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31 December 2013 09:38
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31 December 2013 Page 1 of 13 ProQuest
Table of contents
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Document 1 of 1
The efect of managed care on hospital marketing orientation / Practitioner
response
Author: Loubeau, Patricia R; Janten, Robert; !u"it, Lin#a
Publication info: Journa$ of %ea$t&care 'anagement (3)3 *'a+,Jun 1998-: 229.39; #iscussion (0.
1)
ProQuest #ocument $in/
Abstract (Abstract): 0n t&e &os"ita$ in#ustr+, mar/eting is recognie# as a necessar+
management function in a &ig&$+ com"etiti1e an# resource.constraine# en1ironment) Loubeau
an# Janten #iscuss t&e resu$ts of t&e 2rst nationa$ cross.sectiona$ stu#+ of t&e mar/eting
orientation of 34 &os"ita$s in a manage# care en1ironment) !u"it res"on#s to t&e artic$e)
Abstract: 0n t&e &os"ita$ in#ustr+, a mar/eting orientation is current$+ recognie# as a necessar+
management function in a &ig&$+ com"etiti1e an# resource.constraine# en1ironment) 5urt&er, t&e
$iterature su""orts a mar/eting orientation as su"erior to ot&er orientation t+"es, name$+
"ro#uction, "ro#uct, an# sa$es) 6&e resu$ts of t&e 2rst nationa$ cross.sectiona$ stu#+ of t&e
mar/eting orientation of 34 &os"ita$s in a manage# care en1ironment are re"orte#) 4e1era$ /e+
$essons for &os"ita$ e7ecuti1es &a1e emerge#, inc$u#ing t&e fo$$o8ing: 1) 6o 1ar+ing #egrees, 34
&os"ita$s &a1e a#o"te# a mar/eting orientation) 2) %os"ita$s t&at are $arger, or t&at &a1e
#e1e$o"e# strong a9$iations 8it& ot&er "ro1i#ers t&at in1o$1e some $e1e$ of 2nancia$
inter#e"en#ence, &a1e t&e greatest mar/eting orientation) 3) :s manage# care organiations
&a1e increase# t&eir "resence in a state, &os"ita$s &a1e become $ess mar/eting oriente#) ()
!ontrar+ to "o"u$ar 2n#ings, for."ro2t institutions are not intrinsica$$+ more mar/eting oriente#
t&an t&eir not.for."ro2t counter"arts)
ull te!t: ;<;!360=; 43'':R>
'ar/eting is a centra$ acti1it+ of mo#ern organiations) 6o sur1i1e an# succee#, organiations
must /no8 t&eir mar/ets, attract su9cient resources, con1ert t&ese resources into a""ro"riate
ser1ices, an# communicate t&em to 1arious consuming "ub$ics) 0n t&e &os"ita$ in#ustr+, a
mar/eting orientation is current$+ recognie# as a necessar+ management function in a &ig&$+
com"etiti1e an# resource.constraine# en1ironment) 5urt&er, t&e $iterature su""orts a mar/eting
orientation as su"erior to ot&er orientation t+"es, name$+ "ro#uction, "ro#uct, an# sa$es) 0n t&is
artic$e, t&e resu$ts of t&e 2rst nationa$ cross.sectiona$ stu#+ of t&e mar/eting orientation of 3)4)
&os"ita$s in a manage# care en1ironment are re"orte#)
4e1era$ /e+ $essons for &os"ita$ e7ecuti1es &a1e emerge#) 5irst, to 1ar+ing #egrees, 3)4) &os"ita$s
&a1e a#o"te# a mar/eting orientation) 4econ#, &os"ita$s t&at are $arger, or t&at &a1e #e1e$o"e#
strong a9$iations 8it& ot&er "ro1i#ers t&at in1o$1e some $e1e$ of 2nancia$ inter#e"en#ence, &a1e
t&e greatest mar/eting orientation) 6&ir#, as manage# care organiations &a1e increase# t&eir
"resence in a state, &os"ita$s &a1e become $ess mar/eting oriente#) 5ina$$+, contrar+ to "rior
2n#ings, for."ro2t institutions are not intrinsica$$+ more mar/eting oriente# t&an t&eir notfor."ro2t
counter"arts) 6&is 2n#ing is sur"rising because of t&e tra#itiona$ ro$e of mar/eting in non.&ea$t&
for."ro2t enter"rises an# management?s greater em"&asis on "ro2tabi$it+)
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:n area of concern for &os"ita$ e7ecuti1es arises from t&e 2n#ing t&at as manage# care "ressure
increases, &os"ita$ mar/eting orientation #ecreases) :$t&oug& a mar/eting orientation is "osite#
to $ea# to greater customer satisfaction an# im"ro1e# business resu$ts, a manage# care
en1ironment seems to force &os"ita$s to focus more on cost contro$ t&an on customer satisfaction)
%os"ita$ e7ecuti1es are cautione# t&at cost.cutting, t&e "rimar+ focus in intense manage# care
en1ironments, ma+ $ea# to s&ort.term gains b+ ca"turing manage# care business, but ma+ not be
su9cient for $ong.term success an# sur1i1a$) 3n#erstan#ing consumer nee#s an# "erce"tions,
an# using a""ro"riate mar/eting strategies to ensure greater customer satisfaction an# re"eat
business, 8i$$ be among t&e /e+ tas/s for &os"ita$ e7ecuti1es in t&e future)
@:!ABRC3DD
%os"ita$s can a#o"t one of four management orientations.name$+ a "ro#uction, "ro#uct, sa$es, or
mar/eting orientation) ;ac& orientation #iEers signi2cant$+ in a""roac& an# $i/e$+ mar/et eEects)
Pa+ne *1988- an# Le1itt *19F0- &a1e argue# t&at t&e 2rst t&ree are inferior to t&e $atter)
