External Factor Analysis in the Development of Health Services at Bungur Medika Hospital

ABSTRACT


INTRODUCTION
Improving health services in hospitals is a demand that must be met in order to provide quality services for the community (Budo et al., 2020).However, the challenges faced in the development of health services in hospitals are not only limited to internal factors, but also external factors that can affect the performance and effectiveness of hospitals in providing health services (Piyajeng &;Wibowo, 2017).
Analysis of external factors that affect the development of health services in hospitals is important to do in order to understand the factors that can affect the performance and effectiveness of hospitals in providing optimal health services (Panggabean, 2020).External factors that are the focus of this analysis include social, political, economic, and technological factors that can affect the development of health services in hospitals (Karmawan, 2018).
In this journal, we will discuss the analysis of external factors that influence the development of health services in hospitals with the aim of providing a more comprehensive understanding of the factors that can affect the performance and effectiveness of hospitals in providing optimal health services.There are several previous studies that have been conducted to analyze external factors that influence the development of health services in hospitals, including.
To analyze external factors affecting the development of health services in hospitals in Indonesia.This study uses the SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis method to identify external factors that affect the development of health services in hospitals (Nugraheni &;Kirana, 2021).
Next to analyze external factors that affect the performance of hospitals in Indonesia.This study uses the method of analyzing external factors using the PESTEL (Political, Economic, Social, Technological, Environmental, and Legal) approach to identify external factors that affect the performance of hospitals in Indonesia (Irawan &;Ainy, 2018).
To analyze external factors that affect the performance of hospitals in Indonesia.This study uses the method of analyzing external factors using the PEST approach to identify external factors that affect hospital performance in Indonesia (Septiana, 2017).
From the results of the study, it was found that external factors that affect the development of health services in hospitals include social, political, economic, and technological factors.These factors can affect the performance and effectiveness of hospitals in providing optimal health services, so it needs to be considered in the development of health services in hospitals.Therefore, based on this background, this study aims to analyze external factors in Health Service Development at Bungur Medika Hospital.

METHODS
In this study, the author uses qualitative analysis (Creswell &;Creswell, 2017), namely analysis carried out on data, written descriptions, and verbal descriptions then connected with data, written descriptions, and other verbal descriptions to gain clarity about the truth or vice versa so that new perspectives are obtained or strengthen existing opinions (Basias &;Pollalis, 2018) .This research is included in descriptive research because this study intends to describe an event, namely human resource planning at Bungur Medika Hospital with the development of hospital services as an effort to improve employee performance.The approach in this study uses an interdisciplinary approach.

Competitive Force (Porter's 5 Forces)
Porter's found that there are five competitive forces that need to be analyzed in each industry in developing strategies, namely Threat of New Entrants, Threat of Substitute, Bargaining Power of Suppliers, Bargaining Power of Buyers and Rivalry Among Existing Firms (Wijiharjono, 2021).
When conducting Porter's Five Forces analysis , hospitals weighted and indexed all five competitive forces on the basis of these pressures.Here are the quantitative weighting steps in Porter's Five Forces analysis : 1. Determine the index value for each factor of each competing force.Each factor in determining the index value is divided into index 1 = low / insignificant level of influence, 2 = significant level of influence, 3 = very significant.2. Determining the weight of each factor based on justification for the value that most affects the competitive power, the sum of the weighting results must be 1, where the value of 0 is the value that least affects the competitive power.Justification of weighting based on the results of group analysis.3. Multiplies the weight of each factor by the index, then sums and infers the value based on a predetermined range.The data assessment ranges are as follows: If the results of quantitative calculations of Porter's Five Forces analysis are in the range of 1.00 -1.66, it can be categorized as low where the company is in a competition that is not too competitive.Meanwhile, if the quantitative results produce results in the range of 1.67 -2.33, it is categorized as medium, the company is in a fairly intense competition.Quantitative results that are in the range of 2.34 -3.00 are categorized as high parameters which means the company is in an industry that has a high level of competition and is very competitive.

