Preventive Maintenance Services Research Articles

Optimizing extended warranty options with preventive maintenance service under multinomial logit model

Extended warranty (EW) services have become the primary source of profit for manufacturers. How to design the appropriate EW service to balance customer user experience with the manufacturer’s profit issues has received great attention. Implementing preventive maintenance (PM) actions can not only reduce the customer’s lifecycle cost but also enhance the manufacturer’s brand image. Therefore, EW bundled with PM service has emerged in the after-sales market today. To enrich customers’ choice, we investigate the design of EW menus bundled with PM service options, and then we jointly determine EW prices and the frequency of PM actions for the provided menus. In the proposed model, we combine the multinomial logit model with prospect theory to characterize customer choice behavior when presented with different EW menu options. Based on that, with the aim of maximizing the manufacturer’s profit, we can derive sets of offers, the corresponding EW service prices, and the number of included PM actions. We also introduce two additional models that account for different customer purchase scenarios. Numerical results turn out that when the manufacturer chooses to offer a unified EW menu to all customers, it is consistently more profitable to present the menu at the point of product sales. Another interesting finding is that customized EW menus designed for various customer segments don’t always outperform unified ones. Overall, this study will provide a foundation for manufacturers to make informed decisions regarding the selection and design of EW menus in various scenarios.

ANALISIS KAPASITAS FUNGSIONAL RSU PKU MUHAMMADIYAH BANTUL DALAM PENANGGULANGAN BENCANA

PKU Muhammadiyah Bantul Hospital has been developing a disaster management hospital concept since 2008. A training through HOPE (Hospital Preparedness for Emergency and Disaster) has been conducted successfully. This research was aimed to measure the functional capacity of the PKU Muhammadiyah Bantul hospital in responding disaster and awareness of the staff as in Contingency Plan. The Hospital Safety Index criteria were used as the measurement instrument, which was consisted of five group indices. A descriptive survey technique was applied by means purposive sampling method. The samples were the staff in the Hospital Disaster Management Boards. A number of 61 questions were required by interview, observation and documents identification method. The hospital’s functional capacity index was calculated as 0.66. The scores varied for each group indices from 0.25 to 0.87. The highest score of 0.87 was obtained for group index of the operational plan, preventive maintenance and critical service restoration, whilst, the disaster emergency plan was assigned to the lowest score as 0.25. The mean score of all staffs about their job descriptions in contingency plan was 75.45 out of 100. Knowledge mean score of formulator staffs was 100 (high), while non formulator staffs was 69.7 (average). The core staff positioned in disaster management gained highest score (80.2), while the supporting staff was 74.7 (average). Hospital functional capacity index was 0.66 assessed in A class, indicating deemed to keep functioned during disaster situation. Awareness of the staffs, who designed Contingency Plan, were higher than the others. Deviation in awareness was also found among the staff involved in Contingency Plan. The manager level had a higher understanding in disaster preparedness if compared to the supporting staff.

Optimal Decision for Repairable Products Sale and Warranty under Two-Dimensional Deterioration with Consideration of Production Capacity and Customers’ Heterogeneity

An effective warranty policy is not only an obligation for the manufacturer or vendor, but it also enhances the willingness of customers to purchase from them in the future. To earn more customers and increase sales, manufacturers or vendors should be inclined to prolong the service life of their products as an effort to gain more customers. Nevertheless, manufacturers or vendors will not provide a boundless warranty in order to dominate the market, since the related warranty costs will eventually exceed the profits in the end. Therefore, it is a question of weighing the advantage of extending the warranty term in order to earn the trust of new customers against the investment. In addition, since deterioration depends on both time and usage, the deterioration estimation for durable products may be incorrect when considering only one factor. For such problems, a two-dimensional deterioration model is suitable, and the failure times are drawn from a non-homogeneous Poisson process (NHPP). Moreover, customers’ heterogeneity, manufacturers’ production capacity, and preventive maintenance services are also considered in this study. A mathematical model with the corresponding solution algorithm is proposed to assist manufacturers in making systematic decisions about pricing, production, and warranty. Finally, managerial implications are also provided for refining related decision-making.

