Integrated marketing strategy for insured outpatient care at a municipal hospital
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Published:
Aug 30, 2026
Keywords:
Digital Marketing, Hospital Management, National Health Insurance, Outpatient Services, Strategic Planning
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Economy
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Abstract
Background: Evidence is limited on how municipal hospital management can integrate National Health Insurance demand signals, stakeholder experience, the services marketing mix, digital marketing, and resource constraints into strategic planning for outpatient services. JKN-financed outpatient encounters decreased from 12,324 in 2021 to 11,364 in 2022 (?960; ?7.79%), although total outpatient encounters increased from 18,760 to 19,445; counts represent encounters rather than unique patients. Objective: To develop an evidence-linked marketing strategy for JKN outpatient services at a municipal hospital. Methods: This qualitative single-case study integrated hospital documents, 2020–2022 administrative data, interviews, observations, and a focus group using a framework matrix, the seven-part services marketing mix, and weighted SWOT/TOWS analysis. The sample comprised 15 unique participants: three managers and 12 adult JKN outpatients. Results: Accreditation, competent personnel, location, and JKN eligibility were strategic assets. Referral complexity, restricted hours, parking, registration, pharmacy flow, fragmented information systems, and limited digital communication constrained access. Findings supported positioning based on dependable, inclusive care; phased service, referral, and digital initiatives are author-generated proposals requiring prospective evaluation. Conclusion: The study contributes an integrated planning framework but cannot attribute the observed decline to marketing. Future multicentre longitudinal studies should evaluate clinic-level demand, patient experience, waiting times, reimbursement, and incremental costs
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Tanumiharja, L. J. S., Juju, H. U. J. and Setiawati, T. . (2026) “Integrated marketing strategy for insured outpatient care at a municipal hospital”, Jurnal Mantik, 10(2), pp. 605-614. doi: 10.35335/mantik.v10i2.7390.
References
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Chalkley, M., Hidayat, B., Ramadani, R. V., & Aragón, M. J. (2022). The sensitivity of hospital coding to prices: Evidence from Indonesia. International Journal of Health Economics and Management, 22(2), 147-162. https://doi.org/10.1007/s10754-021-09312-7
Chen, J., & Wang, Y. (2021). Social media use for health purposes: Systematic review. Journal of Medical Internet Research, 23(5), e17917. https://doi.org/10.2196/17917
Cheng, Q., Fattah, R. A., Susilo, D., Satrya, A., Haemmerli, M., Kosen, S., Novitasari, D., Puteri, G. C., Adawiyah, E., Hayen, A., Mills, A., Tangcharoensathien, V., Jan, S., Thabrany, H., Asante, A., & Wiseman, V. (2025). Determinants of healthcare utilization under the Indonesian national health insurance system: A cross-sectional study. BMC Health Services Research, 25(1), Article 48. https://doi.org/10.1186/s12913-024-11951-8
Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743-1748. https://doi.org/10.1001/jama.1988.03410120089033
Farsi, D. (2021). Social media and health care, part I: Literature review of social media use by health care providers. Journal of Medical Internet Research, 23(4), e23205. https://doi.org/10.2196/23205
Fatimah, A., Anselmi, L., Gibson, J., Maharani, A., Irmansyah, I., Idaiani, S., Susilo, D., Wilkinson, J., Sutton, M., Susanti, H., Brooks, H., Bee, P., & Thabrany, H. (2025). Indonesian National Health Insurance scheme longitudinal sample data 2015-2020: Overview and potential uses for health policy analysis. BMC Health Services Research, 25, Article 1593. https://doi.org/10.1186/s12913-025-13756-9
Fauziyyah, A. N., Shibanuma, A., Ong, K. I. C., & Jimba, M. (2024). What are the factors affecting primary care choice when access under a health insurance scheme is limited? A cross-sectional study in Bandung, Indonesia. BMC Primary Care, 25, Article 64. https://doi.org/10.1186/s12875-024-02296-6
Ferreira, D. C., Vieira, I., Pedro, M. I., Caldas, P., & Varela, M. (2023). Patient satisfaction with healthcare services and the techniques used for its assessment: A systematic literature review and a bibliometric analysis. Healthcare, 11(5), Article 639. https://doi.org/10.3390/healthcare11050639
Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13, Article 117. https://doi.org/10.1186/1471-2288-13-117
Galea, G., Chugh, R., & Luck, J. (2024). Why should we care about social media codes of conduct in healthcare organisations? A systematic literature review. Journal of Public Health, 32, 1205-1217. https://doi.org/10.1007/s10389-023-01894-5
Handayani, P. W., Dartanto, T., Moeis, F. R., Pinem, A. A., Azzahro, F., Hidayanto, A. N., Denny, & Ayuningtyas, D. (2021). The regional and referral compliance of online healthcare systems by Indonesia National Health Insurance Agency and health-seeking behavior in Indonesia. Heliyon, 7(9), e08068. https://doi.org/10.1016/j.heliyon.2021.e08068
Hennink, M., Hutter, I., & Bailey, A. (2020). Qualitative research methods (2nd ed.). SAGE.
