The effect on patient loyalty of service quality, patient visit experience and perceived switching costs: lessons from one Taiwan university hospital

Abstract

The reimbursement system changed from fee-for-service to fixed prospective payments in Taiwan, the effect on the physician-patient's relationship is worth being studied. We examined the relationship between patient visit experience, cost perceptions and the two important aspects of quality of care, curing and interpersonal performance, and patients' loyalty to the hospital physicians. A total of 404 patients from an acute care hospital in Taiwan, Kaohsiung Medical University Hospital (KMUH), were investigated using a self-administered mailing survey. All measures including patient loyalty (PL), curing service quality (CSQ), interpersonal service quality (ISQ), visit experience (VE) and perceived switching costs (PSC), were adapted and modified from existing scales. Our results showed that the physician's CSQ and ISQ positively affected patients' loyalty to KMUH. The interaction between the main effects of service quality, patients' VE and three types of switching visit costs, yielded additional insights into the importance of service quality for patient retention. The CSQ of physicians becomes a more important determinant of loyalty than ISQ as patients' VE increases. The importance of CSQ and ISQ increases in relation to PL as the perceived procedural and relational costs of changing care providers increases. Neither CSQ nor ISQ has a reduced relationship with PL as the perceived financial costs of switching hospitals increase. Our study indicates that the impact of CSQ and ISQ on loyalty varies according to the perceived visit costs of changing hospitals and the patients' VE.

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“…We suggest that this can be related to the switching costs. Previous literature [ 8 , 32 , 33 ] shows that older patients stay longer with their current hospitals, and the longer their tenure is, the higher the switching cost is, and in turn, the less likely they will be motivated to switch. Residence is the only factor that does not play a role in patients’ decision-making process during their selection of hospital services.…”

“…The primary barrier that is likely to prevent patients from choosing or switching to an accredited hospital is the perceived switching costs, which can be specified as perceived procedural costs, perceived relational costs, and perceived financial costs [ 32 ]. A prior study shows that as perceived procedural and relational costs of changing hospitals increase, the quality of curing service and interpersonal service become more critical to patient loyalty.…”

“…A prior study shows that as perceived procedural and relational costs of changing hospitals increase, the quality of curing service and interpersonal service become more critical to patient loyalty. In contrast, the perceived financial costs do not have a significant moderating impact on the relationship between the quality of healthcare services and patient loyalty [ 32 ]. In a similar vein, a recent study of women’s choice of hospital for childbirth in Florida also found that switching costs account for approximately 40% of the reasons for women to return to the same hospital [ 33 ].…”

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“…Hospital Loyalty Scale : The scale was developed by Price and Arnould (1999) for use in the service sector, and it was adapted for the health sector by Wang et al (2011). The Turkish adaption, validity and reliability tests were done by Unal et al (2018).…”

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