Effect of Telemedicine Service Quality on Patient Satisfaction and Word of Mouth Intention: Comparison between China and Korea

Abstract

The purpose of this study is first to theoretically examine telemedicine services in China and Korea and the associated policies, with particular attention given to telemedicine service quality, consumer innovation, prior knowledge, patient satisfaction, and word-of-mouth, and relationships between them. Second, to verify the effects of telemedicine service quality on patient satisfaction and word-of-mouth intention. Through this we will identify the factors that affect patient satisfaction and word-of-mouth intention, and derive implications for the improvement and development of telemedicine. Third, to verify whether consumer innovativeness and prior knowledge play a moderating role in the effects of telemedicine service quality on patient satisfaction and word-of-mouth intention. This study will then identify which consumer characteristic can promote the spread of telemedicine services. In order to do this, a questionnaire was sent to patients who have experience of telemedicine services in China and Korea. Of the valid respondents 162 questionnaires were returned from China, and 153 from Korea, thus 315 completed surveys were used as analysis data. An analysis of the results revealed that the effect of telemedicine service quality on patient satisfaction is different between China and South Korea. Specifically, accessibility have significant positive effects on patient satisfaction in both China and Korea. Therefore, hospitals operating telemedicine systems will be able to further improve patient satisfaction by improving their systems to make them more accessible to patients. This is likely to ultimately help hospitals’ sales. A significant positive effect on patient satisfaction is also made by cost effectiveness, but only in China and not in Korea. This indicates that to attract telemedicine patients in China, it is necessary to adjust telemedicine costs so that patients do not face a financial burden. Second, the effect of the operational quality of telemedicine services on patient satisfaction differs in China and Korea. Specifically, the procedural convenience of telemedicine was shown to have no significant effects on patient satisfaction in China, but does have a significant positive effect on patient satisfaction in Korea. Therefore, improvements in the procedural convenience of telemedicine will help attract patients for telemedicine in Korea. Another finding was that the speed of telemedicine services has a significant positive effect on patient satisfaction in China, but not in Korea. Therefore, hospitals providing telemedicine services in China should let existing offline medical staff to additionally provide telemedicine services in order for patients to have a faster telemedicine services. Third, the effect of the physical quality of telemedicine services on word-of-mouth intention appeared to be different in China and Korea. Receptivity (acceptability) and accessibility of telemedicine in both China and Korea have significant positive effects on word-of-mouth intention. This is due to the current COVID-19 pandemic, and the fact that patients may prefer telemedicine to face-to-face care (which carries risks), so the patient's acceptance of telemedicine services increases the likelihood that they will recommend the new treatment method (telemedicine) to other people. In addition, the easier the accessibility (convenience of access), the easier it will be to explain to other people, which will lead to the effects of the word-of-mouth on telemedicine. Furthermore, the cost effectiveness of telemedicine services appeared not to affect the word-of-mouth intension in both China and Korea. In China, the cost effectiveness of telemedicine services can be different depending on the medical treatment services as patients receive different services depending on the type of diseases. However, in Korea, all patients receive similar benefits as the Health Insurance System is well established, so people in Korea may not feel the need to recommend telemedicine services to other people due to the cost effectiveness of telemedicine services. Fourth, the effects of the operational quality of telemedicine services on word-of-mouth appeared to differ in China and Korea. Specifically, it appeared that the procedural convenience of telemedicine has a significant positive (+) effects on the word-of-mouth intention of Chinese patients, but in the case of South Korea it was found not to have a significant effect. In the case of China, hospitals that provide telemedicine can attract more telemedicine patients by improving telemedicine procedures so as to be more convenient. However, in Korea, online access is complicated, largely due to identity security requirements. A simpler system is thus called for. Fifth, it was found that there was no difference in the effect of patient satisfaction with telemedicine on word of mouth intention between China and Korea. Specifically, patient satisfaction with telemedicine service had a significant positive (+) effect on word-of-mouth intention in both Korea and China. This means that Chinese and Korean patients are more likely to recommend telemedicine to their friends and relatives if they are satisfied with the service. Therefore, to attract more telemedicine patients, hospitals that provide telemedicine need to improve their systems and identify factors that can induce patient satisfaction. In relation to the effect of telemedicine service quality on patient satisfaction, the moderating effect of consumer innovation was found to be different in China and Korea. In the case of China, the effect of telemedicine acceptability on patient satisfaction did not change as consumer innovativeness increased, but in Korea, the effect of telemedicine’s acceptability on patient satisfaction appeared to be stronger if consumer innovation is high. Next, in both China and Korea, the higher the consumer innovativeness, the stronger the relationship between telemedicine access convenience and patient satisfaction. Hospitals that provide telemedicine in both countries are expected to attract more telemedicine patients if they target college students or young people, who have relatively strong consumer innovation. Sixth, in relation to the effect of telemedicine service quality on patient satisfaction, there was no difference in the moderating action of prior knowledge between China and Korea. In China, the greater the prior knowledge, the stronger the effect of telemedicine acceptability on patient satisfaction. Hospitals that provide telemedicine in Korea should carry out marketing promotion activities so that more people can improve their knowledge and understanding of telemedicine.