Section III. Market of medical services

Environmental factors and the internal state of a person give rise to a certain range of needs and lead to the formation of a system of appropriate proposals to meet the needs.

There are three groups (complexes) of basic human needs and needs associated with the need to purchase goods and services:

o the need to live;

o the need to be healthy while maintaining working capacity, which forms the desire to restore health in the event of temporary disability and the desire to maintain partial working capacity in the presence of disability;

o the need for the highest degree of freedom of life (physiological, psychosomatic, social), when the need is characterized by the desire to achieve the highest degree of "quality of life".

The healthcare industry market is a set of existing and potential goods and services aimed at protecting and restoring health.

In the medical business, the term "market" is used to define a group of consumers that are grouped together on a common basis and divided into several interconnected markets. These include:

1. Market of medical services.

2. Market of medicines.

3. Market for items and services in the field of sanitation and hygiene.

4. The market of non-traditional methods of treatment and rehabilitation.

5. Medical equipment market.

6. Market of medical technologies.

7. Health insurance market.

8. Market of scientific medical ideas.

9. The labor market of medical personnel.

10. The market of educational services in the field of health protection.

Characteristics of the medical services market

In healthcare marketing systems in Ukraine there is no place for such a concept as medical care, but there is an element of the market - a medical service. Medical care is a category of non-market relations between a doctor and a patient. According to the Constitution of Ukraine, medical care is provided to every citizen of the country free of charge in the network of state and municipal healthcare institutions. According to the legislation of Ukraine, in healthcare institutions of non-state ownership, emergency medical care is provided free of charge.

Features of the medical services market lie in the specificity of the work of medical workers, when saving the patient's life, the humanitarian mission of healthcare and the ethical side of medical activity far outweigh the economic feasibility and profitability of medical activity.

On the other hand, in a modern civilized society, medical services aimed at meeting the needs of improving the "quality of life" are characterized by a highly economical degree of profitability. The structure of the tariff for such medical services, in fact, includes the economic costs of producing medical services in two other segments of the health market: the "marketing segment of life" and the "marketing segment of diseases." Full satisfaction of the needs of consumers in this segment of the health market, to a greater extent, is not associated with medical medical activity, but is determined by other individual, natural and socio-economic factors. Except. The aforementioned medical services market has the following features:

o qualification requirements leading to a limitation in the number of practitioners;

o specific requirements leading to a limit on the number of hospitals that can dictate a certain pricing policy;

o imperfection and specificity of competition, which makes it impossible to attract buyers by reducing the price;

o medical services are heterogeneous and difficult to compare;

o there is no direct connection between the price and the costs of the consumer, a significant part of which is paid by a third party (relatives, employers, subject to voluntary medical insurance or the provision of a social bonus);

o the presence of external effects (externalities), the provision of medical services effectively affects not only the buyers of these services, but also other persons. For example, in connection with the development of spa treatment, access to healing springs is being developed, the infrastructure of the settlement (roads, supplies, etc.) is being developed, which is used not only by vacationers. Preventive vaccinations improve the overall epidemic situation.

In Ukraine and other countries of Eastern and Central Europe, the medical services market is characterized by an oligopoly, which has the following characteristics:

o a small number of competitors with significant entry barriers to the industry of new medical institutions;

♦ within the framework of economic characteristics, a medical service can be either standardized or differentiated;

♦ The efficiency of medical care requires that the volume of production capacity of each medical institution should occupy a large share of the total market for medical services. In this regard, there is a rather high degree of concentration of medical institutions within the region, in which the total share of cho-tirioh-eight medical institutions is not less than 60% of the total volume of needs for medical services;

♦ it is beneficial to expand the material and technical base of a medical and preventive institution to a large size due to weakness or lack of an attractive and moderate competition;

♦ absolute vertical interdependence of medical institutions, neutralizing effective mechanisms of competitiveness;

♦ predominantly non-price competition in the production and consumption of medical services in the system of communal forms of medical care.

There are three main areas with specific forms of offering medical services and meeting medical needs.

I. Medical offers of life-saving medical services (in particular, in the perinatal period, in case of extreme urgent conditions that threaten the life of the patient, in old age, palliative medical services for incurable diseases, etc.). Conventionally, this segment of the health market is called the "marketing segment of life."

II. Medical offers of medical services for the purpose of restoring health, restoring and maintaining a certain level of ability to work in case of its temporary loss. This segment of the health market is conditionally called the "disease marketing segment". The types of medical services in this segment are distributed in the following areas:

♦ medical services aimed at the treatment of acute and prevention of exacerbations of chronic diseases;

♦ medical services aimed at preventing the transition of temporary disability to permanent disability (disability);

♦ medical services for the preservation and maintenance of a certain degree of chronic conditions and disabilities.

III. Medical services that preserve and maintain the state of a healthy body.

This segment includes immunoprophylaxis, clinical examination, cosmetic services, and so on. This segment is characterized as the "health marketing segment".

