SocioEconomic Challenges, Volume 6, Issue 1, 2022

ISSN (print) – 2520-6621, ISSN (online) – 2520-6214

Measuring the Effect of Healthcare Service Quality Dimensions on

Patient's Satisfaction in The Algerian Private Sector
https://doi.org/10.21272/sec.6(1)100-112.
Slimane Mrabet, ORCID ID: https://orcid.org/0000-0002-9859-7823
PhD, Associate Professor, University of Tlemcen, Mecas Laboratory, Algeria
Sidi Mohammed Benachenhou, ORCID ID: https://orcid.org/0000-0002-4079-973X
PhD, Full Professor, University of Tlemcen, Mecas Laboratory, Algeria
Afef Khalil, ORCID ID: https://orcid.org/0000-0001-6163-1998
PhD, Associate Professor, Carthage Business School, University of Tunis Carthage, Tunisia
Abstract
There is a gap in marketing literature related to impact of service quality dimensions on perceived service
quality and patient satisfaction, in the private healthcare industry. The healthcare system is responsible for
improving the general population's health in a country. To differentiate from competitors, the quality of service
is mainly considered a critical success factor for hospitals (Azmit et al., 2017). Therefore, competition is
essential for improving quality and patient satisfaction in healthcare institutions (Kitapci et al., 2014).
This article aims to determine the relationship between health service quality dimensions and patient satisfaction
in the healthcare sector. Specifically, the paper seeks to find out the most critical dimensions of service quality,
which is used to evaluate the characteristics of private healthcare service quality as perceived by patients. A
field study was carried out on a sample of 208 patients in Tlemcen city in Algeria. The questionnaire developed
for this study was based on a SERVQUAL model specifically, based on Parasuraman, Zeithaml, and Berry,
(1985) variables that identified the influence of five dimensions (i.e., reliability, tangibility, assurance,
responsibility, and empathy) in healthcare service environments on patient satisfaction. The results have found
after the application of structural equation modelling that: reliability, tangibility, assurance, responsibility was
more significant in contributing to patient satisfaction, while empathy was not significant. This indicates that
patients tend to have a positive perception about the health service if they consider the perceived quality of the
health service to be credible, reliable, tangible, and responsive, even though they may feel that the health
provider does not empathize with them. Hence, healthcare industry practitioners can consider this model as an
instrument to assess healthcare and help improve their service quality. Therefore, service provider managers can
use this instrument to assess private hospital service quality in Algeria and other African countries.
Keywords: SERVQUAL, healthcare industry, service quality, patient satisfaction.
JEL Classification: I10, I13, I18.
Cite as: Mrabet, S., Benachenhou, S.M., Khalil, A. (2022). Measuring the Effect of Healthcare Service Quality
Dimensions on Patient's Satisfaction in The Algerian Private Sector. SocioEconomic Challenges, 6(1), 100-112.
https://doi.org/10.21272/sec.6(1).100-112.
Received: 02.02.2022 Accepted: 13.03.2022 Published: 29.03.2022

Copyright: © 2022 by the authors. Licensee Sumy State University, Ukraine. This article is an
open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY)
license (https://creativecommons.org/licenses/by/4.0/).

