A Study of Consumer Satisfaction Towards Service Quality and Infrastructure in Private General...

A Study of Consumer Satisfaction towards Service Quality & Infrastructure in Private General Hospitals

A Study of Consumer Satisfaction towards Service Quality and Infrastructure

in Private General Hospitals of Sri Lanka with Special Reference to Colombo

District

By

Imthiyaaz Ahamed Zairak Hassim

Supervised by

Ms. Manjula Gunawardane

Dissertation submitted in partial fulfillment of the requirements

For the degree of

……Business Management…… (B.Sc.)

Imperial Institute of Higher Education

Colombo, Sri Lanka

Validated Center of

The Federal University of Wales, UK

July 2014


Declaration

This work has not been accepted in substance for any degree and is not being currently submitted

in candidature for any degree.

Signature of Candidate:………………………… (Name)

Statement 1

This dissertation is being submitted in partial fulfilment of the requirements for the degree of

B.Sc.


Statement 2

This dissertation is the result of my own independent work and investigation, except where

otherwise stated. Other sources are acknowledged by giving explicit references. A list of

reference is appended.


Statement 3

I hereby give consent for my dissertation, if accepted, for photocopying and for inter library loan,

and for the title and summary to be made available to outside organisations.


Supervisor’s certification

I………………………………………….., certify that the dissertation

titled……………………………………………………………………………………….

Submitted by ………………………………………….. …………………………………

has been reviewed by me and is ready for submission.

Signature of Dissertation Supervisor:………………………………………………….

Signature of the Co-Supervisor (If any).........................................................................

Date:


This is to certify that the dissertation titled “Consumer Satisfaction

towards Service Quality & Infrastructure Facilities in Private General

Hospitals in the Colombo District of Sri Lanka” submitted by has

satisfied the requirement of the partial fulfillment for the award of

B.Sc. (Hons) Degree in Business Management.

…………………… …………….

Director Education Date

…………………… …………….

Director Education Date

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A Study of Consumer Satisfaction towards Consumer Satisfaction & Infrastructure in Private General Hospitals of Sri Lanka with Special Reference to Colombo District

Acknowledgement

At the outset, the author wishes to thank Ms. Manjula Gunawardane (supervisor) and Professor

Neville Warnakulasooriya for overall guidance and support provided during various stages of

preparing this study.

The author wishes to acknowledge the valuable contribution by Wimal Hettiarachichi (Senior

Director, IPS) and D.M.M. Herath (Customer Relations, Durdans Hospital) for their substantive

inputs as well as editorial support.

The author also thanks the publishers and research authors for assisting literature review based

on the research topic of private healthcare.

Finally, the author would like to thank the support of family and friends.

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Table of Contents

Acknowledgement .................................................................................................................................... i

List of Abbreviations ............................................................................................................................... x

Abstract ................................................................................................................................................... 1

CHAPTER ONE ...................................................................................................................................... 3

1.1 Introduction ................................................................................................................................... 4

1.2 Research Problem .......................................................................................................................... 7

1.3 Justification ................................................................................................................................... 9

1.4 Research Aims & Objectives........................................................................................................ 12

1.4.1 Main Research Objective ...................................................................................................... 12

1.4.2 Specific Research Objectives................................................................................................. 12

1.5 Significance ................................................................................................................................. 13

1.5.1 Academic Significance .......................................................................................................... 13

1.5.2 Practical Significance ............................................................................................................ 13

1.6 Scope ........................................................................................................................................... 14

1.7 Outline of Chapters ...................................................................................................................... 14

CHAPTER TWO .................................................................................................................................... 16

2.1 Healthcare Industry ...................................................................................................................... 17

2.1.1 Private Healthcare Industry ................................................................................................... 19

2.1.2 Government Healthcare Industry ........................................................................................... 20

2.1.3 Asian Healthcare Industry ..................................................................................................... 21

2.1.4 Sri Lankan Healthcare Industry ............................................................................................. 23

2.1.5 Sri Lankan Private Healthcare Industry ................................................................................. 24

2.2 Theoretical Underpinning ............................................................................................................ 25

2.2.1 Consumer Satisfaction ........................................................................................................... 25

2.2.2 Service Quality ..................................................................................................................... 27

2.2.3 Hospital Infrastructure Facilities ............................................................................................ 31

2.2.4 Relationship between Service Quality & Consumer Satisfaction ............................................ 34

2.3 Models in Healthcare ................................................................................................................... 35

2.3.1 Consumer Satisfaction Pragmatic Model in Healthcare .......................................................... 35

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2.3.2 SERQUVAL Model .............................................................................................................. 36

2.4 Critical Analysis of Literature ...................................................................................................... 38

2.5 Conclusion................................................................................................................................... 39

CHAPTER THREE ................................................................................................................................ 40

3.1 Research Design .......................................................................................................................... 41

3.2.1 Primary Data ......................................................................................................................... 42

3.2.2 Secondary Data ..................................................................................................................... 42

3.3 Research Questions ...................................................................................................................... 43

3.3.1 Main Research Question........................................................................................................ 43

3.3.2 Specific Research Questions .................................................................................................. 43

3.4 Conceptual Framework ................................................................................................................ 44

3.5 Operationalization........................................................................................................................ 45

3.6 Research Hypotheses ................................................................................................................... 46

3.7 Research Instrument .................................................................................................................... 47

3.8 Sampling Plan .............................................................................................................................. 48

3.8.1 Sampling Population ............................................................................................................. 48

3.8.2 Sample Size .......................................................................................................................... 48

3.9 Data Collection Methods .............................................................................................................. 49

3.9.1 Source of Data ...................................................................................................................... 49

3.10 Data Analysis............................................................................................................................. 50

3.10.1 Analysis Tools .................................................................................................................... 50

3.11 Pilot Study ................................................................................................................................. 51

3.12 Conclusion ................................................................................................................................. 51

CHAPTER FOUR .................................................................................................................................. 52

4.1 Introduction ................................................................................................................................. 53

4.2 Data Presentation ......................................................................................................................... 54

4.2.1 Demographic Data ................................................................................................................ 54

4.2.2 Reasons for Selecting Private General Hospitals .................................................................... 62

4.2.3 Basis of Selecting Private General Hospitals.......................................................................... 63

4.2.4 Is Reputation Considered Prior to Selecting Private General Hospitals ................................... 64

4.2.5 Last Private General Hospital Visited .................................................................................... 65

4.2.6 Purpose of Visit to Private General Hospitals in the Last Six Months..................................... 66

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4.2.7 Are Respondents Insured Under Any Medical Packages ........................................................ 67

4.2.8 Does Medical Insurance Limit the Selection of Hospitals ...................................................... 68

4.2.9 Number of Times Visited the Hospital in the Last Six Months by the Respondent.................. 69

4.2.10 Past Experience ................................................................................................................... 70

4.2.11 Did Healthcare Expenses Influence Repondents in Selecting the Last Visisted Hospital ....... 72

4.2.12 Is the Respondent Aware of the Total Expenditure Spent on Healthcare Needs .................... 73

4.2.13 Service Quality.................................................................................................................... 74

4.2.14 Infrastructure Facilities ........................................................................................................ 84

4.2.15 Has the Respondent been exposed to any type of Marketing Information in the Last Visited

Hospital ....................................................................................................................................... 101

4.2.16 Consumer Awareness ........................................................................................................ 102

4.2.17 Behavior of Medical Personals .......................................................................................... 106

4.2.18 Overall Satisfaction of Service Quality in Private General Hospitals .................................. 113

4.2.19 Overall Satisfaction of Infrastructure Facilities in Private General Hospitals ...................... 114

4.2 Data Analysis ............................................................................................................................ 115

4.2.1 Validation of Measurement Properties ................................................................................. 115

4.2.2 Reliability ........................................................................................................................... 115

4.2.3 Validity ............................................................................................................................... 119

4.3 Cross-Tabulation Analysis ......................................................................................................... 124

4.3.1 Cross Tabulation between Race and Last Visited Hospital ................................................... 124

4.3.2 Cross-Tabulation between Monthly Income Range & Last Visited Hospital......................... 125

4.3.3 Cross-Tabulation between Age Category & Number of Times Visited the Hospital ............. 126

4.3.4 Cross-Tabulation between Monthly Income and Total healthcare Expenditure ..................... 127

4.3.5 Cross-tabulation between Time Taken to Attend Patient’s Needs & Hospital Reputation ..... 128

4.3.6 Cross-Tabulation between Choose the Hospital Last Visited Again and Total Healthcare

Expense ....................................................................................................................................... 129

4.3.7 Cross-tabulation between marketing activities of last hospital visited and Awareness of Latest

Technology .................................................................................................................................. 130

4.3.8 Cross-tabulation between Recommending Hospital to others and Influence of Healthcare

Expenditure ................................................................................................................................. 131

4.4 Hypotheses Testing .................................................................................................................... 132

4.4.1 Testing Hypotheses for Positive Relationship between Service Quality and Consumer

Satisfaction .................................................................................................................................. 132

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4.4.2 Testing Hypotheses for Positive Relationship between Infrastructure Facilities & Consumer

Satisfaction .................................................................................................................................. 133

4.4.3 Testing Hypotheses for Positive Relationship between Past Experience and Consumer

Satisfaction .................................................................................................................................. 135

4.4.4 Hypothesses Testing for Positive Relationship between Consumer Awareness & Consumer

Satisfaction .................................................................................................................................. 136

4.4.5 Hypotheses Testing for Positive Relationship between Behavior of Medical Personal &

Consumer Satisfaction ................................................................................................................. 138

4.4.6 Multiple Regression for Consumer Satisfaction ................................................................... 140

CHAPTER FIVE.................................................................................................................................. 146

5.1 Introduction ............................................................................................................................... 147

5.2 Achievement of Objectives ........................................................................................................ 147

5.2.1 To identify the factors influencing consumer decision making process when selecting a

hospital. ....................................................................................................................................... 147

5.2.2 To assess the level of consumer awareness with regard to the services offered and marketed by

private general hospitals............................................................................................................... 148

5.2.3 To identify consumer preference towards various private general hospitals .......................... 149

5.2.4 To identify the consumer issues with regard to service quality and infrastructure facilities

offered by private general hospitals .............................................................................................. 150

5.2.5 To assess policy implications and present recommendations to further improve the service

quality and infrastructure at private general hospitals ................................................................... 150

5.3 Relating Findings to Literature Review ...................................................................................... 151

5.5 Re-examining the Conceptual Framework .................................................................................. 153

5.5 Conclusion................................................................................................................................. 154

CHAPTER SIX .................................................................................................................................... 155

6.1 Introduction ............................................................................................................................... 156

6.2 Overall Findings ........................................................................................................................ 156

6.3 Recommendations...................................................................................................................... 157

6.3.1 Benchmarking Hospital Services against International Healthcare Services ......................... 157

6.3.2 Changing the Private Sector Healthcare Model .................................................................... 158

6.3.3 Reforms for Private Healthcare Policies .............................................................................. 159

6.3.4 Catering Demanding Healthcare Needs ............................................................................... 160

References........................................................................................................................................... 161

Annexure A ......................................................................................................................................... 165

Annexure B ......................................................................................................................................... 172

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Annexure C ......................................................................................................................................... 183

Annexure D ......................................................................................................................................... 186

List of Figures

Figure 1 Number of Active Private Hospitals by Province 2012 ............................................................... 6

Figure 2 Revenue trends of listed private hospitals ................................................................................... 9

Figure 3 Sri Lanka Aging Population Indicators..................................................................................... 11

Figure 4 Public Sector Share of Medical Spending ................................................................................. 21

Figure 5 Total Healthcare Expenditure in Asia (2007-2008) ................................................................... 22

Figure 6 Core Processes of Service Delivery .......................................................................................... 30

Figure 7 Initial model of patient satisfaction in general practice ............................................................. 35

Figure 8 Measuring Service Quality ....................................................................................................... 37 Figure 9 Hypotheses of Potential Disparity between Expected Consumer Satisfaction & Actual Consumer

Satisfaction............................................................................................................................................ 44

Figure 10 Research Procedure ............................................................................................................... 47

Figure 11 Gender ................................................................................................................................... 54

Figure 12 Age Category......................................................................................................................... 55

Figure 13 Marital Status ........................................................................................................................ 56

Figure 14 Race ...................................................................................................................................... 57

Figure 15 Religion ................................................................................................................................. 58

Figure 16 Education Level ..................................................................................................................... 59

Figure 17 Occupation ............................................................................................................................ 60

Figure 18 Monthly Income Range.......................................................................................................... 61

Figure 19 Reasons for Selecting Private General Hospitals .................................................................... 62

Figure 20 Basis of Selecting Private General Hospitals .......................................................................... 63

Figure 21 Is Reputation Considered Prior to Selecting Private General Hospitals ................................... 64

Figure 22 Last Private General Hospital Visited..................................................................................... 65

Figure 23 Purpose of Visit to Private General Hospitals in the Last Six Months ..................................... 66

Figure 24 Are Respondents Insured Under Any Medical Packages......................................................... 67

Figure 25 Does Medical Insurance Limit the Selection of Hospitals ....................................................... 68

Figure 26 Number of Visited the Hospital in Last Six Months by the Respondent .................................. 69

Figure 27 How Likely would the Respondent Chose the Last Visited Hospital for Healthcare Again ...... 70 Figure 28 How Likely would the Respondent Recommend the Last Visited Hospital for Others for

Healthcare ............................................................................................................................................. 71

Figure 29 Did Healthcare Expenses Influence Respondents in Selecting the Last Visited Hospital ......... 72

Figure 30 Is the Respondent Aware of the Total Expenditure spent on Healthcare Needs ....................... 73

Figure 31 Appearance of Administration Staff ....................................................................................... 74

Figure 32 Appearance of Medical Staff .................................................................................................. 75

Figure 33 Ease of Access to Information ................................................................................................ 76

Figure 34 Effectiveness of Hospital Staff ............................................................................................... 77

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Figure 35 Ease of Providing Complaints or Feedbacks ........................................................................... 78

Figure 36 Ease of Completing/Attending to Administrative Requirements ............................................. 79

Figure 37 Reliability of Instructions & Information Provided by Staff.................................................... 80

Figure 38 Time Taken to Attend Patient's Needs by Hospital Staff ......................................................... 81

Figure 39 Time Taken to Attend Patient Needs by Visiting Consultants/Doctors .................................... 82

Figure 40 Ease of Making Appointments for Sickness/Checkup Facilities Offered by Hospitals ............. 83

Figure 41 Effectiveness of Signs and Directions .................................................................................... 84

Figure 42 Ease of Moving from One End to the Other in the Hospital .................................................... 85

Figure 43 Level of Safeguard or Security in the Hospital Environment .................................................. 86

Figure 44 Visual Appealingness of the Layout and Infrastructure Facilities ............................................ 87

Figure 45 Visual Appealingness of Hospital Entrance ............................................................................ 88

Figure 46 Visual Appealingness of Hospital Reception .......................................................................... 89

Figure 47 Visual Appealingness of Hospital Rooms ............................................................................... 90

Figure 48 Hospital was well equipped with Cable TV, Proper Air Conditioning & Proper Seating ......... 91

Figure 49 Hospital was Spacious & Clean ............................................................................................. 92

Figure 50 Hospital Environment was Peaceful ....................................................................................... 93

Figure 51 Infrastructure Facilities were built to Support Patient Privacy ................................................. 94

Figure 52 Respondents Selected Hospital Contains a Restaurant ............................................................ 95

Figure 53 Respondents Selected Hospital Contains a Pharmacy ............................................................. 96

Figure 54 Respondents Selected Hospital Contains an Automatic Teller Machine .................................. 97

Figure 55 Respondents Selected Hospital Contains a Retail Store .......................................................... 98

Figure 56 Respondents Selected Hospital Contains a Florist .................................................................. 99

Figure 57 Respondents Selected Hospital Contains a Prayer Room ...................................................... 100

Figure 58 Has the Respondent been exposed to any type of Marketing Information in the Last Visited

Hospital ............................................................................................................................................... 101

Figure 59 Awareness of Different Medical Packages ........................................................................... 102

Figure 60 Awareness of Easy Payment Methods .................................................................................. 103

Figure 61 Awareness of Different Type of Services Offered Under Medical Insurance ......................... 104

Figure 62 Awareness of the Latest Technology .................................................................................... 105

Figure 63 Co-operative Nature of Visiting Consultants/Doctors ........................................................... 106

Figure 64 Co-operative Nature of Hospital Staff .................................................................................. 107

Figure 65 Medical Staff Behavior towards Patient’s ............................................................................. 108

Figure 66 Attentiveness of Medical Staff during Emergency Treatments .............................................. 109

Figure 67 Understanding of Patient’s Needs by Hospital Staff ............................................................. 110

Figure 68 Use of Effective Communication by the Medical Staff ......................................................... 111

Figure 69 Respectfulness of Hospital Staff towards Different Patients Religious Beliefs ...................... 112

Figure 70 Overall Satisfaction of Service Quality in Private General Hospitals .................................... 113

Figure 71 Overall Satisfaction of Infrastructure Facilities in Private General Hospitals ........................ 114

Figure 72 Cross-Tabulation between Race and Last Visited Hospital ................................................... 124

Figure 73 Cross-Tabulation between Monthly Income Range & Last Visited Hospital ......................... 125

Figure 74 Cross-Tabulation between Age Category & Number of Times Visited the Hospital .............. 126

Figure 75 Cross-Tabulation between Monthly Income and Total healthcare Expenditure ..................... 127

Figure 76 Cross-tabulation between Time Taken to Attend Patient’s Needs & Hospital Reputation ...... 128

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Figure 77 Cross-Tabulation between Choose the Hospital Last Visited Again and Total Healthcare

Expense ............................................................................................................................................... 129 Figure 78 Cross-tabulation between marketing activities of last hospital visited and Awareness of Latest

Technology ......................................................................................................................................... 130

Figure 79 Cross-tabulation between Recommending Hospital to others and Influence of Healthcare

Expenditure ......................................................................................................................................... 131

Figure 80 ANOVA Table for Service Quality ...................................................................................... 133

Figure 81 Model Summary for Infrastructure Facilities ........................................................................ 133

Figure 82 Coefficients for Infrastructure Facilities ............................................................................... 134

Figure 83 ANOVA TABLE for Infrastructure Facilities ....................................................................... 134

Figure 84 Model Summary for Past Experience ................................................................................... 135

Figure 85 Coefficients for Past Experience .......................................................................................... 135

Figure 86 ANOVA Table for Past Experience...................................................................................... 136

Figure 87 Model Summary for Consumer Awareness .......................................................................... 136

Figure 88 Coefficients of Consumer Awareness ................................................................................... 137

Figure 89 ANOVA Table for Consumer Awareness ............................................................................. 137

Figure 90 Model Summary for Behavior of Medical Personal .............................................................. 138

Figure 91 Coefficients for Behavior of Medical Personals .................................................................... 138

Figure 92 ANOVA Table for Behavior of Medical Personal ................................................................ 139

Figure 93 Model Summary for Consumer Satisfaction ......................................................................... 140

Figure 94 T-Test Graph for Service Quality ......................................................................................... 142

Figure 95 T-Test Graph for Infrastructure ............................................................................................ 143

Figure 96 T-Test Graph for Behavior of Medical Personal ................................................................... 144

Figure 97 Coefficients for Multiple Regressions .................................................................................. 141

Figure 98 ANOVA Table for Regressions ............................................................................................ 145

Figure 99 Re-Examined Conceptual Framework .................................................................................. 153

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List of Tables

Table 1 Comparison of room rates at selected private hospitals .............................................................. 10

Table 2 Capacity Expansions by Private Healthcare Operators ............................................................... 10

Table 3 Investments in Global Industries ............................................................................................... 18

Table 4 Variable Indicators .................................................................................................................... 45

Table 5 Reliability Statistics for Consumer Satisfaction ....................................................................... 116

Table 6 Reliability Statistics for Service Quality .................................................................................. 116

Table 7 Reliability Statistics for Infrastructure Facilities ...................................................................... 117

Table 8 Reliability Statistics for Past Experience ................................................................................. 117

Table 9 Reliability Statistics for Consumer Awareness ........................................................................ 118

Table 10 Reliability Statistics for Behavior of Medical Personals ......................................................... 118

Table 11 Convergent Validity Table .................................................................................................... 120

Table 12 Discriminant Validity Table .................................................................................................. 122

Table 13 Model Summary for Service Quality ..................................................................................... 132

Table 14 Coefficients for Service Quality ............................................................................................ 132

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List of Abbreviations

WHO World Health Organization

PHA Private Hospital Association

PHSRC Private Health Services Regulatory Council

MOH Ministry of Health

OPD Out-patients department

MRI Magnetic Resonance Imaging

ICU Intensive Care Unit

GMOA Government Medical Officers Association

IPS Institute of Policy Studies

NMDP National Medical Drug Policy

SLMC Sri Lanka Medical Council

SQ Service Quality

INFRA Infrastructure

BEHAV Behavior of Medical Personal

PASTEXP Past Experience

AWARE Consumer Awareness

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Abstract

Private Hospitals were in existence prior to the World War Two period, and growth of this sub-

sector coincided with the emergence of a market economy in the country, along with the entry

into the market of the pharmaceutical industry, medical equipment industry and private

insurance. This research attempts to document, understand and offer suggestions concerning the

Private General Hospitals consumer satisfaction towards service quality and infrastructure

facilities. This research has utilized published and unpublished empirical studies, reports in

electronic and print media on the private healthcare sector, findings of survey results, interviews

with hospital authorities and a self-administered questionnaire to measure respondent’s level of

consumer satisfaction.

Sri Lanka’s health sector is complex. It is characterized by mixed ownership patterns, many

types of providers and different systems of medicine. The power acquired by private hospitals in

curative care has now reached a new height since the end of the civil war in the country and

unless a strategy for public health reforms combined with the private sector is formulated,

desired results in equity in delivery of healthcare will become a red herring, in addition to duty

waivers for the import of medical equipment. Also, it is to be noted that land offered so far has

been mainly in urban areas.

The private sector is driven by the desire to maximize profit, and hence concentrate their

operations in densely populated urban areas. As a result, it is reasonable to say that current

medical costs for treatment at private hospitals have contributed towards plunging those that

cannot afford it, into an adverse situation when they seek treatment which is not accessible in

public facilities on an urgent basis. Though such instances of high charges exists many middle

class respondents were ready pay any cost when it comes to satisfying their healthcare needs and

it was identified many leading private general hospitals are providing consumers with necessary

services and facilities that have satisfied respondents needs in healthcare.

