The mediating role of perceived value in the relationship between service quality and trust a case study of private general hospital in HCMC

--- LAM HAI NGUYEN THE MEDIATING ROLE OF PERCEIVED VALUE IN THE RELATIONSHIP BETWEEN SERVICE QUALITY AND TRUST – A CASE STUDY OF PRIVATE GENERAL HOSPITAL IN HCMC MASTER OF BUSINESS

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LAM HAI NGUYEN

THE MEDIATING ROLE OF PERCEIVED VALUE IN THE

RELATIONSHIP BETWEEN SERVICE QUALITY AND TRUST – A CASE

STUDY OF PRIVATE GENERAL HOSPITAL IN HCMC

MASTER OF BUSINESS (Honours)

Ho Chi Minh City – Year 2012

-

LAM HAI NGUYEN

THE MEDIATING ROLE OF PERCEIVED VALUE IN THE

RELATIONSHIP BETWEEN SERVICE QUALITY AND TRUST – A CASE

STUDY OF PRIVATE GENERAL HOSPITAL IN HCMC

ID: 60340102

MASTER OF BUSINESS (Honours)

SUPERVISOR: DR PHAM NGOC THUY

Ho Chi Minh City – Year 2012

Ho Chi Minh City, Viet Nam

Lam Hai Nguyen

ABSTRACT

Healthcare is a significant part of a country's economy The delivery of health care services is very important of health care system, both to patients and hospitals There are many factors in treatment influencing to patients This research aims to identify the service quality affecting to patient perceived value and the patient perceived value affecting to patient trust

A questionnaire has been developed based on the dimension of patient – perceived Total Quality Service ( TQS) in healthcare scale, Corporate reputation scale, Perceived value scale, trust scale and then adjusted by results of in-depth interview of doctors, nurses and patients The number of respondents is 177 people The average duration of the interviews was ten minutes The respondent is that of individuals over the age of

18, who used the hospitalization services of private general hospitals in 12 months (from the interview day)

Findings highlight the positive influences of service quality to perceived value and the strong significant impact of perceived value to trust Therefore, investor should improve service quality to gain patient trust

Because of limited time and resources, the dimension of service quality has 4 factors while the conceptualization of service quality SERVQUAL features five dimensions: tangibles, reliability, responsiveness, empathy and assurance (Parasuraman et al., 1988) Future researches may consider including more factors to understand deeply in

service quality in healthcare

TABLE OF CONTENTS

CHAPTER 1: INTRODUCTION 5

1.1 Research background 5

1.2 Research Problems 6

1.3 Research questions and objectives 7

1.4 Research scope 7

1.5 Research methodology 8

1.6 Thesis structure 8

CHAPTER 2: LITERATURE REVIEW & THEORETICAL MODEL 10

2.1 Service quality 10

2.1.1 Organization reputation 10

2.1.2 The Administrative procedures 11

2.1.3 Facilities: 12

2.1.4 Doctor and Nurse care 12

2.2 Patient perceived value 14

2.3 Patient trust 15

2.4 Conceptual model 15

2.5 Hypotheses 17

2.5.1 Relationship between service quality and perceived value 17

2.5.2 Relationship between perceived value and trust 17

CHAPTER 3: RESEARCH METHODOLOGY 18

3.1 Research process 18

3.2 Qualitative study 19

3.3 Measurement scale 19

3.3.1 Construction of measurement scales 19

3.3.2 Measurement scale of the Organization reputation 20

3.3.3 Measurement scale of Administrative Procedures 20

3.3.4 Measurement scale of the facility 21

3.3.5 Measurement scale of Doctor & Nurse care 21

3.3.6 Measurement scale of Patient perceived value 22

3.3.7 Measurement scale of Patient trust 23

3.4 Questionnaire design 25

3.5 Main survey 26

3.6 Data collection 26

3.7 Data analysis 27

CHAPTER 4: DATA ANALYSIS AND RESULTS 28

4.1 Descriptive data analysis 28

4.1.1 Data summary 28

4.1.2 Characteristics Of Respondents 29

4.1.3 Descriptive data 29

4.2 Assessment of measurement scales 31

4.2.1 Cronbach alpha reliability analysis 31

4.2.2 Exploratory Factor Analysis 33

4.2.3 The revised conceptual model 39

4.3 Correlation and Hypotheses testing 40

4.3.1 Correlation 40

4.3.2 Testing assumptions of multiple regression 42

CHAPTER 5: CONCLUSION AND IMPLICATION 47

5.1 Main finding: 47

5.2 Managerial implications 48

5.3 Research limitations and implications for future 48

CHAPTER 1: INTRODUCTION 1.1 Research background

Healthcare industry is a special service industry that is paid much attention because it has directed relation to citizens According to the World health organization, the health systems‟ goal is good health, responsiveness to the expectations of the population, and fair financial contribution

