ARTICLE ANALYSIS TemplateCHP 475 Marketing in Health Services
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Available online at www.sciencedirect.com
Procedia Social and Behavioral Sciences 15 (2011) 388–393
WCES-2011
The impact of health care consumer education on marketing
strategies of health services organization
Violeta Radulescua, Iuliana Cetinab*
a
b
Lecturer, Ph, Marketing Faculty, Academy of Economic Studies, Bucharest, Romania
Professor,PhD, Marketing Faculty, Academy of Economic Studies, Bucharest, Romania
Abstract
Health care consumer behavior is increasingly influenced more an more by education, regarded, in first way like part of the
cultural environment and in second way, like as a result of the permanent approach consumer information and learning. Level of
education of the people registered a significant increase in last few years, at almost all segments of consumers in all European
countries, including Romania. Today more than ever, consumers look for services provided by organizations responsible and
market-oriented, customer-friendly. In addition, the consumer is now viewed in a new perspective, as a combination of traditional
patient and modern consumer, having much more knowledge about the health system, open to innovation and with an active role
in establishing the diagnosis, treatment and health improvement. For these reasons, this paper aims to present the influence of
culture and education on health care consumer behavior and its impact on marketing strategies of health care organizations.
© 2011 Published by Elsevier Ltd. Open access under CC BY-NC-ND license.
Keywords: health care education; health services consumer behavior; cultural influence; marketing strategy..
1. Introduction
Health organizations operating within a specific market, determined by certain features of supply and demand
and buying and consumption behavior, which leaves its mark on how to develop marketing strategies.
Health care consumer behavior is the result of a complex of factors that act with different intensities. Of these,
socio-cultural factors have an important role by educating the consumer perspective, therefore, on the one hand,
non-formal education, resulting from the belonging to a particular individual’s culture and subculture, and on the
other hand, due to formal education, resulting from a planned process of transmitting the experience and knowledge,
which requires an effort of teaching and learning, and educators.
The paper therefore proposes, based on exploratory research, to identify the main socio-cultural factors affecting
consumer behaviour health services, and direction of action of organization, which must base their marketing
strategies through knowledge of these influences. From this point of view, we will present first, the influence of
socio-cultural factor on health care consumer behaviour, and then we highlight the marketing strategies that the
health organizations can adopt, to improve quality of services offered, taking into account, the one hand, consumer
* Violeta Radulescu. Tel.:+40-072-130-5551; Iuliana Cetina tel: +40-072-243-0482
E-mail address: vio.radulescu@yahoo.com; cetina.iuliana@gmail.com
1877–0428 © 2011 Published by Elsevier Ltd. Open access under CC BY-NC-ND license.
doi:10.1016/j.sbspro.2011.03.109
Violeta Radulescu and Iuliana Cetina / Procedia Social and Behavioral Sciences 15 (2011) 388–393
389
behaviour, but at the same time pursuing its modification by education. The paper ends with a conclusion on the role
of healthcare organizations in educating healthcare consumer.
2. Influence of socio-cultural factors on the behaviour of health services consumer
Among the socio-cultural factors that influence health services consumer behaviour, can be mentioned culture
and subculture, social class to which they belong and level of education.
2.1. Culture and subculture
Culture represents a set of norms, material and moral values, convictions, attitudes and habits acquired by
humanity over time, which are shared by all the members of the society and drive their behaviour, including their
buying and consumption behaviour to a large extent. (Catoiu, Teodorescu, 1997).
Regarding the impact of culture on individual behaviour on health, many studies have shown that the opinions or
beliefs about the illness, disability or death, cultural information and education on the causes and treatment of
diseases, empirical practices of healing, etc., are cultural components that can motivate people to accept or deny the
role or sick, or delay seeking medical care. Thus, there may often communication barriers due to socio-cultural
distinction between educator and receiver information, receptive audience low, negative attitude to the doctor or
teacher, limited understanding or sending contradictory messages.
