|Year : 2017 | Volume
| Issue : 2 | Page : 36-40
Social marketing mix versus induced demand
Nastaran Fathiyan1, Mahin Jafari1, Zeinab Haji Heydari1, Rahele Samouei2
1 Social Determinants of Health Research Center, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
2 Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||31-Aug-2017|
Zeinab Haji Heydari
No. 67, Talar Neighborhood, Jey Street, Baharestan Town, Isfahan
Source of Support: None, Conflict of Interest: None
Introduction: Social marketing mix is a set of controllable tools that can have a wide range of applications in the field of healthcare. Due to the necessity of controlling induced demand, this study aims to use social marketing mix to reduce induced demand in health-care sector. Materials and Methods: This survey study was carried out using keywords “induced demand,” “social marketing,” and “social marketing mix” to search in books, scientific websites, journals, and dissertations. Using these keywords, a total of fifty Farsi and English articles were retrieved and investigated. After investigating the abstract and method of the articles, the irrelevant articles were eliminated leaving 33 journal articles, dissertations and books to be used in this study. It is worth noting that there is a possibility of mistake in eliminating the articles or lack of access to relevant articles. Databases such as MagIran, Google Scholar, NoorMags, SID, IranDoc, Science Direct, PubMed, Springer, and Emerald were the sources for the majority or the articles. After investigating the full text of the relevant articles, relevant information was extracted and used in the study. Results: Based on the results of this study, the components of social marketing mix including suggestion instead of product, cost of participation instead of cost, accessibility instead of location, social contacts instead of promotion and creating partners, policies and guidelines can be used to reduce induced demand. Conclusion: Using the aforementioned methods along with planning and careful evaluation and informing the audience, it is possible to achieve great results in reducing induced demand.
Keywords: Induced demand, social marketing, social marketing mix
|How to cite this article:|
Fathiyan N, Jafari M, Heydari ZH, Samouei R. Social marketing mix versus induced demand. Int J Health Syst Disaster Manage 2017;5:36-40
|How to cite this URL:|
Fathiyan N, Jafari M, Heydari ZH, Samouei R. Social marketing mix versus induced demand. Int J Health Syst Disaster Manage [serial online] 2017 [cited 2018 Mar 17];5:36-40. Available from: http://www.ijhsdm.org/text.asp?2017/5/2/36/213884
| Introduction|| |
The theory of induced demand is one of the most important topics in health economy and healthcare management. Induced demand is “inducing the necessity of care or sale of unnecessary care products to health-care system's clients along with exercise of power by healthcare providers.” The probability of induced demand and the intensity of its effects is the result of a variety of factors that affect the behaviors of physicians and patients. It is difficult to analyze the forces that lead to induced demand, but one can say that induced demand is the result of a variety of economic and structural factors along with health-care market and the behavior of providers and users of health-care services. Due to these factors and as a result of great changes in health-care system and the needs of the patients, healthcare proving organizations must employ more effective management methods in their system  and take steps to reduce induced demand by changing the attitudes and behaviors of people. One of the tools that can be used to control and guide these behaviors is social marketing.
Social marketing was first introduced as a professional discipline by Philip Kotler in 1970 and was recognized as the last and newest concept among the five concepts of marketing. Social marketing encourages marketing staff to seek a balance between demands and long-term interests of the clients, long-term interests of the society and the return of investment goals. Clever managers in medical centers understand that they have to use a variety of marketing tools to increase the appeal of their center for the patients. In this regard, the P7 model (marketing mix) is an accessible tool for medical centers to increase their appeal for their clients. The components of social marketing mix are the basis of interventions in which social marketing is used. The localized version of social health marketing includes seven dimensions and related factors and provides policy makers and health-care managers with necessary tools for the marketing efforts of their organization. The components of this marketing mix include suggestion instead of product, cost of participation instead of price, accessibility instead of location, social connections instead of promotion, the public, creating partners, policy and guidelines.,
In the following section, some of the studies related to behavioral changes in health-care sectors will be reviewed.
In 2015, Samouei et al. in a study titled “Social marketing a key to confronting social harm with emphasis on alcohol and drug abuse” reported that social marketing can be used as an effective and successful strategy to change undesirable behavior such as alcohol or drug abuse. Jabbari et al. in their 2014 study titled “behavior change management in health-care sector using social marketing with emphasis on alcohol and drug abuse,” reported that selecting the behavior that must change, careful planning, and cohesion of different stages along with correct implementation and evaluation or a social marketing initiative can help reduce undesirable behavior and define desirable behavior if a suitable strategy is used to change the awareness, attitude, and behavior of the target audience., Vafaee-Najar et al. in their 2013 study reported that interventions based on social marketing patterns can be effective in increasing the frequency of mammography tests. In 2011, Keshvari also reported that social marketing is essential in marketing products and services in public libraries. Shams in 2007 stated that although social marketing approaches seem to need a lot of time and resources at first glance, the success stories in this regard in various countries show that this increased cost comes with an acceptable increase in effectiveness. Other studies show a positive relationship between social marketing mix and market equity., In 2006, Gordon et al. reported the effectiveness of social marketing in improving diet habits and reducing substance abuse. Furthermore, various studies report the effectiveness of social marketing in changing the attitude of the target audience.,,,,
Due to the importance and applications of social marketing mix in healthcare and its effectiveness in meeting the demands of the clients, this study aims to define and apply the proven effects of social marketing in various areas and disciplines to the topic of induced demand.
