Although it is not commonly accepted within healthcare services industry, the importance of marketing is more and more recognized nowadays by the organizations activating in the field. Current perception resides in a series of factors as: ethical aspects involved in the delivery process; special characteristics of the market; particular profile and behavior of the consumers of healthcare services and probably because of the inadequate understanding of the marketing role in the life of an organization. A deep analysis in the field of healthcare services will emphasize not only its complexity, but also its interdisciplinary feature under many aspects, as it is an area where many fields of interest are intersecting, both economic and social. It also reveals a particular field of study with many particular features - considered a sensitive field (Popa and Vladoi 2010: 232). Generated using the SERVQUAL model, the data presented in the paper are the result of a quantitative research designed to measure and compare the patient/client satisfaction degree for public and private medical services provided by the Romanian hospitals. The aim of the research is to identify and to measure the gap that appears between the patient/clientâ€(tm) expectations and perceptions regarding the delivered services; to identify the potential profile of the private Romanian hospitalsâ€(tm) clients regarding the demographic features and also to pin-point correlations between the image created in the mind of the Romanian patients/clients and the type of medical services (public or private) they were using. We consider that the results of this research are valuable for the managers of the medical units in order to initiate series of actions aiming to improve the quality of their services and, as a result the patient/clientsâ€(tm) satisfaction degree. Later being one of the most important performance indicators of an organization that activates in a highly competitive business environment. We also consider this research may be useful in the process of improving the quality of the medical services in Romania, which must be a priority for any medical unitsâ€(tm) management and for the society as a whole. Present paper intends to lay foundation for future research, tailored to correlate the quality culture for the Romanian hospitals and the satisfaction degree of their patients/clients.relationship marketing, patientsâ€(tm) satisfaction, public and private medical services, Oradea, Romania

Mihoc Florin

Popa Adela Laura

Rosca Remus Dorel

English

Research Papers in Economics

 
768 
 
INVESTIGATING THE PATIENT SATISFACTION WITHIN ROMANIAN 
PUBLIC AND PRIVATE HOSPITALS 
Popa Adela Laura 
University of Oradea, Faculty of Economics, Oradea, Romania 
Roşca Remus Dorel 
University of Oradea, Faculty of Economics, Oradea, Romania 
Mihoc Florin 
Emanuel University of Oradea, Management Faculty 
 
Although it is not commonly accepted within healthcare services industry, the importance of 
marketing is more and more recognized nowadays by the organizations activating in the field.  
Current perception resides in a series of factors as: ethical aspects involved in the delivery 
process; special characteristics of the market; particular profile and behavior of the consumers 
of healthcare services and probably because of the inadequate understanding of the marketing 
role  in  the  life  of  an  organization.  A  deep  analysis  in  the  field  of  healthcare  services  will 
emphasize not only its complexity, but also its interdisciplinary feature under many aspects, as it 
is an area where many fields of interest are intersecting, both economic and social. It also 
reveals a particular field of study with many particular features - considered a sensitive field 
(Popa and Vladoi 2010: 232). Generated using the SERVQUAL model, the data presented in the 
paper  are  the  result  of  a  quantitative  research  designed  to  measure  and  compare  the 
patient/client  satisfaction  degree  for  public  and  private  medical  services  provided  by  the 
Romanian hospitals. The aim of the research is to identify and to measure the gap that appears 
between  the  patient/client’  expectations  and  perceptions  regarding  the  delivered  services;  to 
identify  the  potential  profile  of  the  private  Romanian  hospitals’  clients  regarding  the 
demographic features and also to pin-point correlations between the image created in the mind 
of the Romanian patients/clients and the type of medical services (public or private) they were 
using. We consider that the results of this research are valuable for the managers of the medical 
units in order to initiate series of actions aiming to improve the quality of their services and, as a 
result the patient/clients’ satisfaction degree. Later being one of the most important performance 
indicators of an organization that activates in a highly competitive business environment. We 
also consider this research may be useful in the process of improving the quality of the medical 
services in Romania, which must be a priority for any medical units’ management and for the 
society  as  a  whole.  Present  paper  intends  to  lay  foundation  for  future  research,  tailored  to 
correlate the quality culture for the Romanian hospitals and the satisfaction degree of their 
patients/clients. 
 