In the system of market relations, 4 groups of market counterparties are distinguished, between which the main types of economic relations and economic relations are implemented. With the development of elements of market relations, the concept of a medical subject appeared as a producer of medical services.

Medical entity - provider of medical services - a registered and duly licensed medical institution of any legal form and form of ownership that provides medical services.

Counterparties of the medical services market are:

♦ other health care institutions involved in the implementation of a complex treatment and diagnostic process (suppliers of medicines, medical supplies, companies that sell and maintain medical equipment, health care organizations, which, if necessary, are contacted to get advice from narrow specialists, etc.);

o financial and credit organizations that provide banking services such as leasing and factoring, provide loans, perform intermediary services of voluntary medical insurance;

o the state involves healthcare institutions in the implementation of government programs in the field of healthcare, provides tax incentives;

o citizens - a group that is heterogeneous in composition, functions in the implementation of economic relations in the market.

Positive features of the medical services market:

o improving the quality of medical care, in particular medical services;

o free access to methods and forms of treatment;

o the possibility and implementation of the choice of any provider of medical services;

o the possibility of legal and economic influence in case of dissatisfaction or poor-quality satisfaction of medical needs;

o healthcare worker earnings related to performance and patient satisfaction;

o legal and economic security, both for the consumer and the provider of medical services.

Negative features of the medical services market:

o relaxation of preventive measures,

o rejection of medical services with a high proportion of the humanitarian health mission and a low degree of direct economic benefit;

o Discrimination of sick socially vulnerable groups in need of medical care.

Some negative features of the medical services market can be removed with a methodological approach that considers various groups of patients, their medical needs and needs as unique and specific market segments, determines their rightful place in the healthcare marketing system and finds specific forms and methods to meet the needs and demands of customers. these segments.

Segmentation of the medical services market According to the possibilities of demand for medical services, it is carried out in accordance with economic groups, which are characterized by the type of medical service, medical diagnostic group, cost of the procedure, solvency and personality of the patient.

There is no single method for segmenting the medical services market. Therefore, health care institutions in the management of marketing activities are trying different options for segmentation based on different variables, one or more at once, in order to find the most useful approach to consider the structure of such a market.

Classification of segments of the medical services market carried out according to the following parameters:

o age and gender characteristics (men, women, children, adolescents, adults, the elderly);

o by types of medical care (outpatient, hospital, obstetrics, dental, drug provision, etc.);

o for decrees to groups (healthy, sick, people working in occupationally harmful conditions, military personnel, students, etc.);

o for nosological groups (as a special case - for medical examination groups);

o medical diagnostic groups;

o groups of equal medical standard;

o economic groups (well-being and solvency);

o by types of medical services.

It is not possible to reach out to all health care buyers at once, as they have different needs in terms of maintaining and restoring health, differ in the style of receiving services, as well as in income levels. This determines the direction of specialized segments of the medical services market.

On the other hand, some submarkets may well have competitors. Therefore, health care institutions (medical practices) should be interested in identifying those submarkets that will be most attractive to them and compatible with goals and resources. With the same medical needs, there may be different needs, resources, geographical location, level of sanitary culture, purchasing power, habits. Any of these variables can be used to segment the market.

Ideally, a medical institution (a subject of medical practice) should be the only one in its niche, the narrower this niche, the fewer competitors. But at the same time, the likelihood of large and wide sale of medical services also narrows. The niche of the medical services market segment is the more attractive, the more it corresponds to the following characteristics:

♦ purchasers of medical services (patients) have complex and specific medical needs;

♦ patients are willing to pay a high price in order to receive medical care of absolute quality, that is, when medical procedures are absolutely adapted to their explicit and hidden needs;

♦ the provider of medical services has a high professional and social competence, which is constantly being improved. Since the healthcare industry is knowledge-intensive, the ability of medical workers to constantly improve their skills and the focus of the management personnel of a medical institution on the introduction of innovative technologies in diagnostic and therapeutic processes come to the fore.

Thus, the segmentation of the medical services market has the ability to provide medical care (to satisfy a specific demand) both taking into account the individuality of the patient and taking into account the mass consumption of medical services.

The market for medical services is a market that satisfies the needs of people in maintaining and improving health. It makes it possible to receive and provide medical services, guarantees their required volume and appropriate level of quality. 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 health care institutions. Types of medical services. A medical service can be simple, complex, complex. In addition, a distinction is made between standard and individual medical services.

Standard medical services are mainly provided according to a unified technology for the vast majority of patients and have relatively stable pricing.

Individual medical services have a wide range of manipulations, diagnostic, treatment procedures, a large range of medicines and medical products. They have 13 differentiated price lists that maximally take into account the individuality of costs in their implementation. Specific features of medical services:

intangibility;

inseparability from the source of receiving services;

perishability;

variability in the quality of the medical service provided;

ambiguity in assessing the result of a medical service;

A medical service is a product not only of the producer (doctor), but also of the consumer (patient).

Intangibility. A medical service cannot be seen, heard, touched, felt until it is consumed.

