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56
DOI 10.18551/rjoas.2019-12.02 HOSPITAL MEDICAL TOURISM BUSINESS STRATEGY IN GOVERNMENT HOSPITAL
Juniari Ni Putu*, Suryanatha I Gusti Ngurah Putra
Undiknas Graduate School, Bali, Indonesia *E-mail: ¡uniariputu9@yahoo.com
ABSTRACT
Innovation in providing services is one way to develop a hospital. Hospitals must be able to adapt to the industrial era 4.0. Medical tourism hospital is one of the ways hospitals as an innovation and development of hospitals by providing services to tourists. The aim of this study to analyze the internal and external factors of the Bali Mandara Hospital and develop a business strategy for medial tourism hospitals. This study uses a qualitative approach through observation and in-depth interviews and is formulated by the TOWS matrix. The results of this research business strategy can be developed with several things that must be prepared as well as some recommendations as a reference in carrying out the strategy of medical tourism hospital.
KEY WORDS
Medical tourism, hospital inovation, competitive advantage, public service.
The existence of hospital services in a place as a place to provide health services includes preventive, promotive, curative and rehabilitative services. Hospital services in each country have a different system. Each hospital has superior services that are able to compete with other hospitals. Tourism has experienced several trends such as continuous expansion and diversification, becoming one of the biggest and fastest growing economic sectors supporting the world. Many new destinations have emerged, which provide challenges for "traditional" destinations that have existed so far such as Europe and North America. Despite several shocks, international tourist arrivals have shown almost uninterrupted growth - from 277 million in 1980-528 million in 1995, and 983 million in 2011. Under the UNWTO, the number of international tourist arrivals worldwide is expected to increase by 3.3% per year on average from 2010 to 2030. This 3.3% figure represents around 43 million more international tourist visits each year, reaching a total of 1.8 billion international tourist arrivals in 2030 (UNWTO High Lights, 2012: p. 2).
Medical and health tourism is an activity carried out by an individual to obtain a health service or medical treatment abroad, the costs used by tourists in these activities are directly incurred from the cost of tourists or out of pocket. There are several factors that influence tourists to conduct medical and health tourism activities, namely access to overseas services, inadequate access at home in tourist areas, and waiting times for medical treatment (Crooks et al. 2012). This research is intended to conduct an academic study on the potential of the Bali Mandara General Hospital in developing medical and health tourism by using TOWS analysis and pouring it in purposive sampling so that it can better assess its strategy about the potential of hospitals in medical and health tourism. The final results of this study are intended to get a picture of the potential and provide direction recommendations to management and stakeholders related to Bali Mandara Hospital.
LITERATURE REVIEW
Robbin and Mary Coulter (2004: 174) in the journal Rusniati & Ahsanul Haq (2014) state that planning includes defining organizational goals, establishing overall strategies to achieve those objectives, and compiling a comprehensive set of plans to integrate and coordinate the work of the organization. Planning regarding outcomes ( what needs to be done) and goals (how to do it).
According to Siagian (2008: 15) stated in the journal Rusniati & Ahsanul Haq (2014) the term strategy originally originated from the military and is often expressed popularly as a tool used by generals to win a war. Then today the term strategy has been used by all types of organizations and the main ideas contained in the original sense are retained only the application is adjusted to the type of organization that applies it.
Competitive advantage is located in features and resources that are difficult for competitors to imitate (Iskandar, 2008) Competitive advantage is the ability obtained from the characteristics and resources of a company to have a higher performance than other companies in the same industry or market.
The term tourism in medical tourism refers to tourism activities. The term tourism in Law No. 10 of 2009 concerning Tourism is stated as a tourism activity and is supported by various facilities and services provided by the community of entrepreneurs, the government and the regional government. In the law also explained about tourism or tourism activities are all activities related to tourism and are multidimensional and multidisciplinary in nature that emerge as a manifestation of the needs of each person and country as well as interactions between tourists and the local community, fellow tourists, government, local government, and businessman.
Smith and Pucko (2009) state that health and wellness tourism can be developed based on materials that are already available at a destination (existing assets for health and wellness tourism) and or are held based on needs or requests (use of existing assets).