Threat of New Entrants 2.1.1 Capital Requirements (Weighting 0.3 and Index 1)
Capital requirements in the establishment of a hospital require a large cost budget, this is because strategic land is needed with an area that is not small, besides that the cost needs for the procurement of medical equipment infrastructure, as well as human resource costs also require a high budget, large capital is needed for the establishment of a hospital.So because of this, the threat to newcomers gets a weight of 0.3 with Index 1.

Product Deferentiation (Weight 0.3 and Index 3)
In product differentiation in the hospital business, between one hospital and another hospital does not have a significant difference.To distinguish it from other hospitals, our hospital prioritizes services by utilizing the BPJS Health guarantee facility which is a government program, with no cost, supported by the ease and speed of service utilizing the digitization of the hospital management information system.In the product differentiation section, hospitals with totality in BPJS Health services are not much, because INA CBGs financing is low in paying for the services provided, so in this case it gets a weighting of 0.3 with index 3.

Access to Distribution (Weighting 0.4 and Index 2)
The hospital is a business entity in the field of health services needed by the community, so access to reach consumers in this case patients is very open (Prana, 2013).This hospital utilizes BPJS Health financing guarantees owned by almost all communities, so that community Journal of Social ScienceVol.04, No. 02, March 2023 reach to access health services becomes easy (Widiastuti, 2017).In this section we give a weight of 0.4 with an index of 2.0

Industry rivalry 2.2.1 Diversity of Competitors (Weighting 0.3 and Index 3)
The availability of hospital services in the Central Jakarta area with a variety of services and types of hospitals, gives consumers many choices and increases competition in the health industry.From various types of hospitals in the Central Jakarta area, all types of hospitals are available from type A to type D. This increases competition in the hospital industry.The community can choose a hospital according to their financing ability.Thus, we conclude the weight for Diversity of Competitors is 0.3 with index 3.

Concentration (Weight 0.3 and Index 1)
The concentration here is the number of hospitals competing in a type of service and a similar industry.The number of hospitals in the type C hospital industry in the Central Jakarta area is still relatively small because there are only 4 type C hospitals and 3 special hospitals in the Central Jakarta area with the population in the Central Jakarta area based on the results of the population census in 2020 amounting to 1,056,896 people.Competitors of 4 type C hospitals and 3 special hospitals in the Central Jakarta area: RS.General Mother, General Hospital Menteng Mitra Afia, General Hospital Pertamina Jaya, General Hospital Budi Glory, Special Hospital for Aesthetic Development Surgery, Pond Mother and Child Hospital and Special Hospital for Salemba Satu Surgery.Thus the weight we give is 0.3 with index 1.

Barrier to Exit (Weight 0.3 and Index 1)
In a business, it is very possible if a company has low revenue so that it loses to its competitors but still chooses to survive because it has a strategy (Ritonga, 2020).Because of this, there is an analysis to describe the hospital strategy that will be made in the face of any obstacles and consequences if exiting this business.Based on the analysis conducted, high capital in the hospital business is one of the reasons for not easily exiting this business.With high capital, especially for land, infrastructure, and human resources, so we can conclude the weight given is 0.3 with Index 1.

Bargaining Power of Buyer 2.3.1 Price Sensitivity (Weighting 0.4 and Index 3)
Currently, with government policy in the health sector by organizing the National Health Insurance, people can easily access health services by using BPJS Kesehatan financing guarantees (Adiyanta, 2020).People without being able to seek treatment without being charged, provided that they have a BPJS Health card that can be obtained independently or through a contribution mechanism borne by the government.Cost is no longer an obstacle for people to obtain health services.So we give a weight of 0.4 with index 3.

Buyers Information (Weighting 0.2 and Index 3)
The ease of obtaining information in today's digital era makes it easier for people to obtain information on health services of a hospital very easily (Putra, 2019).The registration process and queue can be trimmed to make it easier for the community.The hospital built will prioritize a digitalization system to support the community to obtain facilities in hospitalization.For this reason, a weight of 0.2 with index 3 is given.

