Marketing Mix 7P Application to Increase Patient Re-visits

Udut Tarihoran, Ermi Girsang*, Sri Lestari R. Nasution, Chrismis Novalinda Ginting

Faculty of Medical, Universitas Prima Indonesia, Indonesia

Keywords: Hospital, Marketing Mix, Visit Rate.

Abstract: Started from the many phenomena of patient dissatisfaction with the services provided, every hospital must

design the best possible service marketing program. For this reason, it is necessary to have a tool or design so

that the products offered by the hospital get more response from the target market. The intended design was

the marketing mix (7P). Marketing mix is a set of marketing tools that can be used by companies to achieve

marketing objectives in the target market, besaides that consumers or satisfied patients will tend to use these

service providers again. This study aims to see the extent of the effect of marketing mix (7P) on increasing

patient return visits. This type of research used in this study was a type of quantitative survey, using a cross-

sectional approach. The population in this study the outpatient services, with a total sample of 82 respondents.

The method of data analysis uses logistic regression analysis. The analysis showed that the marketing mix

variable had an effect of 70.65% on the increase in patient visits. These results indicate that the marketing

mix (7P) has proven to be very helpful for hospitals in increasing the number of patient visits.

1 INTRODUCTION

In recent years business in the health service sector,

especially hospitals in Indonesia, has grown very

rapidly. The emergence of various private hospitals in

big cities to remote areas with various marketing

models offered, some are individualized, networked

hospitals, to hospitals that are internationally labeled.

In its publication, if in the past it was very rare to find

a hospital that carried out promotional activities in the

mass media, but now there are many large hospitals

in Indonesia, especially in the Capital City that really

use print, radio and television as a means of their

promotion (Setiawan, 2011).

Marketing focuses on the basic practices that

every hospital should do by identifying customers,

examining patient needs and preferences, analyzing

factors that influence purchasing decisions and

persuading patients to buy products and services from

hospitals rather than competitors. All this requires a

strategy that is coordinated, considered, and realistic

in terms of making the most effective use of resources

and budgets. Planning a marketing strategy starts with

a detailed and ongoing investigation of the market

and its sub-markets or segments.

The hospital should need to design a marketing

program so that the product gets more response from

the target market. Therefore it is necessary to have a

tool or design so that the program can achieve its

goals. The design intended here is a program that can

be controlled by the organization, the design is often

referred to as a marketing mix (7P). The elements of

service marketing consist of seven elements, namely:

product, price, promotion, place, people, process, and

physical evidence (Lupiyoadi, 2011). Kotler (2015)

argues that the marketing mix is a set of marketing

tools that can be used by companies to achieve

marketing objectives in the target market, besides that

customers or satisfied patients will tend to use these

service providers again.

With the development of private hospitals, of

course there is competition between private hospitals

and government-owned hospitals. A hospital must

retain patients and snatch from its competitors.

Hospitals that do not want to make the latest

innovations and do not improve the quality of

services will sooner or later be left behind by the

health service user community (Turnip et al, 2020;

Wijaya et al, 2019).

The initial survey results that have been

conducted by researchers, found the level of general

patient visits in hospitals moving fluctuatively every

year. That is because more and more private hospitals

have services with higher attractiveness compared to

government-owned hospitals. Some of the patient's

assumptions about the product (service) at the

Tarihoran, U., Girsang, E., R. Nasution, S. and Ginting, C.

Marketing Mix 7P Application to Increase Patient Re-visits.

DOI: 10.5220/0010287400730079

In Proceedings of the International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical (HIMBEP 2020), pages 73-79

ISBN: 978-989-758-500-5

hospital provided are still unsatisfactory. In terms of

determining the price (price) provided, some say

satisfactory and some say less satisfactory because it

is not in accordance with the services provided. In

terms of the place given some patients consider the

location to be quite strategic and easy to reach.