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While over-priced medical bills, remain one area that needs to be addressed, how medical

mishaps (and unforeseen complication) associated with medical procedures in private hospitals

need to be handled, is another area needing due attention by the authorities. The patients who

seek treatment from the private sector are not necessarily the rich and well to do. Many of them

do so despite the issues of affordability they are faced with. They come to private hospitals for

various reasons that include the perception of better care being available in the private hospitals,

and non-availability of specialist out-patients care at government hospitals in the evenings.

In this context, a review of the existing regulations under Private Hospital Regulations Act No.

21 of 2006 and Private Health Regulatory Council (2008), find that regulations have mainly

focused on the registration, licensing and issuing of registration certificates. So far, there has

been no action implemented with regard to overpriced user fees, medical negligence or the

behavior of private providers. Also, the government efforts to regulate were in many instances

opposed by the powerful trade union lobby of doctors (GMOA). Secondly, even though the

regulatory body is adequately resourced they are more often reluctant to operate against their

own membership and self-interest. This situation has been seen in most Asian countries

including in India and Thailand.

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CHAPTER ONE

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1.1 Introduction

The Sri Lankan population is served by a twofold healthcare system comprising of public and

private health sectors. The primary public healthcare provider is the Ministry of Health and

Nutrition (MOH) that provides Sri Lankans the primary, secondary and tertiary healthcare

through various types of healthcare facilities such as public general hospitals, Provincial Base

Hospitals, District Hospitals and Peripheral Units. In recent years due to the increasing demands

for private healthcare has led to an increase in the number of private hospitals and dispensaries or

clinics in Sri Lanka (Institute of Policy Studies of Sri Lanka, 2012).

Since 1948 from the time of independence, successive governments have provided universal and

free welfare services which consisted of free education, healthcare services and subsidized food.

In the 1960’s there was a significant growth of welfare services supported by the growth of

healthcare services in primary, secondary and tertiary healthcare services. In 1977 with the

restructuring of the economy subsidized food were withdrawn while other welfare services such

as free education and healthcare continued to be provided. During this period there was a change

in government policy in healthcare that allowed medical officers and technical officers in the

public sector to practice privately outside their working hours. This was the first initiative that

further developed the privatization of the health sector in Sri Lanka (Dayaratne, 2013).

Currently, Sri Lanka’s dual health system includes of a heavily subsidized public sector and user

charged private sector. In early stages government funded healthcare services provided the whole

population access to modern medical care. But in recent years the demand for modern western

medical services by household units increased and the demand for traditional medical care

declined. Despite the increasing demand for western medical services was present it was not

convoyed by an increase in the ability of the public sector to meet healthcare needs of Sri

Lankans, which paved the way for a section of the population to seek treatment determined their

ability to pay for the service from the private healthcare providers. This scenario led to the

establishment of the Sri Lankan private hospital network from 1980 onwards that witnessed a

continuing shift toward private medical services that became stabilized during the 1990’s

(Dayaratne, 2013).

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In 1990 there were 44 private hospitals, increased to 87 hospitals in 2008 and increased further in

2013 to 145 actively operating private hospitals out of 200 registered private healthcare

institutions as per the private medical institutions (registration) act, No.21 of 2006 (refer

annexure D). The key processes that influence the growth or development of the private

healthcare sector was due to the growth of the middle class and their influence on both the

supply and demand side of the private health services role and the influence of medical

equipment and pharmaceutical industries. The private healthcare industry remains highly

concentrated in heavily populated areas where the rich and the urban middle class are residing.

Such instances indicate that private healthcare services are largely drawn from upper and middle

class Sri Lankans. Data revealed by government departments indicate that there is a large

quantity of biomedical equipment and technology in urban areas compared to rural areas leading

to excess capacities (Annual Bulletin of Medical Statistics, 2009).

Between 1990 and 2013 over 100 hospitals entered the private healthcare industry with an

investment of over LKR 50 billion. Insurance plays a vital role as a source of finance in many

countries in which private healthcare is a key provider. In Sri Lanka, the private healthcare

insurance covers only one percent of the total healthcare expenditure that indicates the utilization

of the private healthcare sector is related to income levels. As per the IPS national health

accounts (2009) estimates that the private sector provides 6 percent of the overall in-patients

admissions and 50 percent of total out-patient treatments which consists of OPD treatments. An

estimated 5000 full time private general consultants provide out-patient care from private clinics

on a ‘fee-for-service’ basis in addition to private hospital charges (Institute of Policy Studies of

Sri Lanka, 2012).

According to surveys conducted by IPS, demand for private curative care has been rapidly

growing after the end of the war and as a result new private hospitals have come up in war

ravaged areas and many existing hospitals in the rest of the country especially in Colombo and

suburbs engaged in development and modernization of infrastructure facilities to meet

competition among other players (Institute of Policy Studies of Sri Lanka, 2012).

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Private hospital providers through market research have rightly identified the health needs of

upper middle class. They have embarked on introducing new biomedical technologies alongside

newly built infrastructure facilities that are categorized by cleanliness and adequate space.

However it does not mean that only the rich and middle class visit private hospitals but poor

households are forced to seek treatments from private hospitals at an affordable cost. As per IPS

national health account (2009), private household out of pocket payments accounts for 45

percent of total healthcare expenditure and 83 percent of total private health expenditure.

Currently, the households are experiencing a very high increase in charges such as consulting

fees, hospital charges, laboratory charges and other system of medication by private healthcare

providers (Dayaratne, 2013).

Figure 1 Number of Active Private Hospitals by Province 2012

(Source: IPS Survey Data, 2012)

15

64

12

11

14

12

3

7

7

0 10 20 30 40 50 60 70

Central

Westren

Southern

Northern

Eastern

North West

North Central

Uva

Sabaragamuwa

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1.2 Research Problem

The private healthcare industry is a highly competitively driven industry, in which supply largely

lies with four major players. The key factors that drive the competition include the number and

quality of resident and visiting medical personals, the quality of services offered and hospital

charges. In Sri Lanka patients or consumers are ‘doctor-centric’ where patients seek out the

service of a specific medical personal and patronize at which late serves. This determines that

large numbers of patients are determined by the number and quality of medical personals that are

visiting the private hospitals (Boshoff, 2004).

Many of the players in the private sector healthcare industry have branded themselves in the

market with profound importance of quality service offerings, state of the art technologies and

well experienced medical teams. But the consumer tends to be confused or mislead with service

offerings, quality of service levels and cost-benefits gained due to the intense role of medical

persons who have a large brunt in their decision making process. The doctor-centric is an

approach in which private sector players attract patients for treatment than a patient selecting a

hospital independently, regardless the service quality standards and infrastructure facilities it has

to offer (Andaleeb, 2001 ).

Rising competition among players and the need to offer a quality health care to safeguard the

brand name, integrated with the capital intensive nature of the business may act to increase the

level of risk in the industry on a long term basis. Bartleet Religare Securities publishing an

equity research report on Nawaloka Hospitals recently stated that the healthcare industry today is

such that hospitals are under constant pressure to have the latest technology and equipment to

offer, in order to outrun competition which required heavy capital expenditures thus leading to

more borrowings (Bartleet Religare Securities , 2011).

According to experts in the industry, the private healthcare sector predominantly in the Colombo

and surrounding city areas is now seeing a higher supply which has in turn resulted in bringing

down occupancy rates to 60% - 70% levels from even 100% couple of years ago.

Meanwhile, Bartleet Religare observes, with increased spending patterns and exposure, the

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modern consumer is becoming more demanding and thus making the private sector hospitals to

offer more customer-friendly healthcare and higher quality services in order to compete.

The report states that investments made by Asiri Hospitals in the Central Hospital in Norris

Canal Road, Colombo and the Durdans Hospital sixth lane wing, as some of those investments.

It is also notes that the present population is increasingly exposed to unhealthy factors such as

smoking, high fat, high calorie diets and thus the risk of cancer, cardiovascular and repository

diseases are higher (Bartleet Religare Securities , 2011). This situation, BRS says, will create

demand for health services and private healthcare will continue to increase within the country.

The independent report prepared by RAM ratings Lanka indicates that common household

annual income have been spent on private healthcare industry where nearly 60% leave with an

intellect of doubt that restrain them from considering that the government hospitals would have

offered the same service provided the infrastructure facilities were in good condition. This is one

of the most conventional and common thinking that manipulate the private healthcare sector

from reaching their patients (RAM Ratings , 2013).

Thus the vital factor for service quality levels and infrastructure are determined based on the

customer satisfaction in private sector hospitals.

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1.3 Justification

The private sector healthcare industry has high potential to earn returns due to the changing trend

in health awareness and the increase in non communicable diseases. The market is more

attractive to current players due to its high entry barriers and large volumes of capital

investments already made by existing players. This can be observed by the below illustrated

chart that shows the revenue of private hospitals from 2007-2012.

Figure 2 Revenue trends of listed private hospitals

(Sources: RAM Ratings , 2013)

But with all the state of new technology used in treating patients and providing a high quality

service, the consumer or patient tends to have a mixed or confused opinion towards the private

sector hospitals in terms of quality service and infrastructure convenience which can affect the

level of satisfaction in certain private sector hospitals.

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Table 1 Comparison of room rates at selected private hospitals

(Source: RAM Ratings Lanka Industry Research in January 2013)

The increasing levels of competition among the players of the private healthcare industry,

infrastructure also has been developed in terms of the increase in bed capacity as illustrated in

figure 4 that has expanded over the 5 years from 2007-2012 and the introduction of various other

medical related infrastructures.

Table 2 Capacity Expansions by Private Healthcare Operators

(Source: RAM Ratings Lanka Industry Research in January 2013)

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The medical trends in Sri Lanka represent an increase in the number of older citizens in the

country as illustrated below by the World Health Organization indicating an increase of an aging

population in Sri Lanka when compared between the 2010 results and the projected results in

2050.

(Source: World Health Organization, 2009)

The 60 years and older proportion of the population is expected to increase at a faster pace than

the broader population growth rates. This increase will be faster among women since they tend to

live longer, and there should be an increasing demand for healthcare services targeted towards

the elderly in the coming decades (World Health Organization, 2009).

And with the increase in the levels of lifestyle diseases such as cardiovascular diseases, cancer,

type 2 diabetes and nephritis have all increasingly become commonplace in the upper classes of

middle-income countries like Sri Lanka. Statistically South Asians have shown higher risk of

coronary heart disease compared with people from other regions. Tobacco consumption, high

blood pressure and high cholesterol intake are all cardiac risk factors increasingly prevalent in

the higher income segment of a country (Ratnayake, 2013).

Figure 3 Sri Lanka Aging Population Indicators

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1.4 Research Aims & Objectives

1.4.1 Main Research Objective

The main objective of this research is to identify the consumer satisfaction towards service

quality levels and infrastructure offered by private sector hospitals in Western Province of Sri

Lanka.

1.4.2 Specific Research Objectives

To identify the factors influencing consumer decision making process when selecting a

hospital.

To assess the level of consumer awareness with regard to the services offered and

marketed by Private General Hospitals.

To identify consumer preference towards various Private General Hospitals in the

Colombo District.

To identify the consumers issues with regard to services and infrastructure facilities

offered by Private General Hospitals.

To assess policy implications and present recommendations to further improve the

service quality and infrastructure at Private General Hospitals.

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1.5 Significance

1.5.1 Academic Significance

This research will benefit students who will be researching on similar topics, researchers and

undergraduates even in other provinces in the country will be able to refer this research because

they will be able to identify the factors in consumer satisfaction towards service quality and

infrastructure facilities in private general hospitals in the Colombo district of Sri Lanka.

This may help student’s research similar subject topics with the help of this study.

1.5.2 Practical Significance

The research will benefit consumers of private general hospitals as the research findings can be

used by hospital management to cater consumer medical needs with a better understanding of

consumer needs and preferences. There will be an added advantage to private general hospitals

that is if consumers are satisfied with medical services offered by private general hospitals, the

consumer will tend to repeat their visits to that private hospital which as a result would allow

private hospitals to create loyal customers.

The fact that there have been no other researchers conducted under this topic, few research topics

were present in service quality in private general hospitals but infrastructure facilities have not

been considered. The findings of this research will facilitate private general hospitals to identify

their key factors that are needed to be developed or not. This will be important in the

international context if Sri Lanka is being promoted in medical tourism.

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1.6 Scope

The scope of this research is to identify consumer satisfaction towards service quality and

infrastructure facilities in private general hospitals in the Colombo district of Sri Lanka. The

research will be focusing on out-patients who have visited private general hospitals in the last six

months in order to identify their levels of satisfaction with regard to private general hospitals in

the Colombo area.

1.7 Outline of Chapters

The research will follow the structure as stated below,

Chapter One Chapter 2

Introduction Introduction

Research Problem Theoretical under-pinning

Justification Empirical research

Research aims & objectives Models

Research Significance Critical analysis of literature

Scope Relating literature to the aim of

the study

Outline of Chapters Conclusion

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Chapter Three Chapter 4

Introduction Introduction

Research question Data presentation

Conceptual framework Data analysis

Rationalization Hypotheses testing

Definition of variables Conclusion

Hypothesis

Operationalization

Research Methodology

Pilot study

Conclusion

Chapter Five Chapter Six

Introduction Summary

Achievement of objectives Findings

Re-capping the aims & objectives Contribution to theory & practice

Relating findings to literature reviews Recommendations

Re-examining the conceptual

framework

Limitations to the study

Conclusion Future research

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CHAPTER TWO

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2.1 Healthcare Industry

The health care sector or industry is a part of an economy made up of companies that specialize

in product and services related to health and medical care (Investing Answers , 2012). Health

care industry has lagged behind other industries in proactively reaching out to consumers. But in

today’s healthcare sector has experienced a rapid expansion making the patient experience its

primary focus (PwC, 2013).

Universal themes drive healthcare markets globally. Although individual health systems have

unique challenges and characteristics searching for the best way to finance and deliver healthcare

with the right balance of quality, cost and access. These shared priorities lead to faster, better and

cheaper solutions that excel borders and cultures. Thus it can be said that the healthcare sector is

becoming more globalized (Levy, et al., 2012).

Total health care spending or expenditure was expected rise 2.6% in 2013 before accelerating to

an average of 5.3% a year over the next four years (2014-2017). This growth will place pressure

on governments, health care delivery systems, insurers and consumers in both emerging and

developed markets to deal with issues such as aging population, the rise in lifestyle diseases,

increasing costs, infrastructure limitations, patient location and disruptive technologies (Deloitte

Touche Tohmatsu Limited, 2014).

As mentioned below the healthcare sector has increased in terms of investment made in the

sector than any of the other top 10 ranked industry sectors in 2012, making the industry the sixth

highest ranking sector by deal value (Levy, et al., 2012).

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Table 3 Investments in Global Industries

(Source: PwC, 2012)

Healthcare requirements differ from one country to another with different care pathways,

delivery mechanisms and compensation procedures. Although some healthcare providers have

strong brands they can leverage abroad, most of them have been despise to risk diluting those

brands in unfamiliar markets (PwC, 2013).

The healthcare industry presently shows signs of growth due to the increase in the aging

population which as a result has increase in the levels of lifestyle diseases such as cardiovascular

diseases, cancer, type 2 diabetes and nephritis have all increasingly become commonplace in the

upper classes of middle-income countries in contienets such as Asia. Statistically South Asians

have shown higher risk of coronary heart disease compared with people from other regions.

Tobacco consumption, high blood pressure and high cholesterol intake are all cardiac risk factors

increasingly prevalent in the higher income segment of a country (PwC, 2013).

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2.1.1 Private Healthcare Industry

People go to private healthcare for higher standard in care, with better facilities and shorter

waiting times to see specialists. Private healthcare services has been one form of satisfying the

needs in healthcare though many governments has imposed various laws and legislation that

would allow citizens to obtain cheaper and better medical care (Bain & Company, Inc., 2014).

Though such laws and legislations would have benefited at the time of inception as of now some

of these programs have failed to attend or satisfy the needs in healthcare. As a result private

healthcare services assured that at a higher rate than public healthcare a better service was

offered. This factor led to an emerging private healthcare industry that allowed consumers to

obtain the maximum from healthcare services (Bain & Company, Inc., 2014).

Due to the high participations levels private healthcare providers in developed countries in Asia

promotes healthcare expenditure. In considering Taiwan has a high participation level of private

healthcare providers that contributes to 65 percent of Taiwan’s total hospital accommodation.

Private involvement in healthcare has enabled efficient delivery to the people, which is been

reflected in scenario of Taiwan. Due to the private participation of the private sector in the

Taiwan healthcare industry was driven by Taiwanese comprehensive national health insurance

scheme that as result has helped to increase the quality of healthcare in Taiwan (Lau , 2012).

In 2013 top global buyouts there were no healthcare deals, the value of global healthcare buyout

deals totaled to more than $16 billion in 2013. That accounted for approximately for 7% of all

buyout deals globally. Investors were willing to invest in private healthcare during earlier stage

of operations this is because the industry in considered as the emerging accountable care services

space in which investments in the early stages is vital (Bain & Company, Inc., 2014).

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2.1.2 Government Healthcare Industry

Many claim that markets for healthcare are unlike that for most goods and services. Healthcare

has been burning issue for many government bodies and certain incidents it has been issues

where even governments have been toppled due to poor healthcare policies. Any given

governments main task is to provide safeguards to citizens in which healthcare will play a major

role. Many political leaders have taken the initiative of protecting people health a present

example is ‘OBAMACARE’ introduced in America by president Barack Obama that would

benefit Americans for over 20 years in healthcare (Etheredge, 2013).

The classic economic basis for government involvement in healthcare activities is on externality

grounds people who smoke, pollute or cause harm to others such costs has to be internalized

when people make their behavioral decisions. In addition to concerns about externalities,

governments may also want to arbitrate to prevent people from worsening their health. By far the

largest involvement in the health sector is in the market for medical care and its derived health

insurance (Cutler, 2002).

The government healthcare industry has been spending over billions of dollars in healthcare in

1995 as depicted in the figure 4 below that illustrates that more and more developing countries

are the highest spenders in healthcare due to the fact of rising aging population and increasing

levels of lifestyle diseases.

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Figure 4 Public Sector Share of Medical Spending

(Source: Cutler, 2002)

2.1.3 Asian Healthcare Industry

Across Asia, a convergence of economic trends, government policies and greater awareness

among the general public of healthcare issues has created an environment that is poised for

dramatic growth and change Faced with the challenge of increasing ageing society and rising

healthcare costs, countries in the Asian continent are expecting cost effective infrastructure and

medical service facilities to be provided by local companies (PricewaterhouseCoopers, 2012).

Although Asia has 60 percent of the world population providing a large share of market

potentials. Asian healthcare expenditure constitutes only 15 percent of global healthcare

expenditure. In 2007, the global healthcare expenditure was at US$ 4.9 trillion with a growth rate

of 6.2 percent as illustrated in the figure below. It is estimated that the healthcare expenditure is

estimated to be at around US$ 791.6 trillion at the end of 2008.

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Figure 5 Total Healthcare Expenditure in Asia (2007-2008)

(Source: Frost & Sullivan, 2012)

Though some parts of Asia are experiencing high growth in population other countries such as

China and Japan are facing the problem of increasing levels of the aging population. For example

Japan is expected to have 22 percent of its population above 65 years of age by 2014 with the

current Asian lifestyle; the occurrence of chronic diseases such as diabetes and cardiovascular

diseases has increased significantly. The increasing levels of the aging population and the

increasing occurrence of chronic diseases are key factors that contribute towards an increase in

Asian healthcare expenditure (Lau , 2012).

Realizing the importance of the demand prevailing in the Asian healthcare market, Asian

governments have invested billions of dollars to improve healthcare related infrastructure

facilities. For example the Malaysian government has initiated to develop sustainability, upgrade

and maintain existing facilities and equipment’s and to improve the quality of healthcare. The

Chinese government announced its ‘Healthy China 2020’ plan that will focus on providing safe,

effective, condiment and low cost public health to both rural and urban citizens by 2020. Such

policies clearly show the eagerness of governments in Asia to provide better healthcare

infrastructure facilities and medical services.

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In recent years many changes were experienced in the healthcare industry because high priority

was given to the prevention of diseases rather than cure. Such scenarios were witnessed in Asia

too, were fighting infections and finding cures have become a priority. Due to such incidents

Asians are becoming more aware of their health, especially in countries namely Chine, Hong

Kong and Singapore that were hit by SARS and Avian influenza few years ago. Both

government and Asian people are now more open towards medical technology and home-based

monitoring (Lau , 2012).

2.1.4 Sri Lankan Healthcare Industry

Sri Lankan health care needs are served by both public and private sectors. In Sri Lanka health

care is provided free of charge for 60% of the population since 1940 (Annual Bulletin of Medical

Statistics, 2009) due to such results the public sector dominates the local health care arena. In

2009 the public sector contribution to health care expenditure grew by 10% through a widely-

dispersed network of general hospitals, teaching hospitals, provincial hospitals and base

hospitals, among others (Annual Bulletin of Medical Statistics, 2009).

The private sector though smaller in terms of size has seen demand growth since 1980’s when

government doctors were permitted to work in private hospitals as well as in public hospitals

(Annual Bulletin of Medical Statistics, 2009). The total bed capacity in the public sector

accounted for 93% of total hospital beds in 2011, serving around 90%-95% of in-patients. The

rest were served by the country’s private healthcare sector, primarily the choice of higher-income

earners and individuals with access to medical insurance (RAM Ratings , 2013).

Out of the estimated hospitals in Sri Lanka are 626 as at October 2013, out of which 51 hospitals

are owned and managed by private companies and groups (Perera, 2013). Out of the 51 private

hospitals, 40 are private general hospitals and most of the private hospitals are centered in

Colombo, an estimated 11 private general hospitals operates in the Colombo district (Perera,

2013).

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Out-patient facilities, the private sector are estimated to accommodate around 50% of out-

patients. Overcrowding, long waiting times and the limited availability of medicines in public

hospitals have enforced demand for private health care, despite the higher cost. Demand has

stemmed mainly from urban areas, with a significant attention in the Colombo area; where

disposable incomes are relatively high (RAM Ratings , 2013).

2.1.5 Sri Lankan Private Healthcare Industry

Private healthcare services contain a range of medical treatments that are compensated directly

by individuals or through private medical insurance (PMI). The Sri Lankan private healthcare

industry comprises 145 hospitals that are equipped to assist patient’s needs. Many consumers

who seek medical needs in private hospitals pay their expenditure through private or public

medical insurance packages (Annual Bulletin of Medical Statistics, 2009).

According to experts in the industry, the private healthcare sector predominantly in the Colombo

and surrounding city areas is now seeing a higher supply which has in turn resulted in bringing

down occupancy rates to 60% - 70% levels from even 100% couple of years ago. In Sri Lanka,

the private healthcare insurance covers only one percent of the total healthcare expenditure that

indicates the utilization of the private healthcare sector is related to income levels. As per the IPS

national health accounts (2009) estimates that the private sector provides 6 percent of the overall

in-patients admissions and 50 percent of total out-patient treatments which consists of OPD

treatments.

