Healthcare has a number of characteristics that give rise to peculiarities of the operation of market mechanisms in this area. These characteristics express the social significance of people’s need to have good health, as well as the specifics of the production and consumption of medical services.
The peculiarities of the market begin to manifest themselves in the product itself - a medical service, which has the following distinctive properties:
– intangibility(the patient cannot know the results of the doctor’s visit in advance);
– inseparability from the source of service provision(the patient no longer receives the same service if he sees another doctor);
– inconsistent quality(the quality of medical services can vary widely);
– unpreservability in time (it is impossible to separate the process of production and consumption, it is impossible to procure and store services).
A medical service is a kind of consumer product that requires the active participation of the consumer in achieving the result (the patient’s recovery cannot be achieved if the doctor’s actions do not find support from the patient). In addition, the direct object of purchase and sale is not the final results of the activity, but the conditions for their achievement - costs.
In many ways, the features of medical services are determined by the features of the medical services market, among which the main ones can be identified:
1. Many health services are not private, but public or quasi-public goods. For example, sanitation and hygiene measures inevitably become the property of large groups of the population. There is a “stowaway” effect: people receive benefits, but do not pay for them. Some medical services generate significant externality. The service is provided to a specific person, but its beneficial effect is felt by many other people. Utility for third parties arises. A classic example is services for the prevention of infectious diseases. Thus, vaccinations against measles benefit not only the vaccinated people, but also society as a whole, since the spread of this disease is limited. These market flaws are expressed in the fact that focusing only on effective demand will not ensure the satisfaction of social needs. Consequently, the market mechanism will produce such medical services in a volume insufficient for society. Therefore, special measures of government subsidies to private producers of these services, or the provision of these services by public medical organizations, are required.
2. Another feature of the production of medical services is related to limited competition. These limitations are manifested in the fact that, firstly, the uniqueness, individuality, heterogeneity of medical services makes it difficult to compare price and quality (my neighbor may like the way his doctor treats him, but if my illnesses are different from those of my neighbor, then it remains to be seen , will I be satisfied with this doctor). Secondly, the peculiarities of professional ethics of medical workers, when open expression of competition is condemned. Often, specific volumes of the medical services market (village, town, small town) give rise to a natural monopoly. The appearance of a second doctor or a second hospital in a small village makes sense if they are able to offer services on much better terms. But then the former will be forced out of the market. Consumers will have choice, but this will come at the expense of higher costs than necessary.
3. The next feature is due to the limited information in the production and consumption of medical services. The doctor-patient relationship is a classic example. information asymmetry. Under these conditions, information essential for concluding a transaction is at the primary disposal of one of its participants. Firstly, a sick person, as a consumer of medical services, does not have the knowledge that would allow him to assess the volume and price of purchased services. It is difficult for him to choose a doctor who can provide services at a lower price. Secondly, in many cases, the patient cannot make a rational choice of necessary services due to his painful condition, and sometimes as a result of temporary or complete incapacity. Third, unlike conventional markets, in health care it is the producer, not the consumer, who determines the volume of benefits provided. Doctors act in two persons - as agents of patients, determining the extent of their needs and the volume of necessary services, and as producers of these services. Doctors may exaggerate the amount of procedures needed, exclude cheaper services and replace them with more expensive ones.
4. Risks and uncertainty of consumer expectations. The demand for medical services is largely random. Each person should consider that there is a risk of illness and associated costs. These costs can be quite significant if medical services are purchased at the time the need arises. To avoid large one-time costs, a person in a situation of uncertainty tends to resort to various forms of insurance. However, the availability of health insurance may encourage people to place greater demands on health care services and lead to higher health care costs. This situation can be depicted on a graph as follows (Fig. 1).
If the insured patient paid the full price of the medical service (P 1), then the demand would be equal to – Q 1. Since the patient pays only part of the price (at the level P 2), the demand will be Q 2.
The insurance company will pay for the increase in demand at a price of P 1 . When demand increases from Q 1 to Q 2, the insurance company's expenses are measured by the rectangle ABEC, and the benefit received by the consumer is measured by the triangle ABC. The additional costs exceed the additional benefits by a triangular
The medical services market in its characteristics differs significantly from the market of perfect competition and is more similar to the market monopolistic competition. Restrictions on competition and information, other things being equal, often lead not to a decrease in price when supply increases, but, on the contrary, to an increase in price. This means: an increase in the number of doctors automatically generates demand for medical services. In addition, most medical services are characterized low price elasticity of demand(elasticity coefficient 0.3 - 0.7), which also means a weak response of demand to price changes.
Thus, the peculiarities of the operation of market mechanisms in healthcare give rise to a tendency towards underproduction of medical services or unjustifiably high consumption of resources per unit of services. At the same time, in healthcare, the prevailing idea in society about justice in obtaining medical services, in access to medical care. Many countries around the world strive to ensure that the distribution of resources and benefits in the field of public health meets certain moral criteria. Therefore, it is extremely important to see and understand the socially acceptable boundaries of market relations in healthcare.
It should be noted that there are additional barriers for manufacturers of medical services when they enter the market: the need to obtain a license, frequent certifications, accreditations, etc. This is due to the fact that dynamic demand, the emergence of new needs and “niches” in the market of medical services and related products are actively attracting new specialists and pseudo-specialists to this area.