Determinants of rural hand-pump functionality through maintenance provision in the Central African Republic

While preventive maintenance services have emerged as promising interventions to improve the continuity of water service delivery, the operational and contextual requirements for sustained functionality within maintenance models are not well understood. This paper uses data analysis to better understand factors influencing the success of rural water service delivery within the circuit rider maintenance model in fragile contexts. Incorporating operational data from a large scale circuit rider hand-pump maintenance program in the Central African Republic, mixed-effect logistic regression models were used to identify determinants of water point functionality and payment compliance. Models were informed by data from over 16,000 maintenance visits across nine years. Faster response time, proximity to urban centers, and proximity to other hand-pumps emerged as significant factors for improving water point functionality, while proximity to maintenance program headquarters, pump functionality, and frequency of maintenance visits significantly influenced payment compliance. The observed high functionality rates of hand-pumps serviced by the maintenance program indicates the potential benefits of professionalized maintenance through the circuit rider model at promoting water system reliability in fragile contexts. Despite adaptability and resilience in implementation of the circuit rider model, insecurity and conflict remain barriers to sustaining service delivery in the Central African Republic.

The role of novel data in maintenance planning: Breakdown predictions for material handling equipment

We build a predictive maintenance model for material handling equipment that incorporates novel data sources to forecast breakdowns. To this end, we develop a framework to structure and extract relevant predictor variables. Subsequently, we conduct a comprehensive study of statistical learning methods for failure detection. We show that the standard sensors in material handling equipment provide sufficient data to predict the majority of breakdowns (>85%). The findings are confirmed in two independent datasets and are thus transferable. Further, we provide a cost-based evaluation of those statistical learning methods and find that K-Nearest-Neighbors and Random Forest Classifier are cost-optimal. While most extant literature focuses on either time or condition-based maintenance, we suggest a more robust approach. We demonstrate that both time and condition are almost equally important. As a result, we present a prediction model that incorporates both variable types. From a managerial perspective we provide recommendations on data collection and highlight the importance to understand the cost ratio between breakdowns and preventive maintenance services.

Comparative cost-benefit analysis of four retrial systems with preventive maintenance and unreliable service station

In various industrial problems, repairable models have been widely employed to derive performance measures. The current investigation compares four unreliable retrial systems with preventive maintenance. The objective is to offer a proper analysis procedure helpful for managers to determine the best configuration resulting in a better performance. A potential application in which the proposed model can be applied is provided. For each system, the state-transition diagram and associated differential-difference equations are presented. Using the Laplace-Stieltjes transform, we derive the explicit formulas for the mean time-to-failure and the steady-state availability, commonly considered critical criteria. Numerical results are tabulated and displayed graphically, and then a comparative cost-benefit analysis is performed. Finally, observed insights into decision-making are provided.

Application of Hierarchical Colored Petri Nets for Technological Facilities’ Maintenance Process Evaluation

The high reliability of modern engineering systems is achieved by performing predictive maintenance. Mathematical models based on stochastic timed colored Petri nets are an effective tool for developing complex production processes for Industry 4.0. This article discusses the maintainability evaluation used in hierarchical Petri net models. The hierarchical simulation model was built using timed colored Petri nets, and was constructed with four levels of repair and maintenance modules. New module structures are proposed for simulating the schedule of production tasks and interaction with technological units. The emphasis is on the processes of predicting maintenance and repair, moving units to service, replacing units, and forming a reserve. The design of the simulation modules allows the setting of probabilistic parameters for the distributions of equipment failures, requests for unit maintenance, repair time, and recovery time after repair. The article proposes to use the hierarchical Petri model in conjunction with solving the problem of minimizing the cost of service. The iterative procedure consists of obtaining an approximate unit distribution by tasks, subsequent simulation of the technological process, and adjusting the optimization problem constraints. For example, the hierarchical Petri net is considered to assess the maintainability of autonomous agricultural vehicles. The results of the simulation experiments are presented. A simulation of the agrotechnical production process was performed, during which vehicles were maneuvered, taken out for repair or maintenance, and returned to the reserve fund. The interdependencies of preventive maintenance periods, service operations, failure rates, and predictive maintenance requests were obtained in order to comply with the task scheduling. The proposed model is a generalization, but it is especially effective in studying mobile equipment servicing.