Switching Cost (Weight 0.2 and index 2)
The cost of transfer by patients who switch to other hospitals, especially those who do not use BPJS Health guarantees, will result in a considerable increase in costs for patients.Patients will try to be able to seek treatment by using BPJS Health insurance as long as the quality of service at the hospital can be maintained.Then the weight given is 0.2 with index 2.

Bargaining Power of Supplier 2.4.1 Number of Suppliers (Weight 0.4 and Index 2)
Suppliers to hospitals determine the availability of materials used to provide health services for patients.In this case, the need for consumables, pharmaceutical supplies, and supplies of medical devices determine the continuity of the service process.In Indonesia, the availability of suppliers of the three things mentioned above is very sufficient, many vendors of consumables, pharmaceutical supplies, and medical devices.This makes it easier for hospitals to obtain materials that are the basic material for health services.Then the weight given is 0.4 with index 2. 2.4.2Supplier Pricing (0.4 Weighting and Index 2) The pricing of pharmaceutical drugs and consumables needed by hospitals in providing services is regulated by the government through the e-catalog process and the highest retail price mechanism, so that prices can be controlled properly and not based on market prices (Indayanti, 2021).Different things are found in the prices of medical devices which are relatively higher than the prices of medical devices in other countries.The availability and prices that have been set by the government provide good opportunities for the hospital industry, especially for hospitals that prioritize the use of generic products, especially those that accept BPJS Health patients.

Supplier Information (Weight 0.2 and Index 2)
To get profile information from suppliers related to health products needed by the hospitals they produce and the prices offered, companies can obtain this information through online media or also get it through information in the form of direct offers from suppliers in Jakarta.In this case, the hospital easily gets information related to suppliers, then the weight given is 0.2 with an index of 2.

Subtitute Competition 2.5.1 Buyers Propensity to Substitute (Weight 0.4 and Index 2)
Hospital services are currently facing challenges through health services that can be accessed through online media .Currently, the era of technology makes it easier for people to conduct health consultations, health consultation applications such as Halodoc, Alodokter, Klikdokter, Good Doctor and SehatQ have become a trend in people's lifestyles to get ease of service (Ayu et al., 2022).Technological advances have caused the tendency to choose substitute services to be high.Although it cannot replace the function of the hospital as a whole, the availability of this service can be a competitor in outpatient services for a hospital.Replacement services are a threat to hospitals emerging from services based on digital technology.Online health services , online consultations , online drug delivery, pose a threat to hospitals although not completely.On the one hand, hospitals can also develop similar services.So we give a weight of 0.4 with index 2.

Relative Price (Weighting 0.2 and Index 2)
Hospital services that focus on the community of BPJS Health guarantee users will make hospitals the main choice in getting health services.The community is facilitated in meeting the needs in the health sector.So that many hospitals will switch to serving BPJS Health patients.Then it is given a weight of 0.2 with index 2.

Performance of Substitute (Weight 0.3 and Index 3)
In the early stages due to newly built and growing hospitals, performance needs to catch up with hospitals that have already been running.That way it is given a weight of 0.3 with an index of 3.
Based on the description above, the following is the conclusion of Porter's Five Forces Analysis : Based on the results of the discussion of the five competing forces listed above, it can be seen that the average weighting of the five competing forces is 1.96.From Porter's Five Forces analysis above, quantitative results in the range of 1.67 -2.33, based on these weightings, it can be concluded that the competitive strength of this industry is moderate.So it takes great competitive power to be able to enter this business or in other words the competition is quite intense.

PEST
External analysis uses PEST analysis which analyzes external factors, namely: political, economic, social and technological.Analysis of these factors greatly helps the company in testing the external environment and determining the right strategy for the company which is an opportunity and threat to the company.

Political analysis
Political conditions affect the plan to establish and operate the hospital through established government policies.These policies bring opportunities and threats to Bungur Medika Hospital.