Kruse, C., & Heinemann, K. (2022). Facilitators and barriers to the adoption of telemedicine during the first year of COVID-19: Systematic review. Journal of Medical Internet Research, 24(1), e31752. https://doi.org/10.2196/31752
Laksono, A. D., Megatsari, H., Senewe, F. P., Latifah, L., & Ashar, H. (2023a). Policy to expand hospital utilization in disadvantaged areas in Indonesia: Who should be the target? BMC Public Health, 23, Article 12. https://doi.org/10.1186/s12889-022-14656-x
Laksono, A. D., Wulandari, R. D., Rohmah, N., Rukmini, R., & Tumaji, T. (2023b). Regional disparities in hospital utilisation in Indonesia: A cross-sectional analysis of the 2018 Indonesian Basic Health Survey. BMJ Open, 13(1), e064532. https://doi.org/10.1136/bmjopen-2022-064532
Maulana, N., Soewondo, P., Adani, N., Limasalle, P., & Pattnaik, A. (2022). How Jaminan Kesehatan Nasional coverage influences out-of-pocket payments by vulnerable populations in Indonesia. PLOS Global Public Health, 2(7), e0000203. https://doi.org/10.1371/journal.pgph.0000203
Ministry of Home Affairs of the Republic of Indonesia. (2018). Regulation of the Minister of Home Affairs Number 79 of 2018 concerning Regional Public Service Agencies. https://peraturan.bpk.go.id/Details/111301/permendagri-no-79-tahun-2018
Nugroho, S. T., Ahsan, A., Kusuma, D., Adani, N., Irawaty, D. K., Amalia, N., & Hati, S. R. H. (2023). Income disparity and healthcare utilization: Lessons from Indonesia's National Health Insurance claim data. Asian Pacific Journal of Cancer Prevention, 24(10), 3397-3402. https://doi.org/10.31557/APJCP.2023.24.10.3397
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16, 1-13. https://doi.org/10.1177/1609406917733847
O'Connell, M., Hafidz, F., Saragih, S., Cashin, C., Nugroho, A., Hatt, L., Farianti, Y., Afflazier, A., & Pambudi, I. (2025). The influence of provider payment mechanisms on tuberculosis service provider behavior in Indonesia: Insights from National Health Insurance data and provider perspectives. Frontiers in Public Health, 13, Article 1396596. https://doi.org/10.3389/fpubh.2025.1396596
Oudbier, S. J., Souget-Ruff, S. P., Chen, B. S. J., Ziesemer, K. A., Meij, H. J., & Smets, E. M. A. (2024). Implementation barriers and facilitators of remote monitoring, remote consultation and digital care platforms through the eyes of healthcare professionals: A review of reviews. BMJ Open, 14(6), e075833. https://doi.org/10.1136/bmjopen-2023-075833
Ramadani, R. V., Svensson, M., Hassler, S., Hidayat, B., & Ng, N. (2024). Effects of the COVID-19 pandemic on healthcare utilization among older adults with cardiovascular diseases and multimorbidity in Indonesia: An interrupted time-series analysis. BMC Public Health, 24(1), Article 71. https://doi.org/10.1186/s12889-023-17568-6
Salampessy, B. H., Ikkersheim, D., Portrait, F. R. M., & Koolman, X. (2022). Do patients' preferences prevail in hospital selection? A comparison between discrete choice experiments and revealed hospital choice. BMC Health Services Research, 22, Article 1136. https://doi.org/10.1186/s12913-022-08403-6
Setiawan, E., Nurjannah, N., Komaryani, K., Nugraha, R. R., Thabrany, H., Purwaningrum, F., & Sarnianto, P. (2022). Utilization patterns of healthcare facility and estimated expenditure of PLHIV care under the Indonesian National Health Insurance Scheme in 2018. BMC Health Services Research, 22, Article 97. https://doi.org/10.1186/s12913-021-07434-9
Susilo, D., Lila, W. L. P., Sukmayeti, E., Asante, A., Jan, S., Thabrany, H., Tangcharoensathien, V., Wiseman, V., & Liverani, M. (2025). Can Indonesia achieve universal health coverage? Organisational and financing challenges in implementing the national health insurance system. SSM - Health Systems, 5, Article 100138. https://doi.org/10.1016/j.ssmhs.2025.100138
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349-357. https://doi.org/10.1093/intqhc/mzm042
World Health Organization. (2024). Does Indonesia's National Health Insurance Scheme mobile phone application, Mobile JKN, support health financing? https://www.who.int/publications/i/item/9789240100893
Wulandari, R. D., Laksono, A. D., Mubasyiroh, R., Rachmalina, R., Ipa, M., & Rohmah, N. (2023). Hospital utilization among urban poor in Indonesia in 2018: Is government-run insurance effective? BMC Public Health, 23(1), Article 92. https://doi.org/10.1186/s12889-023-15017-y
Zhang, H., Ma, W. M., Zhu, J. J., Wang, L., Guo, Z. J., & Chen, X. T. (2023). How to adjust the expected waiting time to improve patient satisfaction. BMC Health Services Research, 23, Article 455. https://doi.org/10.1186/s12913-023-09385-9
Zeithaml, V. A., Bitner, M. J., Gremler, D. D., & Mende, M. (2024). Services marketing: Integrating customer focus across the firm (8th ed.). McGraw Hill.
