Marketing Communications in Health Care Institutions

*Aykut Ekiyor and Fatih Altan*

#### **Abstract**

The aim of this study was to give general information about marketing communication and marketing communication tools in health institutions. Marketing communication is the tools that organizations use to increase brand value and associate their location and character with consumers. Therefore, marketing communication is useful in representing the voice of the brand, engaging in a dialog with consumers, explaining or showing how, where, by whom, and when a product or service can be used. In addition, it contributes to informing consumers about who produces the product or service, what the organization and brand represent, encouraging consumers to try the product or service, and creating brand image by placing the brand of the institution in the minds of consumers. Marketing communication helps to create a stronger consumer-brand connection by creating brand awareness and brand image. As a result, although the marketing communication activities carried out in health institutions are similar to the practices in other institutions, there are differences. Marketing communication in health services does not lead the patient to unnecessary consumption, but rather informs the patient, convinces them about the benefits to be provided, and brings them to a more participatory position in the diagnosis and treatment process.

**Keywords:** marketing communication, health care institutions, health care management, consumer, digital marketing, marketing communication tools

#### **1. Introduction**

Today's developments have affected everything from the lives of individuals to developments in the business world. As a result of this progress, organizations not only changed physical elements, but also had to change their marketing strategies and activities [1]. Health institutions have also taken their share from this change and transformation.

Modern marketing requires much more than developing a good product or service, attractive pricing, and making the developed product or service accessible. Businesses have to communicate with existing and potential stakeholders and the public: businesses in communication with the public; what, how, where, when, how often, and to whom to say. Consumers actively use communication tools such as hundreds of cable and satellite broadcasts, thousands of magazines and newspapers, and millions of Internet pages ([2], p. 579). The increasing competitiveness of the health sector increases the importance of marketing. Health care organizations have to use marketing communication to gain competitive advantage, increase

sales revenue, promote the services offered, and influence customers. Marketing communication is a very popular topic nowadays. No area of marketing is changing as fast and radically as marketing communication. Because with the emergence of concepts such as online, mobile, and social media marketing, customer engagement is increasing day by day ([3], p. 425).

Marketing communication in health services transforms health services according to the needs and expectations of consumers and encourages them to use these services. Due to competitive pressures and increasing patient awareness, health institutions are turning to marketing communication to highlight their services. Health care organizations have to use marketing communication to gain competitive advantage, increase sales revenues, promote the services offered, and influence customers. For this reason, in the following parts of the study, marketing communication tools in health services will be introduced and examples of applications in the field of health will be given.

#### **2. Methodology**

The aim of the study is to reveal a conceptual framework of marketing communication and examples of practice in health institutions. In this context, first, a conceptual structure about communication and communication process will be revealed and then, the study will be concluded by giving examples of marketing communication, marketing communication mix and marketing communication studies from health institutions.

#### **2.1 Communicat**ı**on process**

The aspect of marketing communication that is "credible" and "persuasive" communication activity is the most important quality that distinguishes it from other activities. Therefore, it requires a good communication process to realize effective marketing communication. However, marketing communication is not only to inform the consumer/target audience, but also to directing the current attitude and behavior of the consumer/target audience toward the product or service. In marketing communication, if the consumer attitude and behavior are in the desired direction, it is aimed to strengthen it and to change it in the desired direction if it is not in the desired direction [4].

Communication is basically the process of transition of information. In order to ensure communication, both the sender and the recipient must share common ground. The symbol, letter, or picture used to transmit information must have a common meaning. Therefore, communication can also be expressed as meaning sharing [5].

In order for health organizations to carry out marketing communication activities, they must first carry out an effective communication process with their customers. The communication process consists of source, encoding, message/ media, decoding, receiver, and feedback [6].

**Source** is expressed as a person, group, or organization that has the knowledge/ meaning to share with an audience. **Encoding** is the process of converting information/meaning into a series of signs or symbols representing ideas or concepts to transfer information/meaning to the recipient. **Communication channel** is the communication tool selected by the source to share a meaning/knowledgeable with the receiver/monitor. **Decoding** is to convert signs or symbols into meanings or ideas. **Receiver:** It is the person, group, or organization that decodes an encoded message. **Noise** is anything that reduces the clarity and accuracy of communication.

