Digital Transformation of Medical Sector and Consumer Purchase Intention in New Normal Era

New Normal era triggers a shift in consumer habit and behavior, such as increased awareness regarding the importance of health and sanitation, as well as elevated adoption of digital technology in daily activities. This study explored digital transformation aspects that impact consumer purchase intention in New Normal era, specifically in healthcare setting. An online-based quistionnaire were distributed using Google Form. A total of 225 response were retrieved and analysed using SEM technique (SmartPLS 3.2.1.). This study found that: 1) social media content quality, online customer service quality, and telehealth quality had a positive and significant impact to purchase intention; 2) telehealth quality had the most prominent impact on purchase intention, especially the support aspect; 3) website quality did not have any significant effect on consumer purchase intention. In conclusion, companies are recommended to focus on improving telehealth quality in their healthcare management system, especially by investing in reliable technical support staff to ensure assuring and pleasant experience for patients during telehealth sessions. Also, to focus more on social media content quality and online customer service quality than website refinement considering the current elevating trend on social media rahter than website. Keyword: purchase intention, new normal, telehealth, digital transformation, healthcare management Transformasi Digital Sektor Medis dan Niat Beli Konsumen di Era New Normal ABSTRAK Era New Normal memicu terjadinya pergeseran kebiasaan dan perilaku konsumen, seperti meningkatnya kesadaran akan pentingnya kesehatan dan sanitasi, serta meningkatnya adopsi teknologi digital dalam aktivitas sehari-hari. Studi ini mengeksplorasi aspek transformasi digital yang berdampak pada niat beli konsumen di era New Normal, khususnya di bidang kesehatan. Kuesioner berbasis online disebarkan menggunakan Google Form. Sebanyak 225 respon diambil dan dianalisis menggunakan teknik SEM (SmartPLS 3.2.1.). Penelitian ini menemukan bahwa: 1) kualitas konten media sosial, kualitas layanan pelanggan online, dan kualitas telehealth berpengaruh positif dan signifikan terhadap niat beli; 2) kualitas telehealth memiliki dampak yang paling menonjol terhadap niat beli, terutama aspek dukungan; 3) kualitas website tidak berpengaruh signifikan terhadap niat beli konsumen. Sebagai kesimpulan, perusahaan disarankan untuk fokus pada peningkatan kualitas telehealth dalam sistem manajemen perawatan kesehatan mereka, terutama dengan berinvestasi pada staf dukungan teknis yang andal untuk memastikan pengalaman yang meyakinkan dan menyenangkan bagi pasien selama sesi telehealth. Juga, untuk lebih fokus pada kualitas konten media sosial dan kualitas layanan pelanggan online daripada penyempurnaan situs web mengingat tren peningkatan media sosial saat ini lebih dari situs web. Kata kunci: niat beli, normal baru, kesehatan jarak jauh, transformasi digital, manajemen kesehatan MATRIK: JURNAL MANAJEMEN, STRATEGI BISNIS DAN KEWIRAUSAHAAN Homepage: https://ojs.unud.ac.id/index.php/jmbk/index Vol. 15 No. 1, Februari (2021), 36-51


INTRODUCTION
The highly infectious and unexplored COVID-19 pandemic with no known effective medicament yet leads to a strict social distancing regulation (PSBB) as an effor to minimalize infection spread. Prolonged pandemic and quarantine, which was predicted to last until 2022 1 triggers various changes in living habit of humans globally. This shift in behavior is termed "New Normal" era (Andriani, 2020).
In New Normal era, there are several new characteristics that emerged in the general public. The most prevalent aspects found after reviewing various studies are elevated dependency towards digital technology in executing daily activities and increased awareness on the significance of sanitazion and health, leading to an increase of visitation demand to health centres (Bounie et al., 2020;Chang & Meyerhoefer, 2020;Kim, 2020;Li & Li, 2020;Pham et al., 2020;Reeves et al., 2020;Sheth, 2020;Zwanka & Buff, 2020). However, mobility to medical settings is restricted due to a high risk of infection in said settings (Lewnard & Lo, 2020;Vogler & Lightner, 2020;Wilder-Smith & Freedman, 2020). This restriction on physical movements combined with an increased demand for medical services urge the need of a digital transformation as a solution in the form of online medical consultation and examination. In New Normal era people are obliged to perform their daily activities according to health protocols push them to be ready for digital adoption, including digital transformation of the medical sector (Reeves et al., 2020;Sheth, 2020;Zwanka & Buff, 2020).
