DETERMINANT OF UTHM ACADEMIC STAFF S PREFERENCE ON CHOOSING HOSPITALS. MUHAMMAD IZZAT SYAHMI BIN ADZNAM

DETERMINANT OF UTHM ACADEMIC STAFF S PREFERENCE ON CHOOSING HOSPITALS. MUHAMMAD IZZAT SYAHMI BIN ADZNAM A thesis submitted in fulfillment of the requirement for the award of the Bachelor of Technology Management (Production and Operations) with Honor Faculty of Technology Management and Business Universiti Tun Hussein Onn Malaysia JANUARY 2018

ii I hereby declare that the work in this thesis is my own except for quotations and summaries which have been duly acknowledged. Student :. MUHAMMAD IZZAT SYAHMI BIN ADZNAM Date :.... Supervisor :.. MADAM SITI ANISAH BINTI ATAN@YAAKUB

iii ACKNOWLEDGEMENT I would like to take this opportunity to say thank you to my supervisor, Madam Siti Anisah Binti Atan@Yaakub for the all the support and assistance that she has given for finish this final year project. My heartfelt gratitude for the infinite in her willingness to give guidance, tutoring, and contribute ideas which been used during conduct this research. In addition, thanks to my family members who has sacrificed so much in terms of finance, time and energy to help and give me the opportunity to gain knowledge and also give me support to complete this research. Sincere appreciation to my parents on their sacrifice, support, and encouragement when I face difficulties during conducted this research. Lastly, I want to say thank you to all my fellow friends which have give metal and physical support to me during conducted this research. Without their guidance and moral support is very difficult for me to complete this research. This appreciation also given to all individuals who are involved directly or indirectly in helping me completing this research.

iv ABSTRACT Workers or population that have income are more prefer private hospitals and clinics than public hospitals and clinics due to the level difference of several factors in choosing hospital. This study was conducted with objective to identify the most influence factor that effect working population in choosing hospitals and also to to identify type of hospital that worker population prefer. In addition, this study was conducted also to study the relationship between the factors in choosing hospitals and hospital s preference decision among working population. The objective of this study was achieved through the literature review and questionnaire distribution. Based on this study, the independent variable for factors in choosing hospitals was obtained through literature review of past research journal which are service quality, facilities and physical assets and price. Through the result of analysis using IBM Statistical Package for Social Science (SPSS) Statistics, that can be concluded that facilities and physical assets is the most influence factor that effect working population in choosing hospitals. Using that analysis also, can be conclude that worker population are more prefer private hospitals than government hospitals. When worker population become out-patient, service quality and facilities and physical assets have significant relationship with the hospital s preference decision, while price have no significant relationship. Other than that, when worker population become wardedpatient, that all three factors in choosing hospital do not have significant relationship with hospital s preference decision.

v ABSTRAK Pekerja atau populasi yang mempunyai pendapatan lebih cenderung untuk memilih hospital dan klinik swasta berbanding hospital dan klinik awam disebabkan oleh perbezaan tahap beberapa faktor dalam memilih hospital. Kajian ini dijalankan dengan objektif untuk mengenal pasti faktor paling mempengaruhi golongan yang bekerja dalam memilih hospital dan juga untuk mengenal pasti jenis hospital yang lebih cederung dipilih oleh golongan yang bekerja. Di samping itu, kajian ini juga dijalankan untuk mengkaji hubungan antara faktor-faktor dalam memilih hospital dan keputusan pemilihan hospital dalam kalangan golongan yang bekerja. Objektifobjektif kajian ini telah dicapai melalui kajian literatur dan taburan borang soal selidik. Berdasarkan kajian ini, pembolehubah faktor-faktor pemilihan hospital antaranya ialah kualiti perkhidmatan, kemudahan & aset fizikal dan juga harga telah diperolehi melalui kajian literatur jurnal- jurnal penyelidikan yang lepas. Melalui analisis dapatan kajian menggunakan IBM Statistical Package for Social Science (SPSS) Statistics, dapat disimpulkan bahawa kemudahan & aset fizikal adalah faktor yang paling mempengaruhi golongan bekerja dalam pemilihan hospital. Selain itu, dengan menggunakan analisis tersebut juga, dapat disimpulkan bahawa golongan bekerja lebih cenderung untuk memilih hospital dan klinik swasta daripada hospital dan klinik awam. Seterusnya, dapat juga disimpulkan bahawa apabila golongan bekerja menjadi pesakit luar, kualiti perkhidmatan dan juga kemudahan & aset fizikal mempunyai hubungan yang signifikan dengan pemilihan hospital manakala harga tidak mempunyai hubungan yang signifikan. Akhir sekali, apabila golongan bekerja menjadi pesakit yang menggunakan wad, ketiga-tiga faktor tersebut tidak mempunyai hubungan yang signifikan dengan pemilihan hospital.

