The Effect of Brand Equity and Customer Value in Repeat Visits of the Patients at Dr. Gunawan Mangunkusuma Regional General Hospital

Introduction: Patient visits at dr. Gunawan Mangunkusuma Regional General Hospital in 2020-2021 have increased by 9.78%. However, there is a decrease in the level of patient satisfaction with the services provided. This study aims to examine whether brand equity and customer value with the mediating factor of customer satisfaction affect repeat visits of the patients to dr. Gunawan Mangunkusumo Regional General Hospital. Methods: This type of research is a quantitative approach. The time of the study was in July 2022. The sample in the study was 185 patients using a purposive sampling technique. Linearity analysis in this study was carried out using SmartPLS. Results: The results showed that brand equity had a positive effect on patient satisfaction with a t-count of 4.006 > 1.96 (p<0.05). Brand equity has a positive effect on patient repeat visits with at value of 2,449 > 1.96 (p <0.05). Customer value has a positive effect on patient satisfaction with a t-value of 10,889 > 1.96 (p <0.05). Customer value also has a positive effect on patient repeat visits with a t value of 2,247 > 1.96 (p <0.05). Patient satisfaction has a positive effect on repeat visits of the patients with a t value of 2,869 > 1.96 (p <0.05). The mean repeat visits of the patients variable is 3.76. There are still indicators with a mean <3.76, namely RV1 and RV4 Conclusion: The conclusion from this study is that brand equity and customer value greatly influence patient satisfaction and patient satisfaction greatly influences repeat visits. The hospital should be more aggressive in promoting the existence of the hospital to the community, assessing the suitability of prices paid by patients with the services received, reviewing service procedures at the hospital, improving the HR department that handles patients so that customer satisfaction increases and repeat visits as well increase.


Introduction
Satisfaction of the visitor with the quality of service at the hospital is an added value for the hospital in captivating visitors.The community can give trust by making return visits to hospitals they have trusted.Customer return visits to products/services are influenced by several factors including service quality, object facilities, promotions, brand equity, and customer value [1,2] The dr. Gunawan Mangunkusumo Regional General Hospital (RSUD) is a hospital located in Ambarawa.Based on the results of observations made on the reviews of dr.Gunawan Mangunkusumo Regional General Hospital on Google has a rating of 3.9 out of 5.This indicates that patient satisfaction with the hospital is in JOURNAL OF PUBLIC HEALTH FOR TROPICAL AND COASTAL REGION (JPHTCR) Journal homepage: http:/ejournal2.undip.ac.id/index.php/jphtr/indexISSN : 2597-438 the average category.If reviewed based on patient visit data at the outpatient polyclinic, it shows a decrease in the number of patient visits starting in 2017 -2021.The average outpatient visit data during the 2017 -2019 period was 21.75%, while the 2020 -2021 period was 17 .37%.When compared to the period from 2017 to 2019, there was a decrease in the number of patient visits of around 4.38%.If observed closely, there was a significant decrease in the number of patient visits in both periods.But patient visits in 2020-2021 have increased by 9.78%.Likewise with newly registered patients who experience unstable ups and downs.
Based on the description of the patient visit data at dr. Gunawan Mangunkusumo Regional General Hospital, it is known that there is a decrease in the level of patient satisfaction with the services provided.Therefore, this study aims to examine whether brand equity and customer value with the mediating factor of customer satisfaction affect patient visits to dr.Gunawan Mangunkusumo Regional General Hospital.

Methods
This study uses a type of quantitative research.The research was carried out in July 2022 at dr. Gunawan Mangunkusuma Regional General Hospital.The independent variables in this study were brand equity, customer value, and satisfaction.The dependent variable in this study was repeat visits of the patients.Data collection in this study was carried out using a cross-sectional approach.Primary data in this study were obtained by collecting data based on the results of interviews or the results of filling out questionnaires from respondents.Secondary data in this study, namely data obtained based on documentation from the hospital.Secondary data is needed to add the strengthening the opinions contained in the research.
The population in this study were outpatients at dr. Gunawan Mangunkusumo Regional General Hospital.The sample in the study was 185 patients using a purposive sampling technique.The sample in the study was 185 patients using a purposive sampling technique.The method of data analysis in this study was carried out by analyzing the linearity of the relationship between variables.Linearity analysis in this study was carried out using SmartPLS.This research has passed the ethical review test No: 307/EA/KEPK-FKM/2022.

Respondent's characteristics and research location's description
The dr. Gunawan Mangunkusumo Regional General Hospital is a regional general hospital in Semarang Regency.dr.Gunawan

Brand Equity Variable
Based on the results of research on brand equity variables, some indicators have a mean value of less than 3.69.Seen in the brand awareness (BA) indicator, the mean BA1, BA 2, and BA 3 respectively 3.68; 3.66 ; 3, 65 < mean variable.This shows that there are still patients who do not know the advantages and recognize dr.Gunawan Mangunkusumo Regional General Hospital.
In the additional service 2 indicators, the mean is 3.60 < the mean variable, this indicates that some patients did not attend dr.Gunawan Mangunkusumo is the first choice in treatment.Meanwhile, the mean additional service 3 indicator was 3.64, this indicated that some patients were unfaithful to make RSUD dr.Gunawan Mangunkusumo as a treatment option.This disloyalty can be influenced by various factors such as a poor treatment experience, the patient does not remember having had treatment at the Hospital.

