Chapter-2

Objectives and Methodology

The main aim of this chapter is to define the objectives of the study, outline the methodology
employed for carrying out the research study, and elucidate various concepts related to this
problem and to review the existing literature on marketing of hospital services in India.

Methodology
Need for the study
The available literature clearly indicates that much work has been done on various marketing
and other aspects of hospitals in advanced countries such as USA, UK, Germany etc, in terms of
service quality, brand equity, market function, patient relationship, service development,
consumer behavior, public relations, health care tourism, market segmentation, advertising,
hospital choice factors, customer complaints, food services, market orientation in hospital
industry, techniques regarding reducing different costs, optimum utilization of services
maintenance of bed-nurse ratio, doctor-patient ratio, management & administration, patient
satisfaction etc,. It is unfortunate that marketing in hospitals have not received adequate attention
in India. Due to the changes in technological, economic and political environment in India, the
marketing management scientists entered this field and made trails for improvement, the results
were moderate and not satisfactory.
To day, most hospital administrators would acknowledge that the well-being of their
organization depends upon the attraction of resources to enable a hospital to meet the historical
goals of patient care, teaching and research. Attraction of the necessary resources and acceptance
on the part of various publics of the hospital that the organization has attained its goals are vital
to the long-term survival of the institution. Marketing, with its explicit concern for resource
allocation and public acceptance, can provide useful tools for hospital managers working for the
survival of the voluntary hospitals. Recently more hospitals have deliberately become involved
in traditional marketing activities. This is the result of a changing health care environment on one
side characterized by high cost of treatment, unnecessary tests, lack of continuing medical
education and lack of research, lack of social responsibility, non-utilization of services of

49
specialized people, high expertise exodus, high fixed expenses, less subject to market forces -
have driven hospitals to increase their marketing efforts.
Another side, the problem of providing better services to common man and how to promote
these services in the market. Because the public today shows interest on corporate hospitals
which run their organizations on scientific lines. Some of the distinct features of these corporate
hospitals are; a) provision of all sophisticated services in various fields of specialization b)
availability of all diagnostic facilities under one roof c) availability of different specialists
without any inconvenience. In practice, corporate hospitals also have some drawbacks. Basically,
an average Indian citizen is not in a position to go to corporate hospital because of his
inaffordability. Middle-income groups and low-income group are not in a position to use this
facility because if a patient wants to have a cardiothoraic surgery, he has to spend Rs.75, 000 to
Rs.1, 25, 000 as package amount. For kidney transplantation one has to spend nearly Rs.2,
00,000. In this context, the question arises as to how many patients can utilize these services. The
answer is clear. Only higher income group can afford, leaving all the other groups out of reach.
One of the ways by which corporate hospitals can achieve total quality is by introducing
marketing in hospitals. With the stringent standards that must be maintained in today‘s consumer
driven health care market hospitals will have no option but to pay need to patient‘s demand for
quality.
Marketing to be viewed as a two-edged sword. It can be available tool for identifying the
current health services needs in a community, for helping to increase the rational development
and deployment of hospital resources in a manner that maximizes efficiency, and for serving as a
mechanism or increasing the satisfaction of all purchases of hospital services.
Unfortunately the management scientists have paid little attention on marketing management.
One can not afford to ignore its marketing aspects to tackle the complex situation. To excel in
hospital industry, one has to incorporate new and innovative ways to decrease the costs and to
increase high quality of care and a strong patient orientation. There is a need of shifting the focus
for decision making from provider-focused care to patient-focused care.
As a researcher, my effort is to explore the necessity of establishing marketing principles in to
hospitals for more effective promotion of their services. The study is limited to specific hospitals.
Emphasis has been laid on application of marketing principle i.e. 7p‘s of services marketing

50
(Marketing Mix i.e. Product, Price, Place, Promotion, People, Physical Evidence and Process)
need for better promotion of hospital services to the society in the present complex environment.
Objectives of the Study
The study falls under the area of marketing. The theme in broad is to analyze the marketing
mix and how far this tool useful in the present situation and to compare the hospitals which run
under different managements. The broad objective for which the research has been undertaken is
to investigate in to the marketing process i.e. 7p‘s of services marketing in selected super-
specialty hospitals. The justification of selecting healthcare organizations and emphasis on
hospitals is a matter of interest and where it has been observed that the hospitals has not been
following marketing techniques for effective promotion of their services. Therefore, it has been
thought fit to evolve a suitable marketing programme to the selected hospitals. Specific
objectives of the research can be discussed under the following heads.
To study the growth and working of hospitals.
To analyze the 7P‘s of marketing mix (Product, Price, Place, Promotion, People, Physical
Evidence and Process) in selected hospitals.
To study the perceptions of administrative, doctors and nursing staff.
To ascertain the satisfaction levels of patients in selected hospitals.
To suggest suitable measures for effective marketing of the hospitals
Hypothesis
Most of the hypotheses developed for the study are based on commonly held notions. The
hypotheses framed for this purpose are
1) The perceptions of the doctors, nursing staff and administrative personnel in the
hospitals are indistinguishable with respect to the (Product/Service, Price, Place,
Promotion, People, Physical Evidence and Process) marketing of their services.
2) The perceptions of the patients in the two hospitals are indistinguishable with
respect to the (Admission, Comfort, Food Facilities, Care, Business Office and
Discharge) performance of the hospitals.
3) The hospitals that serve on the principles of marketing can gain better patient
satisfaction.

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Scope of the Study
The scope of the present study extends to analyze how far the marketing mix i.e. 7P‘s of
services marketing; product/service, price, promotion, distribution, people, physical evidence and
process are carried out effectively in sample units. The assumption is that the hospital runs on
sound marketing principles will excel and patient satisfaction will be high. For this purpose it is
proposed to elicit the perceptions from the doctors, nursing staff and administrative staff. The
study however excludes the paramedical staff keeping in view the voluminous of the survey and
poor capabilities in quantifying their qualitative attitudes, other problems like management
process, finance related aspects, and human resources related aspects are also excluded. Bed
capacity sizes offered by super specialty hospitals are taken as basis for sample selection.
In the next step, an attempt has been made to elicit the opinions from patents, because every
human being carries a particular set of thoughts, feelings and needs. The expectations of the
patients might be of value for those who want to know the real person within the patient. It gives
new ideas and suggestions. One must admit that there are lots of things which could be altered-
moreover. The concept, scope and philosophy of the hospital of today are far different from
those of the past. Once upon a time, the hospitals were regarded as curative institutions and today
these hospitals are being recognized more and more as social institutions and focal point is
patient‘s satisfaction. In order to find out an answer to the question how far the high-tech super-
specialty hospitals satisfying the patient needs and what they are wishing for, the survey was
conducted. Patients‘ perceptions about medical care are increasingly important because the
success of a hospital depends on the satisfaction of the users. Moreover an organization exists to
achieve its goal, whatever one may say, is always primarily to provide highest quality of patient
care. For this one has to determine what questions could be put to the patient and which needs
are important to satisfy? There are various factors which influence a patient‘s expectations; some
of the expectations include efficiency, confidence, helpfulness, personal interest, reliability.
These are intrinsic factors. External factors like media influence and experience of others also
influence the patient‘s response. Hence, the study is undertaken to identify various factors
influencing patient‘s satisfaction in two sample hospitals that are having similar and identical
facilities.

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Limitations of the Study
The primary limitation of this study relates to the behavioral sciences. The basic limitation
of behavioral sciences is that they would deal with attitudes. These attitudes differ from
individual to individual. Even though utmost care has been takes in selecting the sample, the
results derived form a study may not be exactly equal to the true value of the population. Hence
results of the study are considered to be true, and relationships hold good, only for this study.
Perceptions of the respondents are measured through observation personal interview
questionnaire and schedules. The authoritarian system in Indian corporates may cause
respondents to answer with partially frank acknowledgement of feelings. It became very difficult
to meet and elicit opinion of administrators, doctors due to their busy schedules. However,
doctors and administrators of different hospitals did co-operate. This research project would not
have been possible without the help received from them.
The second limitation of this study is the size of the problem; the study is limited to
marketing only. It has become difficult for the researcher to collect data from different hospitals.
Therefore popular two sample hospitals are selected.
Research Design
The study is mostly exploratory in nature and it aims at explaining how far the marketing
useful in the present situation to the hospitals. In this part, an attempt has been made to explain
the research design, the procedure of sample selection, methodology used in data collection,
analysis, and presentation.
Selection of Sample Hospitals
The researcher has selected two different hospitals in Hyderabad city. They are APOLLO
HOSPITAL, Jublihills and CARE HOSPITAL, Banjarahills. They run on modern scientific and
high tech lines, under the control of private management.
Selection of Sample Size and its Justification
A detailed study of two super-specialty hospitals (Apollo and Care) that run on different lines
were taken up for study. A study of marketing services in the selected hospitals led the
researcher to propose suggestions with respect to suitable marketing programs. In each hospital,
the sample is taken from four categories after giving adequate representation to all classes. The

53
four classes include 1. Doctors 2. Nursing staff 3. Administrative personnel and 4. Patients. The
analysis relating to patients is dealt in chapter-5
Table no: 2.1 showing the information pertaining to two selected super specialty hospitals

Table No: 2.1

Information Relating to Sample Hospitals

Sl.No Particulars Apollo Care

1 Doctors 156 127
2 Nursing staff 560 510
3 Administrative personnel 45 40
5 In patients 550 460

Table no: 2.2 showing the information regarding the sample size after giving adequate
representation to all classes

Table No: 2.2

Sample Size of Selected Hospitals

Sl.No Particulars Apollo Care Total

1 Doctors 75 75 150
2 Nursing staff 150 150 300
3 Administrative personnel 35 35 70
4 Patients 250 250 500

Pertaining to the questionnaire to doctors in Apollo, out of 156 doctors, the questionnaire was
distributed to 85 doctors. The filled questionnaires were received from 80 respondents and only
75 response sheets were taken for final analysis. Out of 127 doctors in Care hospital, the
questionnaire was distributed to 90 doctors. 85 filled questionnaires were received from
respondents and 75 response sheets were selected for final analysis.
In the case of questionnaire relating to nursing staff in Apollo hospital, out of 560 nurses, 340
nurses are working on permanent basis and 220 are working on contract basis. The questionnaire
was distributed to 170 nurses who are working on permanent basis only. 162 filled
questionnaires were received from respondents and 150 questionnaires were selected for final
analysis.
In the case of Care hospital, out of 510 nurses, 320 nurses are working on permanent basis
and remaining 190 are working on temporary basis. The questionnaire was distributed to 180

54
respondents who are working on permanent basis. Out of them 150 response sheets were taken
for final analysis.
The questionnaire for administrative personnel was distributed to 45 numbers in Apollo, and
35 numbers were selected as sample for final analysis. Out of 40 administrative personnel in
Care hospital, 35 persons are selected for final analysis.
Table no: 2.3 presents the information pertains to the department, designation, experience,
qualifications of sample doctors in selected hospitals.
Table No: 2.3
Departments, Designation, Experience and Qualifications of
Sample Doctors in Selected Hospitals

Sl.No Particulars Apollo Care Total

Total % Total % Total %
Medical 30 40.00 33 44.00 63 42.00
1 Department Surgical 45 60.00 42 56.00 87 58.00
Total 75 100.00 75 100.00 150 100.00
Professors 12 16.00 10 13.34 22 14.66
Assoc. Professors 33 44.00 35 46.66 68 45.35
2 Designation
Asst. Professors 30 40.00 30 40.00 60 39.99
Total 75 100.00 75 100.00 150 100.00
Below 5 years (A) 18 24.00 22 29.34 40 26.67
5yrs.to 10 yrs (B) 28 37.30 33 43.99 61 40.67
3 Experience
Above 10 yrs. (C) 29 38.70 20 26.67 49 32.66
Total 75 100.00 75 100.00 150 100.00
Graduation 8 10.60 12 15.99 20 13.33
Post graduation 27 35.90 32 42.67 59 39.33
Super Specialization 40 53.50 31 41.34 71 47.34
4 Qualification
Total 75 100.00 75 100.00 150 100.00

Through the above table, the researcher tried to elicit the information regarding whether the
respondents belonged to medical or surgical departments. Out of 150 respondents 63 respondents
belong to medical department, and 87 were in surgical departments. Of the 75 respondents in
Apollo, 30 (40.00%) belong to medical department and 45 (60.00%) in surgical department. In
Care, out of 75 respondents, 33 (44.00%) are in medical department and it was followed by 42
(56.00%) respondents in surgical department. From the above analysis the conclusion may be
drawn that all the respondents in different hospitals are almost equally distributed among
medical and surgical departments with very little variations.

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Designation: The table no: 2.3 gives information relating to the distribution of respondents
based on designation. Here the respondents were divided into 3 categories. Professors, associate
professors and assistant professors. Of the 150 respondents. 60 are assistant professors, 68 are
associate professors and 22 are professors. Out of 75 respondents from Apollo, 30 are assistant
professors i.e. 40%, 33 are associate professors i.e. 44%, and 12 are professors i.e. 16%. Out of
75 respondents from care 30 are assistant professors i.e. 40%, 35 are associate professors i.e.
46.66% and 10 are professors i.e. 13.34%. From the above discussion it may be concluded that
out of 150 respondents, most of them, 68 are associate professors and it is followed by assistant
professors and professors.

