This study examines the effect of service quality and hospital image on patient loyalty with patient satisfaction as a mediating variable. Data from 250 patients of hospitals in Central Java were analyzed using PLS-SEM with SmartPLS 4. Service quality and hospital image significantly influence patient satisfaction, and satisfaction strongly predicts loyalty. The direct effects of service quality and hospital image on loyalty are not significant, indicating full mediation, which is confirmed by the specific indirect effects. Patient satisfaction is therefore the key mechanism linking service quality and hospital image to patient loyalty in Indonesian healthcare. Keywords: service quality; hospital image; patient satisfaction; patient loyalty; PLS-SEM; healthcare marketing; Central Java
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