The purpose of this study was to determine the effect of patient satisfaction and retention on loyalty through the relationship between marketing and switching behavior. Case studies on patients using BPJS and Non-BPJS services at the Islamic Hospital of Fatimah Cilacap. The method used was purposive sampling with 90 samples with various specified criteria. Data analysis using Structural Equation Modeling with Partial Least Square approach. The results showed that the marketing relationship has a significant positive effect on satisfaction, loyalty, and switching behavior. Patient Satisfaction has no significant effect on Loyalty. Furthermore, satisfaction does not have a significant effect on switching behavior. Switching behavior does not have a significant effect on loyalty, but retention has a significant positive effect on loyalty. Switching Behavior cannot mediate Marketing Relationships and Satisfaction with Loyalty. And Satisfaction cannot mediate Marketing Relationship to Switching Behavior. There is a difference in loyalty between patients whose treatment is funded by BPJS and Non BPJS at the Islamic Hospital of Fatimah Cilacap.