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COMPARISON OF SERVICE QUALITY BETWEEN PRIVATE AND PUBLIC HOSPITALS: EMPIRICAL EVIDENCES FROM PAKISTAN Essay Sample

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COMPARISON OF SERVICE QUALITY BETWEEN PRIVATE AND PUBLIC HOSPITALS: EMPIRICAL EVIDENCES FROM PAKISTAN Essay Sample

Journal of Quality and Technology Management
Volume VII, Issue I, June, 2011, Page 1 ‐ 22

COMPARISON OF SERVICE QUALITY BETWEEN
PRIVATE AND PUBLIC HOSPITALS: EMPIRICAL
EVIDENCES FROM PAKISTAN
S. M. Irfan1, A. Ijaz2
1COMSATS Institute of Information Technology, Lahore – Pakistan 2Institute of Quality and Technology Management,
University of Punjab, Lahore – Pakistan

ABSTRACT
Healthcare sector of a country needs special attentions from the government as quality of healthcare provides hope and relief to the patients and their dependents. It also helps to maintain a healthy human capital that contributes in the development of the country. Now quality has become an icon for customers while availing any services or buying a product and it is also a strategic advantage for the organizations to gain success and remain competitive in the market by delivering superior quality of services or products based on customer requirements. The objective of this study is to compare the quality of healthcare services delivered by the public and private hospitals to gain patient satisfaction in Pakistan. For this purpose ‘SERVQUAL’ instrument was used to measure the patient’s perception about service quality delivered by these hospitals.

Five service quality dimensions; empathy, tangibles, assurance, timeliness and assurance were used in order to measure the patient’s perceptions about the service quality of public and private hospitals located in the 2nd largest city Lahore, Pakistan . Due to the nature of this study only those respondents were included in the study having perceptions about both the hospitals. Therefore, 320 questionnaires were selected for this study. Results showed that private hospitals are delivering better quality of services to their patients as compared to public hospitals.

Key Words: public hospitals, private hospitals, patient, service quality

INTRODUCTION
Changing customer demands, increased expectations for superior quality of products or services and the global competition has created a competitive environment among different industrial sectors. Quality has become an icon for customers while selecting a service or product and at

Comparison of Service Quality between Private and Public Hospitals: Empirical Evidences from Pakistan

the same time organizations are making efforts for providing quality products or services as per customers’ needs and wants. Quality has been considered as a strategic advantage for the organizations to gain success and to sustain in the business world.

The manufacturing sector in many countries around the globe had successfully benefited by implementing the quality management principles and gained remarkable success both at local market as well as in the global market. Products are tangible in nature and quality of the products can be easily measured whereas the services are intangible in nature and difficult to measure as compared with the products. Due to intangible in nature, it is difficult to measure the quality of any services as it is highly dependent on customer perceptions and expectations (Samson & Parker, 1994).

Quality has become a key determinant in both industrial and service sector to gain maximum return on investments and also significantly contributed in reduction of cost (Anderson and Zeithaml 1984; Parasuraman et al., 1985). Service organizations like the manufacturing organizations are now well aware about the facts that they need to take preventive quality measures to gain customer satisfaction and retention (Spreng & MacKoy, 1996; Reichheld & Sasser, 1990). The importance of service quality has been recognized and its implementation escorts the organizations to increase organizational performance, customer satisfaction and loyalty (Berry et al., 1989; Reichheld & Sasser, 1990; Rust & Zahorik, 1993; Spreng & MacKoy, 1996; Cronin et al., 2000; Yoon & Suh, 2004; Kang & James, 2004).

Like the other service organizations; healthcare sector has also become a highly competitive and rapidly growing service industry around the world. The biggest challenge faced by healthcare markets is to define and measure the service quality. However, it was recognized in earlier study that ‘SERVQUAL’ is a comprehensive scale to empirically estimate the level of quality services delivered to customers, and it is best suitable in the hospital environment (Babkus & Mangold, 1992).