Cidades inteligentes: principais rankings e propostas de melhoria para São Luís, Maranhão

O conceito de cidade inteligente (CI) se refere ao local adequado para as pessoas viverem, com recursos tecnológicos cooperando entre si, gerando bem-estar, inclusão social e participação de seus habitantes, além da sustentabilidade do meio ambiente, crescimento sustentável, monitoramento e integração de todos componentes de infraestrutura; manutenção preventiva, segurança, e serviços aos cidadãos. O presente estudo objetivou analisar os principais rankings que medem as condições das cidades e as classifica entre as CI, visando propostas de melhorias para a cidade de São Luís. Para isto, usa a cidade de Curitiba como referência nacional, primeiro lugar no Ranking Connected Smart Cities, enquanto São Luís não figurava entre as posições analisadas. Trata-se de uma pesquisa aplicada, quali-quantitativa, exploratória, sendo proposto um plano de intervenção, para tornar São Luís mais competitiva quanto à sua classificação como cidade inteligente e sustentável, nos itens mobilidade urbana, meio ambiente, saúde, tecnologia e inovação, e segurança. Tais itens foram consolidados em três linhas estratégicas para organizar as intervenções propostas: Gestão da administração pública; Gestão do saneamento básico, Adequação do uso do território e as relações entre o ambiente natural e o construído, bem como suas interferências sobre a mobilidade no município; além do tema transversal de gestão energética, aliado à aplicação de práticas sustentáveis e saneamento ambiental. Assim, é possível transformar São Luís numa cidade inteligente e sustentável, devendo haver investimentos, e parcerias para alcançar estas metas, melhorando a qualidade de vida de seus habitantes.

Integrated Primary Specialty Care Access for Adults with Sickle Cell Disease in Delaware

INTRODUCTION A major gap in US care for Sickle Cell Disease (SCD) is a dearth of healthcare providers with expertise in adult SCD management. In 2014 TOVA Community Health launched a community-based primary specialty care clinic in Delaware (DE). The Delaware Department of Health and Social Services found that 96 individual adults in DE with Sickle Cell Disease (SCD) utilized hospital services 99.5% of the time for sickle cell crisis (Anderson et al., 2014). The majority of those adults lived in New Castle County, DE. The dearth of sickle cell hematologist/oncologists for adults in this county may drive them to seek recurrent care through the hospital system. Recognizing this as a nationwide public health crisis, the Delaware Department of Health and Social Services (DHSS) partnered with TOVA Community Health in 2014 to establish an adult primary specialty care clinic medical home in New Castle County, DE. This report describes the progress/impact of an integrated primary specialty clinic for adults with SCD METHODS Prospective/ Retrospective tracking of best practices for SCD are featured in the NIH 2014 guidelines. The staff included a hematologist with expertise in SCD, a primary care provider, an advanced practice nurse, a Social Worker (MSW), a nurse care coordinator, and a community health worker, were funded by Sickle Cell Disease Association of America (SCDAA) and Health Resources and Services Administration (HRSA). From 2014 to 2018, integrated primary specialty care services were provided for 33 discrete patients. RESULTS This first cohort of patients was notable for health complications that may be attributed to the lack of coordinated primary specialty sickle cell care access. Therapeutic counseling, support groups and preventive health maintenance services were measured by: outpatient visits to the clinic, access to disease modifying therapies (hydroxyurea therapy or chronic transfusion therapy), immunizations (Pneumococcal), Depression Screens and Personalized Sickle Care Plans (Table). 21 % percent of the patients had no sickle cell provider and/or hematologist/oncologist other than ED or inpatient care for the 12 months preceding their first visit to our clinic. 48% of the patients received a pneumococcal vaccine (Pneumovax 23 val - n=16/33 and Prevnar 13 - n=7/33) and three (n=3/33) received both Pneumococcal vaccines. 30% percent of the patients (n=10/33 patients) seen were offered access to HU but were not on the drug and 42% (n=14) were prescribed HU. All patients did not have a Personalized Sickle Cell Care Plan prior to receiving services at the Primary Specialty Care clinic. 12% (n=4/33) patients had a diagnosis of Substance Abuse Disorder, 15% (n=5/33) had a diagnosis of Opioid Use Disorder and 3% (n=1/33) had both Substance Abuse and Opioid Use Disorder. 70% (n= 7/10) were male and 30% (n-3/10) were female with a diagnosis of Substance Abuse and/or Opioid Use Disorder. 45% (n=15/33) had a Pain Management Agreement established within the time period at the primary specialty clinic. CONCLUSION The creation of an integrated practice primary specialty care clinic for adults with SCD in New Castle County, Wilmington, DE demonstrates the successful leverage of regional networks that engages an academic institution for telehealth consultation, public health, and community-based organizations to develop an adult SCD primary specialty care model. This safety net clinic provides team based primary specialty care to adults whose only option previously was the hospital and/or emergency room. Unique challenges in managing adult SCD acute and chronic pain were addressed. Overall, this is one model for access to integrated primary specialty care and behavioral health services for persons with SCD across their lifespan. Figure 1. Disclosures No relevant conflicts of interest to declare.