Political Opportunity Analysis
1. National Medium-Term Development Plan Policy 2020-2024.The 2020-2024 RPJMN policy in realizing health indicators has a policy direction, namely increasing access and quality of health services towards universal health coverage with an emphasis on strengthening basic health services (Primary Health Care) and increasing promotive and preventive efforts supported by innovation and utilization of technology.Strategies to be implemented in the 2020-2024 RPJMN include: improving maternal, child, and reproductive health; acceleration of improving community nutrition, improving disease control, strengthening the Healthy Living Community Movement (GERMAS) and improving health services and drug and food supervision.The 2020-2024 RPJMN policy provides opportunities for health facilities to continue to progress and develop, including providing opportunities for Bungur Medika Hospital.

Indonesia's commitment to achieving Universal Health Coverage is an opportunity for Bungur
Medika Hospital with the support of the government as a regulator to make policies that support easy access to comprehensive and quality health services without financial barriers.
The government focuses policy targets on the ease of public access to health services.Health development programs with the aim of improving health status through health efforts and community empowerment supported by equitable distribution of health services.3. Law No. 40 of 2004 concerning the National Social Security System which is the legal basis of all regulations related to the National Social Security System.This opens up opportunities for Bungur Medika Hospital to build a business with commercial purposes.Presidential Decree No.The increase in GDP of Central Jakarta City from year to year shows the economic ability of its people is getting better.This affects the purchasing power and access to basic human life facilities, including the health sector.This is a good opportunity for Bungur Medika Hospital to continue to grow by utilizing the potential of a good economic sector. 2. Economic growth of DKI Jakarta

Supply Chain Financing (SCF) Program
This SCF scheme is an opportunity for hospitals.Bungur Medika can maintain liquidity so that cash flow management is not disturbed and RS.Bungur Medika is able to provide the best service.Inflation is a threat to Bungur Medika Hospital, inflation occurs due to price increases indicated by the increase in most expenditure group indexes.The increase in production costs for drug manufacturing and education costs, operational costs and hospital maintenance will have an impact on health service services and the number of facilities and people's purchasing power.Based on the publication of the Ministry of Manpower, UMP in 2022 increased by an average of 1.09%.Every year there is an adjustment to the minimum wage that continues to increase.This is a threat to hospitals where operational costs are increasing but people's purchasing power is declining because the trend of salary increases is still below the increase in health cost prices.Therefore, the low inflation rate is a threat to Bungur Medika Hospital.

Analysis of
Table 9 Economic opportunities and threats

Economic Opportunities
Increasing economic growth of DKI Jakarta The ability of the purchasing power of the people of DKI Jakarta is high Economic Threats INACBGs Package Fare System Inflation rate that tends to be low

Social Analysis 2.3.3.1 Social Opportunity Analysis
Social opportunity analysis includes: 1.Large population.The large population in the Central Jakarta area is a good opportunity for the health business sector.This is also a good opportunity for Bungur Medika Hospital.Based on the age data of the population of Central Jakarta, it appears that the community is dominated by the young adult age group.The age group with the highest population is 30-34 years, then 25-29 years, and followed by 20-24 years.Life expectancy also looks long where there are still people who reach the age of 75 years.In addition, based on data displayed by BPJS in the book Central Jakarta In 2021 Figures, the coverage of education for people in Central Jakarta is high.Overall, only 4% of people do not have an education.
This shows the ease of the community in receiving information and understanding, especially about health.A good level of education in the community will be an opportunity for Journal of Social Science, Vol.04, No. 02, March 2023 businesses in the health sector, especially hospitals.Public awareness of the importance of health is supported by knowledge motivated by formal education owned by the community.This is an opportunity for the implementation of hospitals, with the number of productive age that dominates the community and the long life expectancy shows the need for quality health services, with the target of productive age that is still actively regenerating.In addition, the longevity rate needs to be a concern to see the characteristics of degenerative diseases that increase with the age of the population.There are still poor people, of course, poor people need free health services and do not discriminate against every patient with the same quality standards.This can be an opportunity for hospital business.

