All ETDs from UAB

Advisory Committee Chair

Robert S Hernandez

Advisory Committee Members

Stephen J O'Connor

Thomas L Powers

Haiyan Qu

Marsha B Rieder

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


The Military Health System (MHS) is the most expansive health care system in the world. The MHS provides health care services to 9.7 million eligible beneficiaries spread across six continents. The MHS budget exceeded $52 billion in 2013 or 10 percent of the total 2013 Defense budget. The cost of health care in the MHS is of great concern to the Department of Defense and the US Congress. The MHS needs a strong framework to measure the value of the health care it provides. The purpose of this study was to develop a framework to better understand Patient Satisfaction in the MHS. The study proposed a novel framework, based on patient-satisfaction theory and commitment-trust theory, to describe the relationships that exist between patient experiences and patient loyalty in the MHS. The study used data from a 2013 Army Provider Level Satisfaction Survey (n = 10,684). The study used cluster analyses and logistic regression to find: (1) Patients cluster into mutually exclusive groups based on the experiences with their provider and on the experiences with a health care facility, (2) Significant, and positive, relationships exist between patient experiences and patient satisfaction, patient satisfaction and patient trust, and patient trust with patient loyalty, and (3) Patient characteristics are highly associated with the degree of patients’ satisfaction, the degree of patients’ trust, and the degree of patients’ loyalty. The results of the study provide valuable insight into our understanding of patient satisfaction in the Military Health System.



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