Analysis Of The Effect Of Service Quality, Marketing Mix, On Interest In Service Reuse Hospitalization

The diversity of people's needs for health products and services means that hospitals are competing as much as possible to serve consumers. Hospitals must improve the quality of service and also hospitals need to design marketing programs so that products/services get a response from the target market and run successfully. The marketing mix is a set of marketing tools used by the company to continuously achieve one of the marketing goals, namely to provide satisfaction to the wants and needs of consumers and to generate profits for the company from the mix market. The purpose of this study was to determine the effect of service quality and marketing mix on the intention to reuse inpatient services at RSU Royal Prima Medan in 2022. This research is a type of quantitative research. The research design used was an analytic observational method with a cross sectional approach. The population in this study was the average patient who came for treatment at the Inpatient Installation of RSU Royal Prima Medan in the last 3 months, totaling 1,653 patients. Sampling used SEM analysis where the number of samples was 150 patients. Data analysis used univariate, bivariate and multivariate analysis. The results showed that service quality had a positive and significant effect on the intention to reuse inpatient services at RSU Royal Prima Medan p-value <0.05, the marketing mix had a positive and significant effect on the intention to reuse inpatient services at RSU Royal Prima Medan p-value < 0.05. Simultaneously or simultaneously service quality and marketing mix have a positive and significant effect on the intention to reuse inpatient services at RSU Royal Prima Medan p-value <0.05. The independent variable that has the most influence on the dependent variable in this study is the service quality variable.


Vol 5
The quality assurance approach is an important factor that must be considered in providing health services to patients (Ria, 2022).Like proper doctor-patient communication, providing updates about their care is based on empathy and understanding and goes beyond just communication (Notoatmodjo, 2018).It can also ensure effective healthcare by enabling shared decision-making between doctors and patients (Sewon, 2021).The diverse needs of the community for health products and services make hospitals compete to serve consumers as well as possible (Mitropoulos, 2018).Hospitals must plan marketing programs so that products/services resonate with the target market and succeed (Maman, 2022).
Marketing mix is a set of marketing tools that companies use to achieve one marketing goal consistently (Muliawati, 2022), namely satisfying consumers and needs and generating profits for the company from the marketing mix (Kotler, 2019).The purpose of the marketing mix is to conduct transactions or visits related to outpatient or inpatient in the name of quality services (Cholik, 2017).Quality service makes patients satisfied (Tjipjono, 2020).Finally, the customer/patient concerned is loyal and returns to use the hospital's services (Antoinette, 2020).
A marketing mix strategy is a strategy that includes several elements, namely product, price, promotion, place, people, physical evidence and process (Tjiptono, 2018).All elements must be maximized to achieve optimal results (Muliawati, 2022).This marketing mix is important because it is considered when creating a marketing strategy (Sugiyono, 2018), because all these factors are interrelated with each other and represent factors in the market (Nursalam, 2017), so that the implementation of the specified marketing strategy (Malau, 2017) and positioning can be successful for maximum profit (Umy, 2020).This research will be conducted at RSU Royal Prima Medan, which is one of the largest private hospitals and will be a referral center for the community, especially Medan City and the people of North Sumatra in general.Based on the results of a pre-survey conducted by researchers in August by conducting interviews with several inpatients at Royal Prima Medan Hospital regarding the quality of services provided by officers to patients, the results of interviews with patients said that there are still patients who are not satisfied with the quality of services provided to patients, including the lack of response from nurses when patients ask something, Furthermore, the friendliness of officers is still one of the complaints felt by patients for the services felt during hospitalization at Royal Prima Medan Hospital.The aim of this research is to determine the influence of service quality and marketing mix on interest in reusing inpatient services at RSU Royal Prima Medan in 2022.

