Open Journal Systems

Examining the nexus of relationship marketing and patient loyalty: The mediation and moderation analysis

Abhijeet Chavan, Abhijit Mohanty, Sujata Joshi

Article ID: 2105
Vol 9, Issue 3, 2024, Article identifier:

VIEWS - 129 (Abstract) 62 (PDF)


Studies on association amongst relationship marketing and loyalty of patients are still trying to establish its presence in the healthcare management. Also, the variables impacting this association are still in exploratory phases. The research is being carried out for determining the nature of that relationship and also examining mediating and moderating effect of different variables. Data collected through various Scopus and other online databases have been used for this study. Literature review has been carried out by dividing it into three parts, relationship marketing, patient loyalty and variables like patient satisfaction, age, gender, family size, health insurance, etc. Primary data was collected from 938 patients of private healthcare providers by administering questionnaire online as well as in person. PLS-SEM was applied to analyze the data, which was used after testing the instrument for reliability and validity. After Covid-19 pandemic everyone felt need of a good health insurance but in actual many people were not having a simple health insurance cover also. Hospitals will have a major role in promoting health insurance and in turn providing quality service, but their role is currently limited to processing of health insurance and nothing more. Model from the study will help understand organizations the strength and direction of relationship between patient loyalty and efforts taken for marketing along with impact of moderating and mediating variable on the same. Future research can look into the other variables that will moderate or mediate the relationship in turn will help not only healthcare organizations but insurance companies also to develop product or service according to requirement of relationship. Research focuses on impact of moderating effect of health insurance on association amongst marketing efforts taken for relationship marketing and loyalty of patients through patient satisfactions’ mediation which was not studied before this. The study aims to test the conceptual model of moderating impact of health insurance on association between relationship marketing, patient loyalty and patient satisfaction using SEM.


relationship marketing; patient satisfaction; patient loyalty; healthcare management

Full Text:



1. India Brand Equity Foundation. Healthcare Sector in India 2017 January. New Delhi: IBEF; 2017.

2. Weng RH, Huang JA, Huang CY, et al. Exploring the impact of customer relational benefit on relationship commitment in health service sectors. Health Care Management Review. 2010, 35(4): 312-323. doi: 10.1097/hmr.0b013e3181dc8257

3. Mohammad Shafiee M, Rahmatabadi Y, Soleymanzadeh O. The impact of social networks marketing communication on brand equity, relationship equity and customer responses. Consumer Behavior Studies Journal. 2019, 6(1): 105-124.

4. Fatima T, Malik SA, Shabbir A. Hospital healthcare service quality, patient satisfaction and loyalty. International Journal of Quality & Reliability Management. 2018, 35(6): 1195-1214. doi: 10.1108/ijqrm-02-2017-0031

5. Hernández-Vásquez A, Rojas-Roque C, Barrenechea-Pulache A, et al. Measuring the Protective Effect of Health Insurance Coverage on Out-of-Pocket Expenditures During the COVID-19 Pandemic in the Peruvian Population. International Journal of Health Policy and Management. 2021. doi: 10.34172/ijhpm.2021.154

6. Astuti HJ, Nagase K. Patient Loyalty to Healthcare Organizations: Relationship Marketing and Satisfaction. International Journal of Management and Marketing Research. 2014, 7(2): 39-56.

7. Yıldırım Y, Amarat M, Akbolat M. Effect of relationship marketing on hospital loyalty: the mediating role of patient satisfaction. International Journal of Pharmaceutical and Healthcare Marketing. 2022, 16(3): 337-353. doi: 10.1108/ijphm-01-2021-0010

8. Oliver RL. Whence Consumer Loyalty? Journal of Marketing. 1999, 63(4_suppl1): 33-44. doi: 10.1177/00222429990634s105

9. Wang Y, Po Lo H, Chi R, et al. An integrated framework for customer value and customer‐relationship‐management performance: a customer‐based perspective from China. Managing Service Quality: An International Journal. 2004, 14(2/3): 169-182. doi: 10.1108/09604520410528590

10. Verhoef PC. Understanding the Effect of Customer Relationship Management Efforts on Customer Retention and Customer Share Development. Journal of Marketing. 2003, 67(4): 30-45. doi: 10.1509/jmkg.

11. Tweneboah-Koduah E, Yuty Duweh Farley A. Relationship between Customer Satisfaction and Customer Loyalty in the Retail Banking Sector of Ghana. International Journal of Business and Management. 2015, 11(1): 249. doi: 10.5539/ijbm.v11n1p249

12. Laohasirichaikul B, Chaipoopirutana S, Combs H. Effective customer relationship management of health care: a study of hospitals in Thailand. Journal of Management and Marketing Research. 2011, 17(1): 1-12.