Figure 1 - Research Framework
In the development of a medical tourism, it involves several components in it. The component according to Rosalina (2015) includes the government, private sector / university / academic industry players and the tourism component itself. In the course of these four components, they have interdependence with each other and have their respective roles in medical tourism activities as a development target. For example, the hospital which is a home for experts or implementers of health services or consultants is very instrumental in the development of medical tourism or medical tourism.
METHODS OF RESEARCH
The research design uses qualitative analysis from both primary and secondary data that will follow the process of developing a strategic plan for Bali Mandara General Hospital as outlined in the Thought Framework. Primary data were obtained through direct interviews with informants who were competent in providing information on research subjects, namely those who were in the managerial structure of Bali Mandara General Hospital. Secondary data relating to the Bali Mandara Hospital was obtained from reports on the operational activities of the Bali Mandara Hospital, both medical and non-medical in nature, while other secondary data were obtained from government agencies such as the Health Office and the local Statistics Agency, and other sources of information available. Annual data collected in the form of current data to the initial operational data backward. The study was conducted at Bali Mandara General Hospital, located on Jl. By pass Ngurah Rai Sanur, Denpasar City, Bali Province.
In the external analysis external factors or factors outside the Bali Mandara Hospital are examined that can affect the achievement of the goals of the Bali Mandara Hospital.
These factors will be grouped into opportunities and threats faced by Bali Mandara Hospital. External factors analyzed include: government regulations, medical tourism agents, and competitior medical tourism. Each of these external factors is developed into variables which are then used as a basis in the assessment of the TOWS matrix which is then evaluated by the EFAS matrix analysis.
Internal factors are factors in the environment of Bali Mandara Hospital which are used in internal analysis which can be a strength or weakness for achieving the goals of Bali Mandara Hospital Internal factors that are analyzed include infrastructure, organizational management, human resources, finance, marketing and service products. Each of these internal factors is developed into several variables which are grouped into strengths and weaknesses to be used as a basis for positioning assessments on the TOWS matrix which are then evaluated by IFAS matrix analysis. Qualitative data collection techniques in this study were carried out through observation, in-depth interviews, and documentation methods. In processing the data, the analysis uses the TOWS and IF matrix with a matching process so that the strategies used in implementing medical tourism hospitals are obtained.
RESULTS AND DISCUSSION
Bali Mandara Regional General Hospital of Bali Province is one of the hospitals owned by the Government of the Province of Bali whose construction planning has started in 2012 and in 2016 the physical building has been established based on a Building Permit Letter (IMB) from the Government Investment PPTSP Board Denpasar City with Number: 02/1103 / DS / BPPTSP & PM / 2013, dated July 22, 2013 with the budget coming from the Bali Province Regional Budget.
In the era of the leadership of Bali Governor Made Mangku Pastika with the work program of BALI MANDARA, the first public hospital owned by the provincial government of Bali was built. Through a long process the building was completed at the end of 2016. In early January 2017 based on Pergub (Governor's Law) No. 155 of 2017 dated 28 December 2016 concerning the Establishment of the Organizational Structure and Work Procedure of the Mandala UPT Hospital, the Hospital was only managed by 28 people with the Director of PLT Dr. Bagus Darmayasa, M. Repro. Bali Mandara Hospital was established with the aim of bringing health service access closer to the Balinese Community and Tourists visiting Bali with four (four) basic specialist services, namely: Surgical Services, Obstetrics and Gynecology Services, Child Health Services and Internal Medicine Services, plus with Skin and Venereal Service, ENT Service, Oral Dental Service, Eye Disease Service, Operating Room Service (six Operating Rooms with MOT and C-Arm), Medical Rehabilitation Service, Radiology Service (CT scan, Slide, RO, Fluoroscopy, Mammography, 4 Dimensional Ultrasound), Laboratory Services (Clinical, Anatomical Pathology) with Supporting Services include: Pneumatic (Fast delivery of blood samples and results through pneumatic tubes from all floors to the laboratory section), Nutrition Installation, CSSD and Central Medical Gas. The Vision of the Technical Implementation Unit of the Bali Mandara Regional Hospital of the Province of Bali, namely: "Become a high quality hospital by providing service, education, and research towards a world-class standard by 2025".