According surveys conducted by IPS, demand for private curative care has been rapidly growing

after the end of the war that as result new private hospitals have come up in war ravaged areas

and many existing hospitals in the rest of the country especially in Colombo and suburbs

engaged in development and modernization of infrastructure facilities to meet competition

among other players (Institute of Policy Studies of Sri Lanka, 2012).

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2.2 Theoretical Underpinning

2.2.1 Consumer Satisfaction

Despite of widespread research in the years since Cardozo’s (1965) classical articles, researchers

are yet to develop a proper definition for consumer satisfaction. Oliver (1996) stated that

everyone knows what satisfaction is but until asked to give a definition. Based on the perception

that satisfaction is defined, most researchers focus on testing consumer satisfaction. There are

two clarifications of satisfaction within the literature of satisfaction as a process and satisfaction

as an outcome (Kathleen & Bond, 2001).

Early theories of consumer satisfaction have typically defined satisfaction as a post choice

evaluative judgment concerning a specific purchase decision (Seth, et al., 2004). The most

widely accepted model for the purpose of measuring consumer satisfaction is the disconfirmation

paradigm. This paradigm is the theory that provides the grounding for the vast majority of

satisfaction studies that encompasses four construct namely expectations, performance,

disconfirmation and satisfaction (Seth, et al., 2004).

There is a general agreement that, satisfaction is a person’s feelings of pleasure or

disappointment resulting from comparing a products alleged performance or outcome in relation

to his/her expectations (Kotler , 2003). Based on the assumptions of Kotler (2003), customer

satisfaction is defined as the result of a cognitive and affective evaluation, where some

comparison standard is compared to the actually alleged performance. If the alleged performance

is less than expected, consumers will be dissatisfied. And when alleged performance is more than

expected consumers will be satisfied (Kotler , 2003).

Gustafson (2005) defines consumer satisfaction as a customer’s overall evaluation of the

performance. This overall satisfaction has a strong positive relationship with consumer loyalty

targets across a wide range of product and services categorize (Gustafson & Michael, 2005).

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2.2.1.1 Consumer Satisfaction in the Private Healthcare Industry

The cost of providing health care is increasing at an alarming rate with challenges ranging from

rising levels of malpractice costs to physician turnover due to such challenges it is essential that

medical practices must maximize resources and make tough choices in order to remain profitable

by improving consumer satisfaction in health care. Consumer satisfaction is defined as a

judgement of a product or service in regard to the characteristics possessed by the product or

service, provided a satisfying level of consumption related fulfillment including levels of under

or over fulfillment (Bleich & Murray, 2009).

The issues pertaining to consumer satisfaction has gained attention from executives across the

health care industry. The measurement of consumer satisfaction has helped health care providers

through patient satisfaction surveys has been able to identify that patient perspective when

incorporated as a way to create a culture where service is considered as a vital strategic goal for

health care facilities. However such measurements have been done and identified the core areas

in consumer satisfaction but still evidence shows that more work in the areas is still needed. One

such challenge is sustaining consumer satisfaction improvement initiatives in the face of

competing priorities and diminishing resources (Ilioudi, et al., 2013).

As noted by Bitner and Hubbert (1995) they suggested an ‘encounter satisfaction’, illustrates the

satisfaction the consumer experiences in regard to the service offered and the overall satisfaction

with the service provider is reliant on the number of services offered within the different parts of

a certain organization or with different employee services this can result in positive word of

mouth among consumers especially when considering the healthcare industry (Bitner, 1995).

There are three main reasons in measuring consumer satisfaction. (a) The primary objective of a

health care provider is consumer satisfaction essentially, (b) Consumer satisfaction measures will

assist in obtaining data about structures, processes and outcome of health care & finally (c)

Satisfied and dissatisfied consumers have various behavioral intentions. For instance highly

satisfied consumers would recommend the health care provider to their relatives and friends

(Boshoff & Gray, 2004).

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Richard Baker (1997) developed a pragmatic model in contrast to consumer satisfaction with

medical practices and consultations in the form of a questionnaire. The questionnaire was

developed with psychometric methods from an original question that were extracted from

previously published consumer satisfaction surveys and studies. That included six components in

terms of surgery namely general satisfaction, accessibility, availability, continuity, medical care

and location. The consultation questionnaire included four components namely, general

satisfaction, professional care, depth of relations and perceived time (Baker, 1997).

2.2.2 Service Quality

During the past few decade service quality has been a vital area of attention to managers,

practitioners and researchers owing to strong impact on business performance, customer

satisfaction, customer loyalty, lower costs and profitability (Leonard & Sasser, 1982). There has

been continued research on the definition, models, data collection, measurements, data analysis

and etc. issues of service quality leading towards sound base development for the researcher

(Seth, et al., 2004).

For an organization to gain competitive advantage it should have a clarity of information about

market demands and exchange it between organizations for the purpose of enhancing the service

quality. Researchers and managers thrive in learning details about components of service quality

in their organization of clear reasons of customer satisfaction and increased profitability. In this

context the model will not only help to learn the factors associated but will also help associate to

show the direction of improvements (Seth, et al., 2004).

Today globalization and liberation are affecting the economies of both developing and developed

countries. The focus area of organizations is also changing from increasing profitability to

increase profitability through customer satisfaction. The pressure of competition is forcing

organizations to not only look at their processes but also focus on how they deliver. In today’s

market it has become a must to deliver services better than competitors. Therefore the subject of

service quality needs a fresh understanding in the current business scenario (Seth, et al., 2004).

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Service quality can be measured through various models out of which 19 models are currently

used by researchers and managers. Some of the models are namely technical and functional

model by Gronross (1984), GAP model by Prasuraman (1985), performance only model by

Cronin and Taylor (1992), evaluated performance and normed quality model by Teas (1993),

attribute and overall affect model by Dabholkar (1996), internal service quality model by Forest

and Kumar (2000), model of e-service quality by Santos (2003) and etc.

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2.2.2.1 Service Quality in the Private Healthcare Industry

Health care quality as addressed by Avedis Donabedian, M.D., presented a primary concept

regarding the nature of any activity designed to produce a dependable model that had three steps

that are structure, process and outcome. In considering the practice of medicine which is process

that will result in an output. The quality of an output is considered as an evaluation which is

determined from an individual’s point of view in considering some sets of attributes pertaining to

a certain output (James, 1989).

High quality is achieved by continuous improvements in consumer expectations. The aim of

continuous improvements is to meet consumer needs rather than the competition. Health care

delivery is a complex process which involves a large number of medical workers. Different

workers have different consumer’s depending upon the nature of the individual’s job assignment

in which service quality plays a vital role in such instances (Brent C. James, 1989).

Service quality is defined as a global judgment or attitude relating to overall excellence or

superiority of the service (Zeithmal, et al., 1990). Also, service quality is defined as a customer’s

overall service quality evaluation by applying a disconfirmation model that describes the gap

between service expectation and performance (Cronin Jr & Taylor, 1992). The observations of

service quality permit providers of health care to detect services and processes in need of

improvements that will assist providers in the future to attend to consumer problems that will

help save time and cost in satisfying consumer’s health care needs (Pakdil & Harwood, 2005).

Morris & Bell (1995) describe service quality in healthcare as the features and characteristics of

a healthcare service or product and approach in which the service is provided that will determine

whether a certain hospital would have the ability to satisfy the agreed need of the consumer and

the agreed requirements of the consumer within constraints imposed by medical persons and

reducing the level of waste and losses. This statement illustrates with the philosophy of quality in

consideration and entails an enduring awareness of what consumers require (Morris, et al.,

1995).

A medical service quality active satisfaction model was developed by Bopp (1986) by evaluating

the medical service quality in expenditure stage of the medical consumer purchase cycle that

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explored in regard to the relationship between consumer satisfaction and perceived service

quality. The study revealed three specific stages which are based on the patient evaluation in

considering the interaction between the service providers, the stages of expressive caring,

expressive professionalism and expressive competence such factors contribute in high levels of

patient satisfaction (Bopp, 1986).

A quality monitoring framework has been prepared by an independent health care monitoring

board based on common hospital system model. In the diagram is shown in figure 1 when a

patient who enters a hospital becomes involved in a variety of processes that will lead to an

outcome. Most patients will experience all or most of these processes during an inpatient stay

(Center for Human Services, 2010)

Figure 6 Core Processes of Service Delivery

(Source: Center for Human Services, 2011)

Input

Patient

Trained Personnel

Supplies/Equipment

Clean Facility

Maintenance

Medical Records

Pharmacy

Radiology

Laboratory

Reception & Treatment

Areas

Infection Control Areas

Process

Admission

Diagnostic, Tests,

Exams & Procedures

Medical Treatment

Nursing Care

Complementary

Services

Counseling

Follow-up/Discharge

Outcome

Patient Treated Upon

Agreed Standards

Satisfied Client

Improved Health Status

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2.2.3 Hospital Infrastructure Facilities

Hospitals should have the capability of operating in the worst of conditions due to the fact that

they treat patients that are not capable of healing at home. This will be vital in times of worst

conditions where patients would not be able to get up and walk to safety based on the nature of

their illness. Most patients are in a conceded state, and their welfare is guarded by the people

around them and the environment or infrastructure that protects them (Sauer, 2012).

It is practical to have arguments or conversations about the building’s infrastructure system and

their role of protecting patients and staff in emergency conditions. Many government regulations

and laws govern some of the minimum requirements in infrastructure, but in many circumstances

those requirements are still vulnerable (Sauer, 2012).

But in considering the visual appealingness in infrastructure facilities though present in both

government and private hospitals. The hospital conditions are appealing, but the bigger reasons

which can be seen mostly in developing countries may be the crumbling infrastructure that

prevents the poor from getting the care they need. Such incidents have been reported many times

from rural Indian areas where the infant mortality rates are high. This mainly because though

basic infrastructure is present necessary infrastructure facilities are not maintained or upgraded

for critical conditions and the absence of proper regulations to guide infrastructure development

and needs (Hayden, 2013).

Many healthcare service providers have taken the initiative of expanding their infrastructure

facilities because of the increasing demand for better facilities. Through independent research

conducted by firms that were discussed in the 3rd

International workshop on global healthcare in

2010 emerged the necessity for the implementation of better infrastructure facilities that would

allow patients to feel comfortable in the environment that they will reside during medical care.

Though such improvements were done, the improvements were only limited in expanding the

hospital by constructing buildings to facilitate patients. The needs of patients in constructing

such infrastructure were not considered (University of Copenhagen , 2010).

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To improve hospital environment, the procedure should start with improving how to use existing

resources. The following reflects World Health Organization (WHO) essential environmental

health standards for healthcare settings (World Health Organization , 2011).

Adequate space integrated within primary care.

Protect the privacy of patients and avoid humiliation (confidentiality).

Prevent both transmissions of HIV and TB infection control.

Water, Sanitation and hygiene for infection control.

Sufficient quantities of safe waste management.

The ability to use latrines/toilets for both patients and staff without contaminating the

health center or water supply.

The presence of proper communication facilities to communicate with district health

departments.

Electricity to power essential medical equipment’s.

To take necessary precautions for fire safety.

These infrastructure interventions need to be convoyed by providing information about and

promoting hygiene with patients, staff and healthcare volunteers so that they are knowledgeable

about essential necessary behaviors to limit disease transmission in healthcare facilities (World

Health Organization , 2011).

The necessary requirements in infrastructure facilities in any given hospital should possess the

necessary water quantities in water supply for out-patients (refer appendices), general waiting

room for out-patients (refer appendices), the mode of waste management that has to be done in a

methodical manner by disposing waste with three different colors (refer appendices), waiting

area requirements (refer appendices) and the requirements of the consultation rooms (refer

appendices) (World Health Organization , 2011).

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2.2.3.1 Hospital Infrastructure Facilities in Private Healthcare Industry

Infrastructure facilities in healthcare has been considered vital in the private healthcare industry

this is mainly due to the lack of infrastructure facilities in government healthcare, people tend to

select private healthcare services or facilities. The development infrastructure facilities have

created new investments methods for firms that would allow them to explore markets in which

infrastructure needs of healthcare are necessary (Hong Kong Trade Development Council, 2013).

As an example in Vietnam due to shortfalls in local resources and expertise has led a number of

leading foreign companies to target Vietnam health sector. This trend was emerging because of

the inability of local players to service growing demands. In order to secure overseas instrument,

the Vietnamese government has ensured 10% tax exceptions over the first four years. Some of

the foreign companies include The Chandler Corporation (Singapore), The Triple Eye

Infrastructure Corporation (Canada), United Lab (Philippines) and Mercatus Capital (Singapore)

(Hong Kong Trade Development Council, 2013).

New or reinvented infrastructure facilities are an essential part of most plans in healthcare as

providers attempt to provide creative and attractive patient centered environments to deliver

more efficient models of care, to improve patient outcome and experience, increase market share

and drive revenues. Healthcare providers or firms seeking to combine growth with improvements

in efficiency and the quality of care primarily need a clearly defined decision making process

framework for infrastructure improvements or construction projects (Abadie, 2013).

The necessity of infrastructure development or construction of new facilities have arisen due to

the growth in chronic, age-related illnesses to the increasing demand for access such

transformational trends in healthcare are leading to test new approaches that would enhance the

patient experience in healthcare that would fit to the age category of different patients (Abadie,

2013).

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2.2.4 Relationship between Service Quality & Consumer Satisfaction

There is a reverse relationship between consumer satisfaction and service quality due to such

reasons they are divided into two categories. The first category depicts that satisfied consumers

lead to a good awareness in service quality (Bolton & Drew, 1991) and the second category

suggests that better service quality would lead to better consumer satisfaction (Cronin Jr &

Taylor, 1992). By observing these two categories it can be seen that there is a strong correlation

between service quality and consumer satisfaction. A research conducted by Andaleeb (2001)

based on service quality in Bangladesh private hospitals he identified five dimensions based

upon the SERQUVAL method (Andaleeb, 2001 ).

Andaleeb (2001) in accordance to the SERQUVAL method the five dimensions were namely

responsiveness, assurance, communication, discipline (tangible), and tips. All five dimensions of

service quality were significant in explaining consumer satisfaction. Discipline and assurance

had a bigger impact on consumer satisfaction than the others (Andaleeb, 2001 ). Tucker and

Adams (2001) argued that service quality variables could include caring, empathy, reliability,

and responsiveness. Satisfaction variables were access, communication, and outcomes. In their

study, on consumer satisfaction at American public hospitals, the performance of the service

provider and access provider serving were established approximately 74% of the express consent

variances (Tucker & Adams, 2001).

Al Azmi (2009) studied patient attitudes towards service quality and its effects on patient

satisfaction in physical therapy. The study was conducted based on the relationship between five

dimensions of service quality and three dimensions of patient satisfaction in three hospitals in the

Saudi Arabia. It was observed that there was a statistical significance between service quality

and patient satisfaction on any dimension that reflected a significant effect on both variables. The

results showed that assurance maintained the most effective and empathy kept the least effect on

patient satisfaction. Exploratory Factor Analysis (EFA) and Conformity Factor Analysis (CFA)

were used in measuring patient satisfaction with effect to service quality that resulted in a

difference with previous studies which included latent and observable variables (Al Azmi, et al.,

2012).

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2.3 Models in Healthcare

2.3.1 Consumer Satisfaction Pragmatic Model in Healthcare

Consumer satisfaction model by Richard Baker (1997) was considered viable because the model

has been linked together with the available empirical evidence about consumer satisfaction

pertaining to health care without resources to more general social or psychological theories of

behavior, other than to define satisfaction as an attitude as illustrated in figure 7 (Baker, 1997).

Figure 7 Initial model of patient satisfaction in general practice

(Source: Baker, 1997)

As mentioned before in this model consumer satisfaction has been treated as an attitude that was

an evaluative judgement and secondly attitude is considered in the model as a continuous rather

than the dichotomous variable and finally the model is multi dimensional that consists of

different elements of care each causing differences in satisfaction. This in order to identify when

a consumer is satisfied with a certain care there will be an opposite reaction in another service

which the consumer would be dissatisfied (Baker, 1997).

Characteristics of Patients

Age, sex, culture

Experience of care

Expectations

Others

Behavior Level of

satisfaction

Elements of

Care

Prioritized by

Patients

Interaction with

Healthcare

P a g e | 36


Consumer satisfaction may influence their attitudes towards health care, in the model the

characteristics of consumers are shown as influencing the priorities they assign to different

elements of care and to their different levels of satisfaction after an interaction with the health

care system. Consumer characteristics that may influence include age, sex, past experience of

care, expectations, health, cultural factors and other factors. Finally, consumer satisfaction can

influence consumer future behavior such as agreement with the advice or whether they change

doctors (Baker, 1997).

2.3.2 SERQUVAL Model

The SERQUVAL method is popular instrument used in measuring service quality that has been

used in the health care industry extensively. SERQUVAL method consists of five dimensions i.e.

tangibles, assurance, empathy, responsiveness and reliability are being proposed. This is in order

to identify the differences between consumer perception and expectations that are implemented

for the purpose of measuring perceived service quality (Zeithmal, et al., 1990).

Tangibles: the apperance of physical facilities and medical persons, equipment and

communication methods.

Reliability: The ability of a certain hospital to perform their services as promised to the

consumer.

Empathy: The individual attention or care the medical persons of a certain hospital that

would be provided to the consumer.

Assurance: The level of knowladge and politeness of medical persons of a certain

hospital and their capability to encourage trust and confidence among consumers.

Responsiveness: The level of willingness of a medical person to help customers and

provide prompt services.

Brahmbahtt, Baser, & Joshi (2011) found that customers‘ perceptions did not exceed their

expectations, as the patients were dissatisfied with the level of health care services rendered by 5

P a g e | 37


private hospitals from Ahmadabad and Gandhi agar cities of Gujarat state (Brahmbhatt, 2011 ).

Haque (2012) found in their study that customer satisfaction had direct and indirect relationships

to personnel support, and to attention given to patients and hospital facilities at a private hospital

in Malaysia (Haque, et al., 2012).

The figure illustrated below depicts the method of measuring service quality with assistance of

SERQUVAL method that provides the viewpoints of both patients or consumers and the health

provider and in terms it is able to understand that certain factors affecting or gaps are present in

the system.

Figure 8 Measuring Service Quality

(Source: Zeithmal, et al., 1990)

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2.4 Critical Analysis of Literature

In analyzing the literature review it can be observed that consumers are demanding for private

healthcare that can provide them with better services and facilities in satisfying their medical

needs. As noted by Bitner and Hubbert (1995) they suggested an ‘encounter satisfaction’,

illustrates the satisfaction the consumer experiences or satisfaction with regard to the service

offered and the overall satisfaction with the service provider is reliant on the number of services

offered within the different parts of a certain hospital or with different employee services this can

result in positive word of mouth among consumers especially when considering the healthcare

industry (Bitner, 1995).

As Bitner states such a similar ‘encounter satisfaction’ is currently present in Sri Lankan private

hospitals where hospitals depend on visiting consultants and positive word of mouth among

consumers. Bolton & Drew (1991) identified that there was a positive or strong correlation

between service quality and consumer satisfaction that was witnessed mostly in Asian continent

when it comes to private healthcare this was because of the quality healthcare that has been

identified which only can be provided by private healthcare providers in some Asian countries.

Due to the effects of globalization and modernization, many countries are shaping up or shifting

their economies to a much more open type that allows flow of many products and services. Due

to such scenarios various investments start flowing into the country such form of investments is

the investments in healthcare infrastructure. If governments are unable to fund or develop

infrastructure in healthcare the assistance of private companies are used. Such an instance can be

witnessed in Taiwan.

Literature proves that mature markets may exist in the private healthcare market but many

consumers would not be able to obtain information or experience private healthcare out of their

home country that as a result would create a scenario where consumers will be satisfied based on

the available advance service offerings and infrastructure facilities in private hospitals.

P a g e | 39


2.5 Conclusion

In concluding the literature review it can be stated that there is the positive or direct relationship

between service quality and consumer satisfaction and it has been proven in many forms of

research from developing to developed countries both in public and private sector hospitals.

Infrastructure facilities in healthcare are also an emerging trend in private hospitals which has

been identified by researchers in Sri Lanka as the primary factor that differentiates the public

sector hospitals from the private sector hospitals.

It can also be said that consumers are willing to pay for better healthcare facilities and the poor

are forced to seek medical treatments from private hospitals due to the lack of infrastructure

facilities in public sector hospitals. Although some consumers would not be exposed to service

offering and infrastructure facilities internationally. The consumers will be satisfied with the

services and infrastructure facilities offered to them in their home country.

P a g e | 40


CHAPTER THREE

P a g e | 41


3.1 Research Design

For the purpose of this research the target population would be out-patients of both

communicable and non-communicable disease who have taken medical treatments in the

Colombo district of Sri Lanka. The research would be based on inductive approach or bottom up

research that will enable the move from specific observations to comprehensive generalization

and theories which based on the conclusions are only based on principles relating to service

quality and infrastructure facilities in private sector hospitals (Sekran & Bougie , 2010).

Therefore in order to measure the service quality and infrastructure facilities in private general

hospitals this research can be categorized as an exploratory research that is ideal for quantitative

research hypothesis (Sekran & Bougie , 2010).

(Source: Sekran & Bougie , 2010)

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3.2.1 Primary Data

Primary data would be mainly taken from the structured questionnaire in which Number of

satisfied and unsatisfied consumers due to existing service quality and physical facilities offered,

difficulties/challenges will be identified with reference to service quality and infrastructure

facilities.

3.2.2 Secondary Data

Secondary Data will be collected and observed based on existing out-patient consumer base,

number of complains, the incentive packages offered number of service related complaints, no of

latest machinery available, no of new surgery rooms available, no of beds, wards, new buildings.

No of doctors/supporting staff availability based on reports, articles and independent analysis

done by individual researchers.

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3.3 Research Questions

3.3.1 Main Research Question

What are the factors determining consumer satisfaction towards service quality and infrastructure

facilities offered by hospitals with regard to Colombo district Private General Hospitals in Sri

Lanka?

3.3.2 Specific Research Questions

What are the factors influencing a consumer’s decision making process when selecting a

hospital?

What is the level of awareness with regard to the services and infrastructure facilities

offered and marketed by private general hospitals?

What is the consumer preference towards various private general hospitals in Colombo

District?

What are the consumer issues with regard to services and infrastructure facilities offered

by private general hospitals?

What are the policy implications and present recommendations to further improve the

service quality and infrastructure at private general hospitals?

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3.4 Conceptual Framework

Based on the research of consumer satisfaction towards service quality and infrastructure

facilities in private general hospitals in Colombo district of Sri Lanka with regard to the

SERQUVAL method measuring service quality ‘customer satisfaction’ can be determined as the

‘dependent variable’.