Market “failures” dictate the need to form quasi-market relations in healthcare (see table). These relationships differ markedly from the classical market model. Essentially, we are talking about market design using some tools of entrepreneurial behavior to support health policy priorities.
Limited role price factor. Consumers of medical services in public health systems either do not pay for them at all or make fixed co-payments, the amount of which is established by law. In this situation, their preferences are implemented by the financing party - the insurer in the compulsory medical insurance system or the government authority in budgetary healthcare systems.
Limited development of the commercial sector. In this market, there are predominantly non-profit organizations whose activities, in comparison with commercial organizations, reflect relatively weakly the motives for increasing profitability. In many countries, the use of commercial sector mechanisms based on increasing the autonomy of medical service providers, increasing their financial responsibility for the results of their activities.
“Failures” of the markets for medical services and health insurance
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Market Flaws |
Consequences of flaws market |
Mechanisms for overcoming or limiting market failures |
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Some services have the properties of public goods |
The market does not provide the required volume of these services |
To provide these services, the state creates a special sector of “public health” (sanitary supervision, etc.) |
|
Information asymmetry |
Consumer choice is becoming more complex. The influence of consumers on the quality of medical care is weakening. The principle of independence of the parties to a market transaction is violated. The market position of the medical service provider is strengthened. |
Collective purchasers of medical care (for example, insurers) act in the interests of the population. Information is provided on the performance of medical organizations to facilitate consumer choice. |
|
The supply-driven demand effect |
Establishes a global budget for healthcare organizations. Payment methods are used based on sharing financial risk between the buyer and the healthcare provider. The validity of medical care is monitored. Clinical standards are being introduced. |
|
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Medical services have the properties of socially significant benefits; special role principles of accessibility and equality in receiving MP |
The stimulating effect of effective demand is reduced. Conditions for competition between insurers are limited |
In public healthcare, quasi-market type mechanisms are being introduced: “money follows the patient” Introduced additional programs health insurance |
|
Moral Hazard Effect |
Conditions are created for the costly functioning of healthcare |
Co-payments from the population are being introduced. A system of mandatory referrals of patients by primary care physicians to specialists is being established. Insurers are monitoring the validity of medical care. “Waiting lists” are being established. |
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Adverse selection effect |
The probabilistic nature of insurance is limited. Insured persons with low risks leave the insurance pool, which leads to an increase in insurance premiums (the “insurance spiral” effect). Part of the population turns out to be uninsured. |
Individual risks are assessed. Registration intervals for those insured with a certain insurance organization are increasing. Insurance organizations insure large groups of workers. Medical insurance is becoming mandatory. |
Competition in a situation of a fixed health care budget. Budgetary financing systems have a fixed budget; compulsory medical insurance systems also set a budget or impose restrictions on the influx of funds by increasing insurance premiums. The state exercises financial control over health care resources. As a result, there is no competition between healthcare and other industries in attracting consumer funds.
Maintaining strong government regulation of the health care financing and delivery system. Elements of market relations are combined with the preservation of state regulation of healthcare. Its most important elements are ensuring equality in the availability of medical care for all groups of the population, planning a network of medical organizations, their licensing and accreditation, managing a system of contractual relations, and a set of measures to contain costs.
Market structures with one or multiple purchasers of health care are possible. In the first case, there is one insurer or one government agency that implements the function of purchasing medical care at the national level. In the second case, there are several such organizations. They carry out their operations in different ways: either with a strict territorial consolidation of the population served, or they can extend their activities to any local markets. In the latter case, a “fork in the road” arises. One option is for health care purchasers to secure local markets through government action. For example, in France, autonomous territorial branches of the national health insurance fund (they perform the functions of an insurer under compulsory medical insurance) receive the right to serve the population of neighboring territories. Another option: insurers are free to choose the scope of their activities and can compete for consumers. It is the latter option that is the main object of designing quasi-market relations, which is actively used in the voluntary health insurance system.
The peculiarity of medical services is due to four characteristics: intangibility, inseparability from the source, variability of quality and non-preservation - and this feature is one of the main ones.
Economic features Medical services can be divided into three interrelated groups: those related to price, the specifics of the result, and the process of providing the service.
The first group - features associated with quantitative characteristic of cost services:
The service can be presented both in commodity form and in non-commercial form for
consumer (state guarantees for the provision of free medical
assistance), that is, be market or non-market;
The cost of the service is determined depending on the source of its financing (budget,
insurance company, private clinic);
Determining the value of the cost may have several options;
The cost of a health care service is not some kind of constant, given once and for all.
size;
Despite all the uncertainty and unpredictability of treatment and prophylactic
process, it is possible to create economic standards for its payment.
1. The service can be provided as per commodity(it is in this case that it begins to have cost parameters), and so in non-commercial
form. Commodity money is dominant in the industry today, although even the father of medicine, Hippocrates, advised the doctor not to “behave too inhumanely towards the patient, to pay attention not to the abundance of the patient’s funds and to their moderation, but sometimes to treat would be for nothing, considering the grateful pa-
crumple above momentary glory."
2. Based on the provisions already given, it can be noted that
that the definition of quantity cost health services may have Several variants, when choosing which the doctor inevitably faces the need to solve a complex clinical and economic problem.
