Health Services

MARKETING OF HEALTH SERVICES: A STUDY OF PERCEPTION, EXPECTATIONS AND SATISFACTION LEVEL OF PATIENTS IN RURAL AREAS

Project work
for

MBA (Marketing)

MARKETING OF HEALTH SERVICES: A STUDY OF PERCEPTION, EXPECTATIONS AND SATISFACTION LEVELS OF PATIENTS IN RURAL AREAS

‘Services is defined as an action(s) of organisation (s) that maintains and improves the well-being and functioning of people’

Hasenfield. Y Richard. A. E

TABLE OF CONTENTS
Page No. 1. CHAPTER I
1.1 Introduction 1.2 Statement of the problem 1.3 Importance of the study 1.4 Description of the study area 1.5

1 3 4 6 7

Objectives of the study

2. CHAPTER II
2.1 Research Methodology

8

3. CHAPTER III

3.1 Review of Literature 4. CHAPTER IV
4.1 Presentation, Analysis & interpretation of data

9

17

5. CHAPTER V
5.1 Findings of the study 5.2 Conclusion

37 42

6. APPENDIX
i) ii)

Bibliography Questionnaire

44 45

CHAPTER I INTRODUCTION

1.1 INTRODUCTION
The hospital is a unique, flexible institution of man, capable of adapting its resources to the total health care needs of the community. ‘ The hospital is a integral part of a social & medical organisation, the function of which is to provide for the population complete health, both curative & preventive, & whose outpatient services reach out to the family & its home environment. The hospital is also a centre for training of health workers & for bio-social research’. - WHO (1957) The growth & development of the Indian health sector had much to do with the philanthropic spirit of people who established hospitals purely to serve the society. Now the hospitals have traversed a long route, since the time of its inception as service oriented, non profitable institutions to the current day corporate hospitals. The thrust on viability & profits may not be popular, but it promises to revolutionise the health care delivery system. Professionalism, personal touch, medical audit & marketing are some of the key determinants of the changing face of hospital administration. The importance of marketing in hospital services, be it in urban or rural areas, include the qualitative & quantitative improvements in hospital services, creation of impulse using refined behaviour of the provider, maintaining economy in the cost of services, aggravating health consciousness & maintaining financial viability for organisational

prosperity. Hence, the application of marketing principles in hospital services is significant, as it raises the efficacy of hospitals vis-à-vis acts as a customer- satisfaction – engineering tool. Though the marketing of social service institutions like hospitals is difficult, the main purpose of applying marketing principles in hospitals is to satisfy the user & raise the service generating capacity of the hospitals. It is believed that the first commandment of marketing is to know thy markets, which diverts our attention to the understanding of user’s behaviour. This in the hospital context would mean to understand the patients’ perceptions, satisfaction & expectations. This premise forms the basis of the researchers project work.

1.2 STATEMENT OF THE PROBLEM
As each person is unique, having different desires, perceptions & expectations, it becomes difficult to formulate a management policy, which would satisfy everyone. But a study of the users’ behaviour is found essential to apply the marketing principles in the hospital organisations. ‘Marketing concept represents a management philosophy aimed at determining customer’s wants in order to satisfy them. - Hartley The users’ behaviour is governed not only by internal factors like needs, moves, perceptions & attitudes, but also by external or environmental factors like family, social groups, cultural, economic & business influences. It should be borne in mind that the users of hospital services in both urban & rural areas, unlike other users, would be willing to pay much more than their capacity, in order to receive quality health care. It is not just sufficient to provide quality health care, but it is essential that it is perceived by the patient as qualitative & hence it becomes essential that behaviour management, forms an integral part of hospital management.

1.3 IMPORTANCE OF THE STUDY
Today the hospital administration has shifted its focus from the doctorcentric to patient –centric. After the doctors have been placed under consumer protection act & the alarming number of medico-legal cases in India is a testimony to the fact that patients can no longer be taken for granted. Today the buzzword in patient care is ‘cure with human touch’. Hospital industry is following the pattern of hospitality industry, where personal care towards patients has become important. Humanized treatment has become crucial in view of high expectations, tense situations & constant scrutiny, and it is not just the patients, but the relatives who are equally important. In the service industry, mainly in a hospital one has to be pleasant & sensitive to the relatives of the patients, who are under constant stress. The users’ decision process is a five step activity. In the first step is the need recognition, or the awareness of the problem, to which the user is searching for a solution. Second is the information search, where having recognized the problem the user looks for the product or service that can solve the problem. Consumer has many alternative sources of information, like friends, relatives, neighbours, salesman, advertisements, literatures or the internet. Next is the evaluation & intention stage, where the consumer assigns relative values & weightages to different services, in this case to different hospitals, depending on the image, convenience, facilities & concessions, & judges the relative worth of alternative hospitals from the angle of want

satisfying potential. Once he evaluates, he develops the intention to accept or reject a given hospital. Fourth is the purchase decision – where the consumer, based on the above information makes a final decision on the choice of a service or product. The fifth step is the post usage behaviour which indicates the level of users’ satisfaction, which will result in the user recommending the particular service to others. The reputation of the hospital, reputation of the consulting doctors, the junior doctors & nurses making available the medical aid to patients, behaviour of the administrative & paramedical staff with patients, the supportive services & other facilities provided by the hospital, all have an impact on the behaviour of the users, which in turn affects the image of the hospital. Till a few years back, rural areas were mainly serviced by the government hospitals, primary health units & primary health centres, but today, many private nursing homes & hospitals have been established & many corporate hospitals – like Saagar, Apollo, Wochardt, BGS - are planning to open branches in rural areas. With the competition hotting up everyday, the need for continuous modifications in the hospital setup, especially hospitals in rural areas, based on the users’ perception & expectations assumes paramount importance. It is against this background that the ‘Marketing of health services: A study of perception, expectations & satisfaction level of patients in rural areas’ assumes significance.

1.4 DESCRIPTION OF THE STUDY AREA

For this study, the researcher has selected respondents from government & private hospitals in Kolar district of Karnataka state. The geographic area covered was the towns & villages of Kolar district. The government hospitals – district hospital, taluk hospital & other hospitals & Primary Health Units in hobli headquarters & villages were included for the purpose of the study. The private hospitals & nursing homes included in the study were mainly found in the towns, taluk & hobli headquarters. As far as possible, the researcher has selected respondents, who have received treatment as in-patients in these hospitals, as they would be in a better position to give their opinion regarding the services offered in these hospitals.

