کیفیت خدمات، رضایت مصرف کننده و وفاداری در بیمارستان ها: تفکر برای آینده Service quality, consumer satisfaction and loyalty in hospitals: Thinking for the future

1. Introduction The delivery of high-quality service is the key to success in service industries. In the present era of intense competition, monitoring and improving service quality is highly essential for developing efficiency and business volume (Anderson and Zeithamal, 1984; Babakus and Boller, 1992; and Garvin, 1983). In both manufacturing and service industries, quality improvement is the principal factor that impacts consumer satisfaction and consumer’s purchase intention (Oliver, 1980). Several scholars agree that the quality is critical to consumer’s satisfaction (Omar and Schiffman, 1995; Gremler et al., 2001; and Radwin, 2000). Several business organizations focus on service-quality issues to drive customer’s satisfaction above the rest (Kumar et al., 2008). The healthcare industry in developing countries like India, has recorded a relatively high growth rate with a high demand for its services from both foreign and local patients; despite constraints such as inadequate amount of hospital beds and shortage of highly qualified doctors. But, the growth could be sustained throughout several years that lie ahead (Burns, 2014). Delivery of high-quality service and building patient loyalty are considered to be critical anchors (Anderson and Zeithamal, 1984). The specific dimensions of quality service that contributes substantially to patient’s satisfaction need to be identified. Thus, hospital management can prioritize better their focus on such specific factors, despite the heavy reliance of patients on physicians who first treat them and also refers them to certain a hospital. The overall Indian healthcare market is worth US$65 billion (Burns, 2014). Healthcare industry in India is a source of employment and revenue with strong domestic demand, corporatization of healthcare, rise in innovation, influx of medical tourism, and government pushes. India spends just 4% of its GDP on healthcare, while USA spends 17% of its GDP, while the share of government national healthcare expenditure is 50% in USA compared to a little more than 25% in India (Burns, 2014). On the other hand, India has world-class medical facilities attracting a large number of medical tourists who get a high-quality medical care at the cost of just a fraction of what it costs in USA. In India, only middle and upper classes have access to quality healthcare. Healthcare expenditure is a major cause of household debt in India, since many patients borrow money or sell off their assets to meet their healthcare expenditure, as the majority of the people do not have medical insurance. The hospital industry has become quite competitive in recent times (Raju and Lonial, 2002). Hospitals are interested in identifying the most critical factors in hospitals that, if managed well, will ensure survival and success in the future. For this to happen, the strategic factors need to be identified. Some hospitals are also taking efforts to promote their business overseas in the ‘medical tourism’ segment. They could prioritize areas related to quality management and should determine them most astutely. This euphoria and excitement about healthcare industry is worth examining in the context of service quality. Particularly, after the competitive space becomes crowded and rules of the game get tougher in the sector, quality matters a lot for succeeding in the long run.