Cross-National Emic Scale Development in Health Care Service Quality

Although, health care service quality has been studied extensively and independently in a number of different countries, cross-national service quality research is less common. Several health care service quality measures are available, but to the best of our knowledge, there are no studies on cross-national scale development for health care service quality. Furthermore, when several nations have been compared, the scales have been borrowed, often from Western developed countries. This paper describes the process of cross-national emic scale development for health care service quality in Finland, India, Nigeria, and the People’s Republic of China (PRC). We start our scale development from existing literature, refine the scale with data from the four countries, and arrive to 15-item measure. The factors that we finally arrived on reflect different functions and encounters of health care service; ‘employees’, ‘drugs and diagnosis’, and ‘environment and access’ which we label as functional dimensions. Compared with traditional service quality dimensions, tangibility, reliability, responsiveness, assurance and empathy the functional dimensions measure different encounters of health care service delivery, hence the name. We suggest that health care service quality scales could be further developed by combining the traditional dimensions with functional dimensions such as our data has provided. Each traditional dimension could be combined with a set of functional dimensions. For each combination items could be created to measure the combination. This way, for example tangibility could become more detailed and thus more concrete as tangibility of employees, drugs and diagnosis and environment and access can be measured respectively.