An Empirical Analysis of Patient’s Perception regarding Health Care Service Quality: A Case Study of Public Hospitals of Punjab

Author

Dr. Harinder Singh Professor Department of Management Studies, Amritsar College of Engineering & Technology, Amritsar, Punjab.

Ms. Navalpreet kaur Research Scholar Punjab Technical University, Kapurthala, Punjab.

Postal Address:- 21, Mall Avenue Mall Road

Near Ram Ashram School

Amritsar(143001), Punjab.

Mob no.# 09779710500, 09815200765

Abstract

In this dynamic environment, health care service seekers preferences keep on changing rapidly. Patients are becoming more demanding in terms of quality they entail, in services they obtain at the hospital. Nowadays, quality in health care services is at the forefront of specialists & professional, as it is one of the most important steps towards sustainability and introducing changes in the health care sector. Organizations need to concentrate, comprehend, and keep themselves rationalized, to the changing needs of patients recurrently. Literature affirms, SERVQUAL instrument was used to measure the service quality in health care by various researchers. In the light of above, this study is conducted to check the suitability of SERVQUAL scale, in the context of health care service quality provided at public hospitals in Punjab, India. Along with that, various factors influencing patients perception regarding service quality were also explored and identified in order of importance. Data was collected from 375 respondents, from seventeen public hospitals situated at urban areas, in three different cities of Punjab i.e. Amritsar, Jalandhar, and Ludhiana. Data was analyzed using statistical techniques like mean, standard deviation, cronbach’s alpha and EFA using SPSS 20. Findings of this study revealed reliability of data as well as the suitability of twenty one item servqual scale in context of Punjab. The outcome of EFA identified five factors which were responsiveness (variance explained 15.351), tangibility (variance explained 14.807), reliability (variance explained 12.946), assurance (variance explained 10.622) and empathy (variance explained 10.605). Results of this study can direct policy makers and health care service providers towards the areas, which need more attention so that they could provide best possible service to the patients.

Keywords: Patients Perception, SERVQUAL, Punjab, Public Hospitals, EFA

1. Introduction

Health care sector in India has grown hastily over the past decade. Until the early 1990s, healthcare was relatively neglected in India but at present, it is considered as one of the most important objective of countries development agenda. This sector is expected to be the leader in e-health by 2019 and grow to US$ 280 billion by 2020. It has become one of the important sectors for revenue generation, providing employment in the country and provides vast opportunities for investors (“India’s healthcare sector,” 2016). The government of India has taken various initiatives to enhance the availability of health care to all since years (“Health,” n.d.)India's health sector was allocated Rs 37,330 crore in budget estimates for 2013-14, with a special focus on medical education, training, and research (“Budget 2013: Health sector,” 2013) Similar scenario could be seen in union budget 2016-17. Along with provision of funds, universal health plan (Reddy et al., 2011), mission indradhanush, national dialysis services, health protection schemes, distribution of free drugs & free treatment underNational Health Assurance Mission are some of the efforts that have been put in to fill the gaps in access to healthcare (“Union Budget 2016-17,” 2016) Despite of all efforts, a government still has to face various challenges like imbalanced resource allocation, limited physical access to quality health services, lack of good infrastructure (Joshi, 2005) and inadequate human resources for health. Besides this, high out-of-pocket health expenditures, health spending inflation, and various factors affecting the demand for appropriate health care (Balarajan, Selvaraj, & Subramanian, 2011) are also a major cause of concern.

Infrastructure of health care in Punjab has emerged from small clinics to large private hospitals over a period both in urban as well as rural areas. Punjab being a part of developing country is already heading towards healthcare boom. It has experienced a spectacular growth and change, which has manifested in the form of urge for quality service, improvement in infrastructure & technology for treatment and raise awareness level of masses towards progression in services (“Pulsating Punjab,” n.d.) " Punjab government has been putting constant efforts to improve its infrastructure, ensuring better accessibility and facilities to the industry at large (“Infrastructure,”n.d.). Bhagat Puran Singh Sehat Bima Yojana scheme has been launched by the government recently to provide cash less health care services to farmers (“Punjab launches healthcare service,” n.d.) Regardless of dedicated commitment of Punjab government towards improving the availability of health care services, through launch of various missions and approval of various funds, there are certain challenges, which need immediate attention (“CM assures improved health,” 2010) In this competitive environment, there are large numbers of public as well as private hospitals in punjab but due to lack of quality services in public hospitals, mostly people prefer private hospitals (Mehra & Nanda, 2012).The infrastructure of public hospitals, private practice by government doctors, health services in rural areas, is another cause of concern (“CM assures improved health,” 2010). No doubt, private hospitals are expanding and providing better quality services, but on another hand, this improvement in quality service results in expensive cost of treatment , which is unaffordable for poor people(Reddy et al., 2011).