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Introduction
There has been unprecedented growth and development in the service industries (Ahmed et al., 2017). One of
the primary goals of service marketers is to maximize consumers' perceptions of the service encounter and the
firm-consumer relationship (Hamer, 2015). To this end, research in services marketing has examined how
consumers evaluate service quality (Hamer, 2015). In service sectors, emphasis on quality of services is rising,
but concentration on healthcare service quality is incredible. The healthcare system is responsible for improving
the general population's health in a country. In the healthcare industry, all hospitals provide the same type of
service, but they do not offer the same quality of service (3) (Zaim et al., 2010). Therefore, Service quality has
received much attention from healthcare organizations due to increasing competition (D'Cunha & Suresh,
2015). To differentiate from competitors, the quality of service is mainly considered a critical success factor for
hospitals (Azmit et al., 2017). Therefore, competition is essential for improving quality and patient satisfaction
in healthcare institutions (Kitapci et al., 2014). For most corporate hospitals, superior quality is at the core of
their business strategy (Zaim et al., 2010). To achieve service excellence, hospitals must strive for zero
defections, retaining every customer that the company can profitably serve. Zero defection requires continuous
efforts to improve the quality of the service delivery system (4) (Zaim et al., 2010). Health organizations'
challenge is to ensure a high level of service the customer wants and expects every time perfectly (D'Cunha &
Suresh, 2015).
Even though the role of the private healthcare sector was increasingly important for the population in Algeria,
there has been limited monitoring of private hospitals. This led to the provision of low-quality healthcare
services that failed to meet the expectations of patients (Al-Kuhlani, 2000; MoPHP, 2001; Anbori et al., 2010).
One of the goals of any private healthcare service provider is to increase patient satisfaction by providing
quality health services. This is especially true for private sector providers in Algeria. So the identification and
measurement of quality dimensions are necessary for patient satisfaction and continuous improvement (D'Cunha
& Suresh, 2015).
To our knowledge, no study in Algeria linked patient satisfaction to perceived service quality as assessed by
SERVQUAL. Therefore, the main objective of this study is to measure patients' perceptions of the quality of
healthcare services provided in private hospitals using the five dimensions of the SERVQUAL instrument.
The paper is organized as follows: after a brief introduction, the section 2 develop a consiste literature review.
The presentation of service quality dimensions and patient satisfaction, the research hypotheses are proposed,
and the research methodology is explained. Then, the analysis of the collected data and testing the hypotheses
are complemented by discussing the main results in the complaining literature in the third section. Finally, the
conclusion of this article ends with an overview of results.
Literature review
Early studies during the 1980s focused on determining what service quality meant to customers and developing
strategies to meet customer expectations (Parasuraman et al., 1985). The early pioneers of services marketing in
Europe, especially the Nordic School, argued that service quality consists of two or three underlying
dimensions.
Lehtinen & Lehtinen (1985) referred to physical and interactive quality, while Gronroos (1984) identified a
technical, functional, and image as a third dimension. In later years, Parasuraman et al. (1988) published
empirical evidence from five service industries that suggested five dimensions more appropriately capture the
perceived service quality construct (Chowdhary & Prakash, 2007). In addition, several prior types of research
indicate a positive relationship between dimension service quality and patient satisfaction with hospital care and
a willingness to return to the hospital (e.g., Camilleri & O'Callaghan, 1998; Mostafa, 2005; Wu et al., 2008;
Chaniotakis & Lymperopoulos, 2009; Naidu et al., 2009; Raposo et al., 2009; Anbori et al., 2010; Butt & De
Run, 2010; Yesilada & Direktor, 2010; Al Khattab, S & Aborumman, 2011; Aghamolaei et al., 2014; Kitapci et
al., 2014; D'Cunha & Suresh, 2015; Lee, 2016; RahoKondasani, 2016; Ahmed et al., 2017; Azmit et, 2017;
Lee & Kim, 2017). Though there are relationships between the concepts in question, there is a gap in marketing
