Understanding Patient Revisit Intention and Word of Mouth in Healthcare Services: A SERVQUAL-Based Framework with Higher-Order Constructs
DOI:
https://doi.org/10.26905/jmdk.v13i2.15591Keywords:
Servqual, Perceived Value, Satisfaction, Word of Mouth, Revisit IntentionAbstract
Healthcare quality plays a crucial role, but improving access to healthcare must be prioritized alongside population growth to ensure equitable and sustainable accessibility. This study investigates the impact of hospital service quality on perceived value and patient satisfaction. Additionally, perceived value affects satisfaction, revisit intention, and word of mouth, while patient satisfaction impacts revisit intention and word of mouth. This study employs a quantitative method using an online survey of 174 respondents across five cities in Indonesia. The research data were analyzed using multivariate statistics, specifically variance-based structural equation modeling. The outcomes of the analysis indicate that all the hypotheses proposed are statistically supported. Service quality in hospitals positively and significantly affects perceived value and satisfaction. Furthermore, perceived value affects satisfaction, revisit intention, and word of mouth. Satisfaction also significantly affects revisit intention and word of mouth. This study develops a service quality framework within the literature on hospital service quality and measurement using Higher-Order Constructs. Hospitals can enhance patients' perceived value and foster sustainable satisfaction by focusing on the service quality framework. This strategy is crucial in addressing competition in the healthcare market, particularly in attracting and retaining patients amid the ongoing dynamics of healthcare system reforms.
Downloads
References
Abdi, H. A., Warsame, M. O., Adan, M. A., & Hassan, M. A. (2024). Assessment of Patient Satisfaction Attaining Primary Health Care Services at Health Centers in Mogadishu, Somalia. Patient Preference and Adherence, 18, 2529-2543. https://doi.org/10.2147/PPA.S486919
Abdullah, M. Z., Othman, A. K., Hamzah, M. I., Anuar, A., Tobi, S. N. M., & Solat, N. (2023). The Influence of Healthcare Service Quality on Public University Students’ Satisfaction and Behavioural Intention: Moderating Role of Trust. Journal of Health Management, 25(3), 489-498. https://doi.org/10.1177/09720634221076886
Abekah-Nkrumah, G., Yaa Antwi, M., Braimah, S. M., & Ofori, C. G. (2021). Customer relationship management and patient satisfaction and loyalty in selected hospitals in Ghana. International Journal of Pharmaceutical and Healthcare Marketing, 15(2), 251-268. https://doi.org/10.1108/IJPHM-09-2019-0064
Abu-Hasheesh, S. J., Dandis, A. O., Eid, M. A. H., Alzyoud, S., & Al Khasawneh, M. (2024). The influence of service quality and marketing ethics on relationship marketing outcome in private hospitals. Journal of Marketing Communications. https://doi.org/10.1080/13527266.2024.2376256
Agustiawan. (2022). The Impact of Hospital Health Promotion on Patient Loyalty in Hospital: A Literature Review. Media Publikasi Promosi Kesehatan Indonesia, 5(2), 134-138. https://doi.org/10.56338/mppki.v5i2.2046
Aiken, L. H., Sloane, D. M., Ball, J., Bruyneel, L., Rafferty, A. M., & Griffiths, P. (2021). Patient satisfaction with hospital care and nurses in England: an observational study. BMJ open, 8(1). https://doi.org/10.1136/bmjopen-2017-019189
Ajarmah, B. S., Hashem, T. N., & Swies, R. J. (2017). The effect of 5Q model on patient's satisfaction in military hospitals in Jordan. International Journal of Productivity and Quality Management, 20(3), 273-290. https://doi.org/10.1504/IJPQM.2017.082634
Ajzen, I. (1991). The theory of planned behavior. Organizational behavior and human decision processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T