2. Conceptual framework

Over the past few years, the concept of service quality is seeking attention, as various researchers have stated the impact of service quality on performance of organisation, itz profitability, customer satisfaction and their loyalty towards organisation (Leonard & Sasser, 1982; Cronin & Taylor, 1992; Evert Gummesson, 1998; Walfried M. Lassar, Chris Manolis, & Robert D. Winsor, 2000; Rhian Silvestro & Stuart Cross, 2000; Karin Newman, 2001; G.S. Sureshchandar, Chandrasekharan Rajendran, & R.N. Anantharaman, 2002). The demand for best quality service has increased due to increasing awareness amongst masses and the only factor that can help health care service providers to sustain is quality (Cheng Lim & Tang, 2000). Health care consumers are more cautious towards the service quality they receive. They look in for best quality performance (Penelope Angelopoulou, Peter Kangis, & George Babis, 1998), which further makes them spread positive word of mouth (Fayek N. Youssef, 1996). Majority of the health care organizations are providing multiple services to customers. Therefore, the survival of the organisation depends not only on the service quality delivered by hospitals but also on the marketing strategy used by them (Yezdi H. Godiwalla & Shirley Y. Godiwalla, 2002). Due to this reason, it has become important for organizations to review their service quality from time to time for diverting their focus on the aspect, which needs improvement. (Taner & Antony, 2006; Mi Dahlgaard-Park, Karassavidou, Glaveli, & Papadopoulos, 2009). Moreover, provided services according to needs and expectations of patients have become important for the existence and success of organisation in health care industry (Zeithaml, Berry, & Parasuraman, 1996). Besides researchers also supported the fact that patients are good judge of service quality (Kisch & Reeder, 1969; Brody et al., 1989) and patients perception is one of the most important indicator of quality in health care industry (Mashhadiabdol, Sajadi, & Talebi, 2014). Despite of this fact, the concept of patient’s perception towards health care service quality has been ignored so far. For the above stated reason, it has become important to get insight into various factors, which influence patient’s perception towards health care services provided at public hospitals of Punjab. The paper is organized as follows, starting with the review literature on service quality. The following section presence the need of the study and research methodology. The study proceeds with discussion of results, conclusion, and policy implications.

3. Review of literature

Antecedents of health care service quality and patients perception towards hospitals lay stress on the importance of patients point of view in evaluating and improving service quality. The concept of service quality is multidimentional in nature , so itz evaluation is difficult as each service provider is unique in itz own way. (Mi Dahlgaard-Park, Karassavidou, Glaveli, & Papadopoulos, 2009; Zeithaml, Bitner, & Gremler, 2006). Parasuraman, Zeithaml, & Berry (1988) , developed a model of service quality, which is widely accepted and still used as the best tools for measuring service quality (Sadiq Sohail, 2003; Ladhari, 2008) by various researchers. They laid the foundation of a twenty-two item scale, named it as SERVQUAL, which was, composed of five dimensions namely tangibles, reliability, responsiveness, assurance and empathy. Vandamme & Leunis (1993)after using SERVQUAL instrument to the health care sector stated that there is a need to modify the instrument as per health care industry. Later on, researchers conducted various studies to modify the instrument as per health care industry (Rohini & Mahadevappa, 2006; Wu, Liu, & Hsu, 2008; Li, Huang, & Yang, 2011). Further different studies were conducted on health care services using SERVQUAL instrument (Jabnoun & Chaker, 2003; Mostafa, 2005; Abuosi & Atinga, 2013; Purcarea, Gheorghe, & Petrescu, 2013; Duan, Qiu, Yu, & Hu, 2014; Mashhadiabdol, Sajadi, & Talebi, 2014; Talib, Azam, & Rahman, 2015). Servqual has been used to study various service categories of health care i.e. patients perception (Purcărea, Gheorghe, & Petrescu, 2013), & expectations (Mashhadiabdol, Sajadi, & Talebi, 2014), patient satisfaction (Marley, Collier, & Meyer Goldstein, 2004; Mostafa, 2005; Akter, Upal, & Hani, 2008), comparing the quality of public and private hospitals (Taner & Antony, 2006; Jabnoun & Chaker, 2003; Priya, 2006; Arasli, Haktan Ekiz, & Turan Katircioglu, 2008), measuring quality in NHS hospitals (Mi Dahlgaard-Park, Karassavidou, Glaveli, & Papadopoulos, 2009).

