Marketing Mix Relationship with Patients' Re-Visit Interest of Out Patient in Internal Polyclinic at Gunungtua Hospital

ABSTRACT


INTRODUCTION
According to the World Health Organization (WHO), the hospital is something that is integral to every social and health organization whose function is to provide a complete, curative and preventive health service to the community, and outpatient care designed to reach families who are in At home.The hospital is a center for training and learning of health workers and a bio-medical research center [1], [2], and [3].According to the Ministry of Health of the Republic of Indonesia [4], a hospital is a plenary individual health service institution organized by a health service provider that provides inpatient, outpatient, and emergency services.Good service quality can provide patient satisfaction which generates interest for patients to make repeat visits so that it will indirectly increase patient loyalty to the services provided by the hospital [5].Outpatient services in hospitals are one of the most significant services, where outpatient services are the backbone of the service system because outpatient services themselves have a position as a door [6].
Entrance gate to inpatient services and other health services.Therefore, outpatient services are currently the center of attention by the hospital, due to the many tendencies of residents who often seek fast service and services that are obtained at the same time (one day care) [7].The provision of outpatient services has been growing from time to time, but the number of outpatient visits from year to year has decreased over several decades.The incidence of decreased outpatient visits for the first time since 1983 decreased in the previous year among the more than 6,000 hospitals surveyed by the American Hospital Association (AHA). .The AHA surveyed 6,146 hospitals located across the country.In 2017, the hospital recorded a total of 880.5 million outpatient visits.In 2018, the same hospital made 879.6 million outpatient visits, down 0.09% compared to the previous year and this will affect the hospital's revenue.One of the reasons for the decrease in outpatient visits is because patients have more options to choose better and more comfortable outpatient care [8], [9] and [10] The development of hospitals and outpatient services in Indonesia has also continued to grow, both national private hospitals, international hospitals and government hospitals.Based on data from the Ministry of Health [11].Indonesia has 2,344 registered outpatient hospitals throughout Indonesia .And several hospitals in Indonesia have decreased from year to year in patient visits to almost 0.04%.This is caused by the number of hospitals that are developing, making the originator for patients to have the opportunity to choose to determine the service that the patient wants and requires the hospital to compete in a healthy manner, also due to the lack of marketing carried out by the hospital itself to attract the attention of patients to make home visits.the pain [12] .
The development of hospitals and outpatient services in Indonesia also continues to grow, both national private hospitals, international hospitals and government hospitals.Based on the information [13].Indonesia has 2,344 registered outpatient hospitals throughout Indonesia.And some hospitals in Indonesia have decreased from year to year in patient visits, reaching almost 0.04%.This is caused by the number of growing hospitals, which causes patients to have the opportunity to choose the services that patients want and requires hospitals to compete in a healthy manner the pain.[14] and [15] From the initial survey that was conducted at the outpatient internal medicine polyclinic, it was found that in 2019 the number of outpatient visits to the internal medicine polyclinic in August was 23 0 people, in September there were 317 people, and in November there were 266 people, from the information above there are ups and downs Number of patient visits to outpatient internal medicine polyclinic.And in 2020 there was a decrease in the number of patient visits at the disease polyclinic in the last 3 months of Sembiring General Hospital.The decrease in the number of patient visits from August 2020 was 120 people, in September 2020 there were 85 patients who visited, while from November 2020 patients who returned to the internal medicine polyclinic were 123 people.The decrease in the number of old patient visits shows that the lack of interest in patient visits to make return visits to the Internal Medicine Polyclinic Pathway Installation at the Gunung Tua General Hospital and this decrease is also one of the causes of the Covid 19 pandemic because residents are worried and avoid visiting the hospital.
If this continues to occur, it will lead to a decrease in the number of visits and not reach the target of outpatient visits, which will impact the income of the hospital [16] .Therefore a marketing mix is needed to improve the quality of health services and maintain the number of patient visits.Hospital leadership must be sensitive to changes in consumer behavior so that they can create a strategy in the marketing mix that is always for marketing the hospital so that it can attract consumer favors to make return visits [17] .The interest in the visit being tried is the main goal of the hospital in marketing the hospital, so that it can make the hospital stand out from the existing competition.[18] the Gunungtua regional general hospital as a service facility has never been tried, therefore it is necessary to do research on what marketing mix influences attention to return to visit the outpatient services of the internal medicine polyclinic [19] .It is also hoped that it can serve as a reference for management in making policies so that it results in better service to patients.[20] Using the marketing mix is one way out that is usually used by the hospital to get the desired response from the target, but what is most important is how to understand the marketing mix from the patient's point of view or opinion about problems such as fees that must be paid by the patient, get pleasant, comfortable, safe service and good communication from the hospital to customers .[21] and [22] Interest in making repeat visits is caused by aspects of satisfaction arising from preferences and making these objects as references for using products/services return accompanied by behavioral and behavioral loyalty to carry out a direction that has become a goal [23] This research will try to prove empirically about the marketing mix by using the marketing mix on the interest in revisiting outpatient patients at the internal medicine polyclinic at Gunungtua Hospital.So that researchers want to research about "The Relationship between Marketing Mix and Interest in Repeat Visits for Outpatients at the Internal Medicine Polyclinic at Gunungtua Hospital" so it is interesting to study.

