Affective commitment, trust, perceived value and service quality as predictors of customer engagement in the South African open medical aid industry

Dr CC Williams, Prof N Mckay

Vol 18 | Issue 1 pp. 98-110


The South African open medical aid industry is undergoing various challenges and is experiencing increased pressure to improve its service offerings. This is because customers of open medical aid providers are becoming progressively more educated about the various healthcare products and services available. As a result, customers are better equipped to make informed decisions concerning the available open medical aid options, which may lead to switching from their current open medical aid to a competitor when their needs are not met by the current medical aid product and service offerings. Consequently, open medical aid providers must retain and improve customer engagement by building strong relationships with their customers. Therefore, this study aims to determine if affective commitment, trust, perceived value and service quality predict customer engagement within the context of the open medical aid industry of South Africa. The study considered existing literature and a quantitative descriptive design. Non-probability convenience sampling was used to draw the sample through self-administered questionnaires, which resulted in a total of 307 questionnaires collected for data analysis. A standard multiple regression analysis was also conducted. Results indicated that affective commitment, customer trust, perceived value, and service quality could be predictors of customer engagement.

Keywords: Customer engagement, customer affective commitment, customer trust, customer perceived value, service quality, open medical aid provider

Back to Volume 18 issue 1

This article may be downloaded from the following locations:


Bansal, H.S., Irving, P.G. & Taylor, S.F. 2004. A three-component model of customer commitment to service providers. Journal of the Academy of Marketing Science, 32(3):234-250.

Bisschoff, C. & Clapton, H. 2014. Measuring customer service in a private hospital. Problems and Perspectives in Management, 12(4):43-54.

Bouavang, A. 2014. Importance of building a strong relationship with your clients. Date of access: 3 Jul. 2017.

Bowden, J. 2009. Customer engagement: a framework for assessing customer-brand relationships: the case of the restaurant industry. Journal of Hospitality Marketing and Management, 18(6):574-596.

Brodie, R.J., Hollebeek, L.D., Juric, B. & Ilic, A. 2011. Customer engagement: conceptual domain, fundamental propositions, and implications for research. Journal of Service Research, 14(3):252-271.

Consulta. 2019. Customer satisfaction index for medical schemes shows underwhelming performances. Date of access: 2 November 2019.

Demirgüneş, B.K. 2015. Relative importance of perceived value, satisfaction and perceived risk on willingness to pay more. International Review of Management and Marketing, 5(4):211-220.

Fedhealth. 2017. Why should I have a medical aid plan? Date of access: 26 January. 2018.

Floyd, K.S., Harrington, S.J. & Santiago, J. 2009. The effect of engagement and perceived course value on deep and surface learning strategies. International Journal of an Emerging Transdiscipline, 12:181-190.

Furman, K. 2017. Customer trust: its importance to your customer relationships. Date of access: 7 Dec. 2017.

Hoffman, K.D. & Bateson, J.E.G. 2017. Services marketing: concepts, strategies and cases. 5th ed. Boston: Cengage.

Hollebeek, L. 2011. Exploring customer brand engagement: definition and themes. Journal of Strategic Marketing, 19(7):555-573.

Hunter, S. 2017. South Africa’s five biggest medical aid schemes rated. Date of access: 5 Dec. 2017.

IRR (South African Institute of Race Relations NPC). 2016. Submission to the Department of Health regarding the White Paper on National Health Insurance for South Africa (Version 40) Johannesburg, 25 May 2016.

Istikhoroh, S. & Sukamdani, Y. 2017. Optimize the role of commitment of employees in improving accountability office report on local government budget. International Journal of Economics and Finance, 9(12):116-125.

Jaros, S., 2007. Meyer and Allen model of organizational commitment: measurement issues. The Icfai Journal of Organizational Behavior, 6(4):7-25.

Kaplan, J. & Ranchod, S. 2015. An actuarial perspective on medical scheme benefit design. Paper presented at the Actuarial Society of South Africa’s 2015 Convention, Sandton, 17-18 November. Date of access: 21 November 2017.

KeyHealth Medical Aid. 2015. How important is medical aid in South Africa. Date of access: 19 September 2017.

Kim, Y.H., Kim, D.J. & Wachter, K. 2013. A study of mobile user engagement (MoEN): engagement motivations, perceived value, satisfaction, and continued engagement intention. Decision Support System, 56:361-370.

Lin, C.C. 2003. The role of customer perceive value in generating customer satisfaction: an e-business perspective. Journal of Research in Marketing and Entrepreneurship, 5(1):25-39.

Lombard, M.R. 2011. Customer retention through customer relationship management: the exploration of two-way communication and conflict handling. African Journal of Business Management, 5(9):3487-3496.

Maphumulo, W.T. and Bhengu, B.R., 2019. Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis, 42(1):1-9.