Different things are shown in terms of promotion

(promotion) which according to patients is lacking,

because some patients think they have never seen or

heard of any promotional activities carried out by the

hospital. Viewed from the aspect of the process

(process), patients assume registration or registration

must wait a while so that patient handling is usually

slow. In terms of people / HR (people), some patients

think it is good enough but there are some

assumptions regarding medical and non-medical

personnel who provide less friendly services or lack

empathy towards patients or visitors. Furthermore, in

(physical evidence) is considered to be quite good,

but the parking area is less extensive so many patients

complain about it.

The survey findings indicate that the concept of

marketing carried out in hospitals is still not running

optimally. In fact, if marketing is carried out properly,

it will be able to increase patient satisfaction, which

continues to form patient loyalty so that patients will

always choose the hospital as their primary health

facility. Departing from these phenomena and

problems, researchers felt interested in conducting a

deeper study of "Marketing Mix 7p on increasing

patient return visits".

2 METHOD

The design in this study is quantitative with a cross-

sectional approach. The study was conducted at Dr.

R.M. Djoelham City of Binjai in July-September

2019. The population in this study were 82 patients

who were hospitalized. Samples were taken using

accidental sampling technique, with the inclusion

criteria of patients who were undergoing

hospitalization when collecting data, did not have a

communication disorder and were willing to be

respondents.

Primary data collection is done by using

questionnaires and interviews. Interviews were

conducted based on a questionnaire that had

previously been tested for validity and reliability. In

this research, the independent variable is the

marketing mix which includes 7 indicator variables,

namely product, price, place, promotion, resources,

and physical appearance. For the dependent variable

is the level of patient return visits.

Evaluation of answers in research using the

Guttman scale, this scale developed by Louis

Guttman is a scale that requires firm answers from

respondents, such as yes or no, true or false, ever or

never, and others. The Guttman scale is used if you

want to get a firm answer to a research question

(Sugiyono, 2014). In the answers are converted into

percent. If the answer is yes given a score of 1 = 1 x

100% = 100%, while the answer is not given a score

of 0 = 0 x 0% = 0%. To anticipate the measurement

results that are not absolute 100% or 0%, the

researchers used a range of percentage scales. The

percentage range in this study is <70% which means

no role and> 70% is meant to play a role (Sugiyono,

2014).

Next, the data were analyzed using the chi-square

test to see the relationship between the independent

variables and the dependent variable. Followed by

logistic regression tests to see the effect of the entire

independent variable on the dependent. The research

scheme can be seen in Figure 1.

Figure 1: Scheme of Research Process Result

2.1 Validity and Reliability

Validity test shows the extent to which a measuring

device can measure what will be measured. While the

data reliability test is an instrument test used to state

the level of confidence of the instrument so that it can

be used as a data collection tool. Calculations are

made using the product moment correlation formula

then compare the correlation values or r arithmetic of

the research variables with r tables.

The results of the validity test of each question

item have a value> 0.361 so that all questions on this

questionnaire were declared valid. Based on the

results of the validity of this research questionnaire,

all statements in each variable were declared to have

been valid. In the reliability test results, if the

Cronbach alpha value of> 0.60 is obtained, the

questionnaire is considered to be reliable and can be

Data Validity and Reliability

Data Input and Coding

Analysis of Statistical Data:

Chi Square & Logistic

Regression

Research Proposal

Primary Data

Collection

Research Result

Identification of Problems:

(Rate of Patient Visits and

Hospital Marketing)

Independent Variable:

Marketing Mix 7P (Products,

prices, places, promotions,

people, processes and physical

appearance)

Research Design:

Cross Sectional Analysis

Population and Sample:

567 and 82 Respondents

Research Sites:

RSUD dr. Djoelham Binjai

Dependent Variable:

Patient re-visit

Conclusions and Recommendations

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

distributed to respondents to be used as research

instruments. Based on the results of the reliability

test, it was known that all variables have the value of

r results> r table so it can be concluded that the

instruments used in this study are reliable.