1.5 OBJECTIVES OF THE STUDY

1. To study the perception, expectations & opinions of patients in rural

areas about the health care services, both in government as well as private sector, currently available to them.

2. To find out the demographic & other factors (economic, cultural,

psychological & sociological) that influences the users’ behaviour.

3. To find out the gaps between the expectations & the experiences of the patients in rural areas in both government as well as privately run hospitals

CHAPTER II RESEARCH METHODOLOGY

2.1 RESEARCH METHODOLOGY
In the formulation of this project work, the researcher has used the descriptive research design, by collecting the data regarding patients with regard to their perceptions & expectations. A sample is ‘a miniature picture or section of the entire group or aggregate from which the sample is taken’ - P.V.Young The researcher, in this study has made use of representative sample, by choosing 100 respondents. These hundred patients are from different age & income groups receiving treatment in government & private hospitals located in kolar district of Karnataka state. The primary data was collected from the selected hundred patients by means of a questionnaire, which included a set of questions concerning the different aspects of the patients’ perception, expectation & satisfaction. The secondary data was collected from various public libraries, health department publications, service marketing journals, books & from internet. The analysis of the data collected was done using ‘average’ & ‘means’ statistical techniques. The availability of the time with the researcher was a major limitation during the study. Since the researcher is in an executive post in government, the time available with her for formulation, research & consolidation was very minimal & hence the project took a long time to be completed.

CHAPTER III REVIEW OF LITERATURE

REVIEW OF LITERATURE
A hospital is a residential establishment, which provides short term & long term medical care consisting of observational, diagnostic, therapeutic & rehabilitative services for persons suffering or suspected to be suffering from a disease, injury & for parturients. It may or may not provide services for ambulatory patients on an outpatient basis.
-

WHO Expert committee (1963)

Hospitals, be it in urban or rural areas, should be flexible; in order to adapt their resources to the total health care needs of the people. This adaptation requires effective hospital administration, that is both a science & art, where the right patient should receive the right care at the right time, at the right cost; which is possible, only if the patient receives the right information at the right time, in order to make the right choice & this brings up the need for marketing of hospital services. Hospital marketing implies the application of the marketing principles in a formal social institution with an aim of enriching the potentiality of hospital organisations for making available to the society the best possible services. In other words, hospital marketing is a managerial approach, which aims to satisfy the users by providing quality health care, while at the same time strives to increase the service generating capacity of the hospitals.

The essential ingredient in the practice of hospital marketing is the study of user’s behaviour. Users behaviour is an orderly process, where by the individual interacts with the environment, for making decisions regarding particular product or service. Understanding of the consumer’s expectations & perceptions is the foundation of successful marketing. As each person is unique, with different desires, perceptions & attitudes, & is also influenced by environmental factors – like the family, social, cultural & economic influences, the study of users’ behaviour becomes an uphill task. The formal explanation of the user’s behaviour has been initiated by the classical economists, who propounded the economic man model. This theory stated that man is completely rational in his behaviour, & he always selects the alternative, which gives him the greatest advantage. He makes the search for this best alternative in a planned, orderly & logical manner. But this is not always true, as there are other factors, which influence a person’s behaviour, which leads us to the ‘Bounded rationality theory’ of Herbert Simon. His administrative man uses limited rationality in his decisions, because his information processing skills are limited. In choosing between the alternatives the administrative man, not having the ability to ‘maximise’ (i.e. to find the best alternative), attempts to ‘satisfice’ (i.e. to look for an alternative which is good enough). His search for alternatives is guided by his experience, & uses heuristics to reduce the area of his search to the manageable levels. These theories have been disapproved by classical psychologists, Freud in particular, who have come up with the ‘social man model’. Which states

that man being a bundle of feelings, emotions & instincts is guided by his unconscious desires & is also subject to social pressures & influences. Obviously such a person is not capable of making rational decisions. Though all these theories give an insight into user’s behaviour, it is difficult to use these in isolation. With the human behaviour being so complex, it is impossible to identify all the factors, but it should be borne in mind that each of the behavioural sciences – Economics, Psychology, Sociology & Cultural anthropology- have a significant bearing on user’s behaviour. Growing public awareness, rapid technological advances, the likely impact of insurance & corporatisation is rapidly altering the patterns of hospital administration. Hospital administration is no longer the monopoly of doctors who shuttled between clinical care & administration, or those who settled down for administration after two decades of experience. Today, hospital administration is a full time vocation, handled by professionally qualified managers, be it medicos or non medicos. The rise professional managers has streamlined administration, setting an unwritten pattern of administration & slowly but surely, the concept that marketing of hospitals is unethical is changing in the medical fraternity. While newly established hospitals are marketing to fill the bed capacity, the old ones are doing it to survive the competition. Marketing management is responsible for making decisions on such matters like personal selling, advertising, other promotion, distribution policy & price to gain & hold market favour & these decisions are known as marketing controllables. The combination of marketing controllables used to market a product or service is called the ‘market mix’.

‘Marketing mix is composed of a large battery of devices which might be employed to induce consumers to buy a particular product’. - Professors Keely & Lazor

