WHY DO INTERNATIONAL PATIENTS COME BACK? AN S-O-R EXPLANATION OF SERVICE QUALITY, TRUST, AND SATISFACTION IN SAUDI HOSPITALS

Autores

  • Khalid Alruwaili Azman Hashim International Business School, University Technology Malaysia
  • Basheer Al-haimi Azman Hashim International Business School, University Technology Malaysia
  • Alfonso Infante-Moro Department of Financial Economics, Accounting and Operations Management, University of Huelva
  • Salman Alenzi Azman Hashim International Business School, University Technology Malaysia

DOI:

https://doi.org/10.18623/rvd.v23.n2.4388

Palavras-chave:

Medical Tourism, Service Quality, Patient Satisfaction, Patient Trust, Revisit Intention, SOR Model, Saudi Healthcare

Resumo

Medical tourism has become an increasingly competitive global industry, prompting healthcare destinations to focus on service excellence and long-term patient retention. Using the Stimulus–Organism–Response (SOR) framework, this study examined how service quality (stimulus) affects revisit intentions in Saudi hospitals, with patient satisfaction and trust as organism factors. Service quality is defined as a second-order construct comprising key aspects of healthcare service delivery. A quantitative research approach was adopted, with data collected from international patients in Saudi hospitals, yielding 220 samples. The model was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The results show that service quality has a strong, significant positive impact on both patient satisfaction and trust. Although satisfaction positively influences revisit intention, trust has an even greater effect, highlighting its vital role in shaping patients’ future behaviors in healthcare settings with high perceived risk. The findings confirm the SOR-based mechanism in which service quality serves as a core stimulus, influencing patients’ internal evaluations and subsequent willingness to revisit. This research contributes to the healthcare and medical tourism literature by empirically validating a comprehensive SOR-based model and emphasizing the importance of trust in maintaining patient relationships. In practice, these insights are valuable for healthcare policymakers and hospital managers in Saudi Arabia, especially in light of Saudi Vision 2030, by highlighting the need to improve service quality and to build trust to enhance patient loyalty and international competitiveness.

Referências

Ajina, A. S. (2019). The role of content marketing in enhancing customer loyalty: An empirical study on private hospitals in Saudi Arabia. Innovative Marketing, 15(3), 71. https://doi.org/10.21511/im.15(3).2019.06

Al-Hilou, M., & Suifan, T. (2023). The mediating effect of patient trust on the relationship between service quality and patient satisfaction. International Journal of Health Care Quality Assurance, 36(1/2), 1–16.

Al-Haimi, B., Ali, F., & Hujainah, F. (2024). Digital Transformation in Healthcare: Impact on Organizations' Strategies, Future Landscape, and Required Skills. In Navigating the Intersection of Business, Sustainability and Technology (pp. 61-74). Singapore: Springer Nature Singapore.

Aladwan, M., Salleh, H., Anuar, M., ALhwadi, H., & Almomani, I. (2021). Relationship among service quality, patient satisfaction and patient loyalty: Case study in Jordan Mafraq Hospital. Linguistics and Culture Review, 5(S3), 27–40. https://doi.org/10.21744/lingcure.v5ns3.1368

Aladwan, M. A., Anuar, M. M., Aladwan, R. M., & Salleh, H. S. (2023). The effect of service quality, patient trust and hospital reputation on patient satisfaction in Jordanian public hospital. WSEAS Transactions on Business and Economics, 21, 410. https://doi.org/10.37394/23207.2024.21.36

Alodhialah, A. M., Almutairi, A. A., & Almutairi, M. (2024). Key predictors of patient satisfaction and loyalty in Saudi healthcare facilities: A cross-sectional analysis. Healthcare, 12(20), 2050. https://doi.org/10.3390/healthcare12202050

Alrubaiee, L., & Alkaa’ida, F. (2011). The mediating effect of patient satisfaction in the patients’ perceptions of healthcare quality–patient trust relationship. International Journal of Marketing Studies, 3(1). https://doi.org/10.5539/ijms.v3n1p103.