Service quality, infrastructure needs, past experience, customer awareness and Behavior of

medical personals are considered as ‘independent variable’. The core hypotheses of this research

H1, H2, H3, H4 and H5 are attempts to identify whether the stated independent variables affects

the dependent variable that is customer satisfaction.

Following figure illustrates the potential disparity between expected consumer satisfaction and

actual consumer satisfaction.

Independent Variables

Figure 9 Hypotheses of Potential Disparity between Expected Consumer Satisfaction & Actual

Consumer Satisfaction.

Service quality

Infrastructure Needs

Past Experience

Consumer Awareness

Behavior of Medical Personals

Consumer Satisfaction

H1

H2

H3

H4

H1

H5

Dependent Variable

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3.5 Operationalization

Table 4 Variable Indicators Variables Indicators Measurements

Service Quality Reliability, responsiveness,

administration, number of visits,

access to information, waiting

time, appearance of staff,

complaints

5 point Likert scale

1= Strongly Disagree

2= Disagree

3= Neutral

4= Agree

5= Strongly Agree

Infrastructure Needs Facilities, location, layout,

security, privacy

5 point Likert scale &

Dichotomous questions

Past Experience Loyalty, cost, packages 5 point Likert scale &


Consumer Awareness Marketing campaigns, available

medical packages, easy payment

schemes, , Insurance, Technology

5 point Likert scale &


Behavior of Medical

Personals

Visiting consultants, Empathy,

Accountability, attitudes towards

visitors, interpersonal skills,

emergency treatments, and surgery

treatments.

5 point Likert scale

Demographic Factors Age Seven Answers

Gender Two Answers

Race Three Answers

Income Level Five Answers

Education Level Seven Answers

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3.6 Research Hypotheses

H1: There is a positive and significant relationship between service quality and consumer

satisfaction

H2: There is positive and significant relationship between infrastructure needs and consumer

satisfaction.

H3: There is positive and significant relationship between past experience and consumer

satisfaction.

H4: There is positive and significant relationship between customer awareness and consumer

satisfaction.

H5: There is positive and significant relationship between behavior of medical personals and

customer satisfaction.

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3.7 Research Instrument

A structured questionnaire would be developed based on the key words of this research with

regard to the private general hospitals this would enable to measure the research data in an

orderly manner that would as a result enable to identify customer satisfaction. The quantitative

approach is used in order to quantify data and generalize results based on population of interests

that as a result would be able to measure views and opinions of a certain sample population

(Snap Surveys, 2013).

Figure 10 Research Procedure

(Source: Snap Surveys, 2013)

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3.8 Sampling Plan

3.8.1 Sampling Population

The target population for the research is out-patients who have been consulted to both

communicable and non-communicable diseases into private general hospitals in Colombo district

of Sri Lanka for the past 6 months.

3.8.2 Sample Size

The purpose of this research based on customer satisfaction towards service quality and

infrastructure facilities in private general hospitals will be studied with regard to the Colombo of

Sri Lanka in which the total population of Colombo district is 2,309,809 (Department of Census

& Statistics , 2012), with the possibility of being a patient at any given moment and with 95%

confidence level and with an error rate of 5% the sample size resulting will be a randomly

selected 400 consumers from Colombo district of Sri Lanka to be participating in the consumer

survey.

n = Sample Population

N = Total population (2,309,809)

e = Sample error -5%

Therefore the sample size (n) will be 400

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3.9 Data Collection Methods

3.9.1 Source of Data

Customer satisfaction surveys are mostly based on primary data due to the nature of the research

at hand; therefore it will be measured in terms of primary data too. In order to make it more

scientific for the purpose of understanding the perceptions in a more tangible and statistical

manner a questionnaire with dichotomous and multiple choice questions will be integrated.

Secondary data will be used in order to gain already existing statistical data in the private health

care industry and national healthcare. In order to identify the current trends, opportunities and

threats in the healthcare industry may possess. For the purpose of identifying such trends already

published documents or reports with regard to the healthcare industry in Sri Lanka by

independent research organizations, healthcare magazines, annual reports published by private

hospitals, medical journals etc. Research publications, scholarly journals and other internet

resources will be used in order to collect secondary data.

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3.10 Data Analysis

For the purpose of data analysis the main core areas of the research namely are service quality

and infrastructure facilities in private general hospitals. Further a detailed analysis is being

illustrated in the table below.

3.10.1 Analysis Tools

Due to the nature of this research, which is quantitative data SPSS statistical package will be

used for the data analysis alongside with MS Excel for database building and with the assistance

of other applications in order to have an accurate data analysis.

Main Areas of

Research

Type of Data Research

Instrument

How to measure

Service Quality

Levels

Quantitative 5 point likert scale

questionnaire

The likert scale

enables to convert

qualitative

information to

quantitative data

Infrastructure

Facilities

Quantitative Dichotomous

questions (close-end

questions)

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3.11 Pilot Study

A pilot study is conducted on a small sample of respondents with the objective of improving the

questionnaire by eradicating potential errors which might be present. The removal of such

variables is done by validating the dimensions of the construct. The measurement properties that

were used in assessing the pilot survey are reliability and validity.

The pilot study for ‘consumer satisfaction towards service quality and infrastructure facilities in

private general hospitals in Colombo district of Sri Lanka’ was done by distributing the

questionnaire among 40 respondents who were drawn from the sample of the research.

Reliability and validity tests were conducted based on the 40 distributed data questionnaires.

Once the reliability and validity values were assessed, the questionnaire was modified as

required.

The questions or indicators that passed these tests were then used in the final survey to gather

data for the study. The pilot study has assisted to create an effective questionnaire that has helped

achieve research objectives.

3.12 Conclusion

In conclusion the research methodology is conducted based on an inductive approach which is

suitable for a quantitative research. A sample population of 400 respondents was chosen from the

Colombo district for the study. And Likert scales and dichotomous questions were used to asses

primary data for the research and secondary data was obtained from research publications,

scholarly journals and other internet resources.

Out of 400 respondents 200 were selected and used for the final data survey that helped to

identify consumer satisfaction levels that will be discussed in the next chapter.

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CHAPTER FOUR

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4.1 Introduction

This chapter focuses on the data which was collected through questionnaire by the researcher

with the objective of identifying consume satisfaction towards service quality and infrastructure

facilities in private general hospitals in Colombo district of Sri Lanka. The data gathered through

the self-administered questionnaire were analyzed using Statistical Package for Social Science

(SPSS) and Microsoft excel.

Since the data was obtained by the researcher through a self-administered questionnaire prepared

by the researcher a reliability and validity test was performed. Reliability and validity of each

dimension would be explained after the data presentation of each indicator or dimension in the

questionnaire.

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4.2 Data Presentation

4.2.1 Demographic Data

4.2.1.1 Gender

Figure 11 Gender

(Source: Survey Data)

Based on the research out of 200 respondents 111 were male covering 55% of gender and female

were 89 covering 45% of gender. Gender is also affecting on observation of service quality and

infrastructure in private general hospitals.

55%

45%

Male

Female

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4.2.1.2 Age Category

Figure 12 Age Category


12% of respondents are between the ages of 16 to 25, 15% of the respondents are between the

ages of 26 to 35, 19% of the respondents are between the ages of 36 to 45, 24% of the

respondents are between the ages of 46-55, 13% of the respondents are between the ages of 56 to

65, 9% of the respondents are between the ages of 66 to 75 and 8% of the respondents are over

the age of 75. The highest numbers of respondents are in an age category 46 to 55 (24%).

12%

15%

19%

24

12%

9%

8%

16-25

26-35

36-45

46-55

56-65

66-75

Over 75

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4.2.1.3 Marital Status

Figure 13 Marital Status


70% of respondents are married in this research, 23% of respondents are single and 7% of

respondents are widowed. Marital status is also a vital factor in determining service quality and


23%

70%

7%

Single

Married

Widowed

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4.2.1.4 Race

Figure 14 Race


In this research 48% of respondents were Sinhalese, 31% of respondents were Muslims and 21%

of respondents were Tamil’s. Race is also an important aspect in identifying the specific

hospitals visited by different races and their perception in service quality and infrastructure in

private general hospitals.

48%

31%

21%

Sinhalese

Muslims

Tamils

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4.2.1.5 Religion

Figure 15 Religion


In this research 31% of respondents were Buddhist, 30% of respondents were Islam, 13% of

respondents were Catholic, 13% of respondents were Christian, 11% of respondents were Hindu

and 2% of respondents were Atheist.

31%

30%

13%

11% 2%

Buddhist

Islam

Catholic

Hindhu

Atheist

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4.2.1.6 Education Level

Figure 16 Education Level


1% of respondents are educated to GCE ordinary level, 10% of respondents are educated to GCE

advance level, 16% of respondents are educated to diploma, 8% of respondents are

undergraduates who are currently perusing a degree, 39% of respondents are educated to a

bachelor’s degree, 16% respondents are educated to a master’s degree and 10% of respondents

are educated to a PhD. Findings are indicate that more respondents with a bachelor’s degree tend

to select private healthcare that as a result helps to define the service quality and infrastructure in


1% 10%

16%

8%

39%

16%

10%

GCE OL

GCE AL

Diploma

Undergraduate

Bachelor's Degree

Master's Degree

PhD

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4.2.1.7 Occupation

Figure 17 Occupation


8% of respondents are students, 13% of respondents are housewives, 23% respondents are

managers, 26% of respondents are professionals, 22% of respondents are executives, 5% of

respondents are businessmen and 3% of respondents are both retired military men and a retired

teacher. Findings indicate that majority groups of respondents are professionals who have

knowledge with regard to service quality and infrastructure facilities in private general hospitals.

8%

13%

23%

26%

22%

3%

Student

Housewives

Managers

Professionals

Executives

Businessmen

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4.2.1.8 Monthly Income Range

Figure 18 Monthly Income Range


12% respondents were earning a monthly income range of 20000 to 40000, 12% of respondents

were earning a monthly income range of 40001 to 60000, 26% of respondents were earning a

monthly income range of 60001 to 80000, 15% of respondents are earning a monthly income

range of 80001 to 100000 and 35% of respondents were earning a monthly income range of over

100000. Findings are indicate that a majority of the monthly income range indicates respondents

who are earning more than 100000 which is favorable in observing perception of service quality

and infrastructure in private hospitals.

12%

12%

26%

15%

35%

20000-40000

40001-60000

60001-80000

80001-100000

Over 100000

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4.2.2 Reasons for Selecting Private General Hospitals

Figure 19 Reasons for Selecting Private General Hospitals


In this research 19% of respondents choose private general hospitals due to the quality in

healthcare, 28% of respondents choose private general hospitals due to the better facilities

compared to public general hospitals, 23% of respondents choose private general hospitals

because of better consultants, 9% of respondents choose private general hospitals because their

service was valuable for the respondents time and money, 20% of respondents choose private

general hospitals because it was convenient for respondents compared to public hospitals and 1%

of respondent stated that privacy was well maintained in private general hospitals.

Findings indicated that the majority of respondents choose private general hospitals because of

better facilities that are the factors that are lacking in the public sector hospitals.

19%

28%

23%

9%

20%

1%

0

5

10

15

20

25

30

Quality in healthcare

Better Facilities

Better consultants

Value for time & Money

Convenience Other

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4.2.3 Basis of Selecting Private General Hospitals

Figure 20 Basis of Selecting Private General Hospitals


29% of respondents basis of selecting private general hospital is because of doctor’s

recommendation, 26% of respondents basis of selecting private general hospital is because of the

past experience with the private hospital medical care, 18% of respondents basis of selecting

private general hospital is because it was close proximity from the respondents residence, 3% of

respondents basis of selecting private general hospital is because of personal insurance, 7% of

respondents basis of selecting private general hospital is because of employee insurance provided

by the respondents employer, 16% of respondents basis of selecting private general is because of

third party recommendation.

None of the respondents stated hospital promotions as a basis of selecting private general

hospitals and 1% of respondents stated that their basis of selecting private general hospitals was

because of vouchers they received and reputation of the hospital. Findings indicate that a

majority of the respondent’s basis of selecting private general hospitals is because of the doctor’s

recommendation that proves the ‘doctor-centric’ approach in Sri Lanka.

29% 26%

18%

3% 7%

16%

0

5

10

15

20

25

30

35

P a g e | 64


4.2.4 Is Reputation Considered Prior to Selecting Private General Hospitals

Figure 21 Is Reputation Considered Prior to Selecting Private General Hospitals


75% of respondents do consider reputation prior to visiting or selecting private general hospitals

and 25% of respondents do not consider reputation prior to visiting or selecting private general

hospitals. Findings indicate that the majority of respondents consider the reputation in selecting

hospitals and indicates the perception of service quality and infrastructure in private general

hospitals.

75%

25%

Yes

No

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4.2.5 Last Private General Hospital Visited

Figure 22 Last Private General Hospital Visited


In this research 20% respondents stated that Lanka Hospital was their last visited hospital, 15%

of respondents stated that Asiri (General & Surgical) was their last visited hospital, 14% of

respondents stated that Durdans was their last visited hospital, 12% of respondents stated that

Nawaloka hospital was their last visited hospital, 10% of respondents stated that Hemas hospital

was their last visited hospital, 10% of respondents stated that The Central hospital was their last

visited hospital. 2% respondents stated that Park hospital was their last visited hospital, 6%

respondents stated that Delmon hospital was their last visited hospital, 2% of respondents stated

that the Oasis hospital was their last visited the hospital, 6% of respondents stated that the Royal

hospital was their last visited hospital and 3% of the respondents stated that they their last visited

the hospital was Borella Private hospital that was categorized under other. Findings indicate

that a majority of respondents favored hospital is Lanka Hospital that indicates the perception of

service quality and infrastructure by respondents.

12% 14%

20%

15%

10%

2%

6%

10%

2%

6%

0

5

10

15

20

25

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4.2.6 Purpose of Visit to Private General Hospitals in the Last Six Months

Figure 23 Purpose of Visit to Private General Hospitals in the Last Six Months


41% of respondents stated that their purpose of visit to the hospital was for medical channeling

services in the last six months, 16% of respondents stated that their purpose of visit to the

hospital was for OPD services in the last six months, 5% of respondents stated that their purpose

of visit to the hospital was for employee sponsored medical checkups, 18% of respondents stated

that their purpose of visit to the hospital was for personal medical checkups, 19% of respondents

stated that their purpose of visit to the hospital was to obtain laboratory tests in the last six

months and 1% of respondents stated that their purpose of visit was for therapy sessions that are

categorized under other factors in the last six months.

Findings indicate that a majority of respondents visit hospital for the purpose of medical

channeling services in the last six months that indicates the perception in service quality and

infrastructure in private general hospital.

41%

16%

5%

18% 19%

1%

0

5

10

15

20

25

30

35

40

45

Medical Channeling

services

OPD Services Employee Medical

Checkups

Personal Medical

Checkups

To Obtain Laboratory

Tests

Other

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4.2.7 Are Respondents Insured Under Any Medical Packages

Figure 24 Are Respondents Insured Under Any Medical Packages


42% of respondents were insured under medical packages, 57% of respondents were not insured

under any medical packages and 1% of respondents were doubtful whether they were insured

under any medical packages. Findings indicate that the majority of respondents were not insured

that indicates the perception in service quality and infrastructure will be considered.

42%

57%

1%

Yes

No

Maybe

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4.2.8 Does Medical Insurance Limit the Selection of Hospitals

Figure 25 Does Medical Insurance Limit the Selection of Hospitals


In this research 16% of respondents stated that their insurance package does limit their selection

in hospitals, 76% of respondents stated that such limitations are not present in selecting their

hospital of choice and 8% of respondents stated that they were doubtful whether their insurance

medical package do limit their selection in hospitals. Findings indicate that majority stated that

such limitations are not present.

16%

76%

8%

Yes

No

Maybe

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4.2.9 Number of Times Visited the Hospital in the Last Six Months by the Respondent

Figure 26 Number of Visited the Hospital in Last Six Months by the Respondent


4% of respondents has not visited the hospital in the last six months, 43% of respondents has

visited the hospital at least once in the last six months, 32% of respondents has visited the

hospital at least twice in the last six months, 15% of respondents has visited at least three times

in the last six months, 4% of respondents has visited the hospital at least four times in the last six

months and 4% of respondents has visited the hospital five or more times in the last six months.

Findings indicate that the majority of respondents have at least visited the hospital at least once

in the last six months.

4%

43%

32%

15%

4% 4%

0 times

1 time

2 times

3 times

4 times

5 or more times

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4.2.10 Past Experience

4.2.10.1 How Likely would the Respondents Chose the Last Visited Hospital for Healthcare

Again

Figure 27 How Likely would the Respondent Chose the Last Visited Hospital for Healthcare

Again


3% of respondents are extremely unlikely to choose the last visited hospital for healthcare again,

5% of respondents are somewhat unlikely to choose the last visited hospital for healthcare again,

22% of respondents are neutral in choosing the last visited hospital for healthcare again, 62% of

respondents are somewhat likely to choose the last visited hospital for healthcare again and 8%

of respondents are extremely likely to choose the last visited hospital for healthcare again.

Findings indicate that the majority of respondents are somewhat likely to choose the last visited

hospital for healthcare again that indicates perception of service quality and infrastructure in


3% 5%

22%

62%

8%

0

10

20

30

40

50

60

70

Extremely Unlikely

Somewhat Likely Neutral Somewhat Likely Extremely Likely

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4.2.10.2 How Likely would the Respondent Recommend the Last Visisted Hospital to Others for

Healthcare

Figure 28 How Likely would the Respondent Recommend the Last Visited Hospital for Others

for Healthcare


5% of respondents are extremely unlikely to recommend the last hospital visited to others, 8% of

respondents are somewhat unlikely to recommend the last hospital visited to others, 25% of

respondents are neutral in recommending the last visited hospital to others, 52% of respondents

are somewhat likely to recommend the last visited hospital to others and 10% of respondents are

extremely likely to recommend the last visited hospital to others.

Findings indicate that the majority of respondents are somewhat likely to recommend the last

visited hospital to others that indicates the perception of service quality and infrastructure in


5% 8%

25%

52%

10%

0

10

20

30

40

50

60

Extremely Unlikely Somewhat Likely Neutral Somewhat Likely Extremely Likely

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4.2.11 Did Healthcare Expenses Influence Repondents in Selecting the Last Visisted Hospital

Figure 29 Did Healthcare Expenses Influence Respondents in Selecting the Last Visited Hospital


54% of respondents stated that healthcare expenses did not influence the respondent in selecting

the last visited hospital and 46% of respondents stated that healthcare expenses did influence the

respondent in selecting the last visited hospital. Findings indicate that the majority of

respondents did not consider healthcare expenses in selecting last visited hospital that indicates

the perception of service quality and infrastructure in private general hospitals.

54%

46% Yes

No

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4.2.12 Is the Respondent Aware of the Total Expenditure Spent on Healthcare Needs

Figure 30 Is the Respondent Aware of the Total Expenditure spent on Healthcare Needs


66% of respondents are not aware of total expenditure spent on healthcare needs and 34% of

respondents are aware of total expenditure spent on healthcare needs. Findings indicate that the

majority of respondents are not aware of the total expenditure spent on healthcare needs.

66%

34%

Yes

No

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4.2.13 Service Quality

4.2.13.1 Apperance of Administration Staff

Figure 31 Appearance of Administration Staff


1% of respondents were highly dissatisfied with the appearance of administration staffs, 9% of

respondents were dissatisfied with the appearance of administration staff, 23% of respondents

were neutral with the appearance of administration staff, 63% of respondents were satisfied with

the appearance of administration staff and 4% of respondents were highly satisfied with the

appearance of administration staff.

Findings indicate that the majority of respondents are satisfied with the appearance of

administration staff in private general hospitals that indicates perception in service quality and


1%

9%

23%

63%

4%

0

10

20

30

40

50

60

70

Highly Dissatisfied Dissatisfied Neutral Satisfied Highly Satisfied

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4.2.13.2 Apperance of Medical Staff

Figure 32 Appearance of Medical Staff


1% of respondents were highly dissatisfied with appearance of medical staff, 7% of respondents

were dissatisfied with the appearance of medical staff, 20% of respondents were neutral with the

appearance of medical staff, 64% of respondents were satisfied with the appearance of medical

staff and 8% of respondents were highly satisfied with the appearance of medical staff.

Findings indicate that the majority of respondents are satisfied with the appearance of medical

staff in private general hospitals that indicates the perception in service quality and infrastructure

in private general hospitals.

1%

7%

20%

64%

8%

0

10

20

30

40

50

60

70


P a g e | 76


4.2.13.3 Ease of Access to Information

Figure 33 Ease of Access to Information


1% of respondents are highly dissatisfied with the ease of access to information, 7% of

respondents were dissatisfied with the ease of access to information, 34% of respondents were

neutral with the ease of access to information, 49% of respondents were satisfied with the ease of

access to information and 9% of respondents were highly satisfied with the ease of access to

information.

Findings indicate that the majority of respondents are satisfied with the ease of access to

information that indicates perception of service quality and infrastructure in private general

hospitals.

1%

7%

34%

49%

9%

0

10

20

30

40

50

60


P a g e | 77


4.2.13.4 Effectiveness of Hospital Staff

Figure 34 Effectiveness of Hospital Staff


1% respondents were highly dissatisfied with the effectiveness of hospital staffs, 5% of

respondents were dissatisfied with the effectiveness of hospital staff, 35% of respondents were

neutral with the effectiveness of hospital staff, 53% of respondents were satisfied with the

effectiveness of hospital and 6% of respondents were highly dissatisfied with the effectiveness of

hospital staff.

Findings indicate that a majority of respondents are satisfied with the effectiveness of hospital

staff in private general hospitals that indicates the perception of service quality and infrastructure


1%

5%

35%

53%

6%

0

10

20

30

40

50

60


P a g e | 78


4.2.13.5 Ease of Providing Complaints or Feedbacks

Figure 35 Ease of Providing Complaints or Feedbacks


1% of respondents were highly dissatisfied with the ease of providing complaints or feedbacks,

7% of respondents were satisfied with the ease of providing complaints or feedbacks, 59% of

respondents were neutral with the ease of providing complaints or feedbacks, 30% of

respondents were satisfied with the ease of providing complaints or feedbacks and 3% of

respondents were highly satisfied with the ease of providing complaints or feedbacks.

Findings indicate that the majority of respondents are neutral with the ease of providing

complaints or feedbacks that indicates the perception of service quality and infrastructure in


1%

7%

59%

30%

3%

0

10

20

30

40

50

60

70


P a g e | 79


4.2.13.6 Ease of Completing/Attending to Administrative Requirements

Figure 36 Ease of Completing/Attending to Administrative Requirements


2% of respondents were highly dissatisfied with the ease of completing/attending administrative

requirements, 6% of respondents were dissatisfied with the ease of completing/attending

administrative requirements, 46% of respondents were neutral with the ease of

completing/attending administrative requirements, 42% of respondents were satisfied with the

ease of completing/attending requirements and 4% of respondents were highly satisfied with the

ease of completing/attending administrative requirements.