Ethnical and religious aspects are powerful sources of pressure on the individual, which underlie the latter’s
education and influence the way an illness in accepted and treated. (Thomas, 2005)
Society and values also trigger different reactions to pain. While Italians and Jews react emotionally to pain,
Anglo-Saxons endure pain stoically, while the Irish even tend to deny they feel pain. Thus, they perceive pain
sensations as an immediately harmful fact and can only relax after taking some medication, unlike the Jews who
react not so much to the immediate sensation of pain as to its future significance, and can only relax once an
adequate explanation as to the causes of their pain has been provided (Radulescu, 2002).
There are even certain convictions incorporated in a particular culture or subculture which significantly modify
an individual’s behaviour. The idea that an illness is a punishment for having committed a sin, the prejudice that
sexually transmitted diseases are a blemish of sin and shame, etc., are nothing but forms of cultural anxiety as
compared to the normative landmarks of that culture or subculture.
Even the empiric appraisal the state of health starts from a string of cultural values with regard to the types of
activities and capacities deemed normal by the cultural group in question.
In Romania, the centralized system of financing healthcare services, practiced until 1990, and the social security
system currently in use, which focuses on providing all citizens with access to primary care medical services and to
the most part of specialised healthcare services, has led to some perceptions about healthcare services and the
establishment of certain consumer habits, as part of the people’s cultural values. In addition, is a lack of healthrelated education, both in the rural and the urban areas, leading to lack of prevention of certain diseases, disregard
for symptoms and self-medication. Romanians would rather use traditional treatment methods or follow the advice
of their neighbours or friends, such phenomenon being particularly spread in rural areas.
2.2. Social class
Social class also has a significant impact on the behaviour of the healthcare services consumer. Social class is
defined as individuals grouped together according to economic, historical and sociologic criteria. These are
relatively homogenous and permanent groups, whose members share the same system of values, similar lifestyles,
interests and behaviours. (Catoiu, Teodorescu, 1997)
Differences between social classes, also brought about by education, leave their mark on consumers’ attitudes
and behaviours with regard to healthcare services. Thus, individuals from the lower classes most frequently reject
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the role of potential patients, setting themselves apart from middle-class and upper-class individuals by the
following elements: are less informed and less educated on their symptoms and the medical services available to
them, they pay less attention to the symptoms of an illness, show weaker preventive behaviours, are sceptical
towards the virtues of medicine and delay in seeking assistance for more serious problems. (Radulescu, 2002)
Their belonging to the middle or upper class requires individuals to adopt a certain type of instrumental and
rational behaviour, centred on “normality”, compared to the attitude of consumers from the lower class, who have an
aversion to the role of potential patient, to drug consumption, etc.
2.3. Level of education
The relationship between education and the use of health services resembles that for income, and educational
level is probably one of the better predictors of the utilization of health services. (Thomas, 2005)
The individuals’ level of education influences both the demand for healthcare services and the type of services
solicited. Highly educated individuals, while affected by less serious healthcare concerns than those with lower
levels of education, resort to healthcare services more often, especially to specialized services which can be paid for
on the spot, as opposed to free primary medical care services.
In most countries, educated population is growing, consumers are more concerned about their health, ask
questions and seek answers. More and more, individuals relate to as consumers rather than patients, and expects to
receive information, ask to participate in decisions that affect them directly and insist to receive health services at
the highest qualitative level. (Cetina and others, 2008)
According to “The Empowerment of the European Patient – Options and Implications” Report recently published
in Brussels, Romanian patients are among the least informed in Europe, ranking as the 30th on a list of European
countries. The report shows that Romanian patients, together with those of other European countries, are not aware
of their rights and need to receive explicit, easily accessible information on the healthcare system and the possibility
to choose among various healthcare services providers.
3. Marketing strategies of health care organization
Marketing health services covered by its mode of application, both within social marketing, as well as some in
the marketing of services. By its nature, improving the health of the individual, is a service that involves a sequence
of activities, whose design is achieved at the macroeconomic level, the Ministry of Health, through regulations, and
is virtually created and delivered by organizations in the field. Health policy not only concerns the individual
considered separately, but also the community as a whole, for which there are many organizations working in the
public health sector, aimed at promoting ideas and social behaviors among a community defined geographically and
demographically.