2.2 Univariate Analysis

Univariate analysis basically aims to describe each

variable including respondent characteristics,

independent variables and dependent variables using

the frequency distribution table. Frequency

distribution of respondent characteristics based on

demographic data which includes gender, age,

education, occupation and income. Based on its

characteristics, from 82 respondents observed the

majority of respondents are female, that is 48 people

(58.5%), aged> 40 years there were 74 people

(90.2%), there are 26 types of entrepreneurial jobs

(31.7%), with income> Rp. 3,000,000 there are 63

people (76.8%). (See Table 1).

Table 1 Characteristics of Respondents

No Characteristics n %

Sex

Female

Male

58,5

41,5

2 Age

≤40 years old

>40 years old

9,8

90,2

3 Level of education

High School

College

65,9

34,1

4 Type of work

Government

employees

Entrepreneur

Housewife

Other types of work

26,8

31,7

15,9

25,6

5 Income

≤ Rp. 3.000.000

> Rp. 3.000.000

23,2

76,8

While the product variable as many as 61 people

(74.4%) rated good, as many as 66 people (80.5%)

rated the price good, as many as 64 people (78.0%)

rated the place as good, 48 people (58.5%) rated

promotions as not good, as many as 66 people

(80.5%) rated people as good, 49 people (54.9%)

rated the process good, 67 people (81.7%) rated good

physical appearance and 58 people (70.7%) rated

high return visits. (See Table 2).

Table 2. Characteristics of Marketing Mix

No Variabel n %

Marketing Mix

1 Product

Goo

61 74,4

Not goo

21 25,6

2 Price

Goo

66 80,5

Not goo

16 19,5

3 Place

Goo

64 78,0

Not goo

18 22,0

4 Promotions

Goo

34 41,5

Not goo

48 58,4

5 Resources

Goo

66 80,5

Not goo

16 19,5

6 Process

Goo

49 54,9

Not goo

33 40,2

7 Physical appearance

Goo

67 81,7

Not goo

15 18,3

Patient Visit Rates

8Goo

58 70,7

Not goo

24 29,3

2.3 Bivariate Analysis

Analysis was performed using the Chi Square test

with a significance level (α) = 0.05. The purpose of

this analysis is to see whether there is a relationship

between the independent variables (product, price,

place, promotion, person / HR, process, and physical

appearance) with the dependent variable (the level of

patient visits). The results of the analysis can be seen

in Table 3.

Table 3. Chi square analysis results

Marketing Mix

Patient Visit Rates

value

High Low

n % n %

Product

Goo

51 83,6 10 16,4 0,001

Not Good 7 33,3 14 66,7

Price

Goo

52 78,8 14 21,2 0,001

Not Good 6 37,5 10 62,5

Place

Goo

50 78,1 14 21,9 0,273

Not Good 8 44,4 10 55,6

Promotions

Good

30 88,2 4 11,8

0,015

Not Good

28 58,3 20 41,7

Resources

Goo

15 93,8 1 6,2 0,190

Not Good 43 65,2 23 34,8

Process

Goo

44 89,8 5 10,2 0,001

Not Good 14 42,4 19 57,6

Physical appearance

Goo

55 82,1 12 17,9 0,004

Not Good 3 20,0 12 80,0

Marketing Mix 7P Application to Increase Patient Re-visits

In the product variable, of the 82 respondents

observed, there were 61 respondents who rated the

product as good with 83.6% of them in the high visit

group, while the remaining 16.4% were in the low

visit group. Furthermore, there were 21 respondents

who rated the product not good with 66.7% of them

in the low visit group, while the remaining 33.3%

were in the high visit group. In the results of the

analysis with chi square obtained p value of 0.001

<0.05, it can be interpreted that there is a significant

relationship between product variables with the level

of patient visits.