In this rapidly changing era, people tend to evaluate service, create perceptions quickly, and rely on that perception for future decision-making. Patients can evaluate service quality either based on technical quality (outcome of service quality) or functional quality (way in which quality service is provided to patients) (Lin, Xirasagar, & Laditka, 2004; Edura Wan Rashid & Kamaruzaman Jusoff, 2009). Researchers state that they mostly do it based on functional quality due to less knowledge of technical quality (Lam, 1997). The concept of patients perception has increased importance among health care service providers (Kitapci, Akdogan, & Dortyol, 2014) as it provides a feedback to hospital regarding the services provided by them (Ramanujam, 2011). It is one of the main determinant of patients satisfaction (Taner & Antony, 2006; Naidu, 2009) and profitability of hospital (Donabedian, 1996) and choice of hospitals (Edura Wan Rashid & Kamaruzaman Jusoff, 2009). As indicated by literature, few studies have been conducted using servqual to evaluate patients perception and quality of health care services provided in India but Chakraborty & Majumdar, (2011) based on secondary literature review suggested a deeper study of SERVQUAL model is required in an Indian context. As evident from review of literature, studies related to services delivered at hospitals managed by Punjab health system corporation (Sharma, Ahmed, & Bhatia, 2008), rural health care services, infrastructure of Punjab (Singh , 2010), assessment of health services using mixed method approach (Kumar et al., 2015) and development of analytical model for performance measurement of Punjab (Bhatti, Singh, & Singh, 2015) has been conducted. Hardly any study has been found, which focuses on the patients perception towards services provided at public hospitals situated at urban areas of Amritsar, Jalandhar and Ludhiana.

4. Need of the study

In spite of the availability of vast literature about perception of patients regarding healthcare, there is rarely any study related to services at public hospitals in urban Punjab. Therefore, the lack of consistent findings in the literature, lend justification to empirical analysis in the context of factors affecting patients perception towards hospitals in Punjab. This study contributes to the previous research in the field of service quality by shedding light on the factors that influenced patients perception towards public hospitals at urban areas of Punjab. For the purpose of this study, only the perception scale was used as many researchers have identified that, the perception is a good measure of service quality.

5. Research Methodology

5.1 Objective of the study: The study aimed to check suitability of SERVQUAL scale with respect to health care services in Punjab. Along with that, various dimensions of service quality were evaluated and the factors that were responsible for patients future behaviour towards hospitals were identified in order of their importance.

5.2 Method of data collection

For the purpose of this study, secondary as well as primary data has been collected. Secondary data was collected from various journals, newspapers, and government websites. Primary data has been collected using a closed ended structured questionnaire. A descriptive cross sectional study was conducted from 1st march, 2015 to October 10th, 2015. The research study has been conducted in three representative cities of three districts of Punjab state i.e. Amritsar (Majha region), Jalandhar (Doaba region) and Ludhiana (Malwa region). Another reason for choosing these cities of Punjab was their development with respect to health care industry, availability of modern health care facilities, and increase in awareness level of residents regarding the quality of services that they should receive.

5.3 Sampling design

The universe of this study was people who were admitted as inpatient in public hospitals in urban areas of Punjab. The study conducted comprises of respondents, who were selected using the inclusion criteria of age 18 years old & above, mentally stable and in good condition to response to questionnaire. The data was collected from seventeen multispecialty public hospitals selected randomly from three cities i.e. Amritsar (5 public hospitals), Jalandhar (7 public hospitals), & Ludhiana (5 public hospitals ), who were serving from more than past five years in urban areas of Punjab and having number of beds more than fifty. The proposed sample of 425 respondents was selected from the above mentioned cities using random sampling technique. However, for fulfilling the objective of the study, certain questionnaires were rejected due to incomplete and ambiguous responses. The actual sample of 375 responses (88 percent response) was considered, consisting of 125 responses from each city (Table I). Prior to data gathering, the researchers explained the reason for data collection to the participants and obtained their consent.