Experience: For the sack of convenience, all the respondents in the example hospitals under
study were classified in to three classes: class-A respondents who are having less than 5 years
experience, class-B the respondents who are having experience in between 5 and 10 years and
class-C the respondents with more than 10 years experience. Among 150 respondents, 61 are in
class B and it was followed by class-C respondents with 49 and class-A respondents with 40. In
the case of Apollo, out of 75 respondents, 28 are in class B with the 37.30%, in class-C are with
38.70% and in class-A are 18 with 24%. In care, out of 75 respondents 33 are in class-B with
43.99%, in class-C are 20 with 26.67% and in class-A are 22 with 29.34%. from the above
discussion, it can be said that most of the respondents in Apollo and care are in class-C i.e. with
more than 10 years of experience. But in care considerable number of respondents is in class- B
i.e. with 5 years to 10 years to 10 years of experience.

Qualifications: The table no: 2.3 reveals that, the qualifications of the sample doctors in two
hospitals under study. These qualifications were studied under 3 categories, those who completed
graduation, and those who did post graduation and doctors who are having super specialty
degrees. The cross sectional analysis of the sample doctors reveals that out of 150 respondents 71
have super specialization as their qualification and it was followed by 59 respondents who are
having post graduation and only 20 are graduates. Of the 75 respondents in Apollo, 40 are super
specialization with 40%, 27 are post graduation with 35.90% and 8 respondents is graduation
with 10.60%. In care, out of 75 respondents, 32 are postgraduates with 42.67%, the respondents

56
having super specialization are 31 i.e. 41.34% and only limited number of respondents having
graduation are 12 numbers with 15.99%. From the above information, it may be said that
considerable percentage of respondents are having super specialization as their qualifications.
Especially in Apollo they are in majority and only 8% are graduates.
Table no: 2.4 presents the information pertaining to the department, designation, experience and
qualifications of sample nursing staff in selected hospitals.

Table No: 2.4

Department, Designation, Experience and Qualifications of
Sample Nursing Staff in Selected Hospitals.

Particulars Apollo Care Total

Sl.
No
Total % Total % Total %
Medical 73 48.70 80 53.40 153 51.00
1 Department Surgical 77 51.30 70 46.60 147 49.00
Total 150 100.00 150 100.00 300 100.00
Head Nurse 26 17.30 23 15.30 49 16.30
2 Designation Staff Nurse 124 82.70 127 84.70 251 83.70
Total 150 100.00 150 100.00 300 100.00
Below 5 Years (A) 28 18.60 33 22.00 61 20.50
5yrs.to 10 Yrs (B) 68 45.50 78 52.00 146 48.60
3 Experience Above 10 Yrs. (C) 54 35.90 39 26.00 93 30.90
Total 150 100.00 150 100.00 300 100.00

Diploma 27 18.00 34 22.60 61 20.50

Degree 84 56.00 93 61.90 177 58.90
4 Qualification Others 39 26.00 23 15.50 62 20.60
Total 150 100.00 150 100.00 300 100.00

Department: Out of the 300 respondents who are taken as sample, 153 respondents are from
medical department and remaining 147 are from surgical department. The cross sectional
analysis of the sample reveals that out of 150 respondents in Apollo 153 (51%) belongs to
medical department and 147 (49%) are in surgical department. Out of 150 sample respondents in
Apollo, 77(51.30%) respondents are belonged to the surgical department and 73(48.70%) are in
medical department. In Care, out of 150 sample respondents, 80(53.40%) are in medical
department and, 70 (46.60%) respondents are in surgical department. From the above data, it

57
may be concluded that all the respondents are almost equally distributed among two departments
in different hospitals.

Designation: Out of 300 respondents that are taken as sample, 49 are head nurses, 251 are staff
nurses. In the case of Apollo, out of 150 respondents, 124 (82.70%) are staff nurses and
26(17.30%) are head nurses. Out of 150 respondents who belonged to Care, 127 (84.70%) are
staff nurses and 23 (15.30%) are head nurses. From the discussion it can be stated that, most of
the respondents belongs to staff nurse category.

Experience: For the convenience of the study, the experience of the nursing staff is classified
into 3 classes. Class-A respondents who are having less than 5 years experience, class-B
respondents having experience between 5 and 10 years and class-C the respondents who are
having more than 10 years experience. Among 300 sample employees in three hospitals under
study, 146 employees are in the category of 5 to 10 years and it was followed by 93 employees
with more than 10 years of experience and 61 employees having less than 5 years experience.
Out of 150 respondents in Apollo, 68 (45.50%) are in class-B, followed by 54 (35.90%) in class-
C and 28 (18.60%) in class-A. Out of 150 respondents in care, 78 (52%) are in class-B, followed
by 39 (26%) are in class-C and 33 (20%) are in class-A. From the above analysis it may
concluded that considerable number of employees in both the sample hospitals, having
experience with 5 years to 10 years i.e. class-B.

Qualifications: All the respondents were classified as diploma holders, degree holders and
others. Out of 300 respondents in sample hospitals, 177 (58.90%) are degree holders, 62
(20.60%) are others and 61 (20.50%) are belong to diploma category. In the case of Apollo, out
of 150 sample respondents, 84 (56%) are degree holders, 39 (26%) are others category and 27
(18%) are diploma holders. In Care out of 150 respondents, 93 (61.90%) are degree holders, 34
(22.60%) are diploma holders and 23 (15.50%) are others. From the analysis it may be stated that
in sample respondents most of them are degree holders, considerable number in Apollo are
‗Others‘ and in Care diploma holders.

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 Table no: 2.5 presents the information pertaining to the qualifications, experience of the
administrative personnel

Table No: 2.5

Qualifications, Experience of the Administrative Personnel

Apollo Care Total

Particulars
Sl.No
Total % Total % Total %
1 Experience Below 10 Yrs (A) 8 22.80 12 34.20 20 28.50
10 yrs- 20 Yrs (B) 18 51.50 17 48.60 35 50.00
Above 20 Yrs (C) 9 25.70 6 17.20 15 21.50
Total 35 100.00 35 100.00 70 100.00
2 Qualification Graduation 13 37.20 08 22.90 21 30.00
Post Graduation 12 34.30 19 54.30 31 44.30
Specialization 10 28.50 8 22.80 18 25.70
Total 35 100.00 35 100.00 70 100.00

Experience: For the sake of convenience, all the respondents are grouped in to three categories
in two sample hospitals. They are class-A the respondents having experience of less than 10
years, class-B the respondents having experience between 10 and 20 years and class-C the
respondents having experience of above 20 years. Among the said 35 respondents in Apollo 18
(51.50%) are in class-B, 9 (25.70) are in class-C and running 8 (22.80) are belongs to class-A. in
care, of the 35 respondents, 17 (48.60%) are in class-B, 12 (34.20%) are in class-A and in class-
C there are only 6 (17.20%). From the above discussion, it my be concluded that the respondents
are distributed in such a way that considerable number in Apollo and care are having between 10
years to 20 years (i.e. class-B).

Qualifications: The qualifications of the sample respondents in two hospitals reveals that, 70
respondents were classified into the administrative personnel who are graduates and the
respondents who are postgraduates and the respondents who have specialization degree. Among
70 respondents, 18 are having specialization degrees in addition to basic requisite qualifications
and 31 are only post graduate and rest of the respondents (21) are graduates. Cross sectional
analysis of respondents in two sample hospitals reveals that out of 35 respondents in Apollo, 10
(28.50%) are having specialization degrees, 12 (34.30%) are post graduates and 13 (37.20%) are

59
only graduates. In the case of care‘s, out of 35 respondents, 8 (22.80%) are having specialization
degrees along with basic qualifications, 19 (54.30%) are post graduates and only 8 (22.90%) are
graduates. From the above discussion, the conclusion may be safely drawn that a majority of
respondents in two sample hospitals under study are having post graduate degrees and
considerable percentage of respondents are having specialization degrees along with basic
degrees.
Patient analysis
In order to know the socio economic background of patients which helps in identifying
meaningful relations, an attempt has been made to elicit the information from patients. This was
separately discussed in chapter-5
Data Collection Procedure
First of all permission was sought from the selected two hospitals. The questionnaire was
adopted from eminent research scholars work and was made meticulous changes to suit the needs
of the present scenario, the same was distributed to the personnel who were selected as sample
and in some cases researcher explained the implications of the questions Respondents were
asked to fill the set of questions as per instructions mentioned on them. They were specifically
requested not to read all the items at once but to go through each individual statement and
answer it and then only move on to the next. Respondents were assured of the confidentiality of
their responses. All respondents were encouraged to express their opinions freely and fairly.
Precautions were also taken to obtain unbiased results. On an average it took more than one hour
to answer one questionnaire. Schedules are explained personally in a vernacular language and
were filled in by them personally. The filled in questionnaires were collected back by researcher
personally. The interview schedule was distributed when the patients were in private rooms/ward
before their discharge from the hospital. Each patient is given a brief explanation about the
purpose of the enquiry and asked for their cooperation and assured that strict confidentiality
would be maintained. During interview, the researcher attempted to see that the patients would
be neutral and independent. The questionnaire was collected back after two hours.
Collection of Data
The data has been collected from both sources i.e. primary and secondary. For collection of
data from primary sources, efforts were made to elicit the opinions of almost all personnel in the
organizations through observation, personal interviews, questionnaires and schedules. The

60
researcher spent months together in sample hospitals for observing the marketing process in
selected hospitals. Apart from the notes and other written information, audio cassette recorder
has also been used to personal discussions. In depth interview technique has been used here for
collecting primary data. This has been collected through personnel observation and the
information collected from the hospital documents, annual reports, budgets. Beside primary data,
wherever necessary the information has also been collected from the reports of central and state
governments. The researcher visited and collected information from the various institutions
including National Institute of Health and Family Welfare, All India Institute of Medical
Sciences, Voluntary Health Association of India, National Medical Library, ST. John‘s Medical
College, Administrative Staff College of India Library, Apollo Institute of Hospital Management
Library, Nizam‘s Institute of Medical Sciences library etc.
The date for the study was collected by administering the questionnaires, schedules and
through observation method. Observation method is one of the most important and extensively
used methods in social sciences research. It is one of the primary research methods. All the times
it is not possible to use quantitative techniques. In those circumstances, observation method
bridges the gap. On the other hand questionnaires are widely used for data collection in social
sciences research particularly in surveys. It is fairly reliable tool for gathering data from large,
diverse, varied and scattered social groups. It is used in obtaining objective and qualitative data
as well as in gathering information of qualitative nature. It is treated as the heart of the survey
operation.
In this context it is proposed to distribute two types of questionnaires and each type carries
two parts. The first type was distributed to the doctors, nursing staff and administrative personnel
and the second type of questionnaire was distributed to the patients. Part-1 of both the types of
questionnaire consists of socio-economic information. Part-2 of the questionnaire which was
distributed to doctors, nursing staff and administrative personnel pertains to different statements
regarding marketing process of their services i.e. offering services, pricing of services,
promotional activities, services distribution, people, physical evidence and the process of their
services. The instrument was tested by author for its reliability and validity. A five degree scale
(Summated Scale) was used. It contains the columns of strongly agree, agree, can‘t say, disagree,
strongly disagree of the respondents with the given statement. In this aspect researcher has took
help from the different eminent people in the concern area.

61
 Part-2 of the second type of questionnaire which was distributed to the patients pertaining
different statements regarding satisfaction levels of patients on services offered by the selected
hospitals. The instrument was tested by author for its reliability and validity. A five degree scale
was used. It contains the columns of strongly agree, agree, can‘t say, disagree, strongly disagree
of the respondents with the given statement. In this aspect researcher has took help from the
different eminent people in the concern area.
Methodology for Data Analysis
The questionnaire, which was intended to diagnose the problems involved in marketing the
services in sample hospitals, contains sixty four statements in total. The count of responses are
considered and for each type of response (Strongly Agree, Agree, Can‘t Say, Disagree and
Strongly Disagree) and for each hospital the percentages are calculated. Here an attempt has
been made to diagnose the problems involved in marketing services (marketing mix –wise) in
two sample hospitals based on calculated percentages. Later the data was analyzed by applying
ANOVA to know weather the perceptions of respondents are indistinguishable or not with
respect to the 7P‘s of marketing services of sample hospitals. Further, the data collected from
patients is also analysed by the same technique ANOVA to know the perceptions of the patients
on performance indicators of the sample hospitals. (See statistical analysis and methodology).
Patient Analysis
In order to know the socio economic background of patients which helps in identifying
meaningful relations, an attempt has been made to elicit the information from patients. This was
separately discussed in chapter-5.
History of Sample Hospitals
APOLLO Hospital (Jublihills, Hyderabad)
Apollo Hospitals, Jubilee Hills, Hyderabad (formerly known as Deccan Hospitals Corporation
Ltd.) was formally inaugurated by the then President of India, His Excellency R. Venkat Raman
on 27th, August, 1988. Pratap.C.Reddy floated Deccan Hospitals Corporation Ltd. It is the first
corporate multispecialty hospital in the state of Andhra Pradesh. This corporation started in
purely private sector for providing hospital services and is affiliated to Apollo Hospital Group.

