Factors Affecting the Utilization of Medical Check Up at the Putri Hijau Level II Hospital

The purpose of this research is to investigate the variables that affect the use of medical services. At the Putri Hijau Level II Hospital, you may get checked out. It was decided to employ a kuantitatif research design with a cross sectional design for this particular investigation. Patients who came in for a medical check-up at the Putri Hijau Level II Hospital were included in the research study. According to the results of the first survey, the total number of patients who had medical examinations in 2019 was 2135 individuals. We needed to look at 100 different individuals for our experiment. The chi square test and multiple linear regression were the statistical tests that were used. The results of the chi square test study revealed that the variable service quality (reliability p-value = 0,000, responsiveness p-value = 0,000, assurance p-value = 0,036, empathy p-value = 0,003, physical evidence p-value = 0,026) obtained a p-value less than 0.05, the variable facility p-value = 0.000, the variable rate / price p-value = 0.000, and the variable patient perception obtained a p-value Patient views of the use of Medical Check Up services are associated with service quality (reliability, responsiveness, assurance, empathy, physical evidence) as well as medical facilities, rates / pricing and patient perceptions of the usage of Medical Check Up services (p-value = 0.039 0.05). Using multivariate analysis, it was discovered that one of the variables in this research, the Facility variable, had the most influence on the outcome.


Introduction
In the context of health services, promoter health services are an action or set of activities that emphasize activities that are health promotion-oriented, while preventive health services are activities that are designed to avoid a health issue or illness (Mahmud et al., 2013). his physical well-being Furthermore, as part of its role as a forum for health promotion and illness prevention, the hospital achieves this via the provision of a health screening program known as Medical Check Up, which is aimed at individuals who understand that "prevention is better than cure." When it was first introduced, Medical Check Up (hence abbreviated as MCU) was utilized not only for early illness diagnosis, but also for determining a person's overall health condition. Private/general patients and corporate workers are the two main kinds of patients seen at MCU, according to the organization. Patients who are privately insured or who are not insured are candidates for giving feedback on the services they receive. Private/general patients are divided into two categories: those who undergo routine health checks even if they do not The health examination must be completed fully, in the sense of being carried out from head to toe, from the anamnesis to any further exams that are required. In addition, the MCU is helpful for avoiding or delaying disease consequences, as well as for giving prompt therapy for aberrant results during medical examinations and examinations by others.
People's needs and expectations for health services, including MCU, are rising in the present age of globalization and modernity. The community has grown more competent of both knowledge and economics, both of which have an impact on the decisions made about healthcare services in the community (Christie et al., 2012). It is health care providers (providers) that put the needs of their clients first who will be able to thrive in an age of intense competition and limited financial resources. Customer focus or customer-focused services need the transformation of health care providers' mental attitudes (mind sets) from those of consumers who demand our services to those of service providers who require customers (Tsarenko et al., 2019). Because of this, every hospital should understand the variables that influence patients, particularly private and public patients, when it comes to seeking medical attention.
The MCU at the Putri Hijau Level II Hospital serves two types of patients: organic patients, who are comprised of Army soldiers, Army civil servants, and their families, and general patients, who are comprised of general patients who come alone as well as candidates for the Armed Forces and civil servants. Following the completion of an initial survey of resource people at the Putri Hijau Medan Level II Hospital, valid data and data that has been verified have been obtained, with the latter occurring only in 2019. In accordance with the data collected over the past year, it is known that the number of visitors each service day varies from just 9 people/day to a maximum of 20 people/day, while the MCU Ideal Capacity for Putri Hijau Hospital is to provide 20 people/day of service. As a result, it can be stated that only about 45 percent of the optimum capacity was reached, with Indonesian National Army (TNI) candidates and general patients being the largest proportion of patients from the entire MCU population, accounting for 80-90 percent of all patients. Consequently, it is essential to understand the variables that affect the use of the MCU at the Putri Hijau Level II Hospital, which is currently unknown.

Methods
It is the goal of this type of analytic survey research, which uses a cross-sectional study approach, to determine the influence of service quality factors (reliability and dependability, responsiveness and responsiveness, assurance and assurance; empathy and empathy; physical factors and tangibles; and patient perception factors) on the patient experience. This research looked at patients who went to the Putri Hijau Hospital Level II for medical examinations. There were 2135 individuals in total, with a total sample size of 100 people. A questionnaire is used to gather information for the study. The data that has been gathered is subjected to univariate, bivariate, and multivariate analysis before being analyzed further. The goal of univariate analysis is to provide a visual representation of the frequency distribution of all of the variables under consideration, including both dependent and independent variables. When conducting a bivariate analysis, the goal is to determine the relationship between a dependent variable and an independent variable, and when conducting a multivariate analysis, the goal is to determine how an independent variable affects a dependent variable. The type of multiple logistic regression analysis is used to determine which independent variables are the most influential on the dependent variable.