Pro#uction Crientation
4ome &os"ita$s focus on running a smoot& "ro#uction "rocess, e1en if customer nee#s must be
bent to meet t&e reGuirements of t&at "rocess) : t+"ica$ attitu#e associate# 8it& t&is orientation
is, H6&e on$+ 8a+ to im"ro1e our "ro2ts is to re#uce our mar/eting an# "ro#uction costs)H :n
e7am"$e of t&is orientation can be foun# at a De8 >or/ !it+ &os"ita$ 8&ere "atients in t&e
out"atient o"&t&a$mo$og+ #e"artment are gi1en eit&er 9 a)m) *morning- or 1 ")m) *afternoon-
a""ointment times) Large numbers of "atients, t&erefore, s"en# $ong "erio#s of time in 8aiting
rooms so "&+sicians can ma7imie t&eir e9cienc+ in seeing "atients)
Pro#uct Crientation
Le1itt *19F0- &as argue# t&at man+ organiations #o not ser1e t&eir mar/ets a#eGuate$+ because
t&eir managements are "ro#uct oriente#) 'an+ organiations are strong$+ committe# to t&eir
"ro#uct an# its 1a$ue e1en if t&eir customers are &a1ing secon# t&oug&ts) : "ro#uct orientation
sa+s, HIe are t&e "ro1i#ers an# 8e /no8 8&at is best for +ou)? 5or e7am"$e, a$t&oug& near$+ &a$f
t&e 8omen sur1e+e# in 'iami &a# an a1ersion to t&e combine# $abor room,#e$i1er+
room,"ost"artum conce"t *L)R)D)P)-, some &os"ita$s continue# to "romote suc& obstetrica$
ser1ices *DubuGue 199J-)
: "ro#uct orientation $ea#s to Hmar/eting m+o"iaH *Le1itt 19F0-, b+ focusing on t&e "ro#uct rat&er
t&an t&e customer?s nee#s) 6&e usua$ resu$t of t&is narro8 "reoccu"ation 8it& t&e "ro#uct is t&at
instea# of gro8ing, t&e in#ustr+ #ec$ines) 5urt&er, a "ro#uct orientation assumes t&at
communicating meaningfu$$+ to users of t&e s+stem, se$ecting con1enient "$aces to #istribute
ser1ices attracti1e$+, an# "ac/aging ser1ices to meet customer nee#s are unnecessar+)
4a$es Crientation
4ome organiations be$ie1e t&at t&e+ can substantia$$+ increase t&eir mar/et s&are t&roug&
"romotiona$ eEorts on$+) Rat&er t&an c&ange t&eir "ro#ucts or ser1ices to ma/e t&em more
attracti1e to t&e consumer, t&ese organiations in1est in a#1ertising or ot&er forms of "romotion)
6&is sa$es orientation re$ies on t&e "&i$oso"&+ of getting a "romotiona$ or a#1ertising cam"aign
out to t&e mar/et"$ace as Guic/$+ as "ossib$e, an# 8&en an# if business materia$ies, #e1e$o" a
strateg+ to meet t&e #eman# *4onnenberg an# 'itc&e$$ 198K-) 4ome manage# care organiations
&a1e a#o"te# a sa$es orientation, 8it& t&e goa$ of enro$$ing a $arge number of subscribers, $ea1ing
31 December 2013 Page ( of 13 ProQuest
t&e o"erations staE to #ea$ 8it& 2n#ing t&e resources for #e$i1ering t&e ser1ices 8&en #eman#
materia$ies)
'ar/eting Crientation
6&e &ea$t&care $iterature conc$u#es t&at a#o"ting a mar/eting orientation *Aot$er 19KJ; Aot$er an#
!$ar/e 198K; Dar1er an# 4$ater 1990- is most #esirab$e for &os"ita$s) : mar/eting orientation is
1er+ #iEerent from t&e "ro#uction, "ro#uct, an# sa$es orientations) Cne of t&e most 8i#e$+ Guote#
#e2nitions of a mar/eting orientation is oEere# b+ Aot$er an# !$ar/e *198K-:
: mar/et orientation &o$#s t&at t&e main tas/ of t&e organiation is to #etermine t&e nee#s an#
8ants of target mar/ets an# to satisf+ t&em t&roug& t&e #esign, communication, "ricing an#
#e$i1er+ of a""ro"riate an# com"etiti1e$+ 1iab$e "ro#ucts an# ser1ices) *") 31-
:n a#o"tion of a mar/eting orientation base# on t&is #e2nition reGuires: t&at management
ac/no8$e#ges t&e "rimac+ of customer nee#s an# 8ants in s&a"ing t&e organiation?s "$ans an#
o"erations, an# uses mar/et researc& to obtain information to #etermine t&e "resent an# future
nee#s of target mar/ets;
t&e #e1e$o"ment of a ne8 ser1ice mi7 t&at is a""ro"riate to t&e target mar/et, an# t&e
a""ro"riate "runing of ser1ices t&at no $onger meet nee#s;
t&e #e1e$o"ment of "romotiona$ acti1ities *"ub$ic re$ations, a#1ertising, sa$es "romotion, an#
"ersona$ sa$es- to communicate 8it& t&e target mar/et;
t&e #e1e$o"ment of an a""ro"riate "ricing strateg+ *bot& monetar+ an# nonmonetar+- t&at is
com"etiti1e as 8e$$ as acce"tab$e an# aEor#ab$e; an#
t&e #e1e$o"ment of e9cient an# inno1ati1e #istribution strategies)
!oo"er *199(- &as note# t&at &os"ita$ mar/eting in "ractice can be too narro8$+ construe# an#
becomes s+non+mous 8it& "romotion, a#1ertising, an# "ub$ic re$ations) : mar/eting orientation
focuses on meeting a customer?s c&anging nee#s an# a##ing ser1ice features in res"onse
*Iebster 199(-) 6&e mar/eting conce"t centers on a nee# for organiations to be structure#
interna$$+ in suc& a 8a+ t&at t&e customer is gi1en t&e most e9cient, eEecti1e, an# userfrien#$+
ser1ice "ossib$e *Beorge 1990-) 6&is orientation reGuires t&at a#eGuate$+ Gua$i2e# an# 8e$$.