Customer Value Variable
The customer value variable shows no mean <3.00.This indicates that customer value has a positive effect on customer satisfaction so that patients agree/strongly agree to make repeat visits.Even so, there is still a mean indicator < mean variable (3.72).It can be seen from the functional value 2 (FV2) indicator, the mean is 3.66 < the mean variable, this shows that there are still patients who feel outpatient at RSUD dr.Gunawan Mangunkusumo has service procedures that are not easy to implement (both registration, inspection, and payment).
The social value indicator has a mean value of 3.70 which is smaller than the mean variable, namely the social value 1 (SV1) indicator, this shows that there are still patients who feel they are not well received when seeking treatment at RSUD dr.Gunawan Mangunkusumo.The mean of the SV 3 indicator is 3.64 which is smaller than the mean variable, this shows that there are still patients who feel that they are outpatient employees at RSUD dr.Gunawan Mangunkusumo made it difficult for him to seek treatment.Meanwhile, there is still a mean emotional price (EP) indicator that is less than the total mean, namely the Price indicators EP 1 and EP 3. On the EP 1 indicator, the mean EP 1 indicator is 3.71 < the mean variable, this indicates that some patients feel that their house is less strategic pain.The mean EP 3 indicator is 3.71, this shows that there are still patients who are not comfortable enough waiting in at RSUD dr.Gunawan Mangunkusumo.

Customer Satisfaction Variables
The customer satisfaction variable shows that there is no indicator with a mean < 3.00.This indicates that the majority of patients agree/strongly agree to make a repeat visit to RSUD dr.Gunawan Mangunkusumo in the future.Even so, there are still indicators whose average is < the mean variable (3.61).The mean in the patient satisfaction (PS1) indicator is 3.55 < the total mean, this shows that there are still outpatients who do not receive outpatient care as expected.Seen in the PS3 indicator, the mean is 3.57 < the mean variable.This shows that there are still patients who get services that are not in accordance with the price paid.

Variable Revisitation
The average respondent with a value of 3.76 stated that they would make a repeat visit to dr.Gunawan Mangunkusumo in the future to take care of his health.This was stated in return visit 1 (RV1) and as many as 53% of patients agreed if they would choose to use the services of RSUD dr.Gunawan Mangunkusumo in the future.Then in the RV2 statement, it can be seen that as many as 59% of respondents strongly agreed to recommend dr.Gunawan Mangunkusumo to relatives/relatives to deal with his health problems.Meanwhile, in the RV3 statement, 52% of respondents stated that they strongly agreed if they would consider dr.Gunawan Mangunkusumo is a health service priority.Furthermore, as many as 56% of respondents stated that they strongly agreed to consider using other service units at RSUD dr.Gunawan Mangunkusumo.The mean in the return visit variable is 3.76.There are still indicators with a mean <3.76, namely RV1 and RV4.

