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 Faculty Working Papers 
 
 College of Commerce and Business Administration 
 
 University of Illinois at Urbana-Champaign 
 
FACULTY WORKING PAPERS 
 College of Commerce and Business Administration 
 University of Illinois at Urb ana-Champaign 
 
 CONSUMERISM AND THE BROADENED MARKETING CONCEPT 
 
 Alan R. Andre as en 
 Professor of Business Administration 
 
 #490 
 
 Summary : 
 
 As marketing moves into new broadened domains, it risks the criticism 
 and public disfavor that dogs it in its traditional business milieu. 
 This paper explores several alternative measures of consumer and 
 practitioner satisfaction in one of these broadened domains, health 
 care. It argues that evaluations of the outcomes and process of marketing 
 are essential if marketing's past life cycle is not to repeat Itself 
 in this new area. 
 
•VI- 1 .' 
 
 
 ••'.i!- : '.')".l I.: 
 
Introduction 
 
 Marketing is a major force in our society. By subtly matching hetero- 
 geneous supplies and demands for products and services, it serves, as one 
 marketing sage has put it, to deliver our "standard of living." During 
 
 the 1930's and 1940's, there were many who questioned whether the marketing 
 
 2 
 process cost too much. With the second World War and the postwar boom, 
 
 marketing flourished with only rare suggestions that it was less than a 
 
 3 
 wholesome force in society. 
 
 But all that changed in the early 1960's. With the rise of Naderism, 
 marketing again came into question, but this time on two different grounds. 
 First, it was argued that marketing was not really delivering products and 
 services of good quality; that consumers were much more dissatisfied than 
 market data traditionally showed. The support given to Nader airi his imi- 
 tators was offered as evidence that this level of profound dissatisfaction 
 
 4 
 did, indeed, exist. 
 
 The second charge against marketing was that not only were its outcomes 
 less than desirable for the society, but so too was its process . Many rose 
 to argue that the advertisements that were selling toilet paper to adults or 
 Farrah dolls to kids were turning society into manipulated mush. Others 
 pointed out that the same system that provided credit and low cost, honestly 
 promoted products to the white middle class also provided deceptively promoted 
 products sold at exhorbitant costs and usurious interest rates to those who 
 have the misfortune to be poor and/or members of racial minorities. 
 
 My colleague, Peter Webb, has argued persixasively that this criticism 
 of marketing was (a) inevitable and (b) desirable. The criticism was in- 
 evitable as marketing became more and more visible as business' interface 
 
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 with a skeptical world. The growth in per capita spending power meant that 
 more consumers spent more i;ime on the material dimensions of their lives. 
 This forced them to active.'.y seek out more contact with advertising, sales- 
 men, packages and the like to make purchase decisions. At the same time, 
 the growing ubiquity of television and other media in our leisure lives 
 meant that consumers were "forced" to have more passive contact with this 
 same voice. These contact!}, I would argue, became not only more frequent 
 but progressively more distasteful as increasingly well-educated consumers 
 felt vague guilt about the growing inroads that both materialism and tele- 
 vision made in their lives,. Marketing's increased visibility and its 
 direct link with both forces made it a natural target for consumer anger. 
 
 But the criticism thai: arose can be considered a very healthy sign, 
 particularly when it is directed back at business. It can be the irritant, 
 the flashing red light, that causes the business system to correct itself 
 and the consumer's frustraf.ion to be released. However, as I have noted in 
 another forum, business' present use of this self-corrective and frustration- 
 relieving feedback mechaniiim is surprisingly low. Fifty-edght percent 
 of all problems with products and services are never voiced to business. 
 And, further, of those that; are voiced, fully 44 percent are never resolved 
 to the consumer's complete satisfaction. This leaves both a substantial 
 vocal group of unsatisfied complainers who will lead the chorus of anti- 
 business criticisms and a tiecond non-vocal army which other researchers 
 have described as a "frusti'ated and even possibly an alienated group of 
 
 consumers . . . [i]n frustiation, . . . direct [ing] their anger toward the 
 
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 system, viewing both busintiss and government in very negative terms." 
 
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 Andreasen and Best have proposed that one solution to this feedback problem 
 
 is: 
 
 . . .to market the complaint-handling system to customers. 
 Business should encourage customers to speak out when 
 things go wrong — and make it more convenient for them 
 to do so. Through advertising, point-of-sale promotion, 
 and product inserts, business can tell customers that it 
 wants to know when things go wrong. 
 
