Health Science
Communication
Biosci. Biotech. Res. Comm. 9(4):776-782 (2016)
Effect of marketing mix (7 Ps) on patients’ tendency to
University and social security hospitals in Mazandaran
Samereh Yaghubian
1
, Ghahraman Mahmoudi*
2
and Mohammadali Jahani Tiji
3
1
PhD Scholar Health Services Management, Sari Branch, Islamic Azad University, Sari, Iran
2
Assistant Professor, Department of Health Services Management, Sari Branch, Islamic Azad University,
Sari, Iran
3
Assistant Professor, Department of General Education, School of Medicine, Babol University of Medical
Sciences, Babol, Iran
ABSTRACT
The low quality of services and failure to address patients’ needs cause dissatisfaction and failed relations with
patients. In this respect, this study was conducted to examine the role of the marketing mix (7 Ps) in patients’ ten-
dency to university and social security hospitals in Mazandaran. This applied study with a cross-sectional analytical
design was performed in selected social security and university hospitals in Mazandaran, Iran in 2015. A total of
600 inpatients and outpatients were selected through strati ed random sampling. The data were collected using a
standard questionnaire with interval con dence of 0.85. The regression test and SPSS15 software was used to ana-
lyze the data. Maximum mean score, which belonged to the services variable, in outpatient ward and inpatient ward
was respectively 31.18 ± 8.66 and 36.31 ± 9.36 in university hospitals and 27.78 ± 4.99 and 37.18 ± 9.35 in social
security hospitals. The personnel factor (P <0.0001) in the outpatient ward and services (P < 0.0001) and process (P =
0.03) factors in the inpatient ward of university hospitals mostly affected the patients’ tendency. None of the variables
affected the patients’ tendency in the outpatient ward of social security hospitals, but promotion (P = 0.003) and ser-
vice (P = 0.038) factors in inpatient ward of those hospitals had the highest impact on patients’ tendency. Considering
that the personnel, productions, promotion and process factors were determined as the most ef cient marketing mix
elements in patient’s tendency, senior managers of hospitals and health policymakers are recommended to take into
account the marketing mix elements in their planning for promoting the quality of services, patients’ satisfaction,
and continuity of the hospital-patient relation.
KEY WORDS: MARKETING, PATIENTS, HOSPITALS, INPATIENTS
776
ARTICLE INFORMATION:
*Corresponding Author: ghahraman48@yahoo.com
Received 27
th
Oct, 2016
Accepted after revision 21
st
Dec, 2016
BBRC Print ISSN: 0974-6455
Online ISSN: 2321-4007
Thomson Reuters ISI ESC and Crossref Indexed Journal
NAAS Journal Score 2015: 3.48 Cosmos IF : 4.006
© A Society of Science and Nature Publication, 2016. All rights
reserved.
Online Contents Available at: http//www.bbrc.in/
Samereh, Ghahraman and Mohammadali
INTRODUCTION
A service is a kind of organizational activity that main-
tains or improves people’s performance or health. People
actually buy time, knowledge, expertise, and resources
when they buy services from providers (Sreenivas et al
2013). Service providers compete with one another in
providing health services (Nasiripour et al 2010). Fur-
thermore, methods for provision of hospital care, as an
essential need, are inef cient in the healthcare system
(Nasiripour et al 2012). However, hospitals provide a
range of treatment services to patients (Horwitz & Nich-
ols, 2011). The treatment services encounter market’s
mechanism of supply and demand, which results in the
development of marketing policies with scienti c, pro-
ductive, and service approaches for attracting patients
(customers) (Anagre, 2012, Parmar & Pandya, 2015).
Studies show that service organizations that have
accepted marketing principles and based their programs
on the elements of marketing mix have reached posi-
tive results (Alreck & Settle, 1999). The reason is that
marketing strategies are necessary for organization and
provision of services to patients and evaluation of hos-
pital performance and patients’ satisfaction (Ahmad et
al 2013). Leiderman et al stated that more investment on
marketing would promote the hospital’s infrastructure
(Leiderman et al 2010). In fact, marketing contributes
to proper provision of services to appropriate people at
the proper time and is considered a process of change in
search toward true customers (Parmar & Pandya, 2015).