Analisa Tingkat Resiko pada Komponen Pembangkit Listrik di Kota Balikpapan Dengan Metode FMEA

Company X is a power plant that supplies Balikpapan city electricity. In order to maintain the availability of electricity, regular maintenance is carried out, predictive, preventive and corrective maintenance in company X. The maintenance scheme of each component is based on the level of risk and priority scale. In this study, the determination of the level of risk and priority scale for each component uses Failure Mode And Effect Analysis (FMEA). The subject of the research was the W20V320 engine type diesel fuel component in the X power plant in Balikpapan City. Maintenance data for 2 years, 2017 and 2018, with 420 failure modes from 67 components used as research data. Engines are grouped into 12 systems and each system has a RPN (Risk Priority Number) value. In the RPN the Severity, Occurance, and Detection values are arranged based on company X's condition at the time the report is written. The highest RPN value is found in the Radiator Motor Fan component in the Radiator system and the LO Separator component in the Lube Oil Supply System which is 144. Components with an RPN value> 40 receive predictive and preventive maintenance services, while components with an RPN value 40 mendapatkan jensi perawatan prediktif dan preventif, sedangkan komponen dengan nilai RPN<20 mendapatkan perawatan corrective. Kata kunci : FMEA, Maintenance, RPN

Sustainable offers for drying and storage of grains: Identifying perceived value for Brazilian farmers

The grain drying and storage process currently practiced in Brazil is mostly accomplished by firewood combustion, with a high demand for natural resources, lack of safety for operators, and a high rate of residue and pollutant generation. Brazil is the third-largest producer of grains, and public policies should restrict the firewood drying method as of the year 2020. To solve this problem, a startup developed a technology to dries grains based on oxyhydrogen combustion, using only green energy and water. This study contemplates the assessment of farmers concerning perceived value attributes and willingness-to-pay of a Sustainable Product-Service System. This solution is a mix of tangible products and intangible services offered simultaneously to solve post-harvest problems. A large survey comprising 354 small, medium, and large farmers in the South region of Brazil was conducted to evaluate the value attributes allocated by farmers for their acceptance of a new technology of grain drying and quality preservation. In this survey, to assess farmers’ perceptions were applied offers based on three types of Product-Service System: options of purchasing equipment with corrective maintenance services (product-oriented Product-Service System), renting equipment with corrective and preventive maintenance services (use-oriented Product-Service System), and complementing services for the management of quality, information, drying and storage of grains (result-oriented Product-Service System). The survey results allowed the establishment of the attributes deemed necessary by farmers, who revealed preference towards the purchase offer (56.5%) over the rental offer (43.5%), emphasizing the inclusion of the maintenance service. It is concluded that to implement complete service (maintenances types and process management) offers investments are still necessary to educate farmers in the use of management technologies. The best offer to delivered value to Brazilian farmers is acquired in purchase modality composed by drying machines, preventive maintenance, silo storage, and corrective maintenance.

A robust optimization approach for scheduling a supply chain system considering preventive maintenance and emergency services using a hybrid ant colony optimization and simulated annealing algorithm

A robust optimization approach for scheduling a supply chain system considering preventive maintenance and emergency services using a hybrid ant colony optimization and simulated annealing algorithm

Supply chain coordination of incomplete preventive maintenance service based on multimedia remote monitoring

Manufacturing relies on the Internet of things and intelligent internet technology to provide users with remote monitoring services and early warning of failure, to ensure the smooth operation of the equipment. Based on this background, this paper takes equipment user (customer) and maintenance service provider (agent) consist of the two-stage maintenance service supply chain as the research object. A model is proposed for the maintenance service contracts design, optimization under decentralized decision-making and centralized decision-making. The model is developed under the assumption that there is one customer and one unique service provider who is the Original Equipment Manufacturer (OEM) and is called the agent in this paper. Besides, an extensive sensitivity analysis is performed to examine the impact on the improvement factor of the model output. Under the selective maintenance service outsourcing strategy, the agent makes the price of incomplete preventive maintenance, and the customer decides the incomplete preventive maintenance cycle and the times according to the price. Confronting the equipment failure, customer self-repair service and commitments for the loss of equipment downtime, the customer decides the optimal maintenance services prices, and the agent decides the optimal numbers and the cycles of the preventive maintenance service (equipment life).