In healthcare, patient perceptions are considered to be the major indicator in order to assess the service quality of a healthcare organization (Cronin & Taylor, 1992; O’Connor et al., 1994). It means that customer satisfaction is the major device for critical decision making in selecting a healthcare 2|

Journal of Quality and Technology Management

services (Gilbert et al., 1992) and quality of services delivered to the customers should meet their perceptions (Parasuraman et al., 1985, 1988; Reidenbach & Sandifer-Smallwood, 1990; Babakus & Mangold, 1992; Zeithaml et al., 1993).

In Pakistan most of its population is living in rural areas and small proportion is living in urban areas (Imran et al., 2006). The population in rural area especially and the populations in urban area to some extent are deprived of fundamental rights: especially healthcare facilities as majority of the public and private hospitals are located in big cities (Irfan et al., 2011). Due to the growing importance of service quality especially in healthcare sector of Pakistan, this study is focused on to evaluate the difference between public and private hospital service quality in Pakistan. However, a very little work in evident from the literature to measure the quality of services delivered to satisfy the patients. For this purpose ‘SERVQUAL’ instrument was used to measure the patient’s perception about service quality delivered by these hospitals. Five service quality dimensions; empathy, tangibles, assurance, timeliness and assurance were used in order to measure the patient’s perceptions about the service quality
of public and private hospitals located in the 2nd largest city Lahore, Pakistan . Due to the nature of this study only those respondents were included in the study having perceptions of both hospitals. Descriptive statistics, independent sample t-test was used to compare the quality of services delivered to patients by public and private hospitals to gain the patient satisfaction.

LITERATURE REVIEW
According to Cronin and Taylor (1992), expectations for the high quality of services had increased in the lives of the people due to increase of economic share of service sector in almost all the economies of the world and it has reached to half sum of GNP’s. Customers played a vital role in the success or failure of a service or product as their perceptions about the product or services played a significant role while assessing the quality of that particular services or products. Therefore, delivering superior quality services to the customers are the key strategies adopted by most of the organizations to sustain in this competitive environment (Parasuraman et al., 1985; Zeithaml et al., 1990; Reichheld & Sasser, 1990; Dawkins & Reichheld, 1990) and this area gain considerable attentions of the research scholars around the globe, and this debate continues (Nimit |3

Comparison of Service Quality between Private and Public Hospitals: Empirical Evidences from Pakistan

and Monika, 2007). Therefore, survival of any organizations in this highly competitive environment is depending upon the delivery of superior quality of services to their customers (Parasuraman et al., 1985; Zeithaml et al., 1990).

Services are basically the interaction of two parties and it occurs between service provider and the consumers. Mostly, services in healthcare are intangible in nature like expertise of the doctors, hospital environment, caring staff, cleanliness but sometime it is a combination of intangibles and tangibles (eyeglasses, a prosthetic device, or prescription drugs, laboratory reports) and this bundle makes up the service products. Patients
view services in terms of their whole experience; it includes the successful surgery, hospital environment, cleanliness in rooms and wards, special attentions provided by physicians, nurses, supportive staff, and outstanding follow-up care. In view of the above discussion the healthcare organizations may define services in terms of needs, wants of its patients. Services are characterized in to four categories: intangibility, inseparability, heterogeneity and perishability. These four service characteristics were discussed in the early literature of service marketing (Rathmell, 1966; Regan, 1963; Shostack, 1977; Zeithaml et al. 1985).

SERVICE QUALITY
Service quality got considerable attention and interest of both practitioners and researchers during the last couple of decades in the literature of service quality (Riadh, 2009, Wisniewski, 2001, Nimit and Monika, 2007). Service quality is conceptualized as the consumer’s perception about the level of services either it is of high quality or low quality (Zeithaml et al., 1990). Generally, service quality is assumed to be the difference between customer expectations and perceptions either it is received or being received by the customer (Grönroos, 2001; Parasuraman et al, 1988). Although service quality is a topic of discussion by both academician and researchers for the last couple of decades but still no comprehensive definition has emerged (Wisniewski, 2001). However, service quality can be viewed as:

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It is the difference between customer expectations and perceptions; expectation means service provider performance during deliverance of services whereas perception is measurement of delivery by the service provider (Parasuraman et al., 1985, 1988).

Journal of Quality and Technology Management

According to Asubonteng et al. (1996, p-24): Service quality can be defined as “the difference between customers’ expectations for service performance prior to the service encounter and their perceptions of the service received”.