The main theory basis of this research is Theory of Reasoned Action (TRA). In TRA, humans are recognized as creatures of logic and common sense, capable of rational thinking. Therefore, humans would base their actions and choices based on an evaluation process of informations they have previously acquired in a systematic manner. Humans have a contemplation process before deciding to conduct an action, especially regarding the consequences they would likely receive if they perform or do not perform a certain action (Kan et al., 2017;. Referring to said TRA concept and considering the context of this research, then the behavioral intention aspect would be the purchase intention to health centres that have conducted digital transformation following New Normal adaptation. In the context of this research, the attitude and subjective norms aspect would be manifesting as attitude or perception of respondents on the improtance of the availability of access to quality health services in accordance to health protocols, e.g. virtual health services to minimalize contact and risk. Furthermore, external factor such as facillitated access present and smooth communication and information flow between consumer and company in the form of quality website, online customer service, and social media content also act as stimulating factor for purchase intention (Kan et al., 2017;Mi et al., 2018;Otieno et al., 2016).
A practical step to initiate digital transformation in medical sector is by emphasizing the digital marketing component, esoecially content marketing through social media (Alekseeva et al., 2019;Durai & King, 2015;Kotane et al., 2019). Content marketing is designed to attract potential consumer and stimulate consumer engagment as well as empowerment through relevant, meaningful, valuable, and inspiring content distribution. Previous research had shown a relationship between effective content marketing with brand awareness, customer attraction, customer relationship, and creating lead (Durai & King, 2015;Elisa & Gordini, 2014;Geng et al., 2020;Seyyedamiri & Tajrobehkar, 2019). Although it is important to note that quality is the key, in which a high-quality, inbound, and relevant content triggers positive response, whereas outbound or interuptive content results in negative brand attitude instead (Müller & Christandl, 2019).
Other than social media, official website should also be regulated, considering the high number of internet usage and digital information need in New Normal era. Unlike social media, website is not as interactie. It only displays a one-way information flow but generally does not present an interactive feedback access. Websites also generally only updates important and relevant informations regarding services or products, whereas social media would routinely post various new content. However, this "rigid" character of website is important to allow easy navigation for consumer who requires information specifically on products or services since those essential informations are not buried by additional content that does not directly correspond to companies' products or services (Chawla, 2014;Garett et al., 2016).
Another important aspect in going digital is a decent online customer service. Customer service qualitt is in link with customer satisfaction. Previous studies have found a correlation between customer service quality and consumer loyality, both directly and indirectly (Abd Ghani et al., 2017;Famiyeh et al., 2018;W. K. Liu et al., 2017;Minh & Huu, 2016). However, most previous research only explored conventional offline customer service, while the concept of online customer service has not been fully explored yet.
Other digital transformation aspect that recently gains popularity is telehealth. In fact, the concept of telehealth has existed since 1920s, but neglected due to a lack of momentum to trigger telehealth prosperity (Parodi et al., 2020;Ray Dorsey & Topol, 2016;Wijesooriya et al., 2020). Nowadays, COVID-19 pandemic serves as that momentum for telehealth implementation in medical setting. As a case study, VCU Health Centre in Virginia, USA, experience a 5000 percent increase in virtual appointments as a result of COVID-19. A similar increase and response also happened in various other health centres (N. Liu et al., 2020;Smith et al., 2020;Spiegelman et al., 2020;Wijesooriya et al., 2020). Previous studies had conducted researches regarding the efficacy of telehealth implementation as well as its reliability, however studies on telehealth from managerial perspective and its relation to patient purchase intention is still scarce (Novara et al., 2020;Wijesooriya et al., 2020;Wosik et al., 2020). Moreover, there is still a lack of research regarding public response on telehealth in the setting of developing countries, including Indonesia. Thus, there is still not enough scientific proof on the significance of telehealth in the context of Indonesian customer.
