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Objectives : This research used an exploratory approach to identify factors affecting business strategies due to changes in the healthcare market and customer loyalty factors. Methods : The research model was formulated using antecedents divided into diagnosis quality, employee attitudes, and servicescape. Moreover, differences in the structured model were analyzed according to hospital size. The data were gathered through surveys on clients, who has received care at participating hospitals. From the 200 that were distributed, 150 questionnaires were analyzed, to facilitate analysis of the research model. Results : The effects of diagnosis quality, employee attitudes, and servicescape, on customer loyalty were mediated by trust. We also found the differences between small and large hospitals. Conclusions : Customer loyalty in small hospitals was affected by servicescape, whereas that in large hospitals was affected by diagnosis quality and employee attitudes. The research results could be used to develop strategies to improve customer loyalty.