62
 Apollo Hospitals, Jubilee Hills, Hyderabad is a 550-bed tertiary care centre, with 95% of
occupancy rate. It has over 50 medical and surgical disciplines, spread over a campus area of 35
acres with built-up area of 190,000 square feet. Its services are supported by sophisticated
technology and experienced medical professionals. The first PET CT Scanner in India was
installed at Apollo Hospitals, Hyderabad in January, 2005. Most of the consultants at the hospital
have international experience either educational, work experience - related or observational. The
average staff to patient ratio for the hospital is 3:1 with a 1:1 ratio prevailing in priority areas like
the Intensive Care Unit and the Cardiac Care Unit. Apollo Hospitals, Hyderabad handles close to
100,000 patients a year. International patients from Tanzania, the USA, the UAE, Kenya, Oman
and neighboring Asian countries are treated by the hospital every year.
The corporation has marked the beginning of a new genre of hospitals, committed to bring
the latest advances in medical care within every individual‘s reach. It is primarily a super-
specialty hospital covering every major area of medicine and it was perceived as a part of a
larger cause to improve healthcare delivery system in India.
Today, Apollo Hospitals, Hyderabad has risen to be on par with the best in terms of technical
expertise, deliverables and outcomes. Apollo Health City, Hyderabad covers the entire spectrum
to illness to wellness and is thus a health city and not a medical city. Institutes for Heart
Diseases, Cancer, Joint Diseases, Emergency, Renal Diseases, Neurosciences, Eye and Cosmetic
Surgery are all centers of excellence and are positioned to offer the best care in the safest manner
to every patient. Apart from patient care, each of these centers of excellence spend a significant
amount of time in training and research essentially aimed at preventing disease and improving
outcomes when the disease does occur
Hyderabad Apollo Hospital has the best amalgamation of the medical specialties, lab services,
radiology, rehabilitation, sophisticated equipment, and paramedical staff with the back-up of
other support services. While Apollo heart hospitals the heart of the hospital, other departments
like Oncology, Neurology and Neuro-Surgery, Urology and Nephrology, medical and surgical
Gastro-Enterology, internal medicine, Orthopedics, ENT, Opthomologyto mention a few, were
well established.

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Mission Statement of Apollo
‗To bring healthcare of international standards within the reach of every individual, this group
is committed to the achievement and maintenance of excellence in education, research and
healthcare for the benefit of humanity‘

Objectives of Apollo Hospital

Apollo hospital is working for following objectives.
To provide multi and superspeciality by medicine under one roof by adopting holistic
approach.
To provide healthcare based on state-of-the-art technology and expertise at optimum cost
ensuring value for money.
To provide excellent medical care with a human touch by integrated team work and
effective quality system with monitoring and feedback.
To carry out continuous up gradation of technology and human resources development
activities in a congenial and safe environment.
To be an environment-friendly, socially and ecologically conscious organization.

Today Apollo offers the services of 52 self sufficient departments, each is headed by a
specialist with years of experience and high professional standing. Now Apollo is working with
34 full fledged departments including 4 superspeciality departments. It has 8 wards with more
than 150 doctors. In addition, in-house doctors are available for all major specialties, round the
clock. The major specialties on clinical side include cardio-thoracic-vascular surgeries,
nephrology, urology, gynecology, neonatology, gastro intestinal surgery etc. On the other hand
Apollo Emergency Centre offers the complete range of facilities necessary to take care of a kind
of medical and surgical emergency. It is available for all the 365 days a year and 24 hours a day.
Fig no: 2.1 explain the specialties of Apollo hospital.

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 Fig. No: 2.1
Apollo Hospital Specializations

APOLLO

Heart Institute

Cancer Institute

Institute of Neurosciences

Institute for Ambulatory Care

Institute of Renal Sciences

Institute for Cosmetic Surgery

Institute of Joint Diseases

Institute of Life Style Management &

Preventive Care-

Institute for Rehabilitation &

Rejuvenation

Eye Institute -

Ayurveda Rejuvenation

Apollo knows that good care involves more than good medicine. Apollo Health City,
Hyderabad thus strives to go beyond good medicine towards good health. Being the first city in
Asia, it provides the impetus for more such institutes to develop and places Hyderabad on the
global map of quality healthcare. The highlights of Apollo services include 24 hours emergency
and Trauma care backed by wireless ambulances with life support systems stationed at different
locations in the city available 365 days a year, 24 hours blood bank and lab services, 24 hours
pharmacy in 4 centers in the city, Hospital beds to suit different patients‘ needs, Attendants‘
accommodation in the premises, Restaurant and coffee shop, Very low infection rate,
comparable to world standards. The extra interest in the hospital is Apollo Russian Eye research
institute. It is doing complex eye surgeries like radial keratomy, scieroplasty etc. Deccan

65
Hospital Corporation Ltd., regularly offers health programmes to ensure good health. Already
this group has conducted over one lakh check-ups.
Hyderabad Apollo Hospital is recognized by over one hundred organizations in public as well
as in private sectors. Some of these are – SAIL, Coal India Limited, BHEL, NMDC, IOCL,
ONGC, ESI, CRPF, Indian Airlines, Railways, Steel Plants, MMTC, MECON, NSA, STC, UTI,
TECCO, TISCO, ITC. The hospital is also recognized by CGHS, CGM&A. Army Group
Insurance Fund, Air Force Group Insurance scheme, Kendriya Sainik Board under Central
Government of India and the State Governments of A.P., Assam, Madhya Pradesh, Manipuri,
Meghayala and Orissa.
This Apollo Health Association, the insurance wing of Apollo Group, with large number of
policy holders is dedicated to the concept of preventive healthcare and healthcare insurance. The
members are entitled to credit facilities at all the Apollo Group Hospitals. All inpatient services
including both minor and surgical procedures are covered under this scheme. Apollo Hospital,
Hyderabad is offering Masters Degree in Hospital Management, School of Nursing etc. Apollo
Hospital Educational and Research Foundation was set up with the primary objective of
establishing, maintaining and supporting institutions for promoting medical, paramedical and
hospital management educational courses. The foundation facilitates research and consulting in
hospital administration. Apollo believes that there should be no compromises and that you
deserve only the best, the best doctors, the best nurses, the best medical care system with the
most advances equipment and treatment procedure. The hospital is committed to providing out
patients with the best possible healthcare.
About the Group
The dream nurtured and grew within Dr. Prathap C Reddy, the founder Chairman of Apollo
Hospitals, until the point of inflection happened in 1983. A young man succumbing to an ailing
heart was what it took to ignite Dr. Reddy's vision into a reality - a vision where quality
healthcare was given, where the pursuit of clinical excellence was daily endeavor, India a hub in
the medical tourism map and where the Apollo family touches and enriches lives every minute,
every day.
Apollo Hospitals started as a 150 bed hospital in Chennai in 1983. And it has to be said,
amidst much skepticism. India in the early 80's was not the easiest place for private enterprise.
Moreover private healthcare institutions were unknown and they were not doing cutting edge

66
work. 25 years later it is an amazing story of success, achievement and most importantly, dreams
realized. As Apollo Hospitals has made colossal strides to reach where it is, more and more
facets of the founding vision have turned to reality.
Today Apollo Hospitals is not just one of the country's premier healthcare providers but has
also played a pioneering role in helping India become a center-of excellence in global healthcare.
The Apollo Hospitals group today includes over 7500 beds across 43 hospitals in India and
overseas, neighbor hood diagnostic clinics, an extensive chain of Apollo Pharmacies, medical
BPO and health insurance services and clinical research divisions that are working on the cutting
edge of medical science.
However the largest achievement of the Apollo Group has been to take quality healthcare to
across the length and breadth of India. Of touching 10 million lives and giving hope to an entire
segment of the Indian population who did not have an option beyond limited medical
infrastructure. Apollo has succeeded in being more than just a quality healthcare provider. It has
been a major player in scripting the medical landscape of the nation. This is primarily because
the group has continuously been at the helm of several game-changing innovations in Indian
healthcare. By the start of the new millennium, Apollo Hospitals Group had become an
integrated healthcare organization with owned and managed hospitals, diagnostic clinics,
dispensing pharmacies and consultancy services. In addition, the group's service offerings
include healthcare at the patient's doorstep, clinical & diagnostic services, medical business
process outsourcing, third party administration services and heath insurance. To enhance
performance and service to customers, the company also makes available the services to support
the business of healthcare; telemedicine services, education and training programmes & research
services and a host of not- for- profit projects.
The management structure of Apollo constitutes executive chairman, managing director,
executive director for finance and executive director for operations. There are eleven members
working as non-executive directors for different responsibilities.
Awards & Achievements won by Apollo Group
Over the years, Apollo has received many awards and accolades in recognition of its
pioneering achievements in Indian healthcare. They are, Apollo Hospitals, Chennai & Hyderabad
won the healthcare awards 2008, instituted by the Express Healthcare Publications (The Indian
Express Group), Apollo Hospitals Chennai- Overall Best Hospital of the year, Apollo Hospital

67
Chennai- Operational Excellence, Apollo Specialty Hospital, Chennai- Leveraging Global
Opportunity, Apollo Health City Hyderabad- Sustained Growth, Apollo Health City Hyderabad-
Patient Care, Apollo Hospitals, Chennai has been rated 'Best Private Sector Hospital' in India by
The Week magazine for 2003, 2004, 2007 and 2008, Apollo Hospitals was recognized as a
'Superbrand of India' in the healthcare sector for 2003, and 2004, Apollo Clinics were awarded
Franchisor of the Year for 2003 and 2004, The Asia-Pacific Bio Business Leadership Award
2005 was awarded to Dr. Prathap C. Reddy, Founder Chairman Apollo hospitals group, Modern
Medicare Excellence Award 2006-07 award to Dr.Prathap C Reddy, Founder Chairman, Apollo
Hospitals Group, by ICICI Group, to honor outstanding achievements in the healthcare industry,
Save a Child's Heart (SACH) - was a runner-up in the 'Corporate Governance' category at
Hospital Management Asia 2004, a major hospital expo in Bangkok, Thailand, Avaya Global
Connect award went for the second successive year, in 2006, to Apollo Hospitals, Hyderabad for
customer responsiveness in the healthcare sector based on a nation wide polling exercise.
CARE Hospital (Banjarahills, Hyderabad)
The Care Group of Hospitals owned by Quality Care India Limited (QCIL) acquired a five-
star hotel premises at Banjara Hills, Hyderabad in the year 2000 and converted it into 200 bed
multi-specialty hospital in the year of 2002. Today, the Hospital stands tall with 460 beds,
including 120 critical care beds, with annual inflow of 1, 80,000 patients for consultations, and
16,000 patients for admission. Care Hospital, The Institute of Medical Sciences, Banjara Hills,
the flagship Hospital of Care Group, comprises contemporary accommodation facilities ranging
from general wards to super deluxe rooms. With the presence of more than 127 specialist
physicians the Hospital Provides specialty medical services in cardiology, cardio-thoracic
surgery, pediatric Cardiology, pediatric cardio-thoracic surgery, neurology, Neuro surgery,
nephrology, urology, Internal Medicine, Gastroenterology, Pulmonology, ENT, Orthopedics,
Organ Transplants etc round the clock.
Their services range from inpatient care such as Intensive Care, Cardiac Care, Neurological
Care, Pediatric Care, Medical Care, Surgical Services, Diagnostic and Emergency Services to
outpatient services such as Outpatient Consultancy, Non-Invasive Laboratories, Life Style Clinic
Which Practices Preventive Medicine, Radiology, Respiratory Therapy, Physiotherapy And
Home Health Care.

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 The Hospital is equipped with state of the art equipment and has 10 operating Rooms catering
around 400 cardiothoracic surgeries and 1000 non cardiac surgeries annually. The Hospital also
acquired the first dual source, 128 slice CT scanner (For High Precision Cardiac Imaging) the
first of its kind in south India. Care Banjara also has the reputation of being the first Hospital to
launch online Telemedicine services, a service that links various district hospitals and second
team to perform Cardiac transplantation in the state.
Mission Statement of Care Hospital
‗To provide the best and cost effective care, accessible to every patient through integrated
clinical practice, education and research.‘
Vision
To evolve as a unique university - based health- centre where the quest for the new
knowledge would continuously yield more effective and more compassionate care for all.
To nurture a new generation of professional of life-long commitment, dedication,
knowledge, skills, wisdom and values.
To strive for public trust and maintain medicine‘s humane and noble place amongst
professions.
To be globally competitive in health care and related business integrating local culture
and ethos.
Objectives of CARE
Care hospital is working for following objectives.
Upgrade its education and Research wing on par with the international standards and
consequently develop healthcare solutions for under developed and developing areas.
Offer unique platform to various partners and collaborators, both national and
international, to innovate in healthcare delivery systems, coverage systems like
microfinance/micro insurance, medical education and research.
Develop healthcare solutions for underdeveloped and developing countries.
To develop comprehensive healthcare delivery model that suits our population.
To develop centers of excellence in medical specialties.
To compromise the obsolete and seek excellence through effective and up-to-date
technology and service.
Undertake clinical practice through high-end education and research.