13. Bowen JT, Chen S. The relationship between customer loyalty and customer satisfaction. International Journal of Contemporary Hospitality Management. 2001, 13(5): 213-217. doi: 10.1108/09596110110395893

14. Astuti HJ, Nagase K. Patient loyalty to health care organizations: Strengthening and weakening (satisfaction and provider switching). Journal of Medical Marketing: Device, Diagnostic and Pharmaceutical Marketing. 2014, 14(4): 191-200. doi: 10.1177/1745790415578311

15. Mohammad Shafiee M, Es-Haghi SMS. Mall image, shopping well-being and mall loyalty. International Journal of Retail & Distribution Management. 2017, 45(10): 1114-1134. doi: 10.1108/ijrdm-10-2016-0193

16. Kumari N, Patyal S. Customer to consumer: attitudinal and behavioural loyalty. International Journal of Management Studies. 2017, 4(1): 115-121.

17. Eiriz V, Wilson D. Research in relationship marketing: antecedents, traditions and integration. European Journal of Marketing. 2006, 40(3/4): 275-291. doi: 10.1108/03090560610648057

18. Agariya AK, Singh D. What Really Defines Relationship Marketing? A Review of Definitions and General and Sector-Specific Defining Constructs. Journal of Relationship Marketing. 2011, 10(4): 203-237. doi: 10.1080/15332667.2011.624905

19. Haimowitz IJ. Healthcare Relationship Marketing. Routledge; 2016. doi: 10.4324/9781315586380

20. Hennig-Thurau T, Gwinner KP, Gremler DD. Understanding Relationship Marketing Outcomes. Journal of Service Research. 2002, 4(3): 230-247. doi: 10.1177/1094670502004003006

21. Abhijeet C, Sujata J. Relationship Marketing in Healthcare: A Literature review Analysis of Past, Present & Future in Private Hospitals. Indian Journal of Public Health Research & Development. 2019, 10(5): 668. doi: 10.5958/0976-5506.2019.01086.6

22. Berry LL. Relationship Marketing. Emerging Perspectives on Services Marketing. 1983, 66(3): 33-47.

23. Morgan RM, Hunt SD. The Commitment-Trust Theory of Relationship Marketing. Journal of Marketing. 1994, 58(3): 20-38. doi: 10.1177/002224299405800302

24. Gronroos C. From Marketing Mix to Relationship Marketing: Towards a Paradigm Shift in Marketing. Asia-Australia Marketing Journal. 1994, 2(1): 9-29. doi: 10.1016/s1320-1646(94)70275-6

25. Evans JR, Laskin RL. The relationship marketing process: A conceptualization and application. Industrial Marketing Management. 1994, 23(5): 439-452. doi: 10.1016/0019-8501(94)90007-8

26. Berry LL. Relationship Marketing of Services—Growing Interest, Emerging Perspectives. Journal of the Academy of Marketing Science. 1995, 23(4): 236-245. doi: 10.1177/009207039502300402

27. Sheth JN, Parvatiyar A. The evolution of relationship marketing. International Business Review. 1995, 4(4): 397-418. doi: 10.1016/0969-5931(95)00018-6

28. Mollah AS. The impact of relationship marketing on customer loyalty at Tesco Plc.UK. European Journal of Business and Management. 2014, 6(3): 21-55.

29. Ajarmah BS, Hashem TN. Patient satisfaction evaluation on hospitals; comparison study between accredited and non-accredited hospitals in Jordan. European Scientific Journal. 2015, 11(32): 298-314.

30. Amin M, Zahora Nasharuddin S. Hospital service quality and its effects on patient satisfaction and behavioural intention. Clinical Governance: An International Journal. 2013, 18(3): 238-254. doi: 10.1108/cgij-05-2012-0016

31. Chaniotakis IE, Lymperopoulos C. Service quality effect on satisfaction and word of mouth in the health care industry. Managing Service Quality: An International Journal. 2009, 19(2): 229-242. doi: 10.1108/09604520910943206

32. Choi K, Lee H, Kim C, et al. The service quality dimensions and patient satisfaction relationships in South Korea: comparisons across gender, age and types of service. Journal of Services Marketing. 2005, 19(3): 140-149. doi: 10.1108/08876040510596812

33. Douglas J, McClelland R, Davies J. The development of a conceptual model of student satisfaction with their experience in higher education. Quality Assurance in Education. 2008, 16(1): 19-35. doi: 10.1108/09684880810848396

34. Widayati MY, Tamtomo D, Adriani RB. Factors Affecting Quality of Health Service and Patient Satisfaction in Community Health Centers in North Lampung, Sumatera. Journal of Health Policy and Management. 2017, 2(2): 165-175. doi: 10.26911/thejhpm.2017.02.02.08

35. Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology. 1986, 51(6): 1173-1182. doi: 10.1037/0022-3514.51.6.1173