 This feedback can not only reduce consumer frustration but improve the 
 
 information management has to correct its product and service offerings. 
 
 Broadening Marketing 
 
 It is a curious historical phenomenon that just at the point in time 
 when criticism of the traditional marketing system by one part of society 
 is most virulent, another part is just discovering that marketing has a set 
 of tools that are capable of having profound effects on such crucial domains 
 of our quality of life as health care, the arts, education and social services. 
 In a sense, business* whipping boy now has a chance at redemption. 
 
 But history can repeat itself. As marketing becomes more and more 
 visible as a tool of non-profit administrators, it may again become the 
 lightening rod for the frustrations of those whom these administrators are 
 trying to serve. The problem, obviously, is to avoid this seemingly in- 
 evitable outcome. The solution, equally obviously, is to develop feedback 
 systems that will allow non-profit administrators to improve (a) the out- 
 comes of their marketing systems and (b) the process whereby marketing 
 helps deliver those outcomes. If marketing is to continue to have a posi- 
 tively valued impact on these key life quality dimensions, an effective 
 measurement system must be devised. 
 
iiTia a ni 
 
-4- 
 
 The remainder of this paper explores several of the key measure lent 
 issues raised by the "broadened marketing concept" with particular azten^ 
 tion to health care. The problems of evaluating outcomes and process ar 
 discussed independently. 
 
 Ev aluating Health Care Outcomes 
 
 To make the discussion concrete, let us suppose that the administrate 
 of a federal program that makes grants to medical clinics for diagnostic 
 equipment wishes to make those grants at least in part on the basis of how 
 good patient care outcomes are at various clinics. He/she wish to see 
 developed what Hunt calls "consumer satisfaction/dissatisfaction" (CS/D) 
 measures to insure both that clinics are rewarded for providing good 
 outcomes and that the clinics themselves get adequate feedback to c^ri-ect 
 their own operations and to reduce customer frustration. 
 
 Elsewhere, I have suggested that the administrator's first choice 
 is to specify whether he/she wishes the clinics; 
 
 1. to minimize dissatisfactions or maximize satisfactions; in neaiii 
 care, the analogous question is whether one merely wishes to 
 minimize the frequency, duration and seriousness of illness or 
 to optimize health; 
 
 2. accept a subjective judgment of satisfaction or dissatisfaction: 
 that is, should the patient or practitioner be allowed merely 
 
 to tell you how healthy or free from illness the patient is; oi 
 
 3. meas\ire satisfaction/dissatisfaction before or after the market ir 
 has had a chance to correct any dissatisfactions, which, of 
 course, presumes some system for handling patient complaiats. 
 
-5- 
 
 The alternative measures that this taxonomy offers in business are outlined 
 in Figure 1. In the main, there are six principal kinds of measures: 
 
 1. Sales; 
 
 2. Repeat purchasing (versus "brand" switching); 
 
 3. Salesmen's or middlaBen's opinions; 
 
 4. Consumer's satisfactions; 
 
 5. Voiced complaints; and 
 
 6. Reported problems. 
 We will consider each In turn. 
 
 (1) Sales . Sales at first evaluation is not a very useful measure to 
 test the effectiveness of health care systems, although it has the advan- 
 tage of being non-subjective and relatively easily and frequently measured. 
 In the first instance, if the number of customer visits or customer revenues 
 are used as criteria one can raise the question as to whether more is nec- 
 essarily better at either the individual or societal level. If individuals 
 visit the clinic more often, this does not necessarily mean that the clinic 
 is doing well or that consumers are paying more attention to their health. 
 
 It may simply mean that problems are not being resolved satisfactorily as 
 
 12 
 often on first visits. On the other hand, if consumers are found to 
 
 be spending more, particularly per visit, this may reflect one of two 
 
 socially undesirable outcomes: 
 
 "1. It may indicate a greater Krillingness of clinics to take 
 
 advantage of price inelasticities in a market where most 
 
 payments are by third-party insurers. 
 
 2. It may indicate a growing use of laboratory procedures to 
 
 hedge against malpractice suits. 
 
In either case it means that the nation's health bill may be rising unnec- 
 essarily. In neither case does it mean that consumers are healthier. 
 
 One useful alternative may be to measure the number of customer 
 visits of a particular type. One could, for example, catalogue the fre- 
 quency with which existing patients appear for full or partial physical 
 examinations or for first visits for various ailments. These would appear 
 to be more valid indicia of improved health care behavior. 
 
