Determinants of Patients’ Behavioral Intention and Loyalty in Private Hospitals in Chengdu, China
DOI:
https://doi.org/10.14456/shserj.2023.41Keywords:
Behavioral Intention, Loyalty, Satisfaction, Service Quality, HospitalsAbstract
Purpose: Behavioral intention and loyalty of patients to use the hospital service have been widely discussed to enhance profitability and sustainability in the hospitality industry. This research investigates the causal relationship between medical cost reasonableness, healthcare technicality, interpersonal behavior, service quality, patient satisfaction, behavioral intention, and patient loyalty. Research design, data, and methodology: This study applied a quantitative method to distribute an online questionnaire to 500 patients who use the medical service of private hospitals in Chengdu. The sample techniques are judgmental, convenience, and snowball samplings. The Item Objective Congruence (IOC) Index and the pilot test (n=50) by Cronbach’s Alpha were conducted before the data collection. The data was analyzed through Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM). Results: All hypotheses are supported in this study. Medical costs, reasonableness, healthcare technicality, and interpersonal behavior significantly influence service quality. In addition, service quality has the strongest significant influence on patient satisfaction. Patient satisfaction significantly influences patient loyalty and behavioral intention. Conclusions: In practice, the study can contribute to hospitals and healthcare service providers to consider the significant determinants that can enhance the higher level of patient loyalty for their profitability and sustainability. Furthermore, the government can design policies and incentivized mechanisms to raise the healthcare service standard nationwide.
References
Alanazi, M. H., & Soh, B. (2019). Behavioral Intention to Use IoT Technology in Healthcare Settings. Engineering, Technology & Applied Science Research, 9(5), 4769-4774. https://doi.org/10.48084/etasr.3063
Anbori, A., Ghani, S. N., Yadav, H., Daher, A. M., & Su, T. T. (2010). Patient satisfaction and loyalty to the private hospitals in Sana’a, Yemen. International Journal for Quality in Health Care, 22(4), 1-6.
Anderson, J., & Gerbing, D. (1988). Structural Equation Modeling in Practice: A Review and Recommended Two-Step Approach. Psychological Bulletin, 103, 411-423. http://dx.doi.org/10.1037/0033-2909.103.3.411
Arbuckle, J. (1995). AMOS: Analysis of moment structures user’s guide (1st ed.). Small Waters.
Bartlett, J. E., Kotrlik, J. W., & Higgins, C. C. (2001). Organizational research: determining appropriate sample size in survey research. Learning and Performance Journal, 19, 43-50.
Blumenthal, D. (2009). Stimulating the adoption of health information technology. The New England Journal of Medicine, 360(15), 1477-1479.
Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen, & J. S. Long (Eds.), Testing structural equation models (pp. 136-162). Sage.
Chahal, H., & Kumari, N. (2010). Development of multidimensional scale for healthcare service quality (HCSQ) in Indian context. Journal of Indian Business Research, 2(4), 230255.
Chahal, H., & Mehta, S. (2013). Modeling patient satisfaction construct in the Indian health care context. International Journal of Pharmaceutical and Healthcare Marketing, 7(1), 75-92. https://doi.org/10.1108/17506121311315445
Cham, T. H., Lim, Y. M., Aik, N. C., & Tay, A. G. M. (2016). Antecedents of hospital brand image and the relationships with medical tourists’ behavioral intention. International Journal of Pharmaceutical and Healthcare Marketing, 10(4), 412-431. https://doi.org/10.1108/IJPHM-02-2016-0012
Chino, F., Peppercorn, J., Taylor, D. H., Lu, Y., Samsa, G., Abernethy, A. P., & Zafar, S. Y. (2014). Selfreported financial burden and satisfaction with care among patients with cancer. The Oncologist, 19(4), 414-420.
Cronin, J. J., Brady, M. K., & Hult, T. M. (2000). Assessing the effects of quality, value, customer satisfaction on consumer behavioral intentions in service environment. Journal of Retailing, 76(2), 193-216.
Cronin, J. J., & Taylor, S. A. (1992). Measuring service quality: a reexamination and extension. Journal of Marketing, 56(3), 55-68.
