Outpatient Behaviour in Libyan Private Hospitals: Assessing Service Quality, Value Delivery, Satisfaction, and Switching Cost Effects within Patient Experience Models

Abstract

By evaluating how healthcare service quality affects patient satisfaction, actual value delivery, and loyalty key relationships frequently discussed in the healthcare quality literature, this study investigates the factors influencing outpatient behavioural intentions in Libyan private hospitals (Borhan et al., 2023; Mosadeghrad, 2021). In response to calls to re examine the conventional satisfaction loyalty paradigm in transitional or fragmented healthcare systems, it also examines the moderating effect of switching costs and the mediating role of value delivery (Chahal & Kumari, 2020; El Garem et al., 2024; Ghorbanzadeh, 2021). A quantitative, positivist design was employed using survey data from 389 outpatients attending private hospitals in Tripoli, Benghazi, and Misurata (Alharahsheh & Pius, 2020). Measurement items were adapted from established service quality and behavioural intention scales (Parasuraman et al., 1988; Dagger et al., 2007). The proposed model was analysed using Partial Least Squares Structural Equation Modelling (PLS SEM) in line with best practice guidelines (Hair et al., 2021; Henseler et al., 2015). Mediation and moderation effects were assessed through bootstrapping and confirmatory factor techniques (Aguirre Urreta & Rönkkö, 2018). Consistent with prior healthcare research, service quality exerted a significant positive effect on patient satisfaction and loyalty (Hanaysha, 2021; Sultana et al., 2023). The mediating role of actual value delivery in linking service quality to satisfaction and loyalty was strongly supported (Fitriani et al., 2020; Luo et al., 2024). However, satisfaction did not significantly predict loyalty, and switching costs did not moderate the satisfaction loyalty relationship, indicating that patients remain highly mobile and value driven in competitive or uncertain contexts (Aziz et al., 2021; Kim & Lee, 2022). Causal inference is constrained by the cross sectional design and reliance on self reported data (Baruch & Holtom, 2008). Generalisability beyond Libya’s main private healthcare markets is limited due to the focus on three major cities characterised by post conflict fragmentation (Fitzgerald, 2023; Perroux, 2019). Future research should adopt longitudinal or multi group designs to advance understanding of value based loyalty mechanisms in transitional healthcare settings. Hospitals should prioritise interpersonal service quality, particularly physician and nursing interactions, which significantly influence patient outcomes and perceived value (Kwame & Petrucka, 2020; Shie et al., 2022). As switching barriers appear ineffective in retaining patients, strengthening value creation processes is essential (Burnham et al., 2003; Jones et al., 2000). Sustainable loyalty in Libya’s private healthcare sector therefore depends on value driven and relational service strategies rather than structural constraints. Enhancing value oriented patient experiences may foster trust, improve continuity of care, and stabilise expectations in unstable or recovering health systems (Truppa et al., 2024; Kruk et al., 2018), thereby supporting resilience in Libya’s post conflict healthcare environment. This study integrates HEALTHQUAL, Expectation Confirmation Theory, and Satisfaction Loyalty Theory into a cohesive explanatory model, addressing gaps in service quality research within North African and postconflict contexts (Aloshaiby et al., 2024; Endeshaw, 2021). It challenges traditional satisfaction loyalty assumptions by demonstrating that actual value delivery, rather than satisfaction alone, is the dominant behavioural driver in healthcare (Oliver, 1999; Zeithaml et al., 1996).