A New Analytic Method of Multistate Single-component System Reliability Model

For the reliability modeling of multistate single-component system, single maintenance bench provides the preventive maintenance and alternative maintenance services on the basis of system performance level following the stochastic detection strategy. Phase-type distribution is employed in place of exponential distribution and other typical distributions to describe the stochastic time variable in the reliability modeling process in a unified manner. Through matrix analysis, the analytic expressions for reliability indicators including system steady-state availability, mean time between failures (MTBF) and failure rate of system are obtained. A numerical application is presented to verify the applicability of the model and demonstrate the influence of preventive maintenance threshold and preventive maintenance rate on system reliability.

Performance of health laboratories in provision of HIV diagnostic and supportive services in selected districts of Tanzania

BackgroundRoll-out and implementation of antiretroviral therapy (ART) necessitated many countries in Sub-Saharan Africa to strengthen their national health laboratory systems (NHLSs) to provide high quality HIV diagnostic and supportive services. This study was conducted to assess the performance of health laboratories in provision of HIV diagnostic and supportive services in eight districts (from four regions of Iringa, Mtwara, Tabora and Tanga), after nine years of implementation of HIV/AIDS care and treatment plan in Tanzania.MethodsIn this cross-sectional study, checklists and observations were utilized to collect information from health facilities (HFs) with care and treatment centres (CTCs) for HIV/AIDS patients; on availability of laboratories, CTCs, laboratory personnel, equipment and reagents. A checklist was also used to collect information on implementation of quality assurance (QA) systems at all levels of the NHLS in the study areas.ResultsThe four regions had 354 HFs (13 hospitals, 41 Health Centres (HCs) and 300 dispensaries); whereby all hospitals had laboratories and 11 had CTCs while 97.5 and 61.0% of HCs had both laboratories and CTCs, respectively. Of the dispensaries, 36.0 and 15.0% had laboratories and CTCs (mainly in urban areas). Thirty nine HFs (12 hospitals, 21 HCs and six dispensaries) were assessed and 56.4% were located in urban areas. The assessed HFs had 199 laboratory staff of different cadres (laboratory assistants = 35.7%; technicians =32.7%; attendants = 22.6%; and others = 9.1%); with >61% of the staff and 72.3% of the technicians working in urban areas. All laboratories were using rapid diagnostic tests for HIV testing. Over 74% of the laboratories were performing internal quality control and 51.4% were participating in external QA programmes. Regional and district laboratories had all key equipment and harmonization was maintained for Fluorescence-Activated Cell Sorting (FACS) machines. Most of the biochemical (58.0%) and haematological analysers (74.1%) were available in urban areas. Although >81% of the equipment were functional with no mechanical faulty, 62.6% had not been serviced in the past three years.ConclusionDiagnostic and supportive services for HIV were available in most of the HCs and hospitals while few dispensaries were providing the services. Due to limitations such as shortage of staff, serving of equipment and participation in QA programmes, the NHLS should be strengthened to ensure adequate human resource, implementation of QA and sustainable preventive maintenance services of equipment.

Efficiency Measurement of Maintenance Costs on Customer Service Process PT Indonesia Comnets Plus West Java

Information technology is growing rapidly. The problems arising in the conjunction magnitude of information technology devices are how to manage, maintain, and calculate the amount of required investments. The purposes of this study are to measurepreventive and corrective cost optimization maintenance which determines the most optimal performance for alternative maintenance activity. The case studies in this research is PT Indonesia Comnets Plus (ICON +) West Java focusing on how the process of customer service telecommunication maintenance. Analysis techniques used are descriptive and optimization analysis. The level of corrective maintenance costs are known through services damage probability, average cost of service damage in the period of 2011-2014, and corrective cost analysis formula. To determine the level of preventive maintenance costs, it requires the calculation of damage probability screened estimated monthly service and then calculating the total cost of preventive maintenance. The analysis requires amount of damage and cost of protecting canceling services. The result, general implementation of maintenance services has been running well, but not optimal. Period of preventive maintenance services can be optimized with an average of 12-month treatment.