69
 Create a web of PCD clinics, corporate health plans, and associates program to leverage
the use of technology and gain access to remote areas.
Care hospital always stands first in acquiring new technologies used in disease management.
It facilitate professionals with the latest and advanced equipments i.e. Cath lab. Machine,
Operation Theatres, MRI, CT Scan-Dual Source CT Scan Machine, Echocardiography, TMT,
Holter, Nuclear Medicine. At the outset, Care hospital earned accolades and appreciation from
one and all its expertise in heart care. It continues to set new benchmarks not only in heart care,
but also expanded its horizons by becoming a leading multi-specialty health care provider.
Through the years, CARE has emerged as: the single largest team of cardiologists and Cardiac
Surgeons in the country, a multi specialty hospital with round the clock availability of
Cardiologists, Cardiac Surgeons, Neurologists, Critical Care Specialists, Anaesthiologist, etc. A
hot-bed for many national and international clinical researches with close to 15 on going
international clinical trials, an institution with strong ethos and unflinching devotion ethical
medical practice, institute par excellence with continuous updating of medical knowledge and
putting it into practice, a model hospital for high doctor-patient and nurse-patient ratio, an
enviable solution and role model to ever demanding patient satisfaction through its physician-
cooperative model.
Care hospital has under its auspice various specialty divisions that cater to various aspects of
treatment. Each specialty centre is manned by extremely qualified doctors, nurses and lab
technicians. They are well – versed in knowledge and treatment of the specified disorder.
Extreme care is taken to ensure that patients are given the best available treatment so that no
patient goes back disappointed. The specialties centre is divided into four departments. Apart
from these departments, CARE has under its auspice institutes of excellence. As the name
suggests, these institutes are places that have developed their high standards and are reputed
centers that cater to all aspects of medicine and patient care. Fig no: 2.2 represents the specialties
of Care hospital.

70
 Fig. No: 2.2
Care Hospital Specializations

CARE

Dept.of. Medicine Institute of Excellence

Institute of Heart Diseases
Cardiology
Cardiothoracic Surgery
Dept.of. Surgery
Interventional Cardiology
Institute of Kidney Diseases
Nephrology
Urology
Dept.of.
Institute for Chest Diseases
Laboratory
Institute for Neuro - Sciences
Medicine Neurology
Neuro-Sciences
Dept.of. Imaging Institute for Emergency-
Services Medicine and Critical Care
Emergency Medicine
Critical Care
Institute for Digestive Diseases
Gastro-Enterology
Surgical Gastro Enterology
Institute of Oncology
Medical Oncology
Surgical Oncology
Radio-Therapy
Institute of Bones and Joints
CARE Research Institute

Educational Programmes

Nursing Services, General nursing, Catheter care, Wound care & dressings, Injections,
Intravenous therapy, Tube feedings & care, Physician On Call, Laboratory Services Sample
collection from home, Electrocardiogram Technician to take the ECG at the home of the
patient, Physiotherapists well trained in Orthopedic, Cardiovascular, Neurological,
Respiratory and Rehabilitative Therapy, Medical Equipment -- Available on rental basis,
Diabetic care & patient education, Post Stroke care, Disease process education,
Nebulisation/Suction/Ostomy care & patient education, Trained staff will impart education to
the patients‘ attendants etc.

71
 Care hospital is known for its wide range of healthcare services offered to all sections of
the society. It is providing healthcare services to the poorest of the poor up to the richest of
the rich from the bed-category of general ward to A/C suit with treatment packages keeping
in the view of economy condition of the patients.

Sl.No Patient Class %

1 Low End 25
2 Middle 50
3 High End 25

Besides serving local patients, Care hospital getting patients from every corner of India and
the globe as well. The patients coming from different countries like Tanzania, Nigeria, South
Africa, Kenya, United Kingdom, Russia, Iceland, Fiji, and Dubai etc. It is only because of its
professional approach with human touch towards healthcare as well as the expertise it have in all
specialties. The treatment provided to their patients with combination of best nursing care, best
professional care (doctors), use of latest equipments, at an affordable cost, transparent billing,
human touch, abreast in education & Research activities etc.
Care hospital has its own set of educational programs aimed at improving the quality of
medical education. The programs are affiliated to the universities like, Indira Gandhi National
Open University, Netaji Subhas Open University (NSOU) Director of Medical Education. The
universities are centers of quality educational standards. CARE‘s collaboration with these
universities is to bring out the best in each medical student. The offering courses are Post
Graduate Diploma in Community Cardiology (PGDPCC), Physician Assistant, M.sc in Hospital
Administration for Nursing Graduates, Post-Graduate Diploma Course in Cardiovascular
Nursing and research at CARE. Research programs are generally undertaken by the academic
cell and research centre. The academic cell and research centre (ACRC), the clinical unit of the
CARE foundation was started in July 1999. It will conduct various research programs as per
ICH/GCP and ICMR guidelines. The ACRC has an Institutional Ethics Committee (IEC) where
and other relevant issues are discussed under this committee.
Care hospital has the tie-ups with almost all major corporate-public & private sector units,
insurance companies, TPAs, NGOs and others in order to provide healthcare services to their
employees and dependents.

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 Care hospital apart from treating a multitude of patients has been the source of livelihood for
numerous families. Our efficient and highly qualified personal have been the facilitator for
putting CARE on the world map.

About the Group

The origin of ‗CARE‘ can be traced to 1983 when a team of cardiologists, lead by padmashri
Dr. B. Somaraju, set up a synergy for professional excellence in the Nizam‘s Institute of
Medical Sciences (NIMS) in Hyderabad. The synergy gave moment of Care hospital 13 years
later. CARE hospitals started in 1997 with a bed capacity of 100 in Nampally, Hyderabad. The
group is a multi super-specialty chain of hospitals founded and managed by a team of
professionals with a mission and passion for providing affordable and competent healthcare to
all. M/S Quality CARE India Ltd, a company incorporated under the Indian companies act 1956
(Vide No-01-14728) having its registered office at 6-3-248/2, Road No-01, Banjarahills,
Hyderabad, Andhra Pradesh, India.
CARE group of hospitals desire to provide its medical services to all people in each and every
part of India is responsible for the institution‘s to open branches in strategic location. The
institution has opened various branches so that it can provide quality medical services to all
sections of society and to all people in geographic locations. Beginning with hospitals in
Hyderabad and then continuing with hospitals in Andhra Pradesh and finishing with hospitals in
various part of India; for this Care hospital starts its wing at Banjarahills Road No-1. Hyderabad
in the year of 2002. Now this hospital is having production capacity of 460 beds, and
maintaining the same technological excellence and nurturing that CARE group of hospitals has
established.
Care hospital has achieved several milestones in past 10 years. The hospital has acquired
several milestones so far like; 4,50,000 out patient consultation per year, 30,000 inpatient
admissions per year, 4,000 cardiac surgeries per year, 10,000 cardiac catheterization per year,
1,500 cardiac interventions per year, 7,500 non-cardiac surgeries per year, internationally trained
largest team of critical care professionals. Several awards are under the name of CARE
hospitals- lifetime achievement award to CMD, spine-off award and many more.
Care hospital also performed various transplants surgeries like heart, liver and kidney as well
as various joint replacement surgeries like knee, ankle etc. apart from this CARE performing
major Maxillo-facial surgeries (plastic & cosmetic surgeries). CARE hospital is also extending

73
its footage to villages/towns of different and works with government and semi-government
organizations under PPP programme so at to reach the remote areas and serve the society with
the primary health care facilities. CARE also links with its satellite clinics by TELEMEDICINE
FACILITY (V-SAT) and provides the necessary assistance by interacting with remote area
patients directly.
The group management structure constitutes one chairman and managing director, one director
and CEO, one full time director and six temporary directors for different functional areas of
hospital and one company secretary. Now, the CARE group has more than 13 business units
(hospitals) spread all across India covering 5 major states with total bed strength of 2000 and
hence become the India‘s fourth largest and fastest growing hospitals chain with a difference.
Fig. no: 2.3 represent outlets of Care hospital.
Fig. No: 2.3
CARE Group of Hospitals

Year of
Sr. Business Unit State No. of. Beds
Starting
CARE Heart Institute, Andhra
1 1997 310
Nampally Pradesh
CARE Hospitals, Andhra
2 1998 40
Secunderabad Pradesh
CARE Hospitals,
Andhra
3 Visakhapatnam 1999 230
Pradesh
( Two units)
Care Hospitals, Andhra
4 2002 460
Banjarahills , Hyderabad Pradesh
CARE Hospitals, Andhra
5 2004 150
Vijayawada Pradesh
6 CARE Hospitals, Nagpur Maharastra 2006 105
CARE Hospitals, Andhra
7 2007 130
Musheerabad Pradesh
CARE Hospitals, Pune
8 Maharastra 2007 170
(Two units)
9 CARE Hospitals, Raipur Chattisgarh 2007 125
CARE Hospitals,
10 Orissa 2007 105
Bhubaneswar
11 CARE Hospitals, Surat Gujarat 2008 110

74
 It is indisputable fact that Care group of hospitals has grown in reputation and profits
primarily because of the governance and leadership. CARE‘s governance and leadership team
has been undoubtedly for the growth of CARE as a hospital group.
Survey of Literature
For the purpose of the proposed research study, a thorough study of all possible academic
and non-academic work in the field has been done. It can be classified in the following heads-a)
Doctoral theses b) Text and reference books c) Dissertations and reports d) Articles which
appeared in academic journals e) Articles which appeared in non-academic journals f) Articles
which appeared in news papers g) Articles and research papers which appear in internet.
In search of doctoral theses submitted on the subject, the publications of Association of Indian
Universities (AIU) were checked in the library of Indian Council for Social Research (ICSSR)
which publishes the details of doctoral theses submitted with various universities in social
sciences. For the purpose of textbooks and reference books the catalogues of various libraries
situated in Delhi, Madras, Bangalore, and Hyderabad were seen and a list of books considered to
be useful for the research was made and books were obtained accordingly. A list of these books
is given at the end as bibliography. For the consultation of dissertations, Indian dissertation
abstracts were scanned. For studying the articles published in academic and non-academic
journals. Documentation centers of various libraries such as library of Planning Commission,
New Delhi. Library of All India Institute of Medical Sciences, New Delhi. Library of World
Health Organization ,New Delhi. Library of National Institute of Health and Family Welfare,
New Delhi. Library of Voluntary Health Association of India, New Delhi. National Medical
library, New Delhi. Library of Indian Institute of Management, Bangalore. Library of St.John‘s
Medical College, Banglore. Library of Indian Institute of Technology, Madras. Library of Pond
cherry Central University, Pondicherry . Library of Andhra University, Visakhapatnam and the
library of Nagarjuna University, Guntur, were visited and notes were taken there.
In the process of surveying literature, it has been observed that no doctoral theses have been
submitted on application of marketing principles in hospitals. Taking marketing aspects in to
consideration no academic work has so far been done in hospitals and in the area of health care.
Coming to the articles published in non-academic journals, one can observe that most of the
articles concentrate on slow growth of healthcare issues in India and hardly any one touched
upon the lack of better marketing practices in the hospital industry. Articles published in

75
academic journals of national and international reputes also emphasize on service quality, brand
equity, patient relationship, service development, consumer behavior, public relations, health
care tourism, market segmentation, advertising, hospital choice factors, customer complaints,
market function, food services, market orientation in hospital industry, development, techniques
regarding reducing different costs, optimum utilization of services maintenance of bed-nurse
ratio, doctor-patient ratio, management & administration, patient satisfaction etc, articles and
notes appearing in the news papers also do not highlight any aspect of marketing being practiced
in the organizations. These articles are more informative and statistical in nature and give an
account of the number of patients, beds ratio, and projection for the future and so on. Some of
the articles in the area of marketing in hospitals include
Product
‗Modeling consumer choice of health plans: a comparison of two techniques‘ by Michael
D.Rosko and William Mckenna1. In their research described how conjoint measurement a
multivariate marketing research technique can be applied in health care marketing. They also
compare the validity of results from two conjoint measurements techniques-the full profile
approach and the tradeoff approach. A convenience sample of 97 university students was used in
the study. Fifty-two students supplied data by using the full profile approach. Each respondent
provided a complete rank order of 26 profile cards, which included the following ambulatory
health service attributes: charge for routine visit. Travel time. Office hours. Length of time
needed to make an appointment, waiting time in physician‘s office practice arrangement/freedom
of physician choice, parking arrangements and type of hospital. A fractional factorial design was
used to determine different attribute levels (e.g. charge for routine office visit could be set at $10.
$20 or $30) for each card. Forty-five students performed ranking tasks for the trade-off approach
to conjoint measurement. These respondents ranked 28 grids, which represent all combinations
of factors taken two at a time. From the data collected in the ranking tasks utilities or part-worth
values for each level of each attribute were estimated by using dummy variable regression.
Relative importance of ambulatory service attributes was inferred from the range of utility values
of the attributes. Three measures of validity were assessed-adherence of estimated utility scores
to monotonic assumptions. Plausibility of importance rankings and comparative validity. The
research found that the profile approach satisfied all three criteria. In contrast, the tradeoff
approach results satisfied the first two criteria, but its comparative validity was only marginal.

