Review of literature

A growing Healthcare sector

Healthcare is one of Indias largest sectors, in terms of revenue and employment, and the sector is
expanding rapidly. During the 1990s, Indian healthcare grew at a compound annual rate of 16%.
Today the total value of the sector is more than $34 billion. This translates to roughly 6% of GDP.
By 2012, Indias healthcare sector is projected to grow to nearly $40 billion. The private sector
accounts for more than 80% of total healthcare spending in India. Unless there is a decline in the
combined federal and state government deficit, which currently stands at roughly 9%, the
opportunity for significantly higher public health spending will be limited. The growing elderly
population will place an enormous burden on Indias healthcare infrastructure. However, Indias
thriving economy is driving urbanization and creating an expanding middle class, with more
disposable income to spend on healthcare.



Health services nature and value

Like quality in most services, healthcare quality is difficult to measure owing to inherent intangibility,
heterogeneity and inseparability features that patients participating in production, performance and
quality evaluations are affected by their actions, moods and cooperativeness. Healthcare is dynamic
considerable customer changes have taken place and competition is increasing. Consequently,
healthcare quality evaluations raise problems owing to service size, complexity, specialization and
expertise within healthcare organizations.
Patient satisfaction and its dimensions

Patient satisfaction is defined as an evaluation of distinct healthcare dimensions. It may be
considered as one of the desired outcomes of care and so patient satisfaction information should be
indispensable to quality assessments for designing and managing healthcare. Patient satisfaction is a
multi-dimensional healthcare construct affected by many variables. Healthcare quality affects patient
satisfaction, which in turn influences positive patient behaviors such as loyalty. Patient satisfaction is
predicted by factors relating to caring, empathy, reliability and responsiveness. Primary patient
satisfaction determinants:

1. evaluations of physicians conduct,
2. service availability,
3. continuity,
4. confidence,
5. efficiency,
6. core services,
7. customization,
8. professional credibility,
9. competence,
10. communications,
11. admissions,
12. discharge,
13. nursing care,
14. food,
15. housekeeping and
16. technical services.

Patients perceptions, notably about physician communication skills are also significant satisfaction
determinants. Two dimensions study explained 66 percent of the variance in patients service quality
perceptions:
1. facility quality
2. staff performance

Health service availability (service is available when it is required), and is operationally defined as the
number of patient-physician contacts , waiting times, convenience and availability associated with
healthcare experiences. Communication is the degree to which the patient is heard, kept informed
through understandable terms, afforded social interaction and time during consultation and provided
psychological and non-technical information . If communication is good, which includes information
from the service provider to the patient on the type of care he or she will receive, thereby alleviating
uncertainty that increases his or her awareness and sensitivity about what to expect,then patient
satisfaction is higher.If the service providers competence is perceived high then levels of satisfaction
also increase.Staff demeanour also has a significant impact on customer satisfaction. The manner in
which staff interacts with the patient and staff sensitivity to the patients personal experience seems to
be important. Studies show that if hospital costs are perceived high then patient satisfaction is lower.If
physical facilities, including: cleanliness; modern equipment and the general feeling that the hospital
is in a good physical condition, are well perceived then patient satisfaction increases. Other
dimensions that affect patient evaluations are:
reliability (competence); responsiveness (communication); tangibles (physical facilities); and
empathy (staff demeanor).
Satisfaction with specific service dimensions such as nursing staff, fees and meals were found to
exert positive influence on cumulative patient satisfaction the strongest being satisfaction with
nursing staff and administration.

Healthcare quality and satisfaction
Quality is positively correlated with satisfaction and operational quality definitions are based on
values, perceptions and attitudes. Healthcare quality can be categorized in three ways :
1. Technical aspects how well clinicians diagnose and treat problems.
2. Interpersonal component provider responsiveness, friendliness and attentiveness.
3. Amenities health care facility appeal and comfort.
Individual healthcare quality measures include:
1. Structure the medical delivery systems fixed characteristics such as staff number, types,
qualifications and facilities.
2. Process what is done to and for the patient such as treatment.
3. Outcomes changes in the patients current and future health attributed to antecedent
medical care.