The Influence of Service Quality, Price, and Hospital Image on Outpatient Satisfaction at the Internal Medicine Clinic of RSD Wongsonogoro Semarang�

Jhodi Rent Geopal¹*, Sarwo Edy Handoyo²

Universitas Tarumanagara, Jakarta, Indonesia

Email: [email protected], [email protected]

Abstract

This study aims to analyze the impact of service quality, price, and hospital image on patient satisfaction at the outpatient clinic of internal medicine at K.R.M.T. Wongsonegoro Hospital in Semarang. The research employs a quantitative approach, collecting data through questionnaires distributed to patients receiving outpatient services. Respondents were selected using purposive sampling based on specific criteria, such as having received outpatient services at the internal medicine clinic during the study period. The analysis involved multiple linear regression to assess the relationship between the independent variables (service quality, price, and hospital image) and the dependent variable (patient satisfaction). Data analysis was conducted using statistical software to test the hypotheses and measure the impact of each variable. The findings indicate that service quality has a positive and significant effect on patient satisfaction. Additionally, a reasonable price significantly enhances patient satisfaction, while the hospital image fosters greater trust and satisfaction, though its influence is somewhat less pronounced than the other two factors.

Keywords: service quality, price, hospital image, patient satisfaction, outpatient

INTRODUCTION

Hospitals serve as health service providers that evaluate the overall quality of their services based on patient perceptions while also identifying key dimensions requiring improvement (Pai & Chary, 2016). Service quality in hospitals is not solely determined by luxurious facilities, advanced technology, or physical appearance but also by the professionalism, attitudes, and commitment of employees. In this regard, patient satisfaction surveys are conducted to enhance the hospital environment, patient care facilities, and other supporting services, ultimately improving the quality of care (Supartiningsih, 2017).

Service quality includes various dimensions, such as physical appearance, reliability, responsiveness, assurance, and empathy. These dimensions directly influence patients' perceptions and satisfaction with the services received (Bentum-Micah et al., 2020). A good physical appearance of hospital facilities can create a strong first positive impression on patients, while reliability and responsiveness in providing health services demonstrate the hospital's ability to meet patient needs effectively and efficiently, the assurance provided through the technical and interpersonal competence of medical staff fosters patient confidence in the services provided. Empathy, or the ability to understand and respond sensitively to patients' needs and concerns, further strengthens the relationship between healthcare providers and patients, which in turn increases patient satisfaction (Prasetio et al., 2022).

The price offered should align with the quality of services provided to ensure patients feel comfortable and perceive value for money. Patients are generally attracted to services that balance good quality with affordable prices, leading to higher satisfaction. When the price reflects the service quality, patients tend to be more satisfied and loyal (Arianto, 2017). This balance is essential for enhancing patient satisfaction.

The research phenomenon of "The Effect of Service Quality, Price, and Hospital Image on Internal Medicine Outpatient Satisfaction at Wongsonegoro Hospital Semarang" covers various interrelated aspects in the context of health services. Service quality in hospitals is a major factor influencing patient experience, where timeliness, medical personnel skills, adequate facilities, and good communication play a major role in creating satisfaction.

The hospital's image or reputation significantly impacts patient trust. Positive perceptions of RSD Wongsonegoro, shaped by others' experiences and favorable reviews, can attract more patients. Ultimately, patient satisfaction results from the interaction of these factors. This study aims to examine the extent to which service quality, pricing, and hospital image influence outpatient satisfaction, offering valuable insights for hospital management to enhance services, implement competitive pricing strategies, and build a positive reputation to improve overall patient satisfactio.

Based on the data of BPJS patients at Wongsonegoro Semarang Regional Hospital from January to February 2024, it can be seen that there were more female patients than male patients in both months. In January, there were 7,728 male patients and 8,907 female patients. This shows that the number of female patients is higher than that of male patients by about 1,179 cases. Furthermore, in February, the number of male patients was 6,646, and female patients were 7,670. The number of female patients was also still higher than male patients this month, although with a smaller difference of around 1,024 cases(Yanto & Setyawati, 2017) .

The research conducted at RSD Wongsonegoro was based on the fact that the image or public perception of a hospital can determine patient choice and form loyalty. Through this research, an understanding of what elements form a positive image and how they affect patient satisfaction can be obtained. There are differences in the quality of service provided to outpatients at the Internal Medicine Clinic (Alhajri et al., 2022). This can include the professionalism of medical staff, waiting times, accessibility of services, and the way patients are generally treated. This variability may affect patient satisfaction.

