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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