Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute
Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute

Journal of Health and Medical Sciences

ISSN 2622-7258

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open access

Published: 01 June 2021

Patients Characteristics as Determinants of Patient Satisfaction: Modelling Satisfaction in a Transitional Economy

Vera Dimitrievska, Ana Tomovska Misoska

University American College Skopje

journal of social and political sciences
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Pages: 116-129

Keywords: Patients’ Satisfaction, Service Quality, Care Delivery System, North Macedonia


Introduction: This paper examines the factors and approaches the question of patients’ satisfaction in the health care delivery system in North Macedonia. Aim: The study aims to assess how key service quality dimensions relate to an important measure of performance patient satisfaction and to find the elements that are valued by patients and the reasons behind patient satisfaction or dissatisfaction. Materials and method: In this research study, the factor analysis was used to group 12 questions measuring patient satisfaction under certain extent with Promax oblique rotation using the satisfaction responses gauged by importance. We have performed a structural equation model (SEM) to determine the relationships between one or more independent variables (IVs). Results: All component measures were greater than .702 which shows strong internal reliability among components. The reliability levels for the three components were .842 for the hospital environment, .835 for admin and .702 for interaction with health care professionals. Cronbach’s Alpha test of the whole instrument was .903. Conclusions: The explanatory factor analysis (EFA) analysis identified three distinct components or factors of patient satisfaction: (i) hospital environment, (ii) medical administration and (iii) interactions with professionals or staff behaviour. These three factors obtained after exploratory factor analysis have a significant impact on patient satisfaction. This path estimates for our model provide insights into relationships among various constructs.


  1. A. Naidu. (2008), ‘’Factors affecting patient satisfaction and healthcare quality’’, International Journal of Health Care Quality Assurance. Vol. 22 No. 4, 2009 pp. 366-381.

  2. Ajzen, I. (1991), ‘’The theory of planned behavior’’. Organizational Behavior and Human Decision Processes, 50, 179–211.

  3. Andaleeb, S. (2001), ‘’Service quality perceptions and patient satisfaction: a study of hospitals in a developing country.’’Social Science and Medicine. Vol. 52, pp. 1359-70.

  4. Andronikidis, A., Georgiou, A. C., Gotzamani, K., & Kamvysi, K. (2009), ‘’The application of quality function deployment  in service quality management’’ . The TQM Journal, 21(4), 319–333.

  5. Aragon, Stephen J.; Flack, Sylvia A.; Holland, Cecil A.; Ingram, Racquel R.; and Clements, Michael L. (2007), ‘’The Influence of Patient-Centeredness on Minority and Socioeconomically-Disadvantaged Patients Trust in their Physicians: An Evidence-Based Structural Equation Modeling Investigation’’, Journal of Health Disparities Research and Practice, Vol. 1 : Iss. 1 , Article 5.

  6. Asnawi, A., Awang, Z., Afthanorhan, A., Mohamad, M & Karim, F.. (2019), ‘’The influence of hospital image and ervice  quality on patients’ satisfaction and loyalty .Management’’ Science Letters, 9(6), 911-920. /10.5267/j.msl.2019.2.011

  7. Babakus, E., & Mangold, W. G. (1992), ‘’Adapting the SERVQUAL scale to hospital services: an empirical  investigation’’. Health services research, 26(6), pp. 767–786.

  8. Badri MA, Attia S, Ustadi AM. (2009), ‘’Healthcare quality and moderators of patient satisfaction: testing for causality’’,  Int J Health Care Qual Assur, ;22(4):382-410. doi: https:/

  9. Badri, M., Attia, S. and Ustadi, A. (2008), ‘’Testing the not so obvious models in healthcare quality”, International Journal  for Quality in Healthcare, Vol. 21 No. 2, pp. 159-74.

  10. Bitner M. and Hubbert. (1994), Encounter satisfaction versus overall satisfaction versus quality. CA: SAGE.

  11. Bleustein, C., Rothschild, D., Valen, A., Valaitis, E., Schweitzer, L. and Jones R.. (2014), ‘’Wait times, patient satisfaction  scores, and the perception of care’’, American Journal of Managed Care, Vol.20 No. 5, pp. 393-400.

  12. Braunsberger, K. & Gates, R.H. (2002), ‘’Patient/enrollee satisfaction with healthcare and health plan’’. Journal of  Consumer Marketing, 19, 575– 590. doi:

  13. Chakraborty R, Majumdar A. (2011), ‘’ Measuring consumer satisfaction in the healthcare sector: the applicability of SERVQUAL’’. Res World, 4(3):149–60.