#### *Marketing Communications in Health Care Institutions DOI: http://dx.doi.org/10.5772/intechopen.101370*

**Feedback** is the recipient's response to the source/sender by decoding the message from the source/sender [5, 7].

Health managers need marketing communication to communicate effectively with the target audience. In order to carry out marketing communication, some considerations need to be taken into consideration. These [8, 9] are as follows:


#### **2.2 Marketing communicat**ı**on mix in health care institutions**

The marketing communication mix—also called the promotion mix—consists of advertising, public relations, personal sales, sales promotions, direct sales, and digital marketing, which are used to communicate with the target audience, engage with, and convince customers [3].

The use of health services and marketing communication (promotion) concepts together is a highly controversial area. Which messages should be given to people with health problems by health organizations has always been a topic of discussion. In addition, the fact that it is not clear when and to what extent individuals will need health care is another issue that has inflamed this debate. It is also seen as normal for a healthy person to be indifferent to health care, physician, or health care provider. Based on this information, it is also clear that marketing communication in health services has different dimensions compared to other sectors and that appropriate marketing communication should be designed accordingly [9].

In recent years, health care marketing has become important and indispensable. With technological development, consumer needs and expectations have changed. These changes have also affected the health sector. However, there has been a change in health marketing understandings and practices. Health organizations have sought not only to increase the sales of products and services produced to their target audience, but also to develop lasting relationships with them. The purpose of communication design in health care organizations is to increase the awareness of customers, change their perceptions and attitudes, and strengthen their competitive position in the market [8, 10]. Today, health organizations act customercentered and aim to produce quality services at affordable prices. This has led to the popularity of marketing activities in health institutions. In addition, the increasing rigidity of the competitive environment necessitates marketing communication activities [11].

Marketing communication for health organizations is a very important activity. The function of marketing communication in any product or service sector; it consists of efforts to communicate with existing and potential customers and ensures that customers are aware of the products and services produced by the organization. But in the health sector, the situation is different. It is not appropriate

#### *Communication Management*

for health organizations to use aggressive marketing communication tools, and it is argued that oral communication is more effective [11].

It is necessary to consider the image of the institution before deciding how to conduct marketing communication activities in health institutions. After evaluating the innovative structure, dynamics, level of technology use, etc., of the organization, activities should be decided on marketing communication. Before deciding on marketing communication activities, the following questions should be searched for answers [12].


Marketing communication reveals how health institutions will inform the market about the products and services they produce. Public relations, advertising, and other activities are involved in the data collection and information conversion process. For example, public relations, existing and new services of the health institution, crisis management, stakeholder relations, vision determination, etc., are used for the management activities. Advertising, on the other hand, is aimed at potential customers of the health institution and other health businesses; information about the service provided, the monetary value of the service (price), or the access to the service, such as brochures, billboards, TV, radio, newspaper, magazine, etc., helps to stop through channels.

#### *2.2.1 Advertising*

The advertisement is expressed as the transmission of information about the products and services of the organization to the target audience through various means of communication (TV, radio, internet, newspaper, magazine, direct mail, billboard, etc.). As the communication tools used by consumers change, so do the ads. While the use of traditional advertising tools is decreasing day by day, today it uses digital platforms intensively, which is an important communication tool for organizations to maintain their presence and gain a competitive advantage [5].

Advertising varies from sector to sector, from business to business. Businesses, retailers, etc., that sell products or services in the consumer market often use advertising tools to communicate with their target audience and convince them to purchase these products and services. It uses advertising in enterprises operating in the star/professional market. In addition to its various benefits such as raising awareness about the products and services produced by the organization and guiding sales personnel, it also increases the confidence of customers in the organization and the products and services it produces [13].

The health sector is one of the sectors, which has seen the most growth and development within the service sector. With the increase in interest in health and health services, advertising plays an important role in determining the profitability and market share of health institutions. In the event of this situation, differences between increased competitions among health institutions, increase in the level of education, and awareness of customers and the quality of services offered by health institutions can be listed [14].

#### *Marketing Communications in Health Care Institutions DOI: http://dx.doi.org/10.5772/intechopen.101370*

Hospitals, pharmaceutical companies, medical device manufacturers, physicians, etc., recognize the benefits of advertising for the health care industry. As a result of this, there has been an increase in advertising expenditures in health services. This increase in spending has led to debate among key stakeholders about the benefits and drawbacks of advertising in the health sector. The main problems of the discussion are seen as the physician-patient relationship, patient education, inappropriate resource use, health care costs, health care quality, and its effect on the welfare level of patients [15].

Research by Bell and Vitaska [16] revealed that hospital advertisements were received negatively. These findings reveal that physicians respond to hospital advertisements with a negative attitude in studies by Miller and Waller [17], Kinney and King [18], and are consistent with the study by Bell and Vitaska [16].

Although advertising activities are considered negatively for health institutions, they have been practiced under press and public relations activities for many years. The purpose of advertising activities carried out in health institutions is not only to promote the products or services offered, but also to help improve the education, motivation, and attitudes of health care consumers. In other words, advertising, which is an effective communication tool, is used to warn health care consumers against certain situations and to increase their interest in existing services [8]. Even if there are criticisms for unethical practices or waste of resources, it increases service consumption. Advertising activities carried out within the framework of appropriate resource use and ethical rules will continue to be a powerful marketing communication tool in promoting services to health care consumers [10].

#### *2.2.2 Personal sales*

Selling health services is very complex and difficult. However, it is considered as a very productive effort from a scientific point of view [19]. The fact that health services are consumer-centered causes competition among health institutions and the importance of marketing increases [20]. The large number of specialties emerging in the delivery of medical services increases the importance of personal selling in health services marketing and requires the adaptation of existing marketing approaches.

Health institutions/businesses use personal sales effectively to introduce new products and services, brands, and new facilities to their target audience. Personal sales is the most effective way to communicate meaningfully with customers. Personal sales is one of the marketing communication tools frequently used by low-budget health care institutions/businesses, as it is performed at a lower cost compared to advertisements [21].

Personal sales is carried out through face-to-face communication with the customer. Unlike other forms of marketing communication (advertising, sales promotion, etc.), it occurs as a result of direct interaction between the buyer and the seller [22]. Considering the activities carried out by health institutions, it can be said that almost all of them consist of buyer-seller interaction. In this respect, personal selling is a marketing communication tool used in health institutions.

Personal sales in health care institutions is directly related to the quality of communication between the buyer and the seller. It can be said that it is a more effective marketing communication tool than advertising and public relations activities, thanks to the good relations established with the customer as a result of a quality communication [9].

In organizations operating in the health sector, personal sales are carried out by professional people or by training the health personnel within their own body. Making use of professional people will increase the costs related to this field. For

this reason, "Should personal sales be carried out by professionals in the health sector or should it be provided by the health personnel within their own body by training them?" There is no consensus on the question yet. While organizations operating outside the health sector use professional staff for personal sales, health organizations generally use their own staff (physician, nurse, midwife, etc.) [23]. Personnel who will carry out personal sales in health institutions must have medical knowledge. Companies that produce and sell pharmaceuticals and medical supplies have a large number of sales personnel. However, these personnel do not have as much medical knowledge as a physician. However, such personnel are used for personal sales because they have more medical knowledge than any other person.

The physician who refers patients to the hospital is considered a salesperson. But this is a wrong perception. Sales personnel act with the aim of making sales and increasing sales. However, the physician refers him to a higher level health institution for medical reasons. While the physician has the initiative to refer the patient to any health institution, sales personnel do not have this initiative [24].

#### *2.2.3 Public relations*

Other marketing communication elements other than public relations focus on the organization's customers. But for organizations, not only customers, but also suppliers, staff, shareholders, media, educators, potential investors, government, and society are also important stakeholders. Public relations is an important concept in communicating with both internal and external customers [8]. Public relations is a broad marketing communication tool used to establish, develop, and maintain positive relationships with all of an organization's stakeholders. Positive relationships with stakeholders help the organization increase its sales and profitability and maintain its existence [5].

The use of the concept of public relations in health institutions dates back to 1975. Although it was known that such activities had taken place before, they were carried out at a limited level. But today, there is a wide field of activity in terms of relations with both internal and external stakeholders. Public relations activities in health institutions are used to create a positive image about the products/services and activities produced—not in an effort to increase the sales of products and services as in advertisements. In this direction, health institutions create communication programs to provide image management [9].

It can be said that with the use of public relations in the field of health, which plays an important role in shaping public opinion, it contributes to issues such as family planning, prevention of traffic accidents, combating epidemics, and reducing infant mortality, which are among the important issues of recent times.

#### *2.2.4 Sales promotion*

Sales development can be expressed as other communication efforts that are usually not continuous outside of personal selling, advertising, and other marketing communication tools. Sales promotion consists of many heterogeneous activities and it is difficult to categorize these efforts. However, it can be examined in three categories for consumers, intermediaries, and sales personnel according to the audience that marketing communication addresses. For consumers, giving giveaways, coupons, bonuses, fashion shows, cashback. For intermediaries, these are activities such as purchase advances, gratuitous goods, incentive premiums, and sales contests. As for sales personnel, premium, competition, sales meetings, etc., can be exemplified as activities [25].

Sales promotions attract customers and encourage them to buy. Sales promotions are a powerful tool to accelerate customer responses. Advertisements provide benefits for purchasing products and services, but sales promotions can be a more effective method for instant purchasing. It provides short-term benefits to the organization. It is not an effective method for building images and developing long-term customer relationships [3].

#### *2.2.5 Digital marketing*

Digital marketing is a non-traditional form of marketing carried out on the Internet to promote products and services, increase customer interaction, and identify customer needs using technology. It is seen as one of the most effective and prominent methods to increase brand awareness and develop business [26].

According to the data of 2021, the world population is 7.83 billion. In addition to 5.22 billion mobile phone users, 4.66 billion individuals are known to be Internet users. In addition, 4.20 billion people were registered as active social media users [27]. Social media (Facebook, Twitter, YouTube, Pinterest, Instagram, etc.) is characterized as a special area of use for digital marketing because it can be defined, communicated, personalized, and measurable by organizations. Studies have revealed that 79% of consumers prefer social media to get more information about the products and services of businesses [28]. Social networks are unique environments. Customers can contact the company collectively or individually. In addition, customers have the opportunity to communicate with each other both privately and publicly [29].

Social media marketing is the most prominent form in digital marketing, which also has a wide coverage in the field of health. Social media can be used to promote health education for health organizations. The digitization of human interactions and intimacy has led to the convergence or even disappearance of distances at the push of a button. As a result of digitalization, social media becomes a source of interaction for public health. It has the potential to change many health-related behaviors, especially in times of crisis. With the interaction in social media, multidirectional communication takes place and public health messages are spread faster. As a result of these, the health knowledge of the society increases and contributes to the development of the health level [30].

With the widespread use of digital media by consumers, the necessity of finding new marketing strategies for health care organizations has emerged. Marketing communication activities carried out on the digital platform are less costly than traditional marketing methods. In addition to this, providing communication with customers in the virtual environment makes important contributions to the elimination of distances and increasing consumer awareness. In addition, the use of digital platforms in marketing communication in health institutions plays a key role in determining the target audience ([31], p. 44; [32]).

The Web site of health institutions is also a very effective medium in carrying out marketing communication activities in the digital environment. The fact that users both get detailed information about the services and easily communicate with the health institution provides an advantage for the presence of health institutions in the market. Such platforms have also become an important tool in establishing permanent communication with customers [33].

Health care is an area open to abuse due to the ignorance of customers. For this reason, marketing communication activities should be carried out within the framework of ethical rules. People suffering from serious illnesses will tend to believe the information provided by the health care provider and trust the services to be provided. It would not be right for health institutions to attempt to direct patients to use unnecessary services or to increase their expectations [34, 35].

### **3. Result**

Marketing communication is a very important field of activity not only for for-profit companies, but also for non-profit organizations (such as health care organizations). The main purpose of marketing communication is to inform, persuade, and remind the target audience about the organization and its products and services. In line with this purpose, sales are realized by attracting customer attention as a result.

