Analysis of Marketing Strategies For Health Services in The National Health Insurance Era in Hospital Muhammadiyah Bandung

The National Health Insurance (JKN) has brought significant changes to the healthcare industry. The programme provides financial protection to Indonesians to meet their basic health needs. In the JKN era, hospitals are also faced with challenges and intense competition, so they need to improve service quality and implement effective marketing strategies. The purpose of this study is to analyse the application of the marketing mix in the marketing strategy implementation process as well as the selected marketing strategy in the JKN era at Muhammadiyah Bandung Hospital. This study used a descriptive research method with a qualitative approach, which involved interviews with the head of the marketing unit and the hospital's marketing executive staff. The results showed that well-targeted marketing strategies can strengthen the hospital's image, increase visibility and public awareness of the hospital's healthcare offerings, thus helping to reach more potential patients, and improve patient satisfaction. The implications of this study emphasise the important role of effective marketing strategies in improving healthcare services at Rumah Sakit Muhammadiyah Bandung in the era of the National Health Insurance (JKN).


Introduction
Hospitals play an important role in fulfilling the health needs of the community.In the era of National Health Insurance, hospitals are advanced level service facilities that collaborate with BPJS and must be prepared to undergo changes to receive more referrals and visits from BPJS patients.(1).The National Social Security System (SJSN) consists of the National Health Insurance (JKN), The purpose of JKN is to ensure that participants are covered and have their basic health needs met.(2).
With the development of the times, hospitals are experiencing intense competition.(3) explained the increase in the number of hospitals in Indonesia every year, in 2014-2018 there was an increase of 16.92% consisting of 2,269 general hospitals and 554 specialised hospitals.Meanwhile, based on data from the Central Bureau of Statistics of West Java Province, the number of hospitals in West Java in 2018-2019 was around 281 general hospitals and 64 specialised hospitals (4).
With the above phenomenon, hospitals face a challenge in the form of intense competition.Hospitals must improve the quality and quantity of health services in order to attract patients to use their services.One of the steps needed in efforts to improve health services is to have an effective marketing strategy.An effective strategy is needed to market products and meet consumer needs (5).Therefore, implementing an effective marketing strategy can increase demand for health services (6).
Marketing strategy is comprehensive, because it involves several aspects (7).One important aspect of marketing strategy is market segmentation or consumer grouping.Hospitals need to divide the market into homogeneous groups based on certain characteristics, such as age group, type, disease, or geographical area.Therefore, by conducting market segmentation, hospitals can recognise the groups of JKN participants they are targeting and direct effective marketing efforts.
In addition to market segmentation, attractive offers offered by hospitals, effective communication such as through social media, building partnerships with health services, providing satisfactory services and also evaluating the results that have been achieved are the first steps in identifying the needs and preferences of JKN participants.In this study, the researcher will review the various marketing strategies implemented by the Bandung Muhammdiyah Hospital, including the obstacles overcome in implementing marketing strategies in the era of National Health Insurance.

Methods
This research is an analytical survey research, which analyses the application of the marketing mix in the process of implementing marketing strategies and selected marketing strategies.The location of this research is Muhammadiyah Bandung Hospital with the consideration that it explicitly realises the importance of marketing in order to grow and develop, so that it is in accordance with the research objectives.This research uses qualitative methods in the form of interviews sourced from the parties responsible for the implementation of marketing, namely the head of the sub-unit and marketing executive staff, this is because they want to know the process of implementing marketing in the hospital, and the head of the marketing unit as the person in charge of overall marketing activities at Muhammadiyah Bandung Hospital.

Results and Discussion
In the era of globalisation, intense competition has become a demand for Muhammadiyah Bandung Hospital to improve the quality of its health services.The competition makes hospitals implement the right strategy (8).Thus, hospitals must pay attention to the implementation of marketing strategies on a regular basis in order to improve the quality and improvement of services in a planned manner so that it runs well.
The following are the results of interviews conducted with the Head of the Marketing Unit and Marketing Executive Staff at Muhammadiyah Bandung Hospital.