Alfathi, B. R. (2024, Oct 19, 2024). Jumlah Rumah Sakit di Indonesia Terus Bertambah Selama 5 tahun Terakhir. GoodStats. https://data.goodstats.id/statistic/jumlah-rumah-sakit-di-indonesia-terus-bertambah-selama-5-tahun-terakhir-LMTkC
Ali, M. (2018). How patients perceive healthcare services: A case of Ayub Teaching Hospital, Abbottabad–Pakistan. SERV Service QUAL Quality. International Journal of Healthcare Management, 11(1), 52-59. https://doi.org/10.1080/20479700.2017.1304324
Ali, N., & Dzandu, M. D. (2023). A paradigm shift for medical health care to focus on a service-value approach to achieve greater patient satisfaction. Journal of Health Organization and Management, 37(2), 133-157. https://doi.org/10.1108/JHOM-06-2022-0180
AlOmari, F. (2021). Measuring gaps in healthcare quality using SERVQUAL model: challenges and opportunities in developing countries. Measuring Business Excellence, 25(4), 407-420. https://doi.org/10.1108/MBE-11-2019-0104
AlOmari, F., & A. Hamid, A. B. (2022). Strategies to improve patient loyalty and medication adherence in Syrian healthcare setting: The mediating role of patient satisfaction. PloS one, 17(11). https://doi.org/10.1371/journal.pone.0272057
Alumran, A., Almutawa, H., Alzain, Z., Althumairi, A., & Khalid, N. (2021). Comparing public and private hospitals’ service quality. Journal of Public Health, 29(4), 839-845. https://doi.org/10.1007/s10389-019-01188-9
Álvarez-García, J., Del Río-Rama, M. D. L. C., Durán-Sánchez, A., & González-Vázquez, E. (2019). Quality in Customer Service and Its Relationship with Satisfaction: An Innovation and Competitiveness Tool in Sport and Health Centers. International Journal of Environmental Research and Public Health, 16(20), 3942. https://doi.org/10.3390/ijerph16203942
Ameryoun, A., Najafi, S., Nejati-Zarnaqi, B., Khalilifar, S. O., Ajam, M., & Ansarimoghadam, A. (2017). Factor selection for service quality evaluation: a hospital case study. International Journal of Health Care Quality Assurance, 30(1), 58-66. https://doi.org/10.1108/IJHCQA-05-2016-0070
Andjarwati, T., & Budiarti, E. (2024). Exploration of patient loyalty through value integration and customer satisfaction in class B university hospitals on Java Island. Edelweiss Applied Science and Technology, 8(6), 8057-8080. https://doi.org/10.55214/25768484.v8i6.3746
Araújo, F., Brandão, A., & Shaikh, A. A. (2025). Exploring the influence of patient testimonials on healthcare services: a social identity theory perspective. European Business Review, 37(3), 532-557. https://doi.org/10.1108/EBR-01-2024-0049
Ariffin, A. A. M., Aziz, N. A., Zain, N. M., & Menon, B. V. V. (2022). Antecedents and Consequences of Patient Satisfaction in the Context of Private Hospitalization Services. WSEAS Transactions on Business and Economics, 19, 259-268. https://doi.org/10.37394/23207.2022.19.24
Bhattacharyya, A., Rana, A., & Imran Khan, M. (2024). Study of factors affecting customer patronage: engagement model of health insurance. International Journal of Pharmaceutical and Healthcare Marketing, 18(4), 563-583. https://doi.org/10.1108/IJPHM-03-2023-0024
Bhattacherjee, A., & Premkumar, G. (2004). Understanding Changes in Belief and Attitude toward Information Technology Usage: A Theoretical Model and Longitudinal Test. MIS Quarterly, 28(2), 229-254. https://doi.org/10.2307/25148634
Boakye, K. G., Blankson, C., Prybutok, V. R., & Qin, H. (2017). An assessment of national healthcare service delivery: a Ghanaian illustration. International Journal of Quality and Reliability Management, 34(5), 649-666. https://doi.org/10.1108/IJQRM-12-2014-0200
Bon, A. T. (2019). Service quality of patient's perceived value in private hospital Surabaya, Indonesia. Proceedings of the International Conference on Industrial Engineering and Operations Management,
