Comparison of Services of Public, Private and Foreign Hospitals from the Perspective

of Bangladeshi Patients
Author(s): Nazlee Siddiqui and Shahjahan Ali Khandaker
Source: Journal of Health, Population and Nutrition , JUNE 2007, Vol. 25, No. 2 (JUNE
2007), pp. 221-230
Published by: Springer

Stable URL: https://www.jstor.org/stable/23499418

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J HEALTH POPUL NLTTR 2007 Jun;25(2):221 -230 ® INTERNATIONAL CENTRE FOR DIARRHOEAL
ISSN 1606-0997 I $5.00+0.20 DISEASE RESEARCH. BANGLADESH

Comparison of Services of
Foreign Hospitals from th
Bangladeshi Patients
Nazlee Siddiqui1 and Shahjahan Ali Khan

'School of Business, North South University, 12 Kemal Ataturk Av

Economics Unit, Ministry of Health and Family Welfare, Govern

ABSTRACT

Despite recent developments in the Bangladesh healthcare sector, there is still grea
the quality of healthcare services in the country. This study compared the qualit
services by different types of institutions, i.e. public and private hospitals, from
Bangladeshi patients to identify the relevant areas for development. A survey was
Bangladeshi citizens who were in-patients in public or private hospitals in Dhaka ci
abroad within the last one year. About 400 exit-interviews were conducted using a
tionnaire that addressed the probable factors of the quality of healthcare services in
scales. The results gave an overview of the perspectives of Bangladeshi patients o
service in three types of hospitals. The quality of service in private hospitals scored
in public hospitals for nursing care, tangible hospital matters, i.e. cleanliness, suppl
availability of drugs. The overall quality of service was better in the foreign hospi
that in the private hospitals in Bangladesh in all factors, even the 'perceived cost' f
provides insights into the specific factors of the quality of hospital services that ne
to meet the needs of Bangladeshi patients.

Key words: Comparative studies; Foreign Hospitals; Healthcare; Health services; Pr

Public Hospitals; Quality of services, Bangladesh

INTRODUCTION seekers use government services, 27% use pri

vate/NGO services, and 60% unqualified ser
Bangladesh has a good healthcare network cover- vices (2) In their comparative survey o
ing both rural and urban areas. There are 3,976 and bUc healthcare providers in B
healthcare facilities in the public sector and 975 Ricardo e{ fl/ observed that the overal
privately-run hospitals/clinics (1). The health- for pUt>lic healthcare services was as low
care-delivery system of the country compares (3) Qn the other hand; the uneven d
favourably with that of many other Asian coun- of demand is creating unmanageable p
tries. However, overall healthcare use/consump- on the few reputa51e public hospitals.
tion in Bangladesh is low and is of great concern 'Bangladesh healthcare facility efficie
to society. A survey by the Centre for Interna- Ranan and Somanthan observed tha
tional Epidemiological Training (CIET), Canada, ab patient load in public medical co
showed that, in Bangladesh, 13% of treatment- ^ was approximately five times hi
Correspondence and reprint requests should be that in other Seneral hospitals (4). A
addressed to: ducted by the Health Economics Unit (HEU) of
Dr. Md. Shahjahan Ali Khandaker the Ministry of Health and Family Welfare (Mo
Health Economics Unit HFW), Government of Bangladesh, found that
Ministry of Health and Family Welfare tbe unavailability of doctors and nu
Government of Bangladesh attitudes and behaviour, lack of drugs
Bangladesh Secretariat . , . , , , °
Dhaka 1000, Bangladesh tim
Email: sjahan20@yahoo.com of public hospitals (5).

