Service Quality of Public and Private
Sector Hospitals with Special
Reference to Indore and Ujjain
Cities: A Perceptual Study
VIKRAM UNIVERSITY, UJJAIN (M.P.) INDIA
07/12/13 Introduction 3
Hospitals also known as Health care centres where people get their
health through products and services provided by hospital. Health is
defined as state of complete physical, mental and social well being
and just not the non-existence of diseases or ailment. Health care
sector has been change with time to time. Earlier before
independence health care was based on individual, medicinal
properties of plants and herbs were passed from one generation to
another. After independence Government of India laid down a stress
on Primary health Care (PHC). But only government was not able to
provide more facilities for health care. So to give more facilities to
peoples government allowed private sector health care.
07/12/13 Introduction 4
Service quality has been defined as “the outcome of an evaluation
process where the consumer compares his expectations with the
service he has received” or the difference between expected service
and perceived service. Quality is considered as one of the important
factors in differentiation and excellence of services and it is a basis
of competitive advantage so that its understanding, measuring, and
developing it are important challenges for all health services
organizations. Service quality is the important reason patient select
hospitals. The dimensions of patient perceived Hospital Service
Quality (HSQ) are: Physical Environment and Infrastructure,
Personnel Quality, Image, Trustworthiness, Support, Process of
Clinical Care, Communication, Relationship, Personalization,
Literature Review 6
Review of papers from 2004 to 2013 are as follows:
1.1. Rameshan (2004), aimed to studied the quality of service of
primary health centers. He reveals that the services rendered by
PHCs are deficient in many respects in the perception of customers
and community members of the villages and that the doctors and
the staff are unable to redress adequately the grievances raised by
villagers. Villagers do not like the panchayat coming into the
picture for improving the services of PHCs, district officials totally
discount privatization as a means for providing effective primary
health care in rural areas.
2.2. Mququ (2005), attempted to explore the customer satisfaction,
expectations and perceptions as a measure of service quality. He
shows that the SANBS customers are not satisfied with the service
they receive, both on a zone (geographical) perspective and also on
a customer group perspective. Expectations of private hospitals
and rural state hospitals have higher ratings than those of urban
07/12/13 Literature Review 7
3.3. Jain et al. (2006), studied the health seeking behavior and
perception among rural community. He founds out that for health
related problems, community members first discuss with family
members and other influential persons of their caste community
and accordingly take decision regarding where to seek care and/or
treatment. Majority of people first try some home treatment and
only when they are not relieved they opt for approaching any
provider. Choice of health provider is in fact dependant on
decision makers which could be elder male family members or
some other person from the community Literacy status,
socioeconomic status, past experience and perceived quality of
health care services also play pivotal role in selection of provider.
Quality of available health care services was poor in the opinion
of respondents as a result of which rural community prefers to
approach private providers ranging from indigenous medical
practitioners, RMPs’ and qualified doctors.
4.4. Rao et al. (2006), studied the use of 16-item scale having good
reliability and validity. Patient perceptions of quality at public health
facilities are slightly better than neutral. Multivariate regression
analysis results indicate that for outpatients, doctor behavior has the
largest effect on general patient satisfaction followed by medicine
availability, hospital infrastructure, staff behavior, and medical
information. For in-patients, staff behavior has the largest effect
followed by doctor behavior, medicine availability, medical
information, and hospital infrastructure.
5.5. Çaha (2007), indicates that patient’s perception towards the
private hospitals was more due to believe that they provide
qualitative health service. But large number of patients complains
about services given by private hospitals. The complaints are mainly
about the length of the time that they wait for treatment and the
consultation time given to them. The lack of physical and human
capacities of these hospitals seems to be the main reasons behind the
quality of their service.
6.6. Costa (2008), focuses on developing a health management
information system. More physicians were worked on private sector
located in urban areas. Access of women physicians was low (3.4%).
All providers were negatively correlated to SC proportion and
positively to ST proportions in the districts. Perception of policy
maker on public and private health sector was value conflict and
7.7. Anand and Sinha(2008), investigated the need of cognitive
intermediation, which is likely to define core competence of health
care organizations in India. It seems to have received relatively
higher level of health workers’ visit. Level of public facilities’
utilization is higher in this segment. Adjusted segment characterized
by higher literacy level, higher standard of living, high level of
health workers’ visit and medium/high media exposure. Neglected
and marginalized segment is characterized by the highest level of
illiteracy, higher proportion of non-Hindu, not visited by health
workers’ visits, low women autonomy, low media exposure.
