THE INFLUENCE OF HOSPITAL BRAND IMAGE ON PATIENT'S DECISION TO CHOOSE HOSPITAL: LITERATURE REVIEW

. People nowadays with different characteristics are very selective when choosing medical services. Hospitals as service providers are expected to have a good brand image which is the patient's perception of a brand. It is built by trust in care and knowledge about the hospital. The hospital's brand image makes patients recognize and differentiate them from others. Patient selection of health care facilities is a complex process. The brand image expected to had a direct effect on hospital selection. This article explains the influence of hospital brand image on patients' decisions to choose a hospital. The method used is a literature review study and sources from online academic media such as Mendeley. Studies related to the field of health services and searched for using valid keywords. We found 48 articles, and after evaluation, eight selected articles were included in this study. From various studies, we found that brand image positively impacts patients' decisions in choosing a hospital. A hospital's brand image will influence patient perceptions of service quality. The social aspect and marketing communication strategy have proven to be excellent induction processes for establishing a brand image in the minds of consumers.


INTRODUCTION
The healthcare industry is growing rapidly in the world.People usually need healthcare at some point in their life.Services can range from general health checks, childbirth, special care, and emergency care to treatment of chronic diseases.And it is important for hospitals that provide this service to pay attention to the quality of the services so that the institution can maintain its business.Institutions develop brands to attract and retain customers by promoting lifestyle, values, and image.By mentioning a brand, be it a product or service, an image will appear in the minds of consumers.(1) Brand image in the healthcare industry is a relatively new concept and healthcare institutions must gain a competitive advantage.(2)Brand image is the patient's perception of the brand, and patients may form a certain opinion of the hospital quickly.(3)Furthermore, as patients become more aware of their rights, they expect and demand high-quality healthcare services.If hospitals have a negative image and poor understanding of patient needs from a marketing perspective, this will lead to lack of patient satisfaction.(4)Eventually, negative patient experiences can impact their trust and commitment to apply for treatment in a health institution.(5)A good brand image is built by the patient's trust in the care and knowledge about the hospital, which is expected to increase their tendency to choose treatment there in the future.(3)Therefore, this article aims to discuss the influence of brand image on patients' decision to choose a hospital as a place of treatment.

Theoretical Review
According to Keller in 2013, brand image is the consumer perception of a brand reflected in brand associations ingrained in consumers' minds.(6) In the healthcare field, the initial concept of brand image was described by Kotler and Clarke in 1987.It is an important determinant of the quality of patient care, formed by a combination of beliefs, ideas, and the patient's impression of a particular health service provider and are not absolute or relative to the brand image of other competing institution.(7,8) In the hospital, brand image is the impression patients feel about the hospital based on interactions with services, actions, activities, and things they have read about the hospital or visual symbols they recognize.(9) The brand image of hospital makes patients recognize and differentiate them from others.(10) Patient selection of health care facilities is a complex process.Factors related to health service providers can influence the patient's choice of health service facilities be used.(11) One of the dimensions that influence patient choice is the brand image.(12) Their relationships can be seen in Figure 1.The purchasing decision of the community assists the hospital in achieving its goals, developing the hospital's activities, and surviving the intense competition from other healthcare organizations to increase market share.The brand image had a direct effect on hospital selection and mediates the effect of the services marketing mix such as product, price, place, promotion, people, process, and physical evidence on hospital selection.(13) Services marketing mix are also known as 7P's.Product is the core element in marketing.Its offered for use, purchase or consumption to achieve consumer's satisfaction or needs.13 In the healthcare setting, products are services provided by doctors or hospital staff to serve patients, including promotive, preventive, curative, and rehabilitative.(14) Price is the correspondence between the service rates set with the services provided, the fees charged, and the affordability of drug prices.(14,15) Place is the company's location to carry out its operations or activities and handle staff.Accessibility, visibility, traffic conditions, parking location, and surrounding environment are important factors when choosing a place.Hospitals carry out promotions to convey the benefits of service products to influence and persuade consumers to buy and use the services needed.(13) People refer to the doctor and staff in conveying information about a patient's illness or complaint, information about the medicine, the attitude and skills in serving patients, and service procedures that are not confusing.(14) The process is the entire procedure and mechanism until services are produced and delivered to consumers, including the speed and accuracy of the services provided and the friendliness of doctors and staff in serving patients.(13,14) Physical evidence is the politeness and tidiness of health workers' appearance, the neatness of the clinic layout, and the cleanliness of the clinic room.(14) Those marketing mixes of services can also directly influence the brand image.Their interrelationships can be seen in Figure 2.( 13)