According to Gefan (2002), it is a comparison made by the customers between the quality of services they want to receive and what they actually received from the service provider.

Hence, service quality is the judgment and consequences of consumers after making comparison of expectation with the perception of actual services delivered to them by the service organization (Gronoors, 1984; Berry et al. 1985, 1988) and any lacking between them is represented as a gap.

Measurement of the service quality was another critical issue and number of service quality models were presented during the last couple of decades but most commonly used is ‘SERVQUAL’ by Parasuraman, Zeithmal and Berry (1985). According to Parasuraman et al. (1985), customer perception about the service quality can be determined by five ‘gaps’. The ‘SERVQUAL’ scale was based on gap 5 and original ten dimensions were collapsed in to five dimensions and 22 items. Nitin Seth and Deshmukh (2005) (table 1) conducted a comprehensive study to review 19 models of service quality used till now in different studies in order to measure the service quality in different service environment. These studies showed that there is a significant association between service quality and customer satisfaction.

Table 1: Service Quality Models

1)
2)
3)
4)
5)
6)
7)
8)

SERVICE QUALITY MODEL
Technical and functional quality model
GAP model
Attribute service quality model
Synthesized model of service quality
Performance only model (SERVPERF)
Ideal value model of service quality
Evaluated performance and normed quality
model
IT alignment model

AUTHOR
Gro¨ nroos, 1984
(Parasuraman et al., 1985)
(Haywood-Farmer, 1988)
(Brogowiczet al., 1990)
(Cronin and Taylor, 1992)
(Mattsson, 1992)
(Teas, 1993)
(Berkley and Gupta, 1994)
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Comparison of Service Quality between Private and Public Hospitals: Empirical Evidences from Pakistan

14)
15)

SERVICE QUALITY MODEL
Attribute and overall affect model
Model of perceived service quality and
satisfaction
PCP attribute model
Retail service quality and perceived value
model
Service quality, customer value and customer
satisfaction model
Antecedents and mediator model
Internal service quality model

16)

Internal service quality DEA model

17)

Internet banking model

9)
10)
11)
12)
13)

18)
IT-based model
19)
Model of e-service quality (Santos, 2003)
Source: Nitin Seth and Deshmukh (2005)

AUTHOR
(Dabholkar, 1996)
(Spreng and Mackoy, 1996)
(Philip and Hazlett, 1997)
(Sweeneyet al., 1997)
(Oh, 1999)
(Dabholkar et al., 2000)
(Frost and Kumar, 2000
(Soteriou and Stavrinides,
2000)
(Broderick and
Vachirapornpuk, 2002)
(Zhuet et al., 2002)
(Santos, 2003)

However, “SERVQUAL” model which was originally developed by Parasuraman et al. (1985, 1988) is perhaps the most commonly used to measure service quality (Riadh Lidhari, 2009).

SERVICE QUALITY IN HEALTH SECTOR
In healthcare organizations, service quality and patients satisfaction is getting considerable attentions and this issue is considered in their strategic planning process. Patients’ perceptions about the services provided by a particular health care organizations also effects the image and profitability of the hospital (Donabedian, 1980; Williams and Calnan, 1991) and it also significantly effects the patient behavior in terms of their loyalty and word-of-mouth (Andaleeb, 2001). Moreover, increased patients expectations about the service quality had realized the healthcare service providers, to identify the key determinants that are necessary to improve healthcare services that causes patients satisfaction and it also helps the service providers to reduce time and money involved in handling patient’s complaints (Pakdil & Harwood, 2005).