  14. Chen, Z.X., Shi, Y. and Dong, D. (2008), ‘’An empirical study of relationship quality in a service setting: a Chinese case,’’ Marketing Intelligence & Planning, Vol.26 No.1, pp.11-25.

  15. Cheng Lim, P. and Tang, N.K.H. (2000). ‘’A study of patients’ expectations and satisfaction in Singapore hospitals", International Journal of Health Care Quality Assurance, Vol. 13 No. 7, pp. 290-299.

  16. Cohen, D. Methods in cultural psychology. In Kitayama, S., Cohen, D. (Eds.), (2007), Handbook of cultural psychology, New York, Guilford. pp. 196–236.

  17. Cuevas, E. and Joseph, A. (2012). Improving Process Turnaround Time in an Outpatient Clinic, available at: (accessed 25.12.2020)

  18. Dick, A.S., Basu, K. (1994), ‘’Customer loyalty: Toward an integrated conceptual framework’’. JAMS,  22, 99–113,

  19. Donabedian, A. (2005), ‘’Evaluating the Quality of Medical Care’. The Milbank Quarterly, 83: 691-729. doi:

  20. Donabedian, A. (1980), ‘’The definition of quality and approaches to its assessment’’. Explorations in Quality Assessment  and Monitoring, Vol. 1, Health Administration Press, Ann Arbor, MI.

  21. Faezipoura M. and Ferreiraa S. (2013), ‘’A system dynamics perspective of patient satisfaction in healthcare’’. Procedia Computer Science 16 148 – 156. doi: https://

  22. Fitzpatrick, R. and Hopkins, A. (1983), ‘’Problems in the conceptual framework of patient satisfaction research: an empirical exploration’’, Sociology of Health & Illness, Vol. 5 No. 3, pp. 297-311.

  23. Fox, J.G. and Storms, D.M. (1981), ‘’A different approach to sociodemographic predictors of satisfaction with health care’’, Social Science & Medicine.Part A: Medical Sociology, Vol. 15 No. 5, pp. 557-64.

  24. Gordo LR. (2006), ‘Effects of short- and long-term unemployment on health satisfaction: evidence from German data’’.  Appl Econ, 38(20):2335–50.

  25. Gronroos, C. (2000), ‘’Service Management and Marketing – A Customer Relationship Management Approach’’. John Wiley and Sons, Chichester.

  26. Hall M. (1995), ‘’Patient satisfaction or acquiescence? Comparing mail and telephone survey results’’. J Health Care Marketing, 15:54–61.

  27. Heskett JL, Sasser WE Jr, Schlesinger LA. (1997), The Service Profit Chain. New York: The Free Press.

  28. Hu, L. and Bentler, P. (1997), ‘’Cut-off criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives’’, Structural Equation Modelling, Vol. 6, pp. 1-55.

  29. Kerssens, J. J., & van Yperen, E. M. (1996), ‘’Patient's evaluation of dietetic care: Testing a cognitive-attitude approach’’,  Patient Education and Counseling. 27(3), 217–226.

  30. Kitapci O., Dortyol T.I., Yaman Z., Gulmez M. (2013), ‘’The paths from service quality dimensions to customer loyalty’’, Management Research Review.; 36(3), 239-255. doi:10.1108/01409171311306391

  31. Kurata, J.H., Nogawa A., Phillips D.M., Hoffman S., and Werblum M.N. (1992), ‘’Patient and provider satisfaction with medical care’’, Journal of Family Practice, 35 (2); 176 – 179.

  32. Lazarevik V. and Kasapinov B. (2015), ‘’Medical Doctors’ Attitudes towards Pay-For-Reporting in Macedonia: A Web-Based CrossSectional Survey’’, Maced J Med Sci, 5(4):437-443.

  33. Lewis, K.E. , & Woodside, R.E. (1992), ‘’Patient satisfaction with care in the emergency department’’,  Journal of Advanced Nursing, 17(8), 959–964.

  34. Linder-Pelz, S. (1982), ‘’Toward a theory of patient satisfaction’’, Social Science & Medicine, Vol. 16 No. 5, pp. 577-82.

  35. Loveman, G.W. (1998), ‘’Employee satisfaction, customer loyalty and financial performance: an empirical examination of the service profit chain in retail banking’’, Journal of Service Research, Vol. 1 No. 1, pp. 18-31.

  36. Maitra A, Chikhani C. (1992), ‘’Patient satisfaction in an urban accident and emergency department’’. The British Journal of Clinical Practice, 46(3):182-184.