Vietnam healthcare system relates to government The decision-making powers belong

to the central government, which takes inputs from governing authorities of cities and provinces Its healthcare market emphasizes „cure‟ rather than „prevention‟ In mid-

1993, realizing the need for private foreign investment in medicine, the central government opened the healthcare sector to private local and foreign firms by allowing them to setup clinics and hospitals Since then the number of private hospitals has been growing fast, especially due to the failure of the public sector to meet the country‟s needs of proper healthcare

HCMC is invested to become a centralized health care in South region However, the facilities of public general hospitals are worst The top public general hospitals are Cho Ray hospital, Nhan dan Gia Dinh Hospital… Some of these are downgrading significantly

Health Ministry has some projects to solve this problem such as: upgrading

infrastructure, facilities, training for physician in provinces… Besides this, HCMC will

build new public general hospitals

On the other hand, private general hospitals also improve their ability to server patients Anh Thuy & Phi Khanh (2012) reports that HCMC has 33 private general hospitals in order to solve the over loaded of public general hospitals

In order to compete with public general hospital as well as themselves, private general hospitals are invested modern facilities, human resource to bring the value to patients Providing quality service is considered an essential strategy for successful and survival

in today competitive environment (Zeithaml, Berry & Parasuraman,1996)

Customer perceived value explores the interaction between the product and service, while service quality generally focuses on the product or service, i.e what the organization provided ( Robert, 1996)

1.2 Research Problems

Big cities as HCM have a large population Public general hospitals are not only served for local citizen but also served for other citizens who from provinces to HCMC for their treatment Therefore, these hospitals are always overloaded patients

Overloaded in hospital are defined “many people come to hospitals for their treatment

at the same time that human resource and capability in hospital can not afford and

(Ministry of Health, 2012) The percentage of overloaded in public general hospitals such as 115 hospital, Nhan dan Gia Dinh Hospital are 113%, 106%, respectively (Ministry of Health, 2012)

Because of overloaded, patients are treated without courteousness and attention Therefore, the trend of treating at private general hospital is increasing According to Health Ministry, the number of private general hospital increased 11.4 % in 2011

The investors should understand what patients receive from hospital‟s service attributes

in order to contribute to patient‟s trust

How do the private general hospitals compete with public general hospitals and with themselves Exploring the affecting of service quality on patient‟s trust will help the owner of private general hospital to improve their business

1.3 Research questions and objectives

To solve the problem defined above, the research aims at answering the following questions:

How is the service quality affecting to patient‟s perceived value? By understanding this, the owners or investors can identify the right direction for their investment

How does the patient perceived value affect to patient trust? By evaluating the relationship between patient perceived value and patient trust, private general hospitals will know how to make the customer‟s comeback

Based on the above research questions, the objectives of this study are:

1 To identify the impact of Service Quality on Patient Perceived Value

2 To measure the influence of Patient Perceived Value to Patient Trust

1.4 Research scope

The research focuses on private general hospitals in HCMC

The respondent is that of individuals over the age of 18, who used the hospitalization services of private general hospitals in 6 months (from the interview day) Children (under 18 years old) and old people (over 60 years old) will not include in the study

The respondents choose the private general hospital without health insurance

1.5 Research methodology

This research is applied the quantitative method which were reviewed the theoretical background adaptable to the context The selection of the sample was random, a random route in each hospital being established for each of the interviewers The number of respondents is 177 people The average duration of the interviews was ten minutes The respondent is that of individuals over the age of 18, who used the hospitalization services of private general hospitals in 12 months (from the interview day)

The data collected will be validated by Cronbach Anpha Reliability Analysis and selected by Exploratory Factor Analysis Finally, the model will be tested by using Multiple Regression Analysis by SPSS version 20.0

1.6 Thesis structure

Chapter 1: Introduction This chapter includes an overview of research background,

research problems, questions and objectives The research limitation, method and structure are also mentioned