76
Valid conjoint data can be used for: simulations of market responses to different health services
configurations; market segmentation studies: and development of promotional efforts.
‗An approach to maximize hospital service quality under budget constraints‘ by Wei-Kuo
Chang, Chiu-Chi Wei, Nen-Ting Huang2. This study proposes a mathematical method for
evaluating the quality of hospital services, and it intends to provide the top management with a
systematic means and scientific tool to quantify and improve the service quality from the
customer‘s satisfaction perspective. In order to manage effectively the quality, the author
identify and assess the key elements of the hospital service quality, and quantitatively establish
the relationship between the sufficiency of the service provided and the level of satisfaction, and
between the sufficiency of the service and the amount of the monetary investment. This study
categorized the quality of medical services into three types, namely the must-be-element, one-
dimensional element and additional element. Satisfaction resulting from each of three elements
induces a different cost to the organization: thus management should decide which element
needs to be greatly allocated or slightly allotted. Traditional approaches emphasize qualitative,
such as questionnaire survey and personal interview. The model proposed in this study is able to
determine how much budget must be allocated to each quality element in order to maximize the
customer satisfaction, and the results indicate that the model can be good means for maximizing
customer satisfaction under budget constraint.
‗New service development: From Panoramas to Precision‘ by Anne M. Smith, Moira
Fischbacher, Francis A. Wilson3 This paper argues that a panoramic, or holistic, approach to new
service development and a high level of precision at the micro level, will combine to provide a
more successful service design and new service development process. Five models from the new
product/service development literature are used to illustrate how the approach can be applied to a
complex multi-faceted service such as a hospital.
‗The impact of service quality and marketing on financial performance in the hospital
industry: an empirical examination‘ by P.S. Raju, S.C. Lonial4. Service quality and service
marketing have both been studied extensively in relation to service organizations in this research.
This paper examines these areas simultaneously in terms of their impact on financial
performance in the hospital industry. Drawing from the literature in the quality and service
marketing areas, the area of service quality is represented in terms of the constructs of quality
context and quality outcomes. Quality context (QC) describes the environment related to quality

77
practices within a hospital, which generally encourages and enhances service quality while
quality outcomes (QO) comprises of specific clinical and patient satisfaction outcomes of the
hospital. The area of marketing is represented in terms of the constructs of marketing orientation
and market/product development outcomes. Market orientation (MO) is a well accepted, albeit
complex, construct within the marketing literature. Generally, market orientation can be thought
of as the process of effectively collecting, disseminating, and responding to information in order
to enhance the marketing function within the hospital. Such information generally relates to
market trends, customers, and competitors. Market/product development outcomes (MPD) refer
to specific outcomes in relation to product innovation and market segmentation that are general
indicators of the marketing effectiveness of the hospital. Although the evidence in the literature
suggests that both service quality and marketing are independently related to organizational
performance. The results show that the constructs related to both service quality and marketing
impact on .financial performance. However, the results do not support the proposed framework
of relationships. Instead, the results support a sequential chain of relationships among the
constructs where MO mediates the effect of QC on QO, and MPD mediates the effect of QO on
FP.
‗Developing New Services For Hospitals: A Suggested Model‘ Michael R. Bowers5 The
purpose of this article is to report research that should facilitate hospitals' efforts toward market-
driven service development. Hospitals tend to use an incomplete means of developing new
services. The result is a lack of attention to the needs of the intended target markets. This article
discussed a model for developing new hospital services is suggested, one that allows greater
input from the service recipients. An illustrative case is presented. Finally they concluded that
the process used by most hospitals to develop new services differs to some extent from the series
of activities in the (BAH) Booz-Allen & Hamilton (1982) model. The current process employed
by hospitals can be improved. The path to developing better new hospital services appears to be
a systematic process that allows greater exposure to market forces.
‗Measuring service quality in a medical setting in a developing country: the applicability of
SERVQUAL by Jungki Lee6. This article has been made an attempt to test the applicability of
the ‗SERVQUAL‘ conceptualization to a less studied area medical service in a developing
country specifically this study investigated the usefulness of SERVQUAL conceptualization by
testing both the presence of five SERVQUAL factors i.e. tangibles reliability, responsiveness,

78
assurance and empathy and the stability of those factors as evidenced by the scale‘s reliability.
This study concluded that the major attributes affecting the service quality in the current research
modern facilities being able to trust doctors, employees getting adequate support from the
hospital, willingness to patients and being dependable.
―Marketing government sponsored primary care services‖ by Bolteon, Patric, Mira, Michale7
This case study presents three case studies examining the impact of marketing campaigns on
three different Australian acute primary care services over an 8 years period. Each of these had
adopted its services to meet perceived needs of the public. One of these services, the Balmain
hospital general practice causality (GPC) replaced an existing emergency department with a
primary care service staffed by general practitioners (GP). The second added a general
practitioner-staffed service to an existing emergency department, the Canterbury GP after house
service (CGPAHS) the third offered clients telephone health advice during the after-hour period.
This study observed that the marketing strategies had a significant impact in two of the 3
scenarios. The greatest effect appeared with the health connect telephone advisory service, and
no effect was seen in the CGPAHS, while all three services are innovative. Finally this study
concluded that health connect is less like existing health service models than the two-GP staffed
acute primary care centers. The purpose of the service was to lower barriers to access. The
purpose of the service was to lower barriers to access to after-hours primary care, and less effort
was required for consumers to contact health connect than either of the other two services. This
may in part explain the dramatic effect of the marketing campaign for the service.
―Is product-line management appropriate for your health care activity?‖ by G.M.Naidu;
Klemenhager; Pillari; George.D8 This article examines the result of the study on product-line
management (PLM) as management tool on health care industry in the U.S. In early 1980‘s the
PLM of 500 companies moved its way into health care industry and has a 50 year-record of
success. This study finds out the statistical adoption of PLM indicate a decisive difference
between the two groups. Hospital with PLM had an average of 15.9%; return on equity as
compared to 7.1%; for those hospitals that did not employee PLM concept. From the ungrouped
data, it can be seen that the gross patient revenue per bed was 314,000 dollars for hospitals that
have not implemented PLM. Finally concluded that the bundle-of-elements concept helps
hospital create several products from the same set of elements and offer variants of the product to
different markets.

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 ―Product line management in hospitals; an exploratory study of managing change‖ by Burger,
Philip C; Malhotra, Naresh.K.9. This article presents an abstract of product line management in
hospitals. As per this article product line management is a system in which one manger is
responsible for all aspects of marketing and delivery of one particular product or service bundle.
The purpose is to concentrate information and decision making so that major oversights and
mistakes do not occur. The author performed an explanatory study to find out why hospitals are
beginning to adopt PLM. They also discovered what products are being managed. They found
that the major reason to adopt PLM was to remain competitive at both the primary and tertiary
delivery level. PLM was used for heart services and oncology. The authors also explored
resistance to adopting the PLM concept due to top management compliance and unwillingness to
decentralize decision making.
―Proactive product strategies: An application in the European health market‖ by Frambach,
Rudd T; Weis-Lips, Inge; Gundach, Arjan10 This article develops an empirically based frame
work for formulating proactive product service strategies in the industrial context by
investigating the influence of product services on the adoption of a new medical instrument
among hospitals in Europe. This article defines product service as ‗ the set of all potential
additional services a supplier can supplement his product offering within in order to differentiate
his offering relative to the competitive as perceived by potential customers and distributors‘. In
this study it was found that the perceived relative importance of product services in the context
of the adoption of an industrial product differed over market segments this marketing the
implementation of a proactive product service strategy potentially effective. Further the study
indicated that the classification of product services as proposed in the literature can be extended
meaning fully by distinguishing other categories of product services as well, finally this study
formulated specific managerial implications.
―The influence of mergers on firm‘s product-mix strategies‖ by Ranjani A. Krishnan; Satish
Joshi and Hema Krishnan11 This study draws on the institutional and resource-based theories of
the firm and examines whether multi-product firms use mergers as a strategic tool to reconfigure
their product-mix toward high-profit products. They analyzed data from the U.S hospital industry
reveals that, relative to non- merging hospitals, merging hospitals increased their presence in
profitable, insured services but did not shift away from low-profit services used by the uninsured.
They suggest that, although mergers relax some of the institutional and organizational constraints

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on resource redeployment toward attractive product lines, they do not appear to relax the
constraints on elimination of unprofitable product lines. The institutional factors inhibiting
elimination of unprofitable product lines appear to be more resilient, likely due to non-profit
status of the firms in this sample.
Price
―Using call center data to determine a credible returns on marketing investments‖ by
Speigelman and Paul12 This article presents a tabulated method of using call center data to
determine a credible return on marketing investments. Methodologies and formulas have been
developed that are useful in marketing patient activity with consumer responses to marketing
campaigns. The result of a recent solucient four-year study revealed that the average hospital call
center caller generates $13,848 in hospital charges within 12 months after calling versus $5,524
for patients overall. Finally this study suggested that to ensure the greatest likelihood that call
center data and patient data refer to the same person, applying the same sets of filtering criteria
which are discussed in the study in consecutive order, removing matched records.
―Is there a link between hospital profit and quality?‖ by Zallocco Ronald.L.13 In this article the
author discussed his conducted study of eight hospitals scattered throughout the United States to
investigate the issue of the relationship between quality and profitability. Further, the authors
studied each hospital to determine the relationship between quality and profit levels on one hand
and price, occupancy levels, and costs per patient on the other. Analysis of data from the
hospitals resulted in three major conclusions. First, low quality hospitals have much lower levels
of profitability than high quality hospitals. Second, low profit and quality does not result in lower
demand. Third, poor quality hospitals are understaffed and have inadequate investments in
capital assets.
―Case mix specialization in the market for hospital services‖ by Dean E. Farley and Christopher
Hogan14 Hospitals may be able to reduce their costs by limiting the breadth of services they
provide. Studies have tried to correlated specialization with the reduction of hospital costs, but
there has been little empirical evidence that U.S hospitals are moving toward great specialization
or that specialization leads to cost savings. The difference with this study is that a within hospital
regression is used instead of a cross-sectional approach as in previous studies results show that
specialization can lower costs, though it may not be a long-term strategy. Over time, one would
expect the cost savings to disappear as competition increases the need to compensate labor and

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capital for differences in productivity. The results presented suggest that, the hospital industry is
moving toward a more efficient distribution of services across hospitals. Specialization increased
from 1980 to 1985, specialization can indeed lower hospital costs, and the largest increases in
specialization have been in hospitals with the largest incentives to reduce costs.
Promotion
‗Building a strong services brand: lessons from Mayo Clinic‘ by Leonard L. Berry, Kent D.
Seltman15 This research explains the services branding model by showing how one organization
has created, extended, and protected a powerful brand through an unwavering commitment to
the well being of its customers. Managers outside of healthcare can benefit from three branding
lessons embedded in the Mayo Clinic story: (1) attend to organizational values; (2) play defense,
not just offense; and (3) turn customers into marketers. This research explains how services
brand is built and sustained primarily by customers‘ interactions with the provider. A services
branding model depicts the dynamics of brand creation. From the interrelationships among the
presented brand, external communications, and customers‘ experiences emerge brand awareness,
meaning, and, ultimately, equity.
‗Developing a marketing function in public healthcare systems: A framework for action‘
16
Federico Lega The scope of this research is to analyze the contribution that a marketing
function can bring to the wide variety of healthcare organizations operating in public health
systems (PHs). While extensive research on marketing applied to healthcare services has been
elaborated in competitive and managed care contexts, marketing is a rather new issue in PHs and
little research has been conducted to assess its relevance and benefits in these environments. This
study tackles that gap and is based on a review of the current literature in order to provide
answers to the following points:
- Definition of the scopes of marketing and of the elements that affect its incorporation in the
healthcare sector.
- Conceptualization of the possible approaches to marketing by health organizations operating in
PHs.
- Discussion of the resulting framework for action.
‗Marketing of Health Care Within a Community: A Quality-of-Life/Needs Assessment Model
and Method‘ by Don R. Rahtz, M. Joseph Sirgy17 In this study A community-based health-care
assessment model and method is presented. The model and method are based on theoretical