Understanding the aspects of service quality, price, and hospital image affecting patient satisfaction is critical to understanding patients' decisions in choosing Wongsonegoro Hospital as a healthcare provider. This can assist in designing policies and practices that improve patient satisfaction and loyalty (Meesala & Paul, 2018). Based on the above background, this study raises the research title "The Effect of Service Quality, Price, and Hospital Image on the Satisfaction of Internal Medicine Poly outpatients of Wongsonegoro Hospital Semarang".

Based on the background above, the research problem in this study is: Does service quality affect patient satisfaction at Wongsonegoro Hospital Semarang? The study aims to determine and verify the significant impact of service quality on patient satisfaction. Furthermore, the findings are expected to benefit the hospital by identifying factors influencing patient satisfaction, enabling the implementation of effective strategies to enhance patient satisfaction levels, ultimately improving the hospital's reputation and financial performance.

RESEARCH METHODS

This study employs quantitative research methods to assess the impact of service quality, price, and hospital image on patient satisfaction. This approach was selected to obtain objective and measurable data, providing an accurate representation of factors influencing patient satisfaction. As Sugiyono (2014) states, quantitative research is rooted in the positivist philosophy, emphasizing empirical observation and measurement.

The research adopts a non-probability sampling method with a purposive sampling technique. In this approach, samples are deliberately chosen based on specific criteria set by the researcher. Respondents who are considered most relevant and capable of providing data aligned with the research objectives are intentionally selected. For this study, the target respondents are outpatients at the Internal Medicine Clinic of Wongsonegoro Hospital Semarang, expected to offer valuable insights into the impact of service quality, price, and hospital image on patient satisfaction.

RESULT AND DISCUSSION

The Effect of Service Quality on Patient Satisfaction

The analysis results indicate that service quality (X1) significantly and positively influences patient satisfaction (Y), with a coefficient value of 0.252. This implies that a one-unit improvement in service quality leads to a 0.252-unit increase in patient satisfaction. The T-Statistics value of 2.602 and a P-value of 0.010 confirm that this relationship is statistically significant at the 0.05 level. These findings support the hypothesis that service quality plays a critical role in enhancing patient satisfaction, emphasizing several key factors that define service quality in the healthcare sector. For a more comprehensive understanding, future research should explore additional variables and compare these findings with those of similar studies in healthcare service management.

1) Service Theory: SERVQUAL Model

Service quality is often measured using the SERVQUAL (Service Quality) model, developed by Parasuraman (2014). This model evaluates the gap between patients' expectations and perceptions of the service received. The dimensions of SERVQUAL that are relevant in the context of health services include five main components:

a) Reliability

The hospital's ability to provide consistent and timely services. In healthcare, this has a lot to do with the accuracy of diagnosis, consistent treatment procedures, and the hospital's ability to handle patient needs in a timely manner. If this reliability is met, patients will feel confident that the hospital can be trusted, and their satisfaction will increase.

b) Responsiveness

The ability of medical and non-medical staff to respond quickly to patient requests. High responsiveness indicates that the hospital is proactively paying attention to patient needs and complaints. Speed of service delivery has a huge impact on satisfaction, especially when it comes to emergency medical treatment.

c) Assurance

It refers to the competence, courtesy, and credibility of medical personnel, as well as the sense of security felt by patients. This aspect emphasizes the importance of the ability and expertise of hospital staff in providing services in accordance with medical standards. Patients will feel more satisfied if they believe that hospital staff have sufficient expertise in managing their health conditions.

d) Empathy

The care shown by medical personnel towards patients. In healthcare, empathy plays an important role in forming a good relationship between patients and providers. When patients feel they are treated with genuine care and are valued, their satisfaction tends to increase.

e) Physical Evidence (Tangibles)

The physical appearance of hospital facilities, medical devices, and the general environment. A clean and modern physical condition can create a positive first impression that contributes to patient satisfaction.

This theory is relevant to research conducted in hospitals, especially outpatient services, where these aspects play an important role in shaping patients' perceptions of service quality.