Inseparability from the source of the service. The processes of providing and consuming medical services are inseparable from each other neither in space nor in time. The provision of medical services requires personal contacts between the producer and the consumer, i.e. In the overwhelming majority of cases, the provision of medical care requires the direct participation in this process not only of medical workers, but also of patients - consumers of medical services.

Perishability. Unlike goods, both medical and non-medical, which are first produced and then stored in a warehouse for some time, a medical service is characterized by the fact that the production process coincides with the sales process.

Variability in the quality of medical services provided. According to the wording proposed by WHO, the quality of medical services is a set of their characteristics and properties that are of an empirical nature and the ability to meet established requirements. In diagnostic, tactical and technological aspects, the quality of medical services can vary widely. It depends primarily on the qualifications of the doctor, the equipment of the medical institution, the availability of medical care, the time and place of the service, who is its consumer, and many other factors.

Ambiguity in assessing the result of a medical service. A medical service cannot always be evaluated only positively: for example, when a patient's leg is amputated, we get a positive medical and social effect: the patient remains alive and will be able to perform any work in specially created conditions. But he became disabled - this is a negative effect.

A medical service is a product not only of the producer (doctor), but also of the consumer (patient). The quality of a medical service is formed as a result of the coordinated actions of the doctor and the desire of the patient to benefit, with a really tangible perception of its consumption.

The market of medical services has its own unique features, which include the following:

Three groups of subjects act on the medical services market: a manufacturer, a seller of medical goods and services (a medical institution, a doctor), a buyer (a patient, an employer, the state), an intermediary - territorial CHI funds, and medical insurance organizations.

unlike other markets, the manufacturer of a medical service and its seller act, as a rule, in one person;

pronounced seasonal nature of demand for medical services;

features of territorial segmentation (differentiation) of the medical services market and high variability of market conditions depending on the level and structure of the incidence of the population of a given region (epidemics, environmental and man-made disasters, endemicity of the territory for certain diseases, etc.);

a complex structure of demand for medical services associated with the need for their personification and individualization:

the ability of the seller of medical services to simultaneously influence demand and supply (by conducting necessary or additional studies, the doctor establishes a diagnosis, thus determining the patient's demand for specific medical services and at the same time providing these services, satisfies the demand, i.e. forms an offer);

excessive demand for medical services from patients (the desire of the patient, due to any psychological reasons, to insist on an additional examination, obtaining expensive medicines, etc.)

health care is an area where there is a high degree of trust in the seller (doctor);

special requirements for the quality and safety of medical services;

high priority and social significance of medical services;

lack of a clear link between the labor costs of medical workers and the end result;

the priority of social and medical efficiency and the secondary importance of economic efficiency.

Market as an economic category characterizes the totality of economic relations arising from the sale and purchase of goods (or services). A market can also be defined as a spatial locus of supply and demand for a product (or service).

healthcare market- this is a developed system of relations of commodity and non-commodity exchange, which is an association of separate, interconnected submarkets, including:

Market of medical services;

Market of medicines, materials and hygiene products;

Market of medical equipment and instruments;

The labor market of medical workers;

Market of scientific and technical developments and intellectual work;

Healthcare securities market.

The priority place in the structure of the healthcare market belongs to the medical services market which can be defined, on the one hand, as a set of all medical technologies, medical equipment products, methods of organizing medical activities, pharmacological agents sold in a competitive economy, and on the other hand, as a set of existing and potential manufacturers (HCIs) and consumers of medical services (patients).

Initially originating as an order from a patient to a doctor, medical care has acquired the legal status of a service over time. Consequently, medical services provided to patients in various institutions have also become an integral part of market relations, which led to the emergence and development of the medical services market.

There are a number of classifications of medical services. All services provided in the health care system can be grouped:

By nature: medicinal; diagnostic; preventive; social; rehabilitation; medical experts; paramedical; educational; accreditation and licensing; service;

By segments of the healthcare structure: outpatient, inpatient, sanitary and hygienic, epidemiological, etc.;

By levels of medical care: pre-medical, medical, qualified, specialized;

By intensity over time: fast, urgent, planned.

Some authors propose to classify medical services also according to the qualification of the source of medical services (low, medium, high); by technology and invasiveness (routine, high-tech, invasive and non-invasive); to comply with the standard; by the time to achieve the final result; in accordance with legal regulations.

Systematized properties of medical services can be imagined as:

General properties: intangibility (intangibility of character) before it is received; continuity of production and consumption of services; heterogeneity or variability of quality, inability of the service to be preserved for the future;

Economic components: cost, profitability, efficiency, service price, pricing methodology;

Medico-social properties: timeliness, accessibility, quality.

Let us dwell on a few general and basic characteristics of medical services that are important for the healthcare market.

Intangibility– the inability to see, taste, hear or smell the service until it is purchased. For example, a woman who comes to a plastic surgeon will not see the result until she buys his service, i.e. agree to the operation. The patient who came to the doctor cannot know in advance the result of his visit. The buyer (patient) is forced to take the seller's (doctor's) word for it. This is a key moment in the economics of health care and analysis of the production and consumption of health services. To expand the possibilities of studying the properties of medical services before receiving them, the following measures are proposed:

Increase the tangibility of the service (provide photographs or drawings of any analogues before the service is provided);

Emphasize the patient's attention to the benefits of the medical service;

Assign a brand name to a medical service for sale on the market;

Involve any competent person in the promotion of your service.

inseparable from the source. The service will not be the same if instead of the expected specialist doctor known to patients, the treatment session is performed by another doctor. The doctor and his service are inseparable. You can overcome this limitation in the following way:

A service provider (physician) may learn to work with multiple audiences (eg, a psychotherapist forms a group);

The service provider (physician) can learn to work faster (increase service intensity);

Prepare a lot of service providers - doctors in health facilities.

Quality inconsistency. The quality of services varies widely depending on the various characteristics of providers (physicians), as well as the time and place of delivery. For example, an experienced surgeon operates much better than a freshly graduated surgeon. However, the same doctor treats differently depending on his physical condition, the availability of medicines and equipment. To reduce the “volatility” of services and ensure quality control, you can:

Develop quality standards for medical care;

Allocate funds to attract and train really good specialists (medical training);

Constantly monitor the degree of patient satisfaction through surveys, questionnaires, followed by the formation of a system of marketing information about the quality of medical care.

Inseparability of production and consumption of services. The service cannot be produced for the future and saved. In this regard, many doctors in Western Europe also charge for non-attendance patients, since the value of the service exists even at the time of the patient's non-appearance. The inability of a medical service to be stored requires the development of a strategy that ensures a tighter alignment between patient demand and facility supply, for example:

Establishment of discounts and other incentives, in particular to shift part of the demand from the peak period to the period of decline in demand;

Introduction of a system of pre-orders for medical services (doctor's appointments);

To serve an additional flow of patients during the peak period, train staff to combine functions, hire temporary employees.

According to G.K. Maksimova et al. (1996), the production and consumption of health services is a holistic process. The concept of the life cycle of a medical service includes the following stages of its implementation:

Examination and diagnosis of the patient's condition;

Designing the provision of a medical service: understanding the task (final result), making a decision to provide a service, planning (choosing) a technology for providing a service;

Provision of medical services;

Consumption (use) of a medical service;

Self-destruction of the service or the resumption of a repeated need for it.

Market relations express a certain economic isolation of producers and consumers of products and services. The market mechanism is the process by which sellers and buyers interact to determine the price and quantity of goods produced, whereby demand, supply and price are its main elements.

The mechanism of the medical services market also functions due to the interaction of three main components: demand, supply and price.

Demand- this is the number of medical services that patients are willing and able to purchase for a certain period and at a certain price.

Offer- this is the number of medical services that can be provided in a certain period of time in a given territory by a given medical institution (doctor).

Price- the monetary value of the goods (or services).

In the interaction of supply and demand, other things being equal, a equilibrium market price, the point of intersection of the supply and demand curve, it is the equilibrium price that mutually suits both the seller and the buyer (Fig. 4).

T is the equilibrium point, P "is the equilibrium price, Q" is the equilibrium quantity of medical services at the price P ", which will be purchased by patients at a given point in time and will be provided by doctors in the same period

Fig.4. Graphical representation of the interaction of supply and demand

The key concept expressing the essence of market relations is the concept of competition. In the general case, competition can be defined as a type of relationship between producers regarding the establishment of prices and volumes of supply of goods and services, as well as between consumers regarding the formation of prices and the volume of demand in the market. From the standpoint of the structural organization of the market, the number of producers (doctors, healthcare facilities) and the number of consumers (patients) participating in the exchange process are of decisive importance.

Depending on the ratio between the number of producers and the number of consumers, the following types of competitive market structures are distinguished: perfect competition market, oligopoly, monopoly, monopsony, monopolistic competition. Each of the structures has its own characteristics of price formation, supply and demand, in addition, in the healthcare market, as indicated, special properties of a medical service are added.

Thus, the market of perfect competition presupposes the presence of a large number of independent producers of some homogeneous product, on the one hand, and a mass of isolated consumers of this product, on the other. The structure of communication is such that each consumer, in principle, can purchase a product (or services) from any manufacturer, in accordance with his own assessment of the usefulness of the product and its price. Each producer can sell the goods to any consumer, according to his own benefit. None of the consumers acquires any significant part of the total supply and none of the producers can satisfy any significant share of the total demand. The market of perfect competition is the most efficient structure that allows the best allocation of resources.

If there are any objective restrictions for sellers and buyers, then there are structures of imperfect competition that require adjustment by the state.

Analyzing from these positions the healthcare sector in many developed countries, it should be noted the presence of state restrictions, acting in a variety of forms.