Borzée, J., Cardoen, B., Cherchye, L., De Rock, B., & Roodhooft, F. (2025). Linking outcomes to costs: A unified measure to advance value-based healthcare. Omega (United Kingdom), 133, Article 103270. https://doi.org/10.1016/j.omega.2024.103270
Chaulagain, S. (2024). Hospitality in healthcare: the impacts of utilitarian and hedonic value perceptions on behavioral intentions in the context of medical hotels. Journal of Hospitality and Tourism Insights, 7(5), 3167-3184. https://doi.org/10.1108/JHTI-10-2023-0744
Chen, X., Chen, M., Yu, S. H., Wu, Y., & Tao, A. (2020). Influence of type and source of electronic word-of-mouth on consumers’ health care-seeking decisions. Social Behavior and Personality, 48(11), Article e9535. https://doi.org/10.2224/sbp.9535
Chen, X., Zhao, W., Yuan, J., Qin, W., Zhang, Y., & Zhang, Y. (2022). The Relationships Between Patient Experience with Nursing Care, Patient Satisfaction and Patient Loyalty: A Structural Equation Modeling. Patient Preference and Adherence, 16, 3173-3183. https://doi.org/10.2147/PPA.S386294
Christanto, Y. A., Farida, N., & Arso, S. P. (2024). Analysis of the effect of customer value on patient satisfaction in hospitals: Literature Review. Media Publikasi Promosi Kesehatan Indonesia, 7(2), 366-372. https://doi.org/10.56338/mppki.v7i2.4941
Coutinho, S., Prasad, C. V. V. S. N. V., & Prabhudesai, R. (2020). Antecedents and outcomes of patient satisfaction in healthcare: A conceptual model. Health Marketing Quarterly, 37(4), 300-315. https://doi.org/10.1080/07359683.2021.1947068
Darzi, M. A., Islam, S. B., Khursheed, S. O., & Bhat, S. A. (2023). Service quality in the healthcare sector: a systematic review and meta-analysis. LBS Journal of Management & Research, 21(1), 13-29. https://doi.org/10.1108/LBSJMR-06-2022-0025
Datt, M., Gupta, A., Misra, S. K., & Gupta, M. (2025). CIRMQUAL: a conceptual framework of healthcare service quality. TQM Journal, 37(4), 1058-1095. https://doi.org/10.1108/TQM-08-2023-0260
Endeshaw, B. (2021). Healthcare service quality-measurement models: a review. Journal of Health Research, 35(2), 106-117. https://doi.org/10.1108/JHR-07-2019-0152
Fattahi, M., Farzin, M., Sadeghi, M., & Makvandi, R. (2022). Patient engagement behaviors in hospitals: the role of word of mouth and patient helping behaviors. International Journal of Pharmaceutical and Healthcare Marketing, 16(4), 606-623. https://doi.org/10.1108/IJPHM-01-2020-0003
Ferreira, D. C., Vieira, I., Pedro, M. I., Caldas, P., & Varela, M. (2023). Patient Satisfaction with Healthcare Services and the Techniques Used for its Assessment: A Systematic Literature Review and a Bibliometric Analysis. Healthcare, 11(5). https://doi.org/10.3390/healthcare11050639
Gongora-Salazar, P., Perera, R., Rivero-Arias, O., & Tsiachristas, A. (2024). Unravelling Elements of Value of Healthcare and Assessing their Importance Using Evidence from Two Discrete-Choice Experiments in England. PharmacoEconomics, 42(10), 1145-1159. https://doi.org/10.1007/s40273-024-01416-5
Guo, Y., Zhou, Y., Xing, X., & Li, X. (2020). Exploring the relationship between service quality of private hospitals and patient loyalty from the perspective of health service. Iranian Journal of Public Health, 49(6), 1097-1105. https://doi.org/10.18502/ijph.v49i6.3361
Habibi, A., & Rasoolimanesh, S. M. (2021). Experience and Service Quality on Perceived Value and Behavioral Intention: Moderating Effect of Perceived Risk and Fee. Journal of Quality Assurance in Hospitality & Tourism, 22(6), 711-737. https://doi.org/10.1080/1528008X.2020.1837050
Hair, J., William C, B., Barry J, B., & Rolph E, A. (2019). Multivariate Data Analysis (8 ed.). Cengage Learning EMEA.