vi CONTENTS TITLE DECLARATION ACKNOWLEDGEMENT ABSTRACT ABSTRAK CONTENTS LIST OF TABLES LIST OF FIGURES LIST OF APPENDICES i ii iii iv v vi xi xiii xiv CHAPTER 1 : INTRODUCTION 1 1.1 Introduction 1 1.2 Research Background 2 1.3 Problem Statement 3 1.4 Research Questions 4 1.5 Research Objectives 4 1.6 Significant of Study 4

vii 1.7 Scope of Study 5 1.8 Summary 5 CHAPTER 2 : LITERATURE REVIEW 6 2.1 Introduction 6 2.2 Public and Private Malaysia Healthcare Industry 7 2.3 Service Quality and Patient s Preference Decisions 11 2.4 Facilities & Physical Assets and Patient s Preference Decisions 13 2.5 Price and Patient s Preference Decisions 14 2.6 Independent Variable of Study 15 2.7 Conceptual Framework 16 2.8 Hypotheses 16 2.9 Summary 17 CHAPTER 3 : METHODOLOGY 18 3.1 Introduction 18 3.2 Research Process 18 3.3 Research Design 19 3.4 Data Collection Method 20 3.4.1 Primary Data 20 3.4.2 Secondary Data 21 3.5 Sampling Design 21 3.5.1 Target Population 22

viii 3.5.2 Sampling Elements 22 3.5.3 Sampling Size 22 3.6 Research Instrument 23 3.6.1 Questionnaire Design 23 3.7 Scale Measurement 24 3.8 Data Processing 25 3.8.1 Questionnaire Checking 25 3.8.2 Data Editing and Coding 25 3.8.3 Data Cleaning 26 3.9 Data Analysis 26 3.10 Summary 26 CHAPTER 4 : DATA ANALYSIS 27 4.1 Introduction 27 4.2 Descriptive Analysis 27 4.2.1 Demographic Profile of Respondents 28 4.2.2 Gender 29 4.2.3 Races 30 4.2.4 Ages 31

ix 4.2.5 Marital Status 32 4.2.6 Current Position 33 4.2.7 Service Period 34 4.2.8 Highest Qualification 35 4.2.9 Monthly Salary 36 4.2.10 Purchasing Medical Insurance 37 4.2.11 Frequency go to Hospital 38 4.2.12 Primary Purpose go to Hospital 39 4.3 Scale of Variable Measurement 40 4.3.1 Reliability Test 40 4.3.2 Normality Test 41 4.4 Descriptive Analysis For Independent Variable 42 4.4.1 Descriptive Analysis of Service Quality 44 4.4.2 Descriptive Analysis of Facilities & Physical Assets 45 4.4.3 Descriptive Analysis of Price 46 4.5 Descriptive Analysis For Dependent Variable 47 4.6 Cramer s V Test 50 4.6.1 Out-patient 51 4.6.2 Warded-patient 54

x 4.7 Summary 57 CHAPTER 5 : DISCUSSION, RECOMMENDATIONS, CONCLUSION 58 5.1 Introduction 58 5.2 Summary Analysis Demographic Profile 58 5.3 Discussion of Major Findings 60 5.3.1 Descriptive Analysis for Independent Variable 60 5.3.2 Descriptive Analysis for Dependent Variable 61 5.3.3 Cramer s V Test Analysis 62 5.3.3.1 Relationship Between Service Quality and Hospital s Preference Decision 62 5.3.3.2 Relationship Between Facilities &Physical Assets and Hospital s Preference Decision 63 5.3.3.3 Relationship Between Price and Hopital s Preference Decision 64 5.4 Recommendation and Limitation 65 5.5 Conclusion 66 REFERENCE 67 APPENDIX 73 VITA 80

