Copyright 2020 Foundation of the American College of Healthcare

Copyright 2020 Foundation of the American College of
Healthcare Executives. Not for sale.
Marketing Health Services
Fourth Edition
Richard K. Thomas, PhD
Health Administration Press
Part I
Healthcare Marketing: History and Concepts
The Origin and Evolution of Marketing in Healthcare
Basic Marketing Concepts
Marketing and the Healthcare Organization
Chapter 2
Basic Marketing Concepts
Chapter 2 objectives
Define key marketing terms

Review the functions of marketing
Introduce traditional marketing techniques
Review targeting approaches
Describe healthcare products and their users
Introduce the four Ps of marketing
Describe marketing support services
Key marketing terms
Marketing
Healthcare marketing
Market
The functions of marketing
Enterprise-wide functions
Operational functions
Educational functions
Promotional functions
Overview of traditional marketing techniques
Public relations
Communication
Community outreach

Government relations
Networking
Sales promotion
Overview of traditional marketing techniques (continued)
Advertising
Personal sales
Database marketing
Direct marketing
Customer relationship marketing
Social marketing
Target levels
Mass marketing
Target marketing
Micromarketing
Healthcare products and their users
Products
Ideas
Goods
Services

Healthcare products and their users
Users
Consumers
Customers
Clients
Patients
Enrollees
Patients versus other categories
Patients differ in terms of:
Official status (“vetted” by physician)
Degree of subservience
Relationship with clinician
Ability to control circumstances
Expectations with regard to care
The four Ps of marketing
Product
Price
Place
Promotion

The seven Ps of marketing
Product
Price
Place
Promotion
Packaging
Positioning
People
Introduction to marketing support services
Marketing planning
Marketing management
Marketing research
Parental involvement in child sport psychological treatments
Grand Canyon University PSY 542
May 25, 2020

Athletes work hard to find success in their sport. Many things
can prevent success, such as mental blocks and injuries. Sport
psychologists have treated athletes for many years and have
found that young athletes need more than just mental techniques
and psychological coaching. They also need the help of their
parents to help find a way to mental health. Parents sometimes
do not know how to help and it is the job of the psychologi st to
help them as well. This research study, and others, will help
show that including the parents of the athletes in psychological
treatments will help make a difference in the mental health of
young athletes.
1
Introduction
Problem statements
Parents lack the knowledge to know how to help their child
face sport psychological difficulties
Some parents cause worse problems when they try to help
because they do not understand how to help
The sport psychologist becomes frustrated with the parent
because they make things worse
Hypothesis and plan
The lack of parental involvement in a young athlete's
psychological difficulties and treatment can negatively affect
the athlete's improvement.
Conduct study in which parents are taught how to help sport
psychologist and child with psychological difficulties.
Assess psychological improvement when parents know how to
help
Athletes and sport psychologists are learning that parental
involvement in the treatment of the athlete can be beneficial.

Parents who have not played sports do not understand the
mental training that goes along with physical training. When
they try to help, it often causes more problems, for everyone
involved. This hypothesis of this study will hopefully show that
the lack of parental involvement in a young athlete’s
psychological difficulties and treatment can negatively affect
the athlete’s improvement. It will include both the athlete and
the parent to assess any improvement in either or both group.
2
Method of study
Participants
Parents and their child athlete
Study design
obtain questionnaire from athlete about their psychological
difficulties
obtain questionnaire from parents to assess their concerns
instruct athlete on steps to improve psychological difficulties
instruct parent how to help
obtain follow-up questionnaire to assess improvement in child’s
psychological difficulties
obtain follow-up questionnaire to assess improvement in
parents’ concerns
Before the study begins, consent forms will be signed by the
parents to agree to participate and any questions will be
answered. The student will have a questionnaire that asks about
their mental difficulties and how they perceive their parents’
participation and support in their performance and mental
health. The parents’ questionnaire will ask about any concerns
in their child’s mental health and how they can help. Parents
will participate in the psychological teaching of mental health
techniques so they can understand how to help at home. After a
period of time, a follow-up questionnaire will ask the same