Social Threat Analysis
Social threat analysis includes: 1. Existence of Health Facilities Based on the data below, there are 26 hospitals, 7 Special Hospitals, 3 Maternity Hospitals, and 42 Puskesmas in the Central Jakarta area.The existence of this health facility both at the first and advanced levels can be a competitor for the hospital to be built.Especially there are 5 hospitals in the Senen area according to the location where the hospital will be built.According to the Age Group and Education Level of the people of Central Jakarta at school age is quite good.This shows that people have the ability to capture information and have a good understanding of health.A good level of education makes people have high expectations or standards for health services.This is a threat to the hospital's business if it cannot maintain the quality of service consistently.People will easily leave the hospital and switch to another hospital that provides better services.including electronic medical records bridging with BPJS.This SIMRS was created to integrate all health service business processes at Bungur Medika Hospital into one coordination network that connects reporting and administrative procedures to be able to access information quickly and accurately.SIMRS is in the form of an open source web so that development can be carried out to improve future improvements.In addition, this SIMRS will also be integrated with BPJS, INA CBGs in accordance with hospital accreditation commission standards.This will be an opportunity for hospitals to provide solutions in improving service quality, especially those related to patient waiting times.2. Based on data from the 2020 DKI Jakarta Provincial Sectoral Statistics Portal, as many as 84.32% of DKI Jakarta residents have used Information Communication Technology devices in the form of mobile phones or computers, while 73.46% have accessed the internet.This can be an opportunity in hospital development by prioritizing digitalization of telecommunications information technology.The flow of communication with the community who will become patients can become easier.Hospitals are expected to develop applications that make it easier for patients, such as the registration process, public health data, and remote health services.

Technology Threats
1. Based on data from the 2019 DKI Jakarta Technology, Information, Communication and Internet usage survey, it appears that 76.09% of people use social media.This can be a threat to hospitals, because if there is dissatisfaction in the community, people are very easy to upload their complaints on social media, regardless of the truth of the news.hospitals.This will certainly burden new hospitals that have just started their operations.Social media that is increasingly used by many people The development of medical technology demands high costs.

External Factor Evaluation (EFE)
The External Factor Evaluation (EFE) matrix is an external matrix that shows how effective the company's strategy is in responding to existing opportunities and threats.This analysis must also pay attention to several things such as: competitors , changes in demand, changes in technology, economic changes, demographic shifts and also government policies that can hinder the achievement of company goals.

CONCLUSION
Based on the results of the study, it can be concluded that there are several external factors that affect the development of health services at Bungur Medika Hospital, namely social, political, economic, and technological factors.The social factor that influences is the community's need for quality and affordable health services.Influencing political factors are government

Figure 4
Figure 4 Comparison of DKI Jakarta and National economic growth Economic Challenges 1.The cost system of BPJS that uses the package system (INA CBG's) is a threat to hospitals, this is because INA CBG's tariff standards are still low.Rates based on the class or category of RS and not based on the severity of the disease are considered less relevant.In this case, the change from BPJS rates differ between Class A/B/C/D Hospitals.2. Inflation Rate Journal of Social ScienceVol.04, No. 02, March 2023

Figure 7
Figure 7 Population by District and Gender (Source: Central Bureau of Statistics)

Figure 8 Figure 9
Figure 8 Number of Population by Age Group and Gender, 2020

Figure 12
Figure 12 Experience of Community Activities While Using the Internet

3
Increasing economic growth of DKI Jakarta 4 The ability of the purchasing power of the people of DKI Jakarta is facilities in the Central Jakarta area 6 Higher education level, influencing society's demands for quality services 7 Social media that is increasingly used by many people 8 The development of medical technology demands high costs

Table 2 .
Total Weight of Threat Value of New Entrants

Threat of New Entrants Weight Table of Contents Valu e
Table 3 Total Weight of Industry Rivalry Value Table 6 Total Weights of Substitute Competition Values

Table 10
Bungur Medika will use SIMRS which integrates Front Office and Back Office modules