For the private hospital component, 413 patients were interviewed representing a response rate of 97.64% (see Figure 2). As can be seen from the graph opposite, Tanganyika Care Hospital was the most represented, followed by the van Norman Clinic, Polyceb and CMCK, and finally Kira Hospital with 39 patients.

Figure 2. Distribution of respondents by hospital.

Several departments were visited in these hospitals, the main ones being the radiology department with the most respondents, followed by the internal medicine department, pediatrics, surgery and maternity. Most of the respondents were female, as they were the ones who were most likely to be on call when a child was ill.

The majority of respondents were female (57.38%), while 42.62% were male. The 25 - 40 age group was the most represented overall and for females, while the 40 - 55 age group was the most represented for males (see Figure 3). Of these patients, most (33.17%) had secondary education, followed by primary education (27.60%) and higher education (24.46%), and finally those with no education (14.77%).

Figure 3. Gender distribution of respondents by age.

In this section we will analyze the patients’ perception of the quality of health services provided by the private hospital. The following hypothesis will be tested: “the quality of health services provided by the private hospital has a positive impact on patient satisfaction, in terms of reliability”.

3.3.1. Home of the Administrative Service

As can be seen from the previous graph, 96.61% of patients are satisfied (very satisfied and satisfied) with the reception of the administrative service against 3.39% (not very satisfied and dissatisfied) who are dissatisfied with the reception of the administrative service (see Figure 4).

The Fisher exact test shows that the level of satisfaction (from unsatisfactory to very satisfied) differs according to the level of education, however, the difference in overall satisfaction (satisfied and very satisfied) according to the level of education is not statistically significant (p-value > 0.05). The same is true for patients who are hospitalized or not. This observation differs for patients with health insurance or free care (children under 5 years old and pregnant women), where we note the significance of the diversity of satisfaction (F-exact, p-value = 0.025).

Figure 4. Distribution of respondents on the perception of administrative reception.

3.3.2. Accuracy of Diagnosis

The accuracy of diagnosis is satisfactory, with less than 1% of patients surveyed finding the accuracy of diagnosis unsatisfactory compared to 99.03% of respondents who said they were satisfied with the accuracy of diagnosis of their condition. Overall, the accuracy of the diagnosis is appreciated by all groups of patients. However, most inpatients (61.33%) were very satisfied, while most outpatients (57.76%) were satisfied (see Figure 5), and this difference was statistically significant (p-value of F-exact < 0.01).

Figure 5. Patients perceptions on diagnostic accuracy.

3.3.3. Respect for the Hours of Care and Doctor’s Appointments

The respect of the timetable for the provision of care is highly appreciated in private hospitals. As can be seen from the previous graph, 92.98% (4843% very satisfied and 44.55% satisfied) of patients stated that they were satisfied with the timeliness of care and appointments. Only 7.02% of respondents stated that they were dissatisfied with keeping appointments, mainly for outpatient consultations. The Fisher exact test shows that this level of satisfaction with respect for the timetable of care offers differs according to the patients’ level of education. In fact, patients with secondary education and those with university education are the ones who most mentioned being less satisfied or satisfied, unlike the other patients. It is also noted, thanks to the chi-square test, that this satisfaction differs from one hospital to another. Indeed, among the patients dissatisfied with the timeliness of care, 37.93% are from Kira Hospital, followed by Polyceb with 27.59% and CMCK and Tanganyika Polyclinic with 13.79% of dissatisfied patients on each of them and in last position is the Van Norman Clinic with 6.9% of all respondents (see Figure 6).

Figure 6. Distribution of satisfaction with the timeliness of care.

3.3.4. Reliability of Care Services (From the First Time)

The majority of patients are satisfied with the reliability of the care services offered in private hospitals. Indeed, 54.72% of the respondents were very satisfied with the reliability of care and 44.07% were satisfied. Only 1.21% reported being dissatisfied. In contrast to the other indicators, satisfaction with the reliability of care services is perceived in the same way for all patient groups and regardless of gender. This was confirmed by the chi-square test and the Fisher exact test (p-value > 0.05) (Figure 7).

Figure 7. Distribution of perceived reliability of cares.

The reliability dimension assesses the ability to deliver the promised service confidently and accurately. It is assessed by the four variables (question) above summarized in Table 2 below.

Table 2. Assessment of service quality through the Reliability dimension.

As can be seen from Table 2 above, all four indicators of the reliability dimension show that they have a positive impact on patient satisfaction. We therefore conclude that reliability in private hospitals is indeed a reality and that it has a positive impact on satisfaction.

