Theoretical And Empirical Study On Patient Conative Loyalty Model

World Health Organization explained the validity of medical service quality: " patients get the satisfied effect as expecting. " As medical market competition is becoming more fierce, study on patient satisfaction is regarded more highly. However, on one hand, all kinds of satisfaction study have reached extraordinarily high degree of satisfaction result, on the other hand, the intense criticism is given to the hospital. In fact, patient satisfaction is not the sufficient condition of patient loyalty. How to explain the phenomenon of 'high satisfaction and low loyalty'? The study on patient satisfaction is confronted with unknown puzzle.The study on patient loyalty is the expansion of patient satisfaction, as the 'ultimate goal', loyalty is more important than satisfaction. Researchers and managers acknowledge that small changes in loyalty and retention can yield disproportionately large changes in profitability. A lot of studies on customer satisfaction and loyalty in service industries have been published, but relatively few in healthcare organizations. Problems existing in the previous paper are as follow:â‘ The models are too simple to explain patient loyalty.â‘¡The conclusions are too difficult to make people convinced as lacking for considering particularity of healthcare organizations.â‘¢By few quantitative study and much qualitative analysis , the conclusion is short of the verification.We construct patient conative loyalty model by theoretical and empirical study. Firstly, this paper analyzes service attributes of medical treatment about patient perceived quality, patient satisfaction and patient loyalty. Secondly, systematic studying is devoted to the connotation and extension of patient conative loyalty, perceived quality, perceived price, patient satisfaction, switching costs, substitute selectivity et al. Then we build patient conative loyalty theoretical model. Lastly, we verify theoretical model by statistical and empirical study. In this research, not only conception selection and measurement but also model construction is based on the patient's view. The conclusions of this research have important practical meanings which can help medical service providers catching on interaction mechanism of patient loyalty, improving medical service quality and enhancing market competitive ability. The whole research mode for patient loyalty is formed which devoted to the theory and methods about loyalty research.We study profoundly the partial least squares approach to structural equation modeling including model validation, segmentation algorithm based PLS-SEM and moderating effect in PLS-SEM:â‘ The communality index measures the quality of the measurement model for each block, and the R~2 index measure the inner model. Then the redundancy index measures the quality of the whole model for each endogenous block, taking into account the measurement model. It is also useful to slightly modify the communality index and express the redundancy index in terms of the LVs prediction so as to set the basis for validating the values by means of the cross-validation procedure named blindfolding.â‘¡A modified finite mixture is the approach that integrates customer segmentation into partial least squares based analyses of path models which is realized by the EM algorithm. When applying EM algorithm, the number of segments is unknown and the identification of an appropriate number of K classes is not straightforward. We propose using AIC, CAIC, BIC and entropy statistic for determining the number of classes in a mixture model.â‘¢We discuss the model specification on predictor, moderator and dependent variables. In succession, based of poor statistical power of moderating effect and biased estimation of PLS-SEM, Monte Carlo simulation is adopted to investigate the power and point estimate accuracy.Through the above research work, the main conclusions are as follows:1. The core relationship chain of the patient loyalty modelPatient perceived quality has a direct and positive effect on patient satisfaction, then quality has an indirect effect on patient loyalty via satisfaction. Both patient satisfaction and patient loyalty are affected directly by patient perceived price. The core relationship chain is constructed by patient perceived quality ,perceived price, patient satisfaction and patient loyalty .SERVQUAL is adopted to measure patient perceived quality in our study. The operational definition of SERVQUAL is technology reliability, responsiveness willingness, security and credibility, politeness and consideration, tangibles. We find that 'reliability', 'assurance' and 'empathy' affect patient satisfaction more strongly. In the current models the relationship from quality to value maybe tautological as well as causal because quality is related to value by definition, so we use 'perceived price' instead of "perceived cost' in the patient loyalty model.2. The effect of information communication, medical experience and uncertainty of satisfaction evaluation on patient loyaltyThrough this research work, we find that both patient satisfaction scores and uncertainty of satisfaction evaluation affect patient loyalty profoundly. If a patient is not very knowledgeable about the medical service at stake, uncertainty of satisfaction evaluation may happen. uncertainty of satisfaction evaluation could cause the phenomenon of 'high satisfaction and low loyalty'. Medical experience is not significant for the full set of data, but in segmentation study, medical experience has a significant moderating effect when satisfaction translates into loyalty.3. The effect of switching barriers(switching costs and substitute selectivity) on patient loyaltyNot only patient satisfaction but also patient switching barriers, including switching costs and substitute selectivity, have direct effect on patient loyalty. There is a positive relationship between switching costs and patient loyalty, while a negative relationship exists between substitute selectivity and patient loyalty. Our study shows that the strength of the relationship between switching costs and patient loyalty is stronger than that between substitute selectivity and patient loyalty.4. The segmentation on the antecedent variables of patient loyaltyWe divide patients into three groups which named 'quality oriented group' , 'price oriented group' and 'compositive group' respectively. Through the segmentation research, we find that satisfaction and switching costs are common direct factors of patient loyalty for all kinds of patients, but substitute selectivity and medical experience are significant antecedents only for 'compositive group', 'responsiveness' ,'assurance', 'empathy' and information communication are common factors of patient satisfaction for all patient groups, but the effect of 'responsiveness' is only significant for 'quality oriented group' and 'price oriented group', while the effect of 'tangibles' is only significant for 'quality oriented group'. 5. The dimension of patient loyaltyPatient loyalty is composed of revisiting intention and word-of-mouth communication. A satisfied patient not only has a great probability of revisiting behaviors, but also more likely become a free word-of-mouth advertising agents that informally bring networks of friends, relatives and other potential patients.