The seven P’s of marketing mix are:
1. Product: is the product or service being offered. In the hospital context,

it is the health care facilities provided by the hospital, which should be able to satisfy the patient.
2. Price: is the value of goods or services. Pricing decisions play an

important role in determination of value of the service to the customer, the perception of quality & building the image for the service; hence it becomes important to the hospitals to be systematic in setting the prices. A fine balance needs to be achieved between provisions of health care to the economically weaker sections of the society, while at the same time maintaining the sustainability of the hospitals. Many hospitals now are making use of the pocket based pricing strategy, by charging more to the rich patients, the hospitals are able to earn more, & hence subsidize treatment for the poor.
3. Place: in the words of prof. Kotler, place stands for the site of various

activities the company undertakes to make the product accessible & available to target customers. The hospital should be located in such an area, that it is easily accessible to the patients, with direct bus or train routes. The location of the hospital is an important determining factor in the choice of hospitals, since the patients may find it difficult to go to out of reach hospitals, even though they provide quality health care. In rural areas, it is still the government hospitals which hold the monopoly,

as they are located in far off & remote areas, while private hospitals are concentrated in the taluk or hobli headquarters.
4. Promotion: implies the various communication programmes designed

to market the product or service. Patients & their attendants are the most important persons in the hospital & it depends on the public relations department to see that the patient has the best impression of the hospital. The management should be able to anticipate the customer’s demands & problems & also monitor the coordination between the various departments, doctors & paramedical staff, to promote smooth sailing. It is only through happy & satisfied patients, can there be more new patients. Promotion of the hospital can also be done through health exhibitions, trade fairs, health camps & holding CME’s (continued medical education programmes) & conferences within the hospital. Promotion of the service should be in such a way that the hospital is liked & respected by its employees, patients & community at large.
5. People: services being human intensive, it is difficult to separate the

services offered from the person offering service. The doctors, nurses, paramedical & administrative staff, are all a part of the hospital & the reputation of the hospital is built by the people in it. Hence, great care should be exercised & proper attention paid to the selection, recruitment, training & development of the hospital personnel. For any organisation to be effective, the principles of Scientific Management enunciated by F.W.Taylor, should be borne in mind. i.e.: a) The development of a true science of work b) Scientific selection & progressive development of the workmen (personnel).

c) The bringing together of the science of work & the scientifically selected & trained men, i.e. the concept of right person in the right job. And d) Constant & intimate cooperation of management & worker. These principles hold good in the selection & training of personnel in the hospital setup.

6.

Physical evidence: The environment of the hospital, including the
cleanliness & up keeping is a crucial factor for winning the clients. A clean hospital with shining floors, neat walls, neatly stacked files, clean toilets all add to the appeal of the hospital. The Provision of clean linen, which controls cross infection & makes the ward look bright; are all a part of the public relations exercise & reflect the quality of patient care in the hospital. Very often the first impression lasts for a long time & it is the appearance of the hospital, its environment & the cleanliness which form an impression in the minds of the patients & their attendants.

7.

Process: are operational matters which directly affect the customers’
perceptions. The friendliness of the staff, the imparting of information, responsiveness of the hospital staff, time spent by the doctors are matters that influence the patients perception of the hospital, as the patient has a direct experience of these things. The need for a planned reception counter with polite, courteous & trained staff, who can identify the problems at the registration stage, needs to be underlined.

The development of health care facilities is influenced not only by the opening of hospitals, but more so by their administration & management.

Public relations is one of the cornerstones of effective administration & management. It is a management function which evaluates public attitudes, identifies the policies & procedures of an organisation with the public interest & plans & executes a programme of action to earn public understanding & acceptance. Institute of public relations, states that PR practice is ‘the deliberate, planned & sustained effort to establish & maintain mutual understanding between an organisation & its public’. According to Millet, the public relations of management has four primary aspects i.e.: i) ii)
iii)

Learning about the public desires & aspirations. Advising the public about what it should desire. Ensuring satisfactory contact between public & the organisation officials. And Informing the public about what the agency is doing.

iv)

Managers today have started thinking beyond the concept of product, price & distribution as key elements for selling a product or service & have realized the importance of marketing & public relations. The factor to be kept in mind is that hospital marketing is totally different from the commercial concept, since: a) There is lack of direct payment for services provided in health care.
b) Most patients do not select their hospitals, but this concept is fast

changing – as recent studies have shown that 20- 38% of individuals choose hospitals over physicians. c) Services rendered with the exception of maternity services are usually unpleasant.

Though sustainability of hospitals is important, patients’ satisfaction is vital & this is achieved if marketing strategies are innovative & dynamic. marketing strategies based on the segmentation of the market help in satisfying the user’s, as it provides an opportunity to study the uniqueness of users’ needs & requirements. In hospitals suitable basis for market segmentation include income, regional variations, literacy levels & food habits of the patients. Though under the ‘health for all’ concept, quality health care is to be provided to each & every person, without discrimination & the basic health needs of the people – rich or poor, rural or urban, literate or illiterate – remain the same, still the knowledge of the persons background, makes the job of the medical & paramedical staff easier & the marketing strategies formulated on the basis of segment would have more sensitivity & will be more responsive to the needs of the patients. In conclusion, it can be said that the basic priority of any hospital, in urban or rural area, is to care for the sick & the injured. In order to take proper care of the patients, their perceptions, behaviour & satisfaction assumes importance. Hence the initial planning of the hospital, the architectural design & structure, the selection, recruitment, training & development of the personnel, the provision of supportive services – like linen & laundry, house keeping & maintenance, lab facilities, ancillaries, ambulance etc.are all steps taken to achieve the ultimate goal of the hospital – patient satisfaction.

CHAPTER IV PRESENTATION, ANALYSIS & INTERPRETATION OF DATA

PRESENTATION, ANALYSIS & INTERPRETATION OF DATA

1.

Type of Hospital: The researcher has consolidated the

opinions of patients who have received treatment in government & private hospitals in rural areas. Out of the 100 respondents, the patients from government & private hospitals have been taken in the ratio of 1:1 (i.e. 50 from government & 50 from private hospitals).

2. Age: Though the hospitals treat patients from all walks of life effort
has been made to limit the questionnaire to patients above 18yrs of age, an age when the respondents can use their judgement & give their independent opinions.

TABLE NO. 1 A. NUMBER OF RESPONDENTS AGE WISE (GOVERNMENT HOSPITALS) SL. Age No. Group 1 2 3 Respondents Percentage 18 28 42

Patients 19 – 25 yrs 09 26 – 40 yrs 14 41-60 yrs 21

4

60 – 80 yrs 06 Total 50

12 100

B. NUMBER OF RESPONDENTS AGE WISE (PRIVATE HOSPITALS) SL. Age No. Group 1 2 3 4 Respondents Percentage 22 26 38 14 100

Patients 19 – 25 yrs 11 26 – 40 yrs 13 41-60 yrs 19 60 – 80 yrs 07 Total 50

The respondents who were interviewed are classified under age group from 20yrs to 80yrs this is depicted in Table No.1. The table clearly shows that the highest percentage i.e. 42% in govt. hospitals & 38% in pvt. Hospitals belong to the age group of 41-60yrs. This is followed by the respondents belonging to the age group of 26-40yrs – 28% in govt. & 26% in pvt. hospitals. There are 18% & 22% respondents in govt. & pvt. hospitals respectively in the age group of 19-25yrs. Minimum respondents of 12% in govt. & 14% in pvt hospitals belonged to the age group of 60-80yrs.