36. Li D, Su M, Guo X, et al. The association between chronic disease and depression in middle-aged and elderly people: The moderating effect of health insurance and health service quality. Frontiers in Public Health. 2023, 11. doi: 10.3389/fpubh.2023.935969

37. Ndubisi NO. Relationship marketing and customer loyalty. Marketing Intelligence & Planning. 2007, 25(1): 98-106. doi: 10.1108/02634500710722425

38. Otani K, Kurz RS, Harris LE. Managing Primary Care Using Patient Satisfaction Measures. Journal of Healthcare Management. 2005, 50(5): 311-324. doi: 10.1097/00115514-200509000-00007

39. Chahal H, Mehta S. Modeling patient satisfaction construct in the Indian health care context. International Journal of Pharmaceutical and Healthcare Marketing. 2013, 7(1): 75-92. doi: 10.1108/17506121311315445

40. Carey RG, Seibert JH. A Patient Survey System to Measure Quality Improvement. Medical Care. 1993, 31(9): 834-845. doi: 10.1097/00005650-199309000-00008

41. Moliner MA. Loyalty, perceived value and relationship quality in healthcare services. Journal of Service Management. 2009, 20(1): 76-97. doi: 10.1108/09564230910936869

42. Rigdon EE, Sarstedt M, Ringle CM. On Comparing Results from CB-SEM and PLS-SEM: Five Perspectives and Five Recommendations. Marketing ZFP. 2017, 39(3): 4-16. doi: 10.15358/0344-1369-2017-3-4

43. Rejali SMJ, Sanayei A, Shafiee MM. Value proposition in the buyer-seller relationship quality: a mixed method approach. International Journal of Procurement Management. 2023, 18(3): 357-386. doi: 10.1504/ijpm.2023.134195

44. Huang MH. Examining the Direct and Moderating Effects of Relational Exchange and Innovation Characteristics on New Product Adoption. 2015 9th International Conference on Innovative Mobile and Internet Services in Ubiquitous Computing; July 2015. doi: 10.1109/imis.2015.74

45. Hair JF, Ringle CM, Sarstedt M. PLS-SEM: Indeed a Silver Bullet. Journal of Marketing Theory and Practice. 2011, 19(2): 139-152. doi: 10.2753/mtp1069-6679190202

46. Hair JF Jr, Sarstedt M, Matthews LM, Ringle CM. Identifying and treating unobserved heterogeneity with FIMIX-PLS: part I – method. European Business Review. 2016, 28(1): 63-76. doi: 10.1108/ebr-09-2015-0094

47. Fornell C, Larcker DF. Evaluating Structural Equation Models with Unobservable Variables and Measurement Error. Journal of Marketing Research. 1981, 18(1): 39-50. doi: 10.1177/002224378101800104

48. Abdullahi MS, Raman K, Solarin SA, et al. Employee engagement as a mediating variable on the relationship between employee relation practice and employee performance in a developing economy. Journal of Applied Research in Higher Education. 2021, 15(1): 83-97. doi: 10.1108/jarhe-06-2021-0222

49. Hair JF, Sarstedt M, Pieper TM, et al. The Use of Partial Least Squares Structural Equation Modeling in Strategic Management Research: A Review of Past Practices and Recommendations for Future Applications. Long Range Planning. 2012, 45(5-6): 320-340. doi: 10.1016/j.lrp.2012.09.008

50. Rehman SU, Samad S, Singh S, et al. Tourist’s satisfaction with local food effect behavioral intention in COVID-19 pandemic: a moderated-mediated perspective. British Food Journal. 2021, 124(10): 3133-3151. doi: 10.1108/bfj-08-2021-0869

51. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal. 1999, 6(1): 1-55. doi: 10.1080/10705519909540118

52. Biancalana D, Baione F. A quantitative analysis on the effect of COVID-19 in a private health insurance plan expenditure. Quality & Quantity. 2022, 57(S2): 173-187. doi: 10.1007/s11135-022-01603-6

53. Walsh G, Evanschitzky H, Wunderlich M. Identification and analysis of moderator variables. European Journal of Marketing. 2008, 42(9/10): 977-1004. doi: 10.1108/03090560810891109

54. Yang Y. Using Bibliometric Analysis to Explore Research Trend of Electronic Word-of-Mouth from 1999 to 2011. International Journal of Innovation, Management and Technology. 2012. doi: 10.7763/ijimt.2012.v3.250

55. Yeo SF, Tan CL, Goh YN. Obstetrics services in Malaysia: factors influencing patient loyalty. International Journal of Pharmaceutical and Healthcare Marketing. 2021, 15(3): 389-409. doi: 10.1108/ijphm-08-2020-0070

(129 Abstract Views, 62 PDF Downloads)


  • There are currently no refbacks.

Copyright (c) 2024 Abhijeet Chavan, Abhijit Mohanty, Sujata Joshi

License URL: