Chapter 1
THE ROLE OF MARKETING IN HEALTH CARE ORGANIZATIONS

LEARNING OBJECTIVES

In this chapter, we will address the following questions:

1. What are the major areas in health care in which marketing is regularly applied and practiced?
2. What is the purpose of marketing thinking and planning in health care organizations?
3. What are the major concepts, tools, and skills in marketing?
4. How is marketing normally organized in health care organizations?

OVERVIEW: MARKETING IS PERVASIVE IN HEALTH CARE

Readers might find it strange to hear that marketing plays an important and pervasive role in the health care marketplace. They are probably aware of the marketing efforts of pharmaceutical and medical device companies to sell their branded products and services. But what about hospitals, nursing homes, hospices, physician practices, health plans, rehabilitation centers, and other health care organizations? After all, don't people get sick on their own?

These organizations, for the most part, didn't think about marketing until the early 1970s. But today we see a great deal of marketing taking place in health care organizations. Consider the following facts:

• Virtually every hospital uses its website to tout its facilities and services. Some hospitals run community health programs. Some hospital CEOs appear on talk shows. All of these efforts go toward building their brand.
• Health plans develop insurance products and use marketing tools to vie with other companies in promoting themselves to employers and their employees.
• New physicians seeking to open their own practices use marketing to help determine good locations, attractive office designs, and practice styles that will attract and retain new patients.
• The American Cancer Society, American Heart Association, and other health associations turn to social marketing to encourage more people to adopt healthier life styles, like quitting smoking, cutting down on saturated fats in their diet, and increasing exercise.

These illustrations demonstrate one side of marketing, namely the use of influential advertising and selling to attract and retain customers. But marketing tasks and tools go beyond developing a stream of persuasive messages. Consider the following:

FOR EXAMPLE

Two Vignettes

A hospital is considering adding a sports medicine program to its portfolio of services. Before deciding whether to launch such a program, it plans to do market research to gauge the size of the community need, discover which competitors already offer such a program, consider how it will organize and deliver the program, understand how to price its various services, and determine how profitable the program is likely to be.

Walgreens is opening store-based clinics to provide basic health care services, such as measuring blood pressure, providing vaccinations, and treating such common conditions as sore throats, ear infections, and colds. Key marketing tasks it must perform include deciding which stores will have this service, setting prices, and, most important, determining how physician customers will view this service as possible competition.

From these examples, we recognize that many health sector participants are trying to solve their problems by relying on marketing tools and concepts. Readers who already work in the health care field may recognize some of these tasks as the realm of epidemiology; however, the discipline of marketing is much broader. The American Marketing Association offers the following definition: Marketing is an organizational function and a set of processes for creating, communicating, and delivering value to customers and for managing customer relationships in ways that benefit the organization and its stakeholders.

While value is the fundamental concept underlying modern marketing, value is also now the central focus of health care. The Affordable Care Act, enacted in 2010, linked reimbursements to improved clinical performance. Value-based payment holds health care providers accountable for both the cost and quality of care they provide. It attempts to reduce inappropriate care and to identify and reward the best-performing providers. It makes sense to expand the use of marketing to manage health care since value is their common goal.

Marketing takes place when at least one party to a potential transaction thinks about the means of achieving desired responses from other parties. Marketing takes place when:

• a physician designs an office and trains their staff to enhance the customer experience
• a hospital develops a state-of-the-art cancer center in a location with a growing population of seniors
• a health plan adds free exercise, weight-loss, and smoking cessation benefits to reduce long-term hospitalization costs
• a pharmaceutical firm hires more salespeople to gain physician acceptance and preference for a new drug
• the American Medical Association lobbies Congress to gain support for a new bill
• the Centers for Disease Control and Prevention (CDC) runs a campaign to get more people to get an annual flu shot
• a health information technology firm automates manual tasks for a health plan to improve accuracy and lower costs.

A marketer may aim to secure various responses including a purchase of a product or service; increased awareness, interest, or preference toward an offering or supplier; a change in behavior; or a higher level of customer loyalty.

THE ELEMENTS OF MARKETING THOUGHT

In this section, we introduce the purpose of marketing, some important marketing concepts and skills, and how marketing is organized in health care organizations. We will discuss these topics in greater depth in the following chapters.

The Purpose of Marketing

There are two quite different opinions about marketing's purpose. One might be called the transaction view, which says that its aim is to get an order or make a sale. Marketing's role is, therefore, to use sales skills and advertising to sell more "stuff."1 The focus is on doing everything possible to stimulate a transaction.

The other opinion about marketing can be called the customer relationship-building and loyalty view. Here the focus is more on the customer and less on the particular product or service. The marketer aims to serve the customer in such a way that they will be satisfied and come back for more services or products. In fact, the marketer hopes that loyalty will be sufficiently high that the customer will recommend the seller to others. For example, we know that a physician who develops an excellent service reputation will attract many new patients as a result of word-of-mouth recommendations. Also, as patients experience new medical needs and problems, they will return to the same physician for treatment and advice.

Some marketers question the use of terms such as consumer and patient. The traditional view of a consumer or patient is that of someone who is passively consuming something, but today's consumers are also producers. With respect to health care products and services, they are actively sending messages about their experiences, creating new uses, providing new findings from the web and other resources to their physicians, and lobbying for more and better benefits. Predicting this current environment, Peter Drucker, the noted management consultant, viewed marketing as playing the role of serving as the customer's agent or representative.

In fact, more organizations are moving from the transaction view to the relationship view of marketing, in a shift from Old Marketing to New Marketing. In this environment, the New Marketer's job is to create a long-term, trusted, and valued relationship with customers, which means getting the whole organization to think about and serve customers and their interests. For instance, hospitals that have built a pervasive marketing culture will usually financially outperform those that see themselves simply as selling visits, tests, and services, one at a time.

Marketing Uses a Set of Concepts

The first question a health care organization must ask is, who is potentially interested in the kind of products or services that we offer or plan to offer? Examples include young women and obstetric services, older adults and bypass surgery services, and diabetics and portable blood sugar testing devices. We can summarize the customer-focused marketing philosophy with the acronym CCDV: The aim of marketing is to create, communicate, and deliver value. It is not value just because the supplier believes they are giving value, but true value must be perceived by the customer. One job of the marketer is to turn invisible value into perceived value.

Very few organizations try to serve the entire market, preferring instead to distinguish different groups (segments) that make up a market. This distinguishing process is called market segmentation. The organization will then consider which market segments it can serve best in light of the segments' needs and the organization's capabilities. We call the chosen segment the target market. We can extend CCDV into CCDVT, with the "T" standing for a target market. Instead of an organization generating general value, it aims to generate specific value for a well-defined target market.

If a nursing home decides to serve a high-income market, it must create, communicate, and deliver the...