Objective To evaluate the effect of healthcare employees’ emotional competence (EC) on patient loyalty in public and private hospitals in Ho Chi Minh City, with a focus on the mediating roles of respect, trust, and rapport. Method A survey of 244 patients measured respect, trust, rapport, EC, and patient loyalty using a 5-point Likert scale. Structural equation modeling (SEM) was applied to assess the relationships between EC and patient loyalty, comparing results between public and private hospitals. Results EC significantly enhanced patient loyalty, with respect and rapport serving as key mediators. Private hospitals showed higher EC levels among staff, leading to greater patient loyalty, while public hospitals, impacted by staff fatigue and high patient loads, demonstrated lower EC and reduced loyalty. EC accounted for 58% of service quality variance and 65% of loyalty variance. Conclusions Emotional competence is essential for improving patient loyalty in healthcare settings. Training programs targeting EC, especially in public hospitals, could enhance patient satisfaction and long-term loyalty.