| Materials and Methods|| |
This study was carried out using simple review method my searching the relevant keywords in credible scientific websites, books, and journals in 2014. To this end, several databases including MagIran, Google Scholar, NoorMags, SID, IranDoc, Science Direct, PubMed, Springer, and Emerald were used. Using the previously determined keywords, a total of twenty English and thirty Farsi articles were retrieved and investigated. After evaluating the abstract and method section of the retrieved articles, the irrelevant articles were eliminated, and a total of 33 articles (16 Farsi and 17 English), 3 dissertations, and 1 book were included in the next stage of the study. It is worth noting that there is a possibility of error in eliminating relevant articles and also a chance for lack of access to relevant articles.
The articles were retrieved by searching with keywords: “induced demand,” “marketing,” “Social marketing,” “Marketing mix,” and “social marketing mix.” After reading the full text of the relevant articles, the necessary information was extracted and then summarized and categorized in the next stage.
| Results|| |
Social marketing mix is a set of controllable tools that facilitate accountability to the target market and target audience. The components of social marketing mix in regards to reducing induced demand are shown in [Table 1].
| Discussion|| |
As can be seen in the results, the components of social marketing mix such as suggestion, cost of participation, accessibility, social connections, partners, policies and public can create targeted behaviors in people and society, leading to the reduction of induced demand.
Increase in performance and efficiency in a macrolevel (due to the allocation of resources when necessary), creating a mutual relationship between physicians and patients (instead of the one-sided profit-based relation favoring physicians), and reducing pain and suffering of the patients are among the most important results of implementing these programs in target groups. It is worth noting that the implementation of these programs comes with a cost and as mentioned by Shams in his article, this cost must be lower than the benefits of these programs. One must remember that the cost of the implementation is not only limited to financial costs but can also manifest in the target group as loss of time and energy, creation of stress and anxiety or limiting of some privileges. The costs for the implementers of the programs include the financial cost for holding educational programs and creation of brochures and costs created due to the difficulty of changing behaviors or lack of success in behavioral change. Based on the principals of social marketing which prioritizes the gain for target groups, the costs of programs that will ultimately benefit the target group can usually be justified if the programs are successful.
A location is necessary for the implementation of these programs. This location should be accessible to all members of the target group. Among the present channels, mass media, and national TV are the most comprehensive and accessible method and can take great steps toward reducing induced demand in health-care sector through educational programs and advertisements. Along with the national TV, education of patients or their families in doctors' offices or hospitals can also prove to be successful. One of the benefits of such education is the interaction between educators and their targets, but on the other hand, the cost of this method is higher compared to other methods. Distributing pamphlets and brochures among the target group can also be effective. The benefit of this method is it is easy, simple, and seamless execution which comes with disadvantages such as lack of interaction between educators and their target audience which leads to lower comprehension of the lessons thought. It is also possible that some patients will receive the brochures but pay them no mind and ignore the presented information.
Just as commercial marketing staff use advertisement and other marketing tools to increase the sale of their products and services, social marketing staff need to employ marketing tools known as social interactions. Interviews with experts in mass media support of insurance companies and official organizations and production and screening of documentaries on the dangers of unnecessary surgeries are some of the methods used to guide the target audience toward the desired behavior. To facilitate decision making and adaptation of the behavioral changes, the target audience must be divided into different groups with each group having a different program tailored to its needs.
Given the fact that reducing induced demand is a multidimensional phenomenon created by several groups and organizations, many groups and organizations need to cooperate to reduce induced demand. Among these organizations, the roles of the ministry of health, medical council, universities, insurance companies, and mass media are the most important ones. Each of these organizations can play important roles in reducing induced demand. For example, ministry of health can define a path for treatment through the production of clinical guidelines and also limit the number of radiology and diagnosis centers to what is needed and stop the establishment of extra diagnosis centers to improve the use of existing equipment. The reason for this is that private sector is usually willing to invest in diagnosis centers due to their potential for financial profit and hospitals also need to purchase certain medical equipment which leads to parallel services being provided inside and outside of hospitals, reducing the efficiency, and increasing the possibility of induced demand.
