Digital Service Quality, Patient Satisfaction, and Patient Loyalty: An Empirical Study of Mobile JKN Implementation at A Regional General Hospital in Indonesia

Abstract

The increasing integration of digital technologies into healthcare has transformed patient interactions with healthcare providers, making digital service quality an increasingly important determinant of patient experience and behavioral outcomes. However, empirical evidence regarding how digital service quality influences patient loyalty within government-supported digital healthcare systems remains limited, particularly in the context of Indonesia's National Health Insurance program. This study aimed to examine the effects of digital service quality on patient satisfaction and patient loyalty and to determine the mediating role of patient satisfaction among BPJS Kesehatan participants using the Mobile JKN application at Permata Bunda General Hospital, Tasikmalaya, Indonesia. A quantitative cross-sectional study was conducted among 331 BPJS Kesehatan participants selected through consecutive sampling. Data were collected using a structured questionnaire and analyzed using path analysis. The results showed that digital service quality had a strong positive effect on patient satisfaction (β = 0.878) and a positive direct effect on patient loyalty (β = 0.393). Patient satisfaction also had a positive effect on patient loyalty (β = 0.518). Furthermore, digital service quality demonstrated a positive indirect effect on patient loyalty through patient satisfaction (0.455), with a total effect of 0.848, indicating partial mediation. The model explained 77.2% of the variance in patient satisfaction and 78.2% of the variance in patient loyalty. These findings demonstrate that digital service quality contributes to patient loyalty through both direct functional value and indirect effects mediated by patient satisfaction. The study extends the understanding of digital healthcare service quality by demonstrating that digital interactions constitute an integral component of the patient experience within a national health insurance system. Strengthening the reliability, efficiency, responsiveness, security, accessibility, and usability of digital healthcare services may therefore enhance patient satisfaction and foster more sustainable patient relationships in digitally integrated healthcare delivery.