The reason is that patients are involved in choosing
hospitals and decide which hospital to choose more than
ever (Yaghoubi et al 2011). Moreover, patients’ expecta-
tions of the quality of care have been increasingly tied
to conceptual and practical models for evaluation of
hospital performance (Ahmad et al., 2013). Therefore,
hospital managers make use of the marketing mix as a
practical framework for making decisions and combin-
ing services in order to adjust to customers’ needs and
demands (Lin, 2011). These workers have introduced the
variables of marketing mix (7 Ps) as the production of
goods (services), place, price, physical evidence, promo-
tion, personnel, and processes (Ahmad et al., 2013; Lin,
2011; Parmar & Pandya, 2015). Given that the customers’
satisfaction is central to marketing decisions (Parmar &
Pandya, 2015), focus on the above variables leads to the
development of an appropriate situation in customers’
mind (Hasangholipour et al 2014). York also points out
that patients’ satisfaction and ful llment of their needs
are essential principles of marketing, and this has been
growingly accepted in the healthcare system (York &
McCarthy, 2011).
Furthermore, healthcare and medical organizations
and those involved in the healthcare system face with
the high pressure of costs, quality, and proper delivery
of clinical services (Lega, 2006) think of marketing as a
solution for optimum use of nancial resources in hos-
pitals and medical centers and also return of the invest-
ment and income (Jabbari et al 2013). Spending higher
costs or using more services is not associated with more
favorable clinical outcomes, better technical care or
physicians’ ability to provide higher quality care (Mittler
et al 2010).
Therefore, service marketing mix involves all vari-
ables that an organization can control and provide in
order to ful ll market’s demands and the target market
(Ahmad et al., 2013; Parmar & Pandya, 2015), increase
nancial resources of hospitals, change the attitude of
service providers, and reduce the communicational dis-
tance between the providers and consumers (Sreenivas
et al., 2013). Regarding consumers’ high rate of dissat-
isfaction with healthcare services, poor communica-
tion, and low quality services and low productivity, it
is necessary to study patients’ tendency in and deter-
mine the most in uential factors for choosing a hos-
pital. Therefore, this study was conducted to examine
the effect of marketing mix (7 Ps) on patients’ tendency
to selected university and social security hospitals in
2015 in Mazandaran, Iran in order to identify and ful ll
healthcare service recipients’ desires and needs.
MATERIAL AND METHODS
This study with a cross-sectional analytical design was
performed in 2015. The study population included inpa-
tients and outpatients of a university hospital (Fate-
meh Zahra) and a social security hospital (Valiasr) in
Mazandaran, Iran. Upon coordination with authorities of
the Social Security Organization and Mazandaran Uni-
versity of Medical Sciences and obtaining permission for
performing the study, the researchers went to the hospi-
tals and explained the objective of the study to all par-
ticipants. They were assured that the participation in the
study was voluntarily, and that their information would
remain con dential and be used only for answering the
research questions. The participants were also assured
that they could withdraw from the study whenever they
desired. The participants included 600 people who were
selected from outpatients and inpatients, 300 patients
from each hospital, using strati ed random sampling.
The data were collected using a standard questionnaire
(Abedini et al 2014) with interval con dence of 0.85 and
two parts: the rst part involved demographic speci ca-
tions of the patients (sex, age, educational level, and
marital status), and the second part included 45 ques-
tions about the 7 elements of marketing mix (price,
place, promotion, personnel, physical evidence, process,
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS EFFECT OF MARKETING MIX (7 PS) ON PATIENTS’ TENDENCY TO UNIVERSITY 777
Samereh, Ghahraman and Mohammadali
Table 1: Distribution of demographic speci cations of patients in the university and the social
security hospital in Mazandaran, 2015.
Demographic variables University hospital Social security hospital
Number Percentage Number Percentage
Sex Female 141 47% 143 52.3%
Male 159 53% 157 47.7%
Age <30 22 7.3% 78 26%
31-40 45 15% 73 24.3%
41-50 81 27% 76 25.3%
>50 152 50.7% 73 24.3%
Educational level Below high school diploma 110 36.7% 111 37%
High school diploma 92 30.7% 93 31%
Associate diploma 39 13% 37 12.3%
Bachelor’s 43 14.3% 37 12.3%
Master’s 11 3.7% 12 4%
PhD 5 1.7 10 3.3
Marital status Single 31 10.3 88 29.3
Married 269 89.7 212 70.7
and product or service), which were scored within Lik-
ert scale (from very low to very high). The data were
analyzed in SPSS15 software and were compared using
descriptive statistics, including percent value and mean,
and analytical statistics, including t test. The backward
logistic regression model was used to examine the con-
current effect of variables on patients’ tendency, and R2
was used to determine goodness of t.