Chapter 2: Literature review and conceptual model The chapter consists of a

review of previous research on the concepts of Service Quality Dimensions, Patient Perceived Value and Patient Trust Basing on previous research, a conceptual model and hypotheses are presented

Chapter 3: Research methodology Research process, measurement and methods of

collecting samples and analyzing data are presented

Chapter 4: Data analysis and Result This chapter comprises assessment of

measurements scales, hypothesis testing Interpretation and discussion on the results of quantitative research and statistical analysis are represented

Chapter 5: Conclusion and implication Main findings of this study are drawn out as

well as managerial implications for investors in health care industry

CHAPTER 2: LITERATURE REVIEW & THEORETICAL MODEL 2.1 Service quality

Service quality is a central issue in services marketing and has been discussed in many writing According to Parasuraman et al (1985) the global quality of a service depends

on the encounter between expectations and performance level perceptions and can be measured through the five SERVQUAL underlying dimensions: tangible elements (physical facilities, equipment and appearance of personnel), reliability (ability to perform the promised service dependably and accurately), responsiveness (willingness

to help customers and provide prompt service), empathy (caring and individualized attention that the firm provides to its customers) and assurance (including competence, courtesy, credibility and security) Customer orientation ensures that the content of the service offering satisfies the customer‟s needs However, it demands that the manner in which the service is delivered and the customer‟s relations with the company must also meet customer expectations

Raposo (as cited in Donabedian,1980) service quality in health should include an

analysis of the structure to achieve a given level of healthcare quality (the

characteristics of doctors, hospitals and staff); of the process (interaction with the

structure) and of the result (what happens to the patient after the medical act

2.1.1 Organization reputation

Weigelt and Camerer (1988), a set of attributes ascribed to a firm, inferred from the firm‟s past actions Satir (as cited in Fombrun and Van Riel,1997), a corporate reputation is a collective representation of a firm‟s past actions and results that describes the firm‟s ability to deliver valued outcomes to multiple stakeholders It gauges a firm‟s relative standing both internally with employees and externally with its

stakeholders, in both its competitive and institutional environment According to Firestein (2006), reputation the strongest determinant of any organization‟s subtainability

Basing on Bromley, 2002; Sandberg, 2002, reputation is a socially shared impression, a consensus about how a firm will behave in any given situation Gro ¨nroos (1990) realized the role of “image” in the conceptualization of service quality, and emphasized it as a filter in the perception of service quality in addition to the technical and functional quality dimensions Caruana (2002) and Hong and Goo (2004) found that “corporate image” enjoyed by a service firm influenced its customer satisfaction The image a firm enjoys also plays a pivotal role of conveying to a customer what the firm has to offer in terms of technical and functional qualities The image affects the expectations of the customers and hence it is important in making the customers have realistic expectations So, even in healthcare services, the reputation of hospital has to be considered as an element of service quality

2.1.2 The Administrative procedures

Lewis (1990) stated that a process refers to service delivery systems, the various physical features associated with an organization and is services, and the role of the organization‟s employees (both customer contact and backroom staff) in the service encounter and the delivery of service quality Zeithaml et al (1990) described a process (in the service context) as the actual procedures, mechanisms and flow of activities by which the service is delivered, i.e the service

delivery and the operating system

Service delivery processes should be standardized so that customers could receive a hassle-free service (Sureshchandar et al., 2002a)

Curry and Sinclair (2002) stated that patients would feel less inconvenienced by their treatment if access to the service itself were improved Administrative processes (AP)

in a hospital set-up include the processes during admission, procedures during stay in hospital, and the procedures involved in the exit and discharge stage of the patient‟s stay in hospital

2.1.3 Facilities:

In other service industries such as hotels, restaurants, retail stores, professional offices, and banks, it has long been recognized that the physical environment can have an immediate effect on the attitudes and behaviors of customers and employees (Bitner, 1992) Increasingly, healthcare organizations are acknowledging the important role of the healthcare facility in improved patient and staff outcomes (Berry & Bendapudi, 2003; Nelson et al., 2005) In an increasingly competitive market, healthcare consumers have more options care, healthcare organizations must work hard to create environments that encourage repeat visits and increase patient satisfaction (Fottler, Ford,Roberts, Ford, & Spears, 2000)

Facility includes the cleanliness, maintenance and availability of services such as waiting rooms, diagnostic test rooms, operation theatres, wards, food, beds, resident rooms, ambulance services, technological capability, pharmacy, etc Several studies have attempted to study the importance of the physical facilities, or tangibles, in service delivery

