Correspondence: Khoa Tran Faculty of Business Administration, Nguyen Tat Thanh University, 300A Nguyen Tat Thanh, Ward 13, District 4, Ho Chi Minh City, Vietnam, Tel +84 562 688 998, Email anhkhoatran3007@gmail.com
Received 2021 Aug 10; Accepted 2021 Sep 20. Copyright © 2021 Nguyen et al.This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
Recent literature on healthcare quality demands more contextualized and patient-perspective research, as models from developed countries are not suitable for developing countries. Moreover, research on private healthcare services in Vietnam has long been underestimated by academia, but it has significant economic and commercial value. Hence, this study explores the dimensions of service quality in private healthcare and how they impact in-patient satisfaction, perceived value, and customer loyalty in Vietnam.
This mixed-method study had a sample size of five inpatients for the qualitative phase and 368 inpatients for the quantitative phase from hospitals in Vietnam. The qualitative analysis explores service quality dimensions in private healthcare and incorporates them with the literature to develop a conceptual model. The quantitative phase tests the relationship between each construct in the conceptual model via structural equation modeling.
The four dimensions of service quality were emotion, function, social influence, and trust. Most of these dimensions have a significant impact on customer perceived value and satisfaction. However, emotion does not significantly influence customer perceived value, and function does not considerably impact customer satisfaction. In addition, social influence is an underrepresented variable in the service quality literature, but it has the most substantial impact on customer perceived value and customer satisfaction. The quantitative results also confirm that customer satisfaction and customer perceived value significantly impact customer loyalty (word-of-mouth and revisit intention); however, customer perceived value does not significantly impact customer satisfaction.
The study suggests that private healthcare providers and the government in Vietnam should allocate resources to improve service quality. Practitioners should invest in social branding and e-services to reach out to their customers. Future research should focus on a cost-benefit analysis and compare the effectiveness of service quality dimensions on customer behavioral intention.
Keywords: customer perceived value, customer satisfaction, private healthcare, revisit intention, service quality, word-of-mouth
Private healthcare services are a crucial part of the global health system. Private healthcare providers have increasingly become involved in health systems, both in scale and scope, because of their potential. For instance, privately funded services stimulate equity in the society. Since clients from the middle and wealthy classes prefer to pay more for the private healthcare service to meet their requirements and higher service expectations, private healthcare providers satisfy those who can afford it and facilitate the public healthcare system to focus on those who cannot afford it. Additionally, private healthcare providers’ involvement in healthcare fosters accessibility to health services among people living in rural areas. 1 In addition, the private healthcare system shoulders the fiscal burden with governmental bodies when finance for maintenance, rehabilitation, and new investment in high-quality equipment. Recently, the private healthcare system has reiterated its role by joining the battle with a pandemic crisis. Amid the Covid-19 pandemic, many national healthcare systems worldwide have been overwhelmed. To alleviate the grave challenges and deal with pertinent implications, governments collaborate with private healthcare providers to enhance proactive and collaborative public-private partnerships. Hence, it is crucial to nurture a high-quality and sustainable private healthcare system in all nations.
Health care administrators and physicians have long strived to provide high-quality services. However, many studies have pointed out the healthcare literature lacks patient-centered design and localized research. Scholars have indicated that healthcare service providers should follow the patient-centered design to improve patient experiences and the value of care because it can help healthcare managers and policymakers make investments in the right element. However, a recent study pointed out that while employees consider the quality of a specific service element to be too low, patients do not always perceive it as a big problem. 2 Besides, prior research usually deploys quantitative methods, such as SEM-PLS, when studying service quality and behavioral intention. As service quality dimensions may differ according to surveyed contexts, quantitative analysis alone is not sufficient to make practical recommendations for healthcare service providers. 3 A recent systematic review recognizes that previous papers on measuring the quality of healthcare primarily utilized models from developed countries’ origin. This study suggests that research in developing countries should construct a model for measuring the quality of healthcare services, as models in developed nations might not be appropriate in developing contexts. With regard to research on patient experience of service quality in developing countries, there is little research in Vietnam. The majority is in Iran, Pakistan, Bangladesh, and India. 4 Hence, the context of our research is in Vietnam to bridge the literature gap.
In Vietnam, private health services have coexisted with public health services for over 20 years, but their scale and size are still small compared to their public counterparts. However, private healthcare services have the potential to bring about profitable business opportunities and economic growth. As stated by the Ministry of Health, when they implement a series of preferential policies to invest in medical examination and treatment, a considerable increase in private hospitals and hospitals with foreign investment occurs accordingly. Moreover, according to the Law on Corporate Income Tax since 2009, special tax incentives for businesses operating in the healthcare industry will remove many obstacles in private health activities. As the government has assisted private medical institutions with their supply side challenges, private healthcare providers’ current goal is to redirect patients from the public sector into their sector.
