A Value-Based Perspective on Patient Loyalty: Examining Service Quality, Actual Value Delivery, and Switching Costs in Libyan Private Healthcare

Abstract

This study investigates the dynamics influencing patient loyalty in Libyan private hospitals by examining the roles of hospital service quality (HSQ), patient satisfaction (PS), actual value delivery (AVD), and switching costs (SC). Drawing on value-based healthcare principles and relationship marketing theory, a structural model was developed and tested using survey data from outpatients. The findings reveal that while HSQ significantly enhances PS, satisfaction alone does not directly lead to loyalty challenging traditional assumptions in healthcare management literature. Instead, AVD plays a mediating role, suggesting that tangible health outcomes and cost-effectiveness are critical to shaping satisfaction. Although SC was hypothesized to moderate the satisfaction–loyalty relationship, this effect was not supported, highlighting the dominance of contextual limitations over psychological switching barriers in shaping patient behavior. The validated measurement model offers practical implications for hospital managers and policymakers, emphasizing the need to strengthen AVD, implement loyalty programs, and remove structural barriers to improve patient retention. The study contributes theoretically by refining the satisfaction–loyalty paradigm and provides a culturally contextualized tool for evaluating healthcare service performance in developing economies.