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literature related to the impact of service quality dimensions on perceived service quality and patient satisfaction
in the private healthcare industry. In this context, the purposes of this study are to investigate the effect of
service quality dimensions on perceived service quality and patient satisfaction and to search for a significant
relationship between SERVQUAL dimension quality and patient satisfaction in the private healthcare industry.
Specifically, based on Parasuraman et al. (1985) SERVQUAL variables, we tried to identify the impacts of each
variable on perceived services quality and satisfaction for patients in Algeria.
Accordingly, the Ministry of Public Health and Population (MoPHP) realized that the public sector alone is no
longer capable of providing necessary health care for the people of Algeria. Instead, it has encouraged the
development and expansion of the private healthcare sector to complement the existing public sector (Anbori et
al., 2010). Moreover, according to (MoPHP) the private sector was allowed to play a wider role in providing
medical services. As a result, there has been a remarkable growth of private hospitals, pharmacies, clinics, and
diagnostic centers in Algeria during the 2000s. According to the Annual Health Statistical Report (2000–2015),
there were concerning the number of special health structures counted in 2015, 237 surgical clinics, 33 medical
clinics, 148 blood-purification centers, 18 reproductive assistance centers, 380 healthcare units, 8,352
specialized counseling clinics, 6,910 public consultation clinics and 6,144 Dental surgery clinic and 9.962
pharmaceutical agencies (Anbori et al., 2010).
According to the studies and discussions mentioned above, and to find out the factors that affect perceived
service quality and customer satisfaction in healthcare, the following main problem raises:
How do perceived service quality and patient satisfaction in healthcare?
The questions derived from the main problem are the following:
1) Is there an impact of dimension quality on perceived service quality in the healthcare sector?
2) How does perceived service quality affect patient satisfaction?
Methodology, Research Hypothesis and Conceptual Model
Previously, several researchers have developed alternate concepts for service quality. For example, Bitner &
Hubbert (1994) defined service quality as "the consumer's overall impression of the relative inferiority or
superiority of the organization and its services" (p. 77) (lee et al., 2011). Another study mentioned that service
quality is divided into two main components: functional and technical quality (Gronroos, 1984; Azmit et al.,
2017). The Nordic school (Grönroos, 1984) explains the service quality on two dimensions as functional and
technical quality (Kitapci et al., 2014). Parasuraman et al. (1985) defined perceived service quality as "a global
judgment, or attitude relating to the superiority of a service" (Ahmed et al., 2017). They proposed a gaps model
and defined service quality as the difference between expectations and performance from the customers'
perspective, namely "SERVQUAL." SERVQUAL is a multi-item scale for assessing customers' perceptions of
service quality (To et al., 2013). The measure consists of 22 items and covers five major dimensions common
and relevant to the four service categories included in their study (To et al., 2013). The five major dimensions
are as follows: (1) tangibles (Physical facilities, equipment, and appearance of personnel) (2) reliability (Ability
to perform the promised service dependably and accurately), (3) responsiveness, which describes the
willingness to help customers and providing prompt services (Azmit et al., 2017), (4) assurance, which
describes the knowledge and courtesy of employees and their ability to inspire trust and confidence, and (5)
empathy, which describes caring and the individualized attention provided by the firm to its customers (To et
al., 2013; Kitapci et al., 2014). Since 1997, healthcare analysts have applied the SERVQUAL model to measure
patient satisfaction and loyalty. SERVQUAL helps healthcare service providers to identify the gaps between
service delivery and patient expectations (Al-Borie & Sheikh Damanhouri, 2013; Zarei et al., 2015; Ahmed et
al., 2017).
Quality care can be defined as the features and characteristics that can satisfy a given need (Azmit et al., 2017).
In the healthcare setting, quality is more difficult to define than other services such as those found within
finance or tourism mainly because it is the customer himself/herself and the quality of his/her life that is being