This research uses situation analysis with TOWS analysis method which will examine external and internal health data to determine the position of Bali Mandara Regional General Hospital. Situation analysis for external data uses Tourism Agent data through tourism providers in the study location. For some data taken from the Health Office which is the official data released by each government agency in the last 3 years. While internal health data uses data from Bali Mandara Hospital for the last 2 years operating.
The Bali Provincial Government's efforts to improve health services to the community continue. This makes some of these regulations become influential today for Bali Mandara Hospital. These regulations are health related regulations, one of which contains development efforts based on health insight in the sense of national development must pay attention to public health and is the responsibility of all parties both the Government and the community.
In this case based on a memorandum of understanding between the Ministry of Health and the Ministry of Tourism Number 412 / Menkes / SKB / XI / 2012 and Number NK / 30 / PW.202 / MPEK / 2012 on Health Tourism followed by a cooperation agreement between the Ministry of Health and the Ministry of Tourism Number HK.0.01.01 / IV / 2495/2013 and PK 11 / K8.001 / Secretary General / KPEK / 2013 on the Development of Health Tourism, stipulating that Medical Tourism is part of Health Tourism. In the implementation of hospital services, of course we need an innovation or idea of another hospital product than others. So that in running the service wheels there are special characteristics of executive services in Bali Mandara Hospital. One of them is developing medical tourism to see the strategic location of the hospital and reach all elements.
Hospital service product development must be innovative and beneficial for many people. In the course of the hospital needs to evaluate the hospital services that need to be added. For example the existence of medical tourism see a good and good tourism trend so that medical tourism can be developed. The inhabitants of developed countries choose not to carry out the health care offered in their countries and travel to developing countries in the world to receive various medical services. This phenomenon develops driven by market desires and occurs outside the health system's control. The development of medical tourism services if the promotion arrangements are not complicated by complicated regulations, so that the idea developers are able and easy to do things such as promotions, collaborating with various parties and many others. The development of medical tourism is arguably difficult and difficult, because there are many things that need to be improved to support the running of this program properly.
In the case of an internal environmental analysis of a business entity or company is a useful analysis in identifying strengths and weaknesses on the basis of its resources and capabilities. This analysis looks at the internal hospital to support the medical tourism hospital strategy that will be developed. The internal analysis covers infrastructure, organizational management, human resources, finance, marketing and service products. Operationally financial management at the Hospital must be able to produce data, information and instructions to assist the hospital leadership in planning, controlling and overseeing all activities so that the quality of service can be maintained / improved at a reasonable level of financing. In the case of the desire to run a medical tourism business in the hospital, it is necessary to do a special budget planning in an effort to maximize the business that will be carried out. the amount that will enter or the income obtained. In determining tariffs, discussions with many parties are also needed.
In terms of marketing outside of collaborative visits, various promotions have also been carried out through mass media, social media, advertising media, some humanitarian activities as a marketing effort and hospital approach to the outside community. Provision of information through the official website of the hospital and the official website of the Provincial Health Office of Bali. Development of a network of health services and active in the National Webinar Activity (Web Seminar). Bali Mandara Hospital also participated in the exhibition in an effort to promote and carry out online hospital registration activities as a form of promotion that is digitalizing.
After the translation process of the EFAS and IFAS matrices is obtained, the score is 3.00 for Internal factors and 2.85 for internal factors. Then the position in the IE matrix Bali Mandara hospital is in division IV which is described as a position of grow and build or grow and develop. The intensive strategy of market penetration, market development, and product development or it can also be used interactively can be most appropriate for this division. The position of Bali Mandara Hospital in the TOWS matrix is in quadrant II. Although there are several threats and weaknesses in the implementation of this strategy, the opportunities obtained are quite good and the strengths within the hospital can not be ignored either. In this case the alternatives used are related diversification, related vertical integration, market development, product development, retrenchment, and enhancement. From the positioning obtained based on the TOWS and IE matrix, alternative strategies can be determined through the matching process of the two matrices as shown in the table 1.
Table 1 - Matrix Matching Process
Method Quadrant Alternative Strategies
TOWS Matrix Quadrant II (Internal Fix it Quadrant) - Related diversification - Related Vertical Integration - Market Development - Product Development - Retrenchment - Enhancement
IE Matriks Division IV (Grow and Build) - Market Penetration - Product Development - Market Development - Integrative Strategy
Source: Researcher Processed Data, 2019.