Marketing strategies aim at informing and educating the population on healthcare, as well as at changing the
consumer’s behaviour with a view to increasing the quality of the services offered; these strategies need to be based
on the study of the socio-cultural factors which underlie the Romanian market, which contribute first of all, to
market segmentation, identifying a number of segments that require a different approach, and secondly, their
influence determines the consumer’s degree of participation in the healthcare service provision and the effectiveness
thereof.
In Romania, one of the main purposes of the national healthcare education program is to educate the citizens as a
means to improve their knowledge and change their behaviours into a new health-conscious lifestyle. The main
directions of action target to develop prophylactic medical activities and to raise the medical awareness of the entire
population, which involves the development of wide-scale educational activities in the field of public health.
Violeta Radulescu and Iuliana Cetina / Procedia Social and Behavioral Sciences 15 (2011) 388–393
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3.1. Product strategies
The product strategies developed by healthcare organizations aim to improve the quality of the services they
offer, and consumer education is a first course of action to such an end. Because of healthcare services intangibility,
consumers tend to render them tangible and, to emphasize elements that best describe the service while assessing its
quality, thus resorting to as much information as possible on how the service is provided, what results are obtained,
and how involved the provider is in delivering the service and its desired effects.(Radulescu, Barbu, Olteanu, 2008)
Consumers’ cultural background and level of education also shape their involvement in the steps taken to prevent,
treat and recover and their perception of a particular service.
Therefore, within the organizations which provide healthcare services, the medical personnel have their own role
in educating consumers, acting as follows:
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to provide healthcare information and education in order to prevent certain illnesses;
9
to provide information on the symptoms of certain medical conditions, on the way a service is actually
provided and on the patient involvement in the delivery of the service;
9
to acquire certain attitudes and skills which are beneficial to health;
9
active involvement of the population in public health awareness, with individuals being able to make
decisions regarding their own state of health.
Medical personnel and especially the general practitioner play an important role in promoting health, due to the
prophylactic nature of their activities, which also involves healthcare education. He comes into contact with the
most various categories of population in terms of their age, sex, background and education. Also, because the family
doctor also comes into contact with patients outside his office, and even gets to meet his patients within their work
or family environment, he can get a better understanding of his patients’ overall living environment and of their
guiding life values. Having access to his patients’ family environment, the general practitioner also comes into
contact with healthy individuals, whose education is even more important than that of individuals who are already
ill. The role of the medical personnel is however difficult, for the education of patients, when their behaviour rely on
the beliefs and values of a particular culture, in which the role of medicine is neglected and empirically-based selftreatment is regarded as sufficient.
3.2. Price strategies
The consumers’ level of information and education also affects the pricing strategies developed by healthcare
providers. Even though in Romania, payment for public health services is not made directly but by means of the
social health security system, the private medical sectors includes other forms of payment – such as direct payment
and private health insurance. In such cases, the healthcare organizations’ pricing strategies must take into account, in
addition to costs and competition, consumers’ own perception of prices brought about by the customer’s knowledge
of prices as quality indicators, and non-monetary price (Olteanu, 2003).
The customer’s knowledge of prices is reflected in the reference price, defined as the price known by the
consumer either based on experience or as a result of his efforts to stay informed and educated.
Price as a quality indicator depends on a number of factors: the quality of the information regarding the service
and its price, the consumer’s degree of education in the respective field, the company’s promotional policy, the risk
associated with acquiring the service in question determined by the customer’s ability to assess quality;
Non-monetary prices include the time, effort and discomfort associated with the search, buying and usage of the
service. Consumers refer to these costs as “effort costs” or “stress costs”.
Such costs are usually higher for healthcare services, because the consumer is directly involved in the provision
of the service, which involves travelling, waiting, acquiring information, understanding how the service is provided
and actually participating in its provision.
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3.3. Communication strategies
The communication strategy developed by any organization in the field of healthcare can be regarded by means
of two components – on the one hand the actual promotion, which emphasises internal and external communication
regarding the organization and the services it provides, and, on the other hand, communication with a view to
informing and educating the consumer on prevention, treatment and recovery strategies.