3. Gender: The researcher has selected equal number of male &
female respondents, i.e. 25 male & 25 female respondents each from government & private hospitals.

4. Marital status: The marital status of patients becomes important as it implies to a certain degree the familial pressures exerted on the patient & the factors which may influence the patient’s perception & satisfaction to a great extent.

TABLE NO. 2 A. MARITAL STATUS OF THE RESPONDENTS (GOVERNMENT HOSPITALS) SL. Status No. 1 2 3 4 Married Unmarried Divorced / separated Widow/ Widower Total Respondents Patients 23 14 04 09 50 Percentage 46 28 08 18 100

B. MARITAL STATUS OF THE RESPONDENTS (PRIVATE HOSPITALS) SL. Status No. 1 2 3 4 Married Unmarried Divorced / separated Widow/ Widower Total Respondents Patients 21 15 06 08 50 Percentage 42 30 12 16 100

The study revealed that 46% of respondents in govt. & 42% in pvt. hospitals were married. 28% in govt. & 30% in pvt. hospitals were unmarried. This was followed by widow/ widowers, who constituted 18% & 16% in govt. & pvt. hospitals respectively. And a meagre 08% in govt. & 12% in pvt.hospitals were divorced or separated from their spouses.

4. Education: The literary status of the individual has a bearing on

their awareness levels & their opinions & perceptions. Hence the researcher has collected the educational details of the respondents.

TABLE NO. 3 A. EDUCATIONAL DETAILS OF THE RESPONDENTS (GOVERNMENT HOSPITALS) SL. Educational Details Respondents No. Patients 1 Illiterate 09 th 2 Less than 10 std. 24 3 10th std. – Degree 11 4 Degree 06 5 Postgraduate 00 Total 50

Percentage 18 48 22 12 00 100

B. EDUCATIONAL DETAILS OF THE RESPONDENTS (PRIVATE HOSPITALS) SL. Educational Details Respondents No. Patients Percentage 1 Illiterate 04 08

2 3 4 5

Less than 10th std. 10th std. – Degree Degree Postgraduate Total

13 09 21 03 50

26 18 42 06 100

A variation between the respondents in government & private hospitals was noticed. 48% of respondents in govt. hospitals had studied less than 10th std. & 18% were illiterate, whereas only 26% of respondents in pvt. hospitals had studied less than 10th std. & 8% were illiterate. Majority of the respondents in private hospitals were degree holders (42%) & 6% were postgraduates. Out of the 50 respondents in govt. hospitals only 12% were degree holders & there were no postgraduates. The respondents who had studied between 10th std. to degree were 22% in govt. & 18% in pvt. hospitals.

5. Occupation: Though the provision of healthcare is without any

discrimination on basis of social status, the researcher wanted to know about the occupation & annual income, which reflect the social behaviour of the patient.

TABLE NO. 4 A. OCCUPATION OF THE RESPONDENTS (GOVERNMENT HOSPITALS) SL. Occupation No. Respondents

1 2 3 4 5

Patients Agriculture 27 Professional/ 03 Service Business 01 Housewife 13 Others 06 Total 50

Percentage 54 06 02 26 12 100

B. OCCUPATION OF THE RESPONDENTS (PRIVATE HOSPITALS) SL. Occupation No. 1 2 3 4 5 Respondents Percentage 46 12 14 22 06 100

Patients Agriculture 23 Professional/ 06 Service Business 07 Housewife 11 Others 03 Total 50

The above table clearly indicates the occupation of the patients taken up for the study. Since the study was undertaken in rural areas, majority of the respondents – 54% in govt. & 46% in pvt. hospitals are agriculturists. This is followed by housewives, who were 26% & 22% of respondents in govt. & pvt. hospitals respectively. Of the remaining respondents in govt. hospitals, 6% were from professional or service class, 2% from business & 12% from others (which included labourers).of the remaining respondents in private hospitals 12% were from professional or service class, 14% were businessmen & 6% belonged to other groups.

7. Income: A persons economic circumstances will greatly affect their
service choice. People’s economic circumstances consist of their spendable income, savings, assets, borrowing power & attitude towards spending. This is true also in case of people going in for medical treatment. Hence it was essential for the researcher to study the income of the respondents. The findings are depicted in table no.5.

TABLE NO. 5 A. INCOME OF THE RESPONDENTS (GOVERNMENT HOSPITALS) SL. Annual Income No. (in Rupees) 1 2 3 4 Less than 25,000 25,001 – 50,000 50,001 – 1.5 Lakhs More than 1.5 Lakhs Total Respondents Patients 29 14 07 Nil 50 Percentage 58 28 14 Nil 100

B. INCOME OF THE RESPONDENTS (PRIVATE HOSPITALS) SL. Annual Income No. (in Rupees) 1 2 3 4 Less than 25,000 25,001 – 50,000 50,001 – 1.5 Lakhs More than 1.5 Lakhs Total Respondents Patients 03 09 21 17 50 Percentage 06 18 42 34 100

It was noticed that 58% of respondents in government hospitals had an annual income of less than Rs.25,000/-, & 28% had an annual income between twenty five to fifty thousand rupees ( i.e. 86% of respondents in government hospitals had an annual income of less than fifty thousand rupees). Only 14% of respondents in govt. hospitals had an annual income between fifty thousand to one lakh rupees.

The scenario was contrasting in private hospitals, where 42% of respondents were in the income group of fifty thousand to one lakh & 34% had an annual income more than one and a half lakhs (i.e. 76% had an annual income above fifty thousand rupees). Only 6% of patients in private hospitals had annual income less than twenty five thousand rupees & 18% had annual income between twenty five to fifty thousand rupees. During the survey, the researcher noted that many of the respondents, especially in government hospitals, tended to conceal their real income, as there are many benefits available to the poor in government hospitals. Hence, the numbers indicated above may not be accurate, but by & large, it was noted that the patients availing treatment at private hospitals belonged to a higher income group, than those patients receiving treatment in government hospitals.