Findings indicate a majority of respondents are neutral with the ease of completing/attending

administrative requirements in private general hospitals that indicates the perception of service

quality and infrastructure in private general hospitals.

2%

6%

46%

42%

4%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 80


4.2.13.7 Reliability of Instructions & Information Provided by Staff

Figure 37 Reliability of Instructions & Information Provided by Staff


2% of respondents were highly dissatisfied with the reliability of instructions and information

provided by staff, 9% of respondents were dissatisfied with the reliability of instructions

provided by staff, 31% of respondents were neutral with the reliability of instructions and

information provided by staff, 54% of respondents were satisfied with the reliability of

instructions and information provided by staff and 4% of respondents were highly satisfied with

the reliability of instructions and information provided by staff.

Findings indicate a majority of respondents were satisfied with the reliability of instructions and

information provided by staff in private general hospitals that indicates the perception of service


2%

9%

31%

54%

4%

0

10

20

30

40

50

60


P a g e | 81


4.2.13.8 Time Taken to Attend Patient’s Needs by Hospital Staff

Figure 38 Time Taken to Attend Patient's Needs by Hospital Staff


2% of respondents were highly dissatisfied with the time taken to attend their medical needs by

hospital staff, 10% of respondents were dissatisfied with the time taken to attend their medical

needs by hospital staff, 38% of respondents were neutral with the time taken to attend their needs

by hospital staff, 46% of respondents were satisfied with the time taken to attend their medical

needs by hospital staff and 4% of respondents were highly satisfied with the time taken to attend

their medical needs by hospital staff.

Findings indicate a majority of respondents are satisfied with the time taken to attend their

medical needs by hospital staff that indicates the perception of service quality and infrastructure


2%

10%

38%

46%

4%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 82


4.2.13.9 Time Taken to Attend Patient Needs by Visiting Consultants/Doctors

Figure 39 Time Taken to Attend Patient Needs by Visiting Consultants/Doctors


5% of respondents were highly dissatisfied with the time taken to attend their medical needs by

visiting consultants/doctors, 17% of respondents were dissatisfied with the time taken to attend

to their medical needs by visiting consultants/doctors, 27% of respondents were neutral with the

time taken to attend their medical needs by visiting consultants/doctors, 45% of respondents

were satisfied with the time taken to attend their medical needs by visiting consultants/doctors

and 6% of respondents were highly satisfied with the time taken to attend their medical needs by

visiting consultants/doctors.

Findings indicate that a majority of respondents are satisfied with the time taken to attend their

medical needs by visiting consultants/doctors that depicts the perception in service quality and


5%

17%

27%

45%

6%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 83


4.2.13.10 Ease of Making Appointments for Sickness/Checkup Facilities Offered by Hospitals

Figure 40 Ease of Making Appointments for Sickness/Checkup Facilities Offered by Hospitals


1% of respondents were highly dissatisfied with the ease of making appointments for sickness or

checkup facilities offered by hospitals, 7% of respondents were dissatisfied with the ease of

making appointments for sickness or checkup facilities offered by hospitals, 38% of respondents

were neutral with the ease of making appointments for sickness or checkup facilities by

hospitals, 47% of respondents were satisfied with the ease of making appointments for sickness

or checkup facilities offered by hospitals and 7% of respondents were highly satisfied with the

ease of making appointments for sickness or checkup facilities offered by hospitals.

Findings indicate that a majority of respondents were satisfied with the ease of making

appointments for sickness or checkup facilities offered by private general hospitals that depicts

the service quality and infrastructure in private general hospitals.

1%

7%

38%

47%

7%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 84


4.2.14 Infrastructure Facilities

4.2.14.1 Effectiveness of Signs and Directions

Figure 41 Effectiveness of Signs and Directions


Findings indicate that a majority of respondents were satisfied with the effectiveness of sings and

directions in private general hospitals that depicts perception in service quality and infrastructure


5%

10%

28%

45%

12%

0

5

10

15

20

25

30

35

40

45

50

Highly Dissatisfied

Dissatisfied Neutral Satisfied Highly Satisfied

P a g e | 85


4.2.14.2 Ease of Moving from One End to the Other in the Hospital

Figure 42 Ease of Moving from One End to the Other in the Hospital


In this research 5% of respondents were highly dissatisfied with the ease of moving from one end

to the other in the hospital, 13% of respondents were dissatisfied with the ease of moving from

one end to the other in the hospital, 25% of respondents were neutral with the ease of moving

from one end to the other in the hospital, 46% of respondents were satisfied with the ease of

moving from one end to the other in the hospital and 11% of respondents were highly satisfied

with the ease of moving from one end to the other in the hospital.

Findings indicate that a majority of respondents were satisfied with the ease of moving from one

end to the other in the hospital that depicts the service quality and infrastructure in private

general hospitals.

5%

13%

25%

46%

11%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 86


4.2.14.3 Level of Safeguard or Security in the Hospital Environment

Figure 43 Level of Safeguard or Security in the Hospital Environment


5% of respondents were highly dissatisfied with the level of safeguard or security in the hospital

environment, 12% of respondents were dissatisfied with the level of safeguard or security in the

hospital environment, 21% of respondents were neutral with the level of safeguard or security in

the hospital environment, 47% of respondents were satisfied with the level of safeguard or

security in the hospital environment, 15% of respondents were highly dissatisfied with the level

of safeguard or security in the hospital environment.

Findings indicate that a majority of respondents were satisfied with the level of safeguarding or

security in the hospital environment that depicts the perception in service quality and


5%

12%

21%

47%

15%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 87


4.2.14.4 Visual Appealingness of the Layout and Infrastructure Facilities

Figure 44 Visual Appealingness of the Layout and Infrastructure Facilities


5% of respondents were highly dissatisfied with the visual appealingness of the layout and

infrastructure facilities, 14% of respondents were dissatisfied with the visual appealingness of

the layout and infrastructure facilities, 17% of respondents were neutral with the visual

appealingness of the layout and infrastructure facilities, 49% of respondents were satisfied with

the visual appealingness of the layout and infrastructure facilities and 16% of respondents were

highly satisfied with the visual appealingness of the layout and infrastructure facilities.

Findings indicate that majority respondents were satisfied with the visual appealingness of the

layout and infrastructure facilities in private general hospitals that indicates service quality and


%

14% 17%

49%

16%

0

10

20

30

40

50

60

Highly Dissatisfied


P a g e | 88


4.2.14.5 Visual Appealingness of Hospital Entrance

Figure 45 Visual Appealingness of Hospital Entrance


6% of respondents were highly dissatisfied with the visual appealingness of the hospital

entrance, 11% of respondents were dissatisfied with the visual appealingness of the hospital

entrance, 18% of respondents were neutral with the visual appealingness of the hospital entrance,

47% of respondents were satisfied with the visual appealingness of the hospital entrance and

18% of respondents were highly satisfied with the visual appealingness of the hospital entrance.

Findings indicate that a majority of respondents were satisfied with the visual appealingness of

the entrance in private general hospital that depicts the perception in service quality and


6%

11%

18%

47%

18%

0

5

10

15

20

25

30

35

40

45

50

Highly Dissatisfied


P a g e | 89


4.2.14.6 Visual Appealingness of Hospital Reception

Figure 46 Visual Appealingness of Hospital Reception


7% of respondents were highly dissatisfied with visual appealingness of the hospital reception,

12% of respondents were dissatisfied with the visual appealingness of the hospital reception,

20% of respondents were neutral with the visual appealingness of the hospital reception, 46% of

respondents were satisfied with the visual appealingness of the hospital reception and 15% of

respondents were highly satisfied with the visual appealingness of the hospital reception.


hospital reception that depicts the perception of service quality and infrastructure in private

general hospitals.

7%

12%

20%

46%

15%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 90


4.2.14.7 Visual Appealingness of Hospital Rooms

Figure 47 Visual Appealingness of Hospital Rooms


6% of respondents were highly dissatisfied with the visual appealingness of the hospital rooms,

10% of respondents were dissatisfied with the visual appealingness of the hospital rooms, 18%

of respondents were neutral with the visual appealingness of the hospital rooms, 50% of

respondents were satisfied with the visual appealingness of the hospital rooms and 16% of

respondents were highly satisfied with the visual appealingness of the hospital rooms.


the private general hospital rooms that depicts the perception in service quality and infrastructure


6% 10%

18%

50%

16%

0

10

20

30

40

50

60


P a g e | 91


4.2.14.8 Hospital was well equipped with Cable TV, Proper Air Conditioning & Proper Seating

Figure 48 Hospital was well equipped with Cable TV, Proper Air Conditioning & Proper Seating


3% of respondents were highly dissatisfied with hospital equipped with cable TV, proper air-

conditioning and proper seating, 7% of respondents were dissatisfied with hospital equipped with

cable TV, proper air-conditioning and proper seating, 20% of respondents were neutral with

hospital equipped with cable TV, air-conditioning and proper seating, 52% of respondents were

satisfied with hospital equipped with cable TV, proper air-conditioning and proper seating and

18% of respondents were highly satisfied with the hospital equipped with cable TV, proper air-

conditioning and proper seating.

Findings indicate that a majority of respondents were satisfied with private general hospital

equipped with cable TV, proper air-conditioning and seating that indicates perception in service


3% 7%

20%

52%

18%

0

10

20

30

40

50

60


P a g e | 92


4.2.14.9 Hospital was Spacious & Clean

Figure 49 Hospital was Spacious & Clean


7% of respondents were highly dissatisfied with the space and cleanliness of the hospital, 8% of

respondents were dissatisfied with the space and cleanliness of the hospital, 22% of respondents

were neutral with the space and cleanliness of the hospital, 47% of respondents were satisfied

with the space and cleanliness of the hospital and 16% of respondents were highly satisfied with

the space and cleanliness of the hospital.

Findings indicate that a majority of respondents were satisfied with the space and cleanliness of

private general hospitals that indicates perception in service quality and infrastructure in private

general hospitals.

7% 8%

22%

47%

16%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 93


4.2.14.10 Hospital Environment was Peaceful

Figure 50 Hospital Environment was Peaceful


9% of respondents were highly dissatisfied with the peaceful nature of the hospital environment,

14% of respondents were dissatisfied with the peaceful nature of the hospital environment, 29%

of respondents were neutral with the peaceful nature of the hospital environment, 36% of

respondents were satisfied with the peaceful nature of the environment and 12% of respondents

were highly satisfied with the peaceful nature of the hospital environment.

Findings indicated that a majority of respondents were satisfied with the peaceful nature of the

private general hospital environment.

9%

14%

29%

36%

12%

0

5

10

15

20

25

30

35

40


P a g e | 94


4.2.14.11 Infrastructure Facilities were built to Support Patient Privacy

Figure 51 Infrastructure Facilities were built to Support Patient Privacy


11% of respondents were highly dissatisfied with infrastructure facilities that were built to

support respondent/patient privacy, 19% of respondents were dissatisfied with infrastructure

facilities that were built to support respondents/patient privacy, 30% of respondents were neutral

with infrastructure facilities that were built to support respondent/patient privacy, 30% of

respondents were satisfied with infrastructure facilities that were built to support

respondent/patient privacy and 10% of respondents were highly satisfied with the infrastructure

facilities that were built to support respondent/patient privacy.

Findings indicate that a majority of respondents were both satisfied and neutral with

infrastructure facilities in private general hospitals that were built to support respondent/patient

privacy that depicts service quality and infrastructure in private general hospital.

11%

19%

30% 30%

10%

0

5

10

15

20

25

30

35


P a g e | 95


4.2.14.12 Respondents Selected Hospital Contains a Restaurant

Figure 52 Respondents Selected Hospital Contains a Restaurant


82% of respondents stated that their last selected hospital contained a restaurant and 18% of

respondents stated that their last selected hospital did not contain a restaurant. Findings indicated

that a majority of respondents stated their selected hospital did contain a restaurant.

82%

18%

Yes

No

P a g e | 96


4.2.14.13 Respondents Selected Hospital Contains a Pharmacy

Figure 53 Respondents Selected Hospital Contains a Pharmacy


96% of respondents stated that their last visited hospital contained a pharmacy and 4% of

respondents stated that their last visited hospital did not contain a pharmacy. Findings indicate

that a majority of respondents stated that their last visited hospital did contain a pharmacy.

96%

4%

Yes

No

P a g e | 97


4.2.14.14 Respondents Selected Hospital Contains a Automatic Teller Machine

Figure 54 Respondents Selected Hospital Contains an Automatic Teller Machine


46% of respondents stated that their last visited hospital did contain an automatic teller machine,

54% of respondents stated that their last visited did not contain an automatic teller machine.

Findings indicate that a majority of respondents stated that their last visited hospital did contain a

Automatic Teller Machine (ATM).

46%

54%

Yes

No

P a g e | 98


4.2.14.15 Respondents Selected Hospital Contains a Retail Store

Figure 55 Respondents Selected Hospital Contains a Retail Store


21% of respondents stated that their last visited hospital did contain a retail store and 79% of

respondents stated that their last visited hospital did not contain a retail store. Findings indicated

that a majority of respondents stated that their last visited hospital did not contain a retail store.

21%

79%

Yes

No

P a g e | 99


4.2.14.16 Respondents Selected Hospital Contains a Florist

Figure 56 Respondents Selected Hospital Contains a Florist


7% of respondents stated that their last selected hospital did contain a florists and 93% of

respondents stated that their last selected did not contain a florists. Findings indicated that a

majority of respondents stated that their last visited hospital did not contain a florist.

7%

93%

Yes

No

P a g e | 100


4.2.14.17 Respondents Selected Hospital Contains a Prayer Room

Figure 57 Respondents Selected Hospital Contains a Prayer Room


27% respondents stated that their last selected hospital did contain a prayer room and 73% of

respondents stated that their last selected hospital did not contain a prayer room. Findings

indicated that a majority of respondents stated that their last selected private general hospital did

not contain a prayer room.

27%

73%

Yes

No

P a g e | 101


4.2.15 Has the Respondent been exposed to any type of Marketing Information in the Last

Visited Hospital

Figure 58 Has the Respondent been exposed to any type of Marketing Information in the Last

Visited Hospital


8% of respondents stated that they were exposed to marketing information in their last visited

hospital, 64% of respondents stated that they were not exposed to any type of marketing

information in their last visited hospital and 28% of respondents were unclear whether they were

exposed to any type of marketing information in their last visited the hospital. Findings indicate

that a majority of respondents were not exposed to any type of marketing information in their last

visited hospital.

8%

64%

28%

Yes

No

Maybe

P a g e | 102


4.2.16 Consumer Awareness

4.2.16.1 Awareness of Different Medical Packages

Figure 59 Awareness of Different Medical Packages


50% of respondents were highly unaware of different medical packages offered under different

categorize, 20% of respondents were unaware of different medical packages offered under

different categorize, 20% of respondents were neutral of different medical packages under

different categorize, 9% of respondents were aware of different medical packages offered under

different medical categorize and 1% of respondents were highly aware of different medical

packages offered under different medical categorize.

Findings indicate that a majority of respondents were highly unaware of different medical

packages offered under different categorize.

50%

20% 20%

9%

1%

0

10

20

30

40

50

60

Highly Unaware Unaware Neutral Aware Highly Aware

P a g e | 103


4.2.16.2 Awareness of Easy Payment Methods

Figure 60 Awareness of Easy Payment Methods


49% of respondents were highly unaware of easy payment schemes/methods in hospitals, 25% of

respondents were unaware of easy payment schemes/methods in hospitals, 16% of respondents

were neutral of easy payment schemes/methods in hospitals, 9% of respondents were aware of

easy payment schemes/methods in hospitals and 1% of respondents were highly aware of easy

payment schemes/methods in hospitals.

Findings indicate a majority of respondents were highly unaware of easy payment

schemes/methods in private general hospitals.

49%

25%

16%

9%

1%

0

10

20

30

40

50

60


P a g e | 104


4.2.16.3 Awareness of Different Type of Services Offered Under Medical Insurance

Figure 61 Awareness of Different Type of Services Offered Under Medical Insurance


38% of respondents were highly unaware of different services offered by hospitals under

personal/company insurance, 18% of respondents were unaware of different services offered by

hospitals under personal/company insurance, 18% of respondents were neutral of different

services offered by hospitals under personal/company insurance, 19% of respondents were aware

of different services offered by hospitals under personal/company insurance and 7% of

respondents were highly aware of different services offered by hospitals under

personal/company insurance.

Findings indicate that a majority of respondents were highly unaware of different services

offered by private general hospitals under personal/company insurance.

38%

18% 18% 19%

7%

0

5

10

15

20

25

30

35

40


P a g e | 105


4.2.16.4 Awareness of the Latest Technology

Figure 62 Awareness of the Latest Technology


47% of respondents were highly unaware of the latest technology that were available in their

selected hospital, 14% of respondents were unaware of the latest technology that were available

in their selected hospital, 22% of respondents were neutral of the latest technology that were

available in their last visited hospital, 14% of respondents were aware of the latest technology

that were available in their last visited hospital and 3% of respondents were highly aware of the

latest technology that were available in their last visited hospital.

Findings indicate that a majority of respondents were highly unaware of the latest technologies

that were available in their last selected private general hospital.

47%

14%

22%

14%

3%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 106


4.2.17 Behavior of Medical Personals

4.2.17.1 Co-operative Nature of Visiting Consultants/Doctors

Figure 63 Co-operative Nature of Visiting Consultants/Doctors


Findings indicate that a majority of respondents were satisfied with the co-operative nature of

visiting consultants/doctors in private general hospitals that depicts the perception of service


3.5% 6.5%

22%

58.5%

9.5%

0

10

20

30

40

50

60

70


P a g e | 107


4.2.17.2 Co-operative Nature of Hospital Staff

Figure 64 Co-operative Nature of Hospital Staff


3% of respondents were highly dissatisfied with the co-operative nature of hospital staff, 7% of

respondents were dissatisfied with the co-operative nature of hospital staff, 34% of respondents

were neutral with the co-operative nature of hospital staff, 48% of respondents were satisfied

with the co-operative nature of hospital staff and 8% of respondents were highly satisfied with

the co-operative nature of hospital staff.

Findings indicate that a majority of respondents were satisfied with the co-operative nature of

hospital staff in private general hospitals that indicates perception of service quality and


3% 7%

34%

48%

8%

0

10

20

30

40

50

60

Highly Dissatisfied


P a g e | 108


4.2.17.3 Medical Staff Behavior towards Patient’s

Figure 65 Medical Staff Behavior towards Patient’s


2% of respondents were highly dissatisfied with the medical staff behavior towards patients, 5%

of respondents were dissatisfied with the medical staff behavior towards patients, 35% of

respondents were neutral with the medical staff behavior towards patients, 49% of respondents

were satisfied with the medical staff behavior towards patients and 9% of respondents were

highly satisfied with the medical staff behavior towards patients.

Findings indicate that a majority of respondents were satisfied with the medical staff behavior

towards patients in private general hospitals that indicates perception in service quality and


2% 5%

35%

49%

9%

0

10

20

30

40

50

60

Highly Dissatisfied


P a g e | 109


4.2.17.4 Attentiveness of Medical Staff during Emergency Treatments

Figure 66 Attentiveness of Medical Staff during Emergency Treatments


3% of respondents were highly dissatisfied with the attentiveness of medical staff during medical

treatments, 6% of respondents were dissatisfied with the attentiveness of medical staff during

medical treatments, 31% of respondents were neutral with the attentiveness of medical staff

during medical treatments, 52% of respondents were satisfied with the attentiveness of medical

staff during medical treatments and 8% of respondents were highly satisfied with the

attentiveness of medical staff during medical treatments.

Findings indicate that a majority of respondents were satisfied with the attentiveness of medical

staff during medical treatments in private general hospitals.

3% 6%

31%

52%

8%

0

10

20

30

40

50

60


P a g e | 110


4.2.17.5 Understanding of Patient’s Needs by Hospital Staff

Figure 67 Understanding of Patient’s Needs by Hospital Staff


Findings indicate that a majority of respondents were satisfied with the understanding of

patient’s need/s by hospital staff in private general hospitals that depicts the perception of service


1.5%

10.5%

34%

47.5%

6.5%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 111


4.2.17.6 Use of Effective Communication by the Medical Staff

Figure 68 Use of Effective Communication by the Medical Staff


Findings indicate that a majority of respondents were satisfied with the use of effective

communication by medical staff in private general hospitals that indicate the perception of

service quality and infrastructure in private general hospitals.

1.5%

13.5%

34%

47%

4%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 112


4.2.17.7 Respectfulness of Hospital Staff towards Different Patients Religious Beliefs

Figure 69 Respectfulness of Hospital Staff towards Different Patients Religious Beliefs


5% of respondents were highly dissatisfied with the respectfulness of hospital staff towards

different patients religious beliefs, 10% of respondents were highly dissatisfied with the

respectfulness of hospital staff towards different patients religious beliefs, 43% of respondents

were neutral with the respectfulness of hospital staff towards different patients religious beliefs,

36% of respondents were satisfied with the respectfulness of hospital staff towards different

patients religious beliefs and 6% of respondents were highly satisfied with the respectfulness of

hospital staff towards different patients religious beliefs.

Findings indicate that a majority of respondents were neutral with the respectfulness of hospital

staff towards different patient’s religious beliefs in private general hospitals.

5%

10%

43%

36%

6%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 113


4.2.18 Overall Satisfaction of Service Quality in Private General Hospitals

Figure 70 Overall Satisfaction of Service Quality in Private General Hospitals


10% of respondents were high dissatisfied with private general hospitals with regard to services,

14% of respondents were dissatisfied with private general hospitals with regard to services, 19%

of respondents were neutral with private general hospitals with regard to services, 46% of

respondents were satisfied with private general hospitals with regard to services and 11% of

respondents were highly satisfied with private general hospitals with regard to services.

Findings indicate that a majority of respondents were satisfied with private general hospitals with

regard to services and infrastructure facilities that indicate the perception of service quality in


10%

14%

19%

46%

11%

0

5

10

15

20

25

30

35

40

45

50


P a g e | 114


4.2.19 Overall Satisfaction of Infrastructure Facilities in Private General Hospitals

Figure 71 Overall Satisfaction of Infrastructure Facilities in Private General Hospitals


Research findings indicated that a majority of respondents (52.5%) were overall satisfied with

the infrastructure facilities that are available in private general hospitals. That depicts the

perception of consumer satisfaction in private general hospitals in Colombo district of Sri Lanka.