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 Services of public, private and foreign hospitals Siddiqui N and Khandaker SA

In response to the growing disappointment in Parasuraman et al

the role of the public healthcare sector, the num- model along these
ber of private-run facilities has increased. An es- of service (7,13,14).
timated 15% growth has been observed between its measurement a
1996 and 2000 in this sector (1). However, quali- it cannot measure qu
ty is a major concern both in public and private (8).
healthcare services. Such concern is prompting
a large number of Bangladeshi patients to seek Ilie Present study used
foreign medical care despite the additional costs, refined ^ Andaleeb (
travel, lengthy visa procedures, etc. According to for the Bangladesh
the official record of the Institute of Health Eco- were made to the fr
nomics, University of Dhaka, Bangladeshis spend sultin§ from the tw
approximately Tk 500 million a year on foreign ™ssions (FGDs> condu
healthcare services (6). used
focus §roup comPrised ei8h
healthcare services in Dhaka or abroad with
The quality of service in general is of inherent in the last one year. These members were selected on
importance in any society. In the late 1980s, a random basis without any restriction on gen
Parasuraman etal. presented some parameters of der, occupation, etc. It was ensured that each
the quality of service, i.e. reliability, responsive- group had a mixture of in-country and foreign
ness, assurance, tangibility, and empathy (7). hospital patients. The 'perceived cost' variable
Andaleeb introduced some more Bangladesh mar- focused on the cost of laboratory tests is an ex
ket-specific service-quality parameters, i.e. bak- ample of an addition to the research tool as
sheesh and discipline (8,9). Various reports from result of FGD feedback.
the HEU presented further service-quality pa- . ,x. , . . , . ., .,. ,. , .
, , f? u. The initial nine variables—accessibility, reliabi
rameters, such as access cost of healthcare ,.x ^ ..... . J
tc ,m tu . , jr.!, , lity, tangibility, responsiveness, assurance, com
services (5,10). Aldana etal. and Rahman etal. ■ r. ÍV . , x ,.
i *.. rr, , . . , u, munication, empathy, perceived cost, and dis
analyzed the quality of Bangladesh healthcare ... r ' ¿ ; ,
. , T .. ° A cipline of the research tool—were run through
services from the perspective of patients (11,12). £ \ x ^ ,. . . . , °.
IT .. ... , factor analysis to arrive at the final eight vari
However, these studies were limited to some ex- ,, ' , , . . .. ..., ,
' ... . . , ables—empathy of physicians, availability of phy
tent, as they did not cover the experiences of .. , ± r ...
„ . , ' .. ^ , . , ,. sicians, assurance/competence of physicians,
Bangladeshi patients with foreign healthcare ., c . ,
° empathy of nurses, responsiveness of nurses,
services with an evidence-based case. The present ..... t , . r ., ...^ , . '
^ , ,. .. ,, ,, K . availability of drugs, tangibility, and perceived
study compared the quality of healthcare services . ^ ... £r ...
, 1 . ,, .. cost. Descriptions of these variables are provided
b«w«n m^ountiy public and pnvate hosp.tals ,n ,he A dix Tes
and hospitals abroad from the pers-pective of also dQne
Bangladeshi patients. Based on these findings, ,he „ theses aI
some recommendations have been made to

improve in-country healthcare services to meet (a) The empathy of physicians,

the needs of Bangladeshi patients physicians, assurance/competence
cians, empathy of nurses, responsiveness o
MATERIALS AND METHODS
nurses, availability of drugs, tangibility, a
Background perceived cost at in-country public and pri
vate healthcare services are the same.
Quality of service is an elusive and indistinct
construct and is difficult to measure. Perceptions ^ ' de emPathy of physicians, availability o
of the quality of service result from a comparison physicians, assurance/ competence of physi
of the expectations of consumers with the per- cians, empathy of nurses, responsiveness o
formance of actual services. Evaluation of the qual- nurses, availability of drugs, tangibility, and
ity of service is not made solely on the outcome perceived cost at private healthcare service
of a service rather it also involves evaluation of in Bangladesh and healthcare services abroad
the process of service-delivery (13). Certain cri- are tbe same
teria that measure the quality of service should Questionnaire design
be identified first, and then an analysis of those
identified criteria would definitely provide a sys- A preliminary questionnaire was developed in
tematic assessment of the quality of service (8). English in line with the constructs of the h
222 ~ JHPN