Andreano, P., & Pardede, R. (2023). Service quality and patient trust on patient loyalty mediated by patient satisfaction on inpatients. Interdisciplinary Social Studies, 2(12), 2684–2692. https://doi.org/10.55324/iss.v2i12.595

Arıcı, N. Ç., & Güçer, E. (2018). The antecedents of revisit intention in medical businesses. Journal of Business Research – Turk, 10(2), 740. https://doi.org/10.20491/isarder.2018.453.

Akbar, M., Sankar, J. P., Ramayah, T., & Alkashami, M. (2025). Modeling artificial intelligence-enabled teaching continuance intentions in higher educational institutions using the expectation confirmation model (ECM). Cogent Education, 12(1), 2479401.

Akthar, N., Nayak, S., & P, Y. (2024). A cross-sectional study on exploring the antecedents of patient’s revisit intention: Mediating role of trust in the hospital among patients in India. F1000Research, 12, 75. https://doi.org/10.12688/f1000research.128220.3

Alharbi, M. (2023). Patients’ experience of service quality in government and private hospitals in the Qassim Region, Kingdom of Saudi Arabia. Journal of Medicine and Life, 16(11), 1622–1627. https://doi.org/10.25122/jml-2023-0184

Banahene, J., Dai, B., Kissi, J., & Antwi, M. O. (2021). Examine the extrinsic mechanism of service quality factors and its effect on patient retention in Ghanaian private hospitals, using trust and patient satisfaction as mediator. International Journal of Scientific Research in Science and Technology, 255. https://doi.org/10.32628/ijsrst207563

Boateng, J. (2019). Patients’ satisfaction and its determinants in outpatient and inpatient departments of tertiary hospitals in Ghana: A literature review. Texila International Journal of Management, 149–160. https://doi.org/10.21522/tijmg.2015.se.19.01.art015

Białk-Wolf, A. (2025). Developments in the medical tourism market in Poland from the perspective of international factors. Worldwide Hospitality and Tourism Themes, 17(2), 261–272.

Chang, C., Chen, S.-Y., & Lan, Y.-T. (2013). Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters. BMC Health Services Research, 13(1). https://doi.org/10.1186/1472-6963-13-22.

Choi, K. S., Cho, W. H., Lee, S., Lee, H., & Kim, C. (2004). The relationships among quality, value, satisfaction and behavioral intention in health care provider choice: A South Korean study. Journal of Business Research, 57(8), 913–921.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New Jersey: Lawrence Erlbaum.

Ghali, Z., Garrouch, K., & Aljasser, A. (2023). Drivers of patients’ behavioral intention toward public and private clinics’ services. Healthcare, 11(16), 2336. https://doi.org/10.3390/healthcare11162336.

Gu, L., Tian, B., Xin, Y., Zhang, S., Li, J., & Sun, Z. (2022). Patient perception of doctor communication skills and patient trust in rural primary health care: The mediating role of health service quality. BMC Primary Care, 23(1). https://doi.org/10.1186/s12875-022-01826-4

Hair, J. F., Black, W. C., Babin, B. J., Anderson, R. E., & Tatham, R. L. (2006). Multivariate data analysis (6th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

Hair, J. F., Hult, G. T. M., Ringle, C. M., & Sarstedt, M. (2014). A primer on partial least squares structural equation modeling (PLS-SEM). Los Angeles, CA: SAGE.

Hair, J. F., Hult, G. T. M., Ringle, C. M., & Sarstedt, M. (2017). A primer on partial least squares structural equation modeling (PLS-SEM) (2nd ed.). Thousand Oaks, CA: Sage.