2.1.4 Doctor and Nurse care

The medical encounter between a doctor and a patient requires intensive levels of interaction where the encounter has been shown to have a significant impact on patient satisfaction (O‟Connor et al., 1994) These interactions typically involve complex communication patterns and customer problems (Bitner,1990) There is often a formal, long-term relationship between doctor and patient, with the doctor having a significant discretion in meeting customer needs, and evaluation is largely based on credence attributes (Bitner et al., 1990) Georgette & Robert (1997) found three of five factors affecting service quality perception of hospitals were related to the interactions with doctors or other staff These factors included professional expertise, validation of patient beliefs, interactive communication, image and antithetical performance (Georgette & Robert,1997).Ongoing doctor-patient relationships place more emphasis

on feelings and emotions rather than cognitive elements, as would be the case in an analysis of a discrete exchange Carman (2000) stated that acute hospital services provide a salient setting to study the dichotomy between the affective attributes of the service experience (functional) and the technical attributes of outcomes of physician care

Nursing service is one of the most important components of hospital services Many researchers have made discoveries about the relationship between nursing and patient outcomes Carman (1990) used a regression model in which the quality of a set of attribute dimensions are rated and regressed on a rating of overall quality, and reported that Personal Quality Nursing Care was the most important attribute of acute hospital care In another study by Carman (2000), Personal Quality Nursing Care, as the core service of a hospital, was consistently rated as the most important In addition, several studies have examined the importance of communication in the service interaction Frohna (2001) stated that regardless of whether a patient is cured, the outcome of the physician-patient encounter depends on communication Through effective

communication, physicians are more likely to positively influence health outcomes for their patients

2.2 Patient perceived value

Customer evaluates the quality of the purchased product and updates his or her expectations about the quality of future purchases For customers, the perceived price, which includes time, effort, and search costs, is more meaningful than the actual monetary price of an item or service The customer usually judges price and service quality based on the concept of “equity” and generates his or her satisfaction or dissatisfaction level based on that concept (Oliver, 1997)

According to Chen & Hu (as cited in Rust ,2000), customer choice is influenced by the perception of functional value Which are formed primarily by perceptions of quality, price and convenience

Customer perceived value is also important because it can lead to brand loyalty Consistency between product attributes and customer values (i.e., positive perceived value) reduces uncertainty and helps the customer build trust in the form of reliable expectations of the provider in ongoing exchanges (Carver & Scheier, 1990) Perceived price may be monetary or non-monetary such as time costs, search costs and psychology costs ( Zeithaml, 1988)

This study, the author explores perceived price fairness, in terms of monetary and monetary costs to the consumer

non-2.3 Patient trust

The majority of definitions for trust describe it as the belief by one firm that a partner will perform actions producing positive results for the former (Alrubaiee, & Feras Alkaa'ida as cited in Schurr and Ozanne, 1985; Dwyer, Schurr and Oh, 1987; Anderson and Narus, 1990; Moorman, Deshpande and Zaltman, 1993; Morgan and Hunt, 1994; Sanzo et al., 2003)

As Alrubaiee, & Feras Alkaa'ida (as cited in Sirdeshmukh et al.,2002) stated, trust is

the expectations held by the consumer that the service provider s“can be relied on to deliver on its promises” Alrubaiee, & Feras Alkaa'ida (as cited in Anderson and Weitz,1989) defined trust as one party‟s belief that its needs will be fulfilled in the future by actions undertaken by the other party Alrubaiee, & Feras Alkaa'ida (as cited

in Morgan and Hunt,1994) stated, trust exists when one party has confidence in an exchange partner‟s reliability and integrity

Alrubaiee, & Feras Alkaa'ida (as cited in Mishra et al.,2008) posited that there are four dimensions of trust (i.e., reliability, openness, competence, and concern)

Patient safety concerns may lead customers to stop using a particular hospital‟s services owing to negative word-of-mouth According to Alrubaiee, & Feras Alkaa'ida (as cited in Entwistle and Quick‟s 2006), trusting patients are vigilant, i.e trust is not simply a vague hope or thinking optimistically; health service providers must keep patients alert to errors in the course of their care

2.4 Conceptual model

Many researchers have made service quality affecting to satisfaction Patient satisfaction is regarded as an outcome of care, and it is one of the major contributors clinical or hospital outcomes