07/12/13 Literature Review 10
8.8. Padma et al. (2009), studied two instruments for measuring the
dimensions of hospital service quality, one each from the perspective
of patients and attendants, are proposed.
9.9. Singh (2010), concluded that the important reasons to visit
government hospitals are fewer charges, geographical proximity,
recommended by their friends or relatives. Patients are found to be
dissatisfied with the doctors’ checkups. Mostly patients were found
dissatisfied with the hygiene and overall condition of the basic
amenities. Half of the patients were satisfied with the recovery since
admission in the hospital. Majority of patients were satisfied with
various diagnostic services provided by hospitals. Mostly patients
did not lodge complaint against the behavior of staff and quality of
07/12/13 Literature Review 11
10.10. Narichiti (2010), clearly reveal that the perception of doctors
and nursing staff in case of Government General Hospital. There is a
perceptible gap in the minds of doctors and nursing staff and also on
the dimensions of service expected and received by the patients on
the environment created for achieving patient centre hospitals.
However, the gap is thin in case of the doctors and nursing staff of
St. Joseph’s and NRI General Hospitals.
11.11. Rajendran et al. (2010), identifies that patients and attendants
treat the interpersonal aspect of care as the most important one, as
they cannot fully evaluate the technical quality of healthcare
services. The study also revealed that the hospital service providers
have to understand the needs of both patients and attendants in order
to gather a holistic view of their services.
07/12/13 Literature Review 12
12.12. Shah et al. (2010), indicates that the deficiencies in the public
health delivery system of India, was the key to growth of private
infrastructure in healthcare. The shift of hospital industry for
‘welfare orientation’ to ‘business orientation’ was marked by
the advent of corporate hospitals, supported by various policy
level initiatives made by the government. This paper tracks the
various government initiatives to promote private investment
in healthcare and attempts to explore the reasons for
preference of the private sector. Surprisingly, in contrast to
contemporary belief, quality of medical care doesn’t seem to be
the leading cause for preference of the private sector. Except for a
few select corporate and trust hospitals, quality of medical care in
private sector seems to be poor and at times compromised.
13.13. Chunduri (2011), clearly reveal that service quality was the one
of the important drivers in selection of a hospital. The researcher
would like to state that each demographic was associated with the
choice of hospitals. The results of analysis show that the attitudes of
the patients within each dimension having a uniform or equal
attitude for any item between hospitals.
14.14. Sharma (2011), shows that ‘Healthcare delivery’ and ‘financial
and physical access to care’ significantly impacted the perception
among men while among women it was ‘healthcare delivery’ and
‘health personnel conduct and drug availability’. With improved
income and education, the expectations of the respondents also
increased. The overall quality of healthcare services is perceived to
be higher in Primary Healthcare Centers than in Community
Healthcare Centers (CHCs). Inadequate availability of doctors and
medical equipments, poor clinical examination and poor quality of
drugs were the important drawbacks reported at CHCs.
07/12/13 Literature Review 14
Another interesting finding that emerged was with respect to IPD
and OPD patients and their intention to visit the health centre in
future. For those visiting the hospital for minor health problems,
physical and financial access to health centers, and availability of
doctors providing sufficient time, and satisfactory prescription to
help them recover fast were more important than other factors.
15.15. Natarajan (2011), reveals that Gujarat has a socio-economic
environment which is conducive to achieve these goals. Significant
gains have been made in improving the health care indicators in the
State by increasing financial support, a planned approach to
improve the health care system and involvement of all stakeholders
to attain the desired goals.
07/12/13 Literature Review 15
16.16. Irfan (2011), studied that private hospitals in Pakistan are
making better efforts as compared to the public hospitals. 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. 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 over burdened public hospitals due to rapid growth in
population and people trends to move from rural areas to major
cities. These factors are affecting the service quality of public
17.17. Itumalla (2011), concluded that Patients have pointed out several
shortcomings including lack of responsiveness to patients’ needs,
delays, unreliable supply of medicines in hospital, maintaining
cleanliness and inadequate availability of diagnosis services. Health
personnel conduct and practices was rated lowest with 84.4%out of
four aspects of service quality such as Health personnel conduct
and practices, Adequacy of resources and services, healthcare
delivery and financial and physical accessibility. Overall
respondents in hospital based study perceived quality of care at the
hospital OPD as favourable.