So, for example, the American Medical Association, which unites about half of all private practitioners, plays an important role in artificially curbing the supply of medical services in the United States. It limits enrollment in medical faculties, increases tuition fees, controls the influx of migrant doctors and their access to medical practice. It should be noted that there are additional artificial barriers for medical service providers when they enter the market: frequent attestations, the need to obtain a new license when a doctor moves from state to state, etc.

The limitations of competition and information noted above mean that the market for medical services differs significantly from the market for perfect competition. Under perfect competition, if a firm discovers a better way to produce a product, it simply lowers prices and thus steals buyers from other producers. Production is always efficient, and prices reflect the production costs of the most skilled producers. If these conditions are not met, then those producers can survive, whose prices significantly exceed the cost of production. When the product is heterogeneous and the buyer is not too well informed, then it is difficult for him to determine what a lower price means - a signal about the possibility of a better purchase or about the low quality of the product / service. And when buyers are informed about prices, then firms can raise them above the equilibrium price level only with a limited number of sellers or a limited number of buyers.

It is possible to schematically show the differences between the product market of perfect competition and the market structure that is typical for the medical services market as a whole (Table 4).

Table 4

Differences between the commodity market of perfect competition and the market of medical services

Based on the above comparison, it follows that the market for medical services, from the point of view of the organizational structure, is a market of imperfect competition. At the same time, in terms of its main characteristics, it is closer to structures that are classified in economic theory as a market of monopolistic competition and a monopoly. These circumstances inevitably leave their mark on the behavior of medical service providers (HCPs), changes in their primary goals, the pricing system, which also requires regulation of the ongoing processes in these market structures by the state.

Health care, as a branch of the public economy, has a number of characteristics that violate the market mechanism:

Some medical services have the property of "public goods" (or "public goods") (one of the features of "public goods" is their ability to extend their consumer effect to persons not participating in the market transaction);

Lack of awareness of the consumer, information "asymmetry" of the producer and consumer of medical services deforms the usual interaction of supply and demand;

The special role of the principle of equality in obtaining medical care: the volume and quality of consumption of medical services cannot be determined only by the level of solvency of the population - this, of course, violates the mechanism of market pricing in healthcare.

In this regard, it is extremely important to pay attention to the factors that determine the demand and supply of medical services. The key role here is played by the price of a medical service, which, on the one hand, determines supply and demand, and on the other hand, under conditions of its free change, balances them. In order to build forecasts of the relative change in the magnitude of demand or supply when the price changes, it is necessary to know the quantitative parameters of these changes. The most common quantitative characteristic of demand is the so-called price elasticity of demand.

Price elasticity of demand is measured as the ratio of the percentage increase in the volume of demand for a product (service) to the percentage decrease in the price of this product, all other things being equal. It shows by what percentage the quantity demanded will increase if the price of the service decreases by one percent. Demand for most medical services has a low elasticity, which means that the elasticity coefficient is less than one. According to a number of US experts, the price elasticity of demand for inpatient medical care is on average 0.7 (with the exception of cosmetic surgery), and in many cases it ranges from 0.2 to 0.7. This means that when the price of medical services rises, demand decreases to a lesser extent than the price rises (if the price rises, say, by 10%, demand will decrease by 2-7%).

Supply and demand are affected not only by price, but also by a number of other factors: the determinants of supply and demand. To determinants of demand include the level of income and solvency of the population, the structure of medical services and their cost, the prevalence of diseases, and the level of awareness of patients about them, "forcing demand" by medical workers, and much more. Determinants of supply factors such as the number of doctors, the cost of medical equipment, the improvement of medical equipment, the emergence of new competitors, etc.

Marketing of medical services

The most important components of the analysis of any market, including the medical services market, are marketing research, which is a systematic collection, registration and analysis of data in the field of the market of medical services and goods.

In relation to the healthcare sector, marketing can be defined as a complex process of planning, economic justification and management of the production of medical and pharmaceutical services and products, pricing policy in the field of the treatment and prevention process, promoting services and products to consumers, as well as managing their implementation. In marketing, almost all elements of medical and pharmaceutical activities are grouped into a single technological process. The result of this process is the provision of benefits to consumers that meet their needs for medical and pharmaceutical care.

Marketing is a social and managerial process, which is based on the following key concepts: need, need, desire, demand, product, exchange, market. All these concepts are equally characteristic of both commercial and social forms of marketing. The most important and basic concepts underlying marketing are the idea of ​​human need and need.

Need- a feeling of lack of something. Need is the starting point of marketing. Needs can be physiological (food, clothing, warmth, security), social (spiritual intimacy, influence, affection), personal (need for knowledge and self-expression). For healthcare marketing, this concept means a feeling of unhealthy and a person's desire to become healthy.

Need- a need that has taken a specific form in accordance with the cultural level, the personality of the individual and the offers of the medical services market. For example, the patient feels the need for a certain drug. Producers of goods and services are trying to form a connection between what they produce and the needs of people. They do not create a need, but identify and satisfy it.

