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Title: Health care insurance quality in the UAE using SERVQUAL model from customer perspective


The provision of healthcare within the Middle East and North Africa region continues to evolve and concurrently the real estate as well as operational needs of providers of healthcare becomes increasingly complex. Industry changes and trends compel operators and investors of healthcare facilities to make bold decisions. United Arab Emirates has come up as one of the fastest growing healthcare markets within the Gulf region as a result of increased government budget on healthcare in the strong economic years. UAE healthcare system has strived to keep up with population growth that is immigration-driven and struggles to control increases in per-capita healthcare spending as occasioned by increasing degrees of chronic diseases and affluence. The government of UAE plays a pivotal role in the provision of public healthcare services (Chau, 2012). Nevertheless, the government is promoting the inclusion if the private sector in every area of medical service for the purpose of delivering high standard of healthcare to the citizens. In general a good coverage of basic healthcare has been attained across the country so that less than 200 people live in a place that is 30km from a health service provider. All the Primary Healthcare clinics offer preventive as well as curative services together with a small portion of rehabilitative services (Woodman, 2015). Some of the infectious diseases such as Measles, malaria and poliomyelitis that were endemic have been eradicated whereas post-natal and pre-natal care is at the same level with the most developed countries in the world.

The healthcare sector in UAE is divided between the public and private healthcare providers. The public healthcare services are regulated as well as managed by the federal together with the emirate-level government entities like Health Authority Abu Dhabi, Abu Healthcare Services, Dubai Health Authority, and the Ministry of Health (Bakar, Akgun & AL Assaf, 2008). The entities partner with other foreign healthcare organizations in running the daily operations of clinics and hospitals across UAE. The SERVQUAL model has been used in determining service quality particularly in the service industry. The five dimensions of reliability, tangibles, assurance, responsiveness, and empathy provide a measure that determines the performance of the service provides. Since its discovery, the SERVQUAL model has been widely used in determining customer’s satisfaction in the service industry. Healthcare insurance quality in the UAE has to be enhanced to meet the customers’ expectations in various areas (Woodman, 2015). The functions of SERVQUAL Model cannot be overemphasized. A SERVQUAL model tool is critical in the service industry for gathering data from clients and analyzing them to predict the required trend. A SERVQUAL model is applied to a group of students to determine the healthcare insurance quality in the United Arab Emirates (UAE) under insurance covers of various healthcare insurance firms. This paper explores the use of SERVQUAL Model in determining healthcare insurance quality from the perspective of customers in the United Arab Emirates by analyzing services provided by various companies.

Literature review and Benchmarking

UAE is ranked as among the fastest developing markets within the Middle East. The UAE sector is very developed within the GCC region following in the footsteps of Saudi Arabia with a surge in demand for first-class healthcare. Healthcare standards are regarded to be generally of high level in the UAE, as a result of increased government spending in the course of strong economic years (Bagheri, 2013). The World Health Organization states that in 2004 the whole expenditure on healthcare amounted to 2.9% of the Gross Domestic Product while the per capita expenditure in healthcare was about US$497 (Bakar, Akgun & AL Assaf, 2008). The World Bank went ahead to rank Dubai as well as Abu Dhabi as the second and third popular medical tourism destinations within the Middle East region. The government of UAE plays a critical role in the provision of health services and was responsible of about 70% of spending in the healthcare in the course of 2007. Due to increased pressure within the public health system, the government is aggressively enhancing the involvement of the private sector in various sectors of medical services from diagnosis to treatment. The UAE citizens are offered healthcare services though the Federal Ministry of Health in the government. MoH needs all citizens to get a health card. The pharmaceutical market of the UAE is regarded as one of the lucrative market within the Middle East region (Chowdhary & Prakash, 2007). The growth rate is growing at double digit over the last few years. The robust growth can be linked to various factors like rapid increase in population, trade policies that are liberal and international standards’ adaptation in healthcare. The market remained unchanged by economic crisis. Drugs imports continue to dominate the increasing demand for domestic drug consumption. Nations like Germany, the UK, France and Switzerland remain as the most significant sources for pharmaceutical imports in the UAE. Medical facilities within the UAE are of high standards and reflect the rapid development of the country over the past years (Bakar, Akgun & AL Assaf, 2008). The medical device market within UAE is dependent on important just like the pharmaceutical market. The medical device market is positively supported by lowest import duties within the region.