In previous researches, patient satisfaction considered as one of the most important quality dimensions and key success indicators in health care Despite seemingly alike, perceived service quality and consumer satisfaction However, Customer perceived value is also important because it can lead to brand loyalty Consistency between product attributes and customer values (i.e., positive perceived value) reduces uncertainty and helps the customer build trust in the form of reliable expectations of the provider in ongoing exchanges (Carver & Scheier, 1990)

Based on the models in the Literature review, the conceptual model was built The author justifies the mediating role of perceived value in the relationship between

service quality and

perceived value

Patient trust

2.5 Hypotheses

2.5.1 Relationship between service quality and perceived value

Ladhari and Morale (as cited in Bolton and Drew,1991), reported that service quality is

the most important determinant of perceived value Ladhari and Morale (as cited in

Hartline and Jones, 1996) also mention that in the hospitality service field, service quality has a positive effect on perceived value Ladhari and Morale (as cited in Sweeney et al, 1999) identified a close correlation between service quality and perceived service value

In this research, I propose key factors of service quality that affect to perceived value in health care industry:

Hypothesis H1: Organization reputation of a hospital has a significant impact on the patient perceived value

Hypothesis H2: Administrative Procedures of a hospital has a significant impact on the patient perceived value

Hypothesis H3: Facilities of a hospital has a significant impact on the patient perceived value

Hypothesis H4: Doctor and Nurse care of a hospital has a significant impact on the patient perceived value

2.5.2 Relationship between perceived value and trust

Previous research supports the association between perceived value and trust (Sirdeshmukh et al., 2002; Anderson & Srinivasan, 2003)

Perceived value has direct impact on trust and an indirect impact on commitment (Kim

& Zhao, 2008)

Hypothesis H5: The Patient perceived value has a positive impact on patient trust

CHAPTER 3: RESEARCH METHODOLOGY

3.1 Research process

After the research problem was identified, the research objectives and research scope were defined The literature was conducted to review all relevant theories

Literature Review Conceptual model

Testing of hypothesis Multiple regression

Quantitative study (Main survey, n= 177 )

Assessment of measurement Cronbach alpha, EFA

Qualitative study (In-depth interview, n=15)

Measurement scale

Figure 3.1 : Research process

3.2 Qualitative study

The qualitative study was conducted by in-depth interview in order to discover, adjust and supplement the variables to measure the researched items The qualitative study was conducted by in-depth interview with ten people who are doctors, nurses, admin staffs in hospitals and patients in Ho Chi Minh City This focus group raised the service quality, perceived value that may affect patient trust including: the reputation of hospital, the process of admission, the clean of waiting room, the waiting time, the attention of doctors and nurses

The result of qualitative study had the same items that author figured out in the hypotheses

3.3 Measurement scale

3.3.1 Construction of measurement scales

Based on the proposed hypotheses, the measurement scales adopted from previous studies and the result of qualitative study conducted The five-point Likert scale was used to measure the constructs as follows:

3.3.2 Measurement scale of Organization reputation

This scale was developed by adapting items of corporate reputation scale used by Sabrina Helm (2007):

 I choose X hospital because of its success

 The value for money of treatment is worthy

 I think this hospital is Customer orientation

 I think many people know this hospital reputation

3.3.3 Measurement scale of Administrative Procedures

One of the important dimensions of administrative processes is the delay at different stages of the patient‟s hospital stay This scale was developed by adapting items of perceived value scales used by Mayuri Duggirala, Chandrasekharan Rajendran, R.N Anantharaman, (2008):

 The admission processes are handled promptly and properly

 In emergency case, I am easy of getting the desired bed on admission

 It is easy to get appointments to specialists (doctors) in the X hospital

 It is easy to get appointments to specialists (doctors) in the X hospital

 I am easy to get appointments and the required help, advice or information over the phone and at the reception counter

 The waiting time for me to see doctors is kept minimum in the Out-Patient Department

 The time spent waiting for diagnostic tests and treatment, at the pharmacy, scan centers, blood banks and laboratories was reasonable

3.3.4 Measurement scale of Facilities

This dimension assesses the patient‟s perception of quality with regard to the physical facilities in the hospital This includes the cleanliness, maintenance and availability of services such as waiting rooms, diagnostic test rooms, beds, resident rooms,

ambulance services, technological capability, pharmacy, etc

This scale was developed by adapting items of perceived value scales used by Mayuri Duggirala, Chandrasekharan Rajendran, R.N Anantharaman, (2008):