Benzaghta, M. A., Elwalda, A., Mousa, M. M., Erkan, I., & Rahman, M. (2021). SWOT analysis applications: An integrative literature review. Journal of Global Business Insights, 6(1), 55-73. https://doi.org/10.5038/2640-6489.6.1.1148
Chalkley, M., Hidayat, B., Ramadani, R. V., & Aragón, M. J. (2022). The sensitivity of hospital coding to prices: Evidence from Indonesia. International Journal of Health Economics and Management, 22(2), 147-162. https://doi.org/10.1007/s10754-021-09312-7
Chen, J., & Wang, Y. (2021). Social media use for health purposes: Systematic review. Journal of Medical Internet Research, 23(5), e17917. https://doi.org/10.2196/17917
Cheng, Q., Fattah, R. A., Susilo, D., Satrya, A., Haemmerli, M., Kosen, S., Novitasari, D., Puteri, G. C., Adawiyah, E., Hayen, A., Mills, A., Tangcharoensathien, V., Jan, S., Thabrany, H., Asante, A., & Wiseman, V. (2025). Determinants of healthcare utilization under the Indonesian national health insurance system: A cross-sectional study. BMC Health Services Research, 25(1), Article 48. https://doi.org/10.1186/s12913-024-11951-8
Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743-1748. https://doi.org/10.1001/jama.1988.03410120089033
Farsi, D. (2021). Social media and health care, part I: Literature review of social media use by health care providers. Journal of Medical Internet Research, 23(4), e23205. https://doi.org/10.2196/23205
Fatimah, A., Anselmi, L., Gibson, J., Maharani, A., Irmansyah, I., Idaiani, S., Susilo, D., Wilkinson, J., Sutton, M., Susanti, H., Brooks, H., Bee, P., & Thabrany, H. (2025). Indonesian National Health Insurance scheme longitudinal sample data 2015-2020: Overview and potential uses for health policy analysis. BMC Health Services Research, 25, Article 1593. https://doi.org/10.1186/s12913-025-13756-9
Fauziyyah, A. N., Shibanuma, A., Ong, K. I. C., & Jimba, M. (2024). What are the factors affecting primary care choice when access under a health insurance scheme is limited? A cross-sectional study in Bandung, Indonesia. BMC Primary Care, 25, Article 64. https://doi.org/10.1186/s12875-024-02296-6
Ferreira, D. C., Vieira, I., Pedro, M. I., Caldas, P., & Varela, M. (2023). Patient satisfaction with healthcare services and the techniques used for its assessment: A systematic literature review and a bibliometric analysis. Healthcare, 11(5), Article 639. https://doi.org/10.3390/healthcare11050639
Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13, Article 117. https://doi.org/10.1186/1471-2288-13-117
Galea, G., Chugh, R., & Luck, J. (2024). Why should we care about social media codes of conduct in healthcare organisations? A systematic literature review. Journal of Public Health, 32, 1205-1217. https://doi.org/10.1007/s10389-023-01894-5
Handayani, P. W., Dartanto, T., Moeis, F. R., Pinem, A. A., Azzahro, F., Hidayanto, A. N., Denny, & Ayuningtyas, D. (2021). The regional and referral compliance of online healthcare systems by Indonesia National Health Insurance Agency and health-seeking behavior in Indonesia. Heliyon, 7(9), e08068. https://doi.org/10.1016/j.heliyon.2021.e08068
Hennink, M., Hutter, I., & Bailey, A. (2020). Qualitative research methods (2nd ed.). SAGE.