Vietnamese residents still prefer state-funded healthcare providers, leading to an overload in this sector, but a tragic scene in the other. One of the rationales is the higher price of private health services in Vietnam. However, researchers have stated that price is not a primary determinant when choosing private hospitals. 5 Instead, inpatients in emerging markets rely on convenience, turnaround time, specialties, reputation, and word-of-mouth in their decision-making process of private healthcare services. A previous study has also shown that the clinic’s delivery methods, such as customer-oriented care and amenities, might be more important than perceptions of physician’s technical skills and treatment methods. Therefore, service quality in health care might become a critical factor in inpatients’ choice of hospitals. It also indicated that technical quality across a range of private providers in Vietnam seems to be inferior to that of public institutions, although public healthcare services are also of a low standard. 6
There are two recent studies on service quality and customer loyalty in Vietnam. However, both studies have focused on public institutions. The first study recognizes that total quality management has a significant impact on in-patient’s perceived service quality and patient satisfaction, leading to patient loyalty in the public sector. In the limitation section, the authors question whether these relationships exist in the private healthcare context. 7 The other article, which researched the perceived crowding on patient satisfaction in public institutions, also acknowledges in its discussion that Vietnamese patients have different preferences for service quality between private and public healthcare. Public and private healthcare institutions also have different business models and business selling points; hence, the strategy for public institutions might not be transferable to private healthcare. 8 Thirdly, in terms of methodology, these two articles use SEM to measure patients’ perceptions of service quality, customer satisfaction, and customer loyalty. All these variables are subjective; therefore, quantitative methods may not reflect the perception or view of patients thoroughly. Therefore, there is a need for qualitative methods to comprehensively explore the demand for inpatients. From the practical contribution, the novelty of this research lies in contextualization, as understanding the context is likely to assist in making more practical and effective policies. From the theoretical contribution, this research will enrich the recent literature on the private sector, where profit-driven institutions aim to enhance their service quality to boost profits rather than lower costs and make it affordable in the public sector.
In 1985, scholars defined service quality as the comparison between customers’ expectations and their perceived service performance. 9 In the healthcare context, the main dimensions of service quality are (1) functional quality (or process quality), defined as the way healthcare providers deliver healthcare services to patients; and (2) technical quality (or outcome quality), related to the accuracy of medical procedures and diagnoses. 10 As most patients do not have enough knowledge to assess the technical side, our research concentrates on functional quality. Customer perceived value refers to customers’ assessment of the utility of products and services, which hinge upon their perceptions of what they give and what they receive in return. 11 Researchers normally operationalize customers’ perceptions of service quality in the healthcare context. 12 In other words, CPV in healthcare is patients’ assessment of service quality before deciding to use the healthcare service. Meanwhile, customer satisfaction pertains to customers’ comparison between expectations and the actual performance of services experienced by patients. 13 Therefore, researchers distinguish service quality, CPV, and customer satisfaction based on the patients’ evaluation stage. Service quality provides the criteria that patients use to evaluate hospital services. CPV appears when the patients use the criteria to assess service quality before usage based on external information such as friends’ recommendations or perceived cost and benefit. Customer satisfaction then occurs after usage when patients evaluate whether the quality of service achieves their perception of service quality.
To measure service quality, scholars have also developed the SERVQUAL model to help service providers identify and effectively improve their service delivery. The SERVQUAL model categories service quality into five dimensions: tangibility, reliability, responsiveness, assurance, and empathy. 14 This research paved the way for scholars to examine the impacts of service quality from customers’ perspectives. Subsequently, the modified SERVQUAL model in healthcare settings has become widely used to analyze patient’s perceptions of service quality. When researchers adopt this model in the healthcare context, they define service quality as medical services that simultaneously maximize inpatients’ welfare and balance the expected benefits and losses during the treatment process. The extent to which healthcare service quality meets inpatients’ demand depends on the service outcome, service process, and physical environment. 15 However, scholars have also pointed out the limitations of the SERVQUAL model in the healthcare context. Two significant problems are that this patient-centered approach fails to examine the patient’s evaluation of the outcome and the interaction between service users and service providers. 16 Secondly, there is little research on where scholars investigate the service quality dimensions from Vietnamese inpatients and in Vietnam’s healthcare system. These literature gaps lead the authors to carry out a qualitative review with inpatients, with the aim of determining the dimensions of service quality from the inpatients’ perspectives in the healthcare context of Vietnam.
After the qualitative phase, this study re-categorizes healthcare service quality into four dimensions: (1) emotion, (2) function, (3) trust, and (4) social influence. The researchers defined the scope of these dimensions based on previous studies. First, emotional value is the feeling or affective state generated by consumption experience. This study also stated that promoting positive or mitigating negative emotional states in emotional value plays a vital role in personal health. 17 Secondly, functional value refers to economic benefit and the functionality provided by a product or service. In healthcare, functional value illustrates how patients’ consumption of private healthcare services helps them achieve good health. Third, trust relates to the confidence of inpatients in medical staff’s professional ability and the reliability of medical service. 18 Finally, social influence is patients’ perceptions of service providers’ reputation through patients’ close networks, social media, and patients’ communication with medical experts. It also includes service providers’ contributions to society via offline or digital spaces, such as medical webinars or pro bono services. 19 , 20
Regarding CPV, although the perception of customer-related service quality is very subjective, existing empirical studies have pointed out that companies with high customer perceived value have more competitive advantages than their competitors and are more likely to retain customers. While previous empirical studies have shown that emotional value and social influence significantly affect CPV, these findings are in non-medical contexts. 21 , 22 Hence, to further understand the influence of service quality on CPV, the study posits the following hypotheses:
H1a: Function positively affects Customer perceived value.
H2a: Emotion positively affects Customer perceived value.