 The waiting rooms, clinical and diagnostic test rooms, pre-operative and operative (or patient/resident ward) rooms are adequately quiet, comfortable and clean

post- X hospital has availability of adequate and up-to-date technological capability in the hospital

(e.g diagnostic facilities like CT scans, MRI scans, X-rays and ultrasound) to serve patients effectively

 The pharmacy in X hospital has availability of required drugs in when patients want to buy drugs

3.3.5 Measurement scale of Doctor & Nurse care

This dimension addresses the patient‟s experience with regard to the kind of care given

by the doctors, nurses, paramedical and support staff, and administrative staff in the hospital Gronroos (1990) provided an integrated list of six criteria of good perceived service quality: professionalism and skills, attitudes and behavior, accessibility and flexibility, reliability and trustworthiness, recovery, and reputation and credibility

This scale was developed by adapting items of perceived value scales used by Mayuri Duggirala, Chandrasekharan Rajendran, R.N Anantharaman, (2008):

 I feel doctors are courteous, patient and attentive to my needs and well being

 Doctors answer my questions and clearly explain the diagnosis and treatment outcome to me, in a way that I could understand

 I realize doctors are competent and skilful in their jobs

 The nursing staffs are courteous

 The nursing staffs give me prompt and timely attention

 I realize nurses are competent and skilful in their jobs

3.3.6 Measurement scale of Patient perceived value

This scale was developed by adapting items of perceived value scales used by Walfried Lassar Banwari Mittal and Arun Sharma (1995):

 The expense of treatment is well priced

 Considering what i would pay for the treatment, i will get much more than my money's worth

 I think my request in treatment at X hospital is qualified

 Considering what i would pay for the treatment, I got a good experience during

3.3.7 Measurement scale of Patient trust

This scale was developed by adapting items of trust scale used by Alrubaiee & Alnazer (2010); Zanzo et al.,( 2003); Sirdeshmukh et al (2002); Liu et al (2008); Gaurav (2008); Eisingerich & bell (2007); Garbarino & Johnson (1999); Doney & Cannon (1997) on the patient‟s trust in hospital and staff during hospitalization, taking into account a series of hospital service characteristics

This scale was developed by adapting items of perceived value scales used by Laith

Alrubaiee (2011):

 X hospital provides high quality service

 Patients treated with equality

 X hospital can be trusted

 I feel physician /staff looking out for my satisfaction

 Doctors at X hospital are always reliable to patients

Summary Variables and coding:

Variable Coding Indicators

X hospital

PROCE8 I am easy to access to emergency care and services in the X

hospital PROCE9 I am easy to get appointments and the required help, advice

or information over the phone and at the reception counter PROCE10 The waiting time for me to see doctors is kept minimum in

the Out-Patient Department

PROCE11 The time spent waiting for diagnostic tests and treatment, at

the pharmacy, scan centers, blood banks and laboratories was reasonable

FAC12 The waiting rooms, clinical and diagnostic test rooms are

adequately quiet, comfortable and clean

FAC13 X hospital has availability of adequate and up-to-date

technological capability in the hospital (e.g diagnostic facilities like CT scans, MRI scans, X-rays)

to serve patients effectively

FAC14 The pharmacy in X hospital has availability of required

drugs in when patients want to buy drugs

DOCNU15 I feel doctors are courteous, patient and attentive to my

needs and well being

DOCNU16 Doctors answer my questions and clearly

explain the diagnosis and treatment outcome to me, in a way that I could understand

DOCNU17 I realize doctors are competent and skilful in their jobs DOCNU18 The nursing staffs are courteous

DOCNU19 The nursing staffs give me prompt and timely

attention

DOCNU20 I realize nurses are competent and skilful in their jobs

PERCE26 The expense of treatment is well priced

PERCE27 Considering what i would pay for the treatment, i will get

much more than my money's worth PERCE28 I think my request in treatment at X hospital is qualified PERCE29 Considering what i would pay for the treatment, I got a

good experience during my treatment PERCE230 Considering what i would pay for the treatment, I feel safe,

comfortable with X hospital PERCE231 I think the quality of treatment at X hospital is worth with

my money and my time

3.4 Questionnaire design

Questionnaires for this survey was designed based on The dimension of patient –perceived Total Quality Service ( TQS) in healthcare scale, Corporate reputation scale, Perceived value scale, trust scale

