Patient perceptions of healthcare service quality in Romania: Public versus private hospitals -Implications for developed and developing healthcare systems

Abstract

Objective: Recent increases in per capita income and longevity in Central and Eastern European counties (CEECs), alongside a slow-changing soviet-era public healthcare system, has led to the emergence of private hospitals. This paper investigates the differential patient service quality perceptions for private versus public hospitals, as well as for three types of healthcare services: primary, ambulatory, and inpatient care.
Methods: Data from 1,673 patients of private and public hospitals in the capital of Romania were collected in face-to-face interviews. Analysis of covariance and partial-least-squares techniques were used to examine the relationships between perceived service quality, hospital ownership status and the type of health service patients received.
Results: Over 70% of women prefer private health facilities to public hospitals (compared to less than 30% of men). While private hospitals rank higher than public hospitals on most attributes, the interaction effect of gender and hospital type reveals that assurance and empathy are the only significant attributes in driving women to private hospitals. (Physical facilities and staff appearance) as well as intangible dimensions of service quality (assurance, responsiveness, reliability, and empathy) have a positive impact on perceived overall service quality of healthcare. Improvements in perceptions of hospital’s tangibles, staff’s responsiveness and empathy have the greatest potential to enhance perceived overall service quality.
Conclusions: This paper demonstrates the importance of breaking down health services into various sub-categories both in terms of perceived healthcare attributes and in terms of tangible healthcare facilities, such as public and private hospitals.

Keywords

Private hospitals / Public hospitals / Service quality / Healthcare service type / Romanian healthcare

ACKNOWLEDGEMENTS

Not applicable.

AUTHORS CONTRIBUTIONS

All authors contributed to the conception and initial design, provided data for the work, provided suggestions for revision of the manuscript.

FUNDING

For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission. The authors received funding for this project from the Ratiu Family Foundation.

CONFLICTS OF INTEREST DISCLOSURE

The authors declare they have no conflicts of interest.

INFORMED CONSENT

Obtained.

ETHICS APPROVAL

The Publication Ethics Committee of the Sciedu Press. The journal’s policies adhere to the Core Practices established by the Committee on Publication Ethics (COPE).

PROVENANCE AND PEER REVIEW

Not commissioned; externally double-blind peer reviewed.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are not publicly available due to privacy or ethical restrictions.

DATA SHARING STATEMENT

No additional data are available.

OPEN ACCESS

This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/).

COPYRIGHTS

Copyright for this article is retained by the author(s), with first publication rights granted to the journal.

CONFLICTS OF INTEREST DISCLOSURE

The authors declare they have no conflicts of interest.

References

[1] Berry L, Bendapudi N. Health Care: A Fertile Field for Service Research. J of Service Res 2007; 10(2): 111. https://doi.org/10.1177/1094670507306682

[2] Carrillat FA, Jaramillo F, Mulki JP. The Validity of the SERVQUAL and SERVPERF scales, a meta-analytic view of 17 years of research across five continents. Int J of Service Ind Manage. 2007; 18(5): 472. https://doi.org/10.1108/09564230710826250

[3] Endeshaw B. Healthcare service quality-measurement models: a review. Journal of Health Res. 2

[4] Charalambous A, Efstathiou G, Adamakidou T, et al. Adult cancer patients satisfaction of nursing care: a cross-national evaluation of two Southeastern European countries. The International Journal of Health Planning and Management. 2014; 29(4): e329-46. PMid: 24254548. https://doi.org/10.1002/hpm.2225

[5] Stepurko T, Pavlova M, Groot W. Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries. BMC Health Services Research. 2016; 16(1): 1-3. PMid: 27485751. https://doi.org/10.1186/s12913-016-1585-1

[6] Ali J, Jusoh A, Idris N, et al. Applicability of healthcare service quality models and dimensions: future research directions. Total Quality Management & Business Excellence. 2023; 35(6): 1378-93. https://doi.org/10.1108/TQM-12-2021-0358

[7] Akdere M, Top M, Tekingündüz S. Examining patient perceptions of service quality in Turkish hospitals: The SERVPERF model. Total Quality Management & Business Excellence. 2020; 31(4): 342-52. https://doi.org/10.1080/14783363.2018.1427501

[8] Duc Thanh N, Quynh Anh P, Thi Huyen Chang P, et al. Cross- Cultural Adaption and Validation of SERVPERF Tool for Measuring Healthcare Quality in an Oncology Public Hospital, Vietnam. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2023; 60: 1-6. PMid: 36680357. https://doi.org/10.1177/00469580221146826

[9] Lacerda AB, Souza AS, Da Silva GK, et al. Basic Health Units services quality assessment through Kano and SERVQUAL models. Benchmarking: An International Journal. 2022; 29(9): 2858-80. https://doi.org/10.1108/BIJ-06-2021-0351