Hair Jr, J. F. (2021). Next-generation prediction metrics for composite-based PLS-SEM. Industrial management & data systems, 121(1), 5-11. https://doi.org/10.1108/IMDS-08-2020-0505
Hair Jr, J. F., Hult, G. T. M., Ringle, C. M., & Sarstedt, M. (2022). A primer on partial least squares structural equation modeling (PLS-SEM) (3 ed.). Thousand Oaks: Sage.
K.S., S., Barkur., G., & G., S. (2023). Assessment of healthcare service quality effect on patient satisfaction and care outcomes: A case study in India. Cogent Business and Management, 10(3), Article 2264579. https://doi.org/10.1080/23311975.2023.2264579
Kalhor, R., Omid, K., Zakaria, K. M., Saeed, S., & and Badrlo, M. (2021). Role of service quality, trust and loyalty in building patient-based brand equity: Modeling for public hospitals. International Journal of Healthcare Management, 14(4), 1389-1396. https://doi.org/10.1080/20479700.2020.1762053
Kamra, V. (2021). Improving patients loyalty: A guide for healthcare service providers and policy makers. International Journal of Healthcare Management, 14(4), 1152-1160. https://doi.org/10.1080/20479700.2020.1752992
Kim, S., & Kim, H. S. (2023). A Study on the Effect of Medical Service Quality on Customer Satisfaction during COVID-19 for Foreigners in Korea. Sustainability (Switzerland), 15(7), Article 5953. https://doi.org/10.3390/su15075953
Kock, N. (2015). Common method bias in PLS-SEM: A full collinearity assessment approach. International Journal of e-Collaboration, 11(4), 1-10. https://doi.org/10.4018/ijec.2015100101
Laubscher, A., Rodseth, R. N., Retief, F., & Saville, A. (2025). How value perspectives influence decision-making in the South African private healthcare sector: A cross-sectional comparative study. PloS one, 20(2 February), Article e0316547. https://doi.org/10.1371/journal.pone.0316547
Lin, W., & Yin, W. (2022). Impacts of service quality, brand image, and perceived value on outpatient’s loyalty to China’s private dental clinics with service satisfaction as a mediator. PloS one, 17(6 June), Article e0269233. https://doi.org/10.1371/journal.pone.0269233
Liu, S., Li, G., Liu, N., & Hongwei, W. (2021). The impact of patient satisfaction on patient loyalty with the mediating effect of patient trust. INQUIRY: Journal of Healthcare Provision and Public Health, 58, 1-11. https://doi.org/10.1177/00469580211007221
Machmud, A. A., Brasit, N., Pono, M., Tahyf, H. S., Kadir, A. R., Munizu, M., Munir, A. R., & Machmud, E. (2024). Patient return visit interest: How much does service quality affect customer satisfaction in Dental and Oral Hospital. Journal of Dentomaxillofacial Science, 9(2), 84-87. https://doi.org/10.15562/jdmfs.v9i2.1913
Mai, P. T., Sa, N. P., Luu, T. D., Ly, N. K., & Nguyen, P. D. (2024). Emotional Competence of Healthcare Workers and Its Impact on Patient Loyalty in Vietnamese Hospitals. Health Psychology Research, 12. https://doi.org/10.52965/001c.127128
Majeed, S., Gon, K. W., & and Ryu, K. (2024). Medical Tourism and Cognitive Dissonance: Exploring Tourist Choice Behavior, Post-Choice Pre-Outcome Regret, and Visit Intention. Journal of Quality Assurance in Hospitality & Tourism, 25(3), 514-544. https://doi.org/10.1080/1528008X.2022.2135058
Mandagi, D. W., Rampen, D. C., Soewignyo, T. I., & Walean, R. H. (2024). Empirical nexus of hospital brand gestalt, patient satisfaction and revisit intention. International Journal of Pharmaceutical and Healthcare Marketing, 18(2), 215-236. https://doi.org/10.1108/IJPHM-04-2023-0030
Marino, L., & Capone, V. (2023). Value of Care: An Exploratory Qualitative Study with Doctors and Patients. European Journal of Investigation in Health, Psychology and Education, 13(7), 1117-1129. https://doi.org/10.3390/ejihpe13070084