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Services of public, private and foreign hospitals Siddiqui N and Khandaker SA

potheses. This was translated into Bangla at the In the case of sur
final stage. The 5-point interval scales were pitáis in Banglad
used in the structured format with verbal state- viewed in-patien
ments, such as 'strongly disagree' and 'strongly the hospitals, resp
agree', anchored to the numerals of 1 to 5. The from the list of '
SERVQUAL scales of Parasuraman et al. were 7- by the hospita
point interval scales (7). In this study, a 5-point randomly selecte
interval scale made better sense considering the tained data as per
education and exposure of the sample base. In cases where th
Multiple items were used for representing each n°t interested in
construct. Researchers pretested the question- data collectors mov
naire and adopted it accordingly. In pretesting, "st.
10 interviews were conducted: seven with in-pa- Dat
tients in Bangladesh hospitals (private and pub- were difficult tQ
lie) and three with Bangladeshi patients who method; as ther
received healthcare services from hospitals in complete inform
Bangkok, Thailand, within the last one year. As a result, the
As per internationally-accepted ethical practice, non-probability t
the questionnaire mentioned that the survey based on refer
would not require respondents to provide their was used OT c
ij^-i j 4. j 4. . , , , East-West University, North South University, and
personal details and that data provided by res- . ,, . , ,
, . ,,, , ... ... .. ,, T. the University of Liberal Arts, Dhaka. Respondents
pondentswouldbedealtwithconfidentially.lt ' . ' ,. ..... . ,
1 ' TATorn coroonon fnr rhn como o imni ihr rrirona r\r
were screened
was also mentioned that, w
being an in-pa
encouraged to answer all
the last one ye
questionnaire, they could
ing any specific question
as and when they desired.
Due to resource and time constraints, a maxi
Data-collection method mum of 450 samples was planned for the study.
About 150 samples were to be collected from
A 10-member data-collection team was recruit
each stratum of public, private, and foreign hos
ed from final year Bachelors in Business Admin- pitals The in_country hospital sample
istration (BBA) students of East-West University, Dhaka dty as Dhaka hosts different q
Dhaka. Researchers trained data collectors on hospitals and the highest number of
interview techniques to minimize bias. Permis- in tbe country
sion from the MoHFW was obtained to facilitate
the data-collection process. Table 1 shows the break-up of the actual 400 sam
pies collected in this study.
Sampling method
The sample size of 400 is consistent with the
Two separate lists of public and private hospitals intended sample size value that could be calcu
in Dhaka along with the bed capacity of relevant lated assuming 50% population proportion (p)
hospitals were obtained from the MoHFW. Two with a 95% confidence interval (corresponding
public hospitals—Pub 1 and 2—were chosen z value of 1.96) and sampling error level of 5%
purposively considering a similar patient load. (e value). Therefore, this study assumed that
Three private hospitals—Pri 1, Pri 2, and Pri 3— 50% of the population in Bangladesh could ex
were randomly selected from the list of private press knowledge on the quality of hospital servic
hospitals. es, and the true population value would be
Table 1. Break-up of 400 study samples
Private
Privatepatients Public patients Foreign
Public patients
patients patients
Foreign patients
(n=153)
(n=153) (n=153)
(n=153) (n=94)
(n=94)
Pri 1
Pri 1 Pri
Pri 2
2 Pri
Pri 33 PubPub
1 Pub 2 2IndiaIndia
1 Pub Thailand
Thailand
Single
Single
Others
Others
~~65
65 52 52
36 36 105
10548 4869
69 16
16 7
7 1
1

