International Journal of Medical Science and Pharmaceutical Research

Persistent public sector inefficiencies in low- and middle-income countries frequently drive healthcare consumers toward out-of-pocket spending to secure timely, high-quality treatments. While standard institutional assessments often treat operational bottlenecks as isolated structural challenges, there is a distinct paucity of context-specific research integrating these operational quality metrics into an active econometric framework linking them to patient behavioral intent. This cross-sectional analytical study evaluates how waiting times, provider attitudes, and physical infrastructure influence patients' willingness to pay (WTP) for premium healthcare delivery at a major public tertiary hospital in southeastern Nigeria. Employing convenience sampling, structured questionnaires were administered to 375 adult patients across key clinical service units. Bivariate associations were assessed utilizing Pearson's Chi-square tests, while multi-categorical confounding variables were controlled through multivariable multinomial logistic regression. The results revealed severe operational bottlenecks, with 69.4% of respondents routinely experiencing facility delays exceeding three hours. Bivariate analysis demonstrated a highly significant association between educational attainment (2, p < 0.001) and employment status = 22.84, p = 0.011) with definitive or conditional WTP choice intent. Adjusting for all covariates within the multivariable setting, tertiary education independently predicted higher odds of choosing premium healthcare channels over the standard cost-rejection category (AOR = 8.56, 95% CI = [2.21, 33.15], p = 0.002). In conclusion, while structural delays actively deter service utilization, a robust conditional demand exists for differentiated healthcare packages. Hospital administrators must optimize operational workflows and design targeted premium service frameworks that incorporate strict financial safeguards to ensure healthcare equity for lower-income groups.

Healthcare Quality, Willingness to Pay, Waiting Time, Multinomial Logistic Regression, Health Financing, Nigeria.

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