8.

Expectations of the Respondents undergoing treatment in various hospitals: the choice of a hospital is based on many factors
like – affordability, accessibility, facilities offered, cultural & social

aspects. A person selects a hospital, after evaluating all the information available to him. The decision may be based on experiences of friends, relatives or their own previous experiences or based on facts obtained from literatures or magazines. Hence, when a patient enters a particular hospital for treatment – be it in urban or rural area – he/she has certain expectations. The expectations of rural patients, from the hospitals where they receive treatment is depicted in table no.6 A & B.

TABLE NO. 6 A. EXPECTATIONS OF THE RESPONDENTS (GOVERNMENT HOSPITALS) Expectations Percentage Sl. Criteria No. 1 2 Its physical ambience is appealing. Hospital & surrounding areas are clean & hygienic Hospitals have up to date equipment Have well trained staff Hospitals are dependable Hospitals provides prompt services Agree 1 2 2 3 3 5 4 Disagree Agree Neutral Disagree 4 24 21 5 19 22

4 6

10 8

86 86

3 4 5 6

7 2 7 -

6 4 8 5

1 4 1 3 1 5 1 2

19 19 11 22

4 12 9 11

26 12 30 10

28 26 30 24

46 62 40 66

7 8 9

Hospitals have 2 committed staff The staff are 3 always willing to help Staff in hospitals 1 are responsive to the patients needs Investigation done and treatment given is more reliable Hospitals inform the citizens as to the Facilities available Citizens feel safe in their dealings with the hospitals Accurate records are maintained in hospitals Expensive treatment Corrupt staff 6

7 4 3

1 6 1 1 1 3

19 23 21

6 9 12

18 14 8

32 22 26

50 64 66

10

9

1 1 9

15

9

30

22

48

11

2

4

24

11

12

18

70

12

9

8

1 2 1 2 7 7 1 2

12

9

34

24

42

13 14 15 16

8 4

5 8 1 2 1 4

18 18 3 5

7 13 1

26 24 80 64

24 14 14 24

50 62 6 12

2 8 Easy accessibility 1 8

It is observed that the majority of rural patients going to government hospitals for treatment, don’t have any high expectations about the hospital, cleanliness, staff are services provided. 86% of the respondents did not expect the physical ambience of the hospital to be appealing or its surrounding areas to be clean & hygienic. 62% felt that govt. hospitals did not have well trained staff, 66% felt that

the hospitals did not provide prompt services, 64% felt the staff were not always willing to help & another 66% felt that the staff in govt. hospitals were not responsive to the patients needs. 70% of the respondents had a view that the govt. hospitals did not inform the patients about the facilities available & an overwhelming 80% of respondents expected the hospital staff to be corrupt. However, 62% of the respondents expected the treatment in govt. hospitals to be affordable & 64% felt that these hospitals were easily accessible & these seemed to be the main reasons for their choice of the government hospitals.

B. EXPECTATIONS OF THE RESPONDENTS (PRIVATE HOSPITALS) Expectations Sl. Criteria No. 1 2 Its physical ambience is appealing. Hospital & surrounding areas are clean & hygienic Hospitals have up to date equipment Have well trained staff Hospitals are dependable Hospitals provides prompt Agree 1 1 7 1 4 1 8 1 6 9 1 1 2 1 3 1 1 1 2 1 2 7 1 3 3 1 1 1 3 1 4 1 6 1 3 1 4 Percentage

Disagree Agree Neutral Disagree 4 5 9 5 4 3

60 50

22 26

18 24

3 4 5 6

4 6 12 8

2 9 4

60 56 32 48

28 32 26 28

12 12 42 24

7 8 9 10

11

services Hospitals have committed staff The staff are always willing to help Staff in hospitals are responsive to the patients needs Investigation done and treatment given is more reliable Hospitals inform the citizens as to the Facilities available Citizens feel safe in their dealings with the hospitals Accurate records are maintained in hospitals Expensive treatment Corrupt staff

1 3 1 4 1 5 1 7 2 1

1 1 1 1 1 4 1 2 1 1

1 2 1 1 1 1 1 1 9

8 8 6 7

6 6 4 3

48 50 58 58

24 22 22 22

28 28 20 20

6

3

64

18

18

12

1 9 1 8 2 2 8

1 4 1 3 1 6 7 4

1 1 1 1 9 1 1 8

4

2

66

22

12

13 14 15 16

5 2 13 19

3 1 11 13

62 76 30 20

22 18 22 16

16 6 48 64

Easy accessibility 6

It is observed from the above table that the patients opting to take treatment at private hospitals in rural areas had greater expectations about the cleanliness, facilities, staff & services provided in these hospitals. 60% of the respondents expected the physical ambience of the hospital to be appealing & hospital equipments to be up-to date, while 50% felt the

hospitals would be clean & hygienic & the staff would be always willing to help. 58% of respondents interviewed felt that the staff in private hospitals would be more responsive to patient needs & investigations carried out & treatment given would be more reliable, while 66% felt safe in their dealings with private hospitals. 64% of the respondents felt that the pvt. hospitals kept the people informed about the facilities available & 62% expected the hospitals to maintain accurate records. Though 76% of respondents expected the treatment in private hospitals to be expensive & 64% felt the hospitals were not easily accessible, the expectations seemed to increase due to these factors. As the patients were willing to pay more & had to travel from far off places for treatment at these hospitals, they expected better services & facilities.

9.

Experiences of the Respondents undergoing treatment in various hospitals: wheather the expectation the respondent had
while selecting a particular hospital was met by the hospital, was the question put to the respondents. This post usage behaviour indicates the level of users’ satisfaction. It also results in the user recommending the particular service or hospital to others & hence forms a crucial part of the research.

The experiences of rural patients, in the hospitals where they received treatment are depicted in table no.7 A & B.