Moreira, A., Alves, C., Machado, J., & Santos, M. F. (2023). An Overview of Omnichannel Interaction in Health Care Services. Mayo Clinic Proceedings: Digital Health, 1(2), 77-93. https://doi.org/10.1016/j.mcpdig.2023.03.002
Ng, J. H. Y., & Luk, B. H. K. (2019). Patient satisfaction: Concept analysis in the healthcare context. Patient Education and Counseling, 102(4), 790-796. https://doi.org/10.1016/j.pec.2018.11.013
Nguyen, N. X., Tran, K., & Nguyen, T. A. (2021). Impact of service quality on in-patients’ satisfaction, perceived value, and customer loyalty: A mixed-methods study from a developing country. Patient Preference and Adherence, 15, 2523-2538. https://doi.org/10.2147/PPA.S333586
Nikolaou, E., Kourakos, M., & Kafkia, T. (2022). Satisfaction of healthcare users with their contact with healthcare services and fulfilment of their expectations. Archives of Hellenic Medicine, 39(6), 735-741.
Nuhu, J. A., Yesilada, F., & Aghaei, I. (2025). A critical assessment of male HIV/AIDS patients’ satisfaction with antiretroviral therapy and its implications for sustainable development in Sub-Saharan Africa. Journal of Health Organization and Management. https://doi.org/10.1108/JHOM-01-2024-0009
Özer, L., Başgöze, P., & Karahan, A. (2017). The association between perceived value and patient loyalty in public university hospitals in Turkey. Total Quality Management and Business Excellence, 28(7-8), 782-800. https://doi.org/10.1080/14783363.2015.1124723
Park, S., Kim, H. K., Choi, M., & Lee, M. (2021). Factors affecting revisit intention for medical services at dental clinics. PloS one, 16(5 May), Article e0250546. https://doi.org/10.1371/journal.pone.0250546
Pasinringi, S. A., Rivai, F., Sidin, A. I., Thamrin, Y., & Mumang, A. A. (2024). An analysis of service experience and perceived value influence on patient’s satisification at regional public hospitals in South Sulawesi Province. Asia Pacific Journal of Health Management, 19(1). https://doi.org/10.24083/apjhm.v19i1.3251
Pauli, G., Martin, S., & Greiling, D. (2023). The current state of research of word-of-mouth in the health care sector. International Review on Public and Nonprofit Marketing, 20(1), 125-148. https://doi.org/10.1007/s12208-022-00334-6
Prasad, B., & Ghosal, I. (2019). Perception of cancer patients towards the service quality of the healthcare industry: A paradigmatic research on serviceability. International Journal of Innovative Technology and Exploring Engineering, 8(11), 676-681. https://doi.org/10.35940/ijitee.K1719.0881119
Rahim, A. I. A., Ibrahim, M. I., Yaacob, N. M., Chua, S.-L., & Musa, K. I. (2021). Patient Satisfaction and Hospital Quality of Care Evaluation in Malaysia Using SERVQUAL and Facebook. Healthcare, 9(10), 1369. https://doi.org/10.3390/healthcare9101369
Rajić, T., Rakić, A., & Milošević, I. (2021). Modelling Health Care Customer Satisfaction: Evidence from Serbia. Serbian Journal of Management, 16(1), 125-145. https://doi.org/10.5937/sjm16-25961
Ren, D., & Ma, B. (2021). Effectiveness of Interactive Tools in Online Health Care Communities: Social Exchange Theory Perspective. J Med Internet Res, 23(3), e21892. https://doi.org/10.2196/21892
Rout, S. K., Sundar, S. K., & and Mahapatra, S. (2021). Utilization of health care services in public and private healthcare in India: Causes and determinants. International Journal of Healthcare Management, 14(2), 509-516. https://doi.org/10.1080/20479700.2019.1665882
Rüter, F., & Meier, C. A. (2022). Value-based Healthcare, PROMs und Shared Decision-Making [Review]. Therapeutische Umschau, 79(8), 359-363. https://doi.org/10.1024/0040-5930/a001375