Discussion
It can be seen from the Brand Association 2 indicator, the mean is 3.67 < the mean variable, this shows that there are still patients who have difficulty remembering the motto/service logo or symbol of dr.Gunawan Mangunkusumo Regional General Hospital.The results of other studies also show that there are still respondents who do not know the brand, so brand awareness has no effect [3].Therefore, hospitals need to intensify promotion through various media such as social media (Instagram, TikTok, Facebook, and Hospital Website) and outreach/bazaars in public places.
Based on the results of the inner model hypothesis test, brand equity has a positive effect on patient satisfaction at RSUD dr.Gunawan Mangunkusumo.The test results show that there is a positive and significant effect with a t-value of 4.006 > 1.96 or a p-value <0.05.The test results show a beta coefficient value of 0.312.The results of this study support research conducted by Aluregowda (2011) [4], that brand equity, dimensions: physical quality, staff behavior, and selfalignment have a positive effect on satisfaction.The results of this study are consistent with research conducted by Lukman (2014) that brand equity, dimension: brand awareness has a significant positive effect on consumer satisfaction and is consistent with research conducted by Yuliati (2014), that brand equity consists of brand awareness, and brand perceived quality has a positive and significant effect on customer satisfaction.In this study, it was stated that brand equity affects the level of satisfaction, trust, and commitment.Meanwhile, brand equity has a positive effect on the intention to revisit patients at RSUD dr.Gunawan Mangunkusumo.The test results show that there is a positive and significant effect with a t-value of 2,449 > 1.96 or a p-value <0.05.The test results show a beta coefficient value of 0.234.The better the brand equity that the hospital has in the minds of patients, the more it will increase the attitude of returning to take advantage of health services.Overall RSUD dr.Gunawan Mangunkusumo has succeeded in creating good brand equity in a short period since the establishment of the Hospital.This hospital must maintain patient trust by increasing its brand equity so that it is not competitive with other hospitals, especially those in the same area.Some things that can be done by the Hospital to strengthen brand equity include evaluating the marketing system and improving good quality.
The results of this study are in line with the results of previous research on the relationship between brand image and patients' interest in seeking treatment at the children's polyclinic at PKU Muhammadiyah Yogyakarta Hospital showing that there is a positive relationship between brand image and patients' interest in seeking treatment at the children's polyclinic at PKU Muhammadiyah Yogyakarta Hospital [5].The results on the relationship between brand image and patient loyalty at the Plantation Hospital of PT.Nusantara Medika Utama Jember shows the results that respondents who give a good perception of the brand image have high loyalty to the hospital, so there is a relationship between brand image and patient loyalty at the Plantation Hospital of PT.Nusantara Medika Utama Jember [6].
Based on the results of the inner model hypothesis test, customer value has a positive effect on patient satisfaction at RSUD dr.Gunawan Mangunkusumo.The test results show that there is a positive and significant effect with a tvalue of 10,889 > 1.96 or a p-value <0.05.The test results show a beta coefficient value of 0.606.Meanwhile, Customer Value has a positive effect on the intention to revisit patients at RSUD dr.Gunawan Mangunkusumo.The test results show that there is a positive and significant effect with a t-value of 2,247 > 1.96 or a pvalue <0.05.The test results show a beta coefficient value of 0.246.This is in line with the theory expressed by Aaker which reveals that brand loyalty is closely related to consumer experience in using a brand.If consumers have positive experiences while using a brand, consumers will tend to become loyal customers [7].This research is also in line with Yusuf's research, saying that customer satisfaction has a positive effect on brand loyalty to certain products and vice versa, a customer who is satisfied with a given product is likely to be a customer for a long time [8].
Based on the results of the inner model hypothesis test, patient satisfaction has a positive effect on the interest in repeat visits of patients at RSUD dr.Gunawan Mangunkusumo.The test results show that there is a positive and significant effect with a t-value of 2,869 > 1.96 or a p-value <0.05.The test results show a beta coefficient value of 0.286.This research is in line with the research of Widjaja and Nugraha, saying that conversely, consumer satisfaction has a positive effect on brand loyalty, meaning that a good level of customer satisfaction creates good loyalty to customers [9].This is similar to research that shows that patient satisfaction has a significant and positive effect on repeat visits at Balimed Hospital.Patients are interested in making repeat visits for further treatment because of their good and memorable experiences from previous visits, which they consider satisfactory [10].
It can be seen in the RV1 indicator, the mean is 3.75 < the mean variable, this shows that some patients choose not to use the services of RSUD dr.Gunawan Mangunkusumo in the future.On the RV4 indicator, the mean is 3.74 < the mean variable, this indicates that some patients will not consider using other service units at RSUD dr.Gunawan Mangunkusumo.This is in line with other studies which state that there is a relationship between patient satisfaction in the five dimensions of quality and interest in repeat visits [3].This indicates that satisfaction, trust, and commitment will influence patient repeat visits.Thus, so that the rate of patient return visits continues to increase, the hospital, especially the hospital management department, needs to know the level of patient satisfaction.By knowing the level of satisfaction, it can be known the patient's sense of trust and commitment to the quality provided by the hospital.Several things can be done to find out patient satisfaction with services so that it will attract repeat visits, namely through criticism and suggestions.Through improvements made through criticism and suggestions, improvements to achieve trust and commitment can be made.

Conclusions
Based on the results of the research that has been done, it can be concluded that brand equity has a positive effect on customer satisfaction, customer value has an effect on customer satisfaction, brand equity has a positive effect on customer repeat visits, customer value has a positive effect on customer repeat visits, brand equity, and customer satisfaction have an effect positive effect on repeat visits, customer value, and customer satisfaction have a positive effect on repeat visits.As for the suggestions in the research that has been carried out, among other things, the hospital is expected to be more aggressive in promoting the existence of the hospital to the community so that the community begins to recognize and be interested in seeking treatment at RSUD dr.Gunawan Mangunkusumo, hospitals need to review the suitability of prices paid by patients with the services received so that patients have the satisfaction that repeats visits to hospitals can increase, hospitals need to review service procedures at hospitals to make it easier for patients to seek treatment (both registration, examination, and payment), the hospital is expected to improve the HR department that handles patients, starting from a friendly and solutive attitude to the problems faced by patients, the hospital needs to improve the queue space so that patients feel more comfortable when queuing for treatment.Suggestions for further research need to be studied about what facilities have been offered by the hospital, namely by analyzing from the field of service management

Table 2 .
Path Coefficients Variabel Brand Equity

Table 3 .
Path Coefficients Customer Value Variable

Tabel 1 .
Path Coefficients Customer Satisfaction Variables