 But even if such measures were developed, they only seek to evaluate 
 one function of health care systems, what may be called the cmrative func- 
 tion. Visits to clinics are to diagnose or cure problems. Yet a clinic 
 coxild be performing marvellously if it had a superior preventive function, 
 and, therefore, s eld can had to cure. Many of the marketing activities that 
 pursue the preventive function may be secondary to, or independent of, 
 clinic visits. Brochures, posters, mailers, patient education, television 
 talk show discussions, and other public information activities may all 
 serve to encourage people to take up jogging, stop smoking, practice 
 breast self-examination or to take their medicine (e.g., for high blood 
 pressure). Yet these are exchanges that, unlike curative encounters, do 
 not involve money changing hands. The role of the health marketer is 
 
 to get the customer to perceive that the benefits of what Kasl and Cobb 
 
 13 
 describe as "health behavior" exceed the costs. Indeed, the product 
 
 or service is t3^ically one that custcmers administer to themselves! 
 
 It would again appear highly useful if health care systems could 
 
 develop measures of "sales" in preventive health care, e.g., patients 
 
 taking up jogging and other health giving acts. Among other benefits. 
 
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 such a measurement device could in the long run redirect health profes- 
 sionals toward more preventive marketing. 
 
 (2) Repeat purchasing . Hunt has argued that: 
 
 . . .intention to repurchase is an excellent composite 
 measure of CS/D. The value of this measure is that it 
 is a composite measure getting at all the influences 
 affecting the decision without liaving to identify those 
 influences. It in essence says, given the real world 
 and your psychological world,, what evgr they may be, 
 what choice will you make next time. 
 
 Repeat visit behavior by clinic patients, however, is not a very good 
 measure of performance of the curative function primarily because of the 
 inertia that is built into doctor-patient relationships. Choosing among 
 alternative doctors is typically not an activity a patient undertakes at 
 each visit as he or she might with a toaster or a car repair shop at each 
 repurchase. In part this is because many patients believe that the effec- 
 tiveness of a medical doctor in both a psychological and medical sense is 
 in part a function of his/her accumulated knowledge of the patient. 
 Patients are reluctant to give this up even if they have misgivings about 
 a doctor. Further, they fear (incorrectly) that all the written minutae 
 of their history (x-rays, test results, etc.) cannot be transferred, thus 
 incurring further costs for repeat "work-ups" along with the aforementioned 
 risk that without these records a misdiagnosis is more likely. 
 
 Then, there is the uncertainty involved in any switch in practitioner 
 occasioned by the basic difficulty of acquiring the necessary information 
 to make an informed choice among doctors. In most cOTtnaunities (although 
 there are exceptions), the marketing system does not make it easy for pa- 
 tients to shop around. Information on a doctor^s (or clinic's) training, ex- 
 perience or even prices is simply hard to come by and, thus, a known mediocre 
 
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 medlcal doctor may be preferred to an unknown alternative. In sum, until 
 the health care marketing system is redirected to encourage easy choice 
 and uncomplicated doctor-switching, the absence cf "brand -switching" should 
 not be considered a very good measure of the curative outcomes of health 
 care systems. On the other Iiandj repeat "purchasing" measures may be 
 very useful indicators of good preventive care outcomes. In preventive 
 health care, one is asking people to engage in behaviors that Hochbaum 
 has described as "inherently unpleasant, inconvenient, humiliating and 
 
 painful; they disrupt old, accustomed living habits; and they necessitate 
 
 ] 5 
 depriving oneself of things one wants and enjoys." " Given this char- 
 acteristic, Hochbaum continues: 
 
 In the health area, the concern with use after "purchase" 
 is as critical as and even more critical than the concern 
 with the purchase itself. . . . The most challenging, most 
 difficult, most perplexing problem is not how to sell peo- 
 ple on health-supporting practices, not even how to get 
 them to initiate such practices. We have been fairly 
 successful with these. It is to persuade and help them 
 to stick with new practices, to keep^ these up conscien- 
 tiously for the rest of their lives. 
 
 Again, focus on this measure of repeat purchasing appears necessary to 
 
 assume that marketing direct its efforts toward the essential preventive 
 
 health goal. If marketing focuses on the first purchase, this may lead 
 
 to greater dissatisfaction and frustration rather than less as consumers 
 
 complain that, as marketers urged, they tried to quit smoking (exercise, 
 
 brush after meals) but they couldn't stick, to it (i.e., marketing did not 
 
 follow up), rney may feel badly about themselves and, as in marketing's 
 
 business domain, take it out on the marketing community, e.g., "Why do 
 
 they keep pushing me to stop smoking; I feel guilty enough as it is?" 
 
