Is free also fair? Justice perceptions and sustainability in public healthcare delivery

PURPOSE: By applying the justice theory and social exchange theory, this study examines the relationship between justice perceptions and corporate reputation, with multifocal trust examined as a mediator and patient satisfaction as a moderator. Additionally, it investigates the association between corporate reputation and patient citizenship behaviour in public hospitals in North Cyprus. DESIGN/METHODOLOGY/APPROACH: A cross-sectional survey was conducted among 450 patients who recently received care in public hospitals. Data were analyzed using PLS-SEM, ensuring a robust examination of the direct, mediating and moderating relationships. FINDINGS: The findings show significant associations between distributive and informational justice and corporate reputation, with multifocal trust exhibiting a mediating association in the relationship between justice perceptions and corporate reputation. Corporate reputation is also strongly associated with patient citizenship behaviour. However, patient satisfaction did not moderate the relationship between trust and corporate reputation, indicating that the association between trust and reputation remains consistent regardless of satisfaction levels. ORIGINALITY/VALUE: This study provides a comprehensive examination of justice perceptions, multifocal trust, corporate reputation, multi-level satisfaction and patient citizenship behaviour in non-competitive public healthcare environments. The findings provide practical recommendations for hospital administrators on approaches to managing hospital reputation and supporting patient-centred practices in public hospitals.