In parallel with technological, economic, and social developments, consumer demands, expectations, and needs have also changed. In addition, the supply and demand in the health sector is increasing day by day. All these developments have increased the importance of marketing communication in the health sector. The increase in global health expenditures also increases the share of public budgets allocated to health. Such problems can hinder marketing communication activities. Based on cost pressure, health institutions are turning to marketing communication activities carried out in digital environment rather than traditional marketing communication methods. In addition, marketing communication activities made through various channels such as social media and Web site positively affect the image of the health institution.

Although it is not possible to implement all marketing communication tools in health institutions, advertising and public relations activities are carried out in a wide range of applications. In the marketing communication activities in health institutions, it is aimed to inform the consumers about the services, to create a positive corporate image, to convince them about the benefits of the service, and to participate in the diagnosis and treatment process. These reasons distinguish marketing communication activities in the health sector from the activities carried out in other sectors. It is understood that it is of vital importance for both the health institution and the customers.

#### **Author details**

Aykut Ekiyor1 \* and Fatih Altan<sup>2</sup>

1 Faculty of Economics and Administrative Sciences, Healthcare Management, University of Ankara Haci Bayram Veli, Turkey

2 Department of Medical Services and Techniques, Halil Bayraktar Vocational School of Health Services, University of Erciyes, Turkey

\*Address all correspondence to: aykutekiyor1974@yahoo.com

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Marketing Communications in Health Care Institutions DOI: http://dx.doi.org/10.5772/intechopen.101370*

#### **References**

[1] Biçer DF, Yıldız SY, Sarıtepe ÖK. Mobil Alışveriş Uygulamaları Kullanan Bireylerin Satın Alma Davranışları. Yönetim ve Ekonomi Araştırmaları Dergisi. 2019;**17**:201-221

[2] Kotler P, Keller KL. Marketing Management. 15th Global Edition b. London: Pearson Education; 2016

[3] Armstrong G, Adam S, Denize S, Volkov M, Kotler P. Principles of Marketing. Melbourne: Pearson Education Limited; 2018

[4] McCarthy JE. Basic Marketing: A Managerial Approach. Ontario: Irwin-Dorsey; 1979

[5] Pride WM, Ferrell OC. Foundations of Marketing. USA: Cengage Learning; 2015

[6] Kotler P, Armstrong G. Principles of Marketing. New Jersey: Pearson Prentice Hall; 2006

[7] Korkmaz S, Eser Z, Öztürk SA. Pazarlama; Kavramlar-İlkeler-Kararlar. Ankara: Siyasal Kitabevi; 2017

[8] Ekiyor A, Altan F. Marketing communication and promotion in health services. In: Ayman U, Kaya AK, editors. Promotion and Marketing Communications. London/USA: IntechOpen; 2020. pp. 173-193

[9] Tengilimoğlu D. Sağlık Hizmetleri Pazarlaması. Ankara: Siyasal Kitabevi; 2011

[10] Karaca Ş. Sağlık Hizmetlerinde Pazarlama: Bütünleşik Pazarlama İletişimi Yaklaşıyla. İstanbul: Beta Yayıncılık; 2015

[11] Sreenivas T, Srinivasarao O, Rao US. Analysis on marketing mix in hospital. International Journal of Advanced Research in Management and Social Sciences. 2013;**2**(4):187-207

[12] Gilligan C, Lowe R. Marketing and Health Care Organization. USA: CRC Press; 2018

[13] Belch GE, Belch MA. Advertising and Promotion: An Integrated Marketing Communications Perspective. New York: McGraw-Hill Education; 2012

[14] Andaleeb SS. Determinants of customer satisfaction with hospitals: A managerial model. International Journal of Health Care Quality Assurance. 1998;**11**(6):181-187

[15] Adeoye S, Bozic KJ. Direct to consumer advertising in healthcare: History, benefits, and concerns. Clinical Orthopaedics and Related Research. 2007;**457**:96-104