traine# "ersonne$, 8it& mar/eting /no8&o8 an# un#erstan#ing of &ea$t& ser1ices, be gi1en t&e
res"onsibi$it+ to carr+ out t&e mar/eting function) 4trong management su""ort, interna$
communications, an# a#eGuate resources are a$so reGuire#)
0n t&e &os"ita$ conte7t t&en, t&e mar/eting conce"t can be #e2ne# as management
un#erstan#ing t&at t&e /e+ tas/ of t&e &os"ita$ is to i#entif+ t&e 8ants an# nee#s of /e+
constituents *notab$+ "atients, "&+sicians, an# manage# care organiations-, an# t&en s&a"ing
t&e organiation?s oEerings in suc& a manner as to bring about an e7c&ange) @+ maintaining a
$e1e$ of customer ser1ice an# mar/eting acce"tance t&at 8i$$ ensure continue# satisfaction an#
ne8 an# re"eat business, an organiation?s mar/eting eEorts are geare# to8ar# ma7imiing
"ro2ts an# ensuring an a#eGuate return on in1estment)
L06;R:63R; R;=0;I
'ar/eting managers an# aca#emicians &a1e "roc$aime# for man+ +ears t&at a business t&at
increases its mar/eting orientation 8i$$ im"ro1e its mar/et "erformance *Aot$er 19KJ; Aot$er an#
!$ar/e 198K; Le1itt 19F0; Dar1er an# 4$ater 1990-) 6&e &ea$t&care $iterature is re"$ete 8it& case
stu#+ e7am"$es of &o8 &os"ita$s &a1e a""$ie# mar/eting tec&niGues an# foun# t&at t&e+ 8or/e#
31 December 2013 Page J of 13 ProQuest
a""ro"riate$+ *Borbien, 4immons, an# !atanese 199J; 'o8en, Licata, an# 'cP&ai$ 1993; 6&omas,
5armer, an# Ia$$ace 1991; an# ot&ers-) 0n a##ition to anec#ota$ e1i#ence "ro1i#e# b+ t&e case
stu#ies, t8o recent stu#ies of $arge grou"s of &os"ita$s &a1e s&o8n t&at mar/eting is eEecti1e)
'cDermott, 5rana/, an# Litt$e *1993-, in a stu#+ of me#ium to $arge non.go1ernment genera$
&os"ita$s, &a1e s&o8n t&at mar/eting increases &os"ita$ "ro2tabi$it+) Dai#u, A$eimen&agen, an#
Pi$ari *1992- &a1e a$so s&o8n t&at t&e mar/eting orientation of &os"ita$s is #irect$+ re$ate# to
"erformance in#icators $i/e a#missions "er be#, re1enue "er be#, net income margin, an# return
on eGuit+)
I&i$e no em"irica$ e1i#ence as to t&e eEect of manage# care on &os"ita$ mar/eting &as been
"re1ious$+ re"orte#, t&eorists &a1e argue# about t&eir $i/e$+ re$ations&i") 4ome e7"erts be$ie1e
t&at mar/eting as it &as been "ractice# in t&e "ast.8it& a &ea1+ consumer focus.8i$$ #isa""ear as
manage# care increases *@er/o8it 199F; @urns 1993-) :$$iances of &os"ita$s, mergers, an# t&e
formation of integrate# #e$i1er+ net8or/s ma+ re#uce t&e nee# for mar/eting as &os"ita$s re$+
$ess on com"etition an# more on co$$aboration) H0t isn?t im"ortant to maintain a &ig&."ro2$e
mar/eting #e"artment in a communit+ t&at is re$+ing $ess on consumer a#1ertising an# becoming
more in1o$1e# in manage# care contractingH *Boo#s"ee# 1993-) 0n contrast, man+ &a1e "re#icte#
e1en greater eEorts to8ar# mar/eting) !o&en *1993-, Bri9t& *199J-, =itberg *199F-, Duncan,
Binter, an# 48a+ne *1992-, an# 4c&$ossberg *1990- a$$ &a1e argue# t&at successfu$
im"$ementation of t&e mar/eting function b+ &os"ita$ management 8i$$ become more im"ortant
as manage# care an# "rice.oriente# com"etition gro8s)
D:6:, ';6%CD, :DD R;43L64
6&e "rimar+ #ata for t&is stu#+ 8ere obtaine# from a ran#om sam"$e, stratiLe# b+ geogra"&ic
region, of t&e 3,FFK s&ort.term genera$ &os"ita$s in t&e 3nite# 4tates *:merican %os"ita$
:ssociation 199(,9J-) Bo1ernment &os"ita$s 8ere e7c$u#e# from t&e stu#+ because of t&eir
greater re$iance on go1ernmenta$ reimbursements an# subsi#ies 8as $i/e$+ to ma/e t&eir
mar/eting orientation #iEer signi2cant$+ from com"arab$+ situate# "ri1ate sector &os"ita$s) :
Guestionnaire, simi$ar to t&at suggeste# b+ Aot$er an# !$ar/e *198K- an# use# b+ Dai#u an#
Dara+ana *1991-, 8as mai$e# to t&e c&ief e7ecuti1e o9cers of K1K &os"ita$s, 23J of 8&om
res"on#e# 8it& usab$e information) ;ac& !;C 8as Guerie# about t&eir &os"ita$?s genera$
c&aracteristics an# mar/eting orientation, t&e $atter being gauge# b+ customer "&i$oso"&+,
mar/eting organiation integration, mar/eting information a#eGuac+, o"erationa$ e9cienc+, an#
strategic orientation) 6&ese 21e com"onents &a1e been i#enti2e# in t&e &os"ita$ mar/eting