-9- 
 
 (3) S alesmen's ox- middlemen's opinions . Can one ask clinicians about 
 how setisfled their patients are? The answer is no for two very good rea- 
 sons. First, the nature of the medical practitioner's job is one that re- 
 quires that they be very confident. People who must make daily what are 
 
 often life-and-death decisions about other human beings would sink Into 
 
 37 
 catatonia if they regularly questioned their skills in the field. 
 
 Second, there is the growing problem of malpractice. It is unrealistic 
 
 to expect doctors to indicate that their patients are less than fully 
 
 satisfied if this evaluation is to be written dovm. somewhere (as it pre- 
 
 stanably should) . Such data could well be grounds for a successful future 
 
 malpractice claim. 
 
 (4) Consijmers' satisfaction . A number of scales have been developed 
 in recent years which allow consumers to report how well they are satisfied 
 with the products and services they liave received. Pfaff and Blivice in 
 
 particular have sought to develop consumer satisfaction scales applicable 
 
 18 
 to public services. Such scales could be administered annually to 
 
 19 
 patients of various clinics. Hovjever, as Olander has pointed out, a 
 
 problem with such measures is whether health consumers really have enough 
 
 knowledge to make the appropriate judgments. Partly, this is because the 
 
 medical system has historically been less than candid with patients about 
 
 the patients' condition and/or the medical doctor's frequent uncertainties. 
 
 There are sometimes good medical reasons for this. But often lack of candor 
 
 is designed to maintain "face," to prevent time-consuming debates about 
 
 appropriate care, or to prevent malpractice claims. Thus a patient may 
 
 well feel fully satisfied with a clinic's curative function when this 
 
 merely reflects the practitiovier'e ability to maintain silence! 
 
"10- 
 
 A second prob3.Qn relates to standards. Patients may not really fcaow 
 whether a better alternative exists Bomewhere. The difficulty of directly 
 comparing medical doctors has already been mentioned. A second type of 
 ignorance is at the systems level. Most patients have little familiarity 
 with alternative health care systems. In North America, the medical pro- 
 fession is oriented toward cure and not prevention. In other countries, 
 such as England or Scandinavia, the orientation is much more toward pre- 
 vention. Someone who Is socialised to a curative system may be very 
 pleased with the frequent cures without questioning whether more attention 
 
 to prevention might have made the cures unnecessary. 
 
 20 
 Then there is the matter of one's expectations. As Oliver and 
 
 others have shown, perception of system performance is a function of ex- 
 pectations. It may well be that a given clinic, because it sets and 
 vigorously advertises its high standards, may liave low consumer satisfaction 
 ratingf3 while having superior performance in some objective sense. On the 
 other hand, it may be that the medical system in general stresses too high 
 standards. If patients are led to expect the latest, best equipment in 
 every facility, the cost to society in duplication may be excessive. As 
 Hunt suggests, reducing expectations may be good public policy: 
 
 [Gjovemment could iixrease satisfaction just as well 
 by getting consumers to l ower their expectations. At 
 first it sotinds silly, but with the conserver society 
 coming fast upon us it may be critical in the near 
 future to find ways to reduce consumer expectations 
 because increasing product quality will be socially 
 unacceptable. 
 
 A third problem is, of course, that patients are sometimes unable 
 
 to judge whether curative treatments or preventative recommendations are 
 
 successful. A case in point is the problem of educating high blood pres- 
 
-11- 
 
 sure patients. W:Lth this dit^eace it is very difficult to tell whether 
 a treatment is working since the disease has no syiaptoms. Thus a patient 
 told to diet, exercise and take specified piJla may not feel any different 
 froiD one who did not follGbr this regime. As a consequence he or she may 
 well feel (mistakonly) dissatisfied with the medical care received. 
 