6%

16.5%

23%

52.5%

2%

0

10

20

30

40

50

60


P a g e | 115


4.2 Data Analysis

4.2.1 Validation of Measurement Properties

In order to test the accuracy of the research dimensions a reliability and validity test were done to

identify the efficiency of each independent variable that may affect the dependents variable of

consumer satisfaction in the research.

4.2.2 Reliability

The reliability of a measure is established by testing for both consistency and stability (Sekaran

& Bougie, 2010). Consistency states how well the items measuring a concept drape together as a

group or set. Cronbach’s alpha is a reliability coefficient that shows how well the variables in

groups or set are positively correlated to one another. In simple terms reliability will be

measuring the goodness of data in a research. Reliability would assist the researcher to identify

the accuracy of the data before primary analysis (Sekaran & Bougie, 2010).

4.2.2.1 Internal Consistency

As mentioned before internal consistency assists to identify how well the research will be groped

as a set (Sekaran & Bougie, 2010). In order to measure internal consistency Cronbach’s alpha

was used. The closer Cronbach’s alpha is to 1, the higher the internal consistency reliability.

Based on the dimensions or independent variables and dependent variable internal consistency

was measured both variables are illustrated below.

Dependent Variable: Consumer Satisfaction

Independent Variable: Service Quality, Infrastructure Facilities, Past Experience, Consumer

Awareness and Behavior of Medical Personals.

P a g e | 116


4.2.2.1.1Dependent Variable

4.2.2.1.1.1 Consumer Satisfaction

Table 5 Reliability Statistics for Consumer Satisfaction

Cronbach's Alpha N of Items

.869 2


The requirement for Cronbach’s alpha to be accepted is that the value should be more than 0.70.

The dependent variable that is consumer satisfaction Cronbach’s alpha is 0.896 which is

considered as acceptable rate hence it depicts a strong reliability.

4.2.2.1.2 Independent Variable

4.2.2.1.2.1 Service Quality

Table 6 Reliability Statistics for Service Quality

Cronbach's Alpha Cronbach's Alpha Based on

Standardized Items

N of Items

.898 .900 10


In considering the independent variable for reliability of service quality, it can be seen that all ten

indicators used in the dimension have received a Cronbach’s alpha value of more than 0.70

(0.898) that proves the reliability of service quality.

P a g e | 117


4.2.2.1.2.2 Infrastructure Facilities

Table 7 Reliability Statistics for Infrastructure Facilities

Cronbach's Alpha Cronbach's Alpha Based on

Standardized Items

N of Items

.964 .964 11


In consideration of independent variable reliability for infrastructure facilities, it can be observed

that all eleven indicators or items used in the dimension have received a Cronbach’s alpha value

of more than 0.70 (0.964) that depicts a strong reliability of infrastructure Facilities.

4.2.2.1.2.3 Past Experience

Table 8 Reliability Statistics for Past Experience


.889 2


In observing the independent variable reliability for past experience, it can be observed that the

two items used in the dimension have received a Cronbach’s alpha value of more than 0.70

(0.889) that proves the reliability of past experience.

P a g e | 118


4.2.2.1.2.4 Consumer Awareness

Table 9 Reliability Statistics for Consumer Awareness


.843 4

(Source: Data Survey)

In considering the independent variable reliability for consumer awareness, it can observe that all

four indicators or items of the dimension have received a Cronbach’s alpha value of more than

0.70 (0.843) that depicts a positive reliability of consumer awareness.

4.2.2.1.2.5 Behavior of Medical Personals

Table 10 Reliability Statistics for Behavior of Medical Personals


.884 7


In consideration of the independent variable for reliability for behavior of medical personals, it

can be observed that all 7 indicators or items of the dimension have received a Cronbach’s alpha

value more than 0.70 (0.884) that depicts a strong reliability of medical personals.

P a g e | 119


4.2.3 Validity

Validity can be defined as a test of measuring how consistently a developed instrument measures

a particular concept intended to be measured (Sekaran & Bougie, 2010).

Validity characterizes the degree to which a measurement procedure is competent of measuring

what is supposed to be measured. The term ‘validity’ is used in situations where measurement is

indirect, vague and cannot be specific in principle. To establish validity the statistical techniques

such as the Pearson correlation coefficient, factor analysis and regression is used for

measurements (Institute for Statistics Education, 2014).

Validity is categorized into three parts namely content, criterion and construct. Construct validity

is measured through convergent validity and Discriminant validity. Convergent validity is

obtained when two different components measuring the same component are highly correlated.

Discriminant validity is measured based on the theory that two components are to be predicted

uncorrelated.

Criterion validity is a measurement that is obtained to examine if the measurement scale

performs as expected in relation to other variables selected as a meaningful criteria. Criterion

validity as stated by Sekaran and Bougie (2010), the criterion validity assist to measure the fit the

theories associated with the test or research (Sekaran & Bougie, 2010).

P a g e | 120


4.2.3.1 Convergent Validity

Convergent validity is a measure of construct validity that measures the degree to which the

scale correlates positively with other measures of the same construct. In other terms, it is

established when the scores obtained with two different instruments measuring the same

indicator is highly correlated (Sekaran & Bougie, 2010).

To test the measure of convergent validity of the dimension Kaiser-Meyer-Olkin (KMO),

Bartlett’s test of Sphericity and average variance extracted (AVE) were estimated performing

factor analysis where the construct/composite reliability was measured by performing the

following formula using the data extracted from factor analysis.

The Standard values for establishing convergent validity are that the KMO should be greater than

0.5, the significance level of Bartlett’s test of Sphericity should be less than 0.05, AVE should be

greater than 0.5 and composite reliability should be greater than 0.7. The indicators in this

research did meet standards due to that indicators were not removed for tests. The estimates for

the above test are given in the below illustrated table (table 11) for the research.

Table 11 Convergent Validity Table

SQ INFRA PASTEXP AWARE BEHAV OVL

KMO 0.882 0.933 0.500 0.753 .874 0.500

Bartlett’s Test of

Sphericity

.000 .000 .000 .000 .000 .000

AVE 0.918 0.739 0.91 0.698 0.609 0.894

Composite Reliability 0.5287 0.969 0.951 0.902 0.914 0.941

P a g e | 121



In considering data in the above table (table 11) reveal that of the instrument developed for

measuring consumer satisfaction is established as the values of KMO exceeds the standard value

of 0.5, values of Bartlett’s test of Sphericity are significant at 0.05, AVE values of the instrument

meet the standard value of 0.5 and composite reliability values are greater than 0.7 on the

instrument.

P a g e | 122


4.2.3.2 Discriminant Validity

Sekaran and Bougie (2010) states that Discriminant validity is established when based on theory

that two variables are predicted to be highly uncorrelated. Discriminant validity is recognized by

measuring a paired correlation among each dimension with each other. The values should be less

than the AVE values in the correlation matrix if it greater than the AVE value Discriminant

validity is breached (Sekaran & Bougie, 2010).

Table 12 Discriminant Validity Table

SQ INFRA PASTEXP AWARE BEHAV OVL

SQMEAN Pearson

Correlation

0.894

Sig. (2-tailed)

N 200

INFRAMEAN Pearson

Correlation

.706** 0.918

Sig. (2-tailed) .000

N 200 200

PASTEXPMEAN Pearson

Correlation

.639** .578

** 0.739

Sig. (2-tailed) .000 .000

N 200 200 200

AWARMEAN Pearson

Correlation

.187** .207

** .049 0.91

Sig. (2-tailed) .008 .003 .494

N 200 200 200 200

BEHAVMEAN Pearson

Correlation

.742** .672

** .525

** .117 0.698

Sig. (2-tailed) .000 .000 .000 .099

N 200 200 200 200 200

OVLSQINFRAME

AN

Pearson

Correlation

.672** .731

** .536

** .167

* .686

** 0.609

Sig. (2-tailed) .000 .000 .000 .018 .000

N 200 200 200 200 200 200

**. Correlation is significant at the 0.01 level (2-tailed).

*. Correlation is significant at the 0.05 level (2-tailed).

P a g e | 123



According to the data illustrated in the table (table 12) the correlations of each pair of dimensions

or indicators are less than the AVE of each dimension. Therefore Discriminant validity of the

consumer satisfaction instrument can be observed.

P a g e | 124


4.3 Cross-Tabulation Analysis

4.3.1 Cross Tabulation between Race and Last Visited Hospital

Figure 72 Cross-Tabulation between Race and Last Visited Hospital


The figure above depicts a graphical illustration of the cross tabulation results between race and

last hospital visited by the respondents. When analyzing each private general hospital it can be

seen that more Sinhalese (49%) prefer to visit Asiri Hospital (General & Surgical) (21%) than

the other hospitals. And considering Muslims (30%) prefer to Lanka hospitals (17%) rather than

other hospitals and Tamils (21%) prefer Asiri Hospital (Surgical & General) (9%) more than any

other private general hospital.

12

5

8

11

9 8

18 17

4

21

3

9 10

6

3 2

1 1 2

5 4

14

7

0 1

2 1

3

1 1

3

5

3

0

5

10

15

20

25

Sinhala Muslim Tamil

Nawaloka

Durdans

Lanka (Apollo)

Asiri (General & Surgical)

Hemas

Oasis

Delmon

The Central

Park Hospital

Royal

Other

P a g e | 125


4.3.2 Cross-Tabulation between Monthly Income Range & Last Visited Hospital

Figure 73 Cross-Tabulation between Monthly Income Range & Last Visited Hospital


The figure above depicts the cross-tabulation between monthly income range and last visited

hospital by respondents. When considering the monthly income range respondents who earn a

monthly income range between 20000-40000 (12%) prefer Asiri hospital (General & Surgical)

(8%), respondents who earn a monthly income range between 40001-60000 (12%) prefer Lanka

hospitals (7%), respondents who earn between 60001-80000 (26%) prefer Asiri hospitals (11%),

respondents who earn a monthly income between 80001-100000 (15%) prefer Lanka hospitals

(6%) and respondents earn a monthly income range over 100000 (35%) prefer Lanka hospitals

(19%).

Overall it is clearly evident that majority of respondents (47%) prefer both Lanka and Asiri

based on the respondent monthly income range.

8

4 4

2

7

3

5

10

2

8

1

7 6 6

19

6

0

11

5

11

3 4 4 4 4

1 0

1 1 1 1 1 2

3 4

0 0

9

2

10

0 1

0

2 1

0 0 1

2 2 1

2

4

1

3

0

2

4

6

8

10

12

14

16

18

20

20000-40000 40001-60000 60001-80000 80001-100000 Over 100000

Nawaloka

Durdans

Lanka (Apollo)

Asiri (General & Surgical)

Hemas

Oasis

Delmon

The Central

Park Hospital

Royal

Other

P a g e | 126


4.3.3 Cross-Tabulation between Age Category & Number of Times Visited the Hospital

Figure 74 Cross-Tabulation between Age Category & Number of Times Visited the Hospital


The figure above illustrates the cross-tabulation between age category and number of times

visited the hospital by respondents. When considering age category and number of times, all age

groups have visited the hospital at least once (43%) during the last six months that depicts the

perception in medical needs.

1

3

0 0 0 0 0

11

8

20

25

7

9

7 8

10 11

14

12

3

5 4 4

5

7

3 4

3

0

3

1 1 2

1 0

1

3 2

1 1 0 0

0

5

10

15

20

25

30

16-25 26-35 36-45 46-55 56-65 66-75 Over 75

0 times

1 time

2 times

3 times

4 times

5 or more times

P a g e | 127


4.3.4 Cross-Tabulation between Monthly Income and Total healthcare Expenditure

Figure 75 Cross-Tabulation between Monthly Income and Total healthcare Expenditure


In analyzing the above depicted figure of cross-tabulation between monthly income and total

healthcare expenditure, it can be observed that most of the respondents (54%) are not aware of

their total healthcare expenditure. But most of the respondents who are earning a monthly

income of 20000-40000 (24%) are aware of their healthcare expenditure.

14 8 14 4 28

10

16

38

26

42

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

20000-40000 40001-60000 60001-80000 80001-100000 Over 100000

No

Yes

P a g e | 128


4.3.5 Cross-tabulation between Time Taken to Attend Patient’s Needs & Hospital Reputation

Figure 76 Cross-tabulation between Time Taken to Attend Patient’s Needs & Hospital

Reputation


The cross-tabulation figure generated above depicts the cross-tabulation between time taken to

attend patient’s needs and hospital reputation. It is evident that, respondents (52%) overall prefer

hospitals where the time taken to attend medical needs are efficient when considering the

reputation of private general hospitals (46%).

1

14

56

73

7 2

5

20

19

3

0

10

20

30

40

50

60

70

80

90

100

Highly Dissatisfied


No

Yes

P a g e | 129


4.3.6 Cross-Tabulation between Choose the Hospital Last Visited Again and Total Healthcare

Expense

Figure 77 Cross-Tabulation between Choose the Hospital Last Visited Again and Total

Healthcare Expense


In analyzing the above depicted figure of cross-tabulation between choosing hospital last visited

again and total healthcare expenses. It is evident that, respondents who are unaware of total

expenditure of healthcare (54%) will choose the last visited hospital again for healthcare

regardless of expenditure.

1 2 11 44 10 4 8

33

80

7

0

20

40

60

80

100

120

140

Extremely Unlikely

Somewhat Likely Neutral Somewhat Likely Extremely Likely

No

Yes

P a g e | 130


4.3.7 Cross-tabulation between marketing activities of last hospital visited and Awareness of

Latest Technology

Figure 78 Cross-tabulation between marketing activities of last hospital visited and Awareness of

Latest Technology


Based on the cross-tabulation between marketing activities and awareness of latest technology it

can be observed that respondents (54%) who were unaware of latest technology in private

general hospitals were not exposed to any marketing activities (65%) about the latest technology

used private general hospitals.

3

66

25

3

18

8

3

29

11

3

14 10

2 3 2

0

10

20

30

40

50

60

70

Yes No Maybe

Highly Unaware

Unaware

Neutral

Aware

Highly Aware

P a g e | 131


4.3.8 Cross-tabulation between Recommending Hospital to others and Influence of Healthcare

Expenditure

Figure 79 Cross-tabulation between Recommending Hospital to others and Influence of

Healthcare Expenditure


In considering cross-tabulation between recommending hospital for others and influence of

healthcare expenditure, it can be observed that a majority of respondents (67%) who

recommended the hospital to others were not influenced by healthcare expenditure (54%).

2 8 20 49 14 7 8

30

55

7

0

20

40

60

80

100

120

Extremely Unlikely

Somewhat Unlikely

Neutral Somewhat Likely Extremely Likely

No

Yes

P a g e | 132


4.4 Hypotheses Testing

4.4.1 Testing Hypotheses for Positive Relationship between Service Quality and Consumer

Satisfaction

Table 13 Model Summary for Service Quality

Model Summaryb

Mod

el

R R

Squar

e

Adjuste

d R

Square

Std.

Error

of the

Estimate

Change Statistics Durbin

-

Watso

n

R

Squar

e Chang

e

F

Chang

e

df

1

df

2

Sig. F

Chang

e

1 .672a

.451 .448 .74352 .451 162.65

4

1 19

8

.000 1.971

a. Predictors: (Constant), SQMEAN

b. Dependent Variable: OVLSQINFRAMEAN


As illustrated above the R2

provides the information about the goodness of a fit model. The

above table depicts that 45.1% of the variation can be explained by the model and 54.9% is

unexplained due to error. The R2

value is 0.451 which is low value.

Table 14 Coefficients for Service Quality

Coefficientsa

Model Unstandardized Coefficients Standardized

Coefficients

t Sig.

B Std. Error Beta

1 (Constant) -.814 .329 -2.477 .014

SQMEAN 1.187 .093 .672 12.754 .000

a. Dependent Variable: OVLSQINFRAMEAN


A hypotheses testing can be done to test the significance through two tail’s T-test.

P a g e | 133


Figure 80 ANOVA Table for Service Quality

ANOVAa

Model Sum of

Squares

df Mean Square F Sig.

1 Regression 89.918 1 89.918 162.654 .000b

Residual 109.457 198 .553

Total 199.375 199


b. Predictors: (Constant), SQMEAN


The ANOVA table generated above refelects the significance level between service quality and

consumer satisfaction. At 5% significance level the ‘p’ value obtained is at .000 therefore the

hypothesis can be accepted.

It can be concluded that due to the acceptance of the hypotheses there is a significant and

positive relationship between service quality and consumer satisfcation.

4.4.2 Testing Hypotheses for Positive Relationship between Infrastructure Facilities & Consumer

Satisfaction

Figure 81 Model Summary for Infrastructure Facilities

Model Summaryb

Mode

l

R R

Squar

e

Adjuste

d R

Square

Std.

Error of

the

Estimat

e

Change Statistics Durbin

-

Watson

R

Square

Chang

e

F

Change

df

1

df2 Sig. F

Chang

e

1 .731a

.534 .532 .68469 .534 227.28

3

1 19

8

.000 1.909

a. Predictors: (Constant), INFRAMEAN



P a g e | 134







Figure 82 Coefficients for Infrastructure Facilities

Coefficientsa


Coefficients

t Sig.

B Std. Error Beta

1 (Constant) .514 .193 2.667 .008

INFRAMEAN .805 .053 .731 15.076 .000



Therefore we accept the hypothsis coefficent which is significant individually, for the critical t

value for 198 df at 5% of significance at 15.076 that is better infrastructure facilities would lead

to better consumer satisfaction.

Figure 83 ANOVA TABLE for Infrastructure Facilities

ANOVAa

Model Sum of Squares df Mean Square F Sig.

1 Regression 106.552 1 106.552 227.283 .000b

Residual 92.823 198 .469

Total 199.375 199


b. Predictors: (Constant), INFRAMEAN


The ANOVA table generated above refelects the significance level between infrastructure

afcilities and consumer satisfaction. At 5% significance level the ‘p’ value obtained is at .000

therefore the hypothesis can be accepted.


positive relationship between infarstructure facilities and consumer satisfcation.

P a g e | 135


4.4.3 Testing Hypotheses for Positive Relationship between Past Experience and Consumer

Satisfaction

Figure 84 Model Summary for Past Experience

Model Summaryb

Model R R

Square

Adjusted

R

Square

Std.

Error of

the

Estimate

Change Statistics

R

Square

Change

F

Change

df1 df2 Sig. F

Change

1 .536a .288 .284 .84683 .288 80.019 1 198 .000

a. Predictors: (Constant), PASTEXPMEAN








Figure 85 Coefficients for Past Experience

Coefficientsa


Coefficients

t Sig.

B Std. Error Beta

1 (Constant) .978 .269 3.633 .000

PASTEXPMEAN .647 .072 .536 8.945 .000



P a g e | 136


Figure 86 ANOVA Table for Past Experience

ANOVAa


1 Regression 57.384 1 57.384 80.019 .000b

Residual 141.991 198 .717

Total 199.375 199


b. Predictors: (Constant), PASTEXPMEAN


The ANOVA table generated above refelects the significance level between infrastructure

afcilities and consumer satisfaction. At 5% significance level the ‘p’ value obtained is at .000



positive relationship between past experience and consumer satisfcation.

4.4.4 Hypothesses Testing for Positive Relationship between Consumer Awareness & Consumer

Satisfaction

Figure 87 Model Summary for Consumer Awareness

Model Summaryb

Model R R

Square

Adjusted

R

Square

Std.

Error of

the

Estimate

Change Statistics

R

Square

Change

F

Change

df1 df2 Sig. F

Change

1 .167a .028 .023 .98930 .028 5.711 1 198 .018

a. Predictors: (Constant), AWARMEAN








P a g e | 137


Figure 88 Coefficients of Consumer Awareness

Coefficientsa


Coefficients

t Sig.

B Std. Error Beta

1 (Constant) 2.972 .164 18.161 .000

AWARMEAN .169 .071 .167 2.390 .018



Figure 89 ANOVA Table for Consumer Awareness

ANOVAa


1 Regression 5.589 1 5.589 5.711 .018b

Residual 193.786 198 .979

Total 199.375 199


b. Predictors: (Constant), AWARMEAN


The ANOVA table generated above refelects the significance level between consumer awareness

and consumer satisfaction. At 5% significance level the ‘p’ value obtained is at .018 therefore the

hypothesis can be rejected.

It can be concluded that due to the rejection of the hypotheses there is a insignificant and

negative relationship between past experience and consumer satisfcation.

P a g e | 138


4.4.5 Hypotheses Testing for Positive Relationship between Behavior of Medical Personal &


Figure 90 Model Summary for Behavior of Medical Personal

Model Summaryb

Model R R

Square

Adjusted

R

Square

Std.

Error of

the

Estimate

Change Statistics

R

Square

Change

F

Change

df1 df2 Sig. F

Change

1 .686a .470 .468 .73036 .470 175.767 1 198 .000

a. Predictors: (Constant), BEHAVMEAN





above table depicts that 47% of the variation can be explained by the model and 53% is



Figure 91 Coefficients for Behavior of Medical Personals

Coefficientsa


Coefficients

t Sig.

B Std. Error Beta

1 (Constant) -.331 .281 -1.179 .240

BEHAVMEAN 1.047 .079 .686 13.258 .000



P a g e | 139


Figure 92 ANOVA Table for Behavior of Medical Personal

ANOVAa


1 Regression 93.758 1 93.758 175.767 .000b

Residual 105.617 198 .533

Total 199.375 199


b. Predictors: (Constant), BEHAVMEAN


The ANOVA table generated above refelects the significance level between behavior of medical

personal and consumer satisfaction. At 5% significance level the ‘p’ value obtained is at .000



positive relationship between behavior of medical personal and consumer satisfcation.

P a g e | 140


4.4.6 Multiple Regression for Consumer Satisfaction

Figure 93 Model Summary for Consumer Satisfaction

Model Summaryb

Model R R

Square

Adjusted

R

Square

Std.

Error of

the

Estimate

Change Statistics

R

Square

Change

F

Change

df1 df2 Sig. F

Change

1 .783a .613 .607 .62715 .613 103.637 3 196 .000

a. Predictors: (Constant), BEHAVMEAN, INFRAMEAN, SQMEAN







value is 0.783 which is high value.

P a g e | 141


Figure 94 Coefficients for Multiple Regressions

Coefficientsa

Model Unstandardized

Coefficients

Standardized

Coefficients

t Sig.