$iterature as t&e "rinci"$e attributes of a mar/eting orientation *RaMu, Lonia$, an# Bu"ta 199J;
@er/o8it 199F; !oo"er 199(; Aot$er an# !$ar/e 198K-) 0n a##ition to t&e sur1e+?s "rimar+ #ata,
a##itiona$ secon#ar+ #ata on t&e state8i#e manage# care "enetration rate for eac& of t&e
res"on#ing &os"ita$s 8ere obtaine# from t&e %'C.PPC Digest *199J-)
6&e sam"$e sie of 23J comfortab$+ e7cee#e# t&e necessar+ sam"$e sie of 19(, gi1en t&e #esire#
"o8er, eEect sie, an# signi2cance $e1e$ of t&e stu#+ *!o&en 1988-) : com"arison of t&e sam"$e#
an# "o"u$ation c&aracteristics suggests t&at t&e sam"$e 8as genera$$+ re"resentati1e in terms of
sie, geogra"&+, an# occu"anc+ *6ab$e 1-) 5or"ro2t &os"ita$s 8ere un#erre"resente# in t&e
sam"$e, &o8e1er)
5ort+ items on t&e Guestionnaire assesse# eac& &os"ita$?s mar/eting orientation, as reLecte# b+
t&eir customer "&i$oso"&+, mar/eting organiation integration, mar/eting information a#eGuac+,
o"erationa$ e9cienc+, an# strategic orientation) 6&ese (0 Guestions 8ere #e1e$o"e# in
31 December 2013 Page F of 13 ProQuest
consu$tation 8it& a "ane$ of t&ree aca#emicians 8&o are recognie# aut&orities on &os"ita$
mar/eting) 6&e "ane$ 8as as/e# to rate Guestions 8it& res"ect to t&eir re$e1ance to t&e construct
mar/eting orientation; t&e items t&at 8ere Mu#ge# to be &ig&$+ consistent 8it& t&e construct 8ere
inc$u#e# in t&e Guestionnaire) 5rom t&ese items, a summate# mar/eting orientation score, 8it& a
minimum of 0 an# ma7imum of 80, 8as create#) 5or t&e sam"$e# &os"ita$s, t&e me#ian mar/eting
orientation score 8as J1, #emonstrating t&at &os"ita$s &a1e become consi#erab$+ more
mar/eting oriente# since Aot$er an# !$ar/e *198K- foun# t&at most organiations &a# a "oor to fair
mar/eting orientation) !onsi#erab$e #iEerences e7iste# bet8een &os"ita$s, &o8e1er) 6&e bottom
Guarter of &os"ita$s, in terms of mar/eting orientation, &a# scores t&at a1erage# on$+ 30)8, 8&i$e
t&e to" Guarter a1erage# F1)9 *5igure 1-)
4im"$e corre$ation coe9cients suggest t&at t&e #iEerences in mar/eting orientation bet8een
&os"ita$s are t&e resu$t of sie, o8ners&i", region, an# net8or/ #iEerences *6ab$e 2-) !onsistent
8it& t&e 2n#ings of Dai#u an# Dara+ana *1991-, $arger &os"ita$s in our sam"$e 8ere more
mar/eting oriente# t&an sma$$er ones) 6&is mig&t reLect t&at $arger &os"ita$s &a1e bot& greater
a8areness of mar/eting an# t&e staE to su""ort t&e mar/eting eEort) @ecause $arger &os"ita$s are
a$so more $i/e$+ to be $ocate# in urban areas, 8&ere com"etiti1e "ressures ma+ be greater, t&e
"otentia$ bene2ts of mar/eting ma+ be greater in terms of maintaining or increasing mar/et
s&are)
6&e sim"$e corre$ations a$so in#icate t&at &os"ita$s t&at "artici"ate# in net8or/s 8it& 2nancia$
inter#e"en#ence among "ro1i#ers 8ere more mar/eting oriente# t&an non"artici"ants) Det8or/
"artici"ation, $i/e mar/eting orientation, a$$o8s &os"ita$s to increase "atient access an#
con1enience 8it& broa# geogra"&ic co1erage an# com"re&ensi1e ser1ices) 0n a##ition, &os"ita$s
t&at "artici"ate in integrate# net8or/s ma+ be situate# in more com"etiti1e en1ironments,
31 December 2013 Page K of 13 ProQuest
necessitating coo"eration 8it& com"etitors to contain costs) 'i$$er *199F- note# t&at in#ustr+
integration, b+ increasing t&e $e1e$ of com"etition, &as increase# &os"ita$ e7"en#itures for
mar/eting acti1ities)
'irroring t&e 2n#ings of Dai#u, A$eimen&agen, an# Pi$ari *1992-, for"ro2t &os"ita$s in our sam"$e
8ere a$so more mar/eting oriente# t&an non"ro2ts) :$so, &os"ita$s 8it& greater s&ares of
manage# care 8ere more mar/eting oriente# t&an t&ose 8it& sma$$er manage# care s&ares)
:$t&oug& mar/eting orientation 8as corre$ate# to eac& &os"ita$?s manage# care s&are, t&e
state8i#e $e1e$ of manage# care "enetration 8as not signi2cant$+ re$ate# to mar/eting
orientation)
Beogra"&ic #iEerences in mar/eting orientation 8ere a$so signi2cant) 6&e 8est &a# t&e $o8est
a1erage score *(2-, fo$$o8e# b+ t&e nort& centra$ *(K-, t&e nort&east *J0-, an# t&e sout& *J1-)
6&ese #iEerences ma+ be re$ate# to t&e #iEerences in manage# care "enetration b+ region) 6&e
