to examine the impact of the dimensions of patient-perceived total quality service (TQS) on patients' satisfaction. The research framework and hypotheses are derived from a literature review of service quality and quality in the healthcare industry. The research data were collected through questionnaires and then statistically analyzed using descriptive statistics, Pearson product moment correlation and linear regression. The results suggest that service quality perceptions positively influence patient satisfaction with overall hospital care (SOHC). The most important factors identified in the regression model regarding patient SOHC are the quality of the hospital's social responsibility, administrative processes and overall experience of medical care received. These factors explain 74% of the variance in SOHC. The findings of the study can be used to improve TQS in both private and public hospitals.

Service quality of private hospitals: the Iranian patients' perspective

BACKGROUND

Highly competitive market in the private hospital industry has caused increasing pressure on them to provide services with higher quality. The aim of this study was to determine the different dimensions of the service quality in the private hospitals of Iran and evaluating the service quality from the patients' perspective.

METHODS

A cross-sectional study was conducted between October and November 2010 in Tehran, Iran. The study sample was composed of 983 patients randomly selected from 8 private general hospitals. The study questionnaire was the SERVQUAL questionnaire, consisting of 21 items in service quality dimensions.

RESULTS

The result of factor analysis revealed 3 factors, explaining 69% of the total variance. The total mean score of patients' expectation and perception was 4.91(SD = 0.2) and 4.02(SD = 0.6), respectively. The highest expectation and perception related to the tangibles dimension and the lowest expectation and perception related to the empathy dimension. The differences between perception and expectation were significant (p < 0.001). There was a significant difference between the expectations scores based on gender, education level, and previous hospitalization in that same hospital. Also, there was a significant difference between the perception scores based on insurance coverage, average length of stay, and patients' health conditions on discharge.

CONCLUSION

The results showed that SERVQUAL is a valid, reliable, and flexible instrument to monitor and measure the quality of the services in private hospitals of Iran. Our findings clarified the importance of creating a strong relationship between patients and the hospital practitioners/personnel and the need for hospital staff to be responsive, credible, and empathetic when dealing with patients.