Patient expectations and perceptions of Malta's public and private hospital care service quality.

Abstract

Internationally, the debate of who should define, and how one is to measure, interpret and improve the quality of health care services has been a polemical issue over the last few decades. Fuelled by the recent opening of two new private hospitals, Malta's hospital care service sector has been subject to a similar emphasis and debate on service quality. Managers of both private and public sectors have repeatedly emphasised the high level of quality offered to the patient by their organisations. This study was designed to fill an information gap in Malta. Through the employment of two questionnaires, the study attempted to measure patient expectations of the service quality of each sector, the perceived quality of actually provided hospital services, and the weighted importance given by the patient to the service quality sentinels (indicators) studied. These questionnaires drew their composition and design from the highly acclaimed and quoted SERVQUAL model and Donabedian's framework of hospital service quality. Hospital management input, piloting, and extensive literature review provided extra support for their suitability for Malta and to serve the purposes outlined. Results showed that expectations for delivered service quality of Malta's private sector is higher than the expected quality of the public hospital service for all quality sentinels studied. More in-depth analysis shows that patients see the main difference in the service product to be found in the quality of the augmented and not the core product, although the private sector was also considered as offering a better core product. Results also show that both sectors provide the patient with a service quality that exceeds the respective user's expectations, and thus each sector gives its patients a Total Customer Value of provided service which is over-and-above that expected. Results also indicate that both private and public hospital service users consider the quality of Professional and Technical Care and the Service Personalisation as the two most important factors of the service product, but give significantly different levels of importance to the Price factor being significantly higher for public hospital service users. It is likely that this factor would ultimately determine provider choice. Although the results elicited are valid, their interpretation is open to discussion and requires further research if the true reasons behind the trends described are to be found.