[16] Bell JA, Vitaska CR. Who likes hospital advertising consumer or physician? Journal of Health Care Marketing. 1992;**12**(2):2-7

[17] Miller JA, Waller R. Health care advertising: Consumer vs. physician attitudes. Journal of Advertising. 1979;**8**:20-29

[18] Kinney TL, King KW. Consumer and physician attitudes toward advertising by physicians. In: Patricia AS, editor. Proceedings: Annual Conference of the American Academy of Advertising. 1988. pp. 93-98

[19] Berry LL, Bendapudi N. Health care: A fertile field for service research. Journal of Service Research. 2007;**10**(2):111-122. DOI: 10.1177/1094670507306682

[20] Kotler P, Shalowitz J, Stevens RJ. Strategic Marketing for Health Care Organizations: Building a Customer-Driven Health System. San Francisco: Jossey-Bass; 2008

[21] Pike S. Destination Marketing: An Integrated Marketing Communication Approach. Burlington: Butterworth-Heinemann; 2008

[22] Fahy J, Jobber D. Foundations of Marketing. 5th ed. USA: McGraw-Hill Education; 2015

[23] Karafakioğlu M. Sağlık Hizmetleri Pazarlaması. İstanbul: İstanbul Üniversitesi İşletme Fakültesi Yayın No: 271; 1998

[24] Kotler P, Clarke RN. Marketing for Health Care Organization. New Jersey: Prentice-Hall Inc; 1987

[25] Mucuk İ. Pazarlama İlkeleri. İstanbul: Türkmen Yayıncılık; 2009

[26] Mishra CK. Digital marketing: Scope opportunities and challenges. In: Ayman U, Kaya AK, editors. Promotion and Marketing Communication. London: IntechOpen; 2020. pp. 115-137

[27] We Are Social. Digital 2021: Global Overview Report*.* 2021. Available from: https://wearesocial.com/digital-2021 adresinden alındı [tarihinde: September 18, 2021]

[28] Patrutiu-Baltes L. Inbound Marketing-The most important digital marketing strategy. Bulletin of Transilvania Universitesi of Braşov. 2016;**9**(2):61-68

[29] Dakouan C, Benabdelouahed R, Anabir H. Inbound marketing vs. outbound marketing: Independent or complementary strategies. Expert Journal of Marketing. 2019;**7**(1):1-6

[30] Gupta A, Tyagi M, Sharma D. Use of social media marketing in healthcare. Journal of Health Management. 2013; **15**(2):293-302

[31] Radu G, Solomon M, Gheorghe CM, Hostiuc M, Bulescu IA, Purcarea VL. The adaptation of health care marketing to the digital era. Journal of Medicine and Life. 2017;**10**(1):44-46

[32] Copley P. Marketing Communications Management: Concepts and Theories, Cases and Practices. USA: Routledge Taylor & Francis Group; 2004

[33] Masterman G, Wood EH. Innovative Marketing Communications: Strategies for the Event Industry. Routledge; 2006

[34] Maria S, Gabriel R, Marinela H, Madalin MM, Alexandru BI, Lorin PV. Ethical issues in advertising and promotion of medical units. Romanian Journal of Ophthalmology. 2016;**60**(4): 216-218

[35] Wong WW, Gupta SC. Plastic surgery marketing in a generation of "tweeting". Aesthetic Surgery Journal. 2011;**31**(8):972-976

## *Edited by František Pollák, Jakub Soviar and Roman Vavrek*

*Communication Management* is an edited volume of chapters written by scholars researching various areas of marketing and management sciences. It presents several issues of marketing management within the limits of marketing communication. Starting from the issue of communication channels and basic sensory apparatus for processing information and stimuli, the book continues with a description of the issue of social media in the time of accelerated digitization. The last chapter introduces the reader to the issue of marketing communication in a sharply non-standard environment. The topic itself creates the opportunity to seek qualitative knowledge for future in-depth research into the impact of the COVID-19 pandemic on both national and transnational economies.

Published in London, UK © 2022 IntechOpen © new\_cox / iStock

Communication Management

Communication

Management

*Edited by František Pollák,* 

*Jakub Soviar and Roman Vavrek*