82
notion that community residents‘ satisfaction with individual health-care programs and ser- vices
available within their community affect their satisfaction with the community health-care system.
Examples of individual health-care ser-vices and programs include: drug abuse programs, cancer
health services, children health services, diabetes services, elderly health programs, emergency
health services, physical fitness programs, heart health programs, home health services, mental
health services, in-patient hospital services, obstetrics services, out-patient services, physical
rehabilitation services, and women‘s health programs. In turn, satisfaction with over-all
community health care affects perceived quality of life (over-all life satisfaction) through
satisfaction with the community at large and satisfaction with personal health. Data were
collected in the Mid-Atlantic area of the United States through a mail survey. One hundred and
forty-seven community residents completed the survey. The results were supportive of the model
and provided validation support to the assessment method. Managerial implications of the model
and its application are also discussed. Finally the author suggested that the firm should focus on
establishing long-term relationships with the variety of segments within the community it serves.
Specifically, the firms should do so with the intention of maximizing the firm‘s positive impact
on the lives of those consumers. Health-care organizations, by their very nature and purpose,
seem to be the embodiment of the perfect type of firm to become leaders to a move to a overall
quality of life (QOL) perspective in strategic planning. The use of the proposed model and
method can aid in such a move by providing decision makers with a measurement tool that can
be used to assess the effectiveness of their programs/services to the community they serve.
‗Conceptual Differences in Public Relations and Marketing: The Case of Health-Care
Organizations‘ by James E. Gmnig and Larissa A. Gmnz.18 Developed a normative theory of
public relations that stipulates that excellent public relations programs practice public relations
Strategically and use a two-way symmetrical model of public relations when they do so. This
study also has identified four other characteristics of excellent public relations programs that are
logically related to strategic management and the two-way symmetrical model. At the same time,
have shown that competitive pressures have caused many health-care organizations to sublimate
public relations to the marketing function. Sublimation of the public relations function, however,
results in a more asymmetry-cal approach to public relations, even though public relations may
be practiced according to a strategic model of marketing. As a result, organizations lose the
valuable function that public relations provides-of managing interdependence with publics that

83
constrain the autonomy of organizations to pursue and meet their goals. Finally, they presented a
positive theory to explain why some organizations practice public relations in the excellent and
effective way described by normative theory and other organizations do not. Finally they
concluded that health-care organizations do not practice public relations strategically and
symmetrically unless they are led by a dominant coalition of managers who value and understand
public relations as a management role and as having a symmetrical purpose. The organizations,
in turn, have participative rather than authoritarian cultures and have a high level of
professionalism in their public relations departments that raises the potential of those
departments.
‗Health-care tourism – an exploratory study‘ by Jonathan N.Goodrich and Grace
E.Goodrich19 This article explores the concept of health-care tourism. It is based on a pilot study
that involved a survey of 206 travelers, 22 travel agents, 12 medical doctors and two herbalists; a
review of the tourism and travel literature; and content analysis of 284 travel brochures about 24
countries. Health-care tourism is defined, the sample, methods of data collection, findings, and
implications are discussed, and future research areas suggested. Health-care tourism can be used
to define an effective marketing strategy. This paper has discussed the novel concept of health-
care tourism. The idea can be described as the attempt on the part of a tourist facility or
destination to attract tourists by deliberately promoting its health services/facilities (as well as its
other usual tourist amenities, e.g. hotel accommodation, water sports, golfing. and scenic tours).
The health services could include medical check-ups, minor surgery, special diets, vitamin-
complex treatments, herbal remedies, thermal swimming pools, and so on. Finally this article
concluded as Tourism‘s health-care component is not new. It has existed for many centuries in
many countries of the world, e.g. Switzerland, FR Germany, Austria, Jamaica, Hungary, the
USA and the UK. What is fairly new, however, is the concept of health-care tourism as a
deliberate and growing marketing strategy. It can be a positioning strategy for some hotels or
resorts in a world that is becoming more health conscious. Health-care tourism can, however,
become subject to quackery, so self-regulation and careful government scrutiny are imperative.
‗Brand equity in hospital marketing‘ Kyung Hoon Kim,Kang Sik Kim, Dong Yul Kim, Jong
20
Ho Kim, Suk Hou Kang This article identifies five factors that influence the creation of
Brand equity through successful customer relationships: trust, customer satisfaction, relationship
commitment, brand loyalty, and brand awareness. An empirical test of the relationships among

84
these factors suggests that hospitals can be successful in creating image and positive brand equity
if they can manage their customer relationships well. The study is presented in the following
manner. First, they draw from the research literature to identify the brand equity factors that
influence the building of successful customer relationships in hospitals. Second, they constructed
a research model that explains the relationships of those factors to brand equity and hospital
image. Third, generated research hypotheses and empirically test them. Finally, they discussed
the practical and theoretical implications of the results. Finally this article concluded that, the
hospitals must depend heavily on word of-mouth communication and customer relationship
management (CRM). This study shows that they can succeed in creating positive brand equity
and image if they can manage relationships with their customers well.
― Health Care Marketing: Mini case‖ by Stephen A. RolMns, Christopher M, Kane and Daniel
J, Sullivan21. This study was focused on current trends and practices in hospital marketing. The
study was based on focus groups conducted in 13 southeastern cities. Individuals with
responsibility for marketing in their hospitals participated in the focus groups. The study findings
identify two major areas of concern related to marketing and the direction the field is taking.
First, health care marketing—though much discussed and expensive—is still in a stage of
immaturity. As practiced in hospitals today, marketing is frequently synonymous with
advertising. Second, marketing in health care will not ultimately be a "clone" of marketing
practices in industry and retailing. Though hospitals are looking to those areas for knowledge
and expertise, the unique character of the product will cause health care marketing to evolve into
a practice uniquely different from that in other industries.
‗Assessing advertising Content in a Hospital Advertising Campaign: An Application of Puto
and Wells (1984) Measure of Informational and Transformational Advertising Content‘ by
22
Menon, Mohan K.Goodnight, Janelle M. Wayne, Robin J. This article designed to measure
advertising content based on the cognitive and affective elements of informational (i.e.,
information processing) and transformational (i.e., experiential) content using the measure of
advertising informational and transformational content developed by Puto and Wells (1984). A
university hospital advertising campaign designed to be high in transformational content did not
appear to affect perceived quality of local university hospitals relative to private hospitals or
increase the likelihood of choosing a university hospital in the future. Further, experiences with
university hospitals that seemed to be in direct contrast to the content of the advertisements

85
based on subject perceptions affected how university hospital advertisements were perceived in
terms of content.
―current Marketing Practices in the Nursing Home Sector‖ by Calhoun, Judith G. Banaszak-
Holl, Jane Hearld, Larry R.23 This study examines the extent to which nursing homes have
developed more formulated marketing and related communication and promotional strategies as
market competition has increased in this sector during the past two decades. In addition, we
explored managers' perceptions of their control over marketing decision making, the impact of
competition on the use of marketing practices, and areas for enhanced competitive positioning.
Administrators from 230 nursing homes in 18 Southeastern Michigan counties were surveyed
regarding (1) the adoption level of approximately 40 literature- based, best-practice marketing
strategies; (2) the types of staff involved with the marketing function; and (3) their perception of
their level of control over marketing functions and of local competition. Results from 101 (44
percent) survey participants revealed that although respondents viewed their markets as highly
competitive, their marketing practices remained focused on traditional and relatively constrained
practices. In relation to the importance of customer relationship management, the majority of the
administrators reported intensive efforts being focused on residents and their families, referrers,
and staff, with minimal efforts being extended to insurers and other types of payers. A significant
positive relation was found between the intensity of marketing initiatives and the size of the
facility (number of beds), whereas significant negative correlations were revealed in relation to
occupancy and the perceived level of control over the function.
―The Amherst study of hospital marketing practices‖ by Stephen A. Robbins; Christopher
M.Kane: Daniel J.Sullivan24 This study focused on current trends and practices in hospital
marketing. This study was based on focus groups conducted in 13 southeastern cities. Individuals
with responsibility for marketing in their hospitals participated in the four groups. The study
findings identify two major areas of concern related to marketing and the direction the field is
taking. The result of the study suggest that hospitals marketing programs tend to emphasize
promotional activities rather than comprehensive marketing function. In addition, may directors
of marketing in hospitals believe that the senior executives in the organization remain skeptical
about the benefits of marketing activities. Despite the increased attention to hospital marketing.
Amherst associate‘s study indicates that the area of expertise has not attained the level of
acceptance of other business disciplines in the health care field.

86
 ― What hospitals must do‖ by Pleasant; Jamie T25 This article cites a study which point out
that the once stable health care market has turned into an explosion of aged baby boomers that
required treatment of chronic conditions in a timely and personal manners. The study suggested
that the health care administrators must incorporate sound marketing strategies that will offer a
competitive advantage in this rapidly changing market. For this they suggested that direct
marketing may be a new way to reach target markets effectively and establish long term
relationships with individual patients. Telemarketing programs are being approached with
caution because health care officials are reluctant to becoming very widely accepted data base
marketing may very hold the promises for healthcare because it brings the maximum amounts of
business from existing customers. Relationship marketing programs provide ongoing
communication with customers and potential patients.
―Hospital advertising: The influence of perceptual and demographic factors on consumer
dispositions‖ by Tudor and Kanth26 This article discusses the perceptions of consumers
concerning hospital advertising. This study showed that hospital advertising increases costs to
patients and is manipulate and not very helpful. It was observed a positive correlation was seen
between people who perceived hospital advertising as helpful and favored marketing activity.
Further observed the education-level of consumers is an important factor that effect consumer‘s
differing responses towards hospital advertising.
―Taking direct route‘ by Peltier, James W; Kleimenhagen, Arnok; Naidu.G.M27 In this article
the author discuss the distinct characteristics of direct marketing. This article examines how U.S
hospitals have incorporated direct marketing in to their communication programs and constant a
profile of high and low users. For this a random sample of U.S hospitals received a questioner
that explored use of direct marketing vehicles prior to developing the survey instrument, they
conduct in-depth interviews with several hospital administrations to determine question context
for each of the topic areas. Finally they concluded that direct marketing is an accepted marketing
tool for U.S hospitals, that communicate with prospects. In addition, users are reporting
improved performance in the critical areas of profitability and facility utilization.
―Factors related to the provision of hospital discounts for HMO inpatients‖ by Malhotra,
Naresh K28 This article presents the factors related to the provisions of hospital discounts for
health maintenance organizations. The authors analyzed American hospital association, hospital
survey data from a sample, if 801 hospitals with health maintenance organizations contracts to

87
determine the factors related to hospital‘s provisions of discount and the magnitude of the
discounts, if present. The study scrutinized hospital- health maintenance organizations contact
provisions, hospital operating characteristics, and market conditions. In this survey 78% of
hospitals reported that at least one of HMO contracts provided a discount for patient services.
Four factors of that were statistically significant in a relationship with the dichotomous
dependent variable were disclosed. The majority of hospitals respond to competitive markets
attempting to stabilize patient volume through formal organizational contacts with the HMO‘s
rather than discounting their prices for the entire public. Hospitals are finding it increasingly
necessary to provide substantial discounts in their HMO contacts especially in markets with a
high concentration of hospitals and HMO‘s. The author view a lack of influence of other factors
as evidence that much needs to be learned about how hospitals-HMO markets function.
―Who like hospital advertising- consumer or physician?‖ by Bell Jack A; Vistaska Charles R29
Both consumer and physicians have favorable attitudes toward advertising in general, but their
attitudes toward hospital advertising differ considerably. In particular, the groups differ in their
opinions about the influence of advertising on hospital choice, the value of the information being
advertising, and the economic impact of advertising on hospitals. In this context this study
conducted with the objectives of, to determine whether there are differences in consumer‘s and
physician‘s attitudes toward advertising in general and hospital advertising in particular. The
second objective was to examine any differences between the two groups on 25 attitudinal
attributes related directly to hospital advertising. The third objective was to determine whether
there are any relationships between each group‘s attitudes toward hospital advertising and
selected classification variables. To meet these objectives, the author surveyed both consumers.
Finally concluded that consumers have a generally, favorable attitude toward hospital advertising
and want information about hospital services, medical programs, and the kinds of doctors
available. Advertising seems to be an integral part of the dynamic growth of hospital marketing.
Hospitals can benefit or loss by how the advertising function is implemented and managed.
Physicians as well as consumers responses, including both perceived benefits and limitations
must be recognized and incorporated into the planning process.
―Designing health promotion programs by watching the market‖ by Gellb.Betsy D; Bryant,
John Michael30 This article presents the results of a study which dealt with designing of health
promotion programs. It is noted that more health care providers and payers are beginning to see