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evaluated (Al Khattab & Aborumman, 2011). In addition, referred to HCSQ as "doing the right thing and
making continuous improvements, obtaining the best possible clinical outcome, satisfying all customers,
retaining talented staff, and maintaining sound financial performance. However, healthcare service quality is
difficult to define and measure depending on the type of treatment, perception of patients, and interactions
between patients and providers, including characteristics of care service and ethical culture of the hospital
(Lee & Kim, 2017).
Customer satisfaction has been recognized in marketing thought and practices as an important goal of all
business activities (Wang & Lo, 2002; Kitapci et al., 2014). According to Ismail et al. (2016), Customer
satisfaction is broadly defined as a difference between customers' expectations and experience performance
after using a service and/or product at a certain period (Chowdhary & Prakash, 2007; Mosahab et al. 2010;
Azman et al. 2016). Satisfied customers are likely to exhibit good behavioral intentions, which are beneficial to
the healthcare provider's long-term success (Naidu, 2009). Specifically, patient satisfaction evaluates distinct
healthcare dimensions (Linder-Pelz, 1982; Naidu, 2009). For some studies, patient satisfaction results from the
gap between expected and perceived service characteristics (Fitzpatrick & Hopkins, 1983; Raposo et al., 2009).
For Woodside et al. (1989) patient satisfaction is a special attitude. In other words, it is a post-purchase
phenomenon that reflects the extent to which a patient liked or disliked the service after having experienced it
(Raposo et al., 2009).
For instance, several studies have found that service quality can influence the level of customer satisfaction (Lee
et al., 2000; Murray & Howat, 2002; Muslim & Isa, 2005; Azmit et al., 2017), and service quality positively
influence customer satisfaction (Kuo et al., 2009; Kitapci et al., 2014). Patient satisfaction is widely used in the
healthcare sector to determine service quality (Fenton et al., 2012; Shabbir & Malik, 2016; Ahmed et al., 2017).
It may be considered a satisfaction if one of the desired outcomes of care and the patient satisfaction
information should be indispensable to quality assessments for designing and managing healthcare (Turner &
Pol, 1995; Naidu, 2009). For example, Anbori et al. (2010) show that empathy and assurance dimensions,
mainly represent word-of-mouth communication, strongly influenced patients' willingness to return to the
hospital (Kitapci et al., 2014). Leiter et al. (1998) conducted an empirical study in Canadian hospitals (Ahmed
et al., 2017). They observed nurses, doctors, and information significantly influence patient satisfaction.
Another study, conducted by Mostafa (2005), which tested the dimensionality of the SERVQUAL instrument in
Egypt's hospitals, indicates that the three factors-based solutions are inconsistent with the five elements
associated with the SERVQUAL model (Azmit et al., 2017). Regarding specific health-service research,
Kondasani & Panda (2015) developed and empirically tested a six-dimensional model of patient satisfaction
with customer loyalty in Indian hospital services: Reliability, Physical Environment, Responsiveness, Privacy
Safety, Communication & Customer Friendly Staff. The result of the author's empirical study indicated that the
six dimensions explained 59% of the variation of patient satisfaction and customer loyalty and that the
dimension of "physical environment" had the greatest impact on satisfaction (RahoKondasani, 2016). From the
perspectives of developing countries, Andaleeb (2001) studied service quality perceptions and patient
satisfaction in Bangladesh. He measured patient satisfaction using five dimensions: Responsiveness, Assurance,
communication, discipline, and baksheesh (service tips). The results showed that all five dimensions
significantly affect patients' satisfaction (Ahmed et al., 2017). Zaim et al. (2010) examined the applicability of
service quality. They found that tangibility, reliability, and Empathy are important for customer satisfaction, but
Mengi (2009) found that Responsiveness and Assurance are more important (Lau et al., 2013). On the other
hand, a study conducted by Tucker & Adams (2001) found that patient satisfaction is predicted by factors
relating to caring, Empathy, reliability, and Responsiveness (Naidu, 2009; Ben Khalifa et al., 2021 a, b).
Based on the above studies, we propose the following hypothesis:
We followed a hypothetical-constructive approach to construct an explanatory model of patient satisfaction
through this study. The theoretical model of our research (see figure.1) consists of five independent variables: 1)
Reliability (REL); 2) Tangibles (TANG); 3) Responsiveness (RESP); 4) Assurance (ASSU); and 5) empathy
(EMP) of health care service quality. They are supposed to affect patients' satisfaction.