questions and statistical tests will be done to assess any
changes.
3
Instructions for participants
Athlete
Use specifically psychological skills training (PST)
interventions for athlete
imagery, goal-setting, thought management and self-talk, and
physical relaxation and arousal regulation
Practice interventional techniques during practice
Parents
teach about treatment and how they can help
participate in sessions with sport psychologist
have open discussions with child at home using PST techniques
Psychologists have found that certain techniques can be used to
help the athlete train his mind to think about positive images
and speech using psychological skills training (PST) techniques
(Zakrajsek & Blanton, 2017). These things can help replace
negative thoughts that cause performance failures. Imagery uses
pictures in the mind that help the athlete see successful
performances, which helps the mind practice it before it sends
messages to the body to perform it (Zakrajsek & Blanton, 2017).
Thought management and self-talk are other mind training
techniques that help maintain a positive mental atmosphere for
the person’s mental health. Goal-setting can be written down
and be identified as daily goals, mental goals, and physical
goals. The psychologist will help the athlete realize that some
days will have more positive goal attainment than others, but
not to grade success on all or nothing results. Physical
relaxation and arousal regulation helps the athlete learn about
ways to help keep themselves calm even when they are under
mental stress or pressure. The parents will learn about these

techniques and how they can help their child practice them at
home. Communication with their child and the psychologist is
important.
4
Questionnaires and statistical tests
Questionnaires will be done before and after intervention to
assess any changes
Assess changes in athlete’s answers for improvement in
psychological difficulties
Assess changes in parents’ answers for improvement in
concerns
Assess athlete’s answers for opinion of parents’ involvement
Use statistical tests to indicate any significant change (better or
worse)
Check for any external variances
Check for any other results – concerns or psychological
difficulties that were not known before
The questionnaire answers will be collected and compared using
the statistical t-test, changes can be seen that indicate any
influences on different variables (One sample t-test, 2020).
Different test results will indicate any improvement from the
athlete or parents’ standpoint, which will help adjust any future
treatment plans. Finding any external variances will also help
future studies and discover any influences that the researcher
was not aware of, which will also help guide future studies.
During some studies, the participants will discover influences
they were not aware of and improved communication will help
them learn how to improve treatment plans.
5
Comparable study resultsAthletes’ Ego OrientationAthletes’

Task OrientationAthletes’ Perception of Directive
BehaviorAthletes’ Perception of PressureAthletes’ Perception of
SupportAthletes’ Perception of InvolvementAthletes’
EnjoymentAthletes’ AmotivationParents’ Orientation
Ego.24**.12**.01.06.04.04.04.05Parents’ Orientation
Task.06.25**.05−.03.13**.12**.19**−.08Parents’Directive
Behavior.13**.01.34**.22**.18**.20**−.00.07Parents’
Pressure.29**−.06.21**.40**−.04.11**−.19**.37**Parents’Sup
port.03.25**.17**−.04.39**.25**.31**−.12*Parents’
Involvement.04.01.21**.16**.14**.35**.02.02
As seen in this table of data collected from a previous study by
Sanchez-Miguel, Leo, Sanchez-Oliva, Amado, and Garci-Calvo
(2013), parental support can positively affect the athlete’s
enjoyment in their sport. The athlete’s perception of their
support and involvement also had a positive impact on them.
Using this data will help support the hypothesis of this study
and will translate to a positive influence on the athlete and their
parents.
6
Meaning of changes
Significant changes
indicates interventional techniques were effective
indicates results can be applied to other athletes
indicates participants were receptive to interventional
techniques
Insignificant changes
indicates interventional techniques were not effective
indicates results can not be applied to other athletes
indicates participants were not receptive to interventional
techniques

Changes that are seen after the study treatment will indicate
whether the hypothesis was true and how effective it was.
Significant changes will help other psychologists and athletes
benefit from the treatment plan. However, some changes will
not be significant, which can indicate the treatment was not
effective or the participants were not receptive to it and didn’t
find it helpful. Even though the study would not be considered a
success for the participants, it will help guide future studies and
treatments. As seen on the previous slide, positive significant
changes will help support the hypothesis that including the
parents in the PST treatment will have a positive influence on
everyone involved.
7
APA guidelines
Obtain IRB permission to conduct the study
Use informed consent
No intentional mental harm will occur
Use debriefing statement
Sample group will be large enough to allow for generalization
of results
Use non-biased analyzation of results
Researchers and psychologist will ensure ethical practices
All information will be held in confidentiality
Before, during, and after any study, certain guidelines have to
followed to assure everything was done ethically and morally
correct. Written consents are important to assure the
participants understand what will be done (Garziano & Raulin,
2013). The participant will also be given any information (in a
debriefing statement) that was discovered during the study with