3. Cost of health care services there is no constant, a value given once and for all. On the contrary, it tends to change, more often in the direction of increase (especially with long-term treatment).
4. Perhaps, despite all the uncertainty and unpredictability of the treatment and prophylactic process, creation of economic standards, including a number of interdependent natural, cost and relative indicators and allowing, at least approximately, to determine how much the proposed process of treatment or health care will cost.
The second group - features associated with specificity of manifestation the result itself
professional activity health workers:
The result is embodied in the person himself (material components of the service - as an exception (x-ray, electrocardiogram, prescription);
The service is always individual in nature (it is not the service that is brought to the market, but only
information about services);
The result is always varied in its physical scope;
The result has a complex structure and breaks up into many quasi-results;
The amount of resources required to achieve the result is precisely determined in advance
it can not be;
The result varies in terms of the period of manifestation and the need for repeated exposure.
Effectiveness is not directly related to the amount of costs.
1. The result of professional activity in healthcare, as a rule, embodied in the person himself. Material services are rather an exception for healthcare (for example, these are x-rays, electrocardiograms, prescriptions, which record the clinical and diagnostic thinking of the doctor and which, when written out, begin, like books, a life independent of the will and consciousness of the author, etc. .). It is worth paying attention to the fact that there is not an insurmountable line between material and pure services. On the contrary, in many cases they interpenetrate and complement each other, forming transitional, borderline, mixed forms and modifications.
2. The service, as an industry result of healthcare, is always individual character. Although it itself deals with millions of people, there is not only mass production in healthcare, but also small-scale production. It is also impossible to produce (provide) health care services in advance, so to speak, for future use, and then wait for demand to arise and the sale of this unique product.
The consumption of a significant number of health services coincides in time with their production. Individualization of health care services and creative character Many forms of medical activity lead to the fact that the required result (effect) can often be achieved only by the actions of a fairly limited circle of specialists or even by the actions of one person.
3. The result we are considering, despite all its individuality, may be varied in their physical volume. In this regard, in healthcare it is realistic to implement various options. We can imagine a doctor who deals with only one patient - the personal physician of some celebrity. In this case, the result of his work will be individual in the literal sense. However, to maintain his own qualifications, this doctor will obviously need to have more extensive practice.
The family nurse, based on the multifaceted nature of her functions, must achieve results adequate to the needs in a broader physical scope, dealing with a number of individuals of different ages(usually starting with children school years) and social status.
4. The result in healthcare has a complex component, consisting of many sub-results. At the same time, it is advisable to dwell on the very concept of health as a result of medical activity.
Strengthening the health of the population is not only necessary, but also, perhaps, the only possible universal indicator of obtaining a certain positive result from the work of healthcare workers in the form of a beneficial effect.
Health is determined by a number of demographic and other factors. It is characterized by several main groups of indicators. The first group includes such demographic indicators as population size, its composition, birth rate, mortality, natural increase, etc. The second group consists of population morbidity indicators. And the third group includes indicators of the physical development of individual groups of residents. Many specific methods for assessing the results of medical activities and, accordingly, the health of the population are based on determining a number of indicators of a therapeutic and preventive nature, which are directly and more closely related to the work of medical workers.
5. Productivity b in healthcare is not directly related to the amount of costs.
6. The result is varied according to the period of manifestation and the need for repeated exposure. The range of this diversity can be quite significant: from instantly achieving a result, as happens, for example, when relieving pain, to long-term, often painful, repeated medical interventions, which only in their totality can lead to the achievement of the goal.
7. The nature of payments for what has been achieved the result (service provided) may also be different. This includes both direct payment and payment via budget resources, and payment from the fund formed in insurance organizations.
The third group - features associated with process provision (production) of services:
Dependence on local natural resources climatic conditions;
The presence of an active doctor-patient relationship;
The patient himself is more active - from passivity to interest;
Possibility of territorial movements: services started in one place and completed in
Variety of durations for the provision of identical services;
High degree of risk in obtaining a guaranteed result;
Availability large quantity investors;
Variety of economic ties;
In the process of providing medical services, a variety of influence methods are used.
1. Having a large number of investors(patient, nurse, company, employer, public organizations, including insurance companies, the state and medical structures) paying for the process of providing services. Only the joint use of various investment resources makes it possible to make the process of providing healthcare services continuous, high-quality and efficient.
2. Variety of economic ties, which manifest themselves during the provision of medical services and without which the activities of modern healthcare, which has undergone significant industrialization, cannot be imagined.
3. Dependence of the progress of the provision of health care services on climatic conditions,which can hinder or, conversely, be favorable for the treatment or prevention of various diseases.
4. Presence of active interconnection along the line doctor-patient.
5. Opportunity territorial movements during the rendering process.
6. The patient, as an object of medical influence, himself has the greatest activity, which can also be directed either to his detriment or to his benefit. In this case, in necessary cases, the patient’s conscious activity is turned off (anesthesia, hypnosis).
7. In the process of providing health services, there is an opportunity effort limits achieving an intermediate result with subsequent resumption provision of services with a corresponding change in the conditions for the implementation of this process.
8. Services can start in one territorial place, and continued in another.
9.Process duration provision of health care services may be different. In general, it covers the whole life, and in certain cases even goes beyond the life of a particular person.
10. During the provision of medical services a variety of methods are used influences on the subject of labor: mechanical, physical, chemical, biological, socio-psychological.