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H1: Reliability has a significantly positive influence on patient satisfaction.

H2: Tangibles have a significantly positive influence on patient satisfaction.
H3: Responsiveness has a significantly positive influence on patient satisfaction.
H4: Assurance has a significantly positive influence on patient satisfaction.
H5: Empathy has a significantly positive influence on patient satisfaction.
We followed a hypothetical-constructive approach to construct an explanatory model of patient satisfaction
through this study. The theoretical model of our research (see figure.1) consists of five independent variables: 1)
Reliability (REL); 2) Tangibles (TANG); 3) Responsiveness (RESP); 4) Assurance (ASSU); and 5) empathy
(EMP) of health care service quality. They are supposed to affect patients' satisfaction ( Figure1).
The analytical procedures are as follows. First, Reliability analysis and exploratory factor analysis were
conducted to establish the validity of the measurement scale using SPSS.25. Second, a descriptive study was
conducted to examine the difference in healthcare service quality perception and patient satisfaction. Third,
structural equations modelling was undertaken to investigate five service quality factors (i.e., Tangibles,
Reliability, Responsiveness, Assurance, and Empathy) on patient satisfaction using Statistica.08.
The measures were developed via successive stages of scale development. First, all items were measured on 7-
point Likert-type scales (1= very disagree strongly and 7 = very agree strongly). Instead of limiting the
measures of service quality to the theoretical structure suggested by the SERVQUAL framework, the
development of a service quality scale was based on a focus group of both patients and health care providers to
generate insights into how Algerian patients viewed the health care services they received. There were five
independent variables (tangibles, reliability, Responsiveness, Assurance, and Empathy), and one dependent
variable (Satisfaction). The measurement of the different variables of this study was adopted and revised based
on the items used in the survey carried out by prior studies such as Grantors (1984), Parasuraman et al. (1985,
1988). We collected data using a two-part self-administered questionnaire. Section A measured five dimension
service quality dimensions: tangibles (9 items), reliability (6 items), Responsiveness (5 items), Assurance (6
items), and Empathy (5 items). Section B connected Algerian patient satisfaction (9 items). Both A and B had
40 items and used a seven-point Likert scale. Section C pertained to respondent demographics (age, gender, and
income).
Data Analysis and Results
The goal of the survey was to capture patients' satisfaction with Healthcare services. Due to resource and time
constraints, one of the most famous private hospitals in Tlemcen city (western Algeria) was chosen. A survey is
conducted to examine the hypotheses in this study. Four hundred and thirty questionnaires were distributed to
respondents who experienced Algerian private healthcare service quality. Two hundred and eight responses
were received (90.43% response rate). Table.1 presents the description of the respondents, including
demographic data such as gender, age, and income. Our sample comprised 220 patients, of whom 89 (57.21%)
were male and 119 female (42.78%). In terms of age, nearly 7% of participants were less than 24 years, 19.23%
between 22 and 29 years, 31.73% between 30 and 39 years, 33.65% between 40 and 59 years, and 8.65% more
than 60 years.
Exploratory factor analysis with Varimax rotation examined the structure of factors for perceived service quality
and patient satisfaction. The result from Table 2 presents five factors underlying the 29 service quality items
adopted from the SERVQUAL model of Parasuraman et al. (1992) and 9 items of patient satisfaction adopted
from the disconfirmation model of Oliver (1980). The result, therefore, demonstrates the convergent validity of
the measurement items because all indicators have significant loadings on the respective latent constructs
(T>1.96, p< 0.05) and more than 0.3 with the values varying from 0.327 to 0.876, thus, indicating that the
measurement has sufficient convergent validity.

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Table 3 provides measures of reliability, with inter-trait correlations. Cronbach's alpha was calculated to
measure the internal consistency of the obtained factors (Cronbach, 1951; Nunnally & Bernstein, 1994; lee et
al., 2011). If Cronbach's alpha is greater than 0.7, the item scales are regarded as reliable (Hair et al., 2010,
Ahmed, 2017). Table 3 illustrates Cronbach's alpha for five dimensions, ranging from 0.74 to 0.81, exceeding
the 0.70 requirements. The reliability coefficients for each of the five dimensions of the SERVQUAL scale were
.78 (Tangibles), .76 (Reliability), .80 (Responsiveness), .81 (Assurance), and .74 (Empathy). Additionally, the
alpha Cronbach's for the five-items perceived service quality scale; five trust scale and nine-item satisfaction
scale were .83; .85, and .93, respectively. Thus, all constructs in our research model demonstrate good reliability
because the construct displayed excellent reliability of scales (greater than 0.74). In addition, the value of mean
score for all variables was greater than 4 (𝑥̅ >4) and standard deviation lower than 1.5 (SD<1.5) indicates non-
dispersion. After that, exploratory factor analysis is conducted with varimax rotations to detect the significance
of the hypothesized factors.
However, Hair et al. (2010) say that factor analysis can be performed when KMO and Bartlett's Test is
significant (p<.05) (Ahmed, 2017). The KMO and Bartlett's statistics show that the data set is suitable for factor
analysis. As shown in Table 3, the KMO (Kaiser–Meyer–Olkin) values for each of the 38 survey items
exceeded or equal to 0.75, indicating that research data were suitable for principal component analysis. A mean
was computed for the items that remained after a reliability test for each dimension or construct. Then, the mean
was used for the value for each dimension or constructed addition. A confirmatory factor analysis was
conducted to determine that the variables used are separate, using the varimax procedure for interpretable
factors. The results of these factors accounted for between 51.87% and 63.56% of the cumulative variance
(explained variance), showing that the percentage of these factors exceeds the recommended level of 0.50
(Fornell & Larcker, 1981; Wu, 2013) for the different variables (except Empathy =49.16%). All items from the
SERVQUAL model in each relationship structure were included in a factor analysis to determine whether the
majority of the variance could be accounted for by one general factor, more than 50 percent of the variance of
all measure. The result is inconsistent with five perceived service quality dimensions proposed by Parasuraman
et al. (1988) and the patient satisfaction dimension proposed by Oliver (1980). However, this study found only
five key components of perceived service quality for the Algerian healthcare industry. In conclusion, the results
indicated that the measurement model achieved adequate reliability, convergent validity, and discriminant
validity.
Statistica.8.0 is employed to assess the structural model. The most common SEM estimation procedure is
Generalized Least Square to Maximum likelihood (GLS-ML). This method is suitable for this study because
this research aims to test the causal relationship between service quality dimensions and patient satisfaction in
the healthcare industry. Therefore, the research model fit is acceptable. Results of the hypothesis testing are
illustrated in Figure 2. Firstly to test the hypothesis, the structural model was run. The model's goodness-of-fit
was measured using: Ch2 /df; GFI. Joreskog; PGI; APGI, and CFI. The results indicated an average fit between
the measurement model and the data since all model-fit measures surpassed the recommended value. Secondly,
Figure.2 shows the structural and the testing results. This figure shows that the path coefficients by estimation
procedure GLS-ML for the hypothesized links (βi) were tested. It is significant (except for H.5), with the values
varying from 0.167 to 0.498.
Patient satisfaction value is positively associated to Reliability (β1 = 0,269, p < 0.05), Tangibles (β2 = 0,271, p
< 0.05), Responsiveness (β3 = 0,167, p <0.05), and Assurance (β4 = 0,498, p <0.05). However, satisfaction
value is not associated with Empathy (β5 = -0,124, p >0.05). Thus, H1, H2, H3, and H4 are supported, and H5
is not supported. Overall, the results showed that our model provides a useful framework for measuring patients'
satisfaction with healthcare service quality. The analysis findings revealed that service quality dimensions
display a significant relationship to patient satisfaction. This is consistent with the previous empirical research,
which indicated that the higher the perceived service quality, the greater the patients' satisfaction in private
healthcare services.
To analyze the hypotheses, we conducted the testing of the path coefficients of the structural model. The results
of the path analysis are presented in Table.4. However, the specific dimensions of service quality used in this