 Finally, there is a basic nsthodolgicai probleic with satisfaction 
 scales that may b£; especially serious xn health care. Satisfaction scales 
 tend to ovrreport disnatisfaction because they often reflect inflationary 
 factors. Research by Andreasen and ^est reported that when people were 
 asked how saticfied they were xvith a product oc service, fourteen percent 
 of those who were dissatisfied said that high pr3.cc was their only prob- 
 lem. That figure rises to slraost nineteen percent for those dissatisfied 
 
 22 
 vrfth medical and dental care. Tne. latter is not surprising given the 
 
 very rapid increasie in heslth care costc in the last decade, 
 
 (5) Voiced coisplalatfi, A technique used by lafmy businesses to 
 
 monitor performance is to rejy on the complaints that naturally come to it 
 
 from disgruntled cu6to!E<5rj3 v^ho choase to rp&ak up either by letter or In 
 
 person. And, iijd€:edj. i-an\ ulinlcs ivad hospitals h&ve sought to generate 
 
 such co3iplait;l.s data by e.n rsbiifibin;/. "pa Lieut suvisory boards." " A 
 
 problem noted in oxir own research ovi consutaar coraplaiiitG, however, is that 
 
 voiced ccBEplaJuts imdcrraport the true level of. dissatisfaction since, as 
 
 noted earj.ier, vh^i majority of all nor.--pri.ce problciffis are never voiced. 
 
 Kot onI.y do they under rep oil probleas, i..be> present a distorted picture of 
 
 ^^® JiXE££ °^ problfajce that actualJ.y exist .iiiice some types of complaints 
 
 are more likely to he voiced thars others. 
 
-12" 
 
 Our study sxiggests that or. bot.h coimtSj complaints data may be 
 especially unsatisfactory in the medical field. First » we found tliat 77 
 percent of all mcciical and dental problerao were unvoiced. For such an 
 jjaportant isBue to most consumers, this rate of voicijig Is exceedinjjiy 
 low. Second, our research in general showed' that the kinds of problems 
 that did get voiced were those where the problems were important and/or 
 had a hi^h likel.Lhood of resolution. While medical problems are impor- 
 tant, they were not very likely to be resolved satisfactorily. Our data 
 showed thet consumerc v;ho did voice their jaedical and dental complaints 
 felt that the ccKiplainta were satisfactorily resolved only 34.5 percent 
 of the tiioe, (THils was the second lowest figure in the entire study,) 
 This result laay well accurately reflect the considerable inapproachability 
 the laedical profession has assiduously cultivated over the years. 
 
 A third featiure of the types of problemn that were not voiced vas 
 that they were wliat were called ".-judgment" probleas. These vrere the eases 
 
 where ". ., .deficiencies [were] complicated or ambiguous, and therefore 
 
 25 
 relatively dlffi(;ult to perceive clearly fxnd state with assurances." 
 
 It is, of course., just those tynpcts of problems with which aedical encounters 
 
 abound. Consumers who are unsure of their grounds in a liighly sophisticated 
 
 and arcane subjectt as laedjcine are underntandably reluctant to challenge, 
 
 even indirectly, the usedical high priests, 
 
 ^^^ Report?? of probleas. My own experience strongly argues for the 
 
 use of date geneiated from consumers in surveys on the probleras they have 
 
 26 
 
 encountered \^th goods or services as the best measure of curative outcome. 
 
 Such treasures overcome the ovfitreporting bias of simple satisfaction scales 
 and the underreporting bias and distortions of consumer complaints data. 
 
-13- 
 
 (discussed above). In our research, the rate at which Tuedical or dental 
 care problems involving non-price issues were laentioned was fifteen per- 
 cent. Given coiisunjer ignorance in this area, this figure is undoubtedly 
 low and I would argue vigorously for consumer education in evaluatijng 
 medical care. StJLil, survey reports of probieaas are at present probably 
 our best measure of curative outcomes. 
 
 Measures About Process 
 
 We have already seen that a major defect of the health care marketing 
 process in that consumers seldom liave ade<juate information to evaluate 
 the care they are receiving. While in t-he short run consumer expectations 
 can be suppressed by practitioners to keep them satisfied, in the long 
 run, however, adequate information is essential if customer suspicion and 
 frustration is to be reduced and if the self -correcting potential of an 
 open marketplace is to be actualized, 
 
 A second requirement for the process to work well is that it become 
 more consumer oriented. Tliere is considerable evidence that in curative 
 
 settings practitioners are frequently not very much concerned vlth con- 
 
 27 
 suiaer xntereets. And severnl authors have pointed out that even in 
 
 preventive contexts, health care specialists take the view that they know 
 what is best for consumers; it then become-s marketing's task to con- 
 vince consumers to adopt the system's view. As FJexner puts it: 
 
 One of the major reasons that preventive health 
 care has a relativelj' low priority among consumers 
 Is that all concerned entities . . . have placed 
 too little emphasis on the intended recipients of 
 the product — the consumers, their motivations, 
 and the 'benefits tltat attract them to certain be- 
 haviors. 
 