Quality has been described from many perspectives. Quality is viewed a competitive weapon in the emergence of new markets and the growing market share. Quality can be described as exceeding or satisfying customer expectations and requirements and the customer judges the quality of any product. Service quality is the customer perception of the manner in which a service exceeds or meets their expectations (Chowdhary & Prakash, 2007). Service quality has been defined by some practitioners as the gap between the customer’s expectations for the service encounter and on the other hand, the perceptions of the received service. Customers’ perception and expectation are the main ingredients in service quality (Wicks & Roethlein, 2009). Quality is scored as low by customers if the performance does not live up to their expectations. Customer satisfaction and service are very fundamental concepts that firms have to understand for the purpose of retaining competitive advantage and growth. It is very significant for companies to determine the constructs from the customers’ perspective in order to comprehend their needs and satisfy them. Service quality is crucial since it leads to customer satisfaction, reduced cost; profitability, retention and customer loyalty (Bryman & Bell, 2007). SERVQUAL model plays an important role in the determination of service quality. Service quality has been discussed widely since its inception with regard to obtaining positive results. Service quality is crucial to the performance of any company. Service quality defines or determined customers’ satisfaction. The healthcare industry is very sensitive and customers require high standards in terms of service and products offered to them (Bougoure & Lee, 2009). Quality really matters for customers who are seeking healthcare services. Substandard services will make customers to seek alternative service providers. Consumer approval for products and services sets the benchmark for the required standards in the industry and gives a hint on the future expectations of the customers.

Parasuraman et al. (1985, 1988, and 1991) carried out numerous research projects that resulted into the service quality model “SERVQUAL”. The model initially had been established on ten dimensions of service quality but later they were reduced to five. Service quality is a crucial topic with regard to its important relationship to cost saving, profit and market share. There have been numerous service quality models developed by researchers from 1984 to 2003. The service quality model (SERVQUAL) is ranked as the most invaluable of the available models. According to Kloep (2012) the SERVQUAL model is founded on the assumptions that service quality is normally a function of differences that exist between the expectations of the customers and perceptions along five quality parameters that include responsiveness, reliability, assurance, empathy, and tangibles (Bagheri, 2013). Tangibles refer to physical facilities, appearance of personnel, and equipment. Reliability is the ability to carry out services dependably and accurately. Responsiveness is the willingness to assist customers as well as offer prompt services. Empathy describes caring and individualized attention offered to customers that includes both access to as well as comprehending of customers. Assurance refers providers’ courtesy, knowledge and ability to convey confidence and trust. The SERVQUAL instrument has twenty-two pair of Likert scale questions which are designed to measure expectation of customers of a service and the perception of the customers of the provided service by an organization (Kloep, 2012). In assessing the service quality usually the gap for every question is determined based on drawing a comparison of the perception score with expectation score. Favourable customer perception with regard to service quality creates a positive relationship with the overall customer satisfaction and hence their behavioral intention. Repeat purchases as well as willingness to recommend to others the service happens hence making a company or firm to have a competitive advantage over the rest and to stand out in the industry (Globie, 2012). Generally service quality is divided into two major components that comprise of functional and technical quality. Technical quality defines the technical procedures and diagnosis whereas functional quality describes the way of delivering the defined services to the patients. SERVQUAL is a renowned research instrument that is used in the evaluation of the service quality even in the healthcare industry (Badri, Abdulla & Al-Madani, 2005). Any service industry can use the SERVQUAL instrument in evaluating performance of its services according to the customers’ perspectives. It is crucial to determine the gap between the real performance and the expectations of the clients in order to know where improvement in needed.