xi LIST OF TABLES 2.1 Summary of previous studies on related variables 10 2.2 Variables checklist from previous study 11 2.3 List of variables in this study 15 3.1 Statistic number of academic staff in UTHM 22 4.1 Frequency table for gender 29 4.2 Frequency table for races 30 4.3 Frequency table for ages 31 4.4 Frequency tables for marital status 32 4.5 Frequency table for current position 33 4.6 Frequency table for service period 34 4.7 Frequency table for the highest qualification 35 4.8 Frequency table for monthly salary of respondents 36 4.9 Frequency table for purchasing medical insurance 37 4.10 Frequency table for frequency go to hospital 38 4.11 Frequency table for primary purpose go to hospital 39 4.12 Reliability test 40 4.13 Tests of Normality of independent variable 41 4.14 Tests of Normality of preference decision 41 4.15 Level of mean measurement 42 4.16 Average mean of Independent Variable 43 4.17 Descriptive analysis of service quality 44 4.18 Descriptive analysis of facilities & physical assets 45 4.19 Descriptive analysis of price 46 4.20 Frequency table for preference decision of out-patient 47 4.21 Frequency table for preference decision of warded-patient 49

xii 4.22 Symmetric measures between service quality and out-patient s preference decisions 51 4.23 Symmetric measures between facilities and physical assets and out-patient s preference decisions 52 4.24 Symmetric measures between price and out-patient s preference decisions 53 4.25 Symmetric measures between service quality and warded-patient s preference decisions 54 4.26 Symmetric measures between facilities and physical assets and warded-patient s preference decisions 55 4.27 Symmetric measures between price and warded-patient s preference decisions 56 5.1 Demographic profile summary 59 5.2 Average mean of Independent variable 61 5.3 Frequency for hospital preference decision 61

xiii LIST OF FIGURES 1.1 Statistic of government and private hospitals and clinics 3 2.1 Framework of this research 16 3.1 Layout of research process 19 4.1 Percentage of respondents according to gender 29 4.2 Percentage of respondents according to races 30 4.3 Percentage of respondents according to ages 31 4.4 Percentage of respondents according to marital status 32 4.5 Percentage of respondents according to current position 33 4.6 Percentage of respondents according to service period 34 4.7 Percentage of respondents according to highest qualification 35 4.8 Percentage of respondents according to monthly salary 36 4.9 Percentage of respondent according to purchasing medical insurance 37 4.10 Percentage of respondent according to frequency go to hospital 38 4.11 Percentage of respondent according to primary purpose go to hospital 39 4.12 Percentage of respondent (out-patient) according to hospital s preference decision 48 4.13 Percentage of respondent (warded-patient) according to hospital s preference decision 49

xiv LIST OF APPENDICES Appendix Title Page A Questionnaire 73

CHAPTER 1 INTRODUCTION 1.1 Introduction The overall research is to understand the critical factors that affect the choosing decision of hospitals between public and private hospitals. In this chapter, study background will be briefly described along with research problem. Follow by outlining the problem statement and objective in this research. Research questions are used to guide the whole research and hypotheses used to form a proposed conceptual framework. Then the explanation of significance of the study, outline the chapter layout and end with a conclusion. The healthcare industry (also called the medical industry or health economy) is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. According to Ministry of Health Malaysia(2013) there have 141 government hospital, 1039 government health clinic, 214 private hospitals and 6801 private clinic in Malaysia. Malaysia very concerned about the government in the health sector in the country and have been seen through Malaysia(2016) that state government has reserved more than RM5.83 billion for health sector. The roles of health sector organizations in community development provide a rich example of what might result from more responsible leader behavior in these organizations(leng, Wade, & Teo, 2007). According to Rasiah, Rosnah, Abdullah, & Tumin(2011) it is clear that healthcare delivery in Malaysia is improving due to the increase in the growing of private profit healthcare providers in contrast to the withering public healthcare sector. In addition, Malaysian s patients are educated and