Makgoo, R. 2017. Two medical scheme changes for 2017 that you need to know about. Date of access: 24 August 2017.

Mazzocchi, M. 2011. Statistics for marketing and consumer research. London: SAGE.

McLeod, H. & Ramjee, S. 2007. Medical schemes: pooling of resources and purchasing of health care. South African Health Review, 1(1):47-70.

Medical Plan Advice. 2018. Date of access: 3 Jun. 2018.

Mosavi, S.A. & Ghaedi, M. 2012. A survey on the relationship between trust, customer loyalty, commitment and repurchase intention. African Journal of Business Management, 6(36):10089-10098.

Municipalities of South Africa. 2018. North West municipalities. Date of access: 5 March 2018.

Naumann, K. & Bowden, J. 2015. Exploring the process of customer engagement, self-brand connections and loyalty. Problems and Perspectives in Management, 13(1):55-66.

Nguyen, N., Leclerc, A. & LeBlanc, G. 2013. The mediating role of customer trust on customer loyalty. Journal of Service Science and Management, 6:96-109.

NIUSR. 2014. Medical aids with the worst customer service. Date of access: 24 August 2017.

Pallant, J. 2016 SPSS: survival manual. 6th ed. Maidenhead: McGraw-Hill.

Pansari, A. & Kumar, V. 2016. Customer engagement: the construct, predictors, and consequences. Journal of the Academy Marketing Science, 45:294-311.

Parasuraman, A., Zeithaml, V. & Berry, L.L. 1985. A conceptual model of service quality and its implications for future research. Journal of Marketing, 49(4):41-50.

Parasuraman, A., Zeithaml, V. & Berry, L.L. 1988. SERVQUAL: a multiple-item scale for measuring consumer perceptions of service quality. Journal of Retailing, 64(1):12-40.

Poovalingam, K. & Veerasamy, D. 2007. The impact of communication on customer relationship marketing among cellular service providers. Alternation, 14(1):86-119.

PwC (PricewaterhouseCoopers). 2017. Medical schemes. Date of access: 5 Jun. 2017.

Rangasamy, L. 2021. Healthcare price changes and expenditures in South Africa: Some implications for economic policy. Development Southern Africa, 38(4):607-621.

Roche, L. 2015. Top five essentials for delivering a best-in-class customer experience. Date of access: 10 Jul 2017.

Rossmann, A., Ranjan, K.R. & Sugathan, P. 2016. Drivers of user engagement in eWoM communication. Journal of Services Marketing, 30(5):541-553.

SA Medical Aids. 2018. List of open medical aids in South Africa. Date of access: 22 November 2019.

Sanders, D. 2012. Placing trust in employee engagement. Employment Relations Comment, Nov 2012. Advisory, Conciliation and Arbitration Service, United Kingdom.

Sarwar, M.Z., Abbasi, K.S. & Pervaiz, S. 2012. The effect of customer trust on customer loyalty and customer retention: a moderating role of cause related marketing. Global Journal of Management and Business Research, 12(6):26-36.

Sashi, C.M. 2012. Customer engagement, buyer-seller relationships, and social media. Management Decision, 50(2):253-272.

So, K.K.F., King, C. & Sparks, B. 2014. Customer engagement with tourism brands: scale development and validation. Journal of Hospitality & Tourism Research, 38(3):304-329.

Thakur, R. 2016. Understanding customer engagement and loyalty: a case of mobile devices for shopping. Journal of Retailing and Consumer Services, 32:151-163.

Van Doorn, J., Lemon, K.N, Mittal, V., Nass, S., Pick, D., Pirner, P. & Verhoef, P.C. 2010. Customer engagement behavior: theoretical foundations and research directions. Journal of Service Research, 13(3):253-266.

Van Tonder, E. & Petzer, D.J. 2018. The interrelationships between relationship marketing constructs and customer engagement dimensions. The Service Industries Journal:1-26.

Van Zyl, G. 2015. How important is medical aid? Date of access: 20 Sep. 2017.

Verhoef, P.C., Franses, P.H. & Hoekstra, J.C. 2002. The effect of relational constructs on customer referrals and number of services purchased from a multiservice provider: does age of relationship matter? Journal of Academy of Marketing Science, 30(3):202-216.

Williams, C.C. 2017. Developing a scale to measure the extent of customer engagement in the South African retail banking industry. Potchefstroom: North-West University. (Thesis – PhD).

Williams, C.C. & Mackay, N. 2020. Customer engagement in retail banks: scale development and validation. The Retail and Marketing Review, 16(1):40-52.

Zeithaml, V.A. 1988. Consumer perceptions of price, quality, and value: a means-end model and synthesis of evidence. Journal of Marketing, 52(3):2-22.

Zeithaml, V.A., Berry, L.L. & Parasuraman, A. 1996. The behavioural consequences of service quality. Journal of Marketing, 60(2):31-46.

Back to Volume 18 issue 1