Volume 25 | Number 2 | June 2007 223

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Services of public, private and foreign hospitals Siddiqui N and Khandaker SA

within plus or minus 5% of the estimates based dependent sampl

on this sample. As per the formula, n=z2[p(l-p)]/ phase, comparis
e2; [(1.96)2* (0.5 * 0.5)]/(0.05)2=384, which is near country private
to 400 (15). tals. The other phase covered the comparisons
between the private hospitals in Bangladesh
Analysis
and the foreign hospitals.
As per the results of the factor analysis and reli RESULTS
ability check, the service-quality variables were
finalized to be: availability of physicians, assur- The findings of this study showed
ance/competence of physicians, empathy of quality gap in healthcare service
physicians, responsiveness of nurses, empathy the in-country group and the gr
of nurses, availability of drugs, perceived cost of ancj foreign healthcare providers
healthcare service, and overall tangibility of the the quality of private healthcare s
healthcare service centre. better in the factors of availability of d
In factor analysis, scales having a loading value gibility, perceived costs, empathy o
of 0.5 and higher were accepted as an important responsiveness. Table 3 shows that
component of the variable. Each factor was ana- service of foreign hospitals is bett
lyzed using Kaiser's eigen value of greater than factors compared to that of private
or equal to one (16) to see whether each com- Bangladesh.
ponent measured a single factor or not. Lastly,
The factor of 'availability of drugs' showed t
the factors forming a component were tested ,
for reliability (alpha=0.6 or higher). Following most S1§nificant difference betwe
this technique, the above-mentioned eight vari- healthcare service providers. This is
ables of the quality of healthcare services were ed bythe t value of"n A47 and the m
obtained ence "0.9915. Therefore, the service of public
hospitals in relation to availability of dru
A mean comparison on the identified healthcare timely administration t
service-quality variables was done through in- than that of the private h

Table 2. Independent samples t-testprivate

for public vs private hospitals
hospitals
r-test
t-testtor
for
equality
equality
of means
of means
Variable Mean
t df
Significance
(2-tailed) difference

Availability of -1.616 304 0.107 -0.1291

physicians -1.616 279.771 0.107 -0.1291

Assurance and competence -0.534 304 0.593 -0.0433

of physicians -0.534 303.338 0.593 -0.0433

-1.692 304 0.092 -0.1425

Empathy of physicians -1.692 288.179 0.092 -0.1425

-3.164 304 0.002 -0.2936

Empathy of nurses -3.164 297.538 0.002 -0.2936

-2.143 304 0.033 -0.1850

Responsiveness of nurses -2.143 280.299 0.033 -0.1850

-10.652 304 0.000 -0.7694

Tangible -10.652 294.143 0.000 -0.7694

-11.447 303 0.000 -0.9915

Drug -11.438 285.077 0.000 -0.9915

-7.304 302 0.000 -0.6151

Perceived cost
-7.304 301.762 0.000 -0.6151

df=Degrees of freedom

224 J H PN

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Services of public, private and foreign hospitals Siddiqui N and Khandaker SA

The public hospitals seem to be in a much worse General cleanliness of

condition compared to the private hospitals re- ply, etc. were much
garding cleanliness of the hospital, water supply, pitáis compared to t
availability of equipment, etc. The 'tangibility' country. The t valu
factor, with the fvalue of -10.652 and the mean 'tangibility' demonstr
difference of -0.769, conveys this point. ty—the amenities of care
the highest service gap between th
The results also showed that the 'perceived cost' types of hospitals
at the private hospital was significantly higher
(i.e. t value of -7.3 and the mean difference of The findings also sh
-0.615) than that of the public hospitals. The tients found physicia
'cost' factor was measured not as the absolute more available, com
amount paid but as the patients' perceptions of compared to those
the reasonability of the cost paid for the consul- Bangladesh. Table 3 s
tation of a physician, diagnostics, accommoda- sician-relevant mat
tion, etc. tence, availability and empathy of physicians,
there were substantial mean differenc
With regard to nurse-related matters-empathy dose tQ _() 6 or highe
and responsiveness of nurses—the quality of the hospitals
public healthcare service provider also seemed
to be much worse than that of the private hos- While the nurses
pitals. These are demonstrated through the cor- tained a better ser
responding lvalue of-3.164 and-2.143 accord- service-quality gap
ingly. mean difference of -0.5876) was higher than that
of the empathy factor (the mean differ
It is interesting to note that regarding physician- 0 3995) compared to
related matters—availability, empathy, and as- deshi private hospit
surance/competence of physicians—there were
no significant differences between the quality of Another important f
services in the public and private hospitals. gap between the Ban

