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When Marketing Health Care Services what is the most Suitable Marketing?

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 Vision 2020: Sustainable Growth, Economic Development, and Global Competitiveness 1787

When Marketing Health Care Services what is the most Suitable

Marketing?
Victor Lorin Purcarea, “Carol Davila” University of Medicine and Pharmacy, Romania
Iuliana-Raluca Gheorghe, “Carol Davila” University of Medicine and Pharmacy, Romania
Consuela-Madalina Gheorghe, “Carol Davila” University of Medicine and Pharmacy, Romania

Abstract

Along time, marketing philosophy developed around the concept of marketing-mix. Since the first
introduction of the 4Ps, namely, product, price, place and promotion, all marketing tools, techniques
and instruments revolved around the four politics. The marketing mix even today is the subject of
great debates. It is well known and proved that the marketing-mix for goods has great dissimilarities
in comparison to the one of services. Moreover, for each service individually, the marketing-mix has
to be adjusted to the characteristics enlightened. Health care services are no different. Some scientists
stated that a more suitable approach for services would be composed of 6Ps, 8Ps or 7Ps while for the
health care services some experts replaced the 4Ps with 4Rs. We believe that the health care
marketing-mix from the perspective of a consumer should consist of three stages; the first one being
described by marketing communications, the second one by servicescapes while the third one
emphasizing the benefits of the provided service.

Keywords: health care services, health care marketing, marketing mix

1. The concept of marketing-mix

The most important component and the core concept in marketing is the marketing mix.
Since the first introduction of the grouped elements of the mix, also known in the literature as the
4Ps, the concept became in time a bedrock in the evolution of the marketing field. The relevance of
the 4Ps has always been questioned by several specialists as the universality applied in practice is not
applicable in all settings such as consumer behavior, relationship marketing and service marketing.
Thus, the initial mix suffered modifications by adding, eliminating or merging some elements.
In the beginning there were 12 elements which made up the marketing mix as professor Neil
Borden in 1957 mentioned and described them. In 1964, McCarthy (1964) thought of regrouping the
12 components into four intercorrelated variables, naming them product, price, place and promotion,
none other than the 4Ps. The 4Ps were especially developed for the goods industry. In the area of
services, Booms and Bitner (1981) suggested the addition of other three Ps to the existing ones,
namely, participants, physical evidence and process. Due to the characteristics of services, even the
new 7Ps were to be extended to 8Ps or restrained to 6Ps. For many years the marketing mix in
services has been in the center of attention and, of course, under great debate.
In 1989, Zeithaml and Bitner (1996) called the 6th important P, that is, participants as
“people”. The “person-P” was considered in time as “customer contact” (Fryar, 1991), “personnel”
(Heuvel, 1993), “relationships” (English, 2000) or even “actor” (Grove et al, 2000). We believe that
Zeithaml and Bitner (1996) generally called this component “people” because they wanted to
emphasize both the importance of the established contacts and the role of the people who provide the
service. The product contained descriptive elements of the physical environment, quality levels or
branding. The place encompassed types of channels chosen as distribution as well as the
intermediaries integrated in the delivery system. Promotion designates strategies meant to
communicate something with the help of advertising, sales promotion, publicity, public relations,
online marketing. The price refers to flexibility, differentiation, discounts. The people were
considered all participants who play a fundamental role in the service delivery, as for example, the
1788 Vision 2020: Sustainable Growth, Economic Development, and Global Competitiveness

personnel. Physical evidence is made out of elements from the environment where the service is
offered. The physical evidence represents all tangible objects starting with equipment, building’s
architecture and ending with brochures or other descriptive elements which support the consumer in
“tangibilizing” the service.
In Lovelock and Wirtz’s (2007) opinion, the 4Ps should be extended to 8Ps as follows:
product, place and time, price and other outlays, promotion and education, process, people and
productivity and last but not the least, quality. The new elements are described in the next paragraph.
As such, the place and time component reflects the coordinates in terms of moments in time and
location when several specific methods and channels are employed in order to deliver the service.
The price and other user outlays indicate costs which are monetary and non-monetary. The Promotion
and education dimension is elaborated around the following objectives: to reform and provide advice
for consumers and persuade target consumers to buy the service, respectively. Process consists of
activities which reflect how organizations deliver the service. The physical environment contains
elements such as buildings, landscaping, equipment, interior furnishings while the people dimension
is considered one of the most important part of the services marketing-mix because the personnel is
the symbol of the service. Productivity and quality is the variable which has as outcome an
improvement.
Gronroos (2007) pointed out that other two variables should contribute to a more suitable
description of the marketing mix, namely internal marketing and interactive marketing. Actually he
describes the “service triangle”. The internal marketing is made out of an element to whom Zeithaml
and Bitner (1996) refer to as “the people”, suggesting employees, human resources, employee
recruitment, management and customer service, training, communication with the employees and
between employers. The interactive marketing refers to the components which Zeithaml and Biner
(1996) named process, product, place and physical evidence.
All in all, when analysis is made in different service backgrounds from a marketing-mix
perspective, most specialists apply the 8Ps or the 7Ps in the 4Ps description without motivating their
selection for the extended versions of the marketing-mix but they often describe the impact of a
certain component of the marketing-mix on other elements.