Univariate Analysis
Based on the distribution of respondent characteristics, service quality (reliability/reliability, responsiveness, assurance, empathy, physical factors/tangibles), facilities, rates/price, and patient perception factors shown in Table 1, it is clear that the most dominant respondents are those who are reliable, responsive, and empathic. Men outnumbered women by a margin of 95 to 5, according to the findings of the survey, indicating a gender imbalance (5.0 percent ). The majority of respondents have completed high school, with as many as 61 individuals having completed this level of schooling (61.0 percent ). Patients between the ages of 17 and 25 years old make up the majority of those who participate in Medical Check Up, with as many as 80 participants (80 percent).

Bivariate Analysis
In accordance with Table 2, the connection between service quality (reliability/reliability, responsiveness/responsiveness, assurance, empathy, physical evidence/tangibles), facilities, rates/price, and patient impression variables at the Level II Putri Hijau Hospital has been established. The majority of the 100 responders indicated that they agreed with the majority. The reliability/reliability of the system was poor. The majority of those polled (55 out of 79.7%) said "not good." The majority of 49 respondents (89.1 percent) said they did not like it. 33 (78.6 percent), Empathy/emphaty was rated poorly by the majority of respondents 54 (76.1 percent), Physical evidence was rated poorly by the majority of respondents 56 (72.7 percent), and the majority of rates/prices were rated unaffordable. 63 (74.1 percent) of facilities said that they were not excellent. The majority of patients (56 out of 78.9 percent) said they did not feel well. The use of medical check-ups at the Level II Hospital Putri Hijau Medan accounted for 37 (771 percent) of the total.  Table 3 shows that of the 8 variables tested for multiple logistic regression in the first stage, the variables that have a p-value > 0.05 and the largest are guarantees (p = 0.548), physical evidence (p = 0.921), tariffs/prices ( p=0.790). And then the guarantee variables, physical evidence, and price rates are removed from the modeling in the second stage of logistic regression, the results are as follows: When the results of the multiple logistic regression test were added together, they produced a significant value of 0.0000.05, which is shown in Table 4. Thus, the five variables included as models in the current research were shown to have an extremely strong correlation to medical check-up use at Level II Hospital Putri Hijau Medan.

Reliability with the Utilization of Medical Check Up at the Level II Hospital Putri Hijau Medan
The capacity to provide the promised service on time, correctly, and adequately is referred to as dependability in business (Wau & Purba, 2019). Performance must meet or exceed patient expectations, which includes being on time, providing the same service to all patients without mistakes, displaying a compassionate attitude, and maintaining high accuracy (Sakawati et al., 2021).
According to the findings of a survey of 100 respondents, there are 31 respondents who have excellent dependability, as many as 19 respondents (61.3 percent) who use Health Services / Medical Check Up well, and 12 respondents (38.7 percent) who do not use Health Services / Medical Check Up well. Of the 69 respondents who reported low dependability, 14 respondents (20.3 percent) said that they utilized health services/medical check-ups effectively, while 55 respondents (79.7 percent) reported that they did not. In the Chi Square statistical test, a pvalue of 0.0000.05 was achieved, which indicated that there was an association between reliability and reliability on the usage of medical check-ups at the Putri Hijau Level II Hospital, as determined by the results of the study.
The findings of the reliability study revealed that patients perceived the doctor's services as less reliable, implying that the doctor's ability to provide the promised services correctly and reliably was diminished because the doctor made an examination visit for inpatients and the time of their arrival could not be determined. In reality, during a medical check-up at the Putri Hijau Medan Level II Hospital, there are still physicians or specialists who do not adhere to these guidelines because the general practitioner or the specialist places a higher priority on the practice at home than on the hospital. It also creates delays in attendance and examination of expert physicians for medical check-ups for specialist doctors who correspond with the practice schedule at the specialist poly, as a result of the aforementioned factors.
In accordance with the findings of the research, 45 out of 100 respondents shown excellent responsiveness, 27 respondents (60 percent) used health services/medical checkups effectively, and 18 respondents (40 percent) did not. The response rate was poor among the 55 respondents, with as few as 6 respondents (10.9 percent) reporting that they utilized health services/medical check-ups effectively and 49 respondents (89.1 percent) reporting that they did not. Because the p-value for the Chi Square statistical test was 0.000 0.05, there was a significant connection between responsiveness and the usage of medical check-ups at the Putri Hijau Level II Hospital, according to the results of the study. High levels of patient satisfaction are likely to be achieved if services are delivered in a timely manner. The desire to offer patients with services that are timely and correct, as well as clear information delivery, is defined as responsiveness. Every patient who is going through the treatment process needs service that is quick, practical, and simple, as well as acceptable therapy, so that they do not have to wait too long to get what they anticipate. In addition, the reaction from officers while delivering services has a significant impact on patient satisfaction; a positive response will make the patient feel valued, and vice versa.
They need responsiveness at the Level II Putri Hijau Hospital, which serves 80 percent of TNI candidates who come in for medical examinations. This means they must be ready, present, and available to assist patients with their issues. Many patients have high expectations for the responsiveness of healthcare providers, including the readiness of medical equipment to be used, the ease with which the administrative process can be completed, and the ability of officers to respond quickly and assist patients who require immediate assistance. Patients' perceptions of the hospital will increase if the variable of responsiveness in delivering services is further enhanced by each member of the hospital's staff, which will be followed by a high degree of loyalty among specific patients to the institution.