Table 1: Sample Design for the Present Research Study

Each statement of the scale was explained in Punjabi (local language of Punjab) to the participants to ensure better understanding. They were also communicated that even if data is filled by the person accompanying patient, it has to be filled regarding patient and his perception. Data was filled by respondents who were inpatient or by person accompanying that patient, on, or a day before their day of discharge from the hospital.

5.4 Research tools

The research questionnaire was designed based on empirical literature reviews in health care industry. Questionnaire of this study consists of three parts. First part included questions regarding demographic profile of respondents, in which information regarding socio demographic profile of the participants, which included the following: locality, gender, marital status, age, educational qualification, occupation, caste, family income, health insurance or free medical aid or special discount offered by hospital for availing services were asked. Second part contained questions regarding health related characteristics of patients like perceived health status, need of hospitalization and reported disease of hospitalization. Third part of the questionnaire contained of 22 statements of SERVQUAL scale. Statements were evaluated on a five point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). As stated by Talib, Azam, & Rahman, (2015), servqual scale developed by Parasuraman, Zeithaml, & Berry (1988) is good for analyzing the patients perception, so it was used for this study. Little modification in the scale was done following previously conducted studies by Untachai, (2013) & Aliman & Mohamad, (2013) to make it more suitable to the objective of study. Socio demographic profile and health related characteristics of respondents were analyzed using frequency(count) and percentage. Further statistical techniques like mean, standard deviation, cronbach’s alpha were applied to check reliability of data. An exploratory factor analysis (EFA) was performed using SPSS 20 to identify various factors affecting patient’s perception towards public hospitals.

A pilot study had been conducted before proceeding with final data collection in the month of february, 2015. It was done to check the feasibility of the 22 item scale in the context of Punjab. Sample size of 30 was taken for the above said purpose (Malhotra, 2008). As indicated by results, suggestion of experts and considering respondents suggestions ,one statement from empathy dimension, i.e operating hours as per convenience of patients was removed. Reason behind this was most of the hospitals were providing twenty four seven services. Further based on pilot testing content validity of the scale was verified. The limitation of this study was that it was confined to the state of Punjab, so its results could be generalized only for Punjab and not for entire health care industry in India.

6. Results & Discussions

In this section, findings of the study are discussed. First, socio demographic profile of respondents was explained. It was followed by health related characteristics. In the next part, mean & standard deviation of the responses and Cronbach alpha was discussed. In the latter, part EFA results were elaborated.

 

6.1 Socio- demographic characteristics

Socio- demographic characteristics of respondents were demonstrated in the table II. Regarding the locality of 375 respondents, 51.73 percent (n=194) were from urban areas and 48.27 percent (n=181) were from rural area. In accessing the gender of respondents, more than half of the respondents, 55.2 percent (207) were females, while remaining 44.8 percent (n=168) were males. Out of all, majority of respondents 50.9 percent (n=191) were married, 16.8 percent (n=63) were single, 19.20 percent (n=72) were widowed and 13.07 percent (n=49) were divorced.

Table 2: Socio- Demographic Characteristics of Respondents from All Hospitals

S.no	Profile	Category	Public Hospitals
			Count	%
1	Locality	Urban	194	51.73%
		Rural	181	48.27%
		Total	375	100.00%
2	Gender	Male	168	44.80%
		Female	207	55.20%
		Total	375	100.00%
3	Marital Status	Single	63	16.80%
		Married	191	50.93%
		Divorced	49	13.07%
		Widowed	72	19.20%
		Total	375	100.00%
4	Age	18-30	90	24.00%
		31-40	79	21.07%
		41-50	67	17.87%
		51-60	82	21.87%
		61 & above	57	15.20%
		Total	375	100.00%
5	Educational Qualification	Illiterate	15	4.00%
		Matric	87	23.20%
		Secondary	59	15.73%
		Graduate	108	28.80%
		Postgraduate & above	106	28.27%
		Total	375	100.00%
6	Occupation	Student	12	3.20%
		Labour	23	6.13%
		Farmer	34	9.07%
		Business	50	13.33%
		Employed in private job	78	20.80%
		Employed in government job	86	22.93%
		Housewife	84	22.40%
		Unemployed	8	2.13%
		Total	375	100.00%
7	Caste	Schedule Caste	91	24.27%
		Schedule Tribe	25	6.67%
		OBC	112	29.87%
		General	147	39.20%
		Total	375	100.00%
8	Family Income	0- 20000	19	5.07%
		20,001- 40,000	51	13.6%
		40,001- 60,000	135	36%
		60,001- 80,000	147	39.20%
		80,001 & above	23	6.13%
		Total	375	100.00%
9	HI/MA/SD	Yes	264	70.40%
		No	111	29.60%
		Total	375	100.00%

Source: Author’s Calculation Based on Primary Data.