In this section, we propose to evaluate the quality of health services in private hospitals in terms of helpfulness. The following hypothesis is put forward for verification: “The quality of health services in private hospitals has a positive impact on patient satisfaction in terms of helpfulness”.

The previous graph shows that waiting times for care are generally satisfactory in private hospitals. Indeed, 87.65% of patients say they are satisfied with the waiting time for care. For the 12.35% of patients who said they were not satisfied with this time, they deplored the time spent waiting for outpatient consultations (see Figure 8). In fact, with the Fisher exact test, it can be seen that satisfaction varies according to whether the patient is hospitalized or not. There is also a statistically significant difference in satisfaction with waiting time according to the level of education. This satisfaction also varies according to the hospital (p-value = 0.00). Most dissatisfaction with waiting time is observed in Kira Hospital and Polyceb, and is mainly among outpatients.

Figure 8. Distribution of satisfaction with waiting time for care.

The responsiveness of medical staff is crucial to the perception of patient satisfaction. In private hospitals, as can be seen in the graph above, 95.40% of patients say they are satisfied with the response to their complaints and/or requests.

The Fisher exact test shows that satisfaction with responses to complaints and requests does not differ significantly according to certain patient groups, including whether the patient is hospitalised or not, the level of education or whether the patient is insured (or meets the criteria for free care) or not. However, this satisfaction differs according to gender (F-exact, p-value = 0.03). Indeed, among the dissatisfied patients, most of them (68.4%) were male. The same is true according to the hospital (F-exact, p-value = 0.004) where 42.11% of dissatisfied patients were dissatisfied with the responsiveness of the staff to their complaints at Polyceb, 26.32% at CMCK and 21.05% at Kira Hospital. No dissatisfaction was noted at the van Norman Clinic (see Figure 9).

Figure 9. Perceived satisfaction with responses to complaints.

As can be seen from the graph above, 96.85% (51.33% very satisfied and 45.52% satisfied) of the patients are satisfied with the ability of the private hospital staff to provide services (see Figure 10). The 3.15% declaring dissatisfaction deplored the experience with some of the medical staff not being responsive to them, not always ready to help. Analysis with the F-exact test shows that satisfaction with the ability of the staff varies according to the length of stay in the hospital (p-value = 0.008). It is indeed found that among the dissatisfied patients, most (46.15%) had spent a long time in the hospital. It is also vis-à-vis gender (F-exact, p-value = 0.19) with 76.92% of the dissatisfied patients being male and 58.50% of the satisfied patients being female. This satisfaction does not vary from one hospital to another (F-exact, p-value = 0.37).

Figure 10. Distribution of satisfaction with staff suitability.

The simplicity of the care procedures is satisfactory; indeed, 95.40% (49.15% very satisfied and 46.25% satisfied) state that they are satisfied with the simplicity of the care procedures while only 4.60% state that they are not satisfied (see Figure 11). The Fisher exact statistic (p-value = 0.002) shows that satisfaction with care procedures varies from one hospital to another.

Figure 11. Distribution of satisfaction with simplicity of care procedures.

Helpfulness (timeliness) was assessed by the four previous dimensions summarized in Table 3 below. These are the waiting time for care, responses to complaints, the ability of staff to provide care and the simplicity of care procedures. The aim is to check the willingness of the health care staff to interact with patients and to provide a prompt service.

The results of Table 3 show us that the dimension of helpfulness has a positive effect on patient satisfaction, as the overall average is in the range of 2 to 3. The same is true for each of the four indicators of this dimension, where we see that the effect of the latter is positive on satisfaction. We therefore conclude that helpfulness exists and has a positive effect on patient satisfaction in private hospitals.

Table 3. Summary of the assessment of service quality via the Serviceability dimension.

The next dimension concerns the assurance, the security that the patient has of the health care services received in the medical settings. To assess this, we will start from the patients’ perceived satisfaction with the competence of the medical staff, the image of the medical institution in the community, the perceived confidentiality of their information and communication with the caregivers to study the following hypothesis: “The quality of the health services provided by the private hospital has a positive impact on the patients’ satisfaction, in terms of assurance (safety)”.

Although most patients stated that they could not judge the competence of the medical staff, 98.79% had a satisfactory perception of the competence of the medical staff, of which 58.35% were very satisfied and 1.21% were not very satisfied (see Figure 12). It was also found that this view did not vary significantly between the different patient groups, but also remained unchanged for the different hospitals.

Figure 12. Distribution of satisfaction with the competence of the medical profession.