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study (Parasuraman et al., 1988) showed different impacts on patient satisfaction. As shown in Table 4, The P-
value in the T (student) test between the dimension of reliability and satisfaction is 0.000, less than 5%, which
means that there is a relationship between the two variables and the coefficient of regression (β.1 = 0.269, p <
0.05), shows a positive influence on patient's satisfaction, which means that a grow in reliability dimension
occurs a lift up in the patient's level of satisfaction, according to the quality of private hospital services.
Data demonstrate that patients are quite satisfied with the services provided by the clinic as promised and the
security level of the healthcare services. Patients are confident that the clinic can realize the promised services
to consume services with trust. This result is supported by Arasli et al. (2005), Tucker & Adams (2001), and
Kondasani & Panda (2015), thus supporting H1. Similarly, we followed the same procedure for tangibles and
their tangible dimension and their relation to the patient's satisfaction. The T student test's significance (P-value)
is T<0.05, which shows that patient satisfaction depends on service quality tangibles. Patients satisfaction was
found to be positively affected (β.2 = 0.271, p <0.05) by tangibles. Tangibles refer to the appearance of
facilities, equipment, and written materials (Zeithaml et al., 2006). Current service marketing literature
highlights the importance of tangibles (e.g., providing comfortable, clean, and readily accessible facilities and
equipment) in the process of service delivery and consumption evaluation (Bitner, 1992; Ko & Pastore, 2005;
Snipes et al., 2006; Zeithaml et al., 2006; Kim & Lough, 2007). Zaim (2010) and Siddiqi (2010) found
reliability is one-factor influencing patients' decisions for satisfying the private healthcare sector. Therefore, H2
was supported. In addition, the results demonstrated that our model also disclosed that Responsiveness is
positively and significantly associated with patient satisfaction (β.3 = 0.167, p <0.05). The willingness of
service providers to assist and provide prompt services to customers is very important to customer evaluation of
the clinic. The results show that Responsiveness has a positive influence on patient satisfaction. Patients are
satisfied with the personal services and service personnel who understand their needs. This finding is supported
by Tucker & Adams (2001), Mengi (2009), Kondasani & Panda (2015) studies which found Responsiveness is
one of the factors influencing patients' being satisfied with healthcare services. H3 was also accepted. The
fourth hypothesis concerns whether Assurance is an antecedent of patient satisfaction. The results also show that
assurance positively influences patient satisfaction (β.4 = 0.498, T=8.55, p <0.05). Moreover, flow assurance
has played a critical role in forming patient satisfaction. The degree of trust and confidence that customers feel
about the private clinic services greatly depends on the service provided by the clinic employees. According to
the research results, Assurance positively influences patients' satisfaction. The excellent and competent services
can explain the clinic staff's results. Patients feel that the clinic can honour their commitments and are confident
in using clinic services. This finding is consistent with prior studies for healthcare services (Mengi, 2009;
Siddiqi, 2010 and Lo et al., 2010). Therefore, H4 is supported by the data. Assurance was the most important
factor in predicting patient satisfaction regarding the relationships between service quality and satisfaction
dimensions. Finally, Empathy has the least importance in patients' minds. Results show that Empathy was not
related to patient satisfaction (β.5 = -0.124, p>0.05), but patients perceive a low degree of interaction with
employees in clinics providing personalized service. The clinic reflects a weak ability to fulfil patients'
individual needs, such as solving patients' inquiries and problems. This result contradicts previous studies
(Tucker & Adams, 2001; Zaim et al., 2010; Anbori et al., 2010; Buyukozkan et al., 2011; Kitapci et al., 2011).
Therefore, H5 is not supported.
The results generally support positive relationships among service quality dimensions and satisfaction.
However, the specific dimensions of service quality used in this study (Parasuraman et al., 1988) showed
different impacts on patient satisfaction. Assurance was the most important factor in predicting patient
satisfaction regarding the relationships between service quality and satisfaction. Lack of Empathy in health
service delivery may irritate or annoy patients. However, lack of Empathy alone did not affect patients' overall
satisfaction. This indicates that patients tend to have a positive perception about the health service if they
consider the perceived quality of the health service to be credible, reliable, tangible, and responsive, even
though they may feel that the health provider does not empathize with them.