Note 1: Primary Data has been obtained from three Districts of Punjab (Amritsar, Jalandhar, and Ludhiana)

Note 2: %= percentage of total

Note 3: HI/MA/SD= healths insured/ free medical aid/ special discounts

 

About the age distribution of sampled respondents, 24 percent (n=90) were from age group 18-30, 21.07 percent (n=79) were from age group 31-40, 17.87 percent (n=67) from age group 41-50, 21.87 percent (n=82) from age group 51-60, and 15.20 percent (n=57) from age group 61 & above. In accessing the educational qualification of the respondents of study, 28.80 percent (108) were graduate, 28.27 percent (n=106) were postgraduate & above qualified. Rest 23.20 percent (n=87) were matric passes, 15.73 percent (n=59) were secondary passed and 4 percent (n=15) were illiterate. Regarding the occupation of respondent, majority of them 22.93 percent (n=86) were employed in government job, 22.4 percent (n=84) were housewife's, 20.8 percent (n=78) were employed in private job, 13.3 percent (n=50) were into business, 9.07 percent (n=34) were doing farming, 6.13 percent (n=23) were labour, 3.20 percent (n=12) were students and 2.13 percent (n=8) were unemployed. Majority of respondents 39.20 percent (n=147) belonged to general caste followed by 29.87 percent (n=112) OBC, 24.27 percent (n=91) schedule caste and 6.67 percent (n=25) schedule tribe. In accessing the family income of respondents, 39.20 percent (n=147) were from income group 60,001- 80,000, 36 percent (n= 135) from 40,001- 60,000, 13.6 percent (n=51) from 20,001- 40,000, 6.13 percent (n=23) from 80,001 & above, and 5.07 percent (n=19) from 0- 20,000 income group. Out of 375 respondents, 70.4 percent (n=264) were having health insured or were given free medical aid or special discounts while availing services.

 

6.2 Health related variables

Health of respondents demonstrated in the table III based on their perceived health status, need of hospitalization and reported disease of hospitalization is as follows:

 

Table 3 : Health Related Characteristics

S.No	Profile	Category	Public Hospitals
			Count	%
1	Perceived Health status	Good	154	41.07%
		Poor/bad	221	58.93%
	Total		375	100.00%
2	Need of hospitalization	Health status poor	97	25.87%
		Sudden illness/ accidental injury	148	39.47%
		Pre planned to get treatment	82	21.87%
		Treatment going on from years	48	12.80%
	Total		375	100.00%
3	Reported disease of hospitalization	Non-chronic illness	134	35.73%
		Chronic illness	241	64.27%
	Total		375	100.00%

Source: Author’s Calculation Based on Primary Data.

Note 1: Primary Data has been obtained from three Districts of Punjab (Amritsar, Jalandhar, and Ludhiana)

Note 2: %= percentage of total

 

Out of 375 respondents, 58.93 percent (n= 221) perceived their health status to be bad at the time they were admitted to the hospital and 41.07 percent (n= 154) perceived it to be good. With regard to the need of hospitalization of respondent, 39.47 percent (n=148) were hospitalized due to sudden illness/ accidental injury, 25.87 percent (n= 97) were admitted due to poor health status, 21.87 percent (n=82) had preplanned to get treatment and 12.80 percent (n=48) were admitted as their treatment was going on from years. Regarding the frequency of respondents reported disease of hospitalization, 35.73 percent (n= 134) were suffering from chronic illness and 64.27 percent (n= 241) from non_chronic illness.

 

6.3 Descriptive Statistics and Reliability Analysis

In this part of study, factors influencing patients perception towards health care service quality of public hospitals were determined. Descriptive statistics of the scale were explained with mean and standard deviation. The mean scores for all dimensions (table IV) are as follows: tangibles (3.320), responsiveness (3.410), reliability (3.260), assurance (3.270), and empathy (4.250).

