CONSUMER ’ S CONSIDERATION IN CHOOSING A HOSPITAL Sri Retnaningtyas

The purpose of the research is to find out the consumers’ consideration in choosing a hospital. The researcher utilizes the approach by measuring the impact of motivation, reference group, and marketing mix toward consumers’ decision to choose An-Nisaa’ hospital. The research is a quantitative by applying cross sectional study. Then, the researcher needs for about two months to take 70 respondents, which are taken from outpatients of polyclinic and An-Nisaa’ Hospital by utilizing questionnaire as a research instrument. By the research, the researcher applies independent and dependent variables. The independent variable consists of motivation, reference group, and marketing mix. The dependent variable consists of consumers’ decision to choose An-Nisaa Hospital. The data analysis applies doubled linear analysis by using SPSS program. The result of the research shows that there is a simultaneous effect of motivation, reference group, and marketing mixed toward consumers’ decision in choosing An-Nisaa’ Hospital. Marketing mixed has a dominant influence. However, motivation partially has no effect toward consumers’ decision in choosing An-Nisaa’ Hospital.

Increasing the number of hospitals is one factor that causes patients to have many alternatives and more selective in determining the hospital.Patients have several considerations in choosing a hospital, including the motivation for treatment, family encouragement, and hospital circumstances.This has prompted hospital management to adopt appropriate strategies to attract consumers to choose the hospital.As an implementation of the marketing strategy, hospitals can make plans to attract consumers by doing marketing tactics.There are three marketing tactics that An-Nisaa Public Hospital can do, one of which is the marketing mix.The marketing mix is one of the hospital management tools to generate the desired customer response by the hospital.Consumer response among others is the behavior/attitude of consumers in utilizing health services offered by the hospital.Consumer behavior can reflect individuals, groups, and organizations in choosing, buying, and using something.Such behavior also reflects a good, service, and an idea or experience to satisfy their needs and their wants (Kotler and Armstrong, 2008).
Patients decide to choose a hospital individually influenced by several aspects.These aspects are perception, how to get information, attitude, demography, personality, and lifestyle of patient (Akbar, Consumer's Consideration in Choosing a Hospital et al., 2013et al., andReppi, et al., 2015)).Hospital management should pay attention to information about health services provided to the public.Accurate information will affect the patient's knowledge that may impact the patient's perceptions, beliefs, and motivations about the hospital's service which may ultimately impact on the decision to utilize the health services offered by the hospital (Nurlia, et al., 2012).
Motivation is a human psychological characteristic that contributes to one's level of commitment.Many factors influence motivation.Good motivation will make the decision making to reuse a hospital will be very high (Basit, et al., 2014).Motivation can often have an impact on consumer decisions on purchases (Huriartanto, et al., 2015, andNatalia andHandrijaningsih, 2009).Motivating a person is a management process that affects human behavior based on the knowledge of what drives the person (Suarli and Bahtiar, 2012).
Reference groups have a significant impact on consumer behavior in utilizing products and services (Noel, 2009, andAmaldoss andJain, 2008)which serves as an initial reference for individuals in shaping beliefs, behaviors, and attitudes (Assael, 1992, andAmaldoss andJain, 2008).Based on research by Sampeluna (Sampeluna, et al., 2013)reported that there was a relationship between the reference group and the community's interest to reuse the service at the dental clinic of Montasik Health Center, Aceh Besar District.Khudhori (Khudhori and Nadjib, 2012)mentions that there is a tendency about the increasing influence of family/another party as a referent to the respondent then the respondent will prefer to have maternity in IMC Bontang Hospital compared to those who did not get it.
Currently, there are seven hospitals in Blitar Regency, one of them is An-Nisaa Hospital.An-Nisaa General Hospital 'is located in Talun Subdistrict.Geographically the position of An-Nisaa Hospital is located in an area directly adjacent to Wlingi, Gandusari, Garum, Kanigoro, Sutojayan and Selopuro Subdistricts.Based on the 2014 annual report, An-Nisaa Public Hospital has a marketing area in fifteen sub-districts.The fifteen sub-districts are Talun, Wlingi, Gandusari, Garum, Selopuro, Doko, Kesamben, Binangun, Wates, Selorejo, Bakung, Sanan Kulon, Lodoyo, Sutojayan and Ponggok (Annual Report of An-Nisaa Hospital 2014).The area has a fairly dense population.Based on Central Bureau Statistics data in Blitar in 2014 figures from the total population of Blitar district is 1,140,793 inhabitants(Badan Pusat Statistik Kabupaten Blitar).An-Nisaa General Hospital 'should be able to reach the segment on the scope of the area, so it is expected that the standard of hospital performance can be achieved.But until 2014 the performance of RS An-Nisaa 'Blitar Regency is still not maximal, despite the increasing hospital performance trends.
The performance of the hospital is shown on the description of the utilization and efficiency of inpatient services at An-Nisaa General Hospital.In 2014, BOR (Bed Occupancy Rate) data is 33% LOS (Length Of Stay) that is 3.6 days, BTO (Bed Turn Over) is 3.3 times and TOI (Turn Over Interval) is 10.8 days.Data Bed Occupancy Rate (BOR) shows the performance indicators of the hospital.This indicator highlights the low level of hospital bed utilization.The ideal BOR value is 60-85%.
Utilization of inpatient services in hospitals was also amputated by outpatient visits.Based on the 2015 Annual Report, outpatient visits at An-Nisaa General Hospital during the last four years show stagnant data.In 2012 outpatient visits decreased by 14%, in 2013 outpatient visits increased by 5.6%, and by 2014 outpatient visits increased by 11.33%.
A low Bed Occupancy Rate (BOR) indicates that the inpatient unit has not been fully utilized by the market.General and generalized outpatient visit data were also low.Consumers make use of healthcare products from direct consequences of the impact of psychological variables including taste, perception, healthy pain, expectations, assessment of the provider, and individual characteristics (Hutapea, 2009, andSupriyanti andSoedjono, 2012).Products are often the dominant factors that influence consumer decisions on purchases (Hariadi and Martoadmodjo, 2013).Based on this background, the purpose of this study is to analyze the impact of motivation, reference groups, and marketing mix on consumer decisions in choosing An-Nisaa Hospital 'Blitar' as a place to seek medical treatment.