2) Customer Experience

According to research by Fatkhiya & Rahmawati (2023), patient experience when receiving health services greatly affects satisfaction. Positive experiences through interactions with doctors, nurses, and other support staff are the main determinants of satisfaction. When patients feel that services are provided with high attention and quality, they will feel more satisfied with the care they receive.

This experience encompasses various aspects, from initial registration to post-treatment follow-up (Isaksson et al., 2016). Every point of interaction with the patient is an opportunity for the hospital to make a good impression. When each of these aspects of service is managed well, the end result is a higher level of satisfaction. Therefore, it is important for hospitals to pay attention to every stage in the patient experience, from the moment patients come to the hospital until they leave the healthcare facility.

3) Patient Trust and Loyalty

High service quality significantly builds patient trust in healthcare providers. According to Jonathan & Handoyo (2023), patient trust in hospital service quality plays an important role in increasing patient loyalty. When patients feel that they receive adequate and quality service, they will tend to use the same hospital services on their next visit.

In addition, patients who are satisfied with the service received are more likely to recommend the hospital to their relatives or friends (Leggat, 2015). Thus, service quality not only increases individual patient satisfaction but also helps the hospital build a positive reputation and gain more patients through word-of-mouth recommendations.

4) Emotional Effects in Healthcare

Good service quality affects not only the functional, but also the emotional aspects of the patient experience. As explained by Salis & Jepisah (2022), good interactions between patients and medical personnel can create a feeling of comfort and safety for patients. Positive emotional experiences, such as feeling valued, recognized, and cared for by medical personnel, can increase patient satisfaction.

In hospitals, the attention given by doctors and nurses in explaining the patient's condition and treatment procedures can help relieve the patient's anxiety. This emotional aspect is very important because patients who feel calm and emotionally supported will be more satisfied with the services received.

5) Competition in the Healthcare Industry

In an increasingly competitive healthcare industry, hospitals need to continuously improve their service quality to compete with other healthcare providers. Lestari & Sianturi (2022) emphasized that hospitals that are able to provide better quality services tend to get more patients, as patient satisfaction contributes directly to the hospital's success in retaining and attracting new patients.

Patients today have many options in choosing a healthcare provider, so hospitals must continue to innovate in delivering high-quality services. This includes not only providing superior medical care but also ensuring that the entire patient experience, from check-in to discharge, is well managed.

6) Technology and Innovation in Healthcare

The utilization of information technology, such as more efficient hospital management systems, can also help improve the quality of care. These technologies can speed up the registration process, provide better access to medical records, and enable more efficient schedule management. Handoyo & Darsono (2015) showed that information technology can be used to improve the overall patient experience, thereby increasing patient satisfaction.

The results of this study are in line with the findings of previous studies that emphasize the importance of service quality in improving patient satisfaction. SERVQUAL remains a powerful model in measuring and evaluating service quality, especially in the healthcare sector. In addition, this study reinforces the relationship between service quality and other aspects, such as price and hospital image, which together create a holistic service experience for patients (James et al., 2017). Thus, hospitals that focus on improving service quality will not only increase patient satisfaction but will also maintain patient loyalty in the long run.

The Effect of Price on Patient Satisfaction

The analysis results show that Price (X2) has a significant positive effect on Patient Satisfaction (Y), with a coefficient value of 0.263. This shows that every one-unit increase in the price variable will increase patient satisfaction by 0.263 units. The T-statistics value of 2.672 and the P-value of 0.008 confirm that the effect of price on patient satisfaction is significant at the 0.05 significance level. Thus, this relationship is very strong and means that changes in pricing in line with patient expectations contribute directly to increased patient satisfaction.

This research shows that patients are not only concerned about the quality of service they receive but also the value or benefit they get for the price paid. Here are some key factors that explain how price affects patient satisfaction:

1) Perceived Value

Patients often evaluate the services they receive based on perceived value or how commensurate the price they pay is with the quality of service received. When patients feel that the price paid is in accordance with the service received, they will feel satisfied. According to Fatkhiya & Rahmawati (2023), perceived value is particularly important in the healthcare sector, where patients tend to pay more attention to whether the services received meet their expectations regarding the costs incurred.

When prices reflect perceived value, whether in terms of facilities, service time, or quality of medical personnel, patients will feel that their costs are commensurate with the quality of care received. Conversely, a mismatch between price and service quality can lead to dissatisfaction. This demonstrates the importance of appropriate pricing in creating a balance between patient expectations and the quality of care received.