Table 4: Descriptive Statistics and Reliability Analysis

Code	Statements	Mean	S.D	Coefficient Alpha (α)
Tangibility		3.320	1.005
T1	The hospitals have up-to-date & well-maintained equipments.	3.296	1.067	0.900
T2	Visually appealing physical facilities e.g. Waiting area, rooms, wards etc.	3.267	0.966
T3	Doctors / staff well dressed and neat.	3.363	0.998
T4	Cleanliness & excellent hygiene standard	3.352	0.986
Responsiveness		3.410	0.873
RP1	Doctors/staff interested in solving patients’ problems.	3.352	0.820	0.855
RP2	Patient communicated when and which services will be performed.	3.320	0.817
RP3	Prompt service provided to patients.	3.488	0.874
RP4	Hospital staff willing to help patients.	3.448	0.923
RP5	Staff response quickly to patients questions	3.421	0.930
Reliability		3.260	1.036
RL1	The hospital provides services at the promised time.	3.219	1.092	0.842
RL2	The staff is dependable in handling patients.	3.219	1.011
RL3	Prompt service without an appointment.	3.288	1.012
RL4	Hospital doctors/ staff competent in providing accurate services	3.315	1.028
Assurance		3.270	1.049
A1	Doctors/staff infuse confidence and trust in the patient	3.251	1.019	0.732
A2	Patients feel secure in receiving medical care	3.251	1.090
A3	Doctors /staff to be polite, friendly, and courteous.	3.251	1.124
A4	Patients explained thoroughly his medical conditions	3.323	0.962
Empathy		4.250	0.989
E1	Patient given individual attention	4.379	1.000	0.726
E2	Patients Treated With a warm and caring attitude.	4.341	0.957
E3	Understand specific needs of the patients.	4.115	1.011
E4	Doctors/staff have patient’s best interests at heart.	4.181	0.989
Overall scale				0.726

Source: Author’s Calculations Based on Primary Data.

Note: Primary Data has been obtained from three Districts of Punjab (Amritsar, Jalandhar, and Ludhiana)

 

All constructs have a standard deviation above 0.70, which is considered as good. Reliability analysis was performed to check the internal consistency of the scale (Cronbach, 1951). The alpha values for quality dimensions were as follows: tangible (α=0.900), responsiveness (α=0. 855), reliability (α=0.842), assurance (α=0.732) and empathy (α=0.726). The overall alpha value of service quality scale was (α=0.726). Results state that, the cronbach alpha value of the present scale ranged from 0.726 to 0.900, indicating acceptable consistency among the items within each dimension and reliability of the scale (Nunnally, Bernstein, & Berge, 1967; Sekaran, 1996).

 

6.4 Exploratory Factor Analysis

As stated in table V, over all KMO value was 0.805, and KMO value calculated individually for each item of scale (table VI) ranged from 0.702 to 0.883 indicating that data was appropriate for factor analysis (Kaiser and Rice, 1974 ; Hair, Black, Babin, Anderson, & Tatham, 2006). The Bartlett’s test was also significant (p< 0.001) indicating correlation between the attributes and the matrix was not identity matrix. The determinant was .002 indicating there was no problem of multicollinearity in the data. To access the appropriateness of data for factors, communalities were reviewed (table VI). All of them were having value greater than 0.5, this stated the appropriateness of data (Stewart, 1981).

Table 5: KMO and Bartlett's Test

KMO and Bartlett's Test
Kaiser-Meyer-Olkin Measure of Sampling Adequacy.		.805
Bartlett's Test of Sphericity	Approx. Chi-Square	3009.125
	df	210
	Sig.	0.000

Source: Author’s Calculations Based on Primary Data.

Note: Primary Data has been obtained from three Districts of Punjab (Amritsar, Jalandhar, and Ludhiana)

 

All the items in the scale were subjected to principal component analysis with varimax rotation and kaiser normalization. It was found that none of the statements had factor loading less that 0.5 else, they were to be eliminated (Hair et al., 2006). Results of factor analysis indicate that only five factors were having eigen values greater than one (3.224, 3.109, 2.719, 2.231, and 2.227 respectively for all factors). The total variance explained by factor 1, 2, 3, 4 and 5 were 15.351, 14.807, 12.946, 10.622 and 10.603 percent. The cumulative variance explained by all these factors was 64.329 percent.