The graph above shows that the image of private hospitals is highly appreciated. Indeed 97.58% of the patients are satisfied with the image and the place of the institution in society (see Figure 13). They claim to have the image of private hospitals in the community as institutions offering quality care services but at a very high cost. This satisfaction varies significantly, as observed with the Fisher-exact statistic (p-value = 0.025), depending on whether the patient is hospitalised or not. This finding is also noted according to the hospital, where thanks to the Fisher exact test (p-value = 0.11), it is concluded that the degree of satisfaction with the hospital’s image varies from one hospital to another.

Figure 13. Distribution of image satisfaction in society.

The confidentiality of the caregivers consists in keeping the professional secret which reassures the patients and influences the image of the hospital. As can be seen from the graph above, 98.31% (58.35% very satisfied and 39.95% satisfied) of the patients were satisfied with the confidentiality of their information, while 1.69% were not satisfied (see Figure 14). According to the Fisher exact statistic, confidentiality does not vary significantly between different patient groups, but also between hospitals.

Figure 14. Distribution of satisfaction with confidentiality of information.

The above results show that 97.58% of the patients said they were satisfied with the communication with the care. Only 2.42% reported that they were not satisfied with the communication from care during their hospital stay (see Figure 15). Satisfaction with care communication varied significantly according to the time spent in hospital (p-value = 0.009). This was also the case with regard to the patient’s gender (p-value = 0.021) and also according to the hospital (p-value = 0.41).

Figure 15. Distribution of satisfaction with communication with care.

The study of the four indicators of patient assurance in private hospitals shows that most respondents are satisfied with their experience during their hospital stay. The following Table 4 concludes on the impact of satisfaction on patient assurance in private hospital settings.

Table 4. Summary of the assessment of service quality via the Insurance dimension.

The results of the previous Table 4 confirm the hypothesis stated on the assurance dimension. It can be seen that each indicator of assurance varies between 2 and 3 and therefore positively affects patient satisfaction in private hospitals. Overall, the competence of the employees and their ability to inspire confidence has a positive effect on patient satisfaction.

The dimension of tangibility was studied on the basis of five variables that include all tangible things such as equipment, staff appearance and facilities. To do this, we start from the following hypothesis: “The quality of health services provided by the private hospital has a positive impact on patient satisfaction, in terms of tangibility”.

The results of the previous graph show that 94.76% (59.18% very satisfied and 35.58% satisfied) of the patients surveyed are satisfied with the comfort of their room (cleanliness of the premises, toilets and linen, heating, etc.). 5.24% of the patients who are dissatisfied with the comfort of their room deplore the high number of patients in the common rooms (see Figure 16). Most of them pointed to the lack of gender segregated common toilet facilities in some hospitals which do not provide privacy in cases where the patient needs help to get there. From the Fisher-exact statistic (p-value > 0.05), it can be seen that the null hypothesis of independence of satisfaction with room comfort in private hospitals by hospital and different patient groups cannot be rejected.

Figure 16. Distribution of satisfaction with room comfort in private hospitals.

The catering service is only provided in some hospitals. As can be seen from the graph above, 67.72% are satisfied with the meals received in the hospital in terms of menu variety, quantity, quality and compliance with the patient’s diet. However, 32.28% were dissatisfied with this service and complained mainly about the lack of respect for the patient’s diet and the irregular availability of the meal (at the right time), but also about the overcharging of this service in relation to the quantity and quality of the meal provided (see Figure 17). It is noticeable that this satisfaction depends on certain groups of patients. Indeed, the Fisher exact test shows that the null hypothesis of independence of satisfaction with the level of education (F-exact < 0.05), the possession of an insurance or free care but also according to age can be rejected.

Figure 17. Distribution of meal satisfaction.

The above results show that 95.64% of the patients are satisfied with the general atmosphere of the service (calm, security). We notice 4.36% of the patients who are dissatisfied especially with the security of their property that is stolen. Of these dissatisfied patients, most (61.11%) are observed at the CMCK hospital and 22.22% at the Van Norman clinic (see Figure 18). The Fisher exact statistic reveals that satisfaction varies from one hospital to another (p-value = 0.001).

Figure 18. Distribution of atmospheric satisfaction.

Figure 19. Satisfaction on availability of medical equipment.

From the results of the above graph 64.26% of the patients surveyed are very satisfied with the availability of equipment and medicines and 32.85% are satisfied while 2.89% are dissatisfied (see Figure 19). Patients complain about the non-availability of all tests in some hospitals and are forced to go to other laboratories in other hospitals. The Fisher exact statistic shows that the null hypothesis of independence of satisfaction according to hospital and different patient groups cannot be rejected at the 5% level.