8est, 8it& t&e $o8est mar/eting orientation, a$so &as t&e &ig&est a1erage manage# care
"enetration rate *29 "ercent- 8&i$e t&e sout&, 8it& t&e &ig&est mar/eting score, &as t&e $o8est
"enetration rate *13 "ercent-)
6&e sim"$e corre$ations #iscusse# abo1e, 8&i$e suggesti1e, are unab$e to i#entif+ 8&ic& factors
cause# t&e #iEerences in mar/eting orientation bet8een &os"ita$s because t&e+ are unab$e to
iso$ate t&e inLuence of one factor from t&e ot&ers) 6o i#entif+ t&e causa$ factors, mu$ti"$e
regression ana$+sis 8as uti$ie#) : regression of eac& &os"ita$?s mar/eting orientation score on
t&eir res"ecti1e c&aracteristics in#icates t&at on$+ sie, manage# care "resence in t&e state, an#
net8or/ "artici"ation inLuence# &os"ita$ mar/eting orientation) Deit&er "ro2t status, nor region,
nor manage# care s&are at eac& &os"ita$ mattere#)
6&e inLuence of &os"ita$ sie on mar/eting orientation "ro1e# to be non$inear *i)e), as be# sie
increase#, mar/eting orientation increase#-, but at a #ecreasing rate) 6&e #iEerence in mar/eting
orientation 8as, t&erefore, biggest bet8een sma$$er. an# me#ium.sie# &os"ita$s, an# sma$$est
bet8een $arge an# e7tra.$arge ones) 'e#ium.sie# *1J0 be#s- &os"ita$s 8ere 9)( "ercent more
mar/eting oriente# t&an sma$$ ones *J0 be#s-, 8&i$e t&e $argest &os"ita$s *(J0 be#s- 8ere on$+
()J "ercent more mar/eting oriente# t&an $arge ones *3J0 be#s-) ;1i#ent$+, me#ium.sie#
&os"ita$s &a1e greater mar/eting eEorts t&an sma$$ ones because t&e+ &a1e ac&ie1e# t&e critica$
sie necessar+ to "ro1i#e bot& t&e resources an# t&e s"ecia$ie# staE t&at suc& eEorts reGuire)
'an+ sma$$er &os"ita$s #on?t e1en &a1e a forma$ mar/eting #e"artment *!$ar/e an# Deiman
1988-) 0n contrast, t&e mar/eting eEorts of $arge an# 1er+ $arge &os"ita$s #iEer $itt$e because t&eir
mar/eting eEorts are $i/e$+ to be im"$emente# b+ staE an# #e"artments t&at are organie# Guite
simi$ar$+)
6&e resu$ts a$so s&o8 t&at
bot& t&e state8i#e manage# care "resence an# net8or/ a9$iation inLuence# a &os"ita$?s
mar/eting orientation) Iit& res"ect to t&e former, &os"ita$s t&at o"erate# in states 8it& &ig&
31 December 2013 Page 8 of 13 ProQuest
$e1e$s of manage# care "enetration 8ere signi2cant$+ $ess mar/eting oriente# t&an t&ose in states
8it& $itt$e manage# care "resence) %os"ita$s in t&e &ig&est Guarti$e of states in terms of manage#
care "enetration, a1eraging 31)K "ercent, 8ere 9 "ercent $ess mar/eting oriente# t&an t&ose in
t&e $o8est Guarti$e *3)9 "ercent-) Iit& res"ect to net8or/ "artici"ation, &os"ita$s t&at 8ere strong
"artici"ants &a# mar/eting orientation scores t&at a1erage# 8 "ercent more t&an t&ose &os"ita$s
8&o 8ere not "art of an integrate# #e$i1er+ s+stem)
6&e resu$ts a$so in#icate t&at t&e ear$ier note# sim"$e corre$ations bet8een mar/eting orientation
an# "ro2t status an# &os"ita$ manage# care s&are 8ere sim"$+ reLecting t&e inLuence of t&e
ot&er factors) 5or e7am"$e, for"ro2ts 8ere more $i/e$+ to be $ocate# in states 8it& $o8 manage#
care s&ares, so for."ro2ts 8ere more mar/eting oriente# because of t&e absence of manage#
care, not because of t&eir "ro2t status) :rguments t&at non."ro2ts are intrinsica$$+ $ess mar/eting
oriente# t&an for."ro2ts are not, t&erefore, substantiate# b+ our #ata) 4imi$ar$+, t&e sim"$e
corre$ation bet8een a &os"ita$?s manage# care s&are an# mar/eting orientation $i/e$+ reLects
#iEerences in &os"ita$ sie) Larger &os"ita$s ten# to &a1e greater manage# care s&ares, so t&e
sim"$e corre$ation ca"tures t&e eEect of sie #iEerences, not manage# care #iEerences)
!CD!L340CD4
6&is stu#+ is t&e 2rst nationa$ crosssectiona$ stu#+ of &os"ita$ mar/eting orientation in a manage#
care en1ironment) 6&e stu#+ e7amine# mar/eting orientation an# its re$ations&i" to be# sie,
"ro2t status, integrate# #e$i1er+ s+stem #e1e$o"ment, an#.most im"ortant$+.manage# care
"enetration of t&e in#i1i#ua$ &os"ita$ an# t&e state 8it&in 8&ic& t&e &os"ita$ resi#es)
5ocusing on t&e a#o"tion of mar/eting orientation, strong e1i#ence s&o8s t&at &os"ita$s, to
1ar+ing #egrees, &a1e a#o"te# t&is a""roac&) Cur #ata suggest t&at about 30 "ercent of &os"ita$s