In general, research on the importance of digital transformation in medical setting is still lacking, although it is quite developed in other sectors such as travel industry, retail, finance, banking, logistic, food and beverage, and media. This shows a research gap, mandating a further exploration specifically in medical settings. Another interesting gap is the fact that New Normal impacts every level of human lives, causing a change and different environment compared to how life was before New Normal, including new consumer perspectives, habits, and regulations. This study aims to explore the impact of social media content quality, online customer service quality, website quality, and telehealth quality to consumer purchase intention in New Normal era ( Figure 1).

Figure 1. Research Model and Hypotheses
Source: Data processed with SmartPLS, 2020

RESEARCH METHOD
This research was conducted online via Google Form. Research population are individuals living in Denpasar, Bali, considering Bali is one of the red zone region in Indonesia with the highest hospital bed saturation (almost 100%), thus heavily affecting the realization of New Normal adaptation (Suarna, 2020;WHO Indonesia, 2020). Moreover, the multicultural population of Denpasar aids a more representative result. Another factor is the availability of facillities to enable digital transformation implementation in medical settings.
Inclusion criteria consists of minimum respondent age of 18 years old, considering the need of informed consent. Other inclusion criteria are individuals who planned or has visited health centres during 2020. Sampling technique used is non-probability sampling, combining accidental sampling, snowball samoling, and purposive sampling method to increase efficiency in gathering data. As much as 225 eligible respondents participated in this study (Ferdinand, 2014).
Research instrument used was a 10-point likert scale piloted questionnaire. The questionnaire consistedd of 20 questions representing the exogenous variables. After the data was gathered, both descriptive and inferential analysis were performed. Statistical analysis used was Structural Equation Modeling (SEM) to evaluate a relatively complex relations stilmutaneously and structuredly (Ghozali & Latan, 2015).
Outer model analysis was conducted to ensure the measurement model is valid and reliable. Outer model analysis evaluates the relations between latent variables and the indicators, consisting of three criterions i.e., Convergent Validity, Reliability (Composite Reliability, Cronbach's Alpha, Average Variance Extracted analysis), and Discriminant Validity. Inner model analysis or sturctural model was also evaluated to assess the R square value as well as the path analysis (Haryono, 2017;Hussein, 2015;Priyatno, 2013;Widarjono, 2015).

RESULT AND DISCUSSION
Descriptive analysis showed most of the respondents are Milenialls (42.2%) while respondents classified as Baby Boomers were the fewest (6.2%). 57.3% of the respondents are females and 42.7% were males. As much as 80.4% of the respondents had a high educational background (Diploma, Bachelor, Master, or Doctoral degree). It was also found that based on the classification from the Badan Pusat Statistik (BPS), the statistic central institution of Indonesia, 36.9% of respondents were classified as very high-earning, 15.1% were highearning, 21.8% were medium-earning, and 26.2% had a low-earning (Table 1). The outer model analysis, specifically the Convergent Validity test found that all indicators showed an outer loading value of ≥ 0.7 (Figure 2). Rebiality test also showed satisfactory result, in which the Composite Reliability and Cronbach's Alpha both had a value ≥ 0.7 and AVE had a value ≥ 0.5 (Table 2). Those results indicate a high stability as well as consistency, thererfore it could be concluded that all research constructs are a suitable, valid, and reliable instrusment and all questions administered were capable of measuring each construct excellently. Furthermore, Discriminant Validity test also found that the cross-loading value of each indicator have a bigger coefficient correlation with their respective variables than other variables, thus each indicator are proven to be a suitable component of their associated construct (Table 3) (Hussein, 2015;Priyatno, 2013;Widarjono, 2015).
