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
Copyright
c
2021 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
73
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
terms of service in terms of physical appearance
(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
74
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 %
1
Sex
Female
Male
48
34
58,5
41,5
2 Age
≤40 years old
>40 years old
8
74
9,8
90,2
3 Level of education
High School
College
54
28
65,9
34,1
4 Type of work
Government
employees
Entrepreneur
Housewife
Other types of work
22
26
13
21
26,8
31,7
15,9
25,6
5 Income
≤ Rp. 3.000.000
> Rp. 3.000.000
19
63
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
d
61 74,4
Not goo
d
21 25,6
2 Price
Goo
d
66 80,5
Not goo
d
16 19,5
3 Place
Goo
d
64 78,0
Not goo
d
18 22,0
4 Promotions
Goo
d
34 41,5
Not goo
d
48 58,4
5 Resources
Goo
d
66 80,5
Not goo
d
16 19,5
6 Process
Goo
d
49 54,9
Not goo
d
33 40,2
7 Physical appearance
Goo
d
67 81,7
Not goo
d
15 18,3
Patient Visit Rates
8Goo
d
58 70,7
Not goo
d
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
p-
value
High Low
n % n %
Product
Goo
d
51 83,6 10 16,4 0,001
Not Good 7 33,3 14 66,7
Price
Goo
d
52 78,8 14 21,2 0,001
Not Good 6 37,5 10 62,5
Place
Goo
d
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
d
15 93,8 1 6,2 0,190
Not Good 43 65,2 23 34,8
Process
Goo
d
44 89,8 5 10,2 0,001
Not Good 14 42,4 19 57,6
Physical appearance
Goo
d
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
75
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
p
value
OR
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
76
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
77
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
78
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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