88
health promotion programs as a significant tool for attracting patients, reducing costs, or both.
The author suggested that take into accounts the values and lifestyle of the target group,
naturalistic observation can be useful to design programs. But historically many hospitals have
been skeptical of health promotion programs, failing to understand their revenue generating
potential.
―Developing a hospital web site as a marketing tool: A case study.‖ By Widnier, Thomas G;
Sphepherd,C David31 This article presents a case study which described the efforts of Siskin
Hospital to develop a web site as its marketing tool in 1999. Several years ago, Siskin hospital, a
rehabilitation facility in the Southeastern U.S began the process of developing a hospital web
site. It was agreed that multidisciplinary team was needed. Then the next step was to determine
target audiences for the site based on the objectives. Fourteen district targets were identified. The
type of information each would require was brainstormed and detailed. The information types
were then prioritized using a matrix developed by the team.
―Hospital marketing and the Internet: Revisited‖ by C.David Shephered and Daniel Fell32 In
1995 a study was conducted to explore the use of the Internet in hospital marketing. Use of the
Internet has exploded since that study was published. This manuscript replicates the 1995 study
and extends it by investigating several managerial and operational issues concerning the use of
the Internet in hospital marketing. The results of this study offer several insights into the nature
of hospital marketing on the Internet and suggest several research priorities. First, hospitals are
rapidly accepting the Internet as a marketing tool. Second the results of this study indicate that it
is not easy task to create and maintain a web site. Third, marketing departments tend to be taking
a very active role in this hospital‘s use of the Internet. The results if this study suggests that some
hospitals are ―Jumping in‖ to the Internet without adequate planning for management. Clearly
there is a need for research designed to identify the knowledge and competencies needed by
marketers as they activity participate, and often manage, this hospital‘s Internet efforts.
―Promotion and advertising agency utilization: A nation wide study of hospital providers‖ by
Beth Hgaan; Sharon L. Oswald; Tony L. Henthorne; William Schaninger33 In this study a nation
wide survey of hospital providers was conducted in an effort to determine the type and level of
promotion and advertising agency utilization. The study indicated that a majority of the hospitals
surveyed are engaging in some form of advertising activity. The initial phase of the research
revolved around the construction and testing of the research instrument. The instrument

89
contained a series of questions concerning hospital promotional activities. The promotional
activities included in the questionnaire were based on exploratory studies. Respondents were
asked about their use of advertising and other promotional media and whether they sought the
assistance of advertising agencies. Survey results further showed agency usage was highly
correlated to hospital bed size. Finally their findings shows a majority of hospitals are engaging
in some form of advertising activity. Results indicates approximately half of the sample hospitals
utilize the services of agencies.
―The relationship between health plan advertising and market incentives: Evidence of risk-
selective behaviour‖ by Ateev Mehrotra; Sonya Grler; and R.Adams Dudley34. This study
explores how the content of health plan advertising is related to the competitiveness of the health
plan market. They find that increased competition is associated with greater use of advertising
that targets healthier patients. For this they created a methodology for coding risk selective
characteristics in ads and used an initial sample of ads to generate a set of ten risk selective
characteristics. Then tested hypotheses in two new samples of ads. By this study they found that
the use of ads that are attractive to healthy patients increased notionally. They found preliminary
evidence that health plans change the content of their advertising in response to market
incentives.
―The marketing implications of a hospital-based smoking cessation program‖ by Kathryn R.
Hallgren; John Elder; Cralg Molgard35 This study was designed to evaluate the ability of a
hospital-based smoking cessation program to increase utilization of other hospital services on the
basis of a participant‘s success or failure in the program. The hypothesis was that participants in
the smoking cessation program, who were succeeded in the program, were more likely to utilize
other hospital or clinic services in the future than were those who did not succeed in the program.
Finally the study result indicate that for a hospital attempting to survive in times of economic
trouble, a smoking cessation program in a hospital setting can be a source of indirect revenue and
additional patient referrals.
Place
―Modeling the impact of internet atmospherics on surfer behavior‖ by Marie-Odile Richard36
This paper examines the role of Internet atmospherics cues on the behavior of surfers and their
impact on variables such as site attitudes, site involvement, exploratory behavior, pre-purchase
and purchase intentions. Atmospherics cues are central (structure, organization, in formativeness,

90
effectiveness and navigational characteristics) and peripheral (entertainment). A conceptual
model is developed based on a review of existing findings and tested with a large sample of
consumers who responded to a questionnaire after navigating through an existing pharmaceutical
web site. Structural equations modeling was used to test 10 major hypotheses. Among the key
findings, all atmospherics cues were impacting the other constructs, with the central cues mostly
affecting site involvement and exploratory behavior, while entertainment affected site
involvement and site attitudes. These findings contribute to the theoretical and managerial
understanding of the role of Internet atmospherics on the navigation behavior of visitors.
―Identifying market Segments within A health care delivery System: A two stage
Methodology‖ by Wilbur W.Stanton, Jame8 M. Daley37 This study extends hospital marketing
research by developing and applying a two state methodology for identifying healthcare market
segments. Consumer psychographic measures relative to health medical services, and attitudinal
dimensions, are analyzed to determine homogeneous groupings in a rural setting given
respondent evaluations of specific hospital stimuli. This study demonstrates, by way of an
example, the application of a two-stage approach to the identification and understanding of
consumer segments within a health care delivery system. Segmenting the population by, health
care needs affords an opportunity for hospital management to develop unique services that would
attract, and hold, patients to a specific hospital. Although these results might not be applicable to
a wide range of rural hospital settings, there are important conclusions that can be drawn from
the methodology employed in this paper. (1) This study demonstrates that health care segments
can exist even in rural areas which are relatively homogenous from a demographic standpoint (2)
Information from this type of segmentation approach allows hospital managers to better position
their service mix;(3) The methodology outlined can predict, and profile, health care segments in
terms of consumer evaluations of specific hospitals and physicians;(4) Information obtained in
this fashion can provide the supporting evidence in defense of service-mix decisions to various
publics such as physicians, staff, financial community, government agencies, and community
leaders; and (5) The methodology employed here produces quantitative measures that can be
used as benchmarks in determining health care needs as the community socio/economic
composition changes, and that can be employed as reference points in monitoring the effect of
subsequent marketing efforts.

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People
―The role of the Internet in physician—patient relationships: The issue of trust‖ by S. Altan
Erdem, L. Jean Harrison-Walker38 This research explains the importance of Internet in building
physician-patient relationship in their marketing activities of health care units. The Internet has
proven to be a powerful and very popular vehicle for distributing health information to millions
of individuals; it is interactive, user controlled, and provides an effective means for
communicating detailed information. While there has been increasing use of the Internet in
healthcare, little research has been conducted to examine what, if any, impact the availability and
integrity of healthcare information on the Internet has on the physician—patient relationship.
Importantly, several studies show that Web-based health information frequently contains
inaccurate or incomplete information. Patients who retain such information go so far as to
suggest approaches to their physicians and express disappointment when the physicians refuse to
prescribe as expected. For their part, doctors are concerned about the physician—patient
relationship when they have to explain to patients that their Internet-based information is less
than accurate; consequently, the physician—patient relationship is often affected. While many
issues bear upon the physician—patient relationship, the central one is trust. This article
examines consumer use of the Internet for healthcare information, considers the problems caused
by inaccuracies or omissions from third party websites, and sets forth recommendations
regarding how the Internet can be used to improve the physician—patient relationship. It is
hoped that these suggestions provide a better understanding of the required components of
upcoming healthcare strategies.
―The exploration of consumers‘ behavior in choosing hospital by the application of neural
network‖ by Wan-I Lee, Bih-Yaw Shih,Yi-Shun Chung39 The research applied neural network to
classify consumers‘ behavior in choosing hospitals. A quantitative research of questionnaire was
first conducted to explore consumers‘ behavior in choosing hospitals in southern Taiwan. Factors
of consumers‘ behavior were categorized into four types. Then, a back propagation neural
network classification model was developed. The model demonstrates the usefulness of 85.1%
classification rate in classifying consumers‘ styles. Finally, their marketing implications were
discussed. Based on the results of the research, the evidence is enough to suggest that the neural
network model is useful in identifying existing patterns of hospitals‘ Consumers.

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 ―Concepts in service marketing for healthcare professionals‖ by Christopher L. Corbina, Scott
W. Kelley, Richard W. Schwartz.40 This article opinioned that the Patients are becoming
increasingly involved in making healthcare choices as their burden of healthcare costs continues
to escalate. At the same time, healthcare has entered a tightened market economy. For these
reasons, the marketing of healthcare services has become essential for the financial survival of
physicians and healthcare organizations. Physicians can successfully use the fundamental service
marketing principles proven by other service industries to win patient satisfaction and loyalty
and remain competitive in today‘s market economy. Understanding concepts such as service
quality zone of tolerance, levels of consumer satisfaction, the branding of services, patient
participation, and service recovery can be useful in achieving these goals. Finally the author
opinioned that the dynamics of the competitive healthcare marketplace have required that
profound changes be made by physicians and healthcare organizations in order that they remain
financially and operationally viable. These dynamics have forced physicians and healthcare
organizations to change the way they attract and retain their patients. The practice of medicine
has become a business; simply put, all business entities require revenue in order to continue
operations. Patients initiate the revenue, which requires the effective implementation of service
marketing to ensure success. These service-marketing principles have been provided so that
physicians may begin to appreciate such issues. Acceptance, appreciation, and application of
these introductory principles will become even more important as competition continues to
intensify and profit margins continue to shrink.
―Perceptions of justice and employee willingness to engage in customer-oriented behavior‖ by
Kim, Jae-Young, Moon, Junyean, Han, Donchul, Tikoo, Surinder41 This article examines the
relationships among distributive justice, procedural justice, and employee willingness to engage
in customer-oriented behavior. Data collected from 328 employees at eight general hospitals in
Korea show that distributive justice does and procedural justice does not directly affect employee
willingness to engage in customer-oriented behavior. Procedural justice does, however,
positively affect perceptions of distributive justice.
―Consumer Empowerment Behavior and Hospital Choice‖ by Hui-Ching Weng 42 The article
presents a study that investigates the behavior and a patient's choice of hospitals. A research
design was used to develop the instrument of this study. Participants were asked to generate a list
from a set of predetermined questions from the literature of the most significant factors.

93
Interviews were conducted by trainers in the three regional hospitals in the U.S. The
demographic profiles of three patient groups are presented and key health care marketing
strategies are discussed.
―Perception of justice and employee willingness to engage in customer-oriented behavior‖ by
Kim, Joe-young; Moon, junyean; Han, dongchul; Tikoo, Surinder43. This study examines the
relationships among distributive justice, procedural justice, and employee willingness to engage
in customer-oriented behavior. Data collected from 328 employees at eight general hospitals in
Korea. This study find out that the distributive justice does and procedural justice does not
directly affect employee willingness to engage in customer oriented behaviors procedural justice
does, however, positively affect perceptions of distributive justice.
―What influence the mature consumer?‖ by Moschis, George.P; Bellenger Danny N; Curi,
Carolyn Folkman44. This article presents a study that analyzed the differences in the motives for
patronizing specific hospitals and physicians for mature consumers in the U.S based on a
gerontographic segmentation analysis. This study explains, the geronotographic profile of an
older person helps explain nearly every patronage reason when it comes to choosing among
hospitals. Reasons for patronizing a hospital include convince in searching the service provider
ease of getting related services at the same place, discounts to age groups, attitude of medical
staff and others. Senior discounts as patronage incentives are of greatest to ailing individuals and
least appealing to healthy individuals that are somewhat, withdraw from society. Frail recluse
patients are more likely than older adults in other gerontographic groups to consider the various
billings/payments options available to them. Findings show significant differences in the way.
Older consumers respond to various marketing offerings as compared to younger consumers.
The response of older people in the U.S vary widely by life style characteristics that define the
person‘s geronotographic profile is a strong predictor of his or her patronage.
―Measuring physician attitude of service quality‖ by Walbridge Stephanie; Delene Linda M45
The importance of service quality research increased during the 1980‘s and led to several
different theoretical perspectives on service quality. In this context this article examines a study
on the professional service quality of physicians. Research findings from physicians about
service quality determinants and the importance of various marketing and service characteristics
have been presented in this study. Physician‘s perceptions may most directly affect the design
and delivery of the services offered. Moreover, understanding service quality from a physician

94
perspective is necessary for developing a rational method of including a quality measure in
physician reimbursement mechanisms. In the study a survey was mailed to physician on staff at
two major teaching hospitals. A two page, self- administered questionnaire-covering physician
demographic, practice characteristics, and previously researched determinants of service quality
were designed, pre-tested and mailed. Finally the research suggested that physicians perceptions
of the determinants of service quality in medical practice are not congruent with the findings
from service quality research in other industries. Although similar research on a larger scale is
necessary, the service quality aspect of health care remains important to the consumer and the
health care providers.
―The public‘s perception of quality hospitals II: Implications for patient surveys‖ by Grashof
and John F46 The article presents an abstract of a study titled ―The public‘s perception of quality
hospitals. II: Implications for patient surveys by Joseph.A.Boscarnio, and published in a 1992
issue of the journal ― Hospital and health services administration‖. A study of the results of
patient quality evaluation of 155 hospitals is used as the basis for identifying characteristics
associated with higher quality ratings by patients. Based on the results of the research, the author
suggests several aspects of patient surveys that can improve the quality of the research. First, the
measures should include valid and reliable measures of both patient‘s medical outcomes and
perceived hospital experience. Second, quality should be measured against appropriate standards
for the hospital situation because perception can vary by size, locations etc.
Physical Evidence
―Enhancing Competitive Advantage of Hospitals through Linguistics Evaluation on Customer
Perceived Value‖ by Feng-Chuan Pan Chi-Shan Chen47 This article proposes, would more
precisely exploit the value attributes perceived by customers. This research would be pioneer in a
value perception study for healthcare services; it would contribute to the industry by providing
clear insight to accurately identify target customers who are most valuable in the long-term.
Findings of this research indicate patients/customers perceive more value from quality delivered
by physician competence versus updated facilities. Personal care and a comfortable atmosphere
are more important value attributes than a gorgeous, modern building; price is surprisingly a
significant value similar to the reputation of a hospital. Hospitals in this research are
characterized by diverse value attributes (in terms of five individual value factors studied).
Nevertheless, quality remains the strongest value driver. Physician's competence, along with