Another example is the role of insurance companies. Insurance companies can act as third parties as supporters of programs designed to decrease induced demand. The reason for this is that insurance companies are obligated to pay part or all of the costs of treatments for patients using their insurance plans. Long treatments and excess use of diagnosis tools and surgeries increase the costs and results for net loss for these organizations. Given the fact that part of the costs of insurance companies is paid by the government, loss insurance organizations means a net loss for the country as a whole which can lead to further crisis. Therefore, it is the duty of insurance companies as one of the organizations involved in healthcare, to have proper supervision on physicians and treatment plans and prevent induced demand. Creating a maximum number of possible requests for various services for each physician means that physicians will be more attentive, will not request an unnecessary test and will pay more attention to the patients' treatment, reducing the number of visits to physicians.
Mass media and national TV can also help in this regard by introducing the complications and side effects of unnecessary medicines and surgeries and introducing replacement treatment plans. This helps increase patients' information resulting in patients that will not easily accept any requests by their physicians and cannot be pressured into using extra services.
As the last stage and after creating the desirable changes in the target groups, policies need to change to ensure the continuity of the changes, to force the opponents of these programs to follow the new guidelines and help the supporters of these programs to overcome opposition and unstable situations. Policies and guidelines forbidding physicians from owning hospital equipment, evaluation programs, creating laws limiting the number of physicians, limiting the purchase of unnecessary equipment, price control through tariffs, limiting the possibility of collusions, introducing incentives and punishments for quality of medical services and products such as medicines and medical equipment, are among the possible policies and guidelines that can help reduce induced demand. For example, in regards to the evaluation policies, it can be said that these policies help related organizations such as insurance companies to evaluate the performance of physicians based on defined criteria and with the help of experts and any problem, abuse or shortcoming can be dealt with. As a result, physicians will try to follow the rules and guidelines due to this external supervision which can limit induced demand. Another example is limiting the purchase of unnecessary equipment. Policies that define the necessary equipment for each hospital based on its location and prevalent disease in that location can help reduce induced demand because a large portion of induced demand is due to equipment purchased based on their low price or due to competition with other hospitals. Sometimes, this equipment has limited to no use based on the hospital's location, but hospital management will encourage the use of equipment to cover their costs, leading to induced demand.
| Conclusion|| |
Induced demand is one of the important and controversial topics in health-care economy and one of the reasons for increased cost of the treatment. Social marketing mix is a set of various tools that facilitate accountability to clients and target market and has seen increased attention in recent years. This study aimed to propose methods for reducing induced demand in health-care sector based on social marketing mix. In social marketing mix, along with the initial efforts (location, methods of advertisement, costs, etc.), there are efforts to sustain the changes created through this method (by creating policies and guidelines and cooperation of partners and public). Therefore, it appears that social marketing mix can help reduce induced demand in health-care sector.
Therefore, we suggest that insurance companies and medical council should have careful supervision on the implementation of policies and guidelines by physicians and should use proper incentives and punishments. Furthermore, comprehensive education for patients, physicians and hospitals using proper channels, identification of competition, and removing these competitions can help reduce induced demand.
Given the fact that this study is simply a literature review, the results presented here are simply the summary of results presented in other studies and no survey or empirical studies have been carried out.
This article is the result of a research project approved by Isfahan University of Medical Sciences and Health Services. Therefore, it is appreciated by the Assistant to the Deputy Director and Managing Director of the Faculty of Research of the Faculty.
Financial support and sponsorship
Isfahan University of Medical Sciences.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Keyvanara M, Karimi S, Khorasani E, Jazi MJ. Experts' perceptions of the concept of induced demand in healthcare: A qualitative study in Isfahan, Iran. J Educ Health Promot 2014;3:27.
Keyvanara M, Karimi S, Khorasani E, Jafarian Jazi M. Challenges resulting from healthcare induced demand: A qualitative study. Health Inf Manage 2013;10:538-48.
Keyvanara M, Karimi S, Khorasani E, Jafarian Jazi M. Opinions of health system experts about main causes of induced demand: A qualitative study. Hakim Res J 2014;16:317-28.
Mahboubi M, Ojaghi SH, Gheyasi M, et al
. Supplementary insurance and induced demand in chemical warfare. Veterans Med J 2010;2:22-18.
Kafashpoor A, Mortazavi S, Hasani Moghadam S. Application of social marketing concept in encouraging voluntary blood donors using theory of planned behavior. Sci J Iran Blood Transfus Organ 2012;9:44-53.
Torabi A. Social marketing in health care. J Soc Secur 2006;26:127-44.
Rousta A, Venus D, Ebrahimi A. Marketing and market management. 12th
ed. Tehran: SEMAT; 2008. p. 34.
Souba WW, Haluck CA, Menezes MA. Marketing strategy: An essential component of business development for academic health centers. Am J Surg 2001;181:105-14.