METHODS
This research is a type of quantitative research with the research design used is an analytical observational method with a cross sectional approach.This research will be carried out at RSU Royal Prima Medan.Research time This research was carried out from the time the author conducted a preliminary survey in August 2022 until data collection was followed by a results seminar.The population in this study is the average patient who came for treatment to the Royal Prima RSU Medan Inpatient Installation in the last 3 months, totaling 1,653 patients.The sampling used in this research will be adjusted based on the theory of (Hair, 2018) above, suggesting in the first point the provision of a sample size of 100 -200 for the maximum likelihood (ML) estimation technique, this has met the criteria for a minimum sample size.Based on previous research studies, it can be seen that previous research also used samples ranging from 100-300, so researchers will use samples with a total of 150 samples.Data was collected based on primary data and secondary data.Data collection techniques were carried out using documentation and questionnaire techniques.The data processing stages consist of data coding, data editing and data entry.The data analysis used is descriptive analysis by collecting the data that has been collected, univariate analysis by describing each variable.bivariate analysis using the T-test and multivariate analysis using logistic regression with the level of confidence 95%.In this research, data analysis was carried out using Ms Exel software or other computer software

Royal Prima Medan
The following are the results of the frequency distribution of respondents' assessments based on the quality of service at RSU Royal Prima Medan :  Medan was not good as many as 16 respondents with a percentage of 10.7%.From these results, it can be seen that the majority of respondents said the quality of service at RSU Royal Prima Medan was good.

Frequency Distribution of Respondents' Assessment Based on Marketing Mix at RSU Royal Prima Medan
The following are the results of the frequency distribution of respondents' assessments based on the marketing mix at RSU Royal Prima Medan.Table 4.7 describes the results of research on the frequency distribution of respondents' assessment based on marketing mix at RSU Royal Prima Medan.Respondents who said the marketing mix at RSU Royal Prima Medan was good were 123 respondents with a percentage of 82%, and respondents who said the marketing mix at RSU Royal Prima Medan was not good were 27 respondents with a percentage of 18%.From these results, it can be seen that the majority of respondents said the marketing mix at RSU Royal Prima Medan was good.
Primary Data processed 2023.

Distribution of Respondents' Assessment Frequency Based on Interest in Reusing Royal Prima Medan Hospital
The following are the results of the frequency distribution of respondents' assessments based on interest in reusing Royal Prima Medan General Hospital.
Vol 5 From table 4.9 above, it shows that between the quality of service and the interest in reusing inpatient services at RSU Royal Prima Medan, there is a correlation coefficient (r) of 0.539 with a significance of 0.000.This shows that there is a positive and significant relationship between service quality and service quality on interest in reusing inpatient services at Royal Prima Medan Hospital with a moderate level of relationship, and the correlation is significant because p < 0.05 (0.000 < 0.05).

Prima Medan
The following is the result of research on the effect of marketing mix on interest in reusing inpatient services at RSU Royal Prima Medan using Pearson Correlation Product Moment described in table 4.10 below : From table 4.10 above, it shows that between the marketing mix of interest in reusing inpatient services at RSU Royal Prima Medan, there is a correlation coefficient (r) of 0.441 with a significance of 0.000.This shows that there is a positive and significant relationship between the marketing mix of service quality and the interest in reusing inpatient services at RSU Royal Prima Medan with a moderate level of relationship, and the correlation is significant because p < 0.05 (0.000 < 0.05).