-14- 
 
 It Is just the kind of pifjduction orientation that characterized conciiercial 
 marketing of 40 years ago. A measure then of progress in tha health 
 ffiarketing process is tTie e35:teiit to vhich medical practit."ix>ners begin to 
 adopt the perspectivee, particularly i.n preventive health care, tlwt 
 change programs will only be raasimally ffuccessf u3 when they begin with 
 consuff>er neede and wants. 
 
 The product*-as~givcin approach of laost health care profp.sBionals 
 naturally le^de to heavy emphasis on advertising and promotion to achieve 
 behavior change. Kaedless to a&y^ this /approach snay be entirely appro- 
 priate to riiany preventive health care. raarketiiT.g programs. But even here 
 there is a danger. As ?foriarty notes: "Preventive health care behavior 
 in some cases 'hap. only long run and uncertain outcoifies for the xndivid-oal. 
 Advertising elates of a more healthy life associated with specific changes 
 in behavior will have to be dncttmented. , , ."' Monitoriiig of the 
 truthfulness of health care promotion therefore would also seem ianportant 
 if the marketing process is not to receive a black e5'e in this nen; 
 broadened context. 
 
 And just as we shovtld be co'Acerned aiiout the product and promotion 
 eleaentK of the health care sarkefcing mix, so should, we be concerned 
 about price and dietribfation. As noted earlier f there is very little 
 price competition in health eare^ In partj thio is because often the 
 products are liot coapsrafcle. But this is not alvreiys the case, and if 
 marketing is to be effectiv-e this elemeni: too rouBt becoioe more open and 
 flexible. 
 
 Finally, one should note th/- djj^ficulties business ruarketers have 
 hat by not pajing heed to tha coi^cerns of vhat 1 have called ''disadvan- 
 
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-15-- 
 
 33 
 
 t-aged consumers." ' Adftouate heaith care is soen by ir^aiiy ^r a ^igjit 
 
 of: &11 :mdividualB in na affi<j6*.nt socieliy. Health iiiar):etej.'s are in most 
 
 caoeB already sfcnsj.tized to the prohlems of t-Jje disadvantaged and are 
 
 Bttecking the©. It is, however, not: impossible that: the white middle 
 
 claes uedictl eetaW.ishKsnt (like the white middle class constjmer es- 
 
 tabllehasent) icey not be i^bII attuned to the needs of the disadvantaged. 
 
 Thus, 11 the process is to be TelatlVGly free fros? criticisiB \-f?. nnst 
 
 he Bute not only to keep the overall level of. satisfaction high but 
 
 ensure that this satiafaE-tion is ecuitably distributed across all pop-- 
 
 ulation groups at riok» 
 
 The final pro'bieta sEBrl^tere should be ae.usltlve to is not to ov&T" 
 
 proBiice its coiitrihutionB to its ntltar wajor pnhilcj the henJth care 
 
 practitlonere therasftives- Ghan:berlaj3i puts it wftli: 
 
 Gar corttern should be tkaf. viiarketlaj? will not be 
 equipped to fulfill trie forpectations of the ht-altb 
 )irot'esB5.onale« Such expect^'-.tions tosy he ezeggerateci 
 beyond the. capRbilities of lusrketltig practitiocers. 
 The aarketer who achic-vee n j.5 per.cent chatsge iu 
 consumer behavior Tdll very likely be viewed as a 
 failure by heaith^profesBioDala expecting 99 per- 
 cent compliance, ■ 
 
 If vv. do Rot jsonitor the health profe-ssiontl's ejrpectations and our 
 
 accoiapliehaients, ve rnv the difitJjact risk that they too will see UJarJceting 
 
 an a source of deception « As coie. health marketer told the authors 
 
 "Marketing to rrtany health professionals aieane putting balls and 
 
 vhlf.tlee on ecmie very bsfiic SiesssgeB," For them, raarketing^G (i-nevitable.) 
 
 failure to make large gaiiis taay indelibly iabc;! :it ss just anotlier health 
 
 laanagemenfc fad-— or worpcjt a con job by r.orie ixrory tower acadesnicR. 
 