Crozier, G. K. D., & Baylis, F. (2010). The ethical physician encounters international medical travel. Journal of Medical Ethics, 36(5), 297-301.
Deloitte. (n.d.). China's healthcare provider market. Riding the waves of reform. https://www2.deloitte.com/cn/en/pages/life-sciences-and-healthcare/articles/china-healthcare-provider-market.html
Dick, A. S., & Basu, K. (1994). Customer loyalty: toward an integrated conceptual framework. Journal of the Academy of Marketing Science, 22(2), 99-113.
Donabedian, A. (2005). Evaluating the Quality of Medical Care. The Milbank Memorial Fund Quarterly, 44(3), 166-203. https://doi.org/10.1111/j.1468-0009.2005.00397.x
Fatima, T., Malik, S. A., & Shabbir, A. (2018). Hospital healthcare service quality, patient satisfaction and loyalty: An investigation in context of private healthcare systems. International Journal of Quality & Reliability Management, 35(6), 1195-1214. https://doi.org/10.1108/IJQRM-02-2017-0031
Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39-50. https://doi.org/10.2307/3151312
Fornier, S. (1994). A consumer-based relationship framework for strategic brand management [Published Doctoral Thesis]. University of Florida.
Gagnon, M. P., Godin, G., Gagne, C., Fortin, J. P., Lamothe, L., Reinharz, D., & Cloutier, A. (2003). An adaptation of the theory of interpersonal behaviour to the study of telemedicine adoption by physicians. International Journal of Medical Informatics, 71(2/3), 103-115.
Gaur, S. S., Xu, Y., Quazi, A., & Nandi, S. (2011). Relational impact of service providers’ interaction behaviour in health care. Managing Service Quality, 21(1), 67-87.
Gotlieb, J. B., Grewal, D., & Brown, S. W. (1994). Consumer satisfaction and perceived quality: complementary or divergent constructs. Journal of Applied Psychology, 79(6), 875-885.
Hair, J., Black, W., Babin, B., Anderson, R., & Tatham, R. (2006). Multivariate Data Analysis (6th ed.). Pearson Education.
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate Data Analysis (7th ed.). Edition, Pearson.
Hair, J. F., Ringle, C. M., & Sarstedt, M. (2013). Partial Least Squares Structural Equation Modeling: Rigorous Applications, Better Results and Higher Acceptance. Long Range Planning, 46, 1-12. https://doi.org/10.1016/j.lrp.2013.01.001
Hambleton, R. K., Swaminathan, H., Algina, J., & Coulson, D. B. (1978). Criterion-referenced testing and measurement: A review of technical issues and developments. Review of Educational Research, 48(1), 1-47. https://doi.org/10.2307/1169908
Han, H., & Hyun, S. S. (2015). Customer retention in the medical tourism industry: impact of quality, satisfaction, trust, and price reasonableness. Tourism Management, 46, 20-29.
Han, H., & Kim, W. (2009). Outcomes of relational benefits: restaurant customers’ perspective. Journal of Travel and Tourism Marketing, 26(8), 820-835.
Jiang, P., & Rosenbloom, B. (2005). Customer intention to return online: price perception, attribute level performance, and satisfaction unfolding over time. European Journal of Marketing, 39(1/2), 150-174.
Kessler, D. P., & Mylod, D. (2011). Does patient satisfaction affect patient loyalty?. International Journal of Health Care Quality Assurance, 24(4), 266-273.
Ko, D. K., & Stewart, W. P. (2002). A structural equation model of residents’ attitudes for tourism development. Tourism Management, 23, 521-530.
Ladhari, R. (2008). Alternative measures of service quality: a review. Managing Service Quality, 18(1), 65-86.
Likert, R. (1932). A technique for the measurement of attitudes. Archives of Psychology, 22(140), 55.
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. https://doi.org/10.1108/IJPHM-07-2014-0043
Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1985). A conceptual model of service quality and its implications for future research. Journal of Marketing, 49(4), 41-50.
Prahalad, C. K., & Krishnan, M. S. (1999). The new meaning of quality in the information age. Harvard Business Review, 77(5), 109-118.