Guarantee / Assurance by Utilizing Medical Check Up
Medical check-up patients' trust in the examination process and actions performed during medical check-ups is dependent on the hospital's capacity to offer competent and skilled health professionals on a timely basis, according to the hospital's assurance policy. Assurance from a doctor / assurance from a doctor is the knowledge, competence, and politeness of a doctor who can inspire trust and confidence in patients. Respondents (41.4 percent) said that they utilized health services/medical checkups effectively, whereas 34 respondents (58.6 percent) reported that they did not. Nine respondents (21.4 percent) said that they utilized health services/medical check-ups well, whereas 33 respondents (78.6 percent) reported that they did not. Of the 42 respondents whose insurance was not excellent, According to the results of the Chi Square Test statistical test, the p-value is 0.0360.05, indicating that the usage of medical check-ups at the Putri Hijau Level II Hospital is associated with a guarantee/assurance connection.
According to the findings of the study described above, one of the variables that affect the usage of medical check-ups in hospitals is the aspect of communication between parties. For example, when physicians, medical professionals, and administrative staff utilize effective communication techniques with their patients, patients are more likely to return to the same hospital for follow-up medical check-ups.

Empathy with the Utilization of Medical Check Up
To have empathy for a patient is to be able to comprehend what he or she is experiencing, to see things from the patient's perspective, and to put oneself in that patient's shoes (Sinclair et al., 2017). Empathy is associated with the capacity of health professionals to provide real attention to patients who are undergoing medical examinations. Qualitative health services are more efficient than quantity health services, according to the results of the study. They are health services that always strive to fulfill the expectations of patients and their families, ensuring that they are always satisfied with the services they get.
Patients will discover that their psychological and social requirements are not being fulfilled during a medical check-up as a result of the emotional approach used by hospital personnel, resulting in a more positive attitude about their illness. In medical check-ups, the primary emphasis should be not only on a basic medical check-up, but also on the ability of a health care provider to identify the patient's condition.

Tangibles (physical evidence) with the use of Medical Check Up
A tangible piece of evidence is that consumers are impressed by the physical look of a product or service and the appearance of services that can be immediately touched (Ali & Amin, 2014). All officials, including physicians and nurses, present themselves in a tidy, professional, and persuasive manner, according to protocol. Physical evidence regarding the attractiveness of the existing physical appearance that has an impact on the medical check-up room is clean, the water supply in the medical check-up toilet is adequate, and the equipment required to treat patients is readily available and in good working order, among other things.
According to the findings of a study conducted at the Putri Hijau Medan Level II Hospital on the relationship between physical evidence and the use of medical check-up, it was discovered that out of 100 respondents, it was known that from 23 respondents who were physically/tangibly well, 12 respondents (52.2 percent) used health services/medical check-up with good and 11 respondents (47.8 percent) did not use health services/medical check-up with good. Of the 77 respondents who reported that they were not physically or tangible well, 21 respondents (27.3 percent) said that they utilized health services/medical check-ups effectively, while 56 respondents (72.7 percent) reported that they did not. If we look at the p-value of the Chi Square statistical test, we can see that there is a physical/tangible connection between the usage of medical check-ups at the Putri Hijau Level II Hospital and the use of tobacco products.
According to the results of the study, the better the degree of physical infrastructure, the greater the likelihood that people would seek medical attention. If the physical facilities offered by the hospital, particularly in the medical check-up room, are better, it is one of the factors considered by the patient and his or her family when deciding whether or not to repeat medical check-ups at the hospital.