The listed features of medical services determine the conditions for the establishment of market relations in healthcare. At the same time, a medical service can be considered as an object of market relations in the following cases:
Purchasing services not provided for by the Program of State Guarantees for free medical care in state (municipal) institutions;
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Purchase of services by patients who are not entitled to receive them free of charge;
Purchasing services with increased quality standards for their provision;
Purchasing services at a time convenient for the patient (out of turn, on weekends, etc.):
Purchasing services from non-state (non-municipal) commercial and non-profit medical organizations.
Having examined some problems associated with the general characteristics of the economic side of activity in healthcare, let us move on to the mechanism for forming the structure and mechanism of action of the healthcare services market, the specific features of which are determined by the originality of the very object of this group of market relations, i.e. medical services.
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Marketing in healthcare. Prerequisites for the emergence of marketing in healthcare. Objectives, principles and functions of marketing. Marketing is a business activity that manages the promotion of goods (services) from producer to consumer (user) or a social process through which demand for goods, services, ideas, etc. is predicted, expanded and satisfied. The main content of marketing is the study of demand for goods and services, i.e. his satisfaction. The study of demand for goods and services of the healthcare system is considered as the initial stage of entrepreneurial activity, and in a market economy, medical institutions of various forms of ownership act as entrepreneurs. Marketing not only involves taking into account market conditions, but is also a tool for generating demand, which is especially important for healthcare, since skillful use of marketing opportunities can contribute to the formation of a healthy lifestyle and health protection. Medical marketing is defined as the process by which the market for medical care (medical services) is managed and implemented. Healthcare marketing (or healthcare marketing) is a broader concept of which medical marketing is a part. The field of healthcare marketing includes all types of goods and services, information, ideas, events, specialists, institutions, organizations, etc., related to the preservation and promotion of public health. Healthcare marketing is classified as social marketing, and all types of health-related goods and services are classified as social (public) goods. Marketing in the modern economy is based on scientific research. When conducting marketing research the basic elements of marketing are studied, which include: needs, motives, needs, requests, demand, goods, services, exchange, transactions of the consumer, buyer, seller, manufacturer, market. Marketing in healthcare - social marketing. In it, the population acts as an associated consumer of goods and services, healthcare authorities and institutions of various forms of ownership - as an associated producer of medical services, executive authorities - as an associated buyer of medical services (intermediary or sponsor). This concept reflects the situation today and, probably, the very near future. The insolvent population cannot be a real buyer of all the goods and services it needs, and the state in the economy of the transition period largely retains its previous functions in the social sphere, i.e. elements of monopoly and monopsony
57. Supply and demand in the medical services market. Factors influencing supply and demand. Operating under conditions market economy, healthcare, like any other industry, is subject to the laws of the market.
Market is a set of economic relations manifested in the exchange of goods and services, as a result of which demand, supply and price are formed in a competitive environment.
Market of medical goods and services is a market segment that provides medical goods and services to maintain and improve public health. It makes it possible to receive and provide medical services, guarantees their required volume and an appropriate level of quality.
The healthcare market includes a whole system of interconnected markets: medical services, medicines, labor medical personnel, scientific developments, medical technologies, medical equipment, etc.
The following basic market concepts are distinguished:: demand; proposal; service; price; competition; marketing.
Demand- one of the fundamental concepts of a market economy. Applied to healthcare demand (need) is the quantity of medical goods and services that society (individual patients) is willing and able to purchase in a given period of time at a certain price.
There are the following types of demand in the market for medical goods and services:
negative demand: for vaccinations, appointments with doctors of certain specialties, painful, expensive procedures, etc.;
latent demand: individual patients may have a need that cannot be satisfied with medical goods and services available on the market, for example, family doctor services, disposable medical products, services, individual nutrition in a hospital, etc.;
falling demand: for example, in Lately the demand for syringes, reusable blood transfusion systems, and domestically produced antihypertensive drugs has fallen, so the market responded with an increased supply of syringes and disposable blood transfusion systems, and imported drugs;
irregular demand due to seasonal time fluctuations. For example, the demand for SCL is higher in the spring-summer period than in the autumn-winter period. Referrals to individual medical specialists depend on the seasonality of certain diseases (influenza, peptic ulcer, viral hepatitis, etc.);
excessive demand: for urgent medical care on holidays and after holidays, when patients suffering from chronic diseases violate their diet, regimen, and abuse alcohol; the level of injuries is increasing.
The next fundamental concept of the market isoffer. The quantity supplied is determined by the quantity of goods and services that the producer (seller) is willing and able to sell at a given price in a certain period of time.
Applied to healthcare offer is the amount of medical goods and services that manufacturers can provide to the population over a certain period of time. Supply, other things being equal, also changes depending on changes in price: as prices rise, manufacturers (sellers) offer patients more goods and services. When prices fall, their interest decreases and the volume of medical goods and services they produce decreases accordingly.
Medical service - a structural element of preventive, therapeutic-diagnostic, rehabilitation, sanatorium-resort, sanitary-epidemiological, medicinal, prosthetic-orthopedic and other types of care, which has a certain cost.
According to the conditions and place of provision, medical services can be divided into those provided at home, in outpatient clinics, hospitals, sanatoriums and other healthcare institutions. Medical services can be simple or complex. Under simple medical service understand an indivisible service, for example, a diagnostic procedure, a doctor’s examination, etc.
