Abstract Purpose – The purpose of this study is to analyze how to improve the satisfaction and loyalty of Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS) health patients in Indonesia based on services in Islamic hospitals, where the service quality was analyzed from a Sharīʿah perspective. Design/methodology/approach – The sample for this study was 470 Muslim patients from BPJS health, 248 from large Islamic hospitals and 232 from small Islamic hospitals in Central Java, Indonesia. Overall, the respondents were from five large hospitals and five small hospitals. The study used eight service quality variables that were modified from the SERVQUAL, PAKSERV and CARTER models. All the variables used indicators of Sharīʿah principles and tested their effects on satisfaction and loyalty. Findings – The results of the study showed that the insurance system has been proven to significantly increase the satisfaction and loyalty of BPJS health patients. This means that the efforts of the Indonesian Government to improve the level of health by establishing BPJS can benefit the community. Satisfaction can also be increased through the variables of reliability, empathy and responsiveness, while the loyalty of BPJS Health patients is strongly influenced by satisfaction. The sincerity variable can increase the satisfaction and loyalty of BPJS health patients in small hospitals, but not in large hospitals. On the other hand, the variable of compliance can increase the satisfaction and loyalty of BPJS health patients in large hospitals, but not in small hospitals. Originality/value – The insurance system implemented in Indonesia can influence the improvement of satisfaction and loyalty. Also, hospitals that are fair in serving patients and that apply amanah (trust), tabligh (responsiveness) and are fast in handling BPJS health patients’ complaints are important indicators that need attention from BPJS health and hospitals. These indicators can form variables that can increase satisfaction and loyalty. Keywords Satisfaction, Service quality, Loyalty, Sharia perspective, BPJS health Paper type Research paper