There is a high level of satisfaction among patients with the organization of visiting arrangements in private hospitals. Indeed, 96.19% (63.98% very satisfied and 32.20% satisfied) of patients are satisfied with the visiting arrangements. However, those who are dissatisfied represent 3.81%. With the Fisher exact statistic, at the threshold of 5%, we can see that the satisfaction of the visiting modalities is dependent on the hospital of the patient (see Figure 20).

Figure 20. Breakdown of satisfaction with visiting arrangements.

Most of the five indicators of the tangibility dimension showed satisfactory patient satisfaction in private hospitals in Bujumbura.

It can be seen from the results, overall, tangibility has a positive effect on patient satisfaction with an overall average of 2.41. However, in the hospitals with catering services, it can be seen that the meal offered has an average effect, with an average of 1.81. It is therefore concluded that the stated hypothesis that tangibility has an effect on patient satisfaction is accepted (see Table 5).

Table 5. Summary of quality-of-service assessment via the Tangibility dimension.

The dimension of courtesy consists of the evaluation of the attitude of the staff towards the patients. We propose to analyze the patients’ satisfaction with the behavior of the medical staff during the provision of health care services. The hypothesis is: “The quality of health services provided by the private hospital has a positive impact on patient satisfaction in terms of empathy (courtesy)”.

Almost all patients in private hospitals (99.03%) are satisfied with the politeness and friendliness of private hospital staff (see Figure 21). The staff of these hospitals are indeed reminded a lot about good manners during the exchanges with the patients. However, some of the patients mentioned the case of some of the staff for whom the friendliness is not satisfactory, hence most of the patients stated that they were globally satisfied with the politeness instead of very satisfied. Friendliness is assessed in the same way in all hospitals; indeed, the Fisher exact test shows that the null hypothesis of independence cannot be rejected at the 5% level.

Figure 21. Distribution of satisfaction with staff politeness.

The results of the above graph show that 97.09% of patients are satisfied with the availability of the staff, of whom 57.63% are very satisfied. The 2.91% who found it unsatisfactory mainly deplored the medical staff’s attentiveness in certain cases (see Figure 22). The appreciation of the availability of the staff depends on the hospital. This result is found via the Fisher exact statistic, which proves at the 5% threshold that there is a dependence of the level of satisfaction of the availability of the staff with the hospital.

Figure 22. Distribution of satisfaction with staff availability.

Respect for privacy is highly valued in the private hospital setting. It can be seen from the graph above that 98.06% of the patients are satisfied with their privacy (see Figure 23). Satisfaction with privacy is uniformly respected, as confirmed with the Fisher-exact test, for the different groups of patients and in the different hospitals.

Figure 23. Distribution of satisfaction with privacy.

The individualized interest and attention of the caregiver to each patient is highly appreciated in the private hospital setting (see Figure 24). As can be seen from the graph above, 98.79% (very satisfied and satisfied) say they are satisfied with the way the nursing staff pays attention to each patient.

Table 6 below presents the evaluation of the quality of service through the courtesy dimension.

According to the results of Tab.6 the indicators of the courtesy dimension are all in the range of the positive effect range. It can be seen that individualized attention and consideration for the patient have a significant effect on patient satisfaction. It is therefore concluded that the quality of health services provided by the private hospital has a positive impact on patient satisfaction in terms of empathy (courtesy).

Figure 24. Distribution of the satisfaction of the attention to each patient.

Table 6. Summary of the evaluation of service quality via the Courtesy dimension.

Overall, Figure 25 shows that most patients are satisfied with their stay in private hospitals with an arithmetic mean of 2.42 which falls within the positive effect range. However, the degree of satisfaction differs from one hospital to another. In Tanganyika and van Norman hospitals, most patients (more than 60%) found their stay in these hospitals very satisfactory in contrast to the remaining hospitals such as CMCK, Kira Hospital and Polyceb, where most patients reported being satisfied by 59.55%, 61.54% and 70.79% respectively. The main causes of low satisfaction in these hospitals compared to the others are the high waiting time observed in outpatient clinics as well as the costs considered too high compared to other private and public hospitals.

Figure 25. Distribution of overall satisfaction with stay in private hospitals.

This difference is confirmed by the Chi-square test at the 5% level (chi²(12) = 61.4723, p-value = 0.00), which shows that patients’ satisfaction with their stay in private hospitals differs significantly from one hospital to another. The second study hypothesis is confirmed.