METHOD
The method of this literature review is library research sourced from online media such as Mendeley.This article focuses on the hospital's brand image and its influence on the patient's decision to choose health services at the hospital.The search strategy prioritizes literature review, cross-sectional, systematic reviews, and meta-analyses studies.The main terms we used in our search were brand image, hospital, and patient decision.The inclusion criteria are studies from 2012 to 2023 conducted in the health services area.Exclusion criteria were studies conducted in non-health services and inaccessible articles.We got 48 articles downloaded, and their quality was assessed from the search results.A total of eight selected articles were included in this study.

RESULT AND DISCUSSION
The patient's decision to choose a hospital is an activity of consumers who are directly involved in making decisions to purchase products offered by sellers, one of which includes service products.Currently, People with different characteristics are very selective when choosing medical services.Most consumers think that a company with a good brand image has a high-quality product or service.(16) Healthcare providers must maintain their dominancy medically and economically with professional, ethical, and customer-based management, according to general principles and laws in the market.The services marketing mix has provided a tool to improve the marketing management of medical services in hospitals.Research has shown that the service marketing mix including product, price, place, promotion, people, process, and physical evidence can play an important role in patients' selection towards government or private hospitals.(17) It can also directly influence brand image and hospital selection.(13) High quality health services with doctors, medicines available according to prescription, infrastructure and complete advanced medical facilities such as laboratories and radiology, are several examples that can affect the image of a hospital.The precise image also makes the name of the hospital easy to remember.If patients or customers know the quality of the product and the type or variety of services well, they are willing to choose that service or product.(13) Therefore, in the era of globalization, especially in health services, the influence of brand image on the patient's decision to go to the hospital is becoming an important issue.A better brand image enhances consumer purchasing decisions.(18) Several studies on the relationship between brand image and the patient's decision to choose health services have been carried out in several regions in Indonesia. Research

Table 1 .
Search Results Articles.
(16)rdy states that brand image has a positive impact on the decision of inpatients at the Permata Hati Mother and Child Hospital in Malang.(19)Theseresultsaresimilar to a study by Ali et al showed the results that brand image has a big positive impact on patient purchasing decisions at MCU Eka Hospital.(16)AnotherstudybyChairunnisa,Darmawansyah,andThedecrease in the number of patient visits is a sign that the services received are not in accordance with their expectations and desires.Brand image is needed in evaluating the services provided by the hospital because it can influence patient perceptions and decisions.(18)Healthcareinstitutionssuchashospitals must maintain a strong customer base by accommodating different marketing aspects to generate positive behavioral intentions and long-term profit as competition is getting tougher.The social aspect and marketing communication strategy have proven to be excellent induction processes with a great credibility to establish a brand image in the minds of other consumers.(21)CONCLUSIONHospitalbrand image is the impression felt by patients about the hospital based on interactions with services, actions, activities, what they have read about the hospital, and visual symbols they recognize.It positively impacts the patient's behavioral intention to choose a healthcare service.A good brand image enhances consumer purchasing decisions, trust, and commitment to apply for treatment in a hospital.Therefore, evaluation of marketing management with consideration of services marketing mix known as 7P's and promotion is necessary to maintain and improve the hospital's brand image.