Keywords: relationship marketing, patients’ satisfaction, public and private medical services, 
Oradea, Romania. 
 
JEL Classification: M31, I11 
 
1. Introduction 
The present paper is mainly focusing on presenting the results of a research whose aim started 
from the idea that satisfaction represents a major vector that leads to customer retention and 
loyalty (Chiou and Droge 2006: 613). Details regarding the research aim and methodology were 
the  subject  of  article  entitled  Measuring  Patient  Satisfaction  within  Romanian  Healthcare  
769 
 
Services – a Relationship Marketing Approach, included in the program of the 15th IBIMA 
Conference Cairo, Egypt 6-7 November 2010. Below is the summarized essential features of the 
research methodology of the above paper. 
The purpose of this research was concentrated on analyzing the satisfaction degree as perceived 
by  patients  within  public  and  private  medical  systems  from  Oradea,  Romania;  on  analyzing 
discrepancies between levels of expectations and perceptions on the 5 dimensions which were 
took into account to measure satisfaction level, and on identifying a potential customer profile for 
private medical services, starting from key demographic characteristics (Popa et al 2010: 842-
846).  
The paper objectives are: 
- Quantify discrepancy between expectations and perceptions regarding patients’ satisfaction; 
-  Identify  customer’s  profile  for  private  medical  services  starting  from  key  demographical 
characteristics;  
Referring  to  the  research  methodology,  in  order  to  measure  patients’  satisfaction  degree 
regarding quality of medical services, we use SERVQUAL model, developed by Parasuraman et 
al. in 1985. The five dimensions of the SERVQUAL model, exhibited on a double 22 scale items, 
are the followings (Parasuraman, Zeithaml and Berry 1988; Parasuraman, Berry and Zeithaml 
1991; Bruhn 2001: 82-83): Tangibles – physical/tangible environment acceptability: physical 
facilities, equipment, image/personnel posture; Reliability – reliability/trust/honesty: capacity to 
deliver  promised  service  in  a  consistent  and  correct  manner;  Responsiveness  - 
availability/receptivity:  willingness  to  support  and  offer  a  prompt  service;  Assurance  – 
competence/certainty:  personnel  knowledge  and  skills,  degree  of  inspiring  trust  and 
responsibility; Empathy: involvement, dedication, care, capacity of giving attention individually 
to each patient. 
By comparing the ideal profile – that describes the ideal situations and the real profile – that 
describes the real situations (Bruhn 2001: 83) we will measure discrepancy between expectation 
and perception levels. 
Present research is descriptive and cross-sectional one and has been conducted in May 2010, was 
focusing  on inhabitants of  city  of  Oradea  and  surrounding  areas  that  have  accessed  medical 
services, whether public or private in the last 3 years (during 2007-2010). The research was 
conducted online using a nonprobability sampling technique, the snowball sampling. From a total 
of 141 questionnaires applied, 128 were used in final analysis. 
This  quantitative  research  has  the  survey  as  research  method,  supported  by  a  structured 
questionnaire consisting of 57 questions, of which 22 evaluated on a double scale. 
 
2. Data analysis and interpretation 
 
Table 1 exhibits the demographic characteristics of the group of respondents, as follows:  
 
Table 1: Demographics of respondents 
  Number of respondents  % 
Gender (n=128) 
-  Female 
-  Male 
 
84 
44 
 
65,6% 
34,4% 
Age groups (n=127) 
-  under 25 
-  between 25 and 34 years 
-  between 34 and 44 years  
 
35 
40 
28 
 
27,6% 
31,5% 
22,0%  
770 
 
  Number of respondents  % 
-  over 45 years 
Missing System  
24 
1 
18,9% 
 
Income (n=128) 
-  < 1000 Ron (< 230 Euros) 
-  Ron 1001 - 2000 (Euros 230-470) 
-  Ron 2001 - 3000 (Euros 470-700) 
-  > 3001 Ron (>700 Euros) 
-  Do not know 
-  Decline to answer 
 