Table 3. Independent samples f-test for private

í-test for private hospitals
hospitals vs
vs foreign
foreign hos
ho
r-test
f-test tor
for
equality
equality
of means
of means
Variable Mean differ
t df
Significance
(2-tailed) ence

Availability of -7.960 245 -0.5734

0.000
physicians -8.338 225.104 -0.5734

Assurance and competence -7.621 245 -0.6228

0.000
of physicians -8.255 240.102 -0.6228

-7.452 245 -0.5947

Empathy of physicians 0.000
-7.753 221.295 -0.5947

-4.388 245 -0.3995

Empathy of nurses 0.000
-4.634 229.380 -0.3995

-7.680 245 -0.5876

Responsiveness of nurses 0.000
-8.175 233.200 -0.5876

-9.764 245 -0.6665

Tangible -10.454 235.760
0.000
-0.6665

-7.074 245 -0.5736

Drug 0.000
-7.383 223.114 -0.5736

4.972 245 0.000 0.5343

Perceived cost
4.723 165.658 0.000 0.5343

df=Degrees of freedom

Volume 25 | Number 2 | June 2007 225

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 Services of public, private and foreign hospitals Siddiqui N and Khandaker SA

and the foreign ones was availability of drugs The scope of the
with a mean difference of -0.5736 and t value improving the ta
of -7.383. The Bangladeshi patients found the ing public hospita
services of foreign hospitals in availability of ,
drugs and timely administration to patients to This study c°nfirmed *e fner
be much better than that of the private hospi- the <lua ^ of service °f Phy
tais in Bangladesh. availability, assurance/competency, and empa
thy (Items 2 and 3 in Appendix) in the Bangla
The mean of costs of factors, such as consulta- deshi hospitals are poor compared to foreign
tion of physician, operation, diagnostics, etc., hospitals. This is consistent with the findings of
were found to be unreasonable in the private Ricardo et al. that 100% of outpatients at pub
hospitals of Bangladesh compared to the pub- he hospitals and 47% of the same at private
lie and foreign hospitals. In this study, 50% of hospitals are not attended to at the appointed
the in-country private hospital patients and for- time (3). Reputable physicians in our country
eign hospital patients (mostly Indian hospital ate known to shuffle themselves between differ
patients) belonged to the same income range. ent hospitals visiting an unreasonable number
Also, the patients in the foreign hospitals paid °f patients each day, which makes them totally
higher costs than the private hospitals in ab- incapable of allowing due time and assurance/
solute terms. Despite this, the Bangladeshi pa- competency to patients (19). In his ethnographic
tients perceived foreign healthcare services to be study at a public hospital, Zaman gave evidence
more reasonably priced. of physicians leaving public hospitals early for
private practice (20). The healthcare service pro
DISCUSSION viders in our country should initiate continuous
^ , , technical and behavioural training and an eval
study a,nalyzed the service of in- uation progr
country public and private hospitals from the tQ ^ W
perspective of Bangladeshi patients in an exhaus- evaluatio
tive manner. Comparison of public and private in Banglad
hospitals in Bangladesh with foreign hospitals and priV
derived from this study should allow healthcare the maxi
service providers to make provision for improv- dan a da
ing the quality of services of the in-country hos- hospita
Pita*s- be done to reveal whether such measures could
Tangibility (Item 8 in Appendix) came out to be add enou«h value in Patients' mind to o
a general weakness in the Bangladesh health- relevant cost increases.
care sector. In this study, tangibility did not This study has shown that the service-qu
cover cleanliness of service providers (i.e. doc- between nurses of private hospitals and
tors, nurses), but all other common issues, such foreign hospitals in terms of empa
as supply of utilities, cleanliness of hospital (toi- sponsibility (Items 4 and 5 in Appendi
lets/cabins), and condition of equipment, were higher than the similar service-quality g
covered. The World Health Organization (WHO) exists between nurses of private and pub
had identified that about 50% of the medical pitáis. Therefore, the study could bri
equipment in developing countries is unusable reality that, while the nurses in private
(17). The importance of tangibility matters in are doing a better job than their cou
the Bangladesh healthcare sector has also been in public hospitals, they still lacking
earlier discussed. It has been shown that im- with the service level of nurses in th
provement in tangibility matters enables better hospitals. Concerns with services of
service-delivery and results in improved use of Bangladesh were also raised in pre
healthcare facilities (18). The recent establish- jes. Patients in Bangladesh are very d
ments in the Bangladesh private healthcare sec- with the behaviour of nurses and ineff
tor; i.e. Apollo and Shikder, are some initiatives service-delivery (12). Results of a study
in this regard. From the initial stage, service pro- that nurses in Bangladesh decline to
viders should emphasize maintenance of such rect patient care due to sociocultural
standards of tangibility on a long-term basis. (22). In the same study, it was ident