The questionnaire contained three parts (Appendix 1 – Questionnaire Survey) They were:

- Part one consisted of Usage Period, hospital

- Part two was formatted with 30 statements under The dimension of patient –perceived Total Quality Service (TQS) in healthcare scale, Corporate reputation

scale, Perceived value scale, trust scale Each statement is assessed on a 5-point Likert scale ranging from strongly agree (5) to strongly disagree (1)

- Part three consisted of general demographic of the participants including Age, sex, Occupation and marital status

3.5 Main survey

The main survey was made by means of interviewing 177 patients at private general hospitals in HCMC The main study is a quantitative research The respondents of this research study included people who used to use private general hospitals for their treatment in recent a year (not over a year) They choose the hospital by themselves not instead of health insurance The age of respondent is from 18 year old to under 60 year old

3.6 Data collection

Survey research has been the most common means by which researchers in any subject area collect data (Tull and Hawkins 1987) It has been suggested that questionnaire, individual interview and telephone survey are significant survey research methods in previous literatures In this study, the data were collected through interviews by questionnaire The respondents used to use private general hospitals for their treatment

in recent a year (not over a year) They chose the hospital by themselves not instead of health insurance The age of respondent is from 18 year old to under 60 year old

It took the researcher 3 weeks to finish this survey The researcher received 245 completely-filled questionnaires but 177 questionnaires were qualified, the others were missed answered used public general hospitals or had health insurance

3.7 Data analysis

Huydman (2008) defined that a reliable measure in on that gives the same „reading‟ when used in repeated occasions In other words, reliability checked whether or not respondents‟ scores on any one indicator tend to be related to their scores on the other indicators (Bryman & Bell, 2007)

The researcher computed the Cronbach‟ alpha coefficient to test the reliability of items which meant to assess the internal consistency of the items Nunnally (1978) suggested acceptable value of Cronbach‟ alpha should be above 0.7 for the measurement to be deemed reliable

According to Rungtusanatham (1998), the content validity of a construct can be defined as the degree to which the measure spans the domain of the construct‟s theoretical definition Bagozzi (1996) suggested that three approaches can be used to obtain content validity were: carefully defining what is to be measured, learning from literature review and considering experts‟ opinions

O‟Leary-Kelly and Vokurka (1998) stated that construct validity involves the assessment of the degree to which an operationalization correctly measures it targeted variables In the present study, Exploratory factor analysis (EFA) was applied to identify new factor s in the scale and to assess the uni-dimensionality or the extent to which items on a factor measure on single construct In addition, the author ran regression to confirm the relation between perceived value and trust

CHAPTER 4: DATA ANALYSIS AND RESULTS

This chapter outlines the assessment of measures and hypotheses testing as well as the interpretation of the result In particular, three parts are included in this chapter: part one briefs the descriptive data analysis, part two presents the assessment of measurement adopting cronbach alpha reliability analysis and exploratory factor analysis, part three goes through the hypothesis testing

4.1 Descriptive data analysis

4.1.1 Data summary

The questionnaires were delivered to respondents who used to use private general hospital for their treatment Total numbers are 245 respondents 68 questionnaires were taken out of the sample because these respondents used public general hospitals or had health insurance or missed the answer

The final sample size was 177 (n=177), data was analyzed by SPSS software

The respondents used the private general hospital between 1 month to 3 months ago was 31.6%, less than 1 month ago was 16.9% and over 3 months ago accounted for 51.4 Female is more than Male in this survey, which were 59.9%, 40.1% respectively Over half of the participants were in the age of 18 to 30, about 22.6% in 31-45 year-old range while only 2.8% of sample was over 45 year-old Most of respondents were staff (75.7%), 13.6% was students, 10.2% of sample was manager or Businessman, only 6

% was retired The status single accounted for 70.6%, married was 28.8%

4.1.2 Table 4.1.1: Characteristics Of Respondents

Variables Characteristics Percentage Sample No

PERCEI30 3.44 767 177

Most of items were evaluated higher than middle scale

4.2 Assessment of measurement scales

4.2.1 Cronbach alpha reliability analysis

The table 4.2.1 presented the value of Cronbach alpha coefficient for each item in the measurement scale

Table 4.2.1 Item-Total Statistics

Scale Mean if Item Deleted

Scale Variance

if Item Deleted

Corrected Total Correlation

Item-Cronbach's Alpha if Item Deleted

Organization reputation: Alpha = 728