B Std. Error Beta

1 (Constant) -.805 .286 -2.812 .005

SQMEAN .289 .129 .163 2.240 .026

INFRAMEAN .475 .073 .431 6.536 .000

BEHAVMEAN .420 .107 .275 3.939 .000



Y = 0 + 2 X2 +3 X3 + E

Where Y = Dependent variable i.e. consumer satisfaction

B0 = constant value or Y intercept

X1 = Service quality

X2 = Infrastructure facilities

X3 = Behavior of Medical Personal

E = Error Term

b1, b2, b3 & b4 = Coefficients of the variable X

Y = (0.805) + 0.289X1 + 0.475X2 + 0.420X3 + E

Overall Consumer Satisfaction = (0.805) + 0.289Service quality + 0.475Infrastructure Facilities

+ 0.420Behavior of Medical Personal + Error Terms

P a g e | 142


Figure 95 T-Test Graph for Service Quality


As shown above figure since the observed 2 lies in the critical region, we reject the null

hypothesis that is 2 = 0.

At α = 5%, [t] > t-3, α/2;

t = 2.240 & t-3 = 22 & α/2 = 2.5% (2.074)

Therefore 2.240 > 1.972

Therefore we accept H1: 2 0. 1 partial regression coefficients is individually statistically

significant, for the critical t value for 197 d.f. at α = 5%. level of significance at 2.240 i.e. better

service quality would lead to better consumer satisfaction.

P a g e | 143


Figure 96 T-Test Graph for Infrastructure




At α = 5%, [t] > t-3, α/2;

t = 6.536 & t-3 = 22 & α/2 = 2.5% (2.074)

Therefore 6.536 > 1.972



infarstructure facilities would lead to better consumer satisfaction.

P a g e | 144


Figure 97 T-Test Graph for Behavior of Medical Personal




At α = 5%, [t] > t-3, α/2;

t = 3.939 & t-3 = 22 & α/2 = 2.5% (2.074)

Therefore 3.939 > 1.972



behavior of medical personal would lead to better consumer satisfaction.

P a g e | 145


Figure 98 ANOVA Table for Regressions

ANOVAa

Model Sum of

Squares

df Mean Square F Sig.

1 Regression 122.286 3 40.762 103.637 .000b

Residual 77.089 196 .393 Total 199.375 199


b. Predictors: (Constant), BEHAVMEAN, INFRAMEAN, SQMEAN


From the ANOVA table, under the df column, Fov = 103.637. Using the significance level of .05,

implies the critical F-value or Fcv = F.05, 2, 22= 3.44 from the F distribution table. Thus, we can

reject H3 and H5. This means that the Linear Regression Model that has been estimated is not a

mere theoretical construct; indeed it does exist and is statistically significant.

Independent Variables Capped

Past experience and consumer awareness were capped because of low T values and was

statistically insignificant.

P a g e | 146


CHAPTER FIVE

P a g e | 147


5.1 Introduction

This chapter focuses on discussing how each of the objectives set at the beginning of the study

were achieved, to ensure the completeness and meaningful contribution of this study. In addition

to this findings are related to the literature review in order to expand on the literature which

exists and discuss how the relationship between consumer satisfactions can be related to the

international context in healthcare. Another purpose of this chapter will be to review the

conceptual framework in line with the research findings.

5.2 Achievement of Objectives

5.2.1 To identify the factors influencing consumer decision making process when selecting a

hospital.

There were several reasons identified through the research with regard to consumer decision

making process when selecting a hospital for medical care. Firstly the Sri Lankan healthcare

industry is a ‘doctor centric’ market where many people prefer their doctor of choice (52%) due

to such reasons their selection of hospitals tends to limited. But considering the research findings

it has evident that though people are ‘doctor-centric’ their selection of hospital selection was not

limited. The primary reason was because the respondents doctor of choice (46%) visit hospitals

that are dedicated of achieving consumer satisfaction.

Private General Hospitals in Sri Lanka attracted some of the best consultants in healthcare who

have large number of patients by offering higher payments. And some private general hospitals

such as The Central Hospital in Norris Canal road have one of the best in-house doctors for OPD

services and ENT treatments. Respondents (59%) stated that if visited any private general

hospital in Colombo they are able to channel the best doctors and their doctor of choice are also

available for channeling.

P a g e | 148


Secondly, it was identified that for medical payments respondents who are insured under medical

packages (32%) were highly satisfied because all medical insurance providers included all 8

private general hospitals in the Colombo district that didn’t have effect in consumer decision

making process. This factor led wider selection of hospitals for consumers, respondents who had

employer sponsored medical insurance (29%) stated they were limited to one certain hospital

which majority of respondents stated Hemas hospital, pointed out that they were limited in

selection the particular hospital was equipped with all the facilities that they needed in

healthcare.

Finally some respondents (9%) stated that their selection was limited due to the fact of healthcare

expenditure and the absence of medical technology in private general hospitals in Colombo.

5.2.2 To assess the level of consumer awareness with regard to the services offered and marketed

by private general hospitals

Consumer awareness in healthcare in Sri Lanka tends to be moderate due to the lack of

advertisements and awareness campaigns conducted by private general hospitals in the Colombo

district. Some of the respondents (19%) who were aware of healthcare were either insured under

personal insurance medical packages and others (5%) were having knowledge of healthcare

procedures through the internet or newspaper articles.

Currently respondents (3%) who were aware of healthcare services were exposed to television

advertisements and healthcare programs. Respondents who last visited private general hospital

was Nawaloka hospital stated that they were exposed to marketing activities that was telecasted

in Rupavahini and Vasantham television channels. And many respondents (11%) who were

housewives were exposed healthcare through television programs that were sponsored by some

of the leading private general hospitals.

Consumers were aware of the basic technology in healthcare such as CT scan and etc. But all the

other technological equipments were confusing for some respondents (56%). Many stated that

P a g e | 149


they were not aware of some of the medical terms frequently used by both hospital staff and

doctors that as result have created doubt among consumers (46%).

Finally, some respondents (19%) who were aware of services were either insured under personal

or employer sponsored medical insurance packages and the others were who keep track latest

healthcare developments and programs.

5.2.3 To identify consumer preference towards various private general hospitals

A research published by World Health Organization with regard to aging population has

predicted that out of the world population there will be an increase in the elderly population who

would have passed the age of 80 in 2050. This effect has led to high investments to the global

healthcare industry to cater medical needs efficiently. This effect is also present in Sri Lanka

where many private hospitals are dedicated in improving service quality and infrastructure

facilities.

Firstly many private general hospitals have developed their infrastructure facilities and added

more staff for better service. Respondents (67%) preferred private general hospitals who had the

best doctor’s and best infrastructure facilities and it was observed that though time taken by

visiting consultants were relatively more respondents (52%) were satisfied this was because the

hospital infrastructure was built to keep the consumer occupied such as the a cafeteria and

television equipped with international television channels.

Finally some respondents (29%) who were dissatisfied with the preference in private general

hospitals was due to the over-crowded waiting in Asiri General hospital but those respondents

stated that infrastructure was made support ventilation and proper seating was available.

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5.2.4 To identify the consumer issues with regard to service quality and infrastructure facilities

offered by private general hospitals

Overall findings indicated that there were no bottlenecks in both services and infrastructure

facilities offered by private general hospitals from consumer’s point of view. It was observed

many respondents (70%) were satisfied with the services such as the appearance and the

effectiveness of hospital staffs were highly appreciated the primary reason was because whatever

the doubt the consumer had the medical personal or staff have been trained to tackle it or provide

solutions for the matter.

Infrastructure facilities in private general hospitals were highly appreciated by respondents

(69%) especially The Central Hospital in Colombo was well received by respondents as a model

for advance infrastructure facilities in private general hospitals.

Finally it can be said that the consumer’s point of view in services and infrastructure facilities in

private general hospital tends to have positive view.

5.2.5 To assess policy implications and present recommendations to further improve the service

quality and infrastructure at private general hospitals

The recommendations with regard to the benefits of improving private hospital services and

infrastructure facilities is been presented in Chapter 6.

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5.3 Relating Findings to Literature Review

Bitner and Hubbert (1995) they suggested an ‘encounter satisfaction’, illustrates the satisfaction

the consumer experiences in regard to the service offered and the overall satisfaction with the

service provider is reliant on the number of services offered within the different parts of a certain

organization or with different employee services this can result in positive word of mouth among

consumers especially when considering the healthcare industry (Bitner, 1995).

This statement by Bitner and Hubbert with regard to encounter satisfaction was able to be

observed by responses that proved the theory. There has been positive word of mouth if services

offered were up to standards in private general hospitals that would be result of positive word of

mouth.

There are three main reasons in measuring consumer satisfaction. (a) The primary objective of a

health care provider is consumer satisfaction essentially, (b) Consumer satisfaction measures will

assist in obtaining data about structures, processes and outcome of health care & finally (c)

Satisfied and dissatisfied consumers have various behavioral intentions. For instance highly

satisfied consumers would recommend the health care provider to their relatives and friends

(Boshoff & Gray, 2004).

This proves the pragmatic model designed by Richard Baker (1997), that consumer satisfaction

has been treated as an attitude that was an evaluative judgement and secondly attitude is

considered in the model as a continuous rather than the dichotomous variable and finally the

model is multi dimensional that consists of different elements of care each causing differences in

satisfaction. This in order to identify when a consumer is satisfied with a certain care there will

be an opposite reaction in another service which the consumer would be dissatisfied (Baker,

1997).

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Such factor in the model that is characteristics of patients and interaction with healthcare was

witnessed in the private general hospitals in Colombo district among respondents. It was further

observed that consumer satisfaction may influence their attitudes towards health care, in the

model the characteristics of consumers are shown as influencing the priorities they assign to

different elements of care and to their different levels of satisfaction after an interaction with the

health care system. Consumer characteristics that may influence include age, sex, past

experience of care, expectations, health, cultural factors and other factors. Finally, consumer

satisfaction can influence consumer future behavior such as agreement with the advice or

whether they change doctors.

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5.5 Re-examining the Conceptual Framework

The conceptual framework was re-examined based on the respondents data obtained and few

minor changes were done after initial findings. Specifically the inter-relationship between the

dimensions needed to be reviewed. Therefore the modified conceptual framework is shown

below.

For this purpose past experience variable was removed because the variable was insignificant

and low regression values were observed. Theoretically past experience did not have an effect

based on Bittner & Hubbert (1995) because of encounter satisfaction that was determined word

of mouth.

Figure 99 Re-Examined Conceptual Framework

(Source: Research Author)

Service quality

Infrastructure Facilities

Consumer Awareness

Behavior of Medical Personals


Dependent Variable

Independent Variable

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5.5 Conclusion

In conclusion this chapter discussed how each objective of this research was achieved and such

achievements or findings were related to the literature review. Slight modification was done to

the conceptual framework based on the relative findings in which one independent variable was

removed due to the absence of a positive relationship between the dependent variable. However,

the basic structure and relationship between the different aspects of the conceptual framework

holds true and hence remains the same.

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CHAPTER SIX

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6.1 Introduction

This chapter will focus on the relative findings and recommendation that have been presented by

this study. The information will be derived by the self-administered questionnaire for consumer

satisfaction towards service quality and infrastructure facilities in private general hospitals in

Colombo district of Sri Lanka.

6.2 Overall Findings

Overall findings indicated that the private general hospitals have reached the level of market

maturity that can be proved by the number of satisfied consumers in Colombo district. In

comparison to independent research done by Ram ratings states that many consumers leave with

a doubt in private general hospitals because of the infrastructure facilities. But the fact that

people leave in doubt is mainly because of healthcare expenditure. People who earn more are

able to obtain better infrastructure facilities in a selected hospital (Cross-tabulation analysis

chapter 4) this can be proved by the number of respondents who earned over 100000 monthly

and comparing the number of respondents who earned between 20000-40000 monthly for

healthcare expenditure.

And it is a well known fact that private general hospitals do not participate in marketing

campaigns only few private general hospitals such as Nawaloka and Lanka Hospitals. However

considering the number of private general hospitals in the Colombo district positive word of

mouth can be used one form of marketing for private general hospitals mainly from visiting

doctors, effective staff and infrastructure.

It was also observed many of the respondents were not exposed to any international healthcare

services respondents who were exposed responded in a neutral manner for the service and

infrastructure in private general hospitals this was due to the fact that many private general

hospitals has been made to cater local consumers and still the hospitals are in the process of

developing procedures to cater international consumers.

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Findings also indicated that respondents are shifting from a ‘doctor-centric’ approach to a much

more ‘institutionalize’ approach where rather than being loyal to the doctor the consumer would

be loyal to the hospital. Such instances were observed when a majority of respondents who

picked doctors recommendation for basis of selection also picked majority of the time past

experience that indicates loyalty such instances of shifts are seen in developing countries.

6.3 Recommendations

6.3.1 Benchmarking Hospital Services against International Healthcare Services

A recent publication by the Institute of Policy Studies or IPS titled ‘Private Hospital Healthcare

Delivery’ and authored by D.G. Dayaratne has looked at the issues of equity, fairness and

regulation of the sector. The study says that the “private sector is driven be the desire to

maximize profits and hence concentrate their operations in densely-populated urban areas”. This

is not an argument to discredit the private sector operations since private investments should

always seek profits in order to survive in the market.

However, in order to deliver better services the private general hospitals should focus

international healthcare services. This can be initiative to medical tourism where it is less seen in

Sri Lanka. Minister of Health stated that some foreigners has come to Sri Lanka and undertaken

medical care for free public sector hospitals due to such factor it has become evident that private

hospitals are not taking the initiative of promoting their services.

And IPS states that many foreigners who undertake medical care are not satisfied with services

offered by private hospitals. And it was found that many hospital staff is not trained to

international standards which lack the ability of learning. If medical tourist is to be developed

many private hospitals should take the initiative of changing the perspective from local

consumers to international consumers alike.

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6.3.2 Changing the Private Sector Healthcare Model

Private hospitals provide a valuable service to the people of this country. But the model used by

the private healthcare providers has been defective right from the beginning.

As the IPS study has also revealed, it is the public sector healthcare specialists who are serving

as channeled consultants in private sector hospitals.

Private hospitals also advertise boldly that those specialists are permanently attached to various

Government hospitals to establish their credentials and thereby lure patients for channeled

consultations. Hence, it is simply those specialists going on a ‘circuit’ from one hospital to

another after they have completed their services at the relevant Government hospitals. This

circuit visit of the medical specialists is fraught with several problems for the patients as well as

the specialists.

This has caused many defects in the procedures many doctors are delayed in attending patients;

there is always long waiting periods for patients. Such facts have forced private hospitals to

consider alternative techniques to keep the consumers occupied. But to a certain extent the this

defect is been step by step reducing this is because many private hospitals are employing in-

house doctors.

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6.3.3 Reforms for Private Healthcare Policies

The private healthcare registration healthcare Act no. 21 of 2006 is the only act presented by the

government to regulate private healthcare activities. Finding indicate that many private hospitals

charges above the rate of required charges and it is evident that the consumer is requested to visit

the hospital for tests or to meet the doctor monthly in order to charge the consumer.

As stated before this might be one of the reasons foreigners who come to Sri Lanka are not

seeking healthcare from the private sector. If the government takes the initiative of brining in

policies that would regulate the charges in private hospitals many Sri Lankans would have the

ability of satisfying their medical needs from private healthcare without being pushed or forced

in seeking medical care from private hospitals.

And private hospitals in Sri Lanka are trying to do better than the Government hospitals. That is

a laudable goal. But they should try to benchmark not with the Government hospitals but the

high caliber foreign hospitals. In that respect, they have a lot to learn about courtesy, diagnosis of

ailments by putting several heads together and using the most modern diagnostic equipment and

how patients should be treated.

It is imperative that policy makers look into a comprehensive public and private partnership with

private sector providers. At present there is an unofficial partnership existing in laboratory test

procedures, between government hospitals and private laboratories. Evaluation of the current

situation where 5000 patients are in the waiting list for heart surgeries in government hospitals,

rings the alarm for urgent government action in this direction.

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6.3.4 Catering Demanding Healthcare Needs

In Sri Lanka private hospital system there is no specific separation of primary care, secondary

care and tertiary care as in government hospitals. It is to be noted that in Sri Lanka there is only

very small presence of private institutions at the secondary and tertiary level.

There have been many incidents in small private hospitals where treatments offered for common

alignments are often irrational, ineffective and sometimes harmful. Apart from routine treatment,

the private sector has been unable to respond positively to a crisis during an epidemic and is ill-

equipped to avert death.

Also, there is variability in the cost of services provided by these institutions. Very often the

patients or consumers have no information regarding the costs he or she is likely to incur when

they seek care or the service that needs to be obtained.

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Annexure A

Questionnaire

The following questionnaire is conducted for the basis for identifying consumer satisfaction

towards service quality and infrastructure facilities in private general hospitals in the Colombo

District. The research will be considering out-patients in order to identify the consumer

satisfaction with private general hospitals.

Please Mark as ( ) for your Selected Answer

1. Gender

Male

Female

2. Age Category

16-25 26-35 36-45 46-55 56-65 66-75 Over 75

3. Marital Status

Single Married Widowed

4. Race

Sinhala Muslim Tamil Others…………………………….

5. Religion

Buddhist Islam Hindu Christian Catholic Atheist

6. Education Level

GCE OL GCE AL Diploma Graduate Masters

PhD Undergraduate Other………………………..

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7. Occupation

Students Housewife Managers Professionals

Executives Businessmen Other……………………..

8. Monthly Income Range

20000-40000 40001-60000 60001-80000 80001-100000

Over 100000

9. Reasons for Selecting Private General Hospitals (Multiple answers can be selected)

Quality in health care Better facilities Better consultants Value for time

& Money Convenience Other……………………

10. Your Basis for the Hospital (Multiple answers can be selected)

Doctor’s Recommendation Past Experience Closet Proximity from Home

Insurance (Personal) Insurance (Company) Third Party Recommendation

Hospital Promotions Others…………………………….

11. Last Private General Hospital Visited

Nawaloka Durdans Lanka (Apollo) Asiri (General or Surgical)

Hemas Oasis Delmon The Central Park Hospital Royal

12. Do you consider reputation of the hospital prior to selecting/visiting a hospital

Yes No

13. The Purpose of visit to Private General Hospitals in the last six months (Multiple

answers can be selected)

Medical Channeling Services OPD Services Organization Medical Checkups

Personal Medical Checkups To Obtain Laboratory Tests Others……………..

14. Are you insured under any medical insurance packages that covers all costs

Yes No Maybe

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15. Does your medical insurance package limit your selection in hospitals

Yes No

16. How many times have you visited a certain Hospital in the last six months (Q.N.11)

0 1 2 3 4 5 or more

17. How likely would you choose the hospital last visited for health care again

Extremely Likely Somewhat Likely Neutral Somewhat Unlikely

Extremely Unlikely

18. How likely would you recommend the last visited hospital to others

Extremely Likely Somewhat Likely Neutral Somewhat Unlikely

Extremely Unlikely

19. Did cost (healthcare expenses) influence your decision in selecting your last visited

hospital

Yes No

20. Are you aware of your total expenditure spent on health care needs

Yes No

21. Service Quality experienced at your Last Visited Hospital

Highly

Satisfied

Satisfied Neutral Dissatisfied Highly

Dissatisfied

The appearance of administration

staff

The appearance of medical staff

The ease of access to information

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The effectiveness of hospital staff

The ease of providing complaints

or feedbacks

The ease of completing/attending

to administrative requirements

The reliability of instructions &

information provided by staff

Highly

Satisfied


Dissatisfied

The time taken to attend patient’s

needs by hospital staff

The time taken to attend to

patient’s needs by visiting

consultants/doctors

The ease of making appointments

for sickness or checkup facilities

offered by hospitals

22. Infrastructure Facilities in your Last Visited Hospital

Highly

Satisfied


Dissatisfied

The effectiveness of signs and

directions

The ease of moving from one end

to the other in the hospital

The level of safeguard or security

in the hospital environment

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The layout and infrastructure

facilities were visually appealing

a. Entrance

b. Reception

c. Rooms

The hospital was well equipped

with cable TV, proper air

conditioning, proper seating.

The hospital was spacious and

clean

Highly

Satisfied


Dissatisfied

The hospital environment was

peaceful

The infrastructure facilities were

built to support patient privacy

23. Does the hospital selected by you have the following facilities

Yes No

Restaurant

Pharmacy

Automatic Teller Machines (ATM)

Retail Store

Florists

Prayer Rooms

24. Have you been exposed to any type of marketing information of your selected hospital

after your last visited hospital

Yes No Maybe

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25. Your awareness of health care

Highly

Aware

Aware Neutral Unaware Highly

Unaware

Are you aware of different

types of medical packages on

offer

Are you aware of the

differences of different

medical packages on offer

Are you aware of easy

payment schemes/methods

Highly

Aware

Aware Neutral Unaware Highly

Unaware

Are you aware of types of

services offered by the

hospital which are covered by

personal/company insurance

Are you aware of the latest

technology available in the

hospital selected by you

26. Behavior of hospital staff

Highly

Satisfied


Dissatisfied

The co-operative nature of

visiting consultants/doctors

The co-operative nature of

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hospital staff

Medical staff behavior towards

patient’s

Attentiveness of medical staff

during emergency treatments

The understanding of patient’s

need/s by hospital staff

Effective communication used

by medical staff

The respectfulness of hospital

staff towards different patient

religion beliefs

27. Overall are you satisfied with private general hospitals with regard to services

Highly Satisfied Satisfied Neutral Dissatisfied

Highly Dissatisfied

28. Overall are you satisfied with private general hospitals with regard to Infrastructure

Facilities

Highly Satisfied Satisfied Neutral Dissatisfied

Highly Dissatisfied

Thank You

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Annexure B

Statistics for Survey Data

Service Quality

Total Variance Explained

Component Initial Eigenvalues Extraction Sums of Squared Loadings

Total % of Variance Cumulative % Total % of Variance Cumulative %

1 5.288 52.877 52.877 5.288 52.877 52.877

2 .910 9.100 61.977

3 .811 8.106 70.083

4 .638 6.380 76.463

5 .559 5.588 82.052

6 .497 4.970 87.022

7 .394 3.943 90.965

8 .376 3.758 94.723

9 .316 3.156 97.879

10 .212 2.121 100.000

Extraction Method: Principal Component Analysis.

Component Matrixa

Component

1

Ease of Completing administrative Requirements .790

Time taken to Attend Patient's Needs by Hospital Staff .783

Appearance of Medical Staff .750

Ease of Making Appointments .748

Effectiveness of Hospital Satff .732

Ease of Access to Information .729

Reliability of Instructions and Information Provided by Staff .696

Appearance of Administration Staff .688

Ease of Providing Complaints or Feedbaqck .685

Time taken to Attend Patient's Needs by Visiting Consultants .659


a. 1 components extracted.