2. Health Care Marketing Mix

Since the recognition in the literature of the extended versions of the 4Ps, namely the 7Ps,
the 8Ps or the 6Ps, in the health care field, only few specialists approached the marketing-mix theme
and its application in medical practice. Due to lack of scientific literature, some of the health care
experts developed different variants of the marketing-mix. In contrast, when other service fields were
analyzed, the vast majority applied the extended 7Ps.
We presume that the best solution to uncover the suitable marketing-mix for health care is to
investigate most variants of the extended 4Ps and, consequently, select the most relevant ones
according to the particularities of health care services.
In health care there are two concept descriptions of the marketing-mix. On one hand there is
the 8-elements model (Gombeski, 1998) which consists of internal marketing, benefits development,
product development, targeting, channels, differentiation, selling and positioning, and, on the other
hand, there is the 4Rs version (English, 2000), that is relevance, response, relationships and results.
The 8-component health care marketing-mix is already composed of variables integrated before by
Zeithaml and Bitner (1996) but were renamed such as internal marketing, positioning and selling
which we think are the equivalents of people, price and promotion.
 Vision 2020: Sustainable Growth, Economic Development, and Global Competitiveness 1789

Fig. 1. A combination of different extended versions of the marketing-mix for services

Source: Gheorghe, I.R. (2012). Marketing Communications in Health Care Services. An Electronic-Word-of-
Mouth Approach (Doctoral Thesis). Academy of Economic Studies. Bucharest

The 4Rs of the health care marketing-mix is based on the fact that consumers have an
important role in the marketing process and is distributed through communication channels. The
shifts which took place in both the channel development and the internet led to a model which
according to English (2000) should encompass the following elements: relevance, response,
relationships and results. The Relevance component refers to a current position a health care
organization holds at a given time on a market. It is the equivalent of the targeting and positioning
elements from Gombeski’s (1998) model. Response is the outcome of the relevance dimension which
reflects the ideal position an organization desires to achieve based on the effective delivery. Effective
delivery includes proper targeting. Relationships encompasses the formal established links between
the organization and its targeted consumers started in the clinical process or the consultation stage.
Results is the component which evaluates the success of the strategies developed by an organization.
In general, health care results are measured with the “magnetism” principle. An organization which
develops strategies under the magnetism principle embodies strategies which focus on hiring and
retaining the best employees, increased market shares, partnerships with different other organizations.

3. Health Care Marketing Mix Development

In our opinion, for a better understanding of the marketing-mix in health care services is
necessary to have a clear view of the consumers’ perspectives.
We do not think that only the interactive part is important but the whole process. Thus we
consider the health care marketing-mix more like a process, a flow chart which is divided in several
activities. The in depth description of every step is called blueprinting.
Consequently, we believe that the health care marketing mix should encompass three main stages
as follows:
1790 Vision 2020: Sustainable Growth, Economic Development, and Global Competitiveness

- The first stage consists of elements used by organizations to promote their health care
services with the help of marketing communications, word of mouth, image.
- The second stage focus on elements which help consumers “tangibilize” the service
provided. They are called “servicescapes” (Bitner, 1992) or “physical evidence”.
- The third stage concentrates on the core benefits of a service.

Fig. 2. The Health Care Marketing Mix

Source: Gheorghe, I.R. (2012). Marketing Communications in Health Care Services. An Electronic-Word-of-
Mouth Approach (Doctoral Thesis). Academy of Economic Studies. Bucharest

References:
Bitner, M.J. (1992) ‘Servicescapes: The impact of physical surroundings on customers and
employees’, Journal of Marketing, 56, 57-71
Booms, B.H, and Bitner, M.J. (1981) ‘Marketing strategies and organization structures for
service firms’, in: Donnely, J.H., George, W.R. (Ed.) Marketing of Services. American
Marketing Association, Chicago, 47-51
English, J. (2000) ‘The 4Ps of Marketing are dead’, Marketing Health Services, 20(2), 3-20
Fryar, C.R. (1991) ‘What’s different about service marketing?’, The Journal of Marketing
Services, 5(4), 53-58
Gheorghe, I.R. (2012) ‘Marketing Communications in Health Care Services. An Electronic-
Word-of Mouth Approach (Doctoral Thesis)’, Academy of Economic Studies. Bucharest
Gombeski, W.R. (1998) ‘Better marketing through a principles-based model’, Marketing Health
Services, 18(3), 43-48
Gronroos, C. (2007) Service Management and Marketing. Customer Management in Service
Competition. Sussex: Wiley
 Vision 2020: Sustainable Growth, Economic Development, and Global Competitiveness 1791

Grove, S.J., Fisk, R.P., John, J. (2000) ‘Service as theatre, guidelines and implications’, in:
Handbook Services Marketing and Management. Sage Publications, Thousand Oaks, p. 25
Heuvel, J. (1993) Diensten Marketing. Wolters-Noordhoff, Groniengen, The Netherlands
Lovelock, C. and Wirtz, J. (2007) Services Marketing. People, Technology, Strategy. Prentice
Hall
McCarthy, E.J. (1964) Basic Marketing: A Managerial Approach. 6th Edition. Richard D. Irwin,
Homewood, Illinois
Zeithaml, V.A., Bitner, M.J. (1996) Services marketing. New York, McGraw-Hill
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