Healthcare organizations may use main forms of communication such as (Petrescu, 2006):
x Persuasive or behavioural communication including efforts to persuade the audience to adopt a certain
idea or practice. It includes social marketing techniques.
x Entertainment education involves the use of entertainment productions such as TV shows, radio shows,
comic books, theatre, etc. to relay persuasive messages and lessons on healthcare topics.
x Interactive healthcare communication is defined as the interaction between an individual – consumer,
patient, medical staff – by means of technology or electronic means in order to access or send healthcarerelated information or receive advice and support on healthcare issues.
x Participatory communication involves the target population in the planning and implementation of a
communication campaign.
In all promotion campaigns carried out, the messages should take into account cultural values and education level
of the target audience because the desired behavior change must not violate their cultural values and also be
identified if the benefit promised in return is an individual or the group one, because cultural norms may focus on
individual or community, as appropriate.
Regarding the promotion techniques, over time have been used all kinds of techniques, but the biggest impact it
have had public relations (Thomas, 2005), which aims to communicate the organization’s activities or information
and education on new discoveries in the field, so new treatments.
Also, communication through “word of mouth” has a major role in promoting health services. As a result of
cultural values and level of education, individuals tend to give more reliable information from private sources
because they provide information on experiences regarding the service. Using these sources is difficult to control,
because their use raises many questions about how information will be perceived by the public, which can affect
consumer perception of service and efficiency of other promotion techniques used (Radulescu, 2008).
4. Conclusions
This study attempted to show that consumer behavior is influenced by health services and socio-cultural factors,
especially culture and subculture, social class and education level. Exploratory research undertaken in Romania
showed that the Romania healthcare consumer is less informed, not knowing their rights as secured, and the main
sources of information are leaflets calling for medicine and personal sources. This behavior is determined by
cultural values and a certain level of education.
Therefore, the role of industry is its information and education. The main lines of action to educate, are the
prevention of certain diseases, but also to involve the consumer in higher quality medical service. To achieve these
objectives, organizations can act in the health product, price and promotion.
At the level of service provided must follow the most complete and accurate information to consumers on how to
conduct the service and its role in increasing the quality of service received. An important role of family doctor, who
by constant contact with the patient can greatly contribute to increased consumer education.
The role of education in this area is especially important because Romania consumer is not very knowledgeable
about the price of service offered, as a result of social health insurance system, but when pay service, the price is
perceived as an indicator of quality of service received. In addition, in Romania, there are unofficial costs, which
consist of cash or other assets, provided directly to medical personnel. Also, special attention is given and nonmonetary costs caused by the waiting time or effort to obtain full information.
Communication policy organizations in the area should focus on quality information about various therapies and
providers and services offered, as well as co-payment systems to inform and educate consumers to better manage
Violeta Radulescu and Iuliana Cetina / Procedia Social and Behavioral Sciences 15 (2011) 388–393
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personal health care effort. Informed consumers will be able to assume increasing responsibilities, and will have a
potential major changes in the system-wise.
References
Catoiu I., Teodorescu, N., (1997), Consumer behaviour. Theory and Practice, Bucharest: Economica Publishing House
Cetina, I., Orzan, G., Radulescu, V.and Orzan, M. (2009)Grounding the Marketing Strategy of the Organization in the Field of Healthcare,
Theoretical and Applied Economics, XVI (3), 71-78
Olteanu,V.(2003) Services Marketing, Bucharest: Ecomar Publishing House
Petrescu, E.(2006) Health promotion and health education, Bucharest: Public H Press Publishing House
Radulescu, S. (2002) Sociology of Health and Diseaes, Bucharest: Nemira Publishing House
Radulescu,V. (2008) Marketing Health Services, Bucharest: Uranus Publishing House
Radulescu, V., Barbu, A.M, Olteanu, V. (2008) – Marketing Implementation within Romania Health Care Service Organizations, Proceedings of
The 16th Annual Conference on Marketing and Business Strategies for Central and Eastern Europe, 317-326
Thomas, R.K. (2005) Marketing Health Services, Chicago: Health Administration Press
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