In the price variable, there were 66 respondents

who rated the product as good with 78.8% of them in

the high visit group, while 21.2% in the reverse

group. Furthermore, as many as 16 people rated the

product not good with 62.5% of them in the low-visit

group, while 37.5% in the opposite group. The results

of analysis with chi square obtained p value of 0.001

(p <α), it can be concluded that there is a significant

relationship between the price variable with the level

of patient visits.

Place variable, there were 64 respondents who

rated the product as good with 78.1% of them in the

high visit group, while 21.9% in the low visit.

Furthermore, there were 18 respondents who rated the

product not good with 55.6% of them in the low visit

group, while 44.4% in the high visit. The results of

analysis with chi square obtained p value of 0.273 (p>

α), it can be concluded that there is no significant

relationship between the place variables with the level

of patient visits.

Promotion variable, there were 34 respondents

who rated the product as good with 88.2% of which

were in the high visit group, while 11.8% were on a

low visit. Furthermore, there were 48 respondents

who rated the product not good with 41.7% of them

in the low visit group, while 58.3% in the high visit

group. The results of analysis with chi square

obtained p value of 0.015 (p <α), it can be concluded

that there is a significant relationship between

promotion variables with the level of patient visits.

The resource variables contained 16 respondents

who rated the product good with 93.8% of whom

were in the high visit group, while 6.2% in the low

visit group. Furthermore, there were 66 respondents

who rated the product not good with 34.8% of them

in the low group, while 65.2% were in the high group.

The results of analysis with chi square obtained p

value of 0.190 (p> α), it can be concluded that there

is no significant relationship between resource

variables with the level of patient visits.

Process variable, there were 49 respondents who

rated the product well with 89.8% of them in the high

visit group, while 5 10.2% in the low visit group.

Furthermore, there were 33 respondents who rated the

product not good with 57.6% of whom were in the

low visit group, while 42.4% were in the high visit

group. The results of analysis with chi square

obtained p value of 0.001 (p <α), it can be concluded

that there is a significant relationship between the

process variables with the level of patient visits.

Physical appearance variable, there were 67

respondents who rated the product well with 82.1%

of them in the high visit group, while the remaining

17.9% were in the low visit group. Furthermore, there

were 15 respondents who rated the product not good

with 80.0% of them in the low group, while the

remaining 20.0% were in the high group. The results

of analysis with chi square obtained p value of 0.004

(p <α), it can be concluded that there is a significant

relationship between physical appearance variables

with the level of patient visits.

2.4 Multivariate Analysis

Multivariate analysis was carried out with the aim of

finding out which independent variables most

influenced the dependent variable. Variables that can

be carried out by multivariate analysis were variables

which on the results of bivariate analysis have p

values <0.25. Multivariate analysis used was multiple

logistic regression analysis with prediction models.

In Table 4 the final model of the effect of product,

price, promotion, process, and physical appearance

can be seen on the level of patient visits. The results

show that all variables have a value of p <0.05. This

means that all independent variables significantly

influence the dependent variable.

Table 4. Analysis Results Logistic Regression

Variabel B S.E Wald Df

value

Product 0,215 1,101 2,701 1 0,001 3,203

Price 0,521 1,342 5,421 1 0,001 3,952

Promotion 0,286 0,981 6,245 1 0,020 3,409

Process 0,350 0,210 3,162 1 0,001 3,431

Physical

Evidence

0,421 1,911 3,001 1 0,004 3,251

Prediction of the high level of patient visits that

are influenced by the product, price, promotion,

process, and physical appearance can be explained as

follows: the product value of the regression

coefficient (𝛽) or OR is positive, meaning that the

better the product has the opportunity to increase

patient visits by 3,203 times higher when compared

to less good products. In the price variable the value

of the regression coefficient (𝛽) or OR is positive,

meaning that the better the price then the opportunity

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

to increase patient visits is 3.952 times higher than the

unfavorable price.