Needs translate into concrete desires, which, taking into account monetary opportunities, are transformed into market demand for specific products; exchange is carried out in the form of a transaction between the producer and the consumer.

Demand- A need backed by purchasing power. The demands of people are practically unlimited, and the resources to meet the needs are limited, so a person will choose those services or goods that will give him the greatest satisfaction within his financial capabilities. Human needs, needs and demands suggest the existence of goods (services) to satisfy them.

Product (goods or service)- everything that can satisfy a need or need and is offered to the market for the purpose of attracting attention, acquisition, use or consumption.

The term "product" can be replaced by the term "offer", "satisfying needs". In addition to goods and services, these can be individuals, places, organizations, activities, and ideas. The more the product meets the desires of the consumer, the more successful the manufacturer will achieve. In medicine, goods are medical services, medicines, medical products, medical equipment.

Exchange- the act of receiving from someone a desired object with an offer of something in return. Whether the exchange takes place or not depends on the agreement between the parties on its terms. To make an exchange, the following conditions must be met:

There should be at least two parties: doctor-patient;

Each side must have something that could be of value to the other side;

Each party must be able to communicate and deliver its goods;

Each party must be completely free to accept or reject the proposal of the other party;

Each party must be confident in the expediency or desirability of dealing with the other party.

If the exchange is the main concept, then the unit of measurement in the field of marketing is with deal- commercial exchange of value between two parties. The transaction can be either cash or barter. For example, a client makes repairs in a hospital and receives a medical service as a completed operation for this amount. For the implementation of the transaction, several conditions must be present: at least two objects of value; the agreed requirements of the parties to the transaction, the time and place of the transaction. These conditions are concluded in the form of an agreement between the parties.

For the most part, marketing in medicine, first of all, should be focused on the patient, developing and offering exactly what the patient wants and needs. Marketing in the field of medicine is characterized by the concept social and ethical marketing: a medical organization must not only satisfy the needs of consumers most fully and effectively, but also maintain and improve the health and well-being of both individual citizens and society as a whole.

In the technology of social marketing, one of the main problems is the inseparability of the relationship between economic, social, organizational, legal, socio-psychological aspects, and therefore it is necessary to analyze a set of problems related to the management system, the system of motivation for labor activity, standards and indicators of its effectiveness. .

The implementation of the marketing principles of managing a medical organization allows you to obtain the necessary information about the medical services that patients want to receive; establish how much they can pay for them; determine the segment of the most profitable demand for specific services and optimize the structure of medical specialization; achieve higher volumes and quality of services offered and receive higher incomes, unlike competitors; predict the situation in the medical services market.

Marketing Management- this is the analysis, planning, implementation and control of activities designed to establish and maintain beneficial exchanges with consumers in order to achieve certain goals of the organization (profit generation, sales growth, increase in target market share).

The diagram of the medical marketing management process derived from various data is shown in fig. 5 and includes the following components.

Rice. 5. Adapted scheme of the medical marketing management process

The market opportunity analysis is as follows:

Carrying out marketing research and collecting information;

Assessment of the marketing environment and market opportunities of the enterprise (medical institution).

The selection of target markets involves:

Measurements of the population's demand for medical services;

Market segmentation and selection of target segments;

Positioning of a product/service in the market (i.e. providing a product or service with a desirable, clearly distinct place in the market and in the minds of target consumers).

Marketing mix development includes:

Product development (medical service);

Setting prices (pricing) for medical services;

Choice of method of product distribution (providing medical services);

Development of a sales promotion system.

Implementation of marketing activities is as follows:

Choice of organization development strategy (LPU);

Short- and long-term planning of activities;

Development of a system for monitoring the implementation of marketing activities.

The marketing management process is unified, so it is only necessary to take into account the specifics of the medical services market and the specifics of the service itself in medicine.

The well-being of an organization (institution) depends not only on the applied marketing concept, but also on competitors, trends and events in the environment surrounding the organization (institution). This environment is called marketing.

Marketing Environment- a set of active actors and forces operating outside the organization (institution) and affecting the ability of the management of the marketing service to establish and maintain successful collaborative relationships with target customers (consumers). The marketing environment is made up of micro and macro environments.

Microenvironment- forces that are directly related to the organization (institution) itself and affect its ability to serve the clientele (suppliers, intermediaries, customers, competitors, patients, contact audiences)

macro environment represented by forces of a broader social plan that affect the microenvironment (demographic, economic, natural, scientific and technical, political and cultural factors, the state of health of the population).

In the activities of medical institutions (doctors), marketing research will be of no small importance, which should be ahead of any management decisions.

Marketing research- systematic collection, display and analysis of market information on various aspects of the marketing activities of medical enterprises and healthcare facilities.

The main stages of compiling and conducting marketing research are shown in Figure 6.

The scheme as a whole repeats the usual stages of socio-hygienic research and needs to be explained in the application to marketing.

