In recent years, due to the emergence of holistic marketing (modern marketing), companies have changed the focus from the management of product portfolios to that of customer portfolios.¹ Doing so, companies can have a better understanding of their customer’s needs. Philipp Kotler identified four key dimensions of holistic marketing, and one of them is relationship marketing (RM), along with internal marketing, integrated marketing and performance marketing.¹

The specialty literature concerning relationship marketing provides resembling definitions of the concept, with a similar understanding.Evert Gummesson, an important member of the Nordic School of marketing thought, defined RM as marketing based on interaction within networks of relationships.²"Four key constituents for RM are customers, employees, marketing partners (channels, suppliers, distributors, dealers, agencies), and members of the financial community (shareholders, investors, analysts)”.¹ RM needs at least two parties interacting with each other (the supplier and the customer).

The development of RM is associated with the growth of the service sector. In recent years, "the focus of marketing means seeing customers as a long-term income stream over many years – a so-called "relationship marketing" approach”.³ However, regarding RM in healthcare, "clients" are in fact patients who are separated into two categories: patients who seek medical services because they have a medical emergency and patients that the healthcare unit tries to attract to the services that they offer.

Essentially, RM refers to understanding the economic, emotional and moral needs of the clients, and trying to satisfy them in terms of profitability. In healthcare, "hospitals are trying to increase profits in two basic ways: cost-cutting efforts (eliminating staff, trimming supply expenses, and restructuring operations to become more efficient) and […] generating more revenue through increased marketing efforts”.⁴

The customer culture in healthcare RM is the patient culture. This culture refers to the understanding of the patient's needs as well as the circumstances that lead to access to the services that the healthcare system offers. Moreover, major importance is given to products and services capable of being adapted to specific patient situations.

Customer loyalty strategies in healthcare

In healthcare, patient loyalty strategies are essential and the amount of resources invested varies from one healthcare unit to another.

Attracting patients

To attract new patients, healthcare units must offer competitive medical services at fair pricing. Also, they can develop ads in the media or in social media that will reach new potential patients, send direct emails to their database of patients or participate in various events. According to Philip Kotler, "because attracting a new customer may cost five times as much as retaining an existing one, RM also emphasizes customer retention”.¹

Patient retention

Patient retention refers to the ability of a practitioner or a hospital to retain their patients over a specified period of time. "It is essential that the healthcare practitioners view their patients as customers, if the objective is to keep them satisfied and to keep them coming back when a perceived need on their part arises”.⁵

In healthcare, retention means hard work and dedication by offering personalized patient experience with the physician or the healthcare unit. This involves many aspects, such as meeting the patient’s expectation, building patient’s trust by a clear interpretation of their medical situation and also giving explicit medical indications, guiding the patient through the sections of the healthcare unit as not to waste patient’s time, following-up with patients, etc. "In essence, beyond that of keeping people healthy, the focus is on retention – a basic tenet of RM”.⁵

Patient loyalty

Attracting loyal customers is one of the greatest challenges of a business. "Loyalty or enduring preferences for products and services generally requires that consumers be able and willing to continue interaction with the brand in some way, usually by repetitive purchasing”.⁶ Patients leaving the healthcare unit in a good mood usually indicates that the healthcare unit had satisfied their needs, and this is a critical aspect in gaining loyalty. Therefore, the physician-patient dialogue is extremely important.

Examples of customer loyalty strategies in healthcare are: offering a discount of up to 50% for the patient's birthday, offering discounts to patient's family members, or simply sending greeting cards or text messages on the patient’s birthday or on holidays.

Starting from the assumption that the physician-patient relationship is more important in the private healthcare sector than in the public healthcare sector, due to the fact that both physicians and the entire private healthcare unit have a greater interest for the patients to return, I performed a qualitative research using the questionnaire method.

This study aimed to investigate if the physician-patient relationship and the way patients are treated by the healthcare unit, reflected through patient retention and loyalty, are different in the private and public healthcare sectors.