TABLE NO. 7 A. EXPERIENCES OF THE RESPONDENTS

(GOVERNMENT HOSPITALS) Experiences Percentage Sl. Criteria No. 1 2 Its physical ambience is appealing. Hospital & surrounding areas are clean & hygienic Hospitals have up to date equipment Have well trained staff Hospitals are dependable Hospitals provides prompt services Hospitals have committed staff The staff are always willing to help Staff in hospitals are responsive to the patients needs Investigation done and treatment given is more reliable Hospitals inform the citizens as to the Facilities available Citizens feel safe in their dealings with the Agree 1 2 3 2 3 2 3 9 5 Disagree Agree Neutral Disagree 4 19 19 5 17 21

10 10

18 10

72 80

3 4 5 6 7 8 9 10

1 1 1 5 2 2 7

9 3 7 4 6 3 3 8

1 6 1 1 1 6 9 1 8 1 2 1 2 1 2 8

11 21 13 21 19 22 19 17

3 14 9 14 7 11 16 6

40 8 24 12 12 10 6 30

32 22 32 18 36 24 24 24

28 70 44 70 52 66 70 46

11

3

2

23

14

10

16

74

12

1 1

9

1 4

9

7

40

28

32

13 14 15 16

hospitals Accurate records 5 are maintained in hospitals Expensive 2 treatment Corrupt staff 2 7 Easy accessibility 1 7

3 5 1 3 1 6

1 1 7 5 1 3

22 17 4 4

9 19 1 -

16 14 80 66

22 14 10 26

62 72 10 8

It is noted that there is no significant difference between the expectations of the patients opting for treatment at government hospitals & their experiences. 72% of the respondents opined that the physical ambience of the hospital was not appealing, while 86% had gone to the hospital, believing the physical ambience was not good. 86% of respondents had expected the govt. hospitals to be dirty & unhygienic, post experience, 80% felt that the hospitals were neither clean nor hygienic. 62% of respondents had felt that govt. hospitals did not have well trained staff; post treatment 70% felt that there was lack of trained staff. 40% of respondents had not expected the govt. hospitals to be dependable, post usage, 44% felt that they were undependable. 66% of respondents had not expected govt. hospitals to provide prompt services, after experiencing the treatment, 70% felt that they were not provided prompt services. 50% of respondents did not believe that govt. hospitals had committed staff, post treatment 52% concurred with the view. 64% of the respondents held the view that the staff in govt. hospitals were not always willing to help, after their experience 66% agreed with that view.

66% of respondents opined that staff in govt. hospitals would not be responsive to the patients needs. Post treatment, 70% were of the same opinion. 48% of respondents felt that investigations done & treatment given at govt. hospitals was less reliable, after their experience 46% of respondents felt the same. 70% of the respondents had not expected the govt. hospitals to keep the citizens informed about the facilities available & on experience 74% felt that they were not informed about the facilities available. 42% of the respondents did not expect to feel safe in their dealings with govt. hospitals, post usage, 32% did not feel safe in their dealings with the hospital. 50% of the respondents had not expected govt. hospitals to maintain accurate records, post treatment 62% observed that accurate records were not maintained in these hospitals. 62% of the respondents were of the opinion that treatment at government hospitals would not be expensive, post usage 72% felt the treatment was inexpensive. While 80% of respondents had gone to govt. hospitals expecting the staff to be corrupt, 80% came out confirming the fact that the staffs were corrupt. 64% of the respondents had expected the govt. hospitals to be easily accessible, post experience 66% concurred with the view. The only significant shift seen between expectations & experiences, involved the issue of govt. hospitals having up-to date equipment. While 26% of respondents had expected govt. hospitals to have up-to date equipment, post treatment 40% were of the view that hospitals had up-to date equipment. But they all agreed, that there was lack of trained staff in govt. hospitals to make use of these equipments, due to which many of the

expensive equipments were wasted & patients had to go outside for the same.

B. EXPERIENCES OF THE RESPONDENTS (PRIVATE HOSPITALS) Experiences Percentage Sl. Criteria No. 1 2 Its physical ambience is appealing. Hospital & surrounding areas are clean & hygienic Hospitals have up to date equipment Have well trained staff Hospitals are dependable Hospitals provides prompt services Hospitals have committed staff The staff are always willing to help Staff in hospitals Agree 1 1 6 1 2 1 7 1 4 1 1 9 1 2 1 6 1 2 1 1 9 3 1 4 1 1 1 3 1 3 1 3 1 6 1 3 9 1 Disagree Agree Neutral Disagree 4 6 12 5 3 6

54 42

28 22

18 36

3

1 2 1 1 8 7 1 1 1 2 1

6

2

58

26

16

4 5 6 7 8 9

9 14 9 9 9 7

3 4 9 5 4 3

50 38 32 46 56 54

26 26 32 26 18 26

24 36 38 28 26 20

10

11

12

13 14 15 16

are responsive to the patients needs Investigation done and treatment given is more reliable Hospitals inform the citizens as to the Facilities available Citizens feel safe in their dealings with the hospitals Accurate records are maintained in hospitals Expensive treatment Corrupt staff

1 1 5 1 9 1 6 9

6 1 6 1 1 1 3 1 1 1 7 9 3

3 1 2 1 1 1 2 1 4 8 9 9 5 2 62 24 14

7

2

60

22

18

5

4

58

24

18

9 1 12 19

7 8 13

40 82 42 18

28 16 18 18

32 2 40 64

2 4 1 2 Easy accessibility 6

Above table indicates that the private hospitals in rural areas have not lived up to the expectation of its patients. Only 54% of the respondents opined that the physical ambience of the hospital was appealing, while 60% had gone to the hospital, believing the physical ambience was good. 50%of respondents had expected the pvt. hospitals to be clean & hygienic, post experience, 42% felt that the hospitals were clean & hygienic. 60% of respondents had expected pvt. hospitals to have up to date equipments, post treatment 58% felt the hospitals possessed up to date equipments. 56% of respondents had felt that pvt. hospitals had well trained staff; post treatment 50% felt that there were well trained staff in the hospitals.