The SERVQUAL instrument developed by Parasuraman et al. (1985) comprised of 22-items representing five dimensions had been widely used in health care to measure the service quality and in health care 6|

Journal of Quality and Technology Management

literature ‘SERVQUAL’ is considered as most reliable and valid measurement of
perceived service quality (Reidenbach & SandiferSmallwood, 1990; Babakus & Mangold, 1992; Vandamme & Leunis, 1993; Scardina, 1994; Taylor & Cronin, 1994; Lam, 1997; Wong, 2002; Kilbourne et al., 2004)

HEALTH CARE FACILITIES IN PAKISTAN
According to statistics division of Pakistan (2009-2010) Pakistan is the sixth largest populated country in the world with an estimated 169.9 million people at the end of June 2009, with high growth rate of 2.05%. According to the constitution of Islamic Republic of Pakistan, providing best healthcare facilities to the people is the responsibility of federal and provincial government and they are also responsible for planning and devising the national health policies. In Pakistan Majority of the public hospitals are located in the urban areas especially in major cities of and it had been facilitated by a few number of urban peoples (Arzoo and Hajra, 2005) but still these facilities are inadequate even to fulfill the needs of the people living in urban areas. Healthcare conditions in Pakistan are becoming worst and worst day by day as the healthcare sector is badly ignored by the government. According to economic survey of Pakistan (2009) (table 2), total number of registered doctors in the country is 139,555; total number of dentists 9,822 and registered nurses are 69,313. Table 2: Health Care Facilities in Pakistan

Health Manpower

2007-08

2008-09

2009-10

Registered Doctors

128,093

133,984

139,555

Registered Dentists

8,215

9,013

9,822

Registered Nurses

62,651

65,387

69,313

Population per Doctor

1,245

1,212

1183

Population per Dentist

19,417

18,010

16,914

Population per Bed
1,544
1,575
Source: Ministry of Health (Economic Survey of Pakistan 2009-2010)

1,592

What is the difference between the service quality of private and public hospitals? To address this research question the following hypothesis were developed.

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Comparison of Service Quality between Private and Public Hospitals: Empirical Evidences from Pakistan

Research Hypotheses
H01:
H11:
H02:
H12:
H03:
H13:
H04:
H14:
H05:
H15:

There is no significant difference in the level of empathy in both private and public hospitals
The private hospitals are more empathetic than public hospitals There is no significant difference between the level of tangibles between private and public hospitals
The private hospitals are better in tangibles as compared to public There is no significant difference in the level of assurance in both private and
public hospitals
The private hospitals provide more assurance to patients than public hospitals
There is no significant difference in the level of timeliness in both private and public hospitals
The private hospitals are more committed on timeliness issues than public hospitals.
There is no significant difference in the level of responsiveness in both private and public hospitals
The patient perceives that private hospitals are more responsive than public hospitals.

METHODOLOGY
In this study we used quantitative survey methods to validate the hypothesis based on literature review. This study is conducted in to evaluate the difference between the service quality level between the private and public hospitals. The patients having experience of both the public and private hospitals were included in the study in order to make a close comparison between the public and private hospitals. Respondents were availing facilities from the public and private hospitals. This study was conducted at a local level in the 2nd largest city, Lahore, of Pakistan. The questionnaire was based on SERVQUAL instrument consisting of 22 items representing five dimensions of service quality and considered as five different constructs like: empathy (4 items), tangibles (6 items), assurance (6 items), timeliness (3 items) and responsiveness (3 items). Responses were recorded against two columns in the questionnaire which includes information about both the public and private hospitals. This survey was based on pat perceptions having experience of both public and private hospitals. A total 500 questionnaire were distrusted among patients availing healthcare services from public 8|

Journal of Quality and Technology Management

and private hospitals. The patients having perceptions about both the public and private hospitals were considered for this study. Due to this reason, questionnaire with one response or incomplete were rejected. Therefore, a
total of 320 questionnaires mean 320 responses against public hospitals and 320 responses against private hospitals were selected for analysis and thus representing a good response rate of 64%. Table 3 and 4 provide the descriptive statistics of the respondents of this study. Table 3: Frequency Distribution of Gender

Frequency
Valid

Male
Female
Total

Percent

Valid Percent

Cumulative
Percent

259

80.9

80.9

80.9

61

19.1

19.1

100.0

320

100.0

100.0

Table 3 provides the frequency distribution of the gender comprised of male and female. A total of 320 respondents were included in this study, out of which 259 participants were male representing 80.9 % of the total population and remaining 61 participants were female representing 19.1% of the total population.

Table 4 shows the frequency distribution of the participant qualification. Out of 320 respondents, 289 participants were having master level qualification representing 90.4% of the total population and remaining 31 respondents representing 9.6% of population were graduates.