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1 8.125 73.866 73.866 8.125 73.866 73.866

2 .800 7.272 81.138

3 .569 5.172 86.310

4 .353 3.208 89.518

5 .305 2.772 92.290

6 .236 2.144 94.434

7 .209 1.896 96.330

8 .120 1.093 97.424

9 .107 .969 98.393

10 .094 .851 99.244

11 .083 .756 100.000


Component Matrixa

Component

1

Visual Appealingness of the Rooms .932

Visual Appealingness of the Entrance .925

Visual Appealingness of the Reception .915

Visual Appealingness of Infrastructure .906

Hospital was Spacious and Clean .894

Safegaurd or Security in the Enviroment .859

Hospital Enviroment was Peaceful .836

Equipped with Cable TV, Proper AC and Seating .830

Ease of Moving from One End to the Other .817

Effectiveness of Signs and Directions .781

Infrastructure Facilities were built to Support Patient Privacy .736




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Past Experience




1 1.812 90.595 90.595 1.812 90.595 90.595

2 .188 9.405 100.000


Component Matrixa

Component

1

Choose the Hospital Last

Visited Again .952

Recommend the Last

Visited Hospital to Others .952

Extraction Method: Principal Component

Analysis.



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Consumer Awareness




1 2.796 69.901 69.901 2.796 69.901 69.901

2 .595 14.871 84.772

3 .442 11.060 95.832

4 .167 4.168 100.000


Component Matrixa

Component

1

Awareness of Different

Medical Packages in each

Category

.900

Awareness of Easy

Payment Methods .891

Awareness of Latest

Technology .817

Awareness of Services

offered under Insurance by

Hospital

.724


Analysis.



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Behavior of Medical Personal




1 4.222 60.312 60.312 4.222 60.312 60.312

2 .852 12.175 72.487

3 .638 9.115 81.601

4 .418 5.974 87.575

5 .401 5.725 93.300

6 .267 3.820 97.120

7 .202 2.880 100.000



Component Matrixa

Component

1

Meidcal Staff Behaviour

towards Patient's .863

Understanding of Patient's

Needs by Hospital Staff .839

Effective Communication by

Medical Satff .823

Co-operative Nature of

Hospital Satff .817

Attentiveness of Medical

Satff during Emergency

Treatments

.806

Co-operative Nature of

Visiting Consultants .669

Respectfulness of Hospital

Satff towards Religion .576


Analysis.


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Regression for Survey Data

Service Quality


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Past Experience


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Consumer Awareness


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Behavior of Medical Personal


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Overall Multiple Regressions


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Annexure C

Water Supply Quantities for Out-patients.

(Source: WHO, 2011)

General Medical waiting room for out-patients

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Waste Management requirements in hospitals in three colored containers

(Source: WHO, 2011)

(Source: WHO, 2011)

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Waiting Area requirements

(Source: WHO, 2011)

Consultation Rooms Infrastructure Requirements in Hospitals

(Source: WHO, 2011)

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Annexure D

PARLIAMENT OF THE DEMOCRATIC

SOCIALIST REPUBLIC OF

SRI LANKA

Published as a Supplement to Part II of the Gazette of the Democratic

Socialist Republic of Sri Lanka of July 14, 2006

—————————

—————————

[Certified on 14th July, 2006]

Printed on the Order of Government

—————————

PRIVATE MEDICAL INSTITUTIONS

(REGISTRATION)

ACT, No. 21 OF 2006

Private Medical Institutions (Registration)

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Act, No. 21 of 2006

1

Preamble.

Short title and

date of

operation.

[Certified on 14th July, 2006]

L.D. — O. 37/2003.

AN ACT TO PROVIDE FOR THE REGISTRATION, REGULATION, MONITORING

ANDINSPECTION OF PRIVATE MEDICAL INSTITUTIONS; ANDTO FOSTER

THE DEVELOPMENT OF, PRIVATE MEDICAL INSTITUTIONS; AND TO

PROVIDE FOR MATTERS CONNECTED THEREWITH OR INCIDENTAL

THERETO.

WHEREAS it has become necessary for the Government, in

the interest of providing a safe and efficient medical service

to the public, to set out a National Policy in relation to the

provision of medical services through private medical

institutions and to identify the manner in which such services

are to be so provided in order to achieve its objectives :

NOW THEREFORE BE it enacted by the Parliament of the

Democratic Socialist Republic of Sri Lanka as follows :—

1. This Act may be cited as the Private Medical

P a g e | 188


Institutions (Registration) Act, No. 21 of 2006 and shall come

into operation on such date as the Minister may appoint by

Order published in the Gazette (hereinafter referred to as the

“appointed date”)

2. (1) No person shall—

(a) establish or maintain on any specified premises; or

(b) operate or permit any other person to operate,

a Private Medical Institution, except under the authority of a

Certificate of Registration issued in that behalf in terms of

the provisions of section 4 of this Act.

(2) Any person who contravenes the provisions of

subsection (1) shall be guilty of an offence.

3. (1) Every application for a Certificate of Registration

shall be made to the Private Health Services Regulatory

Council through the respective Provincial Director of Health

Services in the prescribed form and shall be accompanied by

the prescribed fee, and all other relevant documents.

Private Medical

Institutions and

persons

operating them

to be registered.

P a g e | 189


Application for

registration.

2 Private Medical Institutions (Registration)

Act, No. 21 of 2006

(2) On receipt of the applications under subsection (1),

the Private Health Services Regulatory Council shall where

the Private Medical Institution and premises to which the

relevant application relates satisfies the criteria as may be

prescribed, inform the Provincial Director of Health Services

of the respective Province that the Council has no objection

to the registration of such Institution and premises and direct

the respective Provincial Director of Health Services to—

(a) register the Private Medical Institution and its

premises with the Private Health Services Regulatory

Council and register the applicant as the person

registered to maintain such Institution; and

(b) forward to the applicant the Certificate of

Registration in the prescribed form.

(3) A Certificate of Registration granted under this section

shall be valid for such period as shall be specified therein.

(4) A Certificate of Registration shall be renewed on

application being made in that behalf in the manner specified

P a g e | 190


in subsection (1), prior to one month of the date of expiry of

such Registration, and on payment of the prescribed renewal

fee.

(5) Fifty per centum of the fees collected by each

Provincial Director of Health Services under this section shall

be remitted to the respective Provincial Council.

(6) The Provincial Director of Health Services of the

Province shall in carrying out his duties, act in compliance

with such guidelines as are prescribed under this Act, relating

to the registration of Private Medical Institutions.

4. (1) Where any Private Medical Institution is being

operated or maintained by any person on any premises

without being registered as required by section 2, the

Provincial Director of Health Services shall inform the Private

Health Services Regulatory Council of such fact and the

Effect of

registering.


Act, No. 21 of 2006

3

Regulatory Council shall thereupon issue a directive to such

Institution to forthwith register such Institution with the

P a g e | 191


Regulatory Council within such period as shall be specified

in such directive.

(2) Non-compliance with a directive issued by the

Regulatory Council under subsection (1), shall be an offence

under this Act.

(3) Where any person or institution convicted of an offence

under subsection (2) continues to commit such offence after a

period of one month from the date of such conviction , the

Magistrate may upon application for a closure order being

made by the Regulatory Council, order the closure of that

Private Medical Institution being maintained on such premises,

until the institution or person convicted complies with the

directive issued by the Council under subsection (1).

5. (1) Any person or body of persons who is on the

appointed date, operating or maintaining a private medical

institution at any premises shall, within three months from

the appointed date, take such steps as are necessary to register

himself and the premises concerned with the Private Health

Services Regulatory Council.

(2) In giving effect the provisions of subsection (1), the

provisions of section 2, section 3 and section 4 of this Act

shall, mutatis mutandis apply, to and in relation thereto.

P a g e | 192


6. (1) There shall for the purposes of this Act be

established a Private Health Services Regulatory Council (in

this Act referred to as “the Council”), which shall consist

of—

(a) the following members appointed by the Minister

(hereinafter referred to as “appointed members”) :–

(i) a representative each to represent each of the

associations hereinafter set out, nominated by

the respective association;

(a) the Independent Medical

Practitioners Association;

Registration of

existing Private

Medical

Institutions.

Private Health

Services

Regulatory

Council.


Act, No. 21 of 2006

(b) the Sri Lanka Dental Association;

P a g e | 193


and

(c) the Society of General Medical

Practitioners;

(ii) one person each to represent the fields of

Accountancy, Management, Law and Nursing:

provided such person is a person who has

rendered distinguished service in his

respective field;

(iii) nine representatives from the Association of

Private Hospitals and Nursing Homes; and

(b) the following ex-officio members :—

(i) the Director General of Health Services;

(ii) the Director in-charge of development of the

Private Health Sector;

(iii) the Registrar of the Sri Lanka Medical

Council; and

(iv) the Provincial Director of Health Services of

each Province.

(2) The Director-General of Health Services shall be the

Chairman of the Council, and the Director of Private Health

Sector Development shall be its Secretary.

(3) An appointed member of the Council shall, unless

P a g e | 194


such member vacates office earlier by death, resignation or

removal or otherwise, hold office for a period of three years.

(4) An appointed member shall be deemed to have

vacated office if such member absents himself from three

consecutive meetings of the Council without any reason,

which the council considers as being an acceptable excuse.


Act, No. 21 of 2006

5

(5) (a) The quorum for any meeting of the Council shall

be seven members.

(b) The Chairman shall preside at all meetings of the

Council and in the absence of the Chairman, the members

present shall elect one from amongst them to preside at the

meetings.

(6) The Minister may at any time after assigning reasons

therefor, remove an appointed member of the Council from

office.

(7) An appointed member of the Council may at anytime

resign from his office by letter to that effect addressed to the

Minister.

(8) In the event of the vacation of office by an appointed

P a g e | 195


member by death, resignation, removal, the Minister shall,

having regard to the provisions of paragraph (a) of subsection

(1), appoint another person to succeed such member. The

member appointed to fill the vacancy shall hold office during

the unexpired period of the term of office of the member

whom he succeeds.

7. The Council shall, by name assigned to it under section

6, be a body corporate and shall have perpetual succession

and a common seal and may sue and be sued in such name.

8. (1) The Seal of the Council shall be in the custody of

the Secretary of the Council or any other member authorised

by the Council.

(2) The Seal of the Council may be altered in such manner

as may be determined by the Council.

(3) The Seal of the Council shall not be affixed to any

instrument or document except in the presence of the

Chairman of the Council, and one other member, both of

whom shall sign the instrument or document in token of their

presence:

Council to be a

body corporate.

Seal of the

P a g e | 196


Council.


Act, No. 21 of 2006

Provided that where the Chairman is unable to be present

at the time when the seal of the Council is affixed to any

instrument or document, any other member authorized in

writing by the Chairman in that behalf, shall be competent

to sign such instrument or document in accordance with the

preceding provisions of this subsection.

(4) The Council shall maintain a register of the instruments

or documents to which the seal of the Council is affixed.

9. The Council shall exercise, perform and discharge its

powers, duties and functions under this Act in such manner,

as the Council considers best calculated to achieve the

following objects :—

(a) the development and monitoring of standards to be

maintained by the registered Private Medical

Institutions;

(b) the method of evaluation of standards maintained

by such Private Medical Institutions;

(c) to ensure that minimum qualifications for

recruitment and minimum standards of training of

P a g e | 197


personnel, are adopted by all Private medical

Institutions;

(d) to ensure the quality of patient care services rendered

or provided by such Private Medical Institutions.

10. The Council shall exercise, perform and discharge

the following powers, duties and functions:—

(a) the formulation of quality assurance programmes

for patient care in Private Medical Institutions and

monitoring of the same;

(b) the maintenance of minimum standards for

recruitment of all staff engaged or employed in such

Private Medical Institutions;

Duties and

functions of the

Council.

Objects of the

Council.


Act, No. 21 of 2006

7

(c) the collection and publication of relevant health

information and statistics;

P a g e | 198


(d) the implementation of a method of grading

according to the facilities offered by the respective

Private Medical Institutions; and

(e) such other functions as may be necessary to achieve

the objects as referred to in section 9.

11. The Council may where it considers it necessary,

delegate the performance and discharge of its duties and

functions under this Act to any member or members of the

Council or a Committee consisting of members of the Council

who shall perform and discharge such duty or function,

subject to the general direction and control of the Council.

12. (1) The Council shall have its own Fund.

(2) There shall be paid into Fund of the Council—

(a) all such sums of money as may be voted from time

to time by Parliament for the use of the Council;

(b) all such sums of money as may be received by the

Council by way of fees, rates, charges or otherwise

in the discharge of its functions;

(c) all such sums of money as may be made available to

it by way of grants or donations.

(3) There shall be paid out of the Fund such sums of money

as may be required to defray the expenses incurred by the

P a g e | 199


Council in the exercise, discharge and performance of its

powers, duties and functions under this Act.

13. (1) The Minister may on the advice of the Council,

by Order published in the Gazette, formulate and enforce

schemes of accreditation for private medical institutions. Such

Council to

delegate its

duties and

functions.

Accreditation of

Private Medical

Institutions.

Fund of the

Council.


Act, No. 21 of 2006

Order should carry all the details specifying the facilities,

services and any other factors constituting the criteria for

accreditation :

Provided however, that period of nine moths shall be given

to concerned interests, before the implementation of such

schemes of accreditation or subsequent changes that may be

P a g e | 200


made thereto.

(2) Notwithstanding the Order published under

subsection (1), a Private Medical Institution shall continue

to offer its services until such time, the final decision of the

Council on accreditation shall be made known to such

Institution :

Provided however, in the event of a Private Medical

Institution not qualifying for accreditation, sufficient time

shall be given in writing to such institution, to achieve the

standards specified by the Ministry of the Minister in charge

of the subject of Health to qualify for accreditation.

(3) The Council shall where necessary, call upon a panel

of persons who in their opinion possess the necessary

knowledge, expertise, skill or learning to assist and advice

the Council in working out the details in the schemes of

accreditation and to help, examine and evaluate the

applications made in terms of such schemes.

(4) The Council may implement the schemes of

accreditation in stages or in such other manner as the Minister

may determine.

(5) An accreditation of a Private Medical Institution

under this section shall not restrict such institution from

P a g e | 201


attending to life saving emergencies.

14. (1) It shall be lawful for any authorized officer,

without prior notice, at any time by day or night, to enter any

Private Medical Institution, or any premises appertaining

thereto, and do all such acts as may be reasonably necessary

for the purpose of carrying out any inspection, examination,

investigation or survey, for the purposes of this Act.

Power to enter

and inspect.


Act, No. 21 of 2006

9

(2) Nothing in the preceding provisions of this section

shall be deemed or construed to authorize any person to

inspect any medical record relating to any patient in an

institution unless there is a special authorization by the

Council to inspect any records, other than confidential

information which requires the sanction of Court.

(3) Every person who resists or obstructs such authorized

officer by the Council in the exercise of the powers conferred

by the preceding provisions of this section shall be guilty of

an offence under this Act.

P a g e | 202


(4) For the purpose of this section “authorised officer”

means the Provincial Director of Deputy Provincial Director

of Health Services of the respective Provincial Council or

any other officer, as may on the recommendation of the

Council be appointed by the Minister by Order published in

the Gazette.

15. (1) Any registered person or body of persons who—

(a) contravenes or fails to comply with the provisions

of this Act or any regulation or rule made there under,

or any order or direction lawfully given;

(b) contravenes or fails to comply with any condition

or provision contained in any Certificate of

Registration, issued under this Act,

shall be guilty of an offence under this Act.

(2) Any person who—

(a) attempts to commit an offence under this Act; or

(b) aids or abets another person to commit an offence

under this Act,

shall be guilty of an offence under this Act.

Offences.


Act, No. 21 of 2006

P a g e | 203


(3) No prosecution for an offence under subsection (1) or

(2) shall be instituted except with the written sanction of the

Council.

16. (1) Any person who is convictes after summary trial

before a Magistrate, of an offence under this Act, shall be

liable on such conviction—

(a) where such offence involves the causing of injury

to human life or seriously jeopardizing public health

or public safety, to a fine not exceeding fifty

thousand rupees;

(b) for any other offence —

(i) in the case of a first offence, to fine not

exceeding ten thousand rupees;

(ii) in the case of second or subsequent offence,

to a fine not exceeding twenty thousand

rupees; and

(iii) in the case of continuing offence, to a further

fine not exceeding one thousand rupees for

each day on which the commission of the

offence is continued after conviction or to

imprisonment of either description for a term

not exceeding six months or to both such fine

P a g e | 204


and imprisonment.

(2) Where a person convicted of an offence under this Act

is convicted for a second offence of like or similar nature, the

Magistrate’s Court convicting him for the second offence

shall cancel any certificate, authorization or permit granted

or issued to such person or body of persons under this Act, or

any regulation made thereunder and shall cause notice of

such cancellation to be notified to the Council.

Penalties.


Act, No. 21 of 2006

11

17. Where an offence under this Act or any regulation or

rule made thereunder is committed by a body of persons,

then—

(a) if that body is a body corporate, every person who

at the time of the commission of such offence was

the Director, General Manager, Secretary or other

similar executive officer of that body;

(b) if that body is not a body corporate, every person

who at the time of the commission of the offence

was the Chairman, General Manager, Secretary or

P a g e | 205


other similar executive officer of that body;

shall be deemed to be guilty of that offence, unless he proves

that the offence was committed without his knowledge or

that he exercised all due diligence to prevent the commission

of that offence.

18. (1) The Minister may make regulations in respect

of all matters required by this Act to be prescribed or in respect

of which regulations are authorised to be made.

(2) Without prejudice to the powers conferred by

subsection (1), the Minister may on the advice of the Council

make regulations in respect of all or any of the following

matters:—

(a) the guidelines to be complied with by Provincial

Directors of Health Services in the registration or

renewal of registration of Private Medical

Institutions;

(b) the rates, charges and any other expenses, which

shall be recovered or received for any services

rendered or performed in terms of the Act;

(c) the layout, construction, illumination, additions

and improvements and the maintenance of

Regulations.

P a g e | 206


Offences

committed by a

body of persons.


Act, No. 21 of 2006

cleanliness of all the buildings and premises of

registered Private Medical Institutions;

(d) the circumstances in which cases of infectious

diseases may be admitted for treatment and the

precautions to be taken in such event;

(e) the adoption of universally recognized precautions

for the prevention and control of infections;

(f) the classification of Private Medical Institutions into

categories, depending upon services being rendered

or functions discharged by such institutions;

(g) the procedure or practice to be followed in

entertaining any complaint against any Private

Medical Institution or person attached thereto from

any interested or aggrieved person, and the final

disposal thereof;

(h) charges for accommodation, drugs and services

rendered by Private Medical Institutions ;

P a g e | 207


(i) the appointment of competent officers to prosecute

actions instituted under this Act.

(3) Every regulation made by the Minister shall be

published in the Gazette and shall come into operation on

the date of such publication, or on such later date as may be

specified in the regulation.

(4) Every regulation made by the Minister shall as soon

as convenient after its publication in the Gazette be brought

before Parliament for approval. Any regulation, which it is

not so approved, shall be deemed to be rescinded from the

date of it’s disapproval, but without prejudice to anything

previously done thereunder.

(5) Notification of the date on which any regulation made

by the Minister is so deemed to be rescinded shall be published

in the Gazette.


Act, No. 21 of 2006

13

19. (1) The Council may make rules in respect of all or

any of the following matters :—

(a) the maintenance of records, books, registers, bills,

receipts, returns, statements, forms and other

P a g e | 208


documents by a Private Medical Institution;

(b) the reports, returns, statements and other information

required to be furnished periodically by a Private

Medical Institution to the Ministry of the Minister;

(c) the minimum size of wards or rooms and the

minimum floor space, which should be allotted for

each patient;

(d) the provisions of adequate latrine and bathing

facilities for in-patients and personnel employed in

Private Medical Institutions;

(e) the machinery, equipment, devices, utensils,

apparatus, crockery, fittings, furniture and other

requisites of a general or special nature ;

(f) the immunization of personnel employed in Private

Medical Institutions against specified diseases;

(g) the prohibition or restriction of admission of

midwifery cases, except to a maternity home or to

such other Private Medical Institution having

separate and exclusive facilities for the reception

and treatment of such cases;

(h) the prohibition or restriction of the admission of

cases other than midwifery cases to a maternity home

P a g e | 209


or to such other Private Medical Institution having

separate and exclusive facilities for the reception

and treatment of maternity cases;

(i) defining staffing patterns including minimum

qualification, induction and in-service training and

refresher courses that should be followed by such

personnel;

Rules.


Act, No. 21 of 2006

(j) the definition of the specialized departments and

ancillary services that should be maintained in terms

of special fields of treatment;

(k) the disposal of refuse and waste matter;

(l) the provision of sinks, taps and outlets in wards,

kitchens, bathrooms and latrines in proportion to

the ratio of patients and personnel employed therein;

(m) the provision of housing, residential quarters or

transport facilities required for maintaining the

health of patients; and

(n) the provision of adequate expertise for the

maintenance of all institutional assets, machinery

P a g e | 210


and equipment.

(2) No rule made by the Council shall have effect unless

it has been approved by the Minister and published in the

Gazette.

20. In this Act, unless the context otherwise requires —

“accreditation” means a process that is adopted for the

purpose of certification of the technical

competence and quality of service and facilities

of a Private Medical Institutions; and

“Private Medical Institution” means any Institution or

establishment used or intended to be used for the

reception of, and the providing of medical and

nursing care and treatment for persons suffering

from any sickness, injury or infirmity, a Hospital,

Nursing Home, Maternity Home, Medical

Laboratory, Blood Bank, Dental Surgery,

Dispensary and Surgery, Consultation Room, and

any establishment providing health screening or

health promotion service, but does not include a

Interpretation.


Act, No. 21 of 2006

P a g e | 211


15

Sinhala text

to prevail in

case of

inconsistency.

Repeals.

house of observation, Mental hospital, Hospital,

Nursing Home, dispensary, Medical Centre or any

other premises maintained or controlled by the

State, any private dispensary or Pharmacy or drug

stores exclusively used or intended to be used for

dispensing and selling any drug, medical

preparation or pharmaceutical product, or any

Institution or premises registered for any purpose

under the provisions of Ayurveda Act, No. 31 of

1961 and the Homeopathy Act, No. 7 of 1970.

21. (1) The Nursing Homes (Regulation) Act (Chapter

220) is herby repealed.

(2) Notwithstanding the repeal of the Nursing Homes

(Regulation) Act, the registration of any Private Medical

Institution registered thereunder shall be deemed to be valid

and effectual and shall continue to be so valid and effectual

P a g e | 212


for a period of three months from the appointed date, within

which period such medical institution is required to apply

for registration in terms of the provisions of this Act.

(3) Where any Private Medical Institution referred to in

subsection (2), fails to obtain a registration under this Act as

required by that subsection within the period specified

therein, the registration obtained under the repealed Act shall

cease to be valid and effectual from and after the expiry of

such specified period.

22. In the event of any inconsistency between the Sinhala

and Tamil texts of this Act, the Sinhala text shall prevail.

P a g e | 213


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