Han, H., & Hyun, S. S. (2014). Customer retention in the medical tourism industry: Impact of quality, satisfaction, trust, and price reasonableness. Tourism Management, 46, 20. https://doi.org/10.1016/j.tourman.2014.06.003

Han, J., Zuo, Y., Law, R., Chen, S., & Zhang, M. (2021). Service quality in tourism public health: Trust, satisfaction, and loyalty. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.731279

Hidayat, A. (2024). Exploring patient trust as a mediator in factors influencing inpatient revisit intention. Journal of Science Innovare, 7(2), 045–050. https://doi.org/10.33751/jsi.v7i2.12811

Hidayat, A., & Handoyo, S. (2025). The effect of service quality and patient satisfaction on revisit intentions of inpatients at Ciawi Regional Public Hospital mediated by patient trust. JHSS (Journal of Humanities and Social Studies), 9(2), 359–365. https://doi.org/10.33751/jhss.v9i2.12086

Hussain, A. (2025). A cross-sectional study on the impact of administrative procedures and medical staff services on patient satisfaction with trust in public sector hospitals: The moderating role of e-health knowledge. BMC Health Services Research, 25(1). https://doi.org/10.1186/s12913-025-13383-4

Indaryani, L., & Wulandari, R. (2023). Effect of service quality and trust on revisiting interest toward customer satisfaction. International Journal of Management Science and Application, 1(2), 68. https://doi.org/10.58291/ijmsa.v1i2.74

Jaber-Chehayeb, R. (2023). Analyzing the mediating role of service quality in the relationship between service quality and patient satisfaction at Rafic Hariri University Hospital. International Journal of Professional Business Review, 8(11). https://doi.org/10.26668/businessreview/2023.v8i11.3827.

Jalloh, A., Nwosu, L., & Baysan, S. (2023). Evaluation of waiting time and associated factors influencing patient satisfaction levels in an outpatient department: A case study of government hospital in Sierra Leone. SEHS, 23050015. https://doi.org/10.69598/sehs.17.23050015

Kristinawati, F., Gunardi, W., & Fushen, F. (2023). The effect of service quality and patient satisfaction on patient loyalty mediated by patient trust at Rumah Indonesia Sehat (RIS) Hospital. Morfai Journal, 2(4), 701–717. https://doi.org/10.54443/morfai.v2i4.630.

Mabini, S. P., Narsico, L. O., & Narsico, P. G. (2024). Service quality, patient satisfaction, and improvement indicators. International Journal of Multidisciplinary Applied Business and Education Research, 5(4), 1331. https://doi.org/10.11594/ijmaber.05.04.18

Mohd Isa, S., Lim, G. S. S., & Chin, P. N. (2019). Patients’ intent to revisit with trust as the mediating role: Lessons from Penang, Malaysia. International Journal of Pharmaceutical and Healthcare Marketing, 13(2), 140–159.

Noviyani, A., & Viwattanakulvanid, P. (2024). Exploring patients’ perspectives on healthcare service quality in outpatient settings at a public hospital in Palembang, Indonesia: A qualitative study. Belitung Nursing Journal, 10(6), 703–711. https://doi.org/10.33546/bnj.3594.

Pervaiz, S., Javed, U., Rajput, A., Shafique, S., & Tasneem, R. (2024). Examining how and why service quality fosters patients’ revisit intentions: Evidence from Pakistan. International Journal of Pharmaceutical and Healthcare Marketing, 18(3), 455. https://doi.org/10.1108/ijphm-11-2021-0110

Pramana, L., Suryoputro, A., & Purnami, C. (2022). Factors affecting outpatients’ intention to revisit health services at public health center in Demak District. Jurnal Aisyah Jurnal Ilmu Kesehatan, 7(2). https://doi.org/10.30604/jika.v7i2.1049.

Rafi, T., Khalique, M., & Siddiqui, S. (2020). Hospital service quality and patient satisfaction: A moderating role of trustworthiness. Journal of Accounting and Finance in Emerging Economies, 6(1), 237–250. https://doi.org/10.26710/jafee.v6i1.1081

Ringle, C. M., Sarstedt, M., Mitchell, R., & Gudergan, S. P. (2018). Partial least squares structural equation modeling in HRM research. The International Journal of Human Resource Management, 31(12), 1617–1643.