Price, L., Arnould, E., & Deibler, S. (1995). Consumers’ emotional responses to service encounters. International Journal of Service Industry Management, 6(3), 34-63.
Rahman, M. K. (2019). Medical tourism: tourists’ perceived services and satisfaction lessons from Malaysian hospitals. Tourism Review, 74(3), 739-758.
https://doi.org/10.1108/TR-01-2018-0006
Reidenbach, R. E., & Sandifer-Smallwood, B. (1990). Exploring perceptions of Hospital Operations by a Modified SERVQUAL Approach. Journal of Health Care Marketing, 10(4), 47-55.
Ryu, K., & Han, H. (2010). Influence of the quality of food, service, and physical environment on customer satisfaction and behavioral intention in quick-casual restaurants: moderating role of perceived price. Journal of Hospitality and Tourism Research, 34(3), 310-329.
Sadeghi, M., Zandieh, D., Mohammadi, M., Yaghoubibijarboneh, B., & Nasrolahi Vosta, S. (2017). Investigating the impact of service climate on intention to revisit a hotel: the mediating role of perceived service quality and relationship quality. International Journal of Management Science and Engineering Management, 12(1), 12-20.
Seth, A., Momaya, K., & Gupta, H. (2005). An exploratory investigation of customer loyalty and retention in cellular mobile communication. Journal of Service Research, 12, 173-185.
Soper, D. S. (2022, May 24). A-priori Sample Size Calculator for Structural Equation Models. Danielsoper.
www.danielsoper.com/statcalc/default.aspx
Stanworth, J., Hsu, R. S., & Chang, H.-T. (2014). Interpersonal service quality of the Chinese: determinants and behavioral drivers. Service Business, 9(3), 515-540. https://doi.org/10.1007/s11628-014-0238-x
Straub, D., Boudreau, M.-C., & Gefen, D. (2004). Validation guidelines for IS positivist research. Communications of the Association for Information Systems, 13, 380-427.
Studenmund, A. H. (1992). Using Econometrics: A Practical Guide (1st ed.). Harper Collins.
Sumaedi, S., Gede Mahatma Yuda Bakti, I., Rakhmawati, T. J., Astrini, N., Widianti, T., & Yarmen, M. (2014). The empirical study on patient loyalty: The role of trust, perceived value, and satisfaction (a case study from Bekasi, Indonesia). Clinical Governance: An International Journal, 19(3), 269-283. https://doi.org/10.1108/CGIJ-04-2014-0018
Tang, S., Meng, Q., Chen, L., Bekedam, H., Evans, T., & Whitehead, M. (2008). Tackling the challenges to health equity in China. Lancet (London, England), 372(9648), 1493-1501. https://doi.org/10.1016/S0140-6736(08)61364-1
Tseng, K.-C., Chen, C.-C., Huang, J.-M., Chow, T.-H., & Hsu, C.-H. (2022). The Behavioral Intention and Influencing Factors of Medical Staff toward COVID-19 Vaccinations. Healthcare, 10(4), 628. https://doi.org/10.3390/healthcare10040628
Turner, R. C., & Carlson, L. (2003). Indexes of Item-Objective Congruence for Multidimensional Items. International Journal of Testing, 3(2), 163-171. https://doi.org/10.1207/S15327574IJT0302_5
Varki, S., & Colgate, M. (2001). The role of price perceptions in an integrated model of behavioral intentions. Journal of Service Research, 3(3), 232-240.
Wong, D., & Zhang, Z. (2021, November 16). China’s Medical Devices Industry: Key Market Entry Considerations. China Briefing. https://www.china-briefing.com/news/chinas-medica l-devices-industry-key-market-entry-considerations/#:~:text= China%20healthcare%20industry%20is%20currently,that%20from%20the%20previous%20year
Zeithaml, V. A., Berry, L. L., & Parasuraman, A. (1996). The behavioral consequences of ‘trying’. Behavior Therapy, 60(4), 31-46.
Zhang, S., Song, X., Wei, Y., & Deng, W. (2019). Spatial Equity of Multilevel Healthcare in the Metropolis of Chengdu, China: A New Assessment Approach. International journal of environmental research and public health, 16(3), 493.