Rates using Medical Check
In order to deliver concrete results, it is necessary to identify whether or not the patient is suffering from a condition. The rates and costs for medical check-ups have been established. It is necessary to decide in advance the service costs for each medical check-up before charges for medical check-up services may be established. In the case of the medical Check Up package service, it simply adapts to the examination rate that has been set by the head of the medical Check Up service in collaboration with the marketing and finance departments of the hospital.
It is known from 100 respondents that from 15 respondents who have affordable rates, 11 respondents (73.3 percent) use health services/medical check-ups with good quality and 4 respondents (26.7 percent) use health services/medical check-ups with poor quality, according to the findings of a study on the relationship between rates/prices and the utilization of medical check-ups at the Putri Hijau Hospital Level II in Medan. 22 respondents (25.9 percent) said that they utilized health services/medical check-ups well, while 63 respondents (74.1 percent) reported that they did not use health services/medical check-ups well. According to the results of the statistical test Chi Square Test, the p-value for the relationship between price rates and the use of medical check-ups at the Putri Hijau Level II Hospital was 0.0000.05, indicating that there is a relationship between price rates and the use of medical check-ups at the hospital.

Facilities with Utilization of Medical Check Up
Patients' decisions on which health-care services to get are influenced by the comprehensiveness of hospital facilities. When designing tactics to attract patients, hospitals must take into consideration the amenities available to them (Kotler, 2000).
Based on the findings of a study conducted at the Putri Hijau Hospital Level II in Medan to determine the connection between facilities and the usage of medical check-ups. In this survey of 100 respondents, it is known that among 29 respondents who have excellent facilities, 18 respondents (62.1 percent) utilize health services / medical check-ups well, and 11 respondents (37.9 percent) do not use health services / medical check-ups well. The Health Service/Medical Check Up was well used by 15 respondents (21.1 percent) of the 71 respondents who reported inadequate facilities, while 56 respondents (78.9 percent) reported poor utilization. According to the results of the Chi Square statistical test, the p-value is 0.000 0.05, indicating that there is a connection between the availability of medical check-ups and the use of such services at the Putri Hijau Level II Hospital.
According to the researcher's premise, the better the facilities, the greater the likelihood that people would use them for medical check-ups and procedures. It is one of the reasons why patients and their families choose to return to the hospital for medical check-ups if the hospital is providing more and more amenities, particularly in the medical check-up room, as more and more facilities are given by the hospital.

Patient Perception of Utilization of Medical Check Up
In the process of perception, the sensation or feeling that a person gets towards something via a systematic procedure is sorted and chosen in order to create an evaluation or interpretation of the situation.
On the basis of research into the connection between patient views and the usage of medical checkups at the Putri Hijau Hospital Level II in Medan, this paper is being written. is 0.039 0.05, indicating that there is a perceived connection between the use of medical checkups at the Putri Hijau Level II Hospital and the usage of medical check-ups elsewhere.

Quality of Service Facilities, Rates/prices, Patient Perception by Utilizing Medical Check Up
The findings of the multivariate analysis are shown in the table. Based on the data in Table  4.30. On the basis of the results of the multiple logistic regression test, the model was found to have a jointly significant value of 0.000 0.05, which indicates that the seven variables used as models in this study had a statistically significant relationship with the use of medical checkups at the Level II Hospital Putri Hijau in Medan.
This was determined by using logistic regression to conduct a multivariate analysis, and the results revealed that the OR value for the Facility variable was indicated by an OR value of 25,223, which means that respondents who had 25 times the opportunity to use Medical Check Up were more likely to do so, and thus it could be concluded from these findings that the factor that was most influential / dominant in the utilization of Medical Check Up was Facility Service q (Nguyen et al., 2018). To the researcher's understanding, Medical Check Up (MCU) is one of the top services at Putri Hijau Medan Level II Hospital, and it is essential to constantly maintain the quality of service (Reliability, Responsiveness, Guarantee, Empathy and Physical Evidence) The MCU unit has now been turned into a profit center, and as a result, many of the physical looks of the units now resemble hotels, with a focus on providing high service quality in the expectation that the desires and requirements of patients are fulfilled.

Conclusion
There is a relationship between the use of medical check-up services at the Level II Hospital Putri Hijau Medan and the factors of reliability, responsiveness, assurance, empathy, and physical evidence) facilities, tariffs / prices, patient perceptions, and physical evidence.

Thank-You Note
Thanks to the enumerators for their assistance and support, as well as to the director of the Level II Putri Hijau Hospital in Medan for granting permission to conduct the study there.