Comprehensive service can be presented as a set of simple services that reflect the technological process of providing medical care for a given disease that has developed in each specific institution.
In addition, a distinction is made between standard and individual medical services.
Standard medical services are mainly provided using a unified technology for the vast majority of patients; they have relatively stable pricing.
Individual medical services have a wide range of manipulations, diagnostic and therapeutic procedures, a large range of medicines and medical products. They have differentiated price lists that maximally take into account the individual costs of their implementation.
Price- this is the amount of money for which the “buyer” can buy, and the “seller” is ready to sell this product or medical service. Price is a kind of compromise of the economic interests of market participants.
Taking into account the fact that price is organically related to supply and demand, the following concepts are distinguished: demand price, supply price, equilibrium price.
Ask price - such a market price in such a state of supply and demand, when a buyer’s market develops. At this price, the “buyer” is able to purchase a medical service or product. The price cannot rise above this limit, since patients will not have the opportunity to purchase it.
Offer price - the market price in such a state of supply and demand, when the so-called seller's market develops. This is the price at which the “seller” offers his service or product. At the same time, the supply price must cover the costs of producing medical goods and services.
When demand and supply are equal, the so-called equilibrium price. When the price decreases, demand increases as people want to purchase more goods or services, and, conversely, when the price increases, demand may decline.
The main link of the market mechanism is competition.
Competition - competition between economic entities, struggle for markets for goods and services in order to obtain higher incomes and other benefits.
The competitive struggle for economic survival and prosperity is the law of a market economy.
State educational institution higher professional education "Voronezh State Medical Academy named after. N.N. Burdenko Roszdrav"
Department of Management and Organization of Nursing
Head of Department,
Doctor of Medical Sciences L.I. Lavlinskaya
COURSE WORK
MARKETING OF MEDICAL SERVICES
Topic: “Medical service as a product. Market of medical services."
Completed by a 5th year VSE student
Institute of Nursing Education
501 groups of correspondence courses
Zelenova Elena Alekseevna
Checked:
VORONEZH, 2008
Introduction 3
1. General characteristics of the medical services market 6
2. Medical services market
2.1. Features of the medical services market 9
2.2. Service characteristics 9
2.3. Product policy 12
2.4. Price 13
Conclusion 19
References 21
Introduction .
Currently, relations in healthcare are being reformed. Medical institutions have to conduct their activities in the conditions of the medical services market. The amount of funding from the state budget is being reduced, the provision of medical care under the conditions of compulsory health insurance is not paid due to a lack of funds in the territorial compulsory medical insurance funds. All this affects economic situation medical institutions not with the best side. In most cases, medical and preventive institutions (HCIs) are left to their own devices, and not everyone manages to survive. Many clinics, hospitals, and medical units were unable to adapt to market relations and are closing. Therefore, in new market conditions, to ensure the survival of healthcare facilities, they are moving to a new management mechanism.
The new management mechanism, among other things, includes the use of market mechanisms for managing health care facilities and healthcare in general and ensuring the profitability of health care facilities. One of the new areas of activity of medical institutions is marketing.
Currently, healthcare marketing is in its infancy. This is a complex path of evolutionary development, overcoming numerous difficulties and contradictions, and gaining experience. And the sooner positive experience becomes the property of doctors and heads of healthcare institutions, the more successfully difficulties and serious shortcomings relating to the most important value of society – people’s health – will be overcome.
The use of marketing in healthcare helps to optimize the activities of medical institutions in the sense that it helps healthcare institutions plan their activities in the most rational way. Marketing makes it possible to predict turnover, study the needs of the medical services market; the use of marketing research makes it possible to determine what services will find demand among consumers, how much the consumer is willing to pay for it and whether he is willing to pay at all or not.
The main areas of marketing activities include studying the marketing environment, studying consumer markets, market segmentation, setting prices for goods, promoting goods to consumers (for example, advertising). All this will help healthcare facilities understand the current market situation with greater accuracy and build their activities in market conditions.
One of the areas of marketing, as mentioned above, is pricing. The question of the price of medical services is quite new for medical institutions, because during the period of a planned economy the question of the prices of medical services often simply did not exist. Health care facilities provided assistance to the population, and the state budget allocated funds to finance them.
However, with the advent of the market, the issue of prices became acute. Medical institutions had to try on themselves different techniques pricing, including those where prices, for example, were not tied to the costs of providing medical services (budget estimates). Therefore, at present it is necessary to take a serious approach to the problems of pricing in medicine, as this can significantly affect the state of healthcare.
A well-founded methodology for setting prices, a reasonable pricing policy and its consistent implementation are necessary conditions for the effective functioning of a medical institution in the harsh conditions of a market economy. Correct pricing determines the “face” of a medical institution to the same extent as the quality of its services, solvency and reliability in fulfilling its obligations. In market conditions, pricing is a very complex process influenced by a number of factors. The main results of the activities of a medical institution are realized through the price and, therefore, it is the price that determines the effectiveness of these activities.
Price is one of the main elements of the marketing policy of a medical institution in the market. Therefore, a medical institution operating in market conditions, first of all, needs to develop a strategy and principles for determining prices, guided by which it can effectively solve the problems it faces.