Vafaee-Najar A, Shams M, Esmaeily H, Dehnavieh R, Neyestani H, Nikparast N, et al
. Mammography in rural areas of Iran: A qualitative study for designing a social marketing intervention. J Qual Res Health Sci 2013;2:173-83.
Nasiripour AA, Raeissi P, Maliki MR, Akbarian Bafghi MJ. A mixed model for health services marketing in Iranian public hospitals. Health Inf Manage 2013;9:1158-68.
Mohammed N, Rafieefar SH. Comprehensive program of health education. 1st
ed. Tehran: Mehrradesh, 2007. Amiri F, Ghasemi S. Social marketing. Isfahan: Arcan danesh, 2012.
Amiri F, Ghasemi S. Social Marketing. Isfahan: Arcan Danesh; 2012.
Samouei R, Tavakoli N, Mirabdellahi M, Jabbari A. Social marketing, the key for dealing with social pathology especially alcohol and sabstance abuse. Int J Educ Psychol Res 2015;1:1-6.
Jabbari A, Tavvakoli N, Mir Abdullahi M, Samouei R. Managing Behavior Change in Health Extent Through Social Marketing with an Emphasis on Reducing Alcohol and Drug Abuse. Abstract International Conference on Sustainable Development in the Health System; 2014.
Fathian N, Jafari M, Haji Heidari Z, Samouei R. Identification of behavior change methods in social marketing for countering induced demand in health system. Int J Health Syst Disaster Manag 2015;3:S6-11.
Keshvari M. The Use of Social Marketing in Public Libraries. Librarianship and Notify. Vol. 14; 2011. p. 9-32.
Shams M. Categories audiences in workplace health promotion programs: The use of social marketing concepts. Q Healthy 2007;1:8-12.
Hosseini MH, Moezzi H. Exploring impact of marketing mix on brand exutty in insurance industry (case study: Asia insurance firm, Iran). J Asian Sci Res 2015;5:38-45.
Ansari MH, Jafarpour M, Ansari M. The relationship between marketing mix with brand equity in fitness and aerobic gyms. Int J Educ Res Technol 2014;5:36-9.
Gordon R, McDermott L, Stead M, Angus K. The effectiveness of social marketing interventions for health improvement: What's the evidence? Public Health 2006;120:1133-9.
Cates JR, Diehl SJ, Crandell JL, Coyne-Beasley T. Intervention effects from a social marketing campaign to promote HPV vaccination in preteen boys. Vaccine 2014;32:4171-8.
Thrasher JF, Huang L, Pérez-Hernández R, Niederdeppe J, Arillo-Santillán E, Alday J. Evaluation of a social marketing campaign to support Mexico City's comprehensive smoke-free law. Am J Public Health 2011;101:328-35.
Peattie K, Peattieb S. Social marketing: A pathway toconsumption reduction? J Bus Res 2009;62:260-8.
Richards J, Hackett A, Duggan B, Ellis T, Forrest D, Grey P. An evaluation of an attempt to change the snacking habits of pre-school children using social marketing. Public Health 2009;123 Suppl 1:e31-7.
Ayanniyi AA, Bob-Egbe S, Olatunji FO, Omolase CO, Omolade EO, Ojehomon FO, et al.
Social marketing potential of qualitative cost-free-to-patient eye care program in a Nigerian community. Ann Afr Med 2009;8:225-8.
] [Full text]
Shams M, Rashidyan A. Social marketing: The use and advantages of the continuous medical education. J Strides Dev Med Educ 2006;3:58-68.
Bickerdyke I, Dolamore R, Monday I, Preston R. Supplier-Induced Demand for Medical Services. Peroductivity Commission Staff Working Paper; 2002. p. 1-103.
Rahimi F, Shojaei zade D, Zerrati H, Akbaryan M. Oral care based on health belief model in children. J Health Hyg Ardebil 2011;2:74-81.
Mirrak Zade AA, Bahrammi M. Social Marketing is a New Chapter in Marketing Politics. The Growth of Social Science Education. Vol. 14; 2011. p. 38-45.
Keyvanara M, Khorasani E, Jafarian Jazi M. Perception of managers and experts from the concept of induced demand on health services in Esfahan. Management of Health Services. Asfhan: Isfahan University of Medical Sciences and Health Services; 2013.
Charstad P, Kave A. Social Marketing is an Opportunity to Improve the Welfare of Societies; 2013.
Khani M. Evaluation of induced demand by physicians (Case cesarean section in Iran). Tehran: Sharif University of Technology; 2012.
Khaje E. Study of attitudes of social marketing on the reform of the electricity consumption's metod of household subscribers in Isfahan and its impact on the attitudes of managers of organizational transformation of the regional electricity company of Isfahan. Isfahan: University of Esfahan; 2010.