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Services of public, private and foreign hospitals Siddiqui N and Khandaker SA

nurses in general also suffer from inferior so- indication for

cial status. This study does not provide any in- to maintain a q
dividual focus on probable improvement mea- of increasing the c
sures for nurses. However, observing healthcare should be done t
services in the private sector in Bangladesh and noted that the pr
abroad, it could be understood that better pack- unusual findings
age, availability of equipment, and strict super- respondents w
vision of management that allows development whole process: cos
of nurses as well would definitely contribute to modation, travel
improve services of nurses. Bangladesh and its parent need fo
development partners, i.e. World Bank, WHO, higher service
and Department for International Development, chain: service of
have been taking steps to develop skills and management of d
leadership of nurses (22).
Since this study indicates, the perce
The findings of this study explain that the quali-ty private hospital
gap in services regarding drug issue to be much of public hospita
higher in the case of the public vs private see- patients. It is our
nario compared to the private vs foreign see- that the high-co
nario. The availability of drugs and their timely es cannot be suit
administration (Item 6 in Appendix) to patients needy populat
are an important factor of the quality of service desh has taken
as patients draw a logical relationship between lie cooperation,
drugs and the curing process of a disease. Pol- the potential o
icy-makers need to address mismanagement of healthcare service
drugs especially in public hospitals in Bangladesh. Policies to have
Patients at public hospitals face great difficulties free treatments
in getting prescribed medicines and ultimately profit contributio
resort to buying medicines from outside. Inad- hospitals for t
equate supplies of drugs/medicines deter nurs- tals might be rese
ing services (22), while the inefficient manage- majority of the p
ment of drugs could waste scarce resources as well Limitations
(23). Although the situation in private hospitals
is much better in this regard, they still lack the kind This study h
of comprehensive medicine management pro- • based study as
cess as followed in foreign hospitals. While the snowball sampling
process of management of the drugs in the for- as opposed to a p
eign hospitals could be the benchmark to follow A bigger sample
for well-resourced private hospitals, outsourcing of the country
the public hospitals to the private sector may robust. In futur
ensure a non-profit but efficient management. and policy-maker
Some Indian public hospitals have been using tors where a ser
non-governmental organizations (NGOs) for run- also on the r
ning a non-profit pharmacy (23); these experi- discussed in th
enees could be used in our case. draw proper benefit from this study.
Perceived cost of private healthcare services (Ap- The study attempted to identify the specific fac
pendix) came out to be more unreasonable than tors of the quality of service in the Bangladesh
that of foreign healthcare services. This result healthcare sector that should be improved from
could indicate the existence of price and quality the perspectives of Bangladeshi patients. This
imbalance in the Bangladeshi healthcare sector. comparative study has shown that availability
As stated in the Results section in this study, Ban- of physicians, assurance/competence of physi
gladeshis within a similar income-range used in- cians, empathy of physicians, responsiveness of
country private health facilities and foreign hos- nurses, empathy of nurses, availability of drugs,
pitáis Therefore, all such findings might be an tangibility (amenities of care), and perceived cost

Volume 25 | Number 2 | June 2007 227

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Services of public, private and foreign hospitals Siddiqui N and Khandaker SA