METHOD
This research uses an observational quantitative research design with cross sectional approach.The data were collected by questionnaires administered to patients or families of patients who used general polyclinics and accidental sampling specialists.The patient is an outpatient.Sampling time is approximately 2 months.The data obtained are 70 respondents.Data analysis to test the hypothesis using multiple linear regression analysis.Multiple linear regression analysis is performed if it meets the requirements of classical assumptions.In this study used normality test, multicollinearity test, heteroscedasticity test, and linear regression test.
Normality test using Kolmogorov-Smirnov Test method with the provision that if Kolmogorov-Smirnov test results count greater 0.05 than the existing data is normally distributed and vice versa if Kolmogorov-Smirnov test count is smaller than 0.05 then the data is not normally distributed.Assay heteroscedasticity test can be seen through Glejser Test.Residuals have a homogeneous variety if all probabilities of the Glejser Test are greater than the level of significance (á = 5%).While multicollinearity test is used to know the correlation between motivation variable, reference group and marketing mix in the regression model.In this test is expected to be done by looking at the value of Variance Inflation Factor (VIF) of each variable of motivation, reference groups, and marketing mix of decision variables.If the VIF value is not more than 10 and the tolerance value is more than 0.1 then the model is stated there is no multicollinear symptoms.
Hypothesis testing on multiple linear regression was done by simultaneous test (F test) and partial test (t test).F test is performed to see the influence of independent variable to the dependent variable as a whole so it can be known whether or not there is an influence of motivation, reference group, and marketing mix to consumer decision in choosing An-Nisaa hospital.

RESULTS
Data analysis on respondent's characteristic showed that female and male respondents gave a proportional number of women 51.4% and men 48.6%, aged 21-60 years (78.6%), with a minimum of senior high school education (74.3%), work as an entrepreneur (37.1%), have income less than Rp.2,600,000 (77.1%), quite a lot of respondents come from the district and Blitar City which is more than 10 km from RSU An-Nisaa (45.7%), and health financing in general at own cost (without insurance) (62.9%).
Hypothesis testing simultaneously yielded Fcount of 17.721 with p < 0.001.The test results show the probability is smaller than the level of significance (á = 5%).This means that there is a significant impact simultaneously (together) the motivation, the referent group, and the marketing mix on the consumer's decision to choose An-Nisaa General Hospital.The result of the impact test of motivation, referent group, and marketing mix on consumer's decision to choose An-Nisaa General Hospital can be seen in Table 1 However, partially motivation does not give significant impact.
The amount of contribution of motivation, referent group, and marketing mix to consumer's decision to choose An-Nisaa Hospital can be known through its determination coefficient (adj R 2 ) that is The dominant effect of independent variables on the dependent variable can be seen through the largest standardized coefficient.The estimation results listed in Table 1 above can be seen that the variable that has the largest standardization coefficient is the marketing mix of 0.665.This suggests that the marketing mix has the most dominant impact on consumer decision in selecting An-Nisaa Hospital.