32% of respondents had expected the pvt. hospitals to be dependable, post usage, 38% felt that they were dependable. 48% of respondents had expected pvt. hospitals to provide prompt services, after experiencing the treatment, 32% felt that they were provided prompt services. 48% of respondents believed that pvt. hospitals had committed staff, post treatment 46% concurred with the view. 50% of the respondents held the view that the staff in pvt. hospitals were always willing to help, after their experience 56% agreed with that view. 58% of respondents opined that staff in pvt. hospitals would be responsive to the patients needs. Post treatment, 54% were of the same opinion. 58% of respondents felt that investigations done & treatment given at pvt. hospitals was more reliable, after their experience 62% of respondents felt the same. 64% of the respondents had expected the pvt. hospitals to keep the citizens informed about the facilities available & on experience 60% felt that they were well informed about the facilities available. 66% of the respondents expected to feel safe in their dealings with pvt. hospitals, post usage, only 58% felt safe in their dealings with the hospital. 62% of the respondents had expected pvt. hospitals to maintain accurate records, post treatment only 40% maintained in these hospitals. 76% of the respondents were of the opinion that treatment at private hospitals would be expensive; post usage 82% felt the treatment was expensive. While 30% of respondents had gone to pvt. hospitals expecting the staff to be corrupt, 42% came out with the opinion that the staffs were corrupt. 64% of the respondents had not expected the govt. hospitals to be easily accessible, post experience 64% concurred with that view. felt that accurate records were

10. Suggestions to improve the quality of treatment at rural hospitals: The response to the open end questions has brought out many
suggestions to improve the quality of treatment at hospitals in rural areas. These include: A. Government hospitals: a) To ensure that the hospital & its surrounding areas were clean & hygienic. b) Provision of clean linen to the patients. c) Though the housekeeping in most of the govt. hospitals was now outsourced, there was paramount need for proper supervision d) To increase the number of nursing staff, as of now there was one nurse for 15-20 patients. e) Appointment of qualified & committed Doctors, technicians & other Para - medical staff in order to provide quality health care to the patients. B. Private hospitals:
a. Immediate attention towards maintenance of cleanliness of the

hospital – especially the toilets. b. Provision of economical & hygienic canteen, to meet the dietary requirements of patients & their attendants. c. Appointment of well trained junior doctors, nurses & paramedical staff. d. To make the treatment more affordable & less expensive. e. To subsidize the treatment to the poor.

Measures to curb corruption – like added incentives to staff & strict measures against corrupt staff, were suggestions commonly aired by respondents receiving treatment at both government & private hospitals.

CHAPTER V FINDINGS AND CONCLUSION

5.1 FINDINGS OF THE STUDY
Following were the findings of the study: i) Of the hundred respondents selected, fifty were those who had received treatment in govt. hospitals & the remaining fifty were those who received treatment at pvt. hospitals.
ii)

The respondents belonged to the age group of 19-80 years. The highest recorded age group, 42% in govt. & 38% in pvt. hospitals, belonged to the age group between 41- 60 years.

iii) iv)

50% of respondents were male & 50% were female. 46% of respondents in govt. hospitals & 42% in pvt. hospitals were married.

v)

48% of respondents in govt. hospitals had studied less than 10th standard & 42% of respondents in pvt. hospitals were degree holders.

vi)

Agriculture was the major occupation among the respondents. 54% of respondents in govt. & 46% in pvt. hospitals were agriculturists.

vii)

The income of 86% of the respondents in govt. hospitals was less than fifty thousand rupees, whereas 76% of respondents in pvt. hospitals had an income above fifty thousand rupees.

viii) 86% of the respondents in govt. hospitals had not expected its physical ambience to be appealing & post treatment 72% felt the physical ambience was not appealing. In the case of pvt. hospitals, 60% of the respondents had expected to find the physical ambience appealing & post treatment only 54% concurred with the view.
ix)

86% of respondents in govt. hospitals felt the hospitals would not be clean & hygienic & post usage 80% was of the same opinion. 50% of respondents in pvt. hospitals had expected the hospital & surrounding areas to be clean & hygienic, post usage only 42% were of the same opinion.

x)

26% of respondents opting for govt. hospitals had expected the hospitals to have up to date equipments, but post treatment 40% felt the hospital had up to date equipments. In case of private hospitals the ratio was 60% to 58%.

xi)

62% of respondents in govt. hospitals, did not expect it to have well trained staff & post experience 70% agreed. In the pvt. hospitals, 56% of respondents had expected to find well trained staff in the hospital, & post experience only 50% agreed.

xii)

40% of respondents in govt. hospital, had felt that these hospitals were not dependable & post usage 44% agreed. Whereas, in pvt. hospitals the expectation of non dependability was 42% & post experience it was 36%.

xiii) 66% of respondents in govt. hospitals had not expected the hospital to provide prompt services & post treatment 70% subscribed to the same view. Pvt.hospitals would provide prompt services was the expectation of 48% of respondents, but post treatment only 32% agreed.
xiv)

50% of respondents felt that govt. hospitals did not have committed staff & post experience 52% was sure of it. In the pvt. hospital the expectation of presence of committed staff was 48% & post treatment it reduced to 46%.

xv)

The staff in govt. hospitals were not always willing to help was the view of 64% of respondents & post treatment 66% agreed. 50% of respondents going to pvt. hospitals had expected the staff to be always willing to help & post treatment the percentage went up to 56.

xvi) 66% of respondents in govt. hospitals had not expected the staff to be responsive to the patients needs, post treatment 70% agreed. In the pvt. hospitals 58% had expected the staff to be responsive to patients needs & post treatment 54% agreed. xvii) 48% of the respondents in govt. hospitals felt that the investigations done & treatment given was less reliable & post usage 46% concurred. In pvt. hospitals, 58% of respondents had expected the investigation done & treatment given to be more reliable & post usage 62% agreed. xviii) 70% of respondents in govt. hospitals had not expected the hospital to inform them of the available facilities, post experience 74% had the same view. 64% of respondents in pvt. hospital had expected the hospital to inform them of the facilities available & post experience the percentage was reduced to 60. xix) 34% of respondents in govt. hospitals had expected to feel safe in their dealings with the hospital & 42% had expected to feel unsafe, but post usage the figures changed to 40% & 32% respectively. Whereas in case of pvt. hospitals, 66% of respondents had expected to feel safe in their dealings with the hospital but post usage the number reduced to 58%.
xx)