Rice. 6. Stages of marketing research (according to F. Kotler)

Identification of problems and formulation of research objectives

Goals can be:

Search, i.e., provide for the collection of any preliminary data that shed light on the problem or help develop a hypothesis;

Descriptive, that is, a description of certain phenomena, for example, identifying the number and composition of patients using the services of a particular health facility, according to various characteristics (gender, age, social status);

Experimental, involving testing the hypothesis of some kind of causal relationship.

Selection of information sources

The researcher should collect secondary and primary data, or both:

Primary data is information collected for the first time for a specific purpose. To collect primary data, it is necessary to develop a special plan that includes research methods: observation, experiment, survey; research apparatus: questionnaires, technical devices; sampling plan: sampling unit, sample size, sampling methods; methods of communication with the audience: mail, telephone, personal contact, computer, etc.

Secondary data - information that has already been collected for other purposes (for example, official statistics or data on a specific issue from monographs, reports from state enterprises or organizations). Secondary data is the starting point of the study. They are more accessible, but do not provide healthcare facilities with competitive advantages.

Collection of information and its storage

They are carried out in accordance with the research program and are a technical point. It is better to store and accumulate information in the form of databases.

Analysis of the collected information

The most important information and results are extracted from the obtained data. After summarizing the data obtained, various indicators are displayed or calculated in tables, analyzed and conclusions are drawn.

Presentation of the results

The results are presented on paper and electronic media in the form of texts and graphics and are used to make marketing decisions. They must be reasoned, reliable, aimed at solving the problems under study.

Different medical services cannot be needed by all patients at the same time, and therefore health care facilities and individual medical specialists focus on servicing certain parts (or segments) of the market, in other words, target consumer patients. A market segment consists of consumers who respond in the same way to the same set of consumer incentives. The division of the market into similar parts is called segmentation.

Segmentation is carried out according to the main criteria:

Geographical (republic, territory, region, city, district, settlement);

Demographic (gender, age, family size);

Psychographic (according to belonging to a social class, lifestyle or personal characteristics);

Behavioral (based on the behavioral characteristics of consumers of medical services), consumers are divided into groups depending on their knowledge, attitudes, response to the service.

There are many segmentation methods used in marketing. One of them is the construction of a typology of consumers, the most acceptable in healthcare. The typology of consumers is the process of differentiation of the studied population of consumers into groups that are quite homogeneous and stable in time and space with a type of consumer behavior characteristic of each of them. For example, depending on how consumers of medical services react to changes in prices for medical services, they can be divided into 5 types (segments).

First group: economical patients(pensioners, students, low-income: more than 50% of the population of Russia). Patients in this group are highly sensitive to prices. Demand of this group for medical services decreases at their high price.

Second group: prestigious patients(part of entrepreneurs, intellectuals: 20% of potential patients). Prestige and quality of service are important for this group. They are insensitive to prices.

Third group: ethical patients(people economically related to any of the two previous groups: 20% of potential patients). For such patients, certain ethical qualities of medical services are important (belonging to the country of origin, social group).

Fourth group: "innovators" focus on everything new (methods of diagnosis, treatment). The quality of service is associated with the age of the doctor, preference is given to young doctors.

Fifth group: "conservatives" in contrast to the previous group, preference is given to old, proven methods of treatment. They trust doctors with significant experience more.

Depending on the nature and level of demand in relation to the health care market, various types of marketing systems are used.

Negative demand

Medical services such as clinical examination, fluorography, active prevention of caries do not provide patients with immediate benefits. The negative attitude towards these events created a negative demand, which in turn affected medical activity. The consequence of this was an increase in the incidence, worsening of the pathology, treatable in a hospital.

Tasks of marketing (conversion) with negative demand - analyze why the market dislikes the service, create a program that would encourage the consumer to use it.

Lack of demand

Occurs when target consumers are not interested in goods and services or are indifferent to them. Doctors may not be interested in a new therapeutic technique, students may not be interested in learning a foreign language. As long as a person is healthy, he is not going to invest in such a specific product (public good) as health. When he falls ill, he pays for a complex of medical measures aimed at eliminating the pathological process and its consequences. The tasks of marketing (stimulating) in the absence of demand are to find ways to link the inherent benefits of a product / service with natural needs and human interests.

Hidden Demand

It is formed in conditions when many consumers may experience a strong need, which they are unable to satisfy for a number of reasons. A person does not know when he will need this or that medical service (goods), but he wants to be sure that if he falls ill, he will be provided with timely and adequate medical care. In this case, we are talking about hidden demand. Hidden demand may be for the services of certain specialists (sexopathologist, narcologist, dermatovenereologist, psychiatrist), as well as for some information (for example, about sex education). The tasks of marketing (developing) with latent demand are to assess the size of the potential market and create effective goods and services that can satisfy demand, develop the need for these services.

Falling demand

Sooner or later, any organization faces a drop in demand for its product or service. For example, the demand for prophylactic vaccinations fell because patients began to associate the likelihood of HIV infection, the development of complications, especially in children, etc. with their implementation. As a result, there was a sharp decrease in herd immunity, the frequency of infectious diseases increased, which created an excessive demand for the services of infectious disease specialists and epidemiologists. Marketing tasks (remarketing) with falling demand - reverse the trend of falling demand, increase consumer confidence in the service, organize its mass consumption.