5:oip& ReBa&rc"b Replications 
 
 We* are clee.vly a long way Iroj. being ablle l:o rjecBure theisa luarketlnf; 
 outrome amd prc>f.e.8«i variabl&e. At tht- coi^sumer. lti!'el j, ve need to laiov a 
 goad dcfel rjor« rbout how Indiviclualo fcvaiu&te medicRl cBrt. Ke need to 
 know fheli" 'Know3ed.ge of the j-yfjtea aiict its. siternatives; x-»hat i:beir nx- 
 pectatiorts ar& cf cacb iie&lth fcacoiinter and wnal; they know of the he&3.1.}i 
 sypLeai tiS K wTc'.oJ.e. Vie need to l:now v)n pP.Tcexvea probiesus and v.i}jo acta 
 on theiii &ud vhy. We need t.o know what practitioners f.hink of mcxiuitijig 
 aiid what their expectations are ni its periorHaacfe. And finally wc nsieo 
 to know vshst will cliange the/ie vsiiahles. ±ii h iavorahle direction. 
 
 Trife fieveloicijcnt of JuiitriEnentf. sue rel^ited methodologies to assess 
 consoBTsr e.ud prf.ctitioner sstlsfactiouc-; vrJ.th he&lth cere outcoraftt. and thf 
 laari-jsting proceiis tlist brings irh&ih /should occupy ovt attention for nctvex&l 
 yearfj, Cvxt^iiii.y these are critir^;] ieBuefi if marketing is to serve its 
 fu3J pi.tQntiai in iJiiproviug the quality of lifo in this and aiM-ilui: 
 hrofcde.nc'>3 doissirlna . 
 
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 Centurv Timd,, l&SiOV 
 
 ?,. Set, fc-r exatiiplej, llu^hford K. 'fcrr=iaj% ■'%\iiild You Vnut ^oui' Datsg'titer 
 i:o Tfenry ts 'Jfafketing '/-Jan?'' Journsl .of; *fisr kei;^iipg^, Voj . 31 (Jau,u3r.v.> 
 3;&{v;), KufflbBi- 1, ^.p, a -5, ' " 
 
 ^i. Mark Y,. 'Kauel, Tbo J'oli^ics^^fjf Cofcai/juer J^^^ttict ion.. (ItidJ&nBpolif-j 
 yht Bobbi'.-frlerriii Ccu., ItTc'. ^ :ml)T"' 
 
 f«^ Evelyii Kaye, Tmj KetDl'iy G^ij.dfe to C'-xi'j/ir aii^e Ueli.evi.Kiorj (Nev- York; 
 PsTmlhtov. Ik>o1-.Kj 2 9/^). 
 
 6. /i.laii l\, Mi&roi-.BeTi^ "Vne J>i:o^.&vanli'j^fi6 QortF-tfOier (ViP-v York; Tne Vrir.t'. 
 Prees» 1P75).. " " " 
 
 7. AJciiii R. .jfitwireaswi aDC' /.orthur ik^st , "'-{ioi'SOiUf-rs C;oisp:i.R5.v\-"Doei; BxisloGsr 
 Rftsponfl?" llsrvard -fiUBivest. Kc}^£*i< Voutm;e; SS^ Thia&c.r. 4, (July- 
 
 P. ReK H. AterJjjntlj Kfbf;rt 0, We.j.Ti.aRnr; nnd Jiioe 'wxlli-fs., "DiopstiRfie-S 
 
 iO, K, Kfcith Siwnt,, "Cfc/j!; •i'i\'> I'n-'grajr 'PJ:fim.;3 5:sB anil T^nJiuttioi- P.erfipetll^'e," 
 jii Bevej-lf-e Jii. Aodereors yec^.) ^^Ysiu£€^ jl^^ J>jr)S]^t^ Vol. lil. 
 
 (Cincijruiat:i: Asisos'ifctioxi for Coii<ra:ct-.r 'keBcai-cl^ 197 6") ,. j>p. ZS^^-i&Ot 
 
 XI, Al<m 11. .;A.r«<5re&Ciet\j, "A Te^onoaiy ci! CouEsveuvr Si.(ria£ac:t.'j.on/DiyKat:icf&etJ:or! 
 M'ttaiUUTftfe.," .Tonrif&l _oi"^ C!ouf.-.uaar Af-f air s^t Voitane l?j Ilucibp-r 2j (V'Jntej:', 
 i&7?), 5.p. 11-24. 
 
 i2J,^ TJio eD.ajoj5y o^ -C:3r repsiLrK i.fc fipprc»pri/i( e. On'.-, v^ojud certainly not 
 j3w!cri.b.4? iiT; liici-ftase lu visdtt-. to tlit i?epfcir sLcjjj at- a slpn tbat 
 ■ctAre vreie bciijig ludJ.t .better ot ^ uecBBjiEilly,, i'iiett people ware ftaV.iug 
 better cere nf, rb,eKt. 
 