are &ig&$+ mar/eting oriente#, 38 "ercent are mo#erate$+ mar/eting oriente#, an# t&e ba$ance of
32 "ercent are minima$$+ mar/eting oriente#) 6&e #ata a$so in#icate t&at &os"ita$s &a1e ma#e
signi2cant stri#es in t&e $ast #eca#e in a#o"ting a mar/eting orientation since Aot$er an# !$ar/e?s
*198K- statement t&at most &ea$t&care organiations &a1e a "oor to fair mar/eting orientation)
!ou"$e# 8it& rising out$a+s for mar/eting, t&e 2n#ings in#icate t&at &os"ita$s, in res"onse to
com"etiti1e &ar#s&i"s, &a1e embrace# a mar/eting "&i$oso"&+)
6&e regression 2n#ings #emonstrate# t&at $arger &os"ita$s 8ere more mar/eting oriente# t&an
sma$$er ones) : sma$$ &os"ita$ sie, &o8e1er, s&ou$# not "rec$u#e a substanti1e mar/eting eEort;
t&ose t&at &a1e been mar/eting oriente# &a1e enMo+e# outstan#ing resu$ts *DubuGue 198J-)
: signi2cant #iEerence in mar/eting orientation e7ists bet8een &os"ita$s t&at are fu$$ net8or/
"artici"ants an# t&ose t&at are not) 6&ose &os"ita$s t&at &a1e strong a9$iations 8it& ot&er
"ro1i#ers an# t&at &a1e a $e1e$ of 2nancia$ inter#e"en#ence are muc& more mar/eting oriente#)
:ccor#ing to !&i$ingerian *1992-, "ressure from $arge em"$o+ers see/ing ser1ice #e$i1er+ &as $e#
to a gro8t& of a$ternati1e #e$i1er+ s+stems aime# at im"ro1ing &ea$t&care e9cienc+ an#
eEecti1eness) : reasonab$e argument is t&at integrate# #e$i1er+ s+stem *0D4- #e1e$o"ment is a
res"onse to t&ese mar/et nee#s, because it "ro1i#es increase# access at $o8er cost t&an stan#.
a$one s+stems) :n 0D4 a$so a$$o8s &os"ita$s to e7"an# t&eir mar/et s&are t&roug& increase#
referra$s)
6&e 2na$ signi2cant 2n#ing of t&is stu#+ is t&at as t&e manage# care "enetration rate in a state
increases, &os"ita$s #ecrease t&eir mar/eting orientation) %os"ita$s are #ecreasing t&eir
mar/eting orientation in fa1or of a "ro#uction t+"e of orientation in an eEort to contain costs)
31 December 2013 Page 9 of 13 ProQuest
6&ese 2n#ings suggest t&at as t&e mar/et matures from a manage# care "ers"ecti1e, a &os"ita$?s
mar/eting orientation becomes $ess im"ortant) 6&is #ec$ine in im"ortance ma+ be because in
mature manage# care mar/ets, t&e &ea$t&care s+stem focuses on cost as t&e #iEerentiating
1ariab$e, at t&e e7"ense of bran# i#entit+, access, an# customer satisfaction)
6&is res"onse to manage# care ma+ continue to e1o$1e) :s manage# care "enetration reac&es a
saturation "oint across t&e countr+, a re1ersa$ in t&e #egree of mar/eting orientation ma+
emerge) Lin#+ Ric&ar#son, senior 1ice "resi#ent of !o$umbia,%!:, maintains t&at t&e /e+ factor to
mar/et"$ace success rig&t no8 is "rice, 8it& Gua$it+ becoming t&e maMor issue in t8o to t&ree
+ears *=itberg 199F-) 6&is statement is con2rme# b+ >a1as an# 4&em8e$$ *199F- 8&o re"ort t&at
cost.cutting, t&e "rimar+ focus of &os"ita$ a#ministrators to #ate, is not su9cient for success an#
sur1i1a$) 6&e+ conten# t&at, in t&e future, un#erstan#ing consumers? "erce"tions of &os"ita$s an#
using a""ro"riate mar/eting strategies to mo$# #esire# "erce"tions 8i$$ be among t&e /e+ tas/s
for &os"ita$ a#ministrators)
'aMor "urc&asers of &ea$t&care &a1e been as/ing for.an# in some cases #eman#ing.more
information about t&e ser1ices t&eir bene2t #o$$ars bu+) :ccor#ing to Nab$oc/i *199(-, &ea$t& "$an
re"ort car#s no8 inc$u#e #etai$e# information t&at &e$"s customers ma/e c&oices among
"ro1i#ers base# on Gua$it+, satisfaction, an# cost) 0n !a$ifornia, 8it& a &ig& manage# care
"enetration rate of 38)( "ercent, t&e Aaiser Permanente re"ort car# is F0 "ages 8it& a 3K."age
met&o#o$ogica$ su""$ement) %'Cs un#erstan# t&e sim"$e notion t&at /ee"ing members is $ess
cost$+ t&an recruiting t&em) :s e7cess costs are #ri1en out of t&e &os"ita$ in#ustr+, &os"ita$s ma+
again turn to a strong mar/eting orientation to retain manage# care business b+ maintaining &ig&
$e1e$s of "atient satisfaction) 3"ton *199K- argues t&at because consumers are fee$ing t&e rising
cost of &ea$t&care muc& more #irect$+ t&an in t&e "ast.t&roug& &ig&er out.of."oc/et "a+ments for
