Analysis of the Influence of Service Quality, Facilities and Value Rates on Patient Interest through Inpatient Satisfaction at Islam Malahayati Hospital

Hospitals established and managed by private parties. The advantages possessed by private hospitals are the provision of complete facilities for patients, the quality of service that is higher quality when compared to government hospitals, service to patients that is good, friendly, not slow, fast and the attitude of professional medical personnel in handling patients. Within the hospital itself, there are complex organizations, each of which requires a budget. Hospital service activities are also closely related to things such as services, facilities, finances, patient satisfaction, management and community conditions. And in the budget principle rules, there are budget efficiency, effectiveness, transparency, and accountability as a form of accountability for the management system (Rikomah, 2017). Abstract

Hospital is a health service provider that is the choice of the community, especially the middle to upper class, therefore the tariff set must be affordable according to the economic capacity of the local community. According to Wahyuni and Fauzia (2020) Hospitals must have qualified medical personnel and be able to serve the community professionally. Human development can also be interpreted as building a person's ability through improving the level of health, knowledge or education and skills (Suhandojo in Adiwijaya et al, 2018). The hope of the hospital community can provide health services that are easy, cheap, and efficient. Perceived rates greatly influence patient satisfaction. The third factor after service quality and tariff is facilities. The number of health service providers requires consumers to be more critical in choosing which hospital services to use. Medical service support facilities are one of the factors being considered. Improvement of hospital facilities and infrastructure also needs to be done to prevent the emergence of obstacles in the provision of quality health services. With the improvement of facilities and infrastructure, it is hoped that the hospital will be able to anticipate various technical problems in the field faced by patients in obtaining quality services. Efforts aimed at planning, tariff setting, promoting satisfying the needs of both existing and potential buyers mean that marketing activities are carried out not solely to sell goods or services but to satisfy the needs and desires of patients.Providing the best quality service is not something easy for hospital managers because the services provided by the hospital are related to the quality of life of its patients so that if there is an error in medical action it can have a negative impact on the patient. These impacts can include the patient's illness getting worse, disability and even death (John, 1992).
Data on the number of inpatients at Islam Malahayati Hospital from January 2015 to June 2019 are as follows: Meanwhile, the quality of service at the hospital really determines the patient's satisfaction at the time of treatment, both inpatient and non-inpatient. From the description above, it is conveyed that services can provide satisfaction for patients if expectations are the same as the reality received by patients. In this regard, it is very important to conduct research on the quality of service in a hospital.  The table above shows the increasing number of complaints or complaints of inpatients regarding the performance of IMH services. This if allowed to reduce the satisfaction and interest in buying (the desire to use services again) inpatients, which in turn has a negative impact on the progress and development of the hospital.

Service quality
In the health service industry, service quality is one of the business strategies that emphasizes meeting consumer desires. According to Goeth and Davis, as quoted by Tjiptono, quality is a dynamic condition related to products, services, people, environmental processes that meet or exceed expectations (Tjiptono, 2000).
According to Ibrahim, describing quality from producer observations summarized as quality is a basic business strategy that produces goods and services that meet the needs and satisfaction of internal and external consumers, explicitly and implicitly. This strategy uses all the capabilities of the company's management, capital, technology, equipment, materials, systems and human resources to produce value-added goods or services for the benefit of society as well as to provide benefits to shareholders" (Ibrahim, 1997).

Amenities
In simple terms, what is meant by facility is a physical facility that can process an input into the desired output. While the process can be said as a service activity using a facility. For example, the production process, trade process and so on (Zaharuddin, 2006).
Facilities are physical resources that must exist before a service can be offered to consumers (Tjiptono, 2001). Facilities can be in the form of something that makes it easier for consumers to get satisfaction. Because a form of service cannot be seen, cannot be smelled and cannot be felt, the physical aspect becomes important as a measure of service.

Fare Value
Tariff or cost is the value of a number of inputs (factors of production) used to produce a product (output) (Munawar, 2003). Hospital rates are an aspect of which private and government hospitals are concerned. Each hospital will set service rates according to their respective missions. However, there are relatively similar considerations in determining hospital rates, namely obtaining sufficient revenue for hospital operations, both from service users and from other sources. There are hospitals that only need revenue to cover operational costs, there are those that only need funds for consumables, and there are hospitals that need funds for all kinds of expenses, including shareholder income.

Patient Interests
According to Sutantio's research, buying interest is the possibility that the buyer is interested in buying a product (Sutantio, 2004). Meanwhile, according to Howard's research in Sutantio, he defines invention to buy as a statement relating to the mind that reflects the buyer's plan to buy a certain brand within a certain period of time (Sutantio, 2004). Purchase interest is the tendency of consumers to buy a brand or take action related to purchases which is measured by the level of possibility of consumers making a purchase (Henry, 2001).

Patient Satisfaction
According to Kotler and Keller, consumer satisfaction is a feeling of pleasure or disappointment for someone who appears after comparing the performance or product results that are thought of against the expected performance or original (Kotler, Philip & Keller, 2016). Meanwhile, according to Lupiyoadi, customer satisfaction is defined as the customer response to the mismatch between the previous level of importance and the actual performance it feels after use (Rambat Lupiyoadi, 2013). Consumers experience various levels of satisfaction or dissatisfaction after experiencing each service according to the extent to which their expectations are met or exceeded. Since contentment is an emotional state, their post-purchase reactions can be anger, dissatisfaction, irritation, neutrality, excitement or pleasure (Lovelock, Christopher & Lauren K. Wright, 2007).

III. Research Methods
This research is a quantitative research. This study was analyzed using path analysis. The data used in this study are secondary data from the data reports of the Malahayati Islamic hospital in Medan from 2015 to 2019. The population of this study is the Malahayati Islamic hospital. The research sample selected was 56 respondents.