 .15. Staul&iov a-^fiJ and fiafiuey Coiibj '*H£ftlth Bebr.vJ.ai , Ilinef;£ Behavior 
 .a.T(«3 Jiick-^.'olt' Bfch&v.ior," •/irr.hiv^es^o^^^KavjxonE.^^ Voliisae. 
 
 3.2 (I^ebruarv.. 1966).5 pp, 246-266 £m6 Voltvce 22 (hprllf 1966), pp.. 
 
-18- 
 
 14. H. Keith Hunt, "CS/D: Bits and Pieces" in Ralph L. Day (ed.). 
 Consumer Satisfaction, Dissatisfaction and Complaining Behavior 
 (Bloomington, Indiana: Department of Marketing, School of Business, 
 Indiana University, 1977), p. 39. 
 
 15« Godfrey M. Hochbaum, "A Critical Assessment of Marketing's Place 
 In Preventive Health Care," in Philip D. Cooper, William J. Kehoe 
 and Patrick E. Murphy (eds.). Marketing and Preventive Health Care ; 
 Interdisciplinary and Interorganizatlonal Perspectives (Chicago: 
 American Marketing Association, 1978), p. 5. 
 
 16. William J. Nolen, The Making of a Surgeon (New York; Random House, 
 Inc., 1970). 
 
 17. Hochbaum, same reference as 15 above, p. 6. 
 
 18. Martin Pfaff and Sheldon Blivice, "Socioeconomic Correlates of Consumer 
 and Citizen Dissatisfaction and Activism," in Day, same reference as 
 
 In 14, pp. 115-123. 
 
 19. Folke Olander, "Consumer Satisfaction — A Skeptic's View," in H. 
 Keith Hunt (ed.) Conceptualization and Measurement of Consumer 
 Satisfaction and Dissatisfaction (Cambridge, Mass; Marketing 
 Science Institute, 1977), pp. 
 
 20. Richard L. Oliver, "A Theoretical Reinterpretation of Expectation 
 and Dlsconfirmatlon Effects on Posterior Product Evaluation; 
 Experiences in the Field," in Day, seune as in reference 14, pp. 
 2-9. 
 
 21. Hunt, same as reference 14, p. 41. 
 
 22. Andreasen and Best, same as reference 7. 
 
 23. Edmund Rlcci, Bardin Nelson and Robert Pecarchlk, "The Consumer 
 Movement in Health Care," paper presented at the American Sociological 
 Association annual meetings, Montreal, Canada, August 5, 1974. 
 
 24. Andreasen and Best, same as reference 7. 
 
 25. Arthur Best and Alan R. Andreasen, "Consumer Response to Unsatisfactory 
 Purchases: A Survey of Perceiving Defects, Voicing Complaints and 
 Obtaining Redress," Law and Society Review , Voltme 11, Number 3, 
 (Spring, 1977), p. 709. 
 
 26. Andreasen, same as reference 11. 
 
 27. It is recognized that Increased competition is not favorably regarded 
 in the medical community. However, the trend is in this direction 
 with the advent of generic drug prescribing and advertising of basic 
 medical services. 
 
-19- 
 
 28. See, for example, Hochbaiun, same as reference 15 and M. Venkatesan, 
 "Preventive Health Care and Marketing: Positive Aspects," in Cooper, 
 Kehoe and Murphy, same reference as in 15, pp. 12-25. 
 
 29. William A. Flexner, "By Choice A Limited Government Role," in Cooper, 
 Kehoe and Murphy, same reference as in 15, p. 64. 
 
 30. Mark Moriarty, "Advertising Preventive Health Care: Informational, 
 Persuasive, Ethical?" in Cooper, Kehoe, and Murphy, same as in 
 reference 15, p. 57. 
 
 31* Andreasen, same as reference 6. 
 
 32, Robert M. Chamberlain, "Is Marketing Too Stigmatized to be Effec- 
 tively Accepted in Preventive Health Care," in Cooper, Kehoe, and 
 Murphy, same as in reference 15, p. 58. 
 
 M/C/75