"remiums, #e#uctib$es, an# co"a+ments.t&e+ 8i$$ become increasing$+ in1o$1e# in t&e se$ection
an# a#ministration of t&eir &ea$t&care) ;m"$o+ers ma+ #etermine t&e initia$ &ea$t&care "urc&ase
#ecision, but em"$o+ee satisfaction 8i$$ #etermine subseGuent rene8a$ #ecisions) %os"ita$s in
strong manage# care areas ma+, t&erefore, be reGuire# to re1ert to a mar/eting orientation to
remain 1iab$e, "a+ing carefu$ attention to retaining t&ose mar/eting strategies t&at a$$o8 t&em to
assess customers? nee#s an# to meet t&eir e7"ectations)
:c/no8$e#gments
6&is stu#+ 8as fun#e# b+ t&e %ea$t& 'anagement Researc& :8ar# of t&e :merican !o$$ege of
%ea$t&care ;7ecuti1es) 6&e aut&ors gratefu$$+ ac/no8$e#ge t&e assistance of ;ric @er/o8it,
P&)D), 3ni1ersit+ of 'assac&usetts at :m&erst; 4te"&en 6uc/er, D)@):), 6rinit+ 3ni1ersit+, 4an
:ntonio, 6e7as; an# P&i$$i" !oo"er, P&)D), ;ast 6ennessee 4tate 3ni1ersit+, for ser1ing as t&e
aca#emic re1ie8 "ane$ for t&e sur1e+ instrument)
"idebar
5or more information on t&is artic$e +ou ma+ contact Dr) Loubeau at: PLoubeauOiona)e#u
References
References
References
:merican %os"ita$ :ssociation) 199(,9J) :merican %os"ita$ :ssociation %os"ita$ 4tatistics)
!&icago: :%:)
31 December 2013 Page 10 of 13 ProQuest
@er/o8it, ;) D) 199F) ;ssentia$s of %ea$t& !are 'ar/eting) Bait&ersburg, 'D: :s"en Pub$is&ers)
@urns, J) 1993) HReform 4een !utting 'ar/eting?s Ro$e)H 'o#ern %ea$t&care 23 *K-: 33.3()
!&i$ingerian, J) :) 1992) HDe8 Directions for %os"ita$ 4trategic 'anagement: 6&e 'ar/et for
;9cient !are)H %ea$t& !are 'anagement Re1ie8 1K *(-: K380)
!$ar/e, R) D), an# J) 4) Deiman) 1988) H4tate.of.t&e.:rt of 'ar/eting:
References
Lessons from a Dationa$ 4ur1e+)H !&icago: Pa"er "resente# at t&e :merican %os"ita$ :ssociation
!on1ention)
!o&en, J) 1988) 4tatistica$ Po8er :na$+sis for t&e @e&a1iora$ 4ciences, 2n# e#)
References
%i$$s#a$e, DJ: La8rence ;r$baum :ssociates)
!o&en, R) 1993) H%ea$t& !are Reform an# I&at 0t 'eans for 'ar/eters)H %ea$t& !are 'ar/eting
Re"ort 11: 1.() !oo"er, P) D) 199() %ea$t& !are 'ar/eting) Bait&ersburg, 'D: :s"en Pub$is&ers)
DubuGue, 4) ;) *4"ea/er-) 199J) :ccountabi$it+: 'easuring t&e ;Eecti1eness of
References
>our 'ar/eting 4trategies *!assette Recor#ing Do) 13-) !&icago: :merican !o$$ege of %ea$t&care
;7ecuti1es) DubuGue, 4) ;) 198J) HDa+ 4urger+ :ggressi1e 'ar/eting 4ecures 4uccess)H Pro2$es in
%os"ita$ 'ar/eting 18: (.10) Duncan, I) J), P) ') Binter, an# L) ;) 48a+ne) 1992) 4trategic
'anagement of %ea$t& !are Crganiations) @oston: PI4.Aent)
Beorge, I) R) 1990) H0nterna$ 'ar/eting an# Crganiation @e&a1ior: : Partners&i" in De1e$o"ing
!ustomer!onscious ;m"$o+ees at ;1er+ Le1e$) Journa$ of @usiness Re1ie8 20 * 1-: F3K0)
Boo#s"ee#, 4), Guote# in @urns, J) 1993)
References
HReform 4een !utting 'ar/eting?s Ro$e:? 'o#ern %ea$t&care 23 *2K-: 333()
Borbien, ') J), 4) @) 4immons, an# J) R) !atanese) 199J) H4enior %ea$t& Da+)H Journa$ of %ea$t&
!are 'ar/eting 1J *2-: J8.F0)
Bri9t&, J) R) 199J) 6&e Ie$$.'anage# %ea$t& !are Crganiation) !&icago:
References
%ea$t& :#ministration Press) %'C.PPC Digest) 199J) Aansas !it+,
'C: %oec&st 'arion Rousse$) Aot$er, P) 19KJ) 'ar/eting for Don"ro2t Crganiations) ;ng$e8oo#
!$iEs, DJ: Prentice %a$$)
Aot$er, P), an# R) D) !$ar/e) 198K) 'ar/eting for %ea$t& !are Crganiations) ;ng$e8oo# !$iEs, DJ:
Prentice %a$$) Le1itt, 6) 19F0) H'ar/eting '+o"ia)H %ar1ar# @usiness Re1ie8 38 *(-: (JJF)
'cDermott, D) R), 5 5rana/, an# ') Litt$e) 1993) HDoes 'ar/eting Re$ate
References
to %os"ita$ Pro2tabi$it+PH Journa$ of %ea$t& !are 'ar/eting 13 *2-: 18.2J) 'i$$er, !) 199F) H%os"ita$s
@oost 'ar/eting ;7"enses b+ 2J Percent)H 'ar/eting De8s 30 *13-: 2)
31 December 2013 Page 11 of 13 ProQuest
'o8en, J) !), J) I) Licata, an# J) 'cP&ai$) 1993) HIaiting in t&e ;mergenc+ Room: %o8 to 0m"ro1e
Patient 4atisfaction)H Journa$ of %ea$t& !are 'ar/eting 13 *2-: 2F.33)
References
Dai#u, B) '), :) A$eimen&agen, an# B) Pi$ari) 1992) HCrganiation of 'ar/eting in 3)4) %os"ita$s:
:n ;m"irica$ 0n1estigation)H %ea$t& !are 'anagement Re1ie8 1K *(-: 29.(3) Dai#u, B) '), an# !)