[10] Shi H, Fan M, Zhang H, et al. Perceived health-care quality in China: a comparison of second- and third-tier hospitals. Int J of Qual in Health Care. 2021; 33(1): 1. PMid: 33693896. https://doi.org/10.1093/intqhc/mzab027

[11] Lee D, Kim KK. Assessing healthcare service quality: a comparative study of patient treatment types. International Journal of Quality Innovation. 2017; 3(1): 1-5. https://doi.org/10.1186/s40887-016-0010-5

[12] Fiala TG. What do patients want? Technical quality versus functional quality: a literature review for plastic surgeons. Aesthet Surg J. 2012; 32: 751-9. PMid: 22859547. https://doi.org/10.1177/1090820X12452555

[13] Mosadeghrad AM. Healthcare service quality: towards a broad definition. Int J Health Care Qual Assur. 2013; 26: 203-19. PMid: 23729125. https://doi.org/10.1108/09526861311311409

[14] Bem SL. Gender schema theory: a cognitive account of sex typing. Psychol Rev. 1981; 88: 354. https://doi.org/10.1037/0033-295X.88.4.354

[15] Parasuraman A, Zeithaml VA, Berry LL. A conceptual model of service quality and its implications for future research. J Mark. 1985; 49: 41-50. https://doi.org/10.1177/002224298504900403

[16] Parasuraman A, Berry LL, Zeithaml VA. Refinement and reassessment of the SERVQUAL scale. Journal of Retailing. 1991; 67(4): 420.

[17] Babakus E, Mangold WG. Adapting the SERVQUAL scale to hospital services: an empirical investigation. Health Serv Res. 1992; 26: 767.

[18] Hoxha MA. Community and health-care service quality in Kosovo: a confirmatory analytical approach. Journal of Enterprising Communities: People and Places in the Global Economy. 2023; 17(2): 535-561. https://doi.org/10.1108/JEC-11-2021-0151

[19] Li M, Lowrie DB, Huang CY, et al. Evaluating patients’ perception of service quality at hospitals in nine Chinese cities by use of the ServQual scale. Asian Pac J Trop Biomed. 2015; 5: 497-504. https://doi.org/10.1016/j.apjtb.2015.02.003

[20] Teshnizi SH, Aghamolaei T, Kahnouji K, et al. Assessing quality of health services with the SERVQUAL model in Iran. A systematic review and meta-analysis. International Journal for Quality in Health Care. 2018; 30: 82-89. PMid: 29408970. https://doi.org/10.1093/intqhc/mzx200

[21] Van Herk H. Poortinga YH, Verhallen TMM. Equivalence of survey data: Relevance for international marketing. European J of Mark. 2005; 39(3/4): 351. https://doi.org/10.1108/03090560510581818

[22] Brady MK, Cronin Jr JJ, Brand RR. Performance-only measurement of service quality: a replication and extension. Journal of Business Research. 2002; 55(1): 17-31. https://doi.org/10.1016/S0148-2963(00)00171-5

[23] Cronin J, Taylor S. Measuring service quality: A Re-examination and Extension. Journal of Marketing. 1992; 56(3): 55. https://doi.org/10.1177/002224299205600304

[24] Ringle CM, Wende S, Becker JM. SmartPLS 4. Oststeinbek:Smart- PLS GmbH. 2022. Available from: http://www.smartpls.com

[25] Yarimoglu E, Gorkem A. How service quality in hospitals varies based on hospital ownership and demographics: a study on Turkish patients living urban areas. Total Quality Management & Business Excellence. 2022; 33: 7-8, 777-793. https://doi.org/10.1080/14783363.2021.1890576

[26] Fan LH, Gao L, Liu X, et al. Patients’ perceptions of service quality in China: An investigation using the SERVQUAL model. PloS One. 2017; 12(12): e0190123. PMid: 29272312. https://doi.org/10.1371/journal.pone.0190123

[27] Goula A, Stamouli MA, Alexandridou M, et al. Public hospital quality assessment. Evidence from Greek health setting using SERVQUAL model. International Journal of Environmental Research and Public Health. 2021; 18(7): 3418. PMid: 33806126. https://doi.org/10.3390/ijerph18073418

[28] Al-Hilou M, Suifan T. The mediating effect of patient trust on the relationship between service quality and patient satisfaction. International Journal of Health Care Quality Assurance. 2023; 36(1/2): 1-16. PMid: 37938922. https://doi.org/10.1108/IJHCQA-05-202 3-0028

[29] Edgman-Levitan S, Schoenbaum SC. Patient-centered care: achieving higher quality by designing care through the patient’s eyes. Israel Journal of Health Policy Research. 2021; 10: 1-5. PMid: 33673875. https://doi.org/10.1186/s13584-021-00459-9

[30] Thajil KM, AL-Abrrow H. The effect of the bright triad on positive innovation in healthcare sector: The mediating role of emotional intelligence. International JournalofHealthcareManagement. 20 23;1-12. https://doi.org/10.1080/20479700.2023.2177608