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The health care system in China has been undergoing a series of reforms in the past decade to aim to improve accessibility for patients and efficiency in operation.In a market-driven health care infrastructure,patients are having increasing level of access to their health information and hence are empowered to make consumer-like choices.This study aims to discern possible drivers and the extent to which these drivers may influence patients loyalty in China.The study adopted an empirical model: Patients loyalty of hospital i(Yi)is influenced by health care costs(x1i),clinical quality(x2i),hospital reputation(x3i),and hospitals environment(x4i).A questionnaire survey was administered directly with patients in the inpatient department.Guided by a convenience sampling plan,respondents were drawn from several public hospitals in Wuhan,China.A total of 723 usable data points were analyzed with structural equation modeling.The SEM model showed a reasonably good fit to account for the information in the observed covariance matrix(CFI = 0.939 and Tucker-Lewis index(TLI)= 0.927; RMSEA = 0.039).The χ2 test of model fit is significant.Hospital environment is the strongest predictor of patient loyalty(Beta =.36,p <.001,SE=.05),followed by hospital reputation(Beta =.34,p <.001,SE=.06),and clinical quality(Beta =.22,p <.001,SE=.04).These variables accounted for about 90%of the variance in patient loyalty.However,health care costs fails significantly to account for the information in the model(Beta =-.07,p >.05,SE=.06).In this research,we found an association between patient loyalty and clinical quality,hospital reputation and hospital environment; but not health care cost.This needs further studies to verify this finding.It is however reasonable observation as market segmentation is quite distinct in China and patients are usually forced into two main categories,namely those who have the means to go to privately owned hospitals,which usually are not in the network of the national insurance scheme and the others who are priced out of the first market segment.The pricing of the public hospitals is relative standardized and hence the patients have very limited choices for alternatives when visiting those hospitals.For the drivers for patient loyalty,both hospital environment and reputation are important aspects for hospitals to consider when developing their marketing strategies.As mentioned earlier,hospital branding through trust and reputation remains to be important considerations for the patients in China.While patients in China have little choice with charges,the features of hospital services and how the services are being delivered should become more patient-centered in order to stay competitive as the competition becomes keener within the segment.Consideration of the contextual influencers for patient satisfaction is called for in order to enhance reliability and validity.