کیفیت خدمات و رضایت بخشی در بخش مراقبت های بهداشتی پاکستان – انتظارات بیماران Service quality and satisfaction in healthcare sector of Pakistan— the patients’ expectations

Introduction: With rising population (and healthcare issues) and a rising focus on improvement in each sector of the economy to achieve competiveness in national economy, the issues of patient satisfaction and service quality are seeking increasing interest among researchers and scholars all over the world. Developed countries are not only improving their healthcare sectors to serve their masses but also making money by promoting healthcare tourism (Lee and Fernando, 2015; Han and Hyun, 2015; Andaleeb, 2001). Developing countries can also reap these benefits by making available high healthcare quality at affordable costs (De Arellano, 2007; Horowitz et al., 2007; Lee and Fernando, 2015) which is a challenging task in countries like Pakistan where healthcare isn’t a priority and issues like patient satisfaction and service quality are receiving more attention of academicians or scholars and less of policymakers or practitioners. In service industries, the service quality always remained one of the key factors manifesting the successful management of customer relationships and value creation in the market. However, in developing countries, the health care service providers do not pay much attention to the say of service seekers and their perceptions and expectations are generally being neglected (Andaleeb, 2001). Han and Hyun (2015) reported that inviting new consumers is five times more expensive than retaining existing consumers. Thus it can be argued that by not seeking the existing consumers’ (patients’) input in improving or redesigning of value creation processes in hospitals, the service providers are not only closing the door for continuous improvement that is essential for the business survival but also loosing consumers, and thus profits, to their competitors. In case of the private hospitals this can lead to bankruptcy and for public hospitals receiving funds from the state this implies the hospitals that the poor patients consider their last resort. Pakistan is one of the few countries in the world where healthcare never remained a priority for most of the governments since its creation in 1947. The attitude of the political leadership of the country, that can be manifested though their budget allocated for healthcare and frequent visits to the healthcare facilities of the developing countries even for the smallest treatments, can add to this argument. For instance, the country spends almost 2.8% of its budget on healthcare (WHO, 2015) putting it in the basket of countries whose investment on healthcare is less compared to the most of the countries of the world. Media reports highlight that it is not rare for Pakistani politicians, bureaucrats, legislators and government officials to go overseas for treatment that not only costs millions of rupees to Pakistani taxpayers but also exposes their ‘faith in what the country has to offer’ (Siddiqi, 2016; Pakistan Today, 2016; Shehzad, 2015; Ahmad, 2011). Thus it is not difficult to comprehend why the majority of the population of Pakistan perceives that their country’s healthcare system is corrupt (Gadit, 2011). Considering all this in mind it was felt very important to seek the insight of Pakistani healthcare sector from the public’s point of view. There are not many studies conducted in the healthcare sector of Pakistan in order to examine the service quality of public as well as private hospitals in light of service-seekers’ views (see for instance, Irfan and Ijaz, 2011; Saeed and Ibrahim, 2005; Nasim and Janjua, 2014; Shabbir et al., 2016). However, there is a controversy among the studies done on Pakistani healthcare sector. For example, Irfan and Ijaz (2011) and Shabbir et al. (2016) reported that private hospitals’ patients are more satisfied with the healthcare services as compare to their public counterparts however Nasim and Janjua (2014) reported the opposite.