On the other hand, inner model analysis found that the R square value of endogenous variable Purchase Intention (Y) was 0.959, which means Purchase Intention (Y) construct variability could be well explained by Social Media Content Quality (X1), Online Customer Service Quality (X2), Website Quality (X3), and Telehealth Quality (X4) construct variability to as much as 95.9%, while the remaining 4.1% would be explained by other variables outside of this research. R square value of 0.959 indicates model structural equation and a strong capability of the exogenous variables capability in explaining the endogenous variable (Ferdinand, 2014;Ghozali & Latan, 2015;Haryono, 2017).
Hypothesis testing were concluded according to path analysis, refering to T-statistic significancy value or P value. T-statistic or P value in path analysis showed the significance or amount of impact the latent constructs have. A hypothesis is said to have significant effect if the T-statistic is more than 1.0960 or the P value less than 0.05, whereas the Original Sample Estimate value indicates the direction and magnitude of construct (Ferdinand, 2014;Ghozali & Latan, 2015;Haryono, 2017;Hussein, 2015;Priyatno, 2013;Widarjono, 2015). Based on data analysis, it was found that variable Social Media Content Quality (X1), Online Customer Service Quality (X2), and Telehealth Quality (X4) have T-statistic value higher than 1.960, whereas Website Quality (X3) have a T-statistic value below 1.960 (Table 4). This finding indicates thay out of four variables evaluated, only one variable (X3) did not generate a significant effect on Purchase Intention (Y). It was also found from path analysis that Telehealth Quality (X4)

Figure 3. Path Model (T-statistic value)
Source: Data processed with SmartPLS, 2020 Content marketing is a marketing strategy focusing on the creation and distirbution of attractive content in various form (graphic, video, written, photograph, et cetera) while also artfully slip promotion means implicitly with a final objective to stimulate customer interest on companies' products and services (Durai & King, 2015;Geng et al., 2020;Konstantopoulou et al., 2019). The main objective of content marketing is to level consumers' perspective with companies' perspective, thus creating a feeling of connection, which eventually facillitate consumer to have elevated symphaty and emphaty towards said companies. A content rightfully made and delivered will act as a medium for companies to tell a story directed to gain emotional advantage on consumer, leading to brand affinity (Syrdal & Briggs, 2018;Vinerean, 2017).
However, to reach its objectives, a content has to possess certain qualities. Precious research had found that the most affecting element on attitude, loyality, and purchase intention in term of content marketing is a relevant, useful content which does not give a disruptive feeling on consumers' personal space. If a content is not interesting or relevant to target market, consumer would instead feel bothered and generate a feeling of dislike or aphaty towards company. A research by Arli (2017) and Gumus (2017) also showed similar apprehension, in which qualified content had a positive significant effect on consumer purchase intention (Arli, 2017;Gumus, 2017).
Quality content would attract consumer to share said content, leading to elevated publicity and engagement. Moreover, quality content would cause repeated visit and engagement to companies' social media, stimulating a repetitive impression as well, thus stimulating purchase intention both directly and indirectly (Alekseeva et al., 2019;Syrdal & Briggs, 2018;Weerasinghe, 2018).
On the other hand, this research found that website quality did not have a significant effect on consumer purchase intention. This is an interesting finding, considering a company's official website is one of the most relevant source for consumer to search for informations regarding products or services (Garett et al., 2016). This finding indicates a passing of the website era, replaced by other platforms such as social media. Data by Statista Research Department (2020) showed that internet penetration rate of Indonesian people is 70% and stated to be one of the biggest online market places in Asia. Data also revealed that Indonesian people (16-64 years old) spend their time online with a mean number of 7 hours 59 minutes each day. Howeverm most of those time consumed online is spent on social media platforms with a mean number of 3 hours 26 minuters (Statista, 2020).
Furthermore, data also showed that during their online activities, Indonesian consumer generally use smartphone rather than laptop or computer (Statista, 2020;We Are Social & Hootsuite, 2019). Different equipment used have a direct effect on one tendency to visit website or social media, whereas websites are more commonly computer/PC friendly while social media is easily accessible even with a smartphone. In addition, generally websites do not have direct access for consumer to get feedback or ask questions, contrasting with the interactive nature of social media (Agrawal et al., 2019;Garett et al., 2016). Monotous nature of websites, only containing essential information on products or services might also be another reason why website is less visited than social media which routinely and consistently updates its content with implicit pormotion. All in all, website no longer have high number of direct contacts with customer and no longer too crucial towards consumer purchase intention (Alekseeva et al., 2019).