To observe if there are any differences between the physician-patient relationship in the private and public healthcare sectors in Bucharest, Romania, a cross-sectional study was performed on physicians using the questionnaire method in the period between March 30 and April 10 of 2019. Data from a number of 41 physicians (21 from the private healthcare sector and 20 from the public healthcare sector) was obtained by answering the same questions regarding the physician-patient relationship, patient retention and loyalty (Supplementary file). The physicians from the private healthcare sector worked for Sanador, a private medical hospital offering full healthcare services. The physicians representing the public healthcare sector worked for the National Institute for Infectious Diseases "Prof. Dr. Matei Balș”, a tertiary care public hospital.

Statistical analysis

The statistical analysis was performed in IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, NY, USA). Chi-squared test was used to determine if there is a notable variation between the expected and the observed frequencies in one or more categories.⁷

The two groups were balanced in terms of gender distribution and experience in healthcare, but a significant difference was identified when comparing the type of diseases that the respondents generally worked with. Specifically, practitioners from the public sector reported working with patients admitted for acute and chronic diseases alike, while healthcare practitioners from the private sector stated they worked mostly with chronic diseases (p=0.002) – Table 1.

Table 1. General characteristics of the respondents from the two study groups

 

Regarding the physician-patient relationship, the two study groups gave similar answers regarding patient satisfaction and retention, feedback, social statute importance and communication with patients (p=0.002) – Table 2. The only two major differences that were identified relate to patient loyalty strategies and benefits offered to patients, which are considerably more important in the private sector, and to the duration of consultation. Specifically, the majority of practitioners from the private healthcare sector stated that their average duration of consultation is between 21-30 minutes, whereas most public sector healthcare practitioners responded that the average duration of consultation is between 11-20 minutes (p<0.001 – Table 2).

Table 2. Responses regarding the physician-patient relationship in the two study groups, specifically patient satisfaction, retention and loyalty

 

 

In this study, the respondents from the public healthcare sector appeared to have a continuous influx of patients who often come for emergencies, while those from the private healthcare sector reported that they rather monitor patients, albeit not exclusively, for chronic pathologies, based on scheduled periodical assessments. Good communication between the physician and the patient is essential for the success of the medical act.

Good communication with the patients, empathizing with them and patient satisfaction all lead to a long-term relationship between the two sides. On the one side are the practitioner and also the healthcare unit, and on the other side is not only the patient but also the patient's family or friends because a good general relationship with the healthcare unit or

the practitioner leads to referrals from the patient to other people. Also, especially in the private healthcare sector, patient loyalty strategies are extremely important, and the duration of the consultation is most of the time slightly longer than in the public sector. This may be due to the fact that in the public sector the number of patients seen by a doctor per week is most likely higher than in the private healthcare sector, and this may translate into shorter duration of the consultation. This aspect could also stem from differences in patient flow and programming. In the public healthcare sector, it is likely that the volume of patients is higher and the programming system is not used, while in the private healthcare sector the majority of the consultations are scheduled, which makes it easier for each patient to get more time.

As a conclusion to this study, practitioners from the private and public healthcare sectors alike are aware of how valuable the physician-patient relationship is in their day-to-day work. The physicians from the private healthcare sector tend to have a greater emphasis on patient loyalty strategies by offering various benefits to increase patient retention and loyalty.

1. Kotler P, Keller K. Marketing management. 14th Edition. New Jersey, USA: Pearson; 2012.

2. Gummesson E. Total relationship marketing: Rethinking marketing management. Oxford, UK: Butterworth Heinemann; 2002.

3. Lancaster G, Reynolds P. Marketing – the one semester introduction. New York, NY, USA: Routledge; 2011.

4. Wagner HC, Fleming D, Mangold WG, LaForge RW. Relationship marketing in health care. J Health Care Mark 1994;14:42-7.

5. Fullerton S, McCullough T. Patient proactivity: behaviors, attitudes, and its relationship with satisfaction with the American health care delivery system. Health Mark Q 2014;31:78-96. [Crossref]

6. Oliver R. Satisfaction: A behavioral perspective on the consumer. Second Edition. London, UK: Routledge; 2010.

7. McHugh ML. The chi-square test of independence. Biochem Med (Zagreb) 2013;23:143-9. [Crossref]