Healthcare in general and each healthcare facility in particular cannot ignore such issues as marketing and pricing. Solving issues related to the use of marketing is possible by developing your own, more optimal methods pricing will help medical institutions adapt and function effectively in market conditions.
1. General characteristics of the medical services market.
The transition to market relations has placed the issue of pricing in all areas of the national economy in one of the first places. When we talk about the price of a product in the healthcare system, we mean the price of a medical service that is fully endowed with commercial properties.
Through the market mechanism, buyers and sellers interact to determine the price and quantity of goods produced. Consequently, demand, supply and price are the main elements of economic relations in the market.
The key concept expressing the essence of market relations is competition. The pricing policy is developed in accordance with the market structure. Depending on the relationship between the number of producers and the number of consumers, the following types of competitive structures are distinguished:
Market perfect competition;
Oligopoly;
Monopoly;
Monopolistic competition;
The medical services market has the following characteristics:
The number of sellers is limited, there is a restriction on entry into the market;
Heterogeneity of medical services, its individuality, uniqueness;
Imperfect awareness of buyers about the services market;
Impossibility or difficulty of comparing price and quality;
The presence of a large number of public or private non-profit organizations;
To sell a product, in most cases, a competent intermediary is required, who pays for a significant part of the medical service.
Thus, the medical services market for the most part can be classified in structure as a market of monopolistic competition and monopoly.
Budgetary healthcare is an example of a monopsony in the medical services market, when the level of prices at which medical services are purchased is determined not by the real costs of service providers, which no one considers, but by the solvency of the state and its ideas about the value of such a good as the health of citizens.
Thus, one can be convinced that the peculiarity of the Russian medical services market is that it is a strong fusion of monopoly and monopsony, when almost all medical workers and medical institutions are subordinate to the Ministry of Health. At the same time, the state, being a monopolist, also dictates clearly unfavorable conditions for financing the structures subordinate to it, without even ensuring that their real costs are covered.
The patient in such a system is alone and absolutely powerless. Therefore, the goal of the health care reform is the demonopolization and demonopsonization of the medical services delivery system, the gradual transformation of the Russian medical services market, first into a “seller’s market”, when sellers have greater market power (dictating their terms to the buyer, imposing goods (services) and prices on them), and then into the “buyer’s market”, when the central figure determining the position of medical services and their prices will be the consumer-patient.
On the way to this, one of the primary tasks is to determine the legal and economic status of medical institutions and ensure their financing, based, at a minimum, on the real costs of producing medical services provided to the population. Financing at the level of real costs will ensure financial stability of the country's medical institutions will allow them to move from solving problems of survival to problems of improving the quality of medical services.
When considering the market for medical services, it is necessary to pay attention to the factors that determine the supply and demand of medical services, the main one of which is price. In this case, prices can be divided into the following three groups:
1 group– high prices (first price) for a service reflect its uniqueness, technological patent protection, lack of initial stage demand (demand market);
2 group – low prices(breakthrough or penetration price) for a service, reflects the simplicity of the technical and technological solution, low costs, high and stable demand, the strong financial position of the company;
3 group– experimental prices (when a similar product is not on the market) reflect the novelty of the functional purpose, the lack of data on the emergence of a sales market and prices.
Also important is the interaction of the medical services market with the market of labor and material resources. On the one hand, demand in the resource market is a derivative of the demand for medical services, on the other hand, the price level, and in general, the situation in the resource market determines the potential opportunities and boundaries for the development of medical institutions.
2. Medical services market.
2.1 Features of the medical services market.
Having chosen a market, dividing it into segments, assessing the attractiveness of each, it is necessary to develop marketing mix- a set of controllable marketing variables, the combination of which a company uses in an effort to evoke the desired response from the target market.
Response options: make the company (products) known among a certain number of consumers; win the market share established by the marketing program; increase sales volume, etc.
Numerous opportunities for marketing influence on the market are combined in the marketing complex into 4 main elements (tools): product, price, sales, communications.
PRODUCT- a product of labor produced for sale. The goods in this area are services in the medical services market, which means that labor in in this case provides services not as a thing, but as an activity.
2.2 SERVICE CHARACTERISTICS .
1)INTANGIBILITY . Inability to see, taste, hear or smell the service before purchasing it.
For example, a woman who comes to a plastic surgeon will not see the result until she buys his service. A patient who comes to a psychiatrist cannot know in advance the outcome of his visit. The buyer is forced to take the seller's word for it. To increase the opportunity to study services before receiving them (strengthening the “material”), the following measures can be proposed to strengthen client trust:
1) increase the tangibility of the service (provide photographs or drawings of something similar after the service has been provided);
2) focus the buyer’s attention on the benefits that the service brings (chairman admissions committee at the university will tell the applicant how well graduates of this educational institution after finishing studies);
3) assigning a brand name when selling your service.
4) involving a celebrity in promoting your service.
2) INSEPARABILITY FROM THE SOURCE .
The service will no longer be the same if, instead of the expected specialist familiar to patients, the session is performed by someone else.
You can overcome this limitation in the following way:
1) the service provider can learn to work with multiple audiences (for example, a psychotherapist forms a group).
2) the service provider can learn to work quickly (increase the intensity of service, saving time).