Multivariate Analysis
Based on bivariate analysis, it is known that all independent variables in this study have a p value of < 0.05 so that all independent variables in this study deserve to be included in a multivariate test using multiple logistic regression tests, which are as follows :  Table 4.13 explains the results of the independent variable that most affects the dependent variable, from the results of the study it can be seen that the highest t value is found in the service quality variable (X1) which is 5.087, from this result it can be concluded that the independent variable that most affects the dependent variable in this study is the service quality variable.
The results of research on the effect of service quality on interest in reusing inpatient services at RSU Royal Prima Medan showed respondents who said the quality of service at RSU Royal Prima Medan was good as many as 134 respondents with a percentage of 89.3%, and respondents who said the quality of service at RSU Royal Prima Medan was not good as many as 16 respondents with a percentage of 10.7%.From these results, it can be seen that the majority of respondents said the quality of service at RSU Royal Prima Medan was good.The quality of service for the interest in reusing inpatient services at RSU Royal Prima Medan has a correlation coefficient (r) of 0.539 with a significance of 0.000.This shows that there is a positive and significant relationship between service quality and service quality on interest in reusing inpatient services at Royal Prima Medan Hospital with a moderate level of relationship, and the correlation is significant because p < 0.05 (0.000 < 0.05).
The results of research on the influence of marketing mix on interest in reusing inpatient services at RSU Royal Prima Medan showed respondents who said the marketing mix at RSU Royal Prima Medan was good as many as 123 respondents with a percentage of 82%, and respondents who said the marketing mix at RSU Royal Prima Medan was not good as many as 27 respondents with a percentage of 18%.From these results, it can be seen that the majority of respondents said the marketing mix at RSU Royal Prima Medan was good.The marketing mix of interest in reusing inpatient services at RSU Royal Prima Medan has a correlation coefficient (r) of 0.441 with a significance of 0.000.This shows that there is a positive and significant relationship between the marketing mix of service quality and the interest in reusing inpatient services at RSU Royal Prima Medan with a moderate level of relationship, and the correlation is significant because p < 0.05 (0.000 < 0.05).
The results of the study on the effect of service quality and marketing mix on interest in reusing inpatient services at RSU Royal Prima Medan showed that from the results of the study obtained a significant value of 0.000 < 0.05 which means that the independent variables in the study, namely service quality and marketing mix, together or simultaneously have an influence on the dependent variable of interest in reusing inpatient services at RSU Royal Prima Medan.
The most influential independent variable in this study is the service quality variable where from the results of the study it can be seen that the highest t value is found in the service quality variable (X1) which is 5.087, from this result it can be concluded that the independent variable that most affects the dependent variable in this study is the service quality variable.

DISCUSSION
The Influence of Service Quality on Interest in Reusing Inpatient Services at RSU Royal Prima Medan.
The results of research on the influence of service quality on interest in reusing inpatient services at RSU Royal Prima Medan showed that 134 respondents said the quality of service at RSU Royal Prima Medan was good with a percentage of 89.3%, and respondents who said the quality of service at RSU Royal Prima Medan was not good as many as 16 Vol 5 respondents with a percentage of 10.7%.From these results it can be seen that the majority of respondents said that the quality of service at RSU Royal Prima Medan was good.
The quality of service on interest in reusing inpatient services at RSU Royal Prima Medan has a correlation coefficient (r) of 0.539 with a significance of 0.000.This shows that there is a positive and significant relationship between service quality and interest in reusing inpatient services at RSU Royal Prima Medan with a moderate level of relationship, and this correlation is significant because p < 0.05 (0.000 < 0.05).
The results of this research are in line with research conducted by Linda (2019) which stated that there was an influence of service quality on the interest in repeat visits of inpatients at the Manguharjo Maduin Lung Hospital in 2019 (Linda, 2019).Researchers assume that the influence of service quality on interest in reusing inpatient services at Hospital.

Prima Medan
The results of research on the influence of the marketing mix on interest in reusing inpatient services at RSU Royal Prima Medan show that 123 respondents said the marketing mix at RSU Royal Prima Medan was good with a percentage of 82%, and respondents who said the marketing mix at RSU Royal Prima Medan was not good for 27 respondents with a percentage of 18%.From these results it can be seen that the majority of respondents said the marketing mix at RSU Royal Prima Medan was good.
The marketing mix regarding interest in reusing inpatient services at RSU Royal Prima Medan has a correlation coefficient (r) of 0.441 with a significance of 0.000.This shows that there is a positive and significant relationship between marketing mix and service quality and interest in reusing inpatient services at RSU Royal Prima Medan with a moderate level of relationship, and this correlation is significant because p < 0.05 (0.000 < 0.05).
The results of this research are in line with research conducted by Shalmah and Irawati (2021) regarding the influence of the marketing mix on interest in visiting Community Health Centers from 100 respondents.There is an influence between the marketing mix of product, price, promotion, place, physical evidence on interest in repeat visits to health services.at the Ambarawa Regional Health Center (Indrawati, 2021).Researchers assume that there is a positive and significant relationship between the marketing mix and service quality and interest in reusing hospital services Vol 5