DISCUSSION
The results of the research and statistical analysis show that simultaneous hypothesis testing of motivation, referent groups, and marketing mix affect consumer's decision to choose An-Nisaa General Hospital.This can illustrate that when consumers suffer from illness it will be motivated by considering the condition when sick and their own desire to seek treatment.In addition, the patient also considers the advice of family/friends as well as the doctor's advice and consider the marketing mix of An-Nisaa Hospital as a place for medical treatment if there is a health problem in him.This is in line with Priyanto's research, et al. (Priyanto et al., 2012).Natalia and Hadridjaningsih research suggests that there is a significant influence simultaneously between the marketing mix, individual consumer, and environmental influences on the decision to use a product (Natalia and Handrijaningsih, 2009, Parubak, et al., 2010, Indayani, et al., 2014, Kafa R, 2013, and Maria, et al., 2011).
Based on the results of research and statistical analysis of motivation to the decision, show that there is no partial impact on consumers in choosing a hospital.This is because there are many indicators in motivation, namely intrinsic and extrinsic motivation.But often consumers are not always aware of the causes of their actions.Consumers have the same goal for treatment but may seek fulfillment in different ways.In addition, every individual has different needs fulfillment priorities.The results of this study are not in line with other studies which states that the motivation effect on purchasing decisions simultaneously and partially (Wahyuni D. U., 2008, Saputra P. R. andSamuel H., 2013)This difference can occur due to differences in indicators used in the questionnaires by researchers.Wahyuni and Saputra use motivational indicators in the form of quality, after sales price, and comfort of use.
Based on the results of research and partial statistical analysis of the referent group has a negative impact.This indicates that the greater the respondent's perception of the referent group to seek treatment to the hospital, the respondent will increasingly not choose An-Nisaa Hospital as a place for treatment.This may be due to the behavior of respondents when they are sick, so the advice of family/friends and doctor's advice is not the primary consideration in making the decision to choose An-Nisaa '.This is in line with Sianturi's research (Sianturi E., et al., 2012).Sianturi states that the referent group is not a primary consideration for someone in using Black Berry products (Sianturi E., et al., 2012).In this study in line with Priyanto who found that the reference group gives influence to the decision of the patient in choosing a place of health services (Priyanto, et al., 2012, Dian and Artanti, 2013,and Gunawan, et al., 2010).
The study also shows that in making decisions for treatment, patients will consider advice from doctors and family/friends.Therefore An-Nisaa Public Hospital 'needs to strengthen communications to cooperate with reference groups (doctors, midwives, nurses, patient families, and communities) in the area surrounding An-Nisaa Public Hospital'.Efforts that can be done is to actively update the service information according to the hospital program.Sufficient information and experience will have an impact on the behavior of reference groups to refer An-Nisaa public hospital to consumers.
This form of cooperation can increase the credibility of the referent group so as to provide an appeal for consumers to choose An-Nisaa Hospital 'as a place for treatment.One example of cooperation with private health practitioners that is providing patient pick-up facilities for the needy.Efforts to strengthen communication with patient/community families is to provide sufficient information on the location of waiting rooms, corridors and other public places at An-Nisaa Hospital.The information provided can be in the form of brochures/leaflets and banners containing the services available in An-Nisaa General Hospital.This is an attempt to promote hospital services (Natalia and Handrijaningsih, 2009).
An important effort that can be done by RS An-Nisaa 'is to maintain the quality of service that has been assessed by the consumer.Improved quality of service in question is any effort that can provide satisfaction to consumers.Patient satisfaction will have an impact on patient loyalty to reuse health services (Gunawan andDjati, 2011, andSari andAndri, 2014).If An-Nisaa General Hospital is able to maintain the quality of the product, then this will have a positive and significant impact on the purchase (Arumsari D andKhasanah I, 2012, andReppi, et al., 2015).
The limitation of the researcher is the researcher taking the sample of the research on the outpatient who has utilized health service in An-Nisaa 'General Hospital.However, consumers of An-Nisaa Public Hospital 'are actually people in the marketing area ie those who have or have not utilized the health service of An-Nisaa Hospital.The referent group examined was a direct referent group, but in fact, there was an indirect referent group that might have an impact on the decision in the An-Nisaa General Hospital's election.Indirect referent groups are people or groups who each have no direct contact (Schiffman and Kanuk, 2008), such as community leaders, religious leaders, and political leaders.

CONCLUSION
Based on the descriptive analysis and hypothesis testing it is found that motivation, referent group, and marketing mix have an impact on a decision to choose An-Nisaa Blitar Hospital.But partially motivation does not give impact to consumer decision in choosing RS An-Nisaa 'Blitar.Therefore, efforts should be made to strengthen the motivation of consumers by providing adequate product information service An-Nisaa General Hospital as an external impetus to consumer motivation.Improving services by providing patient satisfaction can minimize customer turnover and maximize customer retention.In addition, it needs to expand and strengthen cooperation with reference groups in the marketing area of An-Nisaa General Hospital.