2 the rise of living standards drives them to choose the best healthcare providers and service. 1.2 Research Background Most of the previous study have been focus on the outside country such as Ghana. Previous study also have been conducted and study in all population of citizen. Based of the problem that have been state in problem statement (patients among workers more prefer private hospital than public hospital), this quantitative study decide to focus on population that have working and with the factors they choosing hospitals in Malaysia. This study is different with previous study because this research just want to study the most influence factor that effect working population in choosing hospitals. Other than that, this study also carried out to identify the type of hospital that worker population prefer and also want to study the relationship between the factors in choosing hospitals and hospital s preference decision among working population. A set of survey was carried out to identify that s objectives that have been stated above. Government and private hospitals are very different in term of service, price and facilities. This have been shown in many previous study that government and private hospitals have different characteristic (Online, 2011), (Yeilada & Direktör, 2010), (Hazilah Abd Manaf & Siew Nooi, 2009)

3 Figure 1.1 shows the statistic of government and private hospitals and clinics from Ministry of Health Malaysia(2013). 1.3 Problem Statement Workers or population that have income are more prefer private hospital and clinic than public hospital and this have been showed in research Haliza et al.,(2003) that state almost 74.8% patient in private clinic at Seremban are from workers population. In addition, Alias Mohd yusof (2006) also state that private hospital is appealing to those who are have income. According the previous research, there are several factors that have influence the choosing of private and public hospital. Courage & Kofi (2017) state that the factors influencing the choice of private and public hospitals in Ghana are health services and quality, health services and patient satisfaction, health accessibility and national health insurance, cost and access to healthcare. However, according to Bahadori et al., (2016) the factors such as facilities and physical assets, physicians and employees, location and place, services quality, price, and promotion can effect patient decision in choosing hospitals. Many previous study state these all factors have influence in choosing hospitals include in research (Ghosh, 2015) and (Sarwar, 2014). Many working population choose

4 private hospitals or clinic because they do not like to wait quite a long period in public hospitals and lack of staff in public hospitals (Kosmo, 2011). Other than that, according to Aishah (2015), many pregnant women had great dilemma problems for labor at public hospitals because they are unable to choose a male or female doctor for the birth of her sons at public hospitals. 1.4 Research Questions In this research, there have three research question which design to achieve research objectives which are: 1. What the most influence factor that effect working population in choosing hospitals? 2. What the type of hospital that worker population prefer? 3. What the relationship between the factors in choosing hospitals and hospital s preference decision among working population? 1.5 Research Objectives In this research, there have three research objectives which are: 1. to identify the most influence factor that effect working population in choosing hospitals 2. to identify the type of hospital that worker population prefer 3. to study the relationship between the factors in choosing hospitals and hospital s preference decision among working population 1.6 Significant Of Study This study have several importance towards many sector. One of the importance of this study is to find the factors of choosing hospitals in Malaysia (whether private or public). This importance can be used by health industry in Malaysia (public or private) to improve their health services. In addition, this study also important to

5 identify relationship between factors in choosing hospitals and the preference decision in choosing hospital. Lastly, this study also significant in determine the type of hospitals that worker population prefer. 1.7 Scope Of Study The study covers the Malaysian country in the extent of healthcare industries, with special emphasis on knowledge and satisfaction of healthcare of only Malaysian. This study focusing on patient from working population about choosing factor of private or government hospitals. A set of survey will be conduct through this study. The target respondent of that survey is academic staff in University Tun Hussein Onn Malaysia and the number of target respondents is 200 person. Other than that, this study will using quantitative approach that cover collection of data from the distribution of questionnaire and the related information through online survey and set of questionnaire designed by researcher. The result indicate that the most influence factor that effect working population in choosing hospitals. 1.8 Summary As conclusion, in detail planning and planning step was needed be conducted during this research. It more important to identify current situation during problem statement was occurred in surrounding before conducting the research. In addition, identify research questions and research objectives was very significance in this study to ensure this study was achieve it aims. This research was focused on the worker population which are academic staff in University Tun Hussein Onn Malaysia. This research can be used by all healthcare industry to improve their healthcare services. Lastly, this research have been conducted align to its objectives.