Institute of Health
were certain factors in which significant differ Economics, University of Dha
ka, 2002:5-6.
ences existed among the public, private and for
eign hospitals. The respective service providers
7. Parasuraman A, Zeithami VA, Leonad LB. SERVEQUAL:
should, thus, undertake necessary steps to
a multi-item miti
scale for measuring customer percep
gate this gap to offer better healthcare services
tions of service quality, f Retail 1988;64:12-40.
to patients. Such steps would contribute to the
8. Andaleeb SS. Service quality perceptions and patient
sustainable growth of the healthcare sector in
satisfaction: a study of hospitals in a developing coun
Bangladesh.
try. Soc Sei Med 2001;52:1359-70.

The suggested key recommendations

9. Andaleeb SS.in this
Public and private hospitals in Ban
study are: continuous training and evaluation
gladesh: service quality and predictors of hospi
of physicians and nurses, a holistictalsquality focus
choice. Health Policy Plan 2000;15:95-102.
throughout the service process10. in private hos
Bangladesh. Ministry of Health and Family Welfare.
pitals, cooperation between private and
Health public
Economics Unit. Study on public & private
hospitals in areas of availability of drugs, tangi
hospital provisions on the ESP and Non-ESP servic
bility/amenities of care, and various
es andhealthcare
efficiency. Dhaka: Health Economics Unit,
development projects. Ministry of Health and Family Welfare, Govern
ACKNOWLEDGEMENTS ment of Bangladesh, 2002:1-81.
11. Aldana MJ, Piechulek H, Sabir A.A. Client satisfac
The authors are indebted to Dr. Syed Saad
tion An of health care in mral Bangladesh.
and quality
daleeb, Professor and Program Chair, Marketing, Bull World Health Organ 2001;79:512-6.
Sam and Irene Black School of Business, Penn 12. Rahman MM, Shahidullah M, Shahiduzzaman M,
State Erie, USA, for his valuable guidance in con Rashid HA. Quality of health care from patient
ducting the study. The authors would also like to perspectives. Bangladesh Med Res Counc Bull 2002;
extend gratitude to the Ministry of Health and .28:87-96.
Family Welfare, Government of Bangladesh, for
13. Parasuraman A, Zeithami VA, Leonad LB. A con*
administrative support for this research.
ceptual model of service quality and its implica
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Services of public, private and foreign hospitals Siddiqui N and Khandaker SA

Appendix

Variables determining the quality of healthcare services

1. Physicians: empathy 5. Nurses: responsiveness

• Doctor was sincere whenever necessary • Nurse administered treat
• Doctor was willing to answer any ques- • Nurse was willing to
tion tients' call
• Doctor listened to y
• Doctor rightly ref
problems * Nurse replied correctly to patients query
• Doctor was consistently caring * You felt comfort with nurse
2. Physicians: availability 6. Drugs
• Doctors and specialists were available * Dru§ was available 24 hours at pr
when required * Prescribed drug was timely supplied to
• Doctors followed up treatments regularly patient
• Doctors were present during visiting # Nuiruses adl™njsitered dru§s to Patients
with own hand
hours
7. Perceived cost
3. Physicians: assurance/competence
^ , . • Doctor's consultation fee was higher
Doctors interpreted laboratory reports T , , ...
., • Laboratory test fee was higher
correctly . } °
Operation
• Doctor gave correc
time
Travel cos
Accommo
• Doctors were competent in diagnosing
the problem 8. Tangibility
• Doctors gave knowledgeable answers to . Hospital w
questions . Hospital premises were neat and clean
• You felt safe in the hands of the doctors . There was enough waiting ro
4. Nurses: empathy * Healthcare centres had modern equip
ment

• Nurse communicated your problem to « Cabin/Ward's bedding and floo

doctors clean
• Nurse understood you
• Nurse explained prescription to patient/ cleaned
relatives • Hospital had regular water supply
• Nurse was consistently caring • Hospital had regular electr
• Nurse paid individual attention to patient • Hospital had adequate se
• Nurse provided moral courage • Toilets and bathrooms were clean

230 JHPN

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