95
correctness and speediness of emergency services are the most valuable criteria customers seek
for healthcare service as this research revealed. Therefore it can be concluded that top rate
emergency rooms filled with expert medical teams is of utmost importance in making a
particular hospital a standout in this industry.
―Hospital choice factor: A case study in Turkey‖ by Akinic, Fevvzi: Esatoglu, Tangilimagulu,
Dilaver, Parsons, Amy48. This article examines the factors affecting hospital choice decisions of
869 patients in three public and one private hospital policlinics in Ankara, Turkey and attempts
to determine their importance levels. Identification of factors and determining their effect levels
is important in concentrating management efforts on these key areas and in formulating effective
marketing strategies to retain and expand hospital patient‘s bases in the future. This study
findings highlight the importance of accessibility of hospital services to consumers in hospital
choice as well as the role of hospitals image its physical appearance, and technological
capabilities in informing such choices. These findings are useful for managers to understand how
patients make choices related to health care facilities and to develop marketing strategies that
may more effectively market their facilities.
Process
―Achieving quality and choice for the customer in hospital catering‖ by Michael Kipps and
Victor T. C. Middleton49 The research focuses on the opportunities, issues and problems
associated with catering for National Health Service hospital patients. There is significant
conflict-or gap-to be resolved between management attempts to improve consumer choice and
food quality and the constraints imposed by unit cost targets and the complex operational
conditions associated with hospital catering in the NHS. The paper‘s theme examines the role of
technology and management innovation in defining and bridging the gaps between increasing
consumer (patient) aspirations, and the ability of the catering service to respond with improved
product delivery.
―Structuring the marketing function in complex professional service organizations‖ By Laing,
Angus, Mckee, Lorna50 The organization of the corporate marketing function has attracted
increasing attention from marketers in the 1990‘s. This reflects both the significant conceptual
developments in marketing theory and a questioning of the role of the centralized marketing
development to organizations operating in post-industrial service economies. In this context this
paper examines the organizational solutions adopted by self-governing hospitals in managing the

96
marketing function. The core theme to emerge from the research is the imperative for such
professional service organizations to facilitate the development of flexible project focused
marketing teams, effectively mirroring the notion of the buying center, capable of integrating
core technical professionals directing in to marketing process.
General Marketing
―How marketing oriented are hospital in a declining market?‖ by Naidu G.M, Narayana, Chem
L.51 The article focuses on the role, value and actual implementation of marketing within health
care institutions. The author empirically investigate, first, the extent of marketing orientation in
hospitals. Second , the degree of marketing orientation as it relates to hospital characteristics, and
third, the relationship of marketing orientation to hospital performance. Surveys have been
commissioned to study the trends and the level of marketing activities in hospitals. The study
findings imply that a marketing orientation by hospitals works, if hospitals are to survive and
grow, they must explore specific marketing strategies along continuum of specialization/niche
marketing on one end and complete diversification/ one-stop shopping for all health services on
the other. They believe that a formal marketing department staffed with marketing professionals
knowledgeable of health care fields, with adequate process, is essential to create a true marketing
orientation. Lip services with out true commitment to a marketing orientation can only create a
waste resources and disillusionment.
―The relationship between market orientation and performance in the hospital industry; A
structural equations modeling approach‖ By P.S.Raju; Lonial; Subhash.C; Gupta,
52
Yash.P;Ziegler; Craig This article examines the relation between market orientation and
organizational performance in the hospital industry. One unique future of this study is that both
market orientation and performance are conceptualized as being multi-dimensional constructs.
This study used the technique of structural equation modeling (SEM) is used to examine the
relationship. Analyses were based on market orientation and performance, data obtained from
175 hospitals in a five state region of the united states. They find out multi dimensional nature of
both market orientation and performance and, the strong relationship constructs. Interestingly
this relationship is found to be much stronger for smaller hospitals than for larger hospitals.
―Does marketing relate to hospital profitability?‖ by Mc Dermott, Dennis R, Franzak, Frank
J,Little, Michal W53 This article examines the relationship of marketing activities of hospitals
including the use of market intelligence activities, interventional coordination activities, and

97
organizational responsiveness activities to financial performance. The results suggest that it
would be variable to hospital marketing managers to adopt a data driven, proactive management
style that incorporates a teamwork emphasis to improve the financial performance of the
hospital. The study further suggests to marketing managers that higher-usage levels of marketing
intelligence and in their functional coordination activities are much more likely to be related to
higher profitability than are organizational responsiveness activities. Further this study suggested
that the hospital marketing executives need to recognize the timeliness or function in the
localized, unique marketing environments.
―Market orientation in the hospital industry‖ by Bhuian, Shahid N; Abdul-Gades, Abdallah54
This article discusses the concept market orientation as applied in the hospital industry. The
purpose of this study was to systematically develop and assess a scale of market orientation for
the hospital industry using an updated paradigm for scale development. The resulting
measurement scale would provide a better empirical estimate of market orientation in the
hospital industry. This study used both exploratory factor analysis and confirmatory analysis.
This study is limited by several factors; first this is an initial attempt to systematically develop a
market orientation scale for hospitals so further work remains in both the methodological and
substantive arenas before any generalization can be made. Second, the study assessed the market
orientation of only one particular type of stakeholder. Third, this research used non-profit
hospitals, which constitute about 60% of hospitals in the United States. Further studies should
include for profit hospitals and other type of health care providers. Finally this study developed
and examined a scale of market orientation for the hospital industry. The scale is based on a clear
definition of the content of the construct of market orientation in the hospital industry.
―Looking at innovative multifunctional systems: How marketing differs‖ by Tucker, Lewise
R; Zaremba; Roger A; Ogilvie, John R55 The objective of this study is to investigate empirically
the manner in which the corporate/system-level of multi hospital systems supported and diffuses
marketing practices among member hospitals. The major assumption underlying in this research
is that most multifunctional systems to some extent have adopted and practiced marketing in
these organizations. Further the degree of commitment to formalization of, and proficiency with
marketing is expected to vary widely across systems. The basic conclusion derived from these
studies is that information quality and accessibility are instrumental in determining the
effectiveness of marketing in a hospital setting.

98
Patient Satisfaction
―Capturing the dynamics of in-process consumption emotions and satisfaction in extended
service transactions‖ by Laurette Dube, and Michacl S. Morgan56 This research concentrated on
the trends in consumers emotions and satisfaction during extended service transactions, such as
resorts, hotels, travel services, education and hospital services. The research conducted on ‗Can
the evolution of consumption emotions and satisfaction along the normal course of extended
service transactions be traced and predicted? 49 male, 44 female consumers of health care
services reported in-process positive and negative emotions and satisfaction every day of their
hospital stay median length of stay of 5 days and global retrospective judgments of the same
variables upon departure. Trends in consumption emotions and satisfaction were tested using a
dynamic nonlinear model based on assumptions of monotonic and habituation. Results
confirmed that trends in consumption emotions increasing positive and decreasing negative and
satisfaction under high in-process positive emotions only could be modeled with statistical
confidence and the model showed a good ability to predict retrospective global judgments.
Revealing complex in-process dynamics, higher states of positive emotions magnified increasing
trends in satisfaction and higher states of negative emotions dampened increasing trends in
positive emotions. In-process satisfaction judgments had no significant impact on trends in either
positive or negative emotions. Trends in emotions were influenced by individual gender and
contextual health status conditions. A steeper increasing trend in positive emotions was observed
for men compared to women while a smoother increasing trend in positive emotions and a
smoother decreasing trend in negative emotions were obtained for consumers with poor health
status compared to those with good health status.
―The gift of customer‘s complaints‖ by Stichlu, Jaynelle.F; Schumaches, Lynn57 This article
discusses the benefits of customer‘s complaints in a health care setting. This study opinioned
that, there are two variables influence a customer‘s purchasing decisions. This article observed
that quit dissatisfaction can lead to market share erosion and a financial loss to the organization.
Finally concluded that were brought to this attention revealed that complaint handling was
defined as fixing the situation directly with the customer, whereas complaint management was
defined as fixing the policies, system or protocols so that the problem would not occur for future
patients.

99
 ―The acute hospital food service patient satisfaction questionnaire: the development of a valid
and reliable tool to measure patient satisfaction with acute care hospital food services‖ by Capra,
Sandra; Wright,Olivia; Sardie,Marie;Bauer,Judith; Askew, Deborah58 The objective of this
study was to design a valid and reliable questionnaire to measure patient satisfaction with acute
care hospital food services. The acute care hospital food service patient satisfaction questionnaire
was administered to convenience sample of 2347 acute care hospital in-patients and post
discharge patients from two public hospitals and one 360-bed private hospital in Queensland ,
Australia. A factor analysis and evaluation of cronbach‘s alpha revealed that the final
questionnaire contained 16 statements relating to four factors describing food quality, meal
service quality, staff/service issues and the physical environment. Questions requesting
demographic data were included. Results indicated that the survey is an accurate, reliable
measure of patient food service satisfaction. It differentiates the food service into four factors
and collects detailed information about food service attributes within these factors. This allows
the application of systematic measures to improve food service quality and provides a tool for
the continues assessments of food services quality and measurement of changes in patient food
service satisfaction over time in a variety of accurate care settings.
―Modeling patient satisfaction and service quality‖ by Taylor Steven A; Cronin Jr. J.Joseph59
In this article the author attempt to clarify and extent the conceptualization and measurement of
consumers satisfaction and service quality in health services. Although the two constructs serve
as cornerstones in the design and implementation of heath care marketing strategies, a literature
review suggests that satisfaction and service quality are currently difficult to distinguish both
conceptually and operationally in health care settings. The findings from two studies conducted
by the authors to distinguish the nature of these two important constructs within a healthcare
marketing context reveal that a no recursive relationship between service quality and patient
satisfaction may account for much of the conflicting evidence in the literature.
In India few books were published on marketing of hospital services and related areas. Some
of them include.
―Essentials of Health Care Marketing‖ written by Eric N.Berkowitz, a book discussed the
principles of marketing and their application in healthcare. Moreover, as healthcare has changed
over the past twenty years. In this context this text concentrated on discussion of, how the

100
application of marketing principles also must shift in terms of their strategic application to
respond to the changing environmental forces of the market place.
―Responsive Healthcare: Marketing For A Public Service‖ written by Rod Sheaff, a book
discussed how conventional marketing methods can be adapted for use in healthcare and publicly
funded systems responsible for health promotion and health service planning. This book tries to
explain the different types of marketing tasks found in the health systems: health care
purchasing, health promotion, public hospital provision and primary care and consumer
researches etc.,
―Health Care Market Strategy: From Planning to Action‖ written by Steven G. Hillestad, a
book discussed about how to develop and execute a successful marketing strategy for healthcare
facilities. This book discussed such topics as the challenge of a competitive market place,
conducting the internal/external assessment, determining actions, etc.,
Some more books are, William J. Winstone60, Steaphen Joseph Williams, Paul R. Torrens,
Stephen Williams61,Robert Sweeney, Robert L. Beri, William.J.Winstone62,Montague
Brown63,Phillip D. Cooper64, Sharam Heshm65,William G. Zikmund, Michael66, Dewayne L.
Oberlander67,M.Joseph Sirgy68,Jack Rabin, Marcla B. Steinhauer69,Philip D.Cooper, Cooper,
Larry M. Robinson70,Francic Buttle71,Odin Waldemar Anderson72,David F. Drake73, Neil Baum,
Gretchen Henkel74,Donald R.Self, Walter W.Wyner75,Teresa A. Swartz,
Lacobucci76,G.Hillestad,Eric N.Berkowitz77,Donald R78,Phillip Kotler79,Alan R.Andreasen,
Phillip Kotler80,Gllbert G. Bashe, Nancy J.Hicks, Amy Zlegenfuss81,Peter Boland82,Virginia
Hayden83,Charles D. Schewe84,Kevin W. Green85,Seth B.Goldsmith86,Priscilla L.Clark87,Louis
G.Redstone88,Eric N.Berkowitz89,Angus Laing,Gillian Hogg,Molra Smith90,David
L.Rados91,Barbbara Lehman92,Harsh Kumar93,Norman H.McMilan94,Shsmd95,Patric
T.Buckley96,Marc D.Halley97,John F.O‘Malley98,Paul A.Sommers99,Shahram Heshmat100,David
P.Angrisani, Robert L.Goldman101,Roberta N.Clarke Phillip Kotler102,G.D.Kunder103, Richard K.
Thomas and Michael Calhoun104

101
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