Sanıl, M., & Eminer, F. (2021). An integrative model of patients’ perceived value of healthcare service quality in North Cyprus. Archives of Public Health, 79(1), Article 227. https://doi.org/10.1186/s13690-021-00738-6
Shabbir, A., Malik, S. A., & Malik, S. A. (2016). Measuring patients’ healthcare service quality perceptions, satisfaction, and loyalty in public and private sector hospitals in Pakistan. International Journal of Quality & Reliability Management, 33(5). https://doi.org/10.1108/IJQRM-06-2014-0074
Shmueli, G., Sarstedt, M., Hair, J. F., Cheah, J.-H., Ting, H., Vaithilingam, S., & Ringle, C. M. (2019). Predictive model assessment in PLS-SEM: guidelines for using PLSpredict. European Journal of Marketing, 53(11), 2322-2347. https://doi.org/10.1108/EJM-02-2019-0189
Singh, D., & Dixit, K. (2020). Measuring Perceived Service Quality in Healthcare Setting in Developing Countries: A Review for Enhancing Managerial Decision-making. Journal of Health Management, 22(3), 472-489. https://doi.org/10.1177/0972063420963407
Swain, S., & Kar, N. C. (2017). A Holistic Framework for Conceptualizing Hospital Service Quality. Journal of Health Management, 19(1), 84-96. https://doi.org/10.1177/0972063416682563
Swathi, K. S., Gopal Krishna, B., & Somu, G. (2019). Assessment of in-patient satisfaction using importance-performance map analysis. Indian Journal of Public Health Research and Development, 10(6), 267-271. https://doi.org/10.5958/0976-5506.2019.01280.4
Sweeney, J. C., & Soutar, G. N. (2001). Consumer perceived value: The development of a multiple item scale. Journal of Retailing, 77(2), 203-220. https://doi.org/10.1016/S0022-4359(01)00041-0
Upamannyu, N. K., Singh, A. P., & Gupta, R. (2022). Relationship assessment of perceived quality, perceived value, hospital image and patient satisfaction with respect to health services. International Journal of Trade and Global Markets, 15(2), 201-216. https://doi.org/10.1504/IJTGM.2022.121448
Wilberforce, M., Batten, E., Challis, D., Davies, L., Kelly, M. P., & Roberts, C. (2018). The patient experience in community mental health services for older people: A concept mapping approach to support the development of a new quality measure. BMC Health Services Research, 18(1), Article 461. https://doi.org/10.1186/s12913-018-3231-6
Woo, S., & Choi, M. (2021). Medical service quality, patient satisfaction and intent to revisit: Case study of public hub hospitals in the Republic of Korea. PloS one, 16(6), e0252241. https://doi.org/10.1371/journal.pone.0252241
Wu, H.-C., Li, T., & Li, M.-Y. (2016). A Study of Behavioral Intentions, Patient Satisfaction, Perceived Value, Patient Trust and Experiential Quality for Medical Tourists. Journal of Quality Assurance in Hospitality & Tourism, 17(2), 114-150. https://doi.org/10.1080/1528008X.2015.1042621
Wu, H. L., Liu, C. Y., & Hsu, W. H. (2008). An integrative model of customers' perceptions of health care services in Taiwan. Service Industries Journal, 28(9), 1307-1319. https://doi.org/10.1080/02642060802230130
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
(1)Â Copyright of the published articles will be transferred to the journal as the publisher of the manuscripts. Therefore, the author confirms that the copyright has been managed by the journal.
(2) Publisher of Jurnal Penelitian is University of Merdeka Malang.
(3) The copyright follows Creative Commons Attribution–ShareAlike License (CC BY SA): This license allows to Share — copy and redistribute the material in any medium or format, Adapt — remix, transform, and build upon the material, for any purpose, even commercially.