Measuring service outcomes for adaptive preventive maintenance

Services account for an increasing share of economic activity in the western world. As part of this, preventive maintenance (PM) service volumes are constantly growing as a result of a growing (and aging) asset population and maintenance outsourcing. While the pursuit of improved service productivity is in the interest of both firms and nations, the challenges of measuring service performance, and more specifically service outcomes, persist. This paper presents an outcome-based measure for fleet PM, which has far-reaching implications considering service productivity and performance measurement.We develop a statistical process control based measure that utilizes data typically available in PM. The measure is grounded in reliability theory, which enables generalization of the measure within PM services but also outlines the limitations of its application. Finally we apply the measure in a PM field service process of a servitized equipment manufacturer. Based on actual maintenance records we show that the service provider could reduce their service output by at least 5–10% without significantly affecting the aggregate service outcome.The developed measure and control process form the basis for adaptive preventive maintenance, which is expected to facilitate the transition towards outcome-based contracts through complementing condition-based maintenance. One of the key benefits of the approach is that it provides a cost-effective way of revealing the scarcely studied phenomenon of service overproduction. Based on our case, we conclude that there are significant productivity gains in making sure that you meet required standards for service output but do not exceed them.

A Mathematical Model Used in Repairs for Electric Power Distribution Network

This paper presents a mathematical model applied in the problem of determining the optimal number of teams used in handling events generated by breakdowns in the distribution system of electric power or preventive maintenance services. The model proved to be an excellent tool to quantify the optimal number of teams to attend the services requested of low and medium voltage. The model succeeded in solving the problem where several computational experiments were performed based on actual data provided by a distributor of electricity. The results of computational experiments show as quantified the number of teams per day, month, semester or year.

Analysis of existing and prospective technical control systems of numeric codes automatic blocking

Purpose. To identify the characteristic features of the engineering control measures system of automatic block of numeric code, identifying their advantages and disadvantages, to analyze the possibility of their use in the problems of diagnosing status of the devices automatic block and setting targets for the development of new diagnostic systems. Methodology. In order to achieve targets the objective theoretical and analytical method and the method of functional analysis have been used. Findings. The analysis of existing and future facilities of the remote control and diagnostics automatic block devices had shown that the existing systems of diagnosis were not sufficiently informative, designed primarily to control the discrete parameters, which in turn did not allow them to construct a decision support subsystem. In developing of new systems of technical diagnostics it was proposed to use the principle of centralized distributed processing of diagnostic data, to include a subsystem support decision-making in to the diagnostics system, it will reduce the amount of work to maintain the devices blocking and reduce recovery time after the occurrence injury. Originality. As a result, the currently existing engineering controls facilities of automatic block can not provide a full assessment of the state distillation alarms and locks. Criteria for the development of new systems of technical diagnostics with increasing amounts of diagnostic information and its automatic analysis were proposed. Practical value. These results of the analysis can be used in practice in order to select the technical control of automatic block devices, as well as the further development of diagnostic systems automatic block that allows for a gradual transition from a planned preventive maintenance service model to the actual state of the monitored devices.

Choice and evaluation of hospitals in Bangladesh: insights from patients and policy implications.

This paper attempts to gain insights into the health care system of Bangladesh from the perspectives of hospital patients. The study is based on survey data obtained from 207 recipients of health care services from 57 hospitals in Dhaka City. Patients' choice of hospital is influenced by referrals of doctors (28.7%), reputation of the hospital (23.7%), referral by family and friends (17.4%), closeness to home (14.9%), cost (7.4%) and other miscellaneous factors (7.9%). The major reason for selecting a particular hospital is for treatment (86%). Only few choose preventive or health maintenance services. Demographic trends indicate that better educated and more affluent people are more likely to seek private hospital care, while those who are less educated and less affluent are more inclined to seek public hospital care. The average length of hospital stay, both for private and public hospitals, was 9.9 days. Longer hospital stays are positively associated with nonavailability of needed medicines, poor upkeep of facilities, need to provide "tips" for services, lack of prompt services, a suffocating environment, and unexplained hospital costs. Average satisfaction rate was 4.85, with private hospitals earning higher average ratings than public facilities. The highest income groups gave the highest quality ratings (5.26) compared to other income groups. Implications of findings for health policy are outlined.