In the promotion variable the value of the

regression coefficient or OR is positive, meaning that

the better the promotion has the opportunity to

increase patient visits by 3.409 times higher when

compared to promotions that were considered less

good. In the process variable the value of the

regression coefficient (OR) or OR was positive, by

mean that the better the process has the opportunity

to increase patient visits as much as 3,431 times

higher when compared to the better process. In the

physical appearance variable the value of the

regression coefficient (𝛽) or OR was positive,

meaning that the better the physical appearance then

the opportunity to increase patient visits about 3.251

times higher when compared to physical appearance

which was considered less good.

3 DISCUSSION

3.1 Effect of Hospital Service Products

on Patient Re-Visit

The results of the logistic regression analysis showed

that the service products provided by the hospital had

a significant effect on patient return visits. From the

prediction results the value of the odds ratio is

positive at 3.203. This means that the better hospital

products or services a patient receives, the greater the

chance of increasing patient visits 3 times higher

when compared to hospital products or services. In

hospital marketing, products are the main component

which is defined as a set of services offered to

patients. In general, the form of hospital products or

services can be classified into line services (inpatient,

outpatient, emergency, and operative actions),

support services (laboratory services), and additional

services that assist key services such as administrative

services.

From the findings of researchers at the hospital,

related to the service products offered by the hospital

were considered good by the majority of patients. It

is also known that the most prominent services of the

hospital are access to emergency services and

specialist services. Nearly 91.5% of patients,

especially users of inpatient services, assess hospitals

to be able to provide doctors who are competent in

their fields. In addition to these primary services, at

least 87.8% of patients rated the hospital as having

adequate support services such as radiology

laboratory services, medical rehabilitation and

pharmacy that were fully available. This finding is

also supported by the results of interviews with the

majority of patients, that indeed the service offered by

the hospital is the main reason for patients to choose

the hospital as their health facility. So that, in the last

few years the number of patient visits at the hospital

was recorded to continue to increase especially at

general patient visits. The same results were found in

the research of Mohammadi (2018) & Zulhit (2019),

that a company's service products directly influence

the level of patient satisfaction.

3.2 Effect of Hospital Service Prices on

Patient Re-visit

The next indicator that also significantly influences

patient return is the price of hospital services. The

results of logistic regression analysis showed a p

value of 0.001 (p <α) which means that there is a

corresponding effect between the price of hospital

care and patient visits.

Where of the 82 inpatients observed, there are 66

people assessing the price given according to 52

patients including patients with repeat visit status.

After the product, price is the most important

element in hospital marketing. The price in question

can not only be in the form of a tariff for one type of

examination or service, but the total cost that must be

incurred by the patient for the service he receives. The

price that is affordable by the community will lead to

a sense of satisfaction in patients so that they continue

to choose the hospital as its primary health facility.

From the results of the questionnaire related to the

price offered by the hospital services were assessed in

accordance with the services provided to patients.

Patients admit that the price of care is quite affordable

with the ability of patients, both in terms of treatment

services to the price of drugs in hospital pharmacies.

In addition, researchers also found many patients feel

happy because the hospital apparently also gave a

period of payment for certain patients and provide

relief for patients who are considered unable.

This is what makes many patients always choose

the hospital if the patient or other family members of

patients need hospital care. The same result was also

found by Marlina (2018), where the suitability of

prices had an impact on the return of customers using

the services again.

3.3 Effect of Hospital Service

Promotion on Patient Re-visit

From the analysis and interview results it is known

that hospitals have conducted various forms of

service promotion which are considered to have

Marketing Mix 7P Application to Increase Patient Re-visits

contributed to the decision making of patients in

choosing the hospital as a health facility. The form of

promotion the hospital does among other things, it

only provides information about services in the form

of posters that are posted on each wall of the hospital

building. Hospitals do not facilitate TV in every

patient waiting room, where hospitals should be able

to take advantage of these TV shows by displaying

advertisements that contain information about health

services provided by hospitals such as consulting

services and caring services. Apart from inside the

hospital building, promotion is also done through

internet media (website) that can be easily accessed

by every community. The website presents a special

telephone number for customer service so that

patients can easily ask questions, submit suggestions

or complaints. Some patients admit, promotion

efforts undertaken by the hospital did not attract the

attention of patients, so that service information is not

delivered optimally. Zulhit (2018) also found

interesting promotional activities can attract more

customers.