the assurance that all information is help in confidentiality
(Garziano & Raulin, 2013). In order to assure the results are
accurate, the sample group will be large enough (done randomly
if possible) and non-biased analyzation will be done.
8
Limitations of study
Small number of participants
Participants do not complete study
Information gathered from only one parent
Ages of athletes
Time of parental involvement
Lack of parental involvement
Sometimes studies are limited by things that can limit the
results, such as a small number of participants and their
behavior. Having a larger group would help prevent incomplete
data collection. During the study conducted by Sanchz-Miguel,
et al (2013), they found that data was only collected from one
parent instead of both, which could alter the results if one
parent was more involved than the other. Athletes who are too
young to understand the instructions of the PST techniques may
not be able to make mental changes and not benefit from the
techniques, which would be indicated by scores that would not
reflect the benefits of the treatment. This was the case during a
study conducted by Taylor, Schweichler, Jorgensen, McKown,
and Teresak (2014).A study conducted by Marsac, Kassam-
Adams, Hildenbrand, Kohser, and Winston showed that a lack
of parental involvement was not indicated when the follow -up
questionnaire was collected, which prevent accurate data
analysis (2010).
9

Future studies
Change study samples that include coaches or teammates
Customize it to different sports
Customize it to different ages and genders
Include data from both parents
Add other PST techniques
Based on the results found in this study, future studies could
find more effective treatments and apply them to different ages,
genders, sports, coaches, teammates, and even cultures in
different countries. Using different or more PST techniques
could help identify what is more effective or if it is a
combination of everything. Success comes from different
influences, and finding what those specific influences are can
help athletes find happiness on and off the playing field.
10
References
Garziano, A.M. & Raulin, M.L., (2013), APA (American
Psychological Association) Ethical guidelines for research with
human subjects, Graziano & Raulin research methods (8th
edition) as retrieved fromhttps://graziano-
raulin.com/supplements/apaethics.htm
Marsac, M. L., Kassam-Adams, N., Hildenbrand, A. K., Kohser,
K. L., & Winston, F. K. (2011). After the injury: initial
evaluation of a web-based intervention for parents of injured
children. Health Education Research, 26(1), 1–12. Retrieved
from https://doi-org.lopes.idm.oclc.org/her/cyq045
One sample t-test, (May 25, 2020), One sample t-test, Statistics,
Cliffnotes.com, as retrieved from

https://www.cliffnotes.com/study-guides/statistics/univariate-
inferential-tests/one-sample-t-test
Sánchez-Miguel, P. A., Leo, F. M., Sánchez-Oliva, D., Amado,
D., & García-Calvo, T. (2013). The Importance of Parents'
Behavior in their Children's Enjoyment and Amotivatio n in
Sports. Journal of human kinetics, 36, 169–177.
https://doi.org/10.2478/hukin-2013-0017
References
Taylor, A.C., Schweichler, J.T., Jorgensen, B.L., McKown,
E.H., Teresek, M., (2014). Parental support behaviors for
children participating in community soccer programs. The Sport
Journal. As retrieved from
https://thesportjournal.org/article/parental-support-behaviors-
for-children-participating-in-community-soccer-
programs/#post/0
Zakrajsek, R., & Blanton, J. (2017). Evaluation of
Psychological Interventions in Sport and Exercise
Settings. Oxford Research Encyclopedia of
Psychology. Retrieved 26 May. 2020, from
https://oxfordre.com/psychology/view/10.1093/acrefore/978019
0236557.001.0001/acrefore-9780190236557-e-223.

Chapter 4
The Nature of Healthcare Markets
Introduce the concept of “market” as it relates to healthcare
Review methods of delineating markets
Describe the market profiling process
Describe shifts in levels of marketing
Introduce the notion of “effective” market
Describe the changing nature of healthcare markets
The concept of “market”
“Market” means different things to different organizations
Usually means the geographic area served by a healthcare
organization
For-profits typically serve a “market area”
Not-for-profits typically serve a “service area”

Methods of delineating markets
Based on geography
Based on population segments
Based on consumer demand
Based on opportunities
Markets without walls
Criteria for market delineation
Distribution of patients
Driving time/distance
Anticipated demand
Geography as destiny (exhibit 4.2)
Interaction between geography and health status and health
behavior
Role of geography in determining health status
Health status as a “product” of the community (and not vice
versa)
Geographic units
Political/administrative units
Statistical units
Functional units

Geographic units (continued)
Political/administrative units
Nation
State
County
City
Congressional district
State legislative district
School district
Statistical units
Region
Metropolitan statistical area
Census tract
Census block group
Census block
Zip code tabulation area
Functional units
Zip codes

Areas of dominant influence
Natural regions
Methods of delineating markets (continued)
Existing patient distribution
Prospective markets
Nongeographic boundaries
Proxy data
The market profiling process
Market size
Market composition
Health status
Health services demand
Availability of resources
Shifts in levels of marketing
Mass marketing
Target marketing
Micromarketing

