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Objective: To evaluate patients' satisfaction and loyalty to private hospitals and to identify factors influencing patient loyalty., Design: A cross-sectional, population-based study was conducted between May and September of 2005., Setting: Sana'a, the capital city of the Republic of Yemen., Participants: Eight hundred and nineteen respondents who were admitted for at least 1 day in a private hospital within last 6 months from the date of interview., Main Outcome Measures: The scores on the modified SERVQUAL market research instrument including six domains (tangibility, reliability, responsiveness, assurance, empathy and cost) that identify perceptions of service quality. In addition, the respondents were asked whether or not they would return to the same facility when they need future medical care (loyalty)., Results: Loyalty was higher among females [odds ratio (OR) = 1.44; P < 0.05], among those reporting higher reliability scores (OR = 1.24; P < 0.01), higher assurance scores (OR = 1.2; P < 0.01) and higher empathy scores (OR = 1.13; P < 0.05) and also among those reporting higher cost (OR = 1.15; P<0.05). No significant association was found between patient loyalty and, tangibility and responsiveness score., Conclusions: Improvements are required to achieve high-quality healthcare services in the private hospitals in Yemen and increase loyalty among patients. Findings from this study could inform private sector healthcare development in low- and middle-income countries.