BACKGROUND AND AIM: To address healthcare challenges in Saudi Arabia, such as quality, efficiency, and increasing healthcare demands, the healthcare sector is undergoing significant transformation under the Healthcare Transformation Program in both public and private sectors, aligned with Vision 2030 for the country. The aim of this study was to investigate the factors influencing the preference of patients between public and private hospitals in Riyadh, Saudi Arabia. METHODS: This was a descriptive cross-sectional study. Primary data was collected using a 38-item self-administered questionnaire. The questionnaire included demographic data and patient perceptions of services, efficiency, cost, and hospital selection. The data was collected using convenience sampling from 600 participants living in Riyadh who have attended public or private hospitals. Reliability was evaluated using Cronbach's alpha (α=0.869), demonstrating strong internal consistency. Item-total correlations across domains were statistically significant (p<
0.01), supporting validity. Statistical analyses, including descriptive statistics and an independent sample t-test, were performed. RESULTS: The majority of participants were Saudi nationals (577, 96.2%) and female (399, 66.5%). Participants' ages ranged from 20 to 40 years. More than half of the respondents (303, 50.5%) held a bachelor's degree, while 40.2% reported a monthly family income of 10,000-20,000 SR. Hospital selection (3.79±0.65) was the strongest factor influencing patient preferences. Services provided (2.68±0.65) and efficiency (3.06±0.67) received neutral responses, while the cost of treatment (2.56±0.66) was not a significant factor. Education significantly influenced preferences, with highly educated patients favoring private hospitals. Also, non-Saudi patients valued private hospitals for better cost-effectiveness and services. CONCLUSIONS: Private hospitals are perceived as superior by people living in Riyadh compared to public hospitals when it comes to service level and efficiency. Respondents did not feel that the indirect costs of using public hospitals were significant. It shows the lower cost of public hospitals remains an important attraction that encourages users to rely on public hospitals. Nevertheless, respondents justify the higher cost of private hospitals because of the superior service level. Availability of modern equipment in the hospital, the reputation of doctors employed by the hospitals, overall appearance and outlay of the hospital facilities, hygiene, and location are also important factors that influence their choice of the hospital.