Shifts in levels of marketing (continued)
Mass marketing
Emphasizes organization rather than specific services
Promotes all things to all audiences
Broad-based promotional techniques
Decreasing effectiveness in current healthcare environment
Target marketing
Aimed at selected segments of the total market
Typically emphasizes specific services rather than overall
organization
Customizes approach depending on the target
Increasingly used in healthcare
Micromarketing
Targeted to the level of the individual or household
Involves highly customized promotions
Emphasizes specific promotions to a very select audience
Limited usefulness in healthcare

Delineating the “effective” market
Perceived need/demand
Consumer acceptance
Payer mix
Competition
The changing nature of healthcare markets
Increasing instability and unpredictability
Demographic trends
Changing consumer attitudes/preferences
Evolving competitive situation
Chapter 5
Healthcare Consumers and Consumer Behavior
Describe the healthcare consumer

Compare the healthcare consumer with other types of consumers
Review the variety of healthcare consumers
Describe professional/institutional consumers
Describe consumer segmentation
Discuss consumer behavior
How healthcare consumers are different
Consumer purchases often not discretionary
Purchase decisions often not made by the consumer
Consumers usually unaware of price
Limited ability to evaluate products
Experience an emotional aspect not found for other purchases
How healthcare consumers are similar
A surprising amount of purchases are discretionary
Consumers exhibit elasticity of demand
Purchases influenced by many of the same factors as other
purchases
Financial circumstances affect consumer behavior

The healthcare consumer
In healthcare, a consumer is anyone with the potential to use
health services
Only in recent years have healthcare organizations thought in
terms of “consumers”
Healthcare consumers are different from other consumers in
many ways
Healthcare consumers are similar to other consumers in many
ways
The variety of healthcare consumers
Patients of various types
Professional and institutional customers
Physicians
Other clinicians
Hospitals and other institutions
Employers
Other entities
Trends in international healthcare
American health systems/foreign patients
US health systems overseas

International marketing of US healthcare products
Foreign health systems/international patients
Factors contributing to the growth of international healthcare
Investment in healthcare infrastructure around the world
Prohibitive medical costs in some systems
Growing international medical expertise
Factors contributing to the growth of international healthcare
(continued)
Deficiencies in public health systems
Positive patient experiences in other countries
Strong medical travel industry
Opportunity for international travel
International healthcare marketing strategies
For US organizations marketing overseas
For US organizations establishing satellites overseas
For foreign-based organizations hoping to attract international
patients

Factors critical to attracting international healthcare customers
Excellent care
Physician thoroughness
Word-of-mouth reputation
Physician recommendation
Methods of consumer segmentation
Demographic segmentation
Geographic segmentation
Psychographic segmentation
Health risk segmentation
Usage segmentation
Payer segmentation
Benefit segmentation
Adopters of innovative health services
Innovators
Early adapters
Early majority
Late majority
Laggards
What factors influence the acceptance of innovative health

services?
Consumer behavior in healthcare
Patterns of consumption of goods and services
Factors that contribute to consumer activity
Hierarchy of consumer needs
Importance of consumer engagement
Consumer decision-making
Problem recognition
Information search
Initial awareness
Knowledge emergence
Alternative evaluation
Consumer decision-making (continued)
Contract assessment
Preference assignment
Purchase decision
Product usage
Post-purchase behavior

Chapter 3
Marketing and the
Healthcare Organization
Chronicle the acceptance of marketing by healthcare
organizations
Provide an overview of types of healthcare organizations
Describe the uses of marketing in healthcare
Describe the role of marketing in healthcare
Factors affecting the adoption of marketing
Conservative orientation of nonprofit healthcare providers
Acceptance of the importance of profit
Need to serve multiple constituencies
Role of third-party entities

Types of healthcare organizations
Healthcare providers
Health product suppliers
Consumer product companies
Pharmaceutical companies
Health insurance companies
Support services
Role of insurance in the healthcare system
Emergence as a major influence
Role in influencing consumer behavior
Role in influencing provider behavior
Impact of the Affordable Care Act
Healthcare providers
Hospitals
General hospitals
Specialty hospitals
Nursing homes
Assisted living facilities
Residential treatment centers

Healthcare providers (continued)
Physicians
Other clinicians, counselors, and the like
Alternative therapists
Public health agencies
Other key entities
Product suppliers
Consumer health product companies
Pharmaceutical companies
Health insurance companies
Support services vendors
The uses of marketing
Disseminate information
Solicit business
Encourage consumer interaction
Develop and maintain relationships
The evolution of marketing’s role
Initially inconspicuous—not considered “marketing”
Expansion of public relations and communication functions
Establishment of marketing departments
Expansion of marketing’s role in the organization

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