L) Dara+ana) 1991) H%o8 'ar/eting Criente# :re %os"ita$s in a Dec$ining 'ar/etPH Journa$ of
%ea$t& !are 'ar/eting 2 *1-: 23.30) Dar1er, J) !), an# 4) 4$ater) 1990) H6&e ;Eect of a 'ar/et
Crientation on @usiness Pro2tabi$it+)H Journa$ of 'ar/eting J( *(-: 20.3J) Pa+ne, :) 5) 1988)
HDe1e$o"ing a 'ar/eting.Criente# Crganiation)H @usiness %orions 31 *'a+,June-: (F.J3) RaMu, P)
4), 4) !) Lonia$, an# >) P) Bu"ta) 199J) H'ar/et Crientation an# Performance in t&e %os"ita$
0n#ustr+)H Journa$ of %ea$t& !are 'ar/eting 1J *(-: 3(.(1)
4c&$ossberg, %) 1990) H%ea$t& !are Loo/s ?%;RC? in 'ar/eting)H 'ar/eting
References
De8s 2( *2-: 1.10)
4onnenberg, 5, an# 6) 'itc&e$$) 198K) H'ar/eting !ommunications: : 'eans to an ;n#)H 6&e
Journa$ of @usiness 4trateg+ K *(-: 81.8F) 6&omas, R) A), ;) 5armer, an# @) Ia$$ace) 1991) H6&e
0m"ortance of 0nterna$ 'ar/eting: t&e !ase of Beriatric 4er1ices)H Journa$ of %ea$t& !are 'ar/eting
11 *1-: JJ.J8) 3"ton, R) L) 199K) H!onsumer.Dri1en %ea$t& !are 'ar/eting)H 'anage# !are
Quarter$+ J *1-: 2J.29) =itberg, :) A) 199F) 'ar/eting %ea$t& !are 0nto t&e 68ent+.5irst !entur+)
De8 >or/: %a8ort&)
Iebster, 5) ;) 199() HDe2ning t&e De8 'ar/eting !once"t) H'ar/eting 'anagement 2 *(-: 23.2K)
>a1as, 3), an# D) J) 4c&em8e$$) 199F) H!om"eting for Patients an# Pro2t)H Journa$ of %ea$t& !are
'ar/eting 1F *2-: 30.3K)
Nab$oc/i, ;) 199() H;m"$o+er Re"ort !ar#s)H %'C 'againe 3J: 2F.2)
"ub#ect: 4tu#ies; %os"ita$s; 'ar/eting; 'anagement st+$es; 'anage# care; 4tatistica$ ana$+sis;
$e"%: @e# Cccu"anc+, !ost !ontro$, Data !o$$ection, De$i1er+ of %ea$t& !are, 0ntegrate#,
;conomic !om"etition, ;9cienc+, Crganiationa$, %ea$t& 4er1ices Researc&, %os"ita$
:#ministration .. economics, %os"ita$ :#ministration .. tren#s, %os"ita$ @e# !a"acit+, %os"ita$s ..
c$assi2cation, 'anage# !are Programs .. economics, 'ar/eting of %ea$t& 4er1ices .. organiation
Q a#ministration, 'ar/eting of %ea$t& 4er1ices .. tren#s, C8ners&i", Patient 4atisfaction, Pro#uct
Line 'anagement, 4am"$ing 4tu#ies, 3nite# 4tates, %os"ita$ :#ministration .. statistics Q
numerica$ #ata *maMor-, 'anage# !are Programs .. statistics Q numerica$ #ata *maMor-, 'ar/eting
of %ea$t& 4er1ices .. statistics Q numerica$ #ata *maMor-
&ocation: 34
'lassi(cation: 9190: 34; 9130: ;7"erimenta$,t&eoretica$ treatment; 8320: %ea$t& care in#ustr+;
K000: 'ar/eting; 2200: 'anageria$ s/i$$s
Publication title: Journa$ of %ea$t&care 'anagement
)olume: (3
Issue: 3
31 December 2013 Page 12 of 13 ProQuest
Pages: 229.39; #iscussion (0.1
*umber of pages: 11
Publication +ear: 1998
Publication date: 'a+,Jun 1998
,ear: 1998
Publisher: %ea$t& :#ministration Press
Place of publication: !&icago
'ountr+ of publication: 3nite# 4tates
Publication sub#ect: Pub$ic %ea$t& :n# 4afet+, ;n1ironmenta$ 4tu#ies, %ea$t& 5aci$ities :n#
:#ministration, P&+sica$ 5itness :n# %+giene
I""*: 109F9012
'-./*: J%':5@
"ource t+pe: 4c&o$ar$+ Journa$s
&anguage of publication: ;ng$is&
.ocument t+pe: P;R0CD0!:L
Accession number: 01FJ(928, 10181K99, 0381(F21
ProQuest document I.: 20FK2(0KF
.ocument 0R&: &tt":,,searc&)"roGuest)com,#oc1ie8,20FK2(0KFPaccounti#R1K2(2
'op+right: !o"+rig&t :merican !o$$ege of %ea$t&care ;7ecuti1es 'a+,Jun 1998
&ast updated: 2011.0(.28
.atabase: ProQuest %ea$t& Q 'e#ica$ !om"$ete,ProQuest Dursing Q :$$ie# %ea$t&
4ource,:@0,0D5CR' !om"$ete,ProQuest Researc& Librar+
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