The Role of Marketing Strategy in Improving the Vision and Mission of Muhammadiyah Hospitals in the JKN Era
Muhammadiyah Bandung Hospital in an effort to provide health services to the community is trying to provide quality health services.In this effort, Muhammadiyah Hospital makes the vision and mission of the hospital to guide the service activities carried out.
1) The vision of Muhammadiyah Bandung Hospital is to become a leading Islamic hospital in health services oriented towards the benefit of the people.According to the Head of the Marketing Unit of the Muhammadiyah Bandung Hospital with the existence of the Hospital's Vision and Mission, the role of marketing strategies in the JKN era is inseparable in two fundamental things, the first is to provide health services oriented towards the benefit of the people such as improving optimal physical and spiritual health, while the second is introducing the beauty of Islam through health services, such as providing health education using Islamic principles in increasing public health awareness.If an institution demonstrates service commitment to customers, the institution's goals will be achieved (9).
So, the existence of a vision and mission can be a strategic foundation in directing marketing activities.With a vision that leads to long-term goals and a mission that describes the specific goals of the hospital, marketing can be more focused and effective.

Duties and Functions of the Marketing Unit at Muhammadiyah Bandung Hospital
According to the Head of Marketing, marketing has four keywords: needs, wants, expectations, and customers.
1) Needs, the marketing department conducts research into the community so that it can fulfil its basic needs in the form of medical services, health care, or facilities that meet safety and comfort standards.2) Desire, understanding customers' desires for certain products or services that can satisfy their needs by creating attractive marketing strategies in order to influence customer decisions.3) Expectations, the marketing department must understand or exceed customer expectations, for example when customers expect a safe, effective, and empathetic care experience from medical personnel and hospital staff.4) Customers, in marketing, customers are the main focus for hospitals because they act as recipients of health services, so the marketing department must be able to understand and fulfil customer needs in order to achieve success and build a good reputation in the community.While the task of marketing in general, is to analyse the needs of the health aspect, such as home care services.After the programme has been analysed by the marketing department, it is then directly submitted to the management for review, whether it is worth approving or not.
As for marketing tasks: 1) Analyse the needs from a health aspect.
2) Determine the price by considering the balance between the desired profit and the price that can be accepted by customers.
3) Determine the venue, taking into account the environment.4) Creating advertisements about hospital services through social media such as Instagram, Whatsapp, and Telegram, such as offering special services.5) Conduct socialisation and education to the community with the assistance of hospital public relations.In conclusion, hospital marketing tasks involve various aspects that include price, place, service, and promotion.This is in accordance with someone's researcher, who said that in general a marketing strategy consists of several components or called the 4Ps, namely product, price, promotion, place (10).

Marketing Strategy of Muhammadiyah Bandung Hospital in the JKN Era
According to the head of the marketing unit of the Muhammadiyah Bandung Hospital stated that around 88% of patients are JKN patients, this shows that JKN patients are the largest segmentation in the hospital rather than general patients.
Therefore, hospitals need to implement effective strategies that bring significant changes so that JKN patients do not switch to other hospitals.The Head of Marketing of Muhammadiyah Bandung Hospital created a marketing strategy to execute these factors: 1) Collaborate with primary care facilities to facilitate patients in making referral letters.
2) Conduct visits with primary health care providers, with the aim of strengthening cooperation.3) Educating patients in hospital clinics to reach patients directly, conducted once a month.4) Open a communication forum through health seminars.5) Conduct health promotion to the community through social media, such as live streaming on Instagram, YouTube or Facebook, once a week.6) Conduct online services quickly and responsively when patients are asking through whatsapp and telegram about the doctor's schedule or others related to the hospital, this service is active 24 hours.The results of the interview above show that Muhammadiyah Bandung Hospital has tried to do a good marketing strategy because it pays attention to things that can increase public awareness of health.One way is to take an effective communication approach through digital platforms.The internet has proven to be a powerful tool in finding information because millions of people access health information via the internet (11).Having a good relationship between patients can also affect the quality of health services (12).Therefore, from the explanation above, it can expand the reach in introducing the JKN programme.

Healthcare Workers' Barriers to Implementing Marketing Strategies in the JKN Era
Barriers become a big problem if not handled properly.The head of marketing at Rumah Sakit Muhammadiyah Bandung recognises the importance of overcoming these marketing strategy barriers.Here are the barriers faced by staff in implementing marketing strategies in the JKN era and some ways to deal with them: 1) Communication limitations, such as health workers having difficulty in providing information to patients.This can occur due to language barriers or cultural differences, such as when explaining information.However, officers explain simply and use language that is too informal.The way to overcome this is to improve good communication between officers and the community, and use social media to educate to increase public awareness.(13) explained that one of the marketing strategies to attract and maintain patient loyalty can be done by improving communication.2) Resource limitations, officers face resource limitations such as limited budgets and inadequate infrastructure.For example, when holding a seminar or talk show, the hospital must prepare in a planned and thorough manner so that the event can run well.The way to overcome this is by increasing the management of resources effectively and efficiently, and increasing cooperation with other parties to get the resources needed.Hospitals can maintain healthcare standards with fewer resources when the right policies are chosen (14).3) Technological limitations, officers face technological limitations when serving patients through social media such as WhatsApp and Telegram.For example, when officers are slow to respond due to limited access or lack of clear information, it can hamper the service.Thus, officers must endeavour to improve their technological capabilities.
Based on the results of the interview above, obstacles are a challenge for hospitals in improving their health services.However, if the hospital pays attention to these obstacles, the hospital can turn them into evaluation measuring instruments to improve health services for the better.Therefore, paying special attention to health service standards can improve hospital quality and patient satisfaction(15).