Table 4: Frequency Distribution of Qualification
Frequency
Valid

Graduate

Percent

Valid Percent

Cumulative
Percent

31

9.6

9.6

9.6

Master

289

90.4

90.4

100.0

Total

319

100.0

100.0

Measures
Empathy: Empathy is the first service quality construct in this study, which actually represents the individual concern of doctors, staff, nurses |9

Comparison of Service Quality between Private and Public Hospitals: Empirical Evidences from Pakistan

and the management for patients in order to provide comfort to patients. It includes 4 items and these four items were measured against five point Likert scale ranging from 1= strongly disagree to 5= strongly agree. The reliability coefficient Cronbach Alpha, for the first construct for public and private hospitals is (0.81) and (0.86) respectively.

Assurance: The second service quality construct comprise of 6 items which include doctors expertise and skills about the field of specialization, qualified nurses and supporting staff, accurate lab and medical test results, availability of experts and special attention to emergency patients. These six items were measured against five point Likert scale ranging from 1= strongly disagree to 5= strongly agree. The reliability coefficient, Cronbach Alpha for the second construct for public and private hospitals is (0.84) and (0.87) respectively.

Tangible: Third service quality construct consists of 6 items, which include hygienic conditions, sterilization of equipments, healthy environment, waiting facility for patients, healthy and clean environment, availability of labs and pharmacy within the hospital premises. These six items were measured against five point Likert scale ranging from 1= strongly disagree to 5= strongly agree. The reliability coefficient, Cronbach Alpha of the third construct for public and private hospitals is (0.82) and (0.86) respectively.

Timeliness: Fourth service quality construct consists of 3 items which includes observation of patients according to appointment, availability of the doctors according to promised time, and delivery of reports according to promised time. These three items were measured against five point Likert scale ranging from 1= strongly disagree to 5= strongly agree. The reliability coefficient, Cronbach Alpha for the fourth construct of public and private hospitals is (0.82) and (0.87) respectively.

Responsiveness: Fifth service quality construct comprised of 3 items which includes: how the doctors, nurses and supporting staff respond to patient call and availability of feedback mechanism and how the management respond to patient complaints. These three items were measured against five point Likert scale ranging from 1= strongly disagree to 5= strongly agree. The reliability coefficient, Cronbach Alpha for the fifth construct of public and private hospitals is (0.84) and (0.86) respectively.

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Journal of Quality and Technology Management

As reliability of the instrument helps to provides consistency in the results and the Cronbach alpha is used to measure the reliability of the data (Green et al., 2000). Overall Cronbach Alpha of public and private data along with service quality construct provides values greater than 0.70, as the values of Cronbach Alpha greater than 0.70 is acceptable (Nunnally, 1978).

Results and Discussions
To understand the difference between the service quality delivered by private and public hospitals in Pakistan, descriptive statistics representing the mean, standard deviation and mean square error for each of the service quality construct was used in order to increase understanding regarding the difference in service quality delivered to patients by private and public hospitals against each of the service quality dimension. Secondly, independent sample t-test was performed to calculate the values of Levene’s test for equality of variances, t-value, df and p-value to test the significance level o the private and public service quality constructs. Table 5: List of Variables used in the study

Variables and Constructs

Private
Mean

Public

S.D

Mean

S.D

3.4562

1.05119

2.5125

.99044

3.7500

.90422

2.6625

1.00243

3.9312

.73649

2.6187

1.00234

3.4688

.98365

2.5312

.97724

Empathy
Doctors have genuine concern about
patients
Doctor care their patients
Staff and nurses care the patient
Hospital put their best efforts to provide
comfort to patients
Tangible
Hygienic conditions at hospital
Waiting facilities for attendants and
patients
Healthy environment at hospital

3.7688

.82585

2.2625

.95488

3.3875

.98407

2.4375

1.07976

4.1312

.71041

2.1812

1.05730

Cleanliness of toilets/bathrooms

3.6750

.95529

1.8250

.90804

Cleanliness in wards/rooms (sheets, floor)
Lab and pharmacy facilities within the
hospital

3.9625

.78418

2.2750

1.03371

3.7625

.82024

3.3500

1.06517

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Comparison of Service Quality between Private and Public Hospitals: Empirical Evidences from Pakistan

Private

Variables and Constructs

Mean

Public

S.D

Mean

S.D

Assurance
Doctor’s expertise and skills

3.8500

.75402

3.7125

1.00557

Thorough investigations of the patient

3.6313

.90853

2.8562

1.05119

Doctors almost make right diagnoses
Doctors go for expert opinion in critical
cases
Accuracy in lab reports

3.4250

.98766

3.1812

.96395

3.7000

.95034

3.2250

1.01529

3.6812

.87143

2.9000

1.08853

Special attention to emergency patients

3.9812

.74793

3.1938

1.12433

3.8375

.89645

2.4312

1.06766

3.8438

.88699

2.9062

1.00812

3.7688

.87035

2.5062

.98413

3.8188

.88219

2.4312

1.02560

3.0688

1.06471

2.2375

.87945

3.5500

.87452

2.4062

.92006

Timeliness
Patients are observed according to
appointment
In time delivery of reports/services
Doctors/Staff observe the promised time
Responsiveness
Doctors/staff efficiently respond to the
patients
Doctors/Staff are willing to help/facilitate
the patients
Feedback mechanism

Table 6: Descriptive Statistics: Comparison of service quality constructs between public and private hospitals
Factor
Empathy
Tangible
Assurance
Timeliness
Responsiveness

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N

Mean

Std. Deviation Std. Error Mean

Private

320

3.6516

.66298

.05241

Public

320

2.5812

.70686

.05588

Private

320

3.7812

.57437

.04541

Public

320

2.0094

.54729

.04327

Private

320

3.7115

.61592

.04869

Public

320

3.1781

.67374

.05326

Private

320

3.8167

.64623

.05109

Public

320

2.6146

.75286

.05952

Private

320

3.4792

.68496

.05415

Public

320

2.3583

.68685

.05430

Journal of Quality and Technology Management

Table 5, 6 provide the mean and standard deviation of the variables and constructs used in study. These results indicate that overall mean values of service quality constructs representing private hospitals are higher than the public hospitals. This shows that majority of the respondent availing facilities from private hospitals perceive that private hospitals are providing better services to their patients as compare to the public hospitals. However, the mean value of the service quality construct ‘assurance’ among public hospital is higher as compare to the mean values of other service quality constructs of public hospitals. These public hospitals are the top public hospitals in Pakistan and are associated with best medical college of Pakistan. Highly qualified professors and expert in the field of medicines/surgery are serving in these hospitals as permanent employees. This factor has increased the level of assurance among patients while visiting or selecting the services from the public hospitals for treatment. Figure 1 shows graphical representation of means provide a clear understanding about the service quality delivered by the public and private hospitals in Pakistan based on patient perceptions.

Figure 1: Comparison between Private and Public Hospitals

To compare the mean response of both public and private hospitals regarding the service quality measures constructs based on patient |13

Comparison of Service Quality between Private and Public Hospitals: Empirical Evidences from Pakistan

perception about the service quality constructs used in this study, an independent t-test is performed, which provides mean difference, t-value, degree of freedom and their significance (p-value).

Table 7: Independent t-test
Levene’s Test
for Equality of
Variances

t-test for Equality of Means

F

Tangible

Assurance

Timeliness

Responsiveness

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Equal variances
assumed
Equal variances
not assumed
Equal variances
assumed
Equal variances
not assumed
Equal variances
assumed
Equal variances
not assumed
Equal variances
assumed
Equal variances
not assumed
Equal variances
assumed
Equal variances
not assumed

Sig.

t

df

Lower
Empathy

Upper

1.110

.293

13.970

318

.000

1.07031

.07662

.91958

1.22105

13.970

316.703

.000

1.07031

.07662

.91957

1.22105

28.250

318

.000

1.77187

.06272

1.64847

1.89528

28.250

317.261

.000

1.77187

.06272

1.64847

1.89528

7.390

318

.000

.53333

.07217

.39135

.67532

7.390

315.474

.000

.53333

.07217

.39135

.67532

15.325

318

.000

1.20208

.07844

1.04776

1.35641

15.325

310.860

.000

1.20208

.07844

1.04776

1.35641

14.616

318

.000

1.12083

.07669

.96996

1.27171

14.616

317.998

.000

1.12083

.07669

.96996

1.27171

1.088

.243

2.729

.001

.298

.622

.100

.974

Mean
Difference

Std. Error
Difference

95% Confidence
Interval of the
Difference

Sig.
(2-tailed)

Firstly, values of Levene’s test for equality of variances is reported which shows an insignificant p-values (0.293) showing the variances of both groups are same, hence for further interpretations of results variances are assumed equal. A t-value 13.970, df 318 has a significant p-value 0.000 which shows that private hospitals are more empathic toward the patient’s dealings than public hospitals. In private hospitals, doctors are genuinely concerned for their patients as these hospitals have hired the services of the best doctors and physicians and the patients. As all the hospitals are trying their best to gain competitive edge and to remain market leader and objective of the private hospitals is to provide superior quality services to their patients as compare to their competitors’. To achieve this goal all the people involved in hospital operations either it is doctor, nurse, staff or any other management personal try their best to provide extra care and show concern for them, to make the customer happy. Due to this reason the service quality dimension ‘empathy’ is high in private hospitals as compare to the public hospitals. Where as in public

Journal of Quality and Technology Management

hospitals these highly skilled and expert doctors are involved in teaching, hospital activities and other management duties and they have a limited time to visit the patients or they have allocated some days to examine the patients. It is difficult for the doctors to provide extra care or show concern for the patients as they have to examine a large number of patients on that particular day. Secondly, poor management in the public hospitals and the people visiting hospitals with some references (safarish) also affects smooth functioning of the system in public hospitals. Staff and nurses are also less committed, due to this reason they show less concern for the patients. Therefore, the null hypothesis H01 is rejected and hypothesis (H11) is accepted mean the patient perceives that private hospitals are more empathetic in their dealing with patients than public hospitals.

Secondly, values of Levene’s test for equality of variances is reported which shows an insignificant p-values (0.298) showing the variances of both groups are same, hence for further interpretations of results variances are assumed equal. A t-value 28.250, df 318 has a significant p-value 0.000 which shows that the factor tangible is better than public hospitals. The private hospitals have a better infrastructure as compare to the public hospitals as they are aimed to provide best quality of services to their patients. Private hospitals are providing better hygienic conditions as compare to public hospitals. All areas of the hospitals including wards, private rooms, waiting areas, toilets and bathroom are cleaned on regular intervals by using germ killer and insect killer liquids and are maintaining log. To save time and facilitate the patients, medical test labs, X-rays, ECG, etc. and pharmacy services are available within hospital premises. Private hospitals provide a healthy environment to the patients which show their commitment towards quality of services for their patients. Therefore, the null hypothesis H02 is rejected and H12 is accepted that patient perceives that
in private hospitals the level of tangibility is higher than public hospitals.

Thirdly, values of Levene’s test for equality of variances is reported which shows an insignificant p-values (0.622) showing the variances of both groups are same, hence for further interpretations of results variances are assumed equal. A t-value 7.390, df 318 has a significant p-value 0.000 which shows that private hospitals provide more assurance of better treatment to the patients than public hospitals and causes patient satisfaction. Expert doctors in all fields of medicines and surgery are at their panel list which creates assurance for the |15

Comparison of Service Quality between Private and Public Hospitals: Empirical Evidences from Pakistan

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patients that they are thoroughly investigated and diagnoses. These hospitals have developed well equipped labs and highly skilled lab technicians working under the supervision of qualified doctors generate best results about any test which helps the doctors in making right diagnosis. Therefore, the null hypothesis H03 is rejected and H13 is accepted means patient perceives that in private hospitals the level of assurance among patients is higher than that of public hospitals. Fourthly, values of Levene’s test for equality of variances is reported which shows an insignificant p-values (0.100) showing the variances of both groups are same, hence for further interpretations of results variances are assumed equal. A t-value 15.325, df 318 has a significant p-value 0.000 which shows that private hospitals are more conscious about the timeliness while treating the patients than public hospitals. As success of any business is strongly depending on the timely delivery of services to customer or patients. Private hospitals are making
efforts to develop a mechanism as compare to public hospitals to deliver timely, services to the patients. Patients are examined according to appointment which helps to save the time of both doctors and patients. Medical reports are delivered according to promised time and doctors are also available to examine the patients at promised time. Whereas public hospitals are lack of these factors due to poor management and lack of commitment towards the quality. Therefore, the null hypothesis H04 is rejected and H14 is accepted means patient perceives that in private hospitals the level of timeliness among patients is higher than public hospitals.

