Purpose – Are there cases or contexts where certain groups of customers who are expected to place a considerable emphasis and importance on the tangible qualities of services end up attributing a greater weight to the intangible qualities? This paper attempts to exemplify the existence of such cases, and explain why such cases are, at times, paradoxical in nature, and how such cases could arise. Design/methodology/approach – The paper employs a structuralequationmodeling approach to theorize about, and empirically examine, the tangible and intangible determinants of service quality. The model and the path developed in the paper also capture the relationship between service quality and customer satisfaction. Using AMOS, the empirical estimation of the model is carried out. Findings – The central finding is that all intangible factors associated with service quality turn out to be unequivocally more important than the tangible ones in the Turkish nonprofit healthcare sector under investigation. In other words, intangible factors appear to play a statistically more significant role compared with tangible factors in determining the overall customer satisfaction and the quality of nonprofit healthcare services. Considering that, in developing countries, tangible factors are expected to be among the most scarce, and hence, most valuable ones, the relative unimportance of tangible factors constitutes a paradox to be explained and resolved. Originality/value – This paper contributes to the literature by bringing to light a striking phenomenon which is largely unnoticed in the literature, namely that, in certain cases, there might exist a fundamental asymmetry and difference between the influences of tangible and intangible factors on service quality, and that difference in certain contexts, as in the case of the Turkish healthcare sector, constitutes a paradox to be explained. The paper demonstrates the possibility of such paradoxical cases and provides cultural and sectorspecific explanations for this seemingly puzzling phenomenon in question. © 2005, Emerald Group Publishing Limited
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