18.18. Brahmbhatt et al. (2011), shows that Out of 5 dimensions
Private hospitals perform better than public hospital in 4 dimensions
namely Physical Aspects, Encounter, Process and Policy, while
public sector hospitals perform better than private sector only in one
dimension namely Reliability. Overall private sector is performing
better in Encounter dimension, but specific Encounter-
Responsiveness public sector has lowest score.
19.19. Narang (2011), aims to investigate differences across various
socio-demographic characteristics of the respondents. The opinions
of the respondents towards health care quality were not very
favourable. Negative scores were obtained on items, “availability of
adequate medical equipments” and “availability of doctors for
women”. Education, gender and income were found to be
significantly associated with user perception.
20.20. Kavitha (2012), measures the gap between the management’s
perceptions of patient expectations and the patients expectations of‟
service quality. The perceptions of the Doctors representing the
management about the patient’s expectations of service are very
high when compared to the patient’s expectations in both hospitals.
Aggregate mean values of the two hospitals are calculated and it is
found that for all the dimensions, there is significant difference
between the mean scores of management’s perceptions of patient
expectations and patients’ expectations.
07/12/13 Literature Review 18
However, as between the hospitals, there is no significant difference
between the hospitals in the doctor’s perceptions about patient’s
21.21. Murthy(2012), shows that macro and micro factors affect the
health care situation and identifies Empathy as a key factor on which
private hospitals score over public hospitals. The nurse acts as an
interface between customer and hospital and thus is very important
from the point of view of customer satisfaction. The registration desk
was to improve to ease of registration. The private sector scores over
the public sector in having access to the most modern equipment and
07/12/13 Literature Review 19
22.22. Grøndahl (2012), concludes that patients’ perceptions of quality
of care and patient satisfaction ranged from lower to higher
depending on whether all patients or groups of patients were
studied. 3 clusters of patients were identified regarding their
scores on patient satisfaction and patients’ perceptions of quality of
care. One group consisted of patients who were most satisfied and
had the best perceptions of quality of care, a second group of patients
who were less satisfied and had better perceptions, and a third group
of patients who were less satisfied and had the worst perceptions. The
qualitative study revealed 4 categories of importance for patients’
satisfaction: desire to regain health, need to be met in a
professional way as a unique person, perspective on life, and
need to have balance between privacy and companionship.
07/12/13 Literature Review 20
23.23. Sharmila (2013), study indicates that service quality in
private hospitals is meeting patients‘ satisfactions and private
hospitals are delivering better healthcare services. The result can
be used by the hospitals to reengineer and redesign creatively
their quality management processes and the future direction of
their more effective healthcare quality strategies.
24.24. Vashist and Jain (2013), concludes Private sector delivers
awareness about quality of medical care, greater penetration of
insurance, increased purchasing power, changing demographic
structure, etc. Private sector also changes day to day. As healthcare
was viewed as a profitable venture, corporate culture takes part in
healthcare delivery. Inherent factors like improved efficiency, better
quality, greater reliability and transparency has also aided in the
growth of private sector in healthcare.
07/12/13 Literature Review 21
25.25. Wani et al.(2013), study shows that India lags behind in regard of
health improvement as compared to U.S.A, Canada, China, and
Brazil, but contrary to other developing countries like Pakistan,
Bangladesh the scenario is better with life expectancy, Mortality
ratios, health care spending speak volumes about the healthcare
status. When analyzed through the prism eye, within India there
are large disparities amongst states in achieving health outcomes
as well. Before liberalization the improvement was at a snail’s pace,
but after liberalization the whole picture changed because the key
initiatives to improve the current healthcare standard a two
prong strategy focusing on the infrastructure needs and the
technology solution were implemented, which resulted in the
healthy scenario of the healthcare industry.
On the basis of above studies, it has been found that numbers of
studies have been conducted on service quality of hospital sector.
This is one of the rapid growing sectors of India. But still number of
geographical regions have been uncovered in the above studies i.e.
Malwa region of Madhya Pradesh. The title of the proposed
research is also focusing on the different dimensions of service
quality which have been studied at different geographical regions in
India. The proposed research will also be covering the service
quality part of hospitals of two cities (i.e. Indore and Ujjain) of
Malwa region. These two cities are nearby each other but
demography of people is different. Both are divisions of Madhya
Pradesh, one is (i.e. Indore) fast growing commercial city and
another (i.e. Ujjain) is the religious city of Madhya Pradesh. The
present research topic is an effort to understand the service quality
of hospital sector with special reference to Indore and Ujjain cities
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