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Ping Lei and Alain Jolibert, A three-model comparison of the relationship between quality, satisfaction and loyalty: an empirical study of the Chinese healthcare system, BioMedCentral Health Serv Res. 2012; 12: 436. Published online 2012 November 30. doi:  10.1186/1472-6963-12-43China’s healthcare system is on the brink of major reform, stimulated by a multitude of forces that are driving this change. Since 2002, the Chinese government has primarily allocated its healthcare funding to graduates of medical schools and public hospitals in major cities in an effort to improve the quality of patient care. The strong government commitment to improving health services and patient satisfaction was further emphasized after the 2003 SARS outbreak, when in 2005 the “Year of Hospital Management Reform” was declared, with the key theme of “the patient comes first, improve the quality of service.” In this way, the Chinese government articulated its pledge to the healthcare sector and emphasized the need for public and private sector cooperation . These actions demonstrate the government’s commitment to developing hospital management and organization in a patient-centered manner to increase patient satisfaction.Simultaneous with the government’s new commitment, Chinese patients are becoming more knowledgeable and active in “managing” their healthcare experiences. In major cities, there are increasing numbers of individuals who are taking “responsibility” for their healthcare. There is increasing demand for improved hospital-based services, patients are becoming better informed, and, in turn, more demanding about the type and quality of health services they expect to receive. The government has, in fact, already encouraged the “voice of the consumer” by soliciting patient feedback in evaluating hospitals to help improve the level of patient care.Because of these circumstances, Chinese hospitals are now operating in a new, complex and uncertain environment. The current transformation from a Communist system to a competitive healthcare market is obliging hospital providers to deal with decreased funding and increased competition. Facing this situation, providers must learn to cost-effectively satisfy the needs and desires of their patients. As a result, providers and policymakers are urgently seeking a clear understanding of the quality, satisfaction and loyalty intention relationship in the Chinese healthcare market.Many researchers have studied patient satisfaction in Western healthcare services, and there are some that have studied patient satisfaction in Hong Kong and Taiwan. However, to date no research has focused on mainland China’s healthcare market.Over the past 30 years, a large number of consumer behavior studies have explored the links between quality, consumer satisfaction and loyalty in Western cultures, yet no consensus has been reached. Three theoretical models can, however, be found in the literature.Faced with three contradictory theoretical models, it is challenging to determine which model is most appropriate to utilize in studying healthcare services in mainland China. The purpose of this study is to analyze the relationships between perceived quality, patient satisfaction and loyalty intentions in mainland China’s healthcare system.The empirical data for this study was collected in Shanghai (eastern China), where patients have substantial freedom to choose their medical providers. Read moreThe pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1472-6963/12/436/prepubThe study is the PhD dissertation work of Ping Lei at the CERAG/CNRS, University Pierre Mendes France (Grenoble University France).