3.4 Effect of Hospital Service Process

on Patient Re-visit

As with service products, the service process is also a

major factor in the service marketing mix. Based on

the results of logistic regression analysis showed a p

value of 0.004 (p <α), this means that there is a

significant influence between the hospital service

process on patient visits. The hospital service process

starts from providing information to customers,

registration, examinations, supporting examinations,

and payments to referrals to other hospitals. Known

at the hospital under study, the service process has a

clear flow and is not too confusing to the patient. As

much 98% of patients rated the process of receiving

ER very satisfying, this was seen from patients who

came immediately handled quickly and precisely.

Likewise, when patients are hospitalized, the nurses

work systematically and on time. However, in some

service processes it is still considered to be less than

optimal by some patients, such as doctors who are

often late for examinations and patients who are too

long waiting to receive drugs from hospital pharmacy

officers. From these complaints, it is important for the

hospital management to improve and evaluate every

service process so that patients are always satisfied so

that they will be loyal to the hospital. The same result

was also revealed by Novela (2018), that the service

process that was easy for customers to understand

would be more satisfying to customers and increase

the selling value of service products.

3.5 Effect of Hospital Service Physical

Evidence on Patient Re-visit

The last marketing mix factor that also affects the

patient's return is the physical appearance of the

hospital. The physical building of a hospital is a

tangible form that can be directly seen by patients.

The appearance of the hospital's physical building is

considered to have influenced the patient's decision to

use the products offered. The important elements

relating to the physical appearance of a hospital

building include, the physical environment, in this

case the physical building, equipment, equipment,

logos, colors and appearance of employees and health

workers while on duty at the hospital. In the hospitals

studied, the majority of patients rated the cleanliness

of the treatment room very awake. The room is

equipped with facilities such as a comfortable and

safe bed, neat curtains, a clean toilet and a functioning

air conditioner. Also visible is the well-organized

hospital garden, this provides comfort for visitors.

Mohemmedi's research results (2018) prove that the

physical appearance of a good company, also

contributes to customer decisions that have an impact

on increasing the number of customer visits.

4 CONCLUSIONS

Based on the results of the analysis it can be

concluded that the implementation of marketing mix

at the hospital has a significant effect to an increase

in patient return visits. The most influential

indicators include, hospital products, prices,

promotions, processes and physical appearance.

Some idea conclusions obtained by researchers

include:

 On the product indicators, the most prominent

service of the hospital is access to emergency

services and specialist doctor services.

Predicted OR values indicate patient visits will

increase by 3.203 times higher if product

quality is improved.

 On the price indicator, prices offered by

hospitals are assessed according to the services

provided to their patients. The predicted OR

value indicates that patient visits will increase

by 3,952 times higher if the quality of service

is adjusted to the price.

 On the promotion indicator, promotion efforts

carried out by the hospital were considered less

attractive to patients, so that service

information was not conveyed optimally.

Predicted OR values indicate patient visits will

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

increase by 3.409 times higher if the quality of

promotion is further improved.

 On the e process indicator, the service process

at the hospital studied has a clear flow and is

not too confusing to the patient. Predicted OR

values indicate patient visits will increase by

3,431 times higher if the quality of the service

process flow is improved.

 On the physical evidence indicator, the

cleanliness of the hospital treatment room is

considered very awake so as to provide comfort

for patients and visitors. Predicted OR values

indicate patient visits will increase by 3.251

times higher if the quality of the hospital's

physical appearance is improved.

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