3) it is possible to train a large number of service providers (for example, many followers of the Ilizarov method of treating limb fractures).
3) INCONSISTABILITY OF QUALITY .
The quality of services varies widely depending on the providers, as well as the time and place of provision. For example, an experienced surgeon operates much better than a fresh graduate. But the same doctor treats differently, depending on his physical condition, availability of medications and equipment.
To reduce the “variability” of services and ensure quality control, the following measures can be taken:
1) develop standards of medical care;
2) allocate funds to attract and train truly good specialists(medical “training”);
3) constantly monitor the degree of customer satisfaction through surveys, questionnaires, and the subsequent formation of a marketing information system.
4) CONTINUITY OF PRODUCTION AND CONSUMPTION OF SERVICES .
The inability of a service to store requires the development of a strategy to ensure a tighter match between supply and demand, for example:
1) establishing discounts and other incentives, in particular to shift the necessary part of demand from the peak period to the calm period;
2) introduction of a system of preliminary orders for medical services;
3) to service the additional flow of customers during the peak period, it is necessary to train staff to combine functions and hire temporary employees.
2.3 Product policy.
The analysis of an enterprise's product policy is carried out using theories life cycle goods” (ZhCT). Its essence lies in the fact that the life of any product on the market is considered similar to the life of a living organism and, accordingly, it is stated that it goes through 4 main phases (stages): 1) For stages of introducing a product to the market OK characterized by the formation of primary demand for a product and familiarization of a potential consumer audience with it. For example, in connection with the installation of new medical equipment, there are many informative advertising messages on the Russian medical services market about additional diagnostic or treatment capabilities of health care facilities.
2) On growth stages the consumer is more actively conquered. Advertising is more meaningful, its nature from informing is focused on motivating customers.
3) "Maturity" - the dominant phase, if at the previous stages it was preceded by a competent marketing policy of health care facilities. Despite the decline in growth rates of sales, profits, and consumers, in absolute terms their levels are maximum. The task of the health care facility is to stay at this stage as long as possible.
4) Finally, "decline" stage indicates a decrease in the usefulness of medical services as a product. This may happen in the event of complete elimination of this disease, mortality, or the advent of other methods of treatment, diagnosis, etc. For example, after the introduction of fibrogastroscopy (FGS) in the diagnosis of gastric ulcer, the demand for X-ray contrast examination of the stomach with barium fell sharply.
Thus, the main task of marketers is to track the transition of a product’s life on the market from one phase to another in order to introduce the necessary changes to the marketing program, redistributing marketing efforts.
2.4 Price .
PRICE- monetary expression of the cost of a product (service).
Methodology for pricing:
By cost: based on the actual costs of producing a good or service ( wage, mandatory deductions, rent, overhead expenses);
By analogy: based on competitors' prices.
Differentiated: based on the sale of the same product various groups consumers at different (flexible, differentiated) prices. For example, depending on the terms of payment (on time or not, in cash or non-cash), on the volume of services consumed, on the social significance in society of a particular group of the population (children, students, pensioners, etc.).
The market price will therefore be a “price compromise” between the three methods.
TYPES OF PRICES most often used in market practice:
Exclusive - set arbitrarily by the manufacturer.
Wholesale - the price at which batches of goods are supplied to medical institutions. At this price the manufacturer makes significant discounts.
Retail - the price at which single copies are sold.
Sliding - the price is set depending on certain conditions (for example, it is associated with the exchange rate).
Firm - established in the purchase and sale agreement and is not subject to change.
Penetrating price - the price, as a rule, is deliberately low compared to the corresponding prices of other health care facilities. It is used at the stage of market conquest and expansion.
Psychological price - a price set slightly below the dominant one in the market and at the same time slightly below a certain round amount (for example, 197 instead of 200). This type of price is used to attract buyers purely psychologically. The experience of foreign marketing research shows that prices ending in “0” have a negative impact on consumers, and the number “7,” for example, has a greater psychological effect than “9.”
Prestigious price - the price for medical services that have high consumer demand, provided in “elite” medical institutions, by foreign specialists. Often prestigious prices are in foreign currency.
Elastic (flexible) price - a price that quickly responds to changes in the ratio of supply and demand in the market, both downward and upward, depending on the nature of the market situation.
2.5 Sales .
SALES- sale of a product or service on the market.
Planning and formation of sales channels (distribution policy) can be carried out within the framework of direct and indirect methods.
The DIRECT METHOD involves a direct (without intermediaries) connection between the person providing the medical service and the patient.
The direct method is beneficial to use in the following cases:
There is a concentration of consumers;
There are facilities for highly specialized advertising;
There is a sufficient number of in-house marketing personnel;
The price of services often fluctuates;
The selling price of services is much higher than the cost, which allows for direct sales costs.
THE INDIRECT METHOD involves the presence of an intermediary, a wholesale buyer of medical services (for example, a medical insurance organization, etc.).
Using the indirect method is effective if:
The healthcare provider is not financially strong enough;
Entering the medical services market, which has not been sufficiently studied;
The number of services sold is not large enough;
The service is not highly specialized;
There are not sufficiently trained marketing and management specialists;
The price of services is relatively stable.
The presence of an intermediary always involves payment for his work. Before using the services of an intermediary, with the help of marketing research it is necessary to ensure the feasibility of a particular sales method.