Questionnaires were self-administered to 31 students for determination of service quality within the healthcare insurance industry in the United Arab Emirates. The 31 students are the ones who took part in the survey and returned the questionnaires. The students get healthcare insurance service from various insurance companies in UAE that include Daman Health Insurance, ADNIC Insurance, Oman Insurance, ALAin Alahlia Insurance, AXA Insurance, National Takaful Insurance, Metlife Aleco Insurance, Saico Insurance, Qatar Insurance, MSH International Insurance, Orient Insurance, Aetna Insurance, Al Hilal Takaful Insurance, and Emirates Insurance among others. The healthcare insurance service providers are spread across the various emirates namely Abu Dhabi, Sharja, Dubai,Um Al Qiwein, Ras Al Khaima, Ajman, and Fujaira (Ladhari, 2009). The five dimensions of service quality that include assurance, empathy, tangibles, reliability and responsiveness were used to determined customers’ satisfaction level met by the various insurance providers in the healthcare insurance industry. Better quality of services offered by the healthcare insurance providers has a positive impact on its customers and contributes to the productivity and profitability of the insurance industry. High service quality level leads to more customers seeking services in the healthcare insurance industry (Kumar, Kee & Manshor, 2009). The standards of healthcare service quality in the UAE are high hence the insurance companies are willing to insure people for various reasons. Life assurance is important in a healthy nation. The filled up questionnaires were returned and the results analyzed.

Analysis and Discussion

Healthcare insurance quality in the UAE according to customer perspective using the SERVQUAL model is above par. There is still room for improvement. According to the results obtained from the participants there is a gap between the customer’s expectations and the performance of the healthcare insurance companies. Generally healthcare insurance quality in UAE scores highly in terms of tangibles according to the customers’ perspective. This means that the required facilities, appearance of personnel and equipment are up to standard. The customers have little to complain with regard to the physical facilities of healthcare insurance quality. Many healthcare insurance companies have strived to provide facilities that are appealing to their target clientele.

Perception (P)

(E) Expectations

Gap (E-P)





The average scored gap for tangibles is 0.97 hence it shows that the expectations of the customers are almost met by the various healthcare insurance companies. The customers are generally impressed with the kind of facilities, personnel and equipment that the various healthcare insurance companies have. Whereas the individual scores for the five dimensions on the SERVQUAL scale varied from one person to another, the interpreted results presents the average. However, reliability, responsiveness, and assurance show that there is a significant gap between the customers’ expectations and customers’ perceptions that need to be met. There is a sizable gap when it comes to reliability score. The gap is 1.23.

Healthcare service quality also scored highly for the empathy dimension. There is only a gap of 0.13 between the customers’ expectations for empathy and the perceptions for empathy. This means that individualized attention is given to the customers. The personnel are caring towards the customers. The language used by the workers and how they handle the various needs of their customers is impressive. The SERQUAL model shows that tangibles and empathy scores highly in the UAE healthcare insurance quality. Despite empathy expectations scores being very high for many of the participants in the survey, the perception or performance of the service was also high hence the small gap existing between the perceptions and expectations. The services provided have to meet the dependability and accuracy that the customers are looking forward to. The customers still feel the various healthcare insurance provides in the UAE have to improve on their reliability. The gap is not very big and this shows that reliability in UAE in the healthcare insurance sector is high as compared to other countries in the Middle East region.

Responsiveness and assurance dimensions’ score also show that there is still some room for improvement. There is a gap of 1.21 between the customers’ perception for assurance and the customers’ expectations of assurance. This means that the ability to communicate confidence and trust has not been fully achieved in the healthcare insurance industry in the UAE. Whereas the standards for responsiveness dimension are still high, the customers’ need improvement in order to reduce the gap between expectations and perceptions. Expectations for responsiveness were very high and there is still a gap between the expectations and perception of the services received. This means that attending to customers as prompt as possible and being willing to help them does not occur automatically in many healthcare insurance companies in the UAE. Customers expect to be served promptly and the services individualized to a customer’s preferences. Reliability and assurance are very important to the customers who took part in the survey. Customers want to be sure that the services that they are getting are up to standard and meeting the World Health Organization requirements.

Some customer gave a tangible scoring as low as 1.0. This means that there are places in the healthcare insurance industry where the customers are not satisfied at all with the kind of facilities, equipment and the appearance of the personnel. There customers who are not pleased at all by the facilities available and that is why they can give a score of 1.0 for tangibles. Some customers who had a bad experience in a given healthcare insurance company may end up giving a negative feedback as far as other area are concerned such as tangibles and responsiveness. Possibly customers who give lower ratings are detractors who are trapped in a bad relationship with the service provider. There is a big disparity between the lowest score and the highest score for tangibles. The quality of service for the companies with the lowest scores has to be evaluated to discover the gaps that exist. It is important for the healthcare insurance service providers to keep the attitude of customers positive concerning the kind of service they are providing. The types of customers that are referred to as promoters are enthusiastic about the services provided and sell a positive name to other people and encourage them to test the place. Passives may not be excited about the services provided but they do not have anything in particular to complain about. The trend of a big disparity between the best performer and poorest perform cuts across the various dimensions of service quality and hence it shows variations in the quality of services provided across the industry.

