رتبه بندی خدمات بهداشتی و درمانی: رضایت مصرف کننده و عملکرد سیستم بهداشتی Rating healthcare services: consumer satisfaction vs. health system performance

Introduction Over the last two decades, remarkable progress has been made in the field of medical services and this is obvious for developed economies in terms of both economic and technological development. Lately, new drugs have been discovered, some deadly diseases have been eradicated, the population has been informed about the methods of prevention and treatment, which has led to an increase in life expectancy and quality of life in developed countries. Despite these advances in the developed world, in the case of poor countries, economic development is the first barrier that causes poor population health and low life expectancy. Economic growth is associated with the development of service economy. Among these, healthcare services are important and their development is a priority for public authorities (Andaleeb, 2001). Thus, they are experiencing rapid expansion in the context of an aging population, competitive pressures and technological developments (Dagger, Sweeney, & Johnson, 2007). Previous research on the services market confirms that ensuring the quality of the services offered is a key element for earning profitability and a good market share (Parasuraman, Zeithaml, & Berry, 1985; Parasuraman, Zeithaml, & Malhotra, 2005; Zeithaml & Bitner, 2000). Organisations improve their management strategies so that their efforts are focused on the customer (Andaleeb, 2001; Zeithaml & Bitner, 2000), meeting their requirements and needs, considering that the trust of stakeholders who are interested in service achievement is confirmed by quality assurance. In an organisation that delivers healthcare services, financial indicators or the system performance can be explained by the patients’ appreciation of service quality (Dagger et al., 2007; Naidu, 2009; Nelson et al., 1992). In order to gain competitive advantage and increase system performance on the current economic market, it is necessary to meet at least two conditions: to have satisfied clients and to provide quality services (Dagger et al., 2007). Concepts of service quality and consumer satisfaction are the target of marketing people’s concerns because they have a strong impact on many behavioural variables. In fact, these concepts are at ‘the core of the marketing concept’ (Shemwell, Yavas, & Bilgin, 1998). Therefore, there is a continuing concern within the academic environment as well as among practitioners to study these concepts. Thus, it can be explained why a large number of studies that are analysing these unique but related constructs (Cronin & Taylor, 1994; Oliver, 1993; Shemwell et al., 1998; Taylor & Baker, 1994) consider the quality of services to be objective, cognitive (attributes that correspond to a leftbrained person) while customer satisfaction is subjective, affective (attributes that correspond to a right-brained person). Some researchers argue that satisfaction is more important than service quality (Oliver, 1999) and others advocate that the service type is responsible for the salience of either components (Dabholkar, 1995; Shemwell et al., 1998).