For the successful implementation of a sales policy, a reasonable forecast of sales of the services provided is necessary. Most often, expert, statistical and sociological methods are used here.
MARKETING COMMUNICATIONS - a set of marketing signals from a company to various market audiences. The communication complex in marketing includes the following elements: advertising, public relations, direct communications. The main element is advertising.
Telling the market about a new product or new applications of an existing product;
Information to the market about price changes;
Explanation of the principles of operation of the product;
Description of the services provided;
Forming a preference for this species medical services;
Encouragement to switch to that particular type of health care service;
Correcting misconceptions or allaying consumer concerns;
Formation of the company's image.
Convincing the consumer to buy this service without delay.
Reminding consumers that they may need a product or service in the near future;
Reminding consumers where they can buy a product or service;
Maintaining the product in the memory of consumers during the off-season;
Maintaining product awareness at the highest level.
The experience of self-supporting departments of health care facilities shows that sometimes, even with good organization of work, difficulties arise in attracting clients despite high quality medical care. At the same time, cooperatives, which sometimes employ less skilled workers, can have greater success with well-designed advertising.
Conclusion .
In practice, economic reform has led to an increased role of marketing in the production of goods and services. Marketing is becoming an integral part of healthcare management.
Healthcare, which was previously practically excluded from the sphere of commodity-money relations, is now included in it.
At the same time, pricing becomes one of the most important problems in healthcare.
Price is the most important element of market relations. Under the market mechanism, price is determined as the equilibrium between supply and demand. The study of demand plays an important role, since it will depend on it further activities enterprises. Based on the processing and analysis of the results obtained, the price of the service is planned. However, in healthcare, economic relations cannot be purely market. The level of prices for medical services should, on the one hand, not create excess profits for medical institutions and not limit citizens’ access to basic medical services, and on the other hand, should not lead to a sharp and unjustified increase in the volume of demand for services and unprofitable activities of medical institutions. When developing prices, it should be taken into account that focusing prices on the actual costs of a particular healthcare facility leads to costly and ineffective development of the health care economy, while the establishment of average prices makes it impossible for many healthcare facilities to create the economic funds necessary for expanded reproduction.
The development of market relations in healthcare led the institution to search for information about external environment: competitors, consumers, partners. In current conditions, only a thorough study of the market and forecasting activities contributes to the development of the organization.
The information necessary to develop a development strategy is obtained through marketing research.
Bibliography
1. Dvoinikov S.I. Management in nursing. / S.I. Dvoinikov. – Rostov-on-Don: “Phoenix”, 2006.
2. Health Economics./ Ed. I. N. Denisova. – M.: GOU VUNMC, 2004.
3. Yu. P. Lisitsyn. Public health and healthcare. M.: GEOTAR - MED, 2002.
4. Makarova T. N. Prices for medical services./ T. N. Makarova, V. I. Krichagin, I. S. Mylnikova, E. N. Indeikin. – M.: Priscels. Series “Health Insurance: Advantages and Disadvantages”, 1993.
5. Healthcare in a market economy./ Ed. E. A. Nechaeva, E. N. Zhiltsova. – M.: Medicine, 1994.
A medical service is a specific form of production activity that results in the creation not of a material benefit, but of a certain recognized useful effect, embodied in material object(material service), or aimed directly at the person himself (pure service). Pure service includes, in particular, the activity of a doctor, which results in the effect of preserving and strengthening health.
Let us note a number of characteristics of medical services that are necessary
take into account when developing marketing programs: 1)
intangibility: medical services cannot be seen, felt, or known until the moment of purchase. A patient who comes to see a doctor cannot know in advance the outcome of the visit. He is forced to take the doctor's word for it; 2)
inseparability from the source, be it a doctor, nurse or medical equipment. Take, for example, visiting a renowned psychiatrist. The service will no longer be the same if it is replaced by a lesser-known specialist or even a newcomer; 3)
inconsistency of quality, which depends on suppliers and place of service. A well-known specialist will provide more qualified assistance than a young doctor. But the same specialist can provide services in different ways depending on his mood and physical condition. Therefore, the service provider must constantly monitor the level of client satisfaction through a system of surveys and audits; 4)
unpreservability. It is no coincidence that doctors in the United States also charge fees for patients who do not show up for appointments, since the cost significance of the service existed precisely at the moment the patient did not show up. In conditions of constant demand, service failure is not a problem. If demand fluctuates, the task arises of managing the level of demand by introducing a system of pre-orders and a special work schedule during peak load periods; 5)
impossibility of demonstration; 6)
absence of intermediaries, because all medical services are provided directly: the patient must visit a medical institution; 7)
restriction of transportation of most services. Surgical operations are practically not performed at home, and injections medical worker Can do it on the road too.
Services differ significantly from each other and in their type. They can be classified according to different criteria, in particular, according to the sources of the service.
A psychiatrist needs virtually no equipment, but a cardiologist does. Some services, the source of which is a person, require qualified specialists (doctors, nurses), others require unskilled labor (nurses, etc.). Among the services the source of which is a machine, there are those that require the presence of devices controlled by operators of relatively low qualifications (electrophoresis, ultraviolet radiation, etc.), or equipment operated by highly qualified specialists (computers, etc.).
It should also be noted that specific trait medical service, as the mandatory presence of the client at the time of its provision.
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