The average satisfaction score was 4.68 and the behavior score was 4.82. The customers within the UAE healthcare insurance industry are fairly satisfied although saturation has not been achieved. There is still room for improvement to meet customers; expectations in terms of assurance, reliability and responsiveness. The satisfaction score suggests that there more room for improvement for the healthcare insurance providers. The customers may want more products that are suited to the kind of life that they lead. The healthcare insurance companies have to tailor-make products with the customer in mind in order to meet their needs and increase the satisfaction level. From the findings, the customers still want the healthcare insurance quality to be improved. Even the behavior score of 4.82 still shows there is an opportunity to deliver better services in the healthcare insurance industry. The quality is above par but is has to be up to the customers’ standards. The expectations of some of the customers particularly for tangibles was high as 7.0 but calculating the mean came around 4.6 or there about. This shows that some customers have very high expectations of healthcare insurance provides to have the best facilities and equipment and the appearance of the personnel be up to world-class standard. The variations in the customers’ expectations as well as customers’ perceptions shows the manner in which healthcare insurance providers vary in their product policy provision. Service quality can be based determined using SERVQUAL instrument.

Recommendation and

Healthcare insurance quality in the UAE is of high standards and service providers have differentiated their products to meet various customers’ expectations. The variations in customers’ expectations and perceptions indicate that services provided by healthcare insurance providers differ in quality. There is need for healthcare insurance providers to improve the quality of services that they provide to UAE citizens (Kumar, Kee & Manshor, 2009). Healthcare insurance cover is above par but requires improvement to ensure that the various needs of the customers are met. Healthcare insurance quality in the UAE is of high standard going by the majority of the customers who participated in the survey. However, some of the low score for various dimensions of SERVQUAL models shows that there is still some level of dissatisfaction that has to be addressed by the healthcare insurance providers. Companies have to deeply analyze the kind of service they provide to customers, the facilities they have and how individualized their services are towards meeting the customers’ demands (North central University, 2009). Assurance and reliability are very important dimensions that the service providers have to make sure they score highly besides tangibles, empathy and responsiveness. Many companies scored highly in terms of empathy and tangibles. There is still room for improvement when it comes to reliability, assurance, and responsiveness. Reliability, responsiveness and assurance have almost the same score and the healthcare insurance providers have to further try to fill the gap between customers’ expectations and perceptions.

The government involvement in the healthcare provision is important but there is more streamlining that has to be done to ensure that all people within the UAE are getting high standard services. Healthcare insurance quality has to live up to the expectations of the customers in order to reduce the gap in perception. Healthcare insurance service providers have to listen to customers and provide a means of getting prompt feedback. The providers have to catch up with the trends in the market and differentiate their products to meet various needs of customers (Eshghi, Roy & Ganguli, 2008). The personnel have to be courteous and attend to the needs of customers gentle in order to trigger repeat purchases as well as referrals. The long-term objective of the healthcare insurance providers is to ensure quality remains high. Healthcare insurance quality of about world-class standards and the providers need to improve in some areas as pointed out by participants who took part in the survey.

The dimensions of responsiveness, reliability and assurance have to be taken serious if the expectations of customers were to be met. Service providers have to treat their customers with fairness in order to promote equity and justice. Everybody has a right to get value for his money. Every company in the healthcare insurance industry must have a means of collecting feedback from customers if the quality of service is to be improved. The service providers have to seek and understand what the customers need. When customers’ needs are not met, they will switch to another service provide and this applies across the industry. Government supervision and intervention is required to ensure that the service quality in healthcare insurance is up to standard and the disparities witnessed in the results are eradicated. The future of healthcare insurance quality is bright if the government is committed to ensuring that healthcare insurance firms adhere to the set rules and regulations. SERVQUAL model instrument is an important tool of determining service quality in the service industry. Healthcare insurance providers have to embrace the use of this kind of tool in order to enhance performance and reduce the gap between the customers’ expectations and perception.


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