Validity and Reliability Test a. Validity test
From the list of statements contained in the research questionnaire consisting of 25 statements on service quality variables, 6 statements on facility variables, 5 statements on tariff (price) value variables, 6 statements on interest variables, and 6 statements on patient satisfaction variables towards Islam Malhayati Hospital Medan.

Service Quality Variable
The following are the results of the validity test for the service quality variable (X1), namely:

Facility Variable
The following are the results of the validity test for the facility variable (X2), that is:

Tariff Value Variable
The following are the results of the validity test for the variable tariff rates (X3);

Interests Variable
The following are the results of the validity test for the variable of interest (Y);

Satisfaction Variable
The following are the results of the validity test for the satisfaction variable (Z);

b. Reliability Test
In this study, the reliability test was carried out with an internal consistency. The results of this test will reflect whether or not a research instrument can be trusted, based on the level of accuracy and stability of a measuring instrument. The level of reliability used with Alpha Cronbach is measured from a scale of 0 to 1. The results of the reliability test on the variables of this study are as follows: Based on the output using SPSS Version 21.0 for Windows in the table above the values are obtained Cronbach's Alpha in each of the variables studied were stated to be at a very reliable and reliable level.

Classic Assumption Test a. Normality test
In this study, the normality test used the Kolmogorov-Smirnov Test. The following is presented the results of the Kolmogorov-Smirnov Test in the table below: Based on the results of processing using SPSS Version 21.0 for Windows, it can be concluded that all variables used in this study have a significance level above 0,05. This can be seen with the Asymp results. Sig. (2-tailed) of 0,200> 0,05. This means that the data used in this study have a normal distribution and indicate that the regression model is feasible because it meets the assumption of normality.

b. Heteroscedasticity Test
In this study, to test the occurrence of heteroscedasticity, graphical analysis can be used to detect the presence or absence of a heteroscedasticity symptom by looking at the presence or absence of a certain pattern in the scatterplot between the independent variable (ZPRED) and its residual (SRESID). The basis for this graphical analysis is that if there is a certain pattern such as dots that form a certain regular pattern, it indicates heteroscedasticity. If there is no clear pattern, as well as dots that spread above and below zero on the Y axis, it indicates that heteroscedasticity does not occur.

c. Multicollinearity Test
The multicollinearity test in this study aims to test whether the regression model found in this study has a correlation between the independent variables or not. The output results of SPSS Version 21.0 for Windows from this multicolinearity test can be seen in the following table: From the results of the multicollinearity test using SPSS Version 21.0 for Windows, the coefficients contained in the output can be seen that the VIF value of the service quality variable (X1) = 1.254; facility variable (X2) = 1.190; variable rate rate (X3) = 1.065. While the Tolerance value of the service quality variable (X1) = 0.797; facility variable (X2) = 0.840; variable rate rate (X3) = 0.939. This is indicated by the acquisition of the Variance Inflation Factors (VIF) value of each variable under study which scores below 10 and a Tolerance value greater than 0.1, it can be concluded that the results of all research variables from the regression model do not have multicollinearity symptoms.

Hypothesis Testing a. Path Analysis of Equation I (Indirect Effect)
The first substructure equation in this research model is to determine and analyze the positive and significant effects of X1, X2 and X3 on Z.With the following equation: Z = a + β1 X1 + β2 X2 + β3 X3 + ɛ Based on the I substructure equation above using SPSS Version 21.0 for Windows, the results can be seen as follows: In the attachment above, you can see the Sig. on the table ANOVA a has a Sig value. is equal to 0.000 or smaller than the probability value of 0.05 (sig 0.000 <0.050), then H0 is rejected and Ha is accepted. This means that the regression coefficient built is significant. So, for variables X1, X2 and X3 simultaneously and significantly influence Z. Simultaneously the variables X1, X2 and X3 have a contribution of 63.7% (it can be seen that the value of R Square in the table Model Summary b ) which explains the changes that occur in variable Z while the remaining 36.3% is explained by other variables outside the built model.
On the table ANOVA a It can be seen that simultaneously the independent variables have a significant influence on the Z variable as indicated by the Sig. 0,000 <α 5% (where H0 is rejected and Ha is accepted or in other words, the F statistical test that is carried out is significant). On the coefficient, the t test (partial) shows that the variables X1, X2 and X3 statistically have a significant effect on variable Z as indicated by the Sig value <α 5%, namely 0.079; 0,000 and 0,000. The structural equation looks like this: Z = -1,409 + 0,084 X1 + 0,654 X2 +0,084 X3 + ɛ

b. Path Analysis of Equation II (Direct Effect)
The second substructure equation in this research model is to determine and analyze the positive and significant effects of X1, X3 and Z on Y.With the following equation: Y = a + β1 X1 + β3 X3 + βZ Zz + ɛ Based on the above equation using SPSS Version 21.0 for Windows, the results can be seen as follows:  In the attachment above, you can see the Sig. on the table ANOVA a has a Sig value. is equal to 0.000 or smaller than the probability value of 0.05 (sig 0.000 <0.050), then H0 is rejected and Ha is accepted. This means that the regression coefficient built is significant. So, for variables X1, X3 and Z have a simultaneous and significant effect on Y. Simultaneously, the variables X1, X3 and Z have a contribution of 88.4% (it can be seen that the value of R Square in the table Model Summary b ) which explains the changes that occur in the Y variable while the remaining 11.6.3% is explained by other variables outside the built model.
On the table ANOVA a It can be seen that simultaneously the independent variables have a significant influence on the Y variable as indicated by the Sig. 0,000 <α 5% (where H0 is rejected and Ha is accepted or in other words, the F statistical test that is carried out is significant)