WILLIAM A. FLEXNER, DrPH ERIC N. BERKOWITZ, PhD
SERVICES HAVE BEEN DEFINED as "all personal and public services performed by individuals or institutions for the purpose of maintaining or restoring health" (1). Decisions about the design and delivery of services by private clinics, hospitals, neighborhood health centers, and health maintenance organizations (HMOs) are made primarily by professionals. Yet consumer input into these decisions is increasingly being sought, even demanded. Generally this input has been obtained by four methods: (a) consumer representation on boards, (b) consumer advocacy (for example, Ralph Nader's Health Research Group), (c) a diagnosis of the community (the community being regarded as the patient) and assessment of the community's needs, and (d) behavioral and social science research (2). These four methods provide for firsthand contact between health professionals and the lay public and a medically objective review of health care requirements. Yet, in application, weaknesses in the methods may be revealed, such as presumed representation of the whole consumer population, a tendency toward professional domination of decisions, and ineffective integration of consumer input into the organization's planning. These weaknesses often preclude the creation of programs and services that are sensitive and responsive to all sectors of the population (3).
The strengths of the four methods must be integrated into a managerial structure in order to produce programs and services that are satisfactory to health care consumers. To accomplish such integration, a framework is needed, and marketing research can provide it. Marketing research is the organizational activity of systematically gathering, recording, and analyzing the information needed to make planning and implementation decisions that affect the quality or intensity of an organization's interactions with consumers (4,5). We propose that a marketing research model and marketing research methods be incorporated into the health services planning process at the institutional level.
Marketing: Responsiveness to Consumers
In business, marketing is the matching of a company's capabilities and resources with consumers' needs and wants (6,7). Needs and wants are the things that are important to consumers and that underlie their behavior. Because consumers' preferences and expectations vary, companies provide many different products or services. Through marketing, management can foster mutually beneficial exchanges between the company and specified segments of consumers. Exchanges occur when something of value is given up for something of value received-goods, services, money, attention, devotion, ideas, and so forth (8). Defined in this way, marketing encompasses far more than the narrow activities of advertising or promotion in a traditional business setting. To be successful a business or any other organization must satisfy various consumer segments by providing appropriately designed products or services. Simultaneously, it must also achieve its internal goals and objectives, whether these be defined as profit, market share, health outcomes, or patient compliance. To reach these goals, a November-December 1979, Vol. 94, No. 6 503
Dr. Flexner is assistant professor, Center for Health Services Research, School of Public Health, University of Minnesota. Dr. Berkowitz is an associate of the center and assistant professor of marketing in the university's School of Business Administration. The paper is based on a study conducted under a joint hospital system research program cosponsored by the center and Fairview Community Hospitals, Minneapolis. Tearsheet requests to Dr. William A. Flexner, Center for Health Services Research, School of Public Health, 1350 Mayo Memorial Bldg., Box 197, 420 Delaware St., SE., Minneapolis, Minn. 55455.
business or an organization has to offer the...