Scientific Justification of the Concept of Marketing in the Activities of Commercial Medical Organizations

The dissertation is devoted to the scientific justification of the concept of marketing in the activities of commercial medical organizations in the conditions of structural transformations of the healthcare system of Russia. The research was conducted on the material of the Saratov Region and includes a comprehensive analysis of the organizational and legal structure of commercial medical organizations, the nature of the paid medical services they provide, as well as a sociological study of the opinions of patients and directors of medical institutions. A conceptual model of marketing management of commercial medical organizations was proposed in the work, based on the behavioral paradigm and taking into account the perceived risk of patients and their loyalty.

Relevance of the problem. In the context of the development of market relations in Russia, the formation of entrepreneurship, and the restructuring of the state sector of the economy, the healthcare system is undergoing fundamental changes. One of the manifestations of these changes is the introduction of market mechanisms into the industry (Polyakov I.V. et al., 2004). The commercialization of healthcare, being an objectively conditioned process, contributes to the improvement of the accessibility of medical care in the realities of a multi-tier system (Siburina T.A., 2000).

In the conditions of the formation of market relations with all their inherent features, the nature and direction of managerial activity are changing to a significant extent, including in terms of forming the strategy and tactics of the functioning of organizations (Togunov I.N., 2000). Its success is largely determined by the implementation of marketing approaches in management (Alekseeva V.M. et al., 1994; Vasnetsova O.A., 1998; Vlasov V.V., 1999; Muzalevsky V.A., 2002; Loubacc R.S., 1998; KolicerP, 1999).

The use of marketing implies, in this case, learning and forecasting the market, developing methods of influencing it, determining an effective pricing policy, a system of informational support, the development of a marketing plan, and a system of measures for its implementation (Bashy V.G., 1990; Togunov I.A., 2000; Levin R.P., 1995).

Despite the awareness of this fact, the actual application of the concept of marketing in the practical activities of medical organizations does not find widespread dissemination (Golukhov G.N. et al., 1996). Among the numerous reasons for this phenomenon, no less important is the absence of generally accepted approaches adapted to Russian conditions and methodologies (Zakirova S.A., 2000). Although in recent years a number of works have been devoted to questions of marketing in healthcare (Lebedev A.A., 1998; Lankin K.A., 1998; Malakhova N.G., 1998; Mikhailov L.S. et al., 1998; Kadyrov F.N., 2000; Repina L.A., 2002), they are of a fragmented nature and reveal separate aspects of this insufficiently studied problem. Therefore, any research in this field of knowledge is considered highly relevant.

The aim of the research is the development and scientific justification of marketing technologies for managing the activities of commercial medical organizations in the conditions of structural transformations in the healthcare system.

Research tasks:

1. To analyze and provide a comprehensive characterization of modern methods of marketing in healthcare, identify its features and necessity in the management of commercial medical organizations.

2. To study the organizational and legal structure of commercial medical organizations at the regional level (on the example of the Saratov Region), the nature of the medical care provided in them, and the types of medical services.

3. To analyze the composition of specialists and directors of commercial medical organizations, to study their opinion on the state and problems of the provision of paid medical services, the level of awareness regarding various factors forming the concept of marketing management.

4. To study the composition of patients applying for paid medical services, their motives for seeking care, their attitude toward the paid nature of healthcare, and the degree of satisfaction with the services provided.

5. To propose the main directions for the development of marketing approaches in the management of the activities of commercial medical organizations.

The scientific novelty of the research consists in the fact that, for the first time, a marketing research of the structure of commercial medical organizations of the Saratov Region was conducted in this work. Using the methodology of a systemic approach, the main problems in the provision of paid medical services to the population were revealed, the main strategic tasks for the restructuring of the activities of commercial organizations based on marketing management were outlined. A conceptual model of marketing activities of commercial medical organizations was proposed, based on the behavioral paradigm, substantiating the phenomenon of relationships with buyers and their loyalty through the study of perceived risk before receiving a service and discrepancies after it.

Practical significance of the work. The data obtained in the course of the research are important, firstly, for the implementation of tasks related to the modernization of the entire system of providing medical care to the population at the regional level (integration of all subsystems of healthcare, their adaptation to the actual needs of the population with a clear differentiation of the structure of provided paid and free services in accordance with the potential demand for them), and secondly, for ensuring the maximum adaptation of each of the medical organizations (both commercial and non-commercial) to the objective requirements of market relations, which is impossible without the practical implementation of marketing approaches piloted in the course of the work and proposed as a result of its conduct.

The main provisions of the research made it possible to determine the basic principles and prospects for the development of the system of paid services to the population of the Saratov Region, optimally combined with the program of state guarantees ensuring residents with free medical care, which is used by the Territorial Fund of OMS for the improvement of the regulatory base of out-of-department quality control of medical care (Implementation Act dated 16.12.2005 No. 17/921).