CHAPTER 2 LITERATURE REVIEW 2.1 Introduction In previous chapter, the background of research, problem statement, research objective, research question, scope and significant of the study had been identified. In this chapter, researcher had reviewed past literatures to identify variables that may have direct or indirect relationship with the dependent variable choosing hospital decision. These variables are derived from past studies, journal articles and researches that had proved their existences and impacts on decision in choosing hospitals. Therefore, literature review of this research will further discuss the three independent variables which include the factors of choosing hospital that developed by Bahadori et al., (2016) which is facilities and physical assets, service quality, and price. Table 2.2 show variables checklist from previous study on proposed framework variables. Literature review enables us to identify the important variables in the research, conceptualize the theoretical framework and hypotheses development. In addition, the conceptual framework will propose in graphical form in order to provide a better concept in the study. Finally, conclude and summarize the chapter.

7 2.2 Public and Private Malaysia Healthcare Industry Public Healthcare The Ministry of Health Malaysia (MOH) principally provides public healthcare in Malaysia, although other ministries such as the Ministry of Education (through its university hospitals) and the Ministry of Defence (through its army hospitals) also provide health care services. However, health care services provided by these ministries are limited. Taken as a whole, the Ministry of Health is the main provider of public health care services in the country and accounts for 53 per cent of the government s total health funding allocation (Yon, 2002). An extensive network of public hospitals and clinics throughout the length and breadth of the country provide Malaysia s public health care services. In the urban areas, 92 per cent of the population live within 3 km of a health facility, while in the rural areas, 69 per cent of the population do so (Suleiman & Jegathesan, 2000). Public health care services are also being increasingly complemented by the private sector, particularly general practitioners clinics. This has led the population at large to enjoy a health status that is almost comparable to that in developed countries. While private health care services tend to concentrate in the urban areas to cater for the affluent population, public health care services have been biased towards the poor, and this has greatly reduced inequity and access to health care among the population. Malaysia has managed to reduce its infant mortality rate from 75.5 per 1,000 live births in 1957 when the country gained independence) to 9.1 per 1,000 live births in 1996 (Suleiman & Jegathesan, 2000). Malaysian public hospitals are organized into national, state and district levels. National level hospitals provide a comprehensive range of tertiary care services: an example is Hospital Kuala Lumpur, which serves as the National Referral Centre. State level hospitals, with one located in the capital of all 13 states in the country, provide a comprehensive range of secondary services. District level hospitals, on the other hand, provide basic inpatient care services, and those with resident specialists also provide some specialty services. In rural areas, health care services are provided by an extensive three-tier rural health system consisting of three types of health

8 facility: 1. Main Health Centres (MHCs) 2. Health Sub-Centres (HSCs) 3. Midwife Clinics cum Quarters (MCQs). This system is being gradually changed into a two-tier system by upgrading HSCs and MHCs into Health Centres. This will reduce the coverage from 50,000 to 30,000 per health facility (Sethi et al., 2007). Private Healthcare Until the end of 2013, there were have 132 public hospitals and 214 private health care institutions, which included nursing and maternity homes in Malaysia (Ministry of Health Malaysia, 2013). All private medical services in Malaysia are governed by Private Facilities and Services Act 1998 and they must be compliant with the Ministry of Health that monitors, regulates and coordinates the industry. Malaysia is a multiethnic society with more than 24 million people including Malays, Chinese, Indians and numerous indigenous communities living side-by-side. Despite the country s astonishing economic growth in the last two decades, the Malaysian healthcare sector is still developing. Currently 132 public and 214 private hospitals operate (Ministry of Health Malaysia, 2013). The Malaysian government spends around 3 per cent of its Gross Domestic Product (GDP) on healthcare, considerably lower than other developing countries in the region. Although the Malaysian government continuously allocates funds to improve its public healthcare infrastructure, others allege that government officials indirectly encouraged the private sector by allocating insufficient funds for the public sector healthcare (Ramesh & Wu, 2008). In comparison to neighboring countries such as Thailand, with highly state funded public health sector, the Malaysian government has managed to maintain a balance between private and public healthcare. Malaysia has achieved this balance mainly through gradually reducing public hospital funds, while avoiding any political backlash (Ramesh & Wu, 2008). This has resulted into significant private healthcare provider growth particularly in urban areas.