Marketing Mix at Muhammadiyah Bandung Hospital
According to the head of marketing, marketing strategy involves the marketing mix, namely, product, place, price and promotion, also known as the 4Ps.The head of marketing realises that to design an effective marketing strategy, it is necessary to pay attention to these four components in order to meet the needs and desires of consumers, as well as achieve the desired marketing objectives.Meanwhile, one researcher said that the marketing mix involves 7 factors, namely product, price, location, promotion, people, process and physical environment (16).In this case, the determination of the marketing mix is based on how the hospital decides itself, but has the same goal of achieving better performance.
The following are the results of interviews through questionnaires to the executive staff of Muhammadiyah Bandung Hospital regarding services, layout, prices, and types of promotions carried out by hospitals in the JKN era.

Product or Service
Muhammadiyah Bandung Hospital provides various medical services such as outpatient, inpatient, emergency, medical support in the form of radiology and laboratory, teleconsultation and homecare services.
In improving the quality of services in the JKN (National Health Insurance) era, Muhammadiyah Bandung Hospital carried out several strategies, namely: 1) For JKN participants, the hospital facilitates an APM machine (Anjungan Pendaftaran Mandiri), making it easier for patients to register without long queues when seeking treatment.2) Provide education and assist with issues related to JKN services to patients visiting the hospital, either directly through the information section at the hospital or through social media.
3) Create a WhatsApp group to facilitate coordination and communication between hospitals, hospital partners, and BPJS, so that when there are problems, they can be resolved quickly.
Based on the results of the interview above, the quality of health care products or services is one of the influences in marketing to increase public interest in these services.

Place
Muhammadiyah Bandung Hospital is quite strategic in terms of urban planning, with an easily accessible location because it is located close to the residents of the city of Bandung.A company's location is closely related to its potential market.Therefore, positioning affects the success of the company (1).

Price
In marketing health service tariffs at the Bandung Muhammadiyah Hospital, the hospital does not have a special strategy in marketing its service tariffs.However, if there are patients who need information about medical service rates, they can ask directly to the hospital information section or can contact the hospital by telephone, whatsapp, and telegram.(17) explained that, Hospital administrative costs, overhead costs, salaries of doctors, nurses, and administrative staff, infrastructure, bed occupancy, service quality, and other factors are commonly used to determine the cost of hospital services.

Promotion
Muhammadiyah Bandung Hospital conducted various promotional strategies to improve health services in the JKN era, including the following: 1) Establishing cooperation with the BPJS.With this collaboration, it is hoped that the health services provided by the hospital can be more affordable and of high quality.2) Directly educate patients on the use of mobile JKN.
3) The information service is open for 24 hours either through online or offline.This makes it easy for the public to get information about hospital services whenever needed.The marketing mix consisting of product, place, price, and promotion is a combination of marketing activities to achieve hospital goals (18).Customers also use the marketing mix function to decide whether they should buy an item or not (19).Therefore, the marketing mix and marketing strategy are a unity that cannot be separated in achieving hospital goals.

Conclusions
Based on the results of research on the implementation of marketing strategies in the JKN era at Muhammadiyah Bandung Hospital, it can be concluded that the implementation of marketing strategies plays an important role in improving hospital health services.The right strategy is the main key to attracting people to choose to use health services in this hospital.
This research also shows that marketing strategy is fully related to the marketing mix.Without the marketing mix, the marketing strategy will not run optimally.Quality services, effective communication with patients, and improving reputation to the community through various marketing channels play an important role in improving the hospital's image in the era of National Health Insurance.
2) The mission of Muhammadiyah Bandung Hospital is: a. Provide health services based on patient safety.b.Realising a professional and Islamic SDI.c. Provide adequate facilities, infrastructure and technology.d.Promote harmonious partnerships.e. Increase the syi'ar of Islamic da'wah Amar Ma'ruf Nahi Munkar.