According to David (2016) product development for existing markets can occur in a number of ways namely enhancements in product features, expansion of product lines, development of new technologies, development of new products for existing markets.
The implementation of medical tourism hospital in Indonesia has not run optimally. The existence of regulations and laws that govern this strategy make the hospital officials evaluate this business strategy. Not all provinces or regions are able to implement international-based services. Medial tourism hospitals are usually run in tourism areas such as Bali. Because the number of tourist visits which increases every year. Medical tourism hospital is expected to be able to answer the world's challenges to Indonesia in conducting innovations in the health sector. Implementing this service system requires careful preparation. Provision of competent human resources who are able to compete with foreign workers because this human resource will become the axis in undergoing the wheels of this service. Full service is needed to attract tourists to use this service system. Excellent infrastructure and sophisticated equipment is one of the absolute things that needs to be prepared. In addition, government regulations in providing a legal basis, permits and legal laws are needed as a guideline for hospitals in this service in order to avoid undesirable things such as international demands and the severance of cooperation relations between countries.
In carrying out the medical tourism strategy in Bali Mandara Hospital which is more curative or treatment while health tourism is more rehabilitative and preventive. Medical tourism is more focused on "surgical procedures" or operating procedures. This activity can be carried out if all the supporting factors of the hospital in collaborating and really preparing everything and supporting this activity. When viewed from internal factors, lack of education or training on medical tourism in health workers in hospitals becomes a weakness and is expected to be overcome by conducting research.
Hospitals in the organization of medical tourism services can develop various strategies to develop and improve the quality of their services. One popular strategy is to develop superior services that can be promoted to attract patients from abroad. When viewed from internal and external factors studied, the lack of promotion regarding the existence of hospitals in addition to the complexity of advertising regulations of a hospital in Indonesia is a challenge for all health service agencies in promoting hospitals. Like Bali Mandara Hospital, it is necessary to increase promotion activities with several marketing strategies so that the purpose of organizing medical tourism is to run well. Medical tourism at the Bali Mandara Regional General Hospital can develop with the support of a strong government commitment to improve the management system, the promotion of hospitals, sustainable human resource training facilitated, tourism management capabilities, modern health facility infrastructure, and the existence of a sharp vision for the stakeholders that Bali in particular the Regional General Hospital can become a world health tourism destination. It is hoped that this will even be able to generate foreign exchange that might replace other sectors.
SUGGESTIONS
Based on the research objectives to Analyze and explore at Bali Mandara Regional General Hospital in developing medical tourism hospital based on internal and external potentials owned, the results of this study produce several conclusions. The external environment in the surroundings of Bali Mandara Hospital which is a threat to Bali Mandara Hospital includes competing hospitals providing medical tourism based services as well as an opportunity for Bali Mandara Hospital to develop medical tourism based hospitals in Bali. While the external environment which is an opportunity is the government regulation regarding medical tourism and medical tourism agents. The internal environment in Bali Mandara Hospital which is a weakness that must be anticipated includes Human Resources and Marketing. While the internal environment which is a strength includes infrastructure and financial costs. Current infrastructure and adequate and economical tariffs make this service can be developed and able to compete with other competitors.
Based on the TOWS analysis conducted on the internal and external factors of the Bali Mandara Hospital and the matching process carried out from the results of the mapping on the TOWS matrix and the IE matrix, the Bali Mandara Regional Hospital is in the Internal Fix-it and Grow and Built positions, with strategies to be developed are product development or market development or market development. The potential of the Bali Mandara Regional General Hospital as the only government hospital owned by the Province of Bali in developing the medical tourism business strategy is very large. In the hospital's vision "To Become A Quality Hospital By Promoting Services, Education And Research Towards A World-Class Hospital In 2025". In the vision of the hospital, it has been explained and used as a basic framework for all aspects of the development of the medical tourism industry. In addition, with the opening of the government with the outside world along with a number of international meetings held as a venue to appear and be ready to compete with other countries as competitors for medical tourism-based hospitals. The combination of internal and external factors in the hospital environment, becomes a strong foundation and hospitable services in the step of realizing an international hospital so that the hospital is able to become a hospital that is able to respond to global challenges and respect both the Balinese community and the outside community country and be able to contribute income to the state.
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