Excessive demand

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Health care has a number of characteristics that give rise to the peculiarities of the operation of market mechanisms in this area. These characteristics express the social importance of people's need to have good health, as well as the specifics of the production and consumption of medical services.

The features of the market begin to appear in the product itself - a medical service, which has the following distinctive properties:

– intangibility(the patient cannot know in advance the results of the visit to the doctor);

– inseparability from the source of the service(the patient receives the wrong service if he gets to another doctor);

– variability of quality(the quality of medical services can vary widely);

– perishability 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 involves the active participation of the consumer himself in achieving the result (the patient's recovery cannot be achieved if the doctor's actions are not supported by the patient). In addition, the direct object of the sale and purchase are not the final results of the activity, but the conditions for their achievement - the costs.

In many ways, the features of medical services determine the features of the medical services market, among which the main ones can be distinguished:

1. Many health services are not private, but public or quasi-public goods. For example, sanitary and hygienic 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. There is utility for third parties. A classic example is infectious disease prevention services. Thus, vaccination against measles is beneficial not only to vaccinated people, but also to 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 an insufficient volume for society. Therefore, special measures of state subsidies are required for private providers of these services, or the provision of these services by state medical organizations.

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, but if my illnesses are different from those of a neighbor, then it remains to be seen Will I be happy with this doctor). Secondly, the features of the professional ethics of medical workers, when the open manifestation of competition is condemned. Often, specific volumes of the medical services market (village, township, 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 get choice, but this will come at the cost of increasing costs beyond what is 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 the services purchased. It is difficult for him to choose a doctor who can provide services at a lower cost. Secondly, in many cases, the patient cannot make a rational choice of necessary services already because of his morbid condition, and sometimes as a result of temporary or complete incapacity. Third, unlike conventional markets, in health care, the producer, not the consumer, determines the amount of benefits provided. Physicians act in two ways - as agents of patients who determine the measure of their needs and the amount of necessary services, and as producers of these services. Physicians may exaggerate the number of procedures required, exclude cheap services and replace them with more expensive ones.

4. Risks and uncertainty of consumer expectations. Demand for medical services is largely random. Each person must take into account that there is a risk of disease and associated costs. The size of these costs can be quite significant if you buy medical services at the time of the need for them. 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 make greater demand for health care and lead to higher health care costs. This situation can be depicted on the graph as follows (Fig. 1).

If the insured patient fully paid the 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 of P 2 ), the demand will be Q 2 .

The insurance company will pay for the increase in demand at the price P 1 . With an increase in demand from Q 1 to Q 2, the costs of the insurance company are measured by the rectangle ABEC, the benefit received by the consumer is measured by the triangle ABC. The incremental cost exceeds the incremental benefit by a triangular

The market of medical services in its characteristics differs significantly from the market of perfect competition and is more close to the market. monopolistic competition. Restrictions on competition and information, ceteris paribus, often lead not to a decrease in price with an increase in supply, but, on the contrary, to an increase in price. This means that an increase in the number of doctors automatically creates a demand for medical services. In addition, most medical services are characterized by 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 health care give rise to a tendency towards underproduction of medical services or an unreasonably high expenditure of resources per unit of services. At the same time, in health care, the prevailing idea in society about justice in obtaining medical services, in the availability of medical care. In many countries of the world, there is a desire 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 attestations, 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.

"Failures" of the market dictate the need for the formation of quasi-market relations in healthcare (see table). These relationships differ markedly from the classical market model. Essentially, it is about market design using some entrepreneurial behavior tools to meet health policy priorities.

Limited role of the price factor. Users of health 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 CHI system or the state administration body in the budgetary health care systems.

Limited development of the commercial sector. This market is dominated by non-profit organizations, whose activities, in comparison with commercial organizations, relatively poorly reflect the motives for increasing profitability. In many countries, the use of mechanisms specific to the commercial sector is increasing, 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

Competition in a hard budget health care situation. Budget financing systems have a fixed budget, CHI systems also set a budget or have restrictions on the flow of funds through increased 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.

Preservation of strong state regulation of the system of financing and provision of medical care. Elements of market relations are combined with the preservation of state regulation of health care. Its most important elements are ensuring equality in access to medical care for all groups of the population, planning a network of medical organizations, their licensing and accreditation, managing the system of contractual relations, and a set of measures to contain costs.

Market structures with one or many buyers of medical care are possible. In the first case, there is one insurer or one government body 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 fixing of the population they serve, or they can expand their activities to any local markets. In the latter case, there is a "fork" of its own. One option is for health care buyers to secure local markets by government decision. For example, in France, autonomous territorial branches of the national health insurance fund (they act as an insurer for CHI) 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 constructing quasi-market relations, which is actively used in the system of voluntary medical insurance.