 

6.5 Resulting Factors

The results specified five dimensions of service quality, which were as follows:

 

Factor one explains 15.351 percent variance and was named as responsiveness. This factor included statements related to communicating patients when and which service will be performed, providing them with prompt service, solving their problem, willing to help patients and respond quickly to them. Factor two explains 14.807 percent of the variance and was named as tangible. This factor includes statements related to hospitals having up to date equipment, doctors and staff well dressed, visually appealing, hygiene and clean hospitals. Factor three explains 12.946 percent variance and was named as reliability. This factor includes statements related to the provision of services on time, dependability, and competency of staff. Factor four explained 10.622 percent of the variance and was named as assurance. This factor includes statements like the secure feeling of the patient, confidence and trust in doctors, patient explained his queries politely and in a friendly manner.

Table 6: Factor Structure for Perceived service quality

Factor Dimensions	Code	Factor Loadings	Communalities	KMO	Eigen value	Explained Variance
Responsiveness (F1)	RP1	0.839	0.710	0.819	3.224	15.351
	RP4	0.791	0.637	0.823
	RP5	0.783	0.622	0.815
	RP3	0.781	0.635	0.846
	RP2	0.757	0.582	0.808
Tangibility (F2)	T1	0.888	0.797	0.848	3.109	14.807
	T4	0.880	0.778	0.883
	T3	0.878	0.777	0.838
	T2	0.853	0.729	0.869
Reliability (F3)	RL1	0.842	0.713	0.772	2.719	12.946
	RL2	0.830	0.703	0.791
	RL4	0.818	0.694	0.805
	RL3	0.775	0.629	0.836
Assurance (F5)	A2	0.762	0.592	0.727	2.231	10.622
	A1	0.744	0.580	0.732
	A3	0.740	0.562	0.743
	A4	0.727	0.531	0.730
Empathy (F4)	EM1	0.784	0.624	0.703	2.227	10.603
	EM2	0.764	0.591	0.702
	EM4	0.732	0.438	0.799
	EM3	0.654	0.583	0.763
Total Variance Explained						64.329

Source: Author’s Calculations Based on Primary Data.

Note: Primary Data has been obtained from three Districts of Punjab (Amritsar, Jalandhar, and Ludhiana)

 

Factor five accounts for 10.603 percent variance and was named as empathy. This factor includes statements like patient given individual attention, doctors/staff having best interest of the patient at heart, understand patient needs and treat them with warm & caring attitude. As reported in the results, the most important factor that influences patients' perception towards health care service quality was responsiveness and the least important was empathy. Factors other than the above-mentioned factors, which were given due importance by the patients were tangibility, reliability and assurance.

7. Conclusion

The findings of the study illustrated some interesting facts about patient’s perception regarding service quality provided at public hospitals in urban areas of Punjab. Respondents from urban as well as rural areas of Punjab took treatment from public hospitals at urban areas. The outcome of study also indicates that respondents from all age group, illiterate or literate, belonging to any occupation, even the once who are into business, having health insurance or free medical aid or given a special discount, they all avail services at public hospitals. Moreover, the respondents whose monthly family income lies between 40,001-80, 000, also they took services from public hospitals. The reason behind this may be drastic improvement in the availability of services at public hospitals. As indicated in the literature, slowly and gradually service quality at public hospitals is improved, at least in urban hospitals with constant efforts of government. Findings also stated that majority of the respondents were suffering from chronic disease. It could be make out that, they were taking treatment due to availability of latest technology equipment and advances medical facilities at hospitals. Results reveal that respondent from public hospitals feels responsiveness as the most important factor influencing them. If services provided by doctors & staff were quick, they were attentive to the patients need & requirements and handled their queries properly, then definitely hospital services would have a positive impact on patients. This factor was followed by tangibility, reliability, assurance, and empathy respectively. Results also states that servqual scale with twenty one statements is suitable to check health care service quality in Punjab. Further, for future research, this scale could be verified using confirmatory factor analysis (CFA). The results of this study provide useful guidelines for health care service providers & policy makers in Punjab. Findings of this study could be taken as a base for future, as it indicates areas in which service providers need more attention. Further, these can help in formulating valuable marketing strategies, which could help health care service providers in meeting and keeping up with changing demands of patients with time. Moreover, that could help them in reducing marketing related costs as these strategies could help them in increasing customer base. This could further help them in breaking the mundane in services by adding more value to the health care service quality.

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