2) Affordability

Affordability plays an important role in healthcare accessibility. Patients who feel that the services are within their budget tend to be more satisfied with the services received. Conversely, prices that are too high or out of the patient's financial reach may lead to dissatisfaction, especially when they feel they are not getting the benefits commensurate with the fees paid.

In this case, affordable pricing allows patients from various economic backgrounds to access the healthcare services they need. This relates to the research findings by Tarigan & Handiyani (2019), who asserted that reasonable and affordable pricing will increase patient satisfaction and encourage them to return to the hospital's services in the future.

3) Service Quality and Price

Higher prices are often associated with better service quality. Patients who pay more for a service have higher expectations of the quality of care they will receive. If these expectations are met or even exceeded, patients will feel satisfied. Conversely, if higher prices are not accompanied by improved service quality, patients will feel disappointed and less satisfied.

Research by Lestari & Sianturi (2022) shows that price plays an important role in influencing patient perceptions of service quality. If patients pay a higher price, they expect better service. In the context of RSD Wongsonegoro, competitive prices that still reflect high quality will increase patients' positive perceptions of the hospital.

4) Comparison with Other Providers

Patients often compare the price of services between one provider and another. If the price offered by RSD Wongsonegoro is more competitive than other hospitals with equivalent service quality, patients will be more likely to choose RSD Wongsonegoro and feel more satisfied. Conversely, if the price is considered too high compared to other hospitals that provide similar services, patients may feel dissatisfied and look for alternatives.

Research by Handoyo & Darsono (2015) shows that price comparisons with other healthcare providers can affect patient satisfaction. When patients feel that they are getting a competitive price with quality services, they will feel more satisfied and more likely to reuse the hospital's services in the future.

5) Price Transparency

Transparency in pricing also plays an important role in improving patient satisfaction. When patients clearly understand the fee structure, and there are no unanticipated additional costs, they will feel more satisfied with the services received. Conversely, ambiguity in pricing, such as hidden costs or undisclosed fees, can lead to dissatisfaction and distrust.

Patients who have clarity regarding the cost of services will feel more comfortable and trust the healthcare provider. This transparency also helps patients make informed decisions regarding their care, increasing their sense of control and satisfaction.

6) Emotional Influence

Price affects not only the economic aspect but also the emotional experience of patients. Prices that are too high can lead to feelings of pressure or stress, especially when patients feel that they are paying more than they should. On the contrary, prices that are reasonable and in line with the quality of service can provide a sense of security and comfort, which in turn increases overall satisfaction.

Tarigan & Handiyani (2019) emphasized that this emotional aspect is an important part of the patient experience at the hospital. When patients feel that the price paid is appropriate, they are not only satisfied with the services received, but also feel more emotionally comfortable during the treatment period.

The results of this study support previous studies, such as those conducted by Fatkhiya & Rahmawati (2023) and Lestari & Sianturi (2022), which found that price has a significant effect on patient satisfaction. This study also strengthens the relationship between price and perceived quality, where higher prices are often associated with better service quality. In addition, these results support the findings of Handoyo & Darsono (2015), who emphasized the importance of competitive pricing in creating patient satisfaction.

Overall, good price management is critical to creating a positive patient experience. Appropriate, transparent, and competitive pricing not only improves patient satisfaction but also encourages loyalty, recommendations, and a positive image of the hospital. In RSD Wongsonegoro, a good pricing strategy can significantly improve patient satisfaction and strengthen the hospital's position in the healthcare market.

The Effect of Hospital Image on Patient Satisfaction

The results of the analysis show that Hospital Image (X3) has a significant positive effect on Patient Satisfaction (Y). The coefficient of 0.256 indicates that every one-unit increase in hospital image will contribute to a 0.256-unit increase in patient satisfaction. Although the T Statistics value of 2.186 and P Value of 0.029 indicate that this effect is significant at the 0.05 level, the contribution of hospital image is slightly lower than that of service quality and price. However, these results still confirm that hospital image plays an important role in determining patient satisfaction.