26% of respondents in govt. hospitals had expected the hospital to maintain accurate records, while 50% had no such expectations. Post experience only 16% felt the hospital maintained accurate records, while the percentage of respondents who did not feel the hospital maintained accurate records went up to 62.The reverse

was seen in case of pvt. hospitals, where 62% had expected the hospital to maintain accurate records & 16% disagreed with the view, post experience, only 40% felt the hospital kept accurate records & 32% disagreed.
xxi)

62% of respondents in govt. hospitals expected the treatment to be inexpensive & post usage 72% agreed. In pvt. hospitals 76% had expected the treatment to be expensive & post usage 82% agreed.

xxii) 80% of respondents in govt. hospitals had expected the staff to be corrupt & post experience the figure remained the same. In pvt. hospitals, 30% of respondents had expected the staff to be corrupt & 48% expected them to be non corrupt, but post experience the figures changed to 42% & 40% respectively.
xxiii) 64% of respondents in govt. hospitals held the view that the

hospitals were easily accessible & post experience 66% concurred. In case of pvt. hospitals, 64% of respondents subscribed to the view that the hospitals were not easily accessible & post experience the figure remained the same.

5.2 CONCLUSION
The primary purpose of an organisation is to satisfy its customers & a hospital, be it government or private, rural or urban has the same objective. This study has shown that the expectation of people from government hospitals in rural areas is very less. In this era of increasing competition, the need for change becomes pronounced & the govt. hospitals can no longer remain complacent. As of now, the only advantage the govt. hospitals have over pvt. hospitals seems to be that they are less expensive & are easily accessible. But with the corporate hospitals planning to open branches in rural areas & intending to subsidize the treatment offered to poor patients, the fate of govt. hospitals in their current form appears to be numbered. The government hospitals can make use of the users fund (a minimal amount collected from patients) to bring about improvements in the hospital surroundings, cleanliness, facilities & services provided. Efforts should also be made to recruit more committed doctors & staff willing to

work in rural areas, in order to provide effective treatment with a human touch, this alone can restore the glory of the government hospitals. There were great expectations by the patients who were receiving treatment in private hospitals, as they were paying more & coming from far of places. But when these expectations were not met, the disappointment & dissatisfaction were evident; especially regarding the criteria of cleanliness of the hospital, availability of well trained staff, provision of prompt services & maintenance of accurate records. When the people are willing to pay more, they expect quality in the services provided by the hospital. This should be realized by the hospital administration & efforts made to provide quality health care to the patients. Corruption among the hospital staff is a malaise noticed in both government & private hospitals. Though corruption is more rampant in government hospitals, the private hospitals cannot afford to ignore the same. Suitable incentives to the staff & taking strict action against the corrupt will send out a strong signal. The patients should be discouraged from making payment to the staff & encouraged to report the corrupt staff to the authorities, but care should be taken to ensure that the services provided to them is not affected by these issues. With due attention being given to cleanliness & maintenance of hospital & its surroundings, recruitment of qualified, committed, non corrupt & well trained staff, maintenance of accurate records, provision of supporting services – like linen & laundry, house keeping, lab facilities, ancillaries etc, the rural areas can have an ideal hospital. If the medical personnel can impress the users of the services provided, there will be no scope for

dissatisfaction & such hospitals will achieve their ultimate goal of patient satisfaction.

CHAPTER VI APPENDIX

APPENDIX – (i): BIBLIOGRAPHY
i) S.M.Jha - Services marketing, BangaloreHimalaya Publishing house ii) Kotler Philip - Marketing management – Analysis, Planning and Control; New Delhi; Prentice Hall of India. iii) K.Park - Park’s text book of Preventive and Social medicine, Jabalpur – Banarasidas Bhanot Publishers iv) Prasad & Prasad - Administrative thinkers – New Delhi – Sterling Publishers v) R.K. Sapru - Development Administration New Delhi – Sterling Publishers.

vi)Dr. P.N. Reddy & P.C. Tripathi

- Essentials of Management Bombay – Himalaya Publishing House.

vii) P.C. Tripathi & Reddy

- Principles of Management – New Delhi – Tata Mcgraw hill

viii) Health care management journals & Journals of Indian Medical Association.

APPENDIX – (ii)
QUESTIONNAIRE (for study purpose only) MARKETING OF HEALTH SERVICES: A STUDY OF

PERCEPTION, EXPECTATIONS & SATISFACTION LEVEL OF PATIENTS IN RURAL AREAS. 1. Type of hospital a) Government 2. Name:
3. Age: a) 19- 25yrs

b) Private

b) 26- 40yrs d) 61 – 80yrs b) Female b) unmarried

c) 41 – 60yrs 4. Gender: a) Male
5. Marital Status: a) Married

c) Divorced / separated d) Widow/ Widower

5. Educational Details: a) illiterate e) Post Graduate 6. Occupation: a) Agriculture c) Business e) Others

b) less than 10th std

c) 10th std. – Degree d) Degree

b) Professional/ Service d) House wife

7. Annual Income: a) less than Rs.25,000 b) Rs.25,001 – 50,000 c) Rs. 50,001 – 1.5Lakh d) More than 1.5lakh 8. Expectations from the hospitals & Experiences in the hospitals:
Sl CRITERIA .N o 1 Its physical ambience is appealing. 2 Hospital & surrounding areas are clean & hygienic 3 Hospitals have up to date equipment 4 Have well trained staff 5 Hospitals are dependable 6 Hospital provides prompt services 7 Hospitals have committed staff 8 The staff are always willing to help 9 Staff in hospitals are responsive to the patients needs 10 Investigation done and treatment given is more reliable EXPECTATAION AGREE DISAGRE E 1 2 3 4 5 EXPERIENCE AGREE DISAGREE 1 2 3 4 5

11 Hospitals inform the citizens as to the Facilities available 12 Citizens feel safe in their dealings with the hospitals 13 Accurate records are maintained in hospitals 14 Expensive treatment 15 Staff are corrupt 16 Easy accessibility

9. Any suggestions you would like to give, to improve the

quality of treatment in rural hospitals. Please specify.

- Thank you -