• Yanghang Yu, Zhixia Chen, Yuanyuan Zhao, Yanan Wang, Rong Zhang, and Xining Zhou.
• School of Public Finance and Management, Yunnan University of Finance and Economics, Kunming, Yunnan Province.
• Medicine (Baltimore). 2020 Nov 25; 99 (48): e21079.

AbstractThe purpose of this study is to examine the mediating effect of psychological contracts (including relational and transactional psychological contracts) on the relationship between medical service quality and patient loyalty.A cross-sectional survey was conducted between September and December 2017. Questionnaires assessing medical service quality, the psychological contract, and patient loyalty were distributed to a random sample of 600 patients across 6 hospitals. The final sample consisted of 469 participants. Hierarchical regression analyses were conducted to examine the mediating effect of psychological contracts on the relationship between medical service quality and patient loyalty.The mean scores of medical service quality, psychological contracts, and patient loyalty were 3.497 ± 0.571, 3.699 ± 0.503, and 3.342 ± 0.724, respectively. Medical service quality is positively related to psychological contract (β = 0.612, 95% confidence interval [CI] = 0.476-0.603) and patient loyalty (β = 0.676, 95% CI = 0.773-0.944). Further, psychological contract is positively related to patient loyalty (β = 0.599, 95% CI = 0.757-0.968). Both relational psychological contract and transactional psychological contract mediate the relationship between medical service quality and patient loyalty.Our findings reveal that medical service quality is associated with patient loyalty and that this association is mediated by relational and transactional psychological contracts. Therefore, in order to improve patient loyalty, psychological contracts should be reinforced, and medical service quality should be improved.

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