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In sum, this study was an initial attempt to investigate the relationships among service quality dimension and
satisfaction in Algerian healthcare services. The findings provide useful insights into the effects of the five
service quality factors on patient satisfaction.
Funding: self-funded.
Author Contributions: Conceptualization: Mrabet S., Benachenhou S.M., Khalil A.; Data curation:
Benachenhou S.M.; Formal analysis: Mrabet S., Benachenhou S.M., Khalil A.; Investigation: Mrabet S., Khalil
A.; Methodology: Mrabet S.; Validation: Mrabet S., Benachenhou S.M.; Visualization: Mrabet S., Benachenhou
S.M.; Writing – original draft: Mrabet S., Benachenhou S.M., Khalil A.; Writing – review & editing: Mrabet S.
Conclusions
Understanding service user encounters from a consumer's perspective is highly relevant in healthcare (Butt &
De Run, 2010). However, few studies in the Algerian context have investigated multiple direct links between
service quality dimensions and patient satisfaction. Therefore, hospital managers should determine how much
patient behavior is influenced by service quality and satisfaction before implementing service improvement
programs (Wu et al., 2008). Therefore, service providers can better understand how various dimensions and
items affect overall service quality and efficient design service delivery processes.
This research aimed to test SERVQUAL in an Algerian private healthcare sector and contribute to satisfaction
formation. This dimension's quality gives healthcare managers the ability to evaluate patients' satisfaction and
improve service quality and user satisfaction throughout the management of the relevant antecedents identified
by the proposed model. Our findings show significant differences between service quality and patient
satisfaction regarding their perception of tangibles, reliability, Responsiveness, and Assurance. In addition, the
SERVQUAL dimensions offer positive relationships with customer satisfaction (accept Empathy). This study
also suggests that the SERVQUAL model of service quality is a suitable instrument for measuring the
healthcare service quality in Algeria. Therefore, service provider managers can use this instrument to assess
private hospital service quality in Algeria and other African countries. Service quality should be emphasized for
maintaining and improving customer satisfaction. This implies that these four dimensions are most important to
Algerian customers. Future studies can incorporate behavioral intention measures to study service quality
effects on purchase intention objectives, trust, word of mouth, involvement, etc. Finally, it can also broaden its
scope by directly measuring patients' satisfaction and its relation to service quality dimensions.
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Sources: Author’s own work.

Figure 1. Conceptual Model

Table 1. Survey respondent profile

Gender Male 89 42.78%

Female 119 57.21%

24≥ 14 6.73%
25-29 40 19.23%
Age group
30-39 66 31.73%
40-59 70 33.65%
60≤ 18 8.65%

30> 63 30.28%
Income 30-40 80 38.46%
40-50 45 21.63%
50< 20 9.61%

Sources: Author’s own work.

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Table 2. Factor Loadings [λ] For Dimensions Of Service Quality and patients satisfaction
Items FIAB TANG RESP ASSU EMPT SATIS
fiab1 0,869
fiab2 0,739
fiab3 0,666
fiab5 0,402
fiab6 0,459
tang3 0,598
tang4 0,647
tang5 0,739
tang6 0,404
tang7 0,441
tang8 0,602
tang9 0,327
resp1 0,876
resp2 0,737
resp4 0,590
resp5 0,660
assu1 0,712
assu2 0,656
assu3 0,733
assu4 0,629
assu5 0,589
assu6 0,572
empt1 0,634
empt2 0,581
empt3 0,524
empt4 0,565
empt5 0,711
satis1 0,667
satis2 0,704
satis3 0,730
satis4 0,793
satis5 0,734
satis6 0,704
satis7 0,733
satis8 0,817
satis9 0,742
Sources: Author’s own work.

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Table 3. Descriptive statistics, reliability, and Factor Analysis

Variables No. of Scale ̅
X SD  KMO Bartlett V(x)
Items Mean Standard Cronbach Khi-deux explained
Score Deviation. variance
Reliability 5 2,19 1,443 0,76 0,75 296,35 52,50
Tangibles 9 2,38 1,784 0,78 0,77 467,30 52,77
Responsiveness 4 2,40 1,601 0,80 0,75 277,41 63,56
Assurance 6 2,14 1,235 0,81 0,81 375,57 51,87
Empathy 5 2,05 1,242 0,74 0,75 214,55 49,16
Satisfaction 9 2,29 1,044 0,93 0,91 1359,55 65,97
Sources: Author’s own work.

Sources: Author’s own work.

Table 4. Path analysis by Structural Equation Modeling (SEM)

Hypothesis β t-value p-value Supported

H1:Reliability → Satisfaction 0,269 4,277 0,000 Yes
H2: Tangibles → Satisfaction 0,271 4,139 0,000 Yes
H3:Responsiveness → Satisfaction 0,167 2,613 0,009 Yes
H4:Assurance → Satisfaction 0,498 8,552 0,000 Yes
H5:Empathy→ Satisfaction -0,124 -1,827 0,068 No
Notes: Standardized estimates are shown; 0.000,p < 0.05.
Sources: Author’s own work.

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