METHOD
This research was conducted at Gunung Tua Hospital using a quantitative research type, which is a type of research that is systematic, planned, structured, uses lots of numbers starting from data collection, processing to results and emphasizes objective phenomena and is studied quantitatively.The research design used is analytic observational method with a cross sectional approach.Slowvin formula, the number of samples for this study was 150 respondents.[24] [25] Research process diagram

RESULTS AND DISCUSSION
The number of respondents involved in the study of interest in repeat visits to outpatient clinics of internal medicine was 150 respondents.These respondents were patients who had outpatient internal medicine polyclinic at the Gunung Tua Regional General Hospital.
Based on gender characteristics, the results showed that the majority were female as many as 77 respondents or 51.3%, based on age characteristics, the results showed that the majority of respondents were in the age group > 61 years, as many as 87 respondents or 58.5% , based on the latest educational characteristics, it was found the result is that the majority of senior high school graduates are 93 respondents or 62.0 %.Based on univariate data for the product marketing mix with an interest in revisiting the outpatient internal medicine polyclinic at the Gunung Tua Regional Hospital, the majority of the product marketing mix was good as many as 90 respondents or 60.0%, Based on univariate data for the price marketing mix with an interest in repeat visits of internal medicine polyclinic outpatients at the Gunung Tua Regional Hospital, the majority of the affordable price marketing mix were 108 respondents or 72.0% , Based on univariate data for the marketing mix of places with an interest in repeat visits outpatient internal medicine polyclinic at the Gunung Tua Regional Hospital, the majority of the marketing mix places well as many as 97 respondents or 64.7%,Based on univariate data for promotional marketing mix with interest in repeat visits of internal medicine polyclinic outpatients at Gunung Tua Regional Hospital, the majority of promotional marketing mixes were not good as many as 91 respondents or 60.7%, Based on univariate data for interest in repeat outpatient visits internal medicine polyclinic at the Gunung Tua Regional Hospital, the majority of interested repeat visits were 79 respondents or 52.7% who were not interested.

The Relationship between Product Marketing Mix and Interest in Repeat Visits
The results of the statistical test obtained a p-value of 0.002* <α 0.05, so Ho was rejected, which means that there is a significant influence between the product marketing mix and the interest in repeat visits of outpatients at the internal medicine polyclinic at the Gunung Tua Padang Lawas Utara Regional General Hospital.

The Relationship between Price Marketing Mix and Repeat Interests
The results of the statistical test obtained a p-value of 0.001* <α 0.05, so Ho was rejected, which means that there was a significant influence between the marketing mix price and the interest in repeat visits of outpatients at the internal medicine polyclinic at the Gunung Tua Regional General Hospital, Padang Lawas Utara

Table 1 .
Frequency Distribution of Outpatient Characteristics at the Internal Medicine Polyclinic

Table 2 .
Frequency Distribution Based on Univariate Analysis of Interest in Repeat Visits of Outpatients

Table 3 .
Tabulation of Product Marketing Mix with Interest in Repeat Visits of Outpatients