This research also found that online customer quality has a positive significant effect on consumer purchase intention. This finding is in line with similar previous studies that assess conventional customer service quality (Hussain & Ali, 2018;Khatoon et al., 2020;Küster et al., 2016;Mohd Paiz et al., 2020). A decent customer service would lead to pleasant impressive and experience for consumer, causing consumer to unconsciously correlate associated company with positive emotions (Abd Ghani et al., 2017;Chicu et al., 2019;Hussain & Ali, 2018). This research found that online customer service aspect with biggest impact is the assurance element, which is the ability of customer service officer in providing such care that consumer feels more relaxed in time of stress and anxiety. This finding is in line with the context of public general situation nowadays in New Normal, where everyone is affected by the pandemic negatively, directly nor indirectly. Prolonged and uncertain pandemic time, followed by months of quarantine depletes the people from their social needs as humans and also repress their mobility or space. Unstable economic condition and looming health risk produce emotional pressure, manifesting in the form of anxiety, fear, and restlessness (Andriani, 2020;N. Liu et al., 2020;Suryono, 2020). The presence of a customer service capable of easing the restlessness of consumer becomes a very important and impressive experience in this New Normal era. Even more so when considering the fact that the customer in this context is a patient, or a closed one of a patient, in which health issues are a highly sensitive topic in this era. When a consumer receives quality care from the online customer service, consumer would feel satisfied and undergo a positive cognitive, behavioral, and affective experience, leading to an increase in company favorability and grooming purchase intention (Godovykh & Tasci, 2020;Hussain & Ali, 2018;Marques & Ferreira, 2020).
The findings of this research also reveal that amongst all variables considered, the most impactful variable on purchase intention in the New Normal era was telehealth quality. The reason behind might be related to the fact that specifically in Indonesia, the number of COVID-19 cases are still increasing day to day, even after months of efforts to contain the infection by the government. Ironically, just recently the government ease up the pandemic regulations ("Analisis Data Covid-19 Indonesia," 2020;Andriani, 2020). This condition even more so urges the establishment of a high-quality telehealth service, meaning that consumer would have stronger intention to visit, recommend, acquintance, and make a health centre with excellen telehealth services as the first choice when in need of medical services. Increased awareness on the importance of health and sanitation and increased digital adoption during New Normal also act as a stimultant, causing telehealth to be highly regarded during these times (Bounie et al., 2020;Chang & Meyerhoefer, 2020;Kim, 2020;Li & Li, 2020;Pham et al., 2020;Reeves et al., 2020;Sheth, 2020;Zwanka & Buff, 2020). Additionaly, its essence of practicality, easily accesible wherever whenever, and the availability of simple devices to aid its implementation (such as smatphones, tablets, PCs) also furhter support the perception that telehealth is important to present in medical settings, well adapting to current demands and conditions.
Although the implementation of telehealth is actually rather practical, it still yields some technical difficulties that migh confuse the patients during its execution (Ray Dorsey & Topol, 2016;Wosik et al., 2020). This is one of the most fatal flaws of telehealth, namely, the risk of sudden technical problems occurrence that could not be resolved by medical staffs as operators nor patients as customers, considering the fact that technological affairs are not their area of expertise. In line with said problem, this study found that what the respondents perceived to be the most important aspect of telehealth is support element. The support element consists of the presence of specific technical support staff who would immediately assists and solve technical problems should any arises during telehealth sessions. It could be said that during this critical moment, the public is still in a transition period from Old Normal to New Normal, thus confusion or troubles with adapting are common, including matters regarding telehealth adoption in a technological perspective (Barnes, 2020). Therefore, a skillful human capital becomes an important investment worthy of special attention from the managerial board. Presence of technical support would ensure the limitation of technical difficulties and problems during telehealth implementation, as well as ensuring a comfortable and efficient telehealth session for both patients and medical workers, thus telehealth experience would be as enjoyable as conventional health sessions.

