Perceived service quality and the theory of planned behavior in patients' choice of providers in a dual health system

PURPOSE: This study examines psychological mechanisms underlying patients' choice of healthcare providers in a dual health system. Specifically, it applies an extended Theory of Planned Behavior (TPB) model integrating perceived service quality (SERVQUAL) to analyse how attitudes, subjective norms, perceived behavioural control and perceived quality are associated with intention and breadth of provider utilisation across public and private settings. DESIGN/METHODOLOGY/APPROACH: A cross-sectional survey was conducted among 309 adult healthcare users in Serbia (156 public and 153 private users). TPB constructs and intention were measured across five service types, while utilisation breadth captured the number of service categories used with the current provider. Perceived service quality was assessed using a global SERVQUAL index. Correlations, multiple regressions and exploratory indirect-effect analyses were conducted. FINDINGS: Attitude, subjective norm and perceived behavioural control jointly explained 54% of the variance in intention. Perceived Behavioural Control had the largest coefficient among public users, whereas Attitude and Subjective Norm had the largest coefficients among private users. Intention was weakly associated with utilisation breadth, mainly in the public sector. Exploratory analyses identified indirect associations through perceived quality, particularly for Perceived Behavioural Control and among public-sector users. ORIGINALITY/VALUE: The study integrates TPB and SERVQUAL-based perceived quality in a comparative analysis of public- and private-sector users within the same dual health system, providing context-specific evidence on predictor patterns and indirect associations.