Rosyida, H. L., Suprapto, S. I., Dian, A., & Indasah, I. (2025). Building patient loyalty: The role of brand image and service quality in outpatient healthcare revisit behavior—A systematic review. Journal of Applied Nursing and Health, 7(1), 23. https://doi.org/10.55018/janh.v7i1.272

Saputri, V., & Berlianto, M. (2023). Factors influencing patients’ revisit intention to public health center during COVID-19 pandemic. Jurnal Administrasi Kesehatan Indonesia, 11(1), 57–66. https://doi.org/10.20473/ijha.v11i1.2023.57-66

Sekar, H., & Tan, P. (2024). The relationship between hospital service quality and patient trust is mediated by patient satisfaction in patient loyalty at Hospital X. Syntax Literate Jurnal Ilmiah Indonesia, 9(7), 3808–3819. https://doi.org/10.36418/syntax-literate.v9i7.16457

Rahmatia, S., Basri, M., Ismail, I., Adi, S., Nasrullah, N., & Ahmad, A. (2025). Service quality in hospital inpatient care: SERVQUAL model approach. Health SA Gesondheid, 30. https://doi.org/10.4102/hsag.v30i0.3055

Ramazani, Y., Aref, M., & Shahtaghi, M. (2020). Customer care in medical tourism industry: Explaining the relationship between quality, satisfaction, trust and logical price. Depiction of Health, 11(1), 31. https://doi.org/10.34172/doh.2020.04

Sharka, R., Sedayo, L., Morad, M., & Abuljadayel, J. (2024). Measuring the impact of dental service quality on revisit intention using an extended SERVQUAL model. Frontiers in Oral Health, 5. https://doi.org/10.3389/froh.2024.1362659

Suleiman, A. K., & Ming, L. C. (2025). Transforming healthcare: Saudi Arabia's Vision 2030 healthcare model. Journal of Pharmaceutical Policy and Practice, 18(1), 2449051.

Wahyuningsih, E., Mariyanti, T., & Hatta, Z. M. (2023). Patient satisfaction mediates the influence of trust, service quality and hospital sharia compliance on patient loyalty in Sharia hospitals in Riau province from an Islamic perspective. International Journal of Research in Business and Social Science, 12(9), 39. https://doi.org/10.20525/ijrbs.v12i9.2988

Tessema, D. H., Nuhu, J. A., Obeng, H. A., & Assefa, H. (2024). The relationship between total quality management, patient satisfaction, service quality, and trust in the healthcare sector: The case of Ethiopian public hospitals. Uluslararası Anadolu Sosyal Bilimler Dergisi, 8(1), 164. https://doi.org/10.47525/ulasbid.1402805

Veasna, S., Wu, W. Y., & Huang, C. H. (2013). The impact of destination source credibility on destination satisfaction: The mediating effects of destination attachment and destination image. Tourism Management, 36, 511–526.

Yuniarti, Y., & Hidayat, A. (2021). The analysis of patients’ revisits intention factors in sub-urban hospital. International Journal of Research in Business and Social Science, 10(4), 420. https://doi.org/10.20525/ijrbs.v10i4.1232.

Zahidah, S., & Al-haimi, B. (2024). Telemedicine: Transforming healthcare accessibility and quality with sustainable technological advancement. Navigating the Intersection of Business, Sustainability and Technology, 137-149.

Zehra, S., Ranjan, J., & Shukla, M. (2025). Service quality in healthcare: Understanding the relationship between patient experience and healthcare outcomes. International Journal of Health Care Quality Assurance, 38(4), 233. https://doi.org/10.1108/ijhcqa-09-2024-0090.

Downloads

Publicado

2026-01-22

Como Citar

Alruwaili, K., Al-haimi, B., Infante-Moro, A., & Alenzi, S. (2026). WHY DO INTERNATIONAL PATIENTS COME BACK? AN S-O-R EXPLANATION OF SERVICE QUALITY, TRUST, AND SATISFACTION IN SAUDI HOSPITALS. Veredas Do Direito , 23, e234388. https://doi.org/10.18623/rvd.v23.n2.4388