MANAGERIAL IMPLICATION
This result of this study highlights the importance of digital transformation in medical setting, specifically through social media content marketing, presence of online customer service, and a quality telehealth system. In the New Normal era, there is a shift in consumer behaviours, followed by new preferences and demands. A combination of prolonged quarantine, fear of infection, uncertain situation, as well as other factors, caused consumers to be more dependent to digital technology in executing their daily activities, which then becomes a habit (Bounie et al., 2020;Chang & Meyerhoefer, 2020;Kim, 2020;Li & Li, 2020). Due to a social distancing regulation, a lot of time is spent online, whether for obligatory pursuit or entertainment. This situation signifies an opportunity for online marketing strategy, especially through social media content. A statistical data from Statista (2020) has indeed showed that Indonesian people spend approximately 7 hours 59 minutes online, whereas the majority of that time (3 hours 26 minutes) is spent on social media. Previous research also showed that consumers are becoming more sensitive and spiteful to interruptive method of advertisement, deeming it ineffective. Therefore, a new practice of marketing needs to be implemented, namely a pull-marketing technique. A successful content marketing through social media would increase positive attitude, loyalty, and purchase intention of consumers, as consumer would feel benefited from the free and resourceful content instead of bothered, although the content itself implicitly contain promotional means (Müller & Christandl, 2019). A wellorganized social media would also resonate certain dependable image of associated company. Interestingly, although both platforms are online, website seems to have lost its popularity to social media. Thus, it is recommended for managers to focus more on social media rather than website development. Other than social media content quality, this study also found a significant result on the impact of online customer service quality on consumer purchase intention. Other than social distancing reason, efficient online customer service also allows consumer to save time and energy, enabling consumer to receive staff support whenever and wherever. Practicality is another reason why online customer service is important, as previous research has shown that consumers in New Normal era have a heightened tendency of perceiving practicality as a top priority in purchase decision (Hussain & Ali, 2018;Khatoon et al., 2020;Küster et al., 2016;Mohd Paiz et al., 2020). There is also an increase in demands of medical services, but the high risk of infection in medical settings poses as a problem that restricts consumers from seeking treatment or services. Telehealth becomes a commendable solution and a must-have system for medical centres, especially during these times. Naturally, technical support becomes an urgent need to ensure a stable and pleasant telehealth session, even when problem occurs, it would be solved immediately. Presence of technical support would also help consumer adapt to the new telehealth system smoothly, allowing a comfortable experience and easier acceptance (Ray Dorsey & Topol, 2016;Wosik et al., 2020). On a different note, telehealth implementation has the potential of becoming a "gold mine" for companies if rightfully utilized, considering the fact that telehealth system would cut down fixed cost and staffing cost while also generating a profitable revenue compared to conventional health sessions. Telehealth also enables companies to reach patients without being restricted by physical borders like distance or accommodation, widening market place and possible source of profits. Telehealth system also enable companies to make beneficial contracts or agreements with valuable human capitals (doctors, specialists, staffs) from all over the world, following the current of market demands and gaining more competitive advantage (N. Liu et al., 2020;Parodi et al., 2020;Smith et al., 2020;Wijesooriya et al., 2020).

CONCLUSION
A high-quality digital transformation of medical settings in New Normal era is an important element that needs to be attentively considered by stakeholders. Telehealth quality is the most impactful aspect to consumer purchase intention, especially the support element. The findings of this study also indicate a shift of consumer habits from accessing website to social media. This study also found that online customer service quality has a positive significant effect on customer pruchase intention, specifically on the assurance element.
On the other hand, this study has several limitations, such as a limited study scope, restricted only to population living in Denpasar, Bali. This study also did not consider perceived behavioral control variable since this research used TRA as the theoretical basis. It is recommended for future studies to conduct a research with a wider scope while also adding more complex variables to get a more comprehensive data and understanding regarding this phenomenon.