Abstract: Objective This study aimed to construct an outpatient satisfaction index model (HX-CCSI) applicable to the Hexi region within the context of the new healthcare reform. The research sought to explore the determinants of outpatient satisfaction, thereby providing a theoretical foundation for enhancing regional medical service quality and optimizing physician-patient relationships. Methods Based on the Customer Satisfaction Index (CCSI) model and service encounter theory, a theoretical model (HX-CCSI) and a corresponding measurement scale were developed. A questionnaire employing a Likert 5-point scale was designed. Following a pilot test to validate its reliability and validity, a cross-sectional survey was administered to 10 634 outpatients in the Wuwei area from January to July 2024. The collected data were analyzed using structural equation modeling to verify the path relationships among the latent variables. Results The pilot test yielded a Cronbach's alpha coefficient of 0.89 for the HX-CCSI scale, with all latent variables exceeding 0.70, and a split-half reliability coefficient of 0.811. Exploratory factor analysis extracted six factors, accounting for a cumulative variance of 68.5%, which indicated good construct validity. Correlation analysis of the latent variables revealed significant positive correlations (all P<0.01) for Perceived Value (PV) (r=0.71), Patient Satisfaction (PS) (r=0.66), Loyalty (LO) (r=0.63), Doctor-Patient Communication (DPC) (r=0.60), and Medical Competence (MC) (r=0.61). Moderate positive correlations (all P<0.01) were observed for Patient Expectations (PE) (r=0.58), Process Efficiency (PEFF) (r=0.55), and Service Environment (SE) (r=0.52). Complaint Tendency (CT) was negatively correlated with satisfaction (r=-0.42, P<0.01). Cost Transparency (CTY) demonstrated a weaker correlation (r=0.30, P<0.05). Perceived Value (PV) exerted the strongest positive effect on Satisfaction (PS) (β=0.57). Satisfaction (PS) significantly enhanced Loyalty (LO) (β=0.63) but had a weaker inhibitory effect on Complaint Tendency (CT) (β=-0.28). Conclusions The HX-CCSI model constructed in this study confirms that medical competence and doctor-patient communication are pivotal factors in enhancing outpatient satisfaction. The influence of cost transparency was found to be attenuated by high medical insurance reimbursement rates. It is recommended that priority be given to improving medical technology and communication quality, optimizing service processes, and establishing a dedicated complaint mechanism. These findings provide a scientific basis for the improvement of outpatient services in the Hexi region.

Key words: Patient satisfaction, Satisfaction index model, Doctor-patient communication, Medical competence, Perceived value, Loyalty