Patients who feel that the hospital has a positive image are more likely to be satisfied with the services they receive. A positive image is closely related to the public's perception of the quality of service, reputation, and overall experience that the hospital offers. Mahfud (2020) states that a hospital's image is based on several key factors that can affect the level of trust and comfort of patients, as well as their loyalty to the hospital. The factors that influence the image of the hospital are:

1) Service Quality

The quality of healthcare services provided by a hospital is the foundation of a positive image. This includes speed of service, accuracy of diagnosis, effectiveness of treatment, and staff attention to patient needs. Patients who are satisfied with the medical services provided will have a more favorable perception of the hospital's image. In this context, perceived service quality creates a direct link with the hospital's reputation and image in the eyes of patients.

2) Patient Trust

Trust plays a key role in shaping a hospital's positive image. When a hospital has a good reputation and is seen as reliable, patients are more likely to trust the services they receive. This contributes to patients' comfort during the treatment period, which ultimately affects their level of satisfaction. According to Mahfud (2020), this trust is also closely related to consistent service standards and good communication between patients and hospitals.

3) Staff Professionalism

Hospital staff, both medical and non-medical, play a role in shaping the image of the hospital. Their professionalism, expertise, and work ethics create a positive or negative perception of the hospital. For example, doctors and nurses who show empathy and good communication will make patients feel more valued, which contributes to the image of the hospital as a caring institution. Continuous training for medical and administrative staff is also necessary to maintain and improve high standards of service, which in turn improves the image of the hospital.

4) Cleanliness and Comfort

The physical condition of the hospital environment, including the cleanliness of patient rooms, waiting areas, and other public facilities, also affects the hospital's image. Patients and visitors will have a positive impression if the facilities are well-maintained and comfortable. Salis & Jepisah (2022) emphasized that a clean and comfortable environment increases the feeling of safety and calmness for patients, which ultimately affects their satisfaction with the services received.

5) Communication

�� The relationship established between the hospital and the patient through communication also contributes to the positive image of the hospital. Clear and transparent information about procedures, costs, and treatments helps patients feel more comfortable and at ease. Jonathan & Handoyo (2023) assert that effective communication can build good relationships between hospitals and patients, strengthen trust, and ultimately improve the image of the hospital.

6) Effective Image Management

Managing a hospital's image requires appropriate communication strategies, such as a good marketing campaign and the use of positive testimonials from patients. Patients' direct experience greatly influences their perception of the hospital. Positive feedback from satisfied patients can strengthen the hospital's good image, while negative experiences can damage the reputation that has been built. Hospitals should, therefore, be responsive to patient feedback and make continuous improvements to enhance service quality.

In addition to increasing satisfaction, a positive image of the hospital can also encourage patient loyalty. Patients who are satisfied with the services received are more likely to return to use the hospital's services and recommend it to others. This creates a positive cycle where a good image reinforces loyalty, which in turn attracts more new patients through word of mouth and positive testimonials on various digital platforms and social media.

Thus, hospital image acts as a determinant factor in patient satisfaction. Patients who have a positive perception of the hospital's image tend to be more satisfied with the services they receive. This shows the importance of good hospital image management, including improving service quality, staff professionalism, and a comfortable and clean environment. With proper image management, hospitals can increase patient satisfaction, encourage loyalty, and strengthen their reputation in an increasingly competitive healthcare industry.

CONCLUSION

Based on the findings of this study, conclusions can be drawn regarding the influence of service quality, price, and hospital image on patient satisfaction at Wongsonegoro Hospital Semarang. The research indicates that service quality has a significant positive impact on patient satisfaction. This highlights that higher service quality leads to greater patient satisfaction. Key factors such as the professionalism of medical personnel, reliability in delivering care, and prompt responsiveness to patient needs play a critical role in enhancing patient satisfaction. To strengthen these findings, hospitals should consider implementing targeted strategies that continuously improve service delivery, ensure competitive pricing, and maintain a positive hospital image.

Price is also proven to have a positive and significant effect on patient satisfaction. Price adjustments in accordance with the quality of services provided will make patients feel that they are getting value for money. When prices are perceived as reasonable by patients, this increases feelings of satisfaction with the services received. Hospital image also plays a role in influencing patient satisfaction. Although its contribution is slightly lower than that of service quality and price, a positive hospital image is still significant in increasing patient trust. A good image includes the hospital's reputation, the positive experiences of other patients, and the general perception of the community, all of which contribute to the creation of patient satisfaction.

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Copyright holders:

Jhodi Rent Geopal, Sarwo Edy Handoyo (2024)

First publication right:

AJEMB - American Journal of Economic and Management Business