The results of the research were used by the Ministry of Health and Social Protection of the Saratov Region (Implementation Act dated 19.12.2005 No. 16/938) in determining the volumes of state guarantees in the field of medical servicing of the population and medical services provided on a commercial basis, which made it possible to take into account the interests of the population to the maximum extent and ensure high-quality medical care and service services with the maximum preservation of the volumes and accessibility of free medical services provided from the budget and through OMS. On the basis of the positions developed by the author in the course of the research, the Guild of Non-Governmental Medicine of the Saratov Chamber of Commerce and Industry outlined the main strategic tasks for the restructuring of the activities of commercial organizations based on marketing management, determined the optimal paths and forms of their interaction with the state healthcare system of the region (Implementation Act dated 20.12.2005 No. 1549).

The use of methodological approaches developed in the research by the Association of Medical Insurers of the Saratov Region made it possible to optimize the programs of medical insurance and the development of the sector of commercial medical services (Implementation Act dated 03.11.2005 No. 121).

The elements of the marketing approach proposed by the author of the research made it possible to identify weak points in the management system of a commercial clinic, significantly increase the motivation of employees, and achieve a stable growth in the revenues of the medical institution LLC Clinic "Family Doctor" in the city of Saratov (Implementation Act dated 20.12.2005 No. 40).

The results of the dissertation research were used in the compilation of the informational and methodological letter "Marketing Approaches in the Activities of Commercial Medical Institutions," approved by the Ministry of Health and Social Protection and the Guild of Non-Governmental Medicine of the Saratov Chamber of Commerce and Industry on 20.12.2005 and intended for workers and directors of medical institutions, healthcare organizers, listeners of advanced training courses and postgraduate education of medical and economic universities.

The results of the study of the methodology of marketing management of commercial medical organizations were used in the educational process at the Department of Public Health and Healthcare, the course of management and economics of healthcare at the Saint Petersburg State Medical Academy named after I.I. Mechnikov, Saratov State Medical University.

Presentation of research materials. The results of the research and the main provisions of the dissertation were presented and discussed at:

— the scientific-practical conference of the State Scientific Center of Social Medicine of the Russian Academy of Medical Sciences "The Role of Healthcare in the Preservation of Population Health" (Moscow, 2004);

— the V International Scientific-Practical Conference "Health and Education in the XXI Century" (Moscow, 2004);

— the scientific-practical conference with international participation "Environment and Health" (Saratov, 2002);

— the scientific-practical conference of the Interregional Association "Healthcare of the Volga Region" (Saratov, 2003);

— the working group session at the Ministry of Health and Social Protection of the Saratov Region on the development of the territorial program of state guarantees (Saratov, 2004);

— the Field Commission of the Ministry of Health and Social Protection of the Saratov Region on guarantees of quality and standards of medical care for the population (Balakovo, 2005);

— the joint session of the Saratov Regional Association of Insurers and members of the Guild of Non-Governmental Medicine of the Saratov Chamber of Commerce and Industry on issues of coordination of programs of voluntary medical insurance, service, and paid medical services (Saratov, 2005);

— the Saratov Conciliation Commission on the formation of tariffs for medical services (Saratov, 2005).

Personal contribution of the author. The literature review, the compilation of the plan, and the development of the program were personally conducted by the author; the medico-social and marketing research was conducted by the author (contribution 100%). With the participation of the graduate student, the collection of scientific information by reading data from primary medical documentation and surveying medical workers was conducted (90%), and its analysis was performed (95%). Overall, the author's personal contribution exceeded 95%.

Main provisions to be defended:

I. The non-state healthcare system has specific features and problems of organization management that require targeted study and special approaches based on the ideology of marketing.

II. Despite the awareness of the majority of the population regarding the justification of providing paid medical services, the directors of medical organizations (and first and foremost, commercial ones) face a number of problems (of both objective and subjective nature) that impede the functioning of commercial medical organizations.

III. For the effective development of the commercial sector in healthcare, it is necessary to take into account the results of the sociological survey of patients regarding the causes of their dissatisfaction with the medical care provided in state and non-state organizations, as well as the opinion of medical service producers on the problems of their coverage by various media as an integral part of marketing management.

IV. The methodological approaches to the implementation of the strategy of marketing management proposed in the work should be widely used in the activities of commercial medical organizations and state-form institutions providing paid medical services.

Structure and volume of the dissertation. The dissertation consists of an introduction, a literature review, a program, methodology, and organization of research, 4 chapters of original research, conclusions, practical recommendations, a list of references, and appendices. The dissertation is presented across 156 pages of the main text, illustrated by 26 tables and 25 figures. The list of references includes 126 sources, including 20 foreign ones.