Finally values of Levene’s test for equality of variances is reported which shows an insignificant p-values (0.974) showing the variances of both groups are same, hence for further interpretations of results variances are assumed equal. A t-value 14.616, df 318 has a significant p-value 0.000 which shows that private hospitals are more

responsiveness while attending the patients than public hospitals. Private hospitals are aimed to satisfy their patient to get quick relief from illness through quality of health services to the patients. Doctors, nurses and other staff respond to the patients call quickly, to make them comfortable and developed a feedback mechanism for

continuously increasing their service quality. Whereas in public hospitals, there is a lacking of above discussed factors which shows their less commitment towards quality. Therefore, the null hypothesis H05 is rejected and H15 is accepted means the patient perceives that in private hospitals the more responsive than that of public hospitals.

Journal of Quality and Technology Management

CONCLUSION
Form the above results and discussion; the empirical findings are evident that private hospitals are aimed at providing better healthcare facilities to the patients and also contributing a positive role in order to lower the
public hospital burden. This validates our study that private hospitals in Egypt are delivering better quality of services as compared to public hospitals (Mostafa, 2005). Similarly, the patient realization about quality of healthcare drives a greater proportion of the population towards private hospitals in Bangladesh (Andaleeb, 2000). However, a study conducted to measure the patients satisfaction in Pakistan by Shabbir et al. (2010) reported that public hospitals in Islamabad are providing better quality of services to patients as compare to private hospitals and these results are quite different with the other studies conducted on this topic (like Andaleeb, 2000, 2001; Mostafa, 2005). As these public hospitals are located in the capital city of Pakistan and having better healthcare facilities as compare to other public hospitals even public hospitals located in the adjacent city Rawalpindi.

Private hospitals in Pakistan are making better efforts as compared to the public hospitals. As the private hospitals have to depend on customers in order to meet the financial constraints and gain profitability. So, like the other private sector organizations. Results of this study shows that private hospitals like the other service organizations are focusing on their patients demands and developing themselves in order to provide maximum healthcare facilities to their patients. From the results discussed above also showed that in private hospitals, all the people including doctors, nurses and supporting staff are aimed to provide care to their patients, providing clean and healthy environment to both the patients and their attendants, sterilized equipments, efficiently attending patient calls, availability of medical test and pharmacy facilities within the hospital and development of a feedback mechanism. All these efforts led these hospitals towards continuous improvement in the processes, system and provide continuously quality of healthcare service to their patients. Whereas the poor quality of healthcare services delivered to patients by public hospitals as compare to the private hospitals are due to the many factors. These factors include: government funding, lack of government interest in development of new healthcare projects rural areas and overburdened public hospitals due to rapid growth in population and |17

Comparison of Service Quality between Private and Public Hospitals: Empirical Evidences from Pakistan

people trends to move from rural areas to major cities. These factors are affecting the service quality of public hospitals. Results showed that in public hospitals, doctors, nurses and supporting staff are not taking pain to attend the patient or to provide individual care to the patients, take care of cleanliness, and sterilization of equipments, lack of feedback mechanism showed a low commitment level towards their

responsibilities. It requires government attentions to improve the existing quality of the public hospitals and develop more hospitals in public sector to maintain the healthcare needs of the people.

RECOMMENDATIONS FOR FUTURE RESEARCH
This research is based on the SERVQUAL instrument based on five service quality dimensions and a more comprehensive study may be conducted by adding more dimensions like Andaleeb (2001) used Communication, discipline, bakseesh of other than five service quality dimensions. Secondly, this study is limited to one city only. Therefore, it is needed to develop a comprehensive study in order to gain clear understanding about the service quality of public and private hospitals. This will provide more accurate response regarding their perceptions about the services delivered to them.

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