Kruse, C., & Heinemann, K. (2022). Facilitators and barriers to the adoption of telemedicine during the first year of COVID-19: Systematic review. Journal of Medical Internet Research, 24(1), e31752. https://doi.org/10.2196/31752
Laksono, A. D., Megatsari, H., Senewe, F. P., Latifah, L., & Ashar, H. (2023a). Policy to expand hospital utilization in disadvantaged areas in Indonesia: Who should be the target? BMC Public Health, 23, Article 12. https://doi.org/10.1186/s12889-022-14656-x
Laksono, A. D., Wulandari, R. D., Rohmah, N., Rukmini, R., & Tumaji, T. (2023b). Regional disparities in hospital utilisation in Indonesia: A cross-sectional analysis of the 2018 Indonesian Basic Health Survey. BMJ Open, 13(1), e064532. https://doi.org/10.1136/bmjopen-2022-064532
Maulana, N., Soewondo, P., Adani, N., Limasalle, P., & Pattnaik, A. (2022). How Jaminan Kesehatan Nasional coverage influences out-of-pocket payments by vulnerable populations in Indonesia. PLOS Global Public Health, 2(7), e0000203. https://doi.org/10.1371/journal.pgph.0000203
Ministry of Home Affairs of the Republic of Indonesia. (2018). Regulation of the Minister of Home Affairs Number 79 of 2018 concerning Regional Public Service Agencies. https://peraturan.bpk.go.id/Details/111301/permendagri-no-79-tahun-2018
Nugroho, S. T., Ahsan, A., Kusuma, D., Adani, N., Irawaty, D. K., Amalia, N., & Hati, S. R. H. (2023). Income disparity and healthcare utilization: Lessons from Indonesia's National Health Insurance claim data. Asian Pacific Journal of Cancer Prevention, 24(10), 3397-3402. https://doi.org/10.31557/APJCP.2023.24.10.3397
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16, 1-13. https://doi.org/10.1177/1609406917733847
O'Connell, M., Hafidz, F., Saragih, S., Cashin, C., Nugroho, A., Hatt, L., Farianti, Y., Afflazier, A., & Pambudi, I. (2025). The influence of provider payment mechanisms on tuberculosis service provider behavior in Indonesia: Insights from National Health Insurance data and provider perspectives. Frontiers in Public Health, 13, Article 1396596. https://doi.org/10.3389/fpubh.2025.1396596
Oudbier, S. J., Souget-Ruff, S. P., Chen, B. S. J., Ziesemer, K. A., Meij, H. J., & Smets, E. M. A. (2024). Implementation barriers and facilitators of remote monitoring, remote consultation and digital care platforms through the eyes of healthcare professionals: A review of reviews. BMJ Open, 14(6), e075833. https://doi.org/10.1136/bmjopen-2023-075833
Ramadani, R. V., Svensson, M., Hassler, S., Hidayat, B., & Ng, N. (2024). Effects of the COVID-19 pandemic on healthcare utilization among older adults with cardiovascular diseases and multimorbidity in Indonesia: An interrupted time-series analysis. BMC Public Health, 24(1), Article 71. https://doi.org/10.1186/s12889-023-17568-6
Salampessy, B. H., Ikkersheim, D., Portrait, F. R. M., & Koolman, X. (2022). Do patients' preferences prevail in hospital selection? A comparison between discrete choice experiments and revealed hospital choice. BMC Health Services Research, 22, Article 1136. https://doi.org/10.1186/s12913-022-08403-6
Setiawan, E., Nurjannah, N., Komaryani, K., Nugraha, R. R., Thabrany, H., Purwaningrum, F., & Sarnianto, P. (2022). Utilization patterns of healthcare facility and estimated expenditure of PLHIV care under the Indonesian National Health Insurance Scheme in 2018. BMC Health Services Research, 22, Article 97. https://doi.org/10.1186/s12913-021-07434-9
Susilo, D., Lila, W. L. P., Sukmayeti, E., Asante, A., Jan, S., Thabrany, H., Tangcharoensathien, V., Wiseman, V., & Liverani, M. (2025). Can Indonesia achieve universal health coverage? Organisational and financing challenges in implementing the national health insurance system. SSM - Health Systems, 5, Article 100138. https://doi.org/10.1016/j.ssmhs.2025.100138
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349-357. https://doi.org/10.1093/intqhc/mzm042
World Health Organization. (2024). Does Indonesia's National Health Insurance Scheme mobile phone application, Mobile JKN, support health financing? https://www.who.int/publications/i/item/9789240100893
Wulandari, R. D., Laksono, A. D., Mubasyiroh, R., Rachmalina, R., Ipa, M., & Rohmah, N. (2023). Hospital utilization among urban poor in Indonesia in 2018: Is government-run insurance effective? BMC Public Health, 23(1), Article 92. https://doi.org/10.1186/s12889-023-15017-y
Zhang, H., Ma, W. M., Zhu, J. J., Wang, L., Guo, Z. J., & Chen, X. T. (2023). How to adjust the expected waiting time to improve patient satisfaction. BMC Health Services Research, 23, Article 455. https://doi.org/10.1186/s12913-023-09385-9
Zeithaml, V. A., Bitner, M. J., Gremler, D. D., & Mende, M. (2024). Services marketing: Integrating customer focus across the firm (8th ed.). McGraw Hill.
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