  37. Masood A. Badri Samaa Attia Abdulla M. Ustadi (2009), ‘’Healthcare quality and moderators of patient satisfaction: testing  for causality", International Journal of Health Care Quality Assurance, Vol. 22 Iss 4 pp. 382 – 410.

  38. Messner, E. R.,(2005), ‘’ Quality of care and patient satisfaction the improvement efforts of one emergency department ’’, Top Emerg. Med., ;27(2):132–141.

  39. Mohamed B, Azizan NA. (2015), Perceived service quality's effect on patient satisfaction and behavioural compliance. Int J Health Care Qual Assur, ;28(3):300-14. doi: 10.1108/IJHCQA-06-2014-0074. PMID: 25860926.

  40. Mummalaneni V, Gopalakrishna P. (1995), ‘’Mediators vs. Moderators of patient satisfaction’’, J Health Care Mark, 15(4):16–22.

  41. Ogbeibu, S., Senadjki, A., & Gaskin, J. (2018), ‘’The moderating effect of benevolence on the impact of organisational culture on employee creativity’’, Journal of Business Research, 90, 334–346.

  42. Øvretveit  J., Gustafson D. (2003), ‘’ Using research to inform quality programmes’’  BMJ, 326 :759.


  44. Parasuraman, A. Zeithaml, VA. and Berry, LL. (1991), ‘’Refinement and reassessment of the SERVQUAL scale’’, Journal of Retailing, Vol.67, Iss:4, pp. 420-50.

  45. Pascoe, G.C. (1983), ‘’ Patient satisfaction in primary health care: a literature review and analysis’’, Evaluation and Program Planning, Vol. 6 Nos 3-4, pp. 185-210.

  46. Payal M. (2016), ‘’ Outpatient clinic waiting time, provider communication styles and satisfaction with healthcare in India’’, International Journal of Health Care Quality Assurance, Vol. 29 Iss 7.

  47. Robin DiMatteo, M.; Prince, L.M. Taranta, A.(1979), ‘’Patients’ perceptions of physicians’ behaviour’’, J. Community  Health, 4, 280–290.

  48. Runciman W, Hibbert P, Thomson R, Van Der Schaaf T, Sherman H, Lewalle P. (2009), ‘’Towards an International Classification for Patient Safety: key concepts and term’’, Int J Qual Health Care, 21:18-26.

  49. Sahin, B., Yilmaz, F. & Lee, K. (2007), ‘’Factors Affecting Inpatient Satisfaction: Structural Equation Modeling’’, J Med  Syst., 31, 9–16.

  50. Shabbir, A.; Malik, S.A.; Malik, S.A. (2016), ‘’Measuring patients’ healthcare service quality perceptions, satisfaction, and loyalty in public and private sector hospitals in Pakistan’’, Int. J. Qual. Reliab. Manag, 33, 538–557.

  51. Strasser, S., Aharony, L. and Greenberger, D. (1993), ‘’The patient satisfaction process: moving toward a comprehensive model’’, Medical Care Review,bVol. 50 No. 2, pp. 219-45.

  52. Swan, J.E., Richardson, L.D. and Hutton, J.D. (2003), ‘’Do appealing hospital rooms increase patient evaluations of physicians, nurses, and hospital services?’’, Health Care Management Review. 2003, 28 No. 3, pp. 254-64.

  53. Tiwari, Y, Goel, S and Singh, A. (2014), ‘’Arrival time pattern and waiting for time distribution of patients in the emergency outpatient department of a tertiary level health care institution of north India', Emergency Trauma Shock. 2014, Vol. 7 No. 3, pp.160–165. https:// /10.4103/0974-2700.136855

  54. Tucker, J.L. (2002), ‘’The moderators of patient satisfaction’’, Journal of Management in Medicine, 16, pp. 48–66.

  55. Ware, J.E. Jr and Snyder, M.K. (1975), ‘’Dimensions of patient attitudes regarding doctors and medical care services’’,  Medical Care, Vol. 13 No. 8, pp. 669-82.

  56. Yeşilada, F. and Direktör E. (2010), ‘’Health care service quality: A comparison of public and private hospitals’’, African  Journal of Business Management, Vol. 4, Iss:6, pp. 962-971.

  57. Yi, Y. (1990), “A Critical Review of Consumer Satisfaction,” in Review of Marketing, Zeithaml, Valarie A. , ed. Chicago: American Marketing Association, 68–123.

  58. Zineldin, M. (2006), ‘’The quality of health care and patient satisfaction: an exploratory investigation of the 5Q model at some Egyptian and Jordanian medical clinics’’, International Journal of Health Care Quality Assurance, 2006; Vol. 19 No. 1, pp. 60-92.