48 
41 
14 
11 
11 
3 
 
37,5% 
32,0% 
10,9% 
8,6% 
8,6% 
2,3% 
Studies (n=128) 
-  Undergraduate Studies 
-  University degree 
-  Postgraduate Studies 
 
59 
39 
30 
 
46,1% 
30,5% 
23,4% 
Type of medical services (n=128) 
-  Private 
-  Public 
 
68 
60 
 
53,1% 
46,9% 
Source: own research 
 
Overall aim was to identify a possible profile for the people who turn to the private medical 
services. By correlating the variable Type of medical services (public/private) with each of the 
variables Gender, Age groups, Income, Studies, conclusion reached was that out of those who 
required private medical services: 
-  73,5% are women; 
-  38,8% are between 25 and 34 years old; 
-  45,6% have highschool education; 
-  49,1% have the income under 1000RON (about 230Euros). 
It is important to mention that there is a significant correlation (Pearson coefficient value being 
0,034 <0,05) only when we have it between Type of services and Gender variables. Still, the 
intensity of the link is weak, Cramer coefficient value being of 0,177. From a standpoint of these 
characteristics, there is not resulting a profile of the private medical services customer, at least at 
Oradea level.  
H1:  The  discrepancy  between  expectations  and  perceptions  is  bigger  in  the  case  of  public 
medical services than in the private ones. 
In order to check this hypothesis, for each of the 5 dimensions involved in the satisfaction level 
calculations we determined the average results both at expectation and perception levels. The 
discrepancy is calculated as difference between the results on these 2 levels.  
Based  on  the  resulted  data,  it  can  be  concluded  that  the  level  of  discrepancies  between 
expectations and perceptions related to medical services is a lot less for private services (the 
values are between 0,40 and 0,79 for private medical services, while they have values between 
1,39 and 1,67 for public medical services). 
  
771 
 
 
Figure 1: Comparison expectations vs. perceptions for medical services (public vs. private) 
Source: own research 
 
According  to  the  above  data  we  can  remark  that  the  highest  level  of  expectations  from  the 
medical services aims at Reliability followed by that of Assurance. The smallest score regarding 
expectations refers to Empathy.  
Interestingly enough regarding perceptions is that the highest calculated score for the public 
medical services is lower than the lowest score for the private medical services. It is also worth 
mentioning  that  the smallest  calculated  results  concern empathy,  for  both public  and  private 
medical  services.  Also,  even  if  there  is  a  difference  between  the  scores  calculated  for  the 
perception of dimensions in the case of private medical services compared with the public ones, 
the  hierarchy  is  almost  the  same.  The  only  difference  is  that  the  perception  of  the  physical 
elements has the highest result for the private medical services (see Tables 2 and 3). 
 
Table 2   Table 3 
Hierarchy perception scores for public 
medical services 
  Hierarchy perception scores for private medical 
services 
Empathy  2,76    Empathy  3,67 
Responsiveness - 
availability/receptivity  2,84    Responsiveness - availability/receptivity  3,76 
Tangibles – physical/tangible 
environment acceptability  2,85    Reliability – reliability/ trust/ honesty  3,8 
Reliability – reliability/ trust/ honesty  2,97    Assurance – competence/certainty  4,05 
Assurance – competence/certainty  3,03    Tangibles – physical/tangible 
environment acceptability  4,12 
Source: own research   Source: own research 
  
Figure 2: Discrepancy between expectations and perceptions for private medical services
 
It  can  be  noticed  that  for  the  private  hospitals,  the  greatest  discrepancy  is  in 
Reliability/Trust/Honesty, a dimension that has actually the highest le
smallest discrepancy concerns the physical environment, the tangibles. A pretty 
noticed for the empathy, this one having also the smallest value regarding expectations.
 
Figure 3: Discrepancy between expectations
 
The  dimension  which  reflects  the  quality  of  endowment  is  the  one  with  the  biggest  value 
referring the discrepancies between expectations and perceptions for the public medical services. 
Although the values are close enough, we see that the smallest discrepancy aims at empathy
 
3. Conclusions and future research approach
- The hypothesis according to which the discrepancy between expectations and perceptions is 
bigger  for  the  public  medical  services  than  for  the  private  ones  is  confirmed.  The  scores 
calculated for the way in which the 5 analyzed dimensions are perceived from the quality point of 
view  (of  the  offered  satisfaction)  are  between 2,76
between 3,67–4,12 for the private ones, 5 being the maximum value to give. 
 