Influence of Service Quality, Marketing Mix on Interest in Reusing Inpatient Services at RSU Royal Prima Medan
The results of research on the influence of service quality and marketing mix on interest in reusing inpatient services at RSU Royal Prima Medan show that the research results show a significant value of 0.000 < 0.05, which means that the independent variables in the research are service quality and marketing mix.together or simultaneously have an influence on the dependent variable of interest in reusing inpatient services at RSU Royal Prima Medan.
The independent variable that has the most influence in this research is the service quality variable where from the research results it can be seen that the highest t value is found in the service quality variable (X1) which is 5.087, from these results it can be concluded that the independent variable has the most influence on the dependent variable in This research is a service quality variable.
Based on the statement above, the researcher believes that if the respondent's perception regarding the quality of service and marketing mix at RSU Royal Prima Medan is good, it will influence the patient's decision to choose health services again at RSU Royal Prima Medan.With the quality of service and a good marketing mix, this can automatically influence patients in utilizing the services provided by the hospital and can also increase the number of patient visits which will increase the income of RSU Royal Prima Medan.

CONCLUSIONS
From the research results and research conclusions regarding the analysis of the influence of service quality, marketing mix on interest in reusing inpatient services at RSU Royal Prima Medan in 2022, the suggestions that can be given are as follows: RSU Royal Prima Medan must maintain the quality of existing services and improve improve the quality of services to be even better than those currently provided to patients, to increase patient interest in returning to use health services at RSU Royal Prima Medan.RSU Royal Prima Medan must improve existing marketing strategies to be more targeted to meet targets in implementing better marketing strategies such as by explaining the various advantages that the hospital has.

Table 4 .
6 describes the results of research on the frequency distribution of respondents' assessment based on service quality at RSU Royal Prima Medan.Respondents who said the quality of service at RSU Royal Prima Medan was good were 134 respondents with a percentage of 89.3%, and respondents who said the quality of service at RSU Royal Prima

Table 4 .
8 describes the results of the study on the frequency distribution of respondents' assessment based on the interest in reusing RSU Royal Prima Medan.Respondents who said they were interested in reusing RSU Royal Prima Medan were 127 respondents with a percentage of 87.4%, and respondents who said they were not interested in reusing RSU Royal Prima Medan as many as 23 respondents with a percentage of 15.3%.From these results, it can be seen that the majority of respondents are interested in reusing Royal Prima Medan General Hospital.

The Effect of Service Quality on the Interest in Reusing Inpatient Services at RSU Royal Prima Medan
The following is the result of research on the effect of service quality on interest in reusing inpatient services at RSU Royal Prima Medan using Pearson Correlation Product Moment described in table 4.9 below :

Table 4 .11 Selection of candidates for multivariate analysis
From table 4.11 it can be seen that all independent variables in this study have a p value of < 0.05.Based on these results, all independent variables enter the multivariate test model in table 4.12 below :

Table 4 .
12 explains the results of multivariate analysis on independent variables against dependent variables, from the table can be seen the calculated F value of 33.824 > F table 3.06 and significance value of 0.000 < 0.05 which means that the independent variables in this study together or simultaneously have an influence on the dependent variable.Furthermore, to find out the independent variable that most affects the dependent variable can be seen in the following table:

Table 4 .13 The Independent Variable That Most Influences the Dependent Variable
Source : Data processed 2023