Customer loyalty, with satisfaction of customers as its main precondition, has long been regarded as an overarching goal of service businesses. With the proliferation of health care providers, which brought about rising competitive pressures on the market, the issue of how to satisfy and keep patients has been attracting increasing attention of researchers and health care management. Therefore, this study aims to examine the antecedents of patient satisfaction and its direct and mediated impact on patients' behavioural intentions in thus far under-studied context of emerging economy's health care system. The study has been conducted in a primary health care setting, on a convenience sample of 300 patients, by means of structured questionnaire. The application of structural equation modelling (SEM) revealed direct impact of health care service quality on patient satisfaction and its mediated impact on satisfaction, via perceived value of health care services. In addition to direct influence of satisfaction on patients' behavioural intentions, its total effect on positive intentions of patients is increased by the impact of patient commitment to a health care provider, which, as evidenced by this study's findings, increases with patient's rising trust into a health care provider. Implications for theory and practice are discussed and further research directions are provided.

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Research question: This study aims to investigate the determinants of customer loyalty in a European emerging economy’s health care setting. Motivation: In spite of a rising research interest in the determinants of patients’ loyalty over previous years, scarce attention has been paid to date to simultaneous examination of the influential factors of patients’ loyalty. Although a number of studies have pointed to patients’ perceptions of service quality as an important determinant of loyalty, there is a paucity of research of the impact of service quality, at a disaggregate level, on patients’ loyalty. Idea: To address this knowledge gap, this study builds upon the South Korean health care service quality measurement instrument and, upon supporting its validity in the Serbian health care setting, examines a relative contribution of service quality dimensions and satisfaction to patients’ loyalty. Data: Quantitative research has been performed, by means of a structured questionnaire, on a convenience sample of 300 health care customers in Serbia. Tools: Structural equation modelling (SEM) has been applied to simultaneously examine the impact of service quality dimensions and satisfaction on patients’ loyalty. Findings: Results of the study point to patient satisfaction as the most significant determinant of loyalty, followed by tangibles and concern of other medical staff, which in terms of total effect resulted as statistically significant determinants of loyalty.  Findings of this study indicate that managerial attention to these predictors may results in higher levels of patients’ loyalty to the institution. Contribution: This study adds to the body of knowledge on patients’ loyalty and points to the relevance of a more holistic approach in future examinations of customer loyalty in a health care setting.

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