772 
2: Discrepancy between expectations and perceptions for private medical services
Source: own research 
that  for  the  private  hospitals,  the  greatest  discrepancy  is  in 
Reliability/Trust/Honesty, a dimension that has actually the highest level of expectations. The 
smallest discrepancy concerns the physical environment, the tangibles. A pretty low 
noticed for the empathy, this one having also the smallest value regarding expectations.
Figure 3: Discrepancy between expectations and perceptions for public medical services
Source: own research 
The  dimension  which  reflects  the  quality  of  endowment  is  the  one  with  the  biggest  value 
referring the discrepancies between expectations and perceptions for the public medical services. 
hough the values are close enough, we see that the smallest discrepancy aims at empathy
3. Conclusions and future research approach 
The hypothesis according to which the discrepancy between expectations and perceptions is 
services  than  for  the  private  ones  is  confirmed.  The  scores 
calculated for the way in which the 5 analyzed dimensions are perceived from the quality point of 
view  (of  the  offered  satisfaction)  are  between 2,76-3,03  for  the  public  medical  services  and 
4,12 for the private ones, 5 being the maximum value to give.  
 
2: Discrepancy between expectations and perceptions for private medical services 
that  for  the  private  hospitals,  the  greatest  discrepancy  is  in 
vel of expectations. The 
low value can be 
noticed for the empathy, this one having also the smallest value regarding expectations. 
 
and perceptions for public medical services 
The  dimension  which  reflects  the  quality  of  endowment  is  the  one  with  the  biggest  value 
referring the discrepancies between expectations and perceptions for the public medical services. 
hough the values are close enough, we see that the smallest discrepancy aims at empathy. 
The hypothesis according to which the discrepancy between expectations and perceptions is 
services  than  for  the  private  ones  is  confirmed.  The  scores 
calculated for the way in which the 5 analyzed dimensions are perceived from the quality point of 
3,03  for  the  public  medical  services  and  
773 
 
- The highest score calculated for the public medical services is smaller than the smallest score 
calculated for the private medical services. 
- Another interesting aspect refers to empathy. This has the smallest score for both expectations 
and perceptions in both private and public medical services. An explanation of the low score 
regarding the expectations of this dimension could be the way in which it has been perceived in 
the course of time. The empathy here refers to the involvement, dedication, care, capacity of 
offering/giving attention to each customer/patient individually.   
- There is solid argument, at least for Oradea surveyed area, from the point of view of these 
characteristics,  that  a  profile  of  the  private  medical  services  customer  is  still  vague  and 
undefined. 
- Even if there are discrepancies between the private medical services and the public ones for the 
calculated  scores  of  the  5  dimensions,  the  hierarchy  is  almost  the  same:  Empathy, 
Responsiveness,  Reliability/Trust/Honesty,  Competence/Certainty,  except  for  the  dimension 
aiming at the Physical/tangible environment acceptability. This one has the highest score for the 
private medical services and the third place for the public ones. 
- As future research, we intend to measure (using a structured questionnaire) the intensity of the 
quality culture for the Romanian hospitals. As a consequence of all these results, we seek to 
validate  there  is  a  correlation  between  quality  culture  for  the  Romanian  hospitals  and  the 
satisfaction degree of their patients/clients.  
 
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Building patient loyalty using online tools.”

Measuring Patient Satisfaction Within Romanian Healthcare Services – A Relationship Marketing Approach.”

Orientarea spre clienţi. Temelia afacerii de succes. Bucureşti: Editura Economică,

Service Quality, Trust, Specific Asset Investment, and Expertise: Direct and Indirect Effect in Satisfaction-Loyalty Framework”,

SERVQUAL: a multiple item scale for measuring consumer perceptions of service quality”,

INVESTIGATING THE PATIENT SATISFACTION WITHIN ROMANIAN PUBLIC AND PRIVATE HOSPITALS

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INVESTIGATING THE PATIENT SATISFACTION WITHIN ROMANIAN PUBLIC AND PRIVATE HOSPITALS

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