9 Today, private healthcare plays a significant role in Malaysian overall healthcare sector growth. This is also evident by recent growth projections that Malaysian private health carers will be responsible for half its needs by 2020 (Ramesh & Wu, 2008). These trends indicate that a highly competitive healthcare industry is emerging in Malaysia, where private healthcare will face competition from existing public healthcare facilities and the growing private enterprise. Traditionally, private healthcare providers are perceived to provide healthcare more efficiently and robustly (Bhatta, 2001). The difference between private and public sector organization is well documented in the literature (Zeppou & Sotirakou, 2003). These differences are largely environmental the situation in which these organizations operate. The private sector is considered more efficient compared to public sector owing to different incentives, market orientation and a decentralized business model (Bhatta, 2001). These fundamental differences provide strategic advantages leading to private sector growth and profitability. Nevertheless, these advantages are costly. The biggest is raising customer expectation regarding service quality (SQ) provided by private healthcare institutions. The only way private healthcare providers can manage and exceed these expectations is by continuously measuring customer expectations and perception. This allows a service provider to better align itself, to ever demanding customers, without losing them. This requires a robust and reliable instrument that captures service quality expectations and perceptions from a customer s perspective.

10 Table 2.1 shows summary of the previous studies on related independent variables toward choosing hospital decision. No. Author Variables Findings 1 (Courage & Service quality, patient All variable except Kofi, 2017) satisfaction, word-of- cost of service have a mouth, type of ailment, statistically national health significant effect on insurance, cost of the choice of service. hospital. 2 (Mosadeghrad, Type of hospital, type All variable have 2009) of service, word-of- influenced patients mouth, cost of choice of hospital. services, health insurance programme, location, facilities 3 (Al- Medical services, The most important Doghaither, accessibility, component was Abdelrhman, administrative medical services Saeed, & services, age, income, accounting for 28% Magzoub, gender, education. of the total variance. 2003) 4 (Bahadori et Facilities and physical The most significant al., 2016) assets, physician and contributing factors employee, location and to attract patients place, service quality, were the "physicians price and employees," 5. (Sarwar, 2014) cost and location, All variable have service quality, effect the patient facilities. satisfaction. Market Research Ghana London, UK Riyadh, Saudi Arabia. Iran

11 Table 2.2 : Variables checklist from previous study on proposed framework variables. Authors Variable Service quality (Courage & Kofi, 2017) (Mosadeghrad, 2009) (Al- Doghaither et al., 2003) (Bahadori et al., 2016) (Sarwar, 2014) Price Facilities and Physical Assets 2.3 Service Quality and Patient s Preferences Decisions Health care organizations have undergone major changes over time to meet the specific conditions of each period. Various changes have altered scientists' views of the health care system, ad these changes include the rapid growth of health care costs and technologies, the increase in the complexity of health care processes, and the increase in competition among organizations that provide health care services (Sibbel & Urban, 2001). Therefore, these organizations are required to develop and implement plans for attracting more patients to ensure their survival and success. One of the most important ways to achieve these goals is to improve the quality of services provided by enhancing all medical processes, because the quality of service is a main determinant of the choice of health care providers (Jenkinson et al., 2005). Similarly, patients expectations and preferences must be considered, and the quality of services must be improved based on their opinions and comments (Torres & Guo, 2004). When patients have a good perception of the quality of health care services provided by a hospital and their opinions and beliefs are considered, they will probably return themselves, and their relatives and friends will come to that hospital as well (Lee & Yom, 2007). The concept of quality is different when viewed from the different perspectives of providers and patients. Therefore, in order to assess the quality of services, each viewpoint should be measured appropriately,