RESULTS
There were 284 women (47.3%) and 316 men (52.7%) in
this study, and 225 patients (37.5%) were older than 50
years. The educational level of most participants, 221
people (36.8%), was under high school diploma, and 481
patients (80.1%) were married. Table 1 provides other
demographic speci cations.
The results showed that mean score of “Production”
variable in the outpatient ward of the university hospital
was higher than that of the social security hospital (P <
0.0001). Mean score of “price” variable in the inpatient
ward (P = 0.10) and outpatient ward (P < 0.0001) of the
university hospital was higher than that of the social
security hospital. Moreover, mean score of “place” vari-
able in the inpatient ward (P < 0.0001) and outpatient
ward (P < 0.0001) of the university hospital was higher
than that of the social security hospital. Mean score of
“promotion” variable in the outpatient ward of the uni-
versity hospital was higher than that of the social secu-
rity hospital (P < 0.0001), but no signi cant difference
was found between these two hospitals in inpatient ward
(P = 0.173).
Mean score of “personnel” variable in the outpatient
ward of the university hospital was higher than that of
the social security hospital (P < 0.0001), but no signi -
cant difference was found between these two hospitals
in inpatient ward (P = 0.814). Mean score of “physical
evidence” variable in the outpatient ward of the uni-
versity hospital was also higher than that of the social
security hospital (P < 0.0001), but there was no signi -
cant difference between these two hospitals in inpatient
ward (P = 0.141). Eventually, there was no signi cant
difference between these two hospitals in inpatient ward
(P = 0.927) and outpatient ward (P = 0.29) in terms of
“process” variable (Table 2).
The backward logistic regression analysis was used
to examine concurrent effect of the studied variables on
patients’ tendency in outpatient and inpatient ward of
each hospital. The concurrent effect of services, price,
place, promotion, people, physical evidence, and pro-
cess variables was examined in each model. The results
showed that people in outpatient ward of the univer-
sity hospital signi cantly correlated with patients’
tendency (P < 0.0001). Other variables did not signi -
cantly correlate with tendency. The goodness of t of
the model was R2 = 0.23. Moreover, the process (P =
0.038) and Productions (P < 0.0001) variables in inpa-
tient ward of the university hospital signi cantly cor-
related with patients’ tendency, but other variables did
not correlate with tendency. The goodness of t of the
model was R2 = 0.287. Although Productions vari-
able in outpatient ward of the social security hospital
closely correlated with patients’ tendency, the corre-
lation was not signi cant. The goodness of t of the
778 EFFECT OF MARKETING MIX (7 PS) ON PATIENTS’ TENDENCY TO UNIVERSITY BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS
Samereh, Ghahraman and Mohammadali
Table 3: Results of the nal logistic regression analysis using backward model about the effect of studied
variables on patients’ tendency in the university hospital and the social security hospital in Mazandaran,
winter 2015.
Hospital/ ward Variable Coef cient of
variation (B)
Standard
Error (SE)
Odds ratio (OR) Signi cance
level (P)
Goodness
of t (R2)
University/
outpatient
Constant
coef cient
-4.33 1.05 ---- 0.000 0.23
Personnel 0.179 0.046 1.19(1.09-1.3) 0.000
University/
inpatient
Constant
coef cient
-6.19 1.049 --- 0.000 0.287
Process 0.09 0.044 1.095(1.005-1.19) 0.038
Productions 0.107 0.03 1.12(1.049-1.18) 0.000
Social security/
outpatient
Constant
coef cient
-4.79 1.85 --- 0.01 0.072
Productions 0.112 0.62 1.18(0.99-1.26) 0.071*
Social security/
inpatient
Constant
coef cient
-6.89 1.54 --- 0.000 0.333
Productions 0.069 0.033 1.07(1.004-1.14) 0.038
Promotion 0.145 0.48 1.15(1.05-1.27) 0.003
*Insigni cant
Table 2: Comparison of the university hospital and the social security hospital in Mazandaran, 2015
in terms of values of the studied variables.
University (Fatemeh Zahra) Social security (Valiasr) P-value
Variable Mean ± Standard deviation Mean ± Standard deviation
Production Inpatient 36.63±9.36 37.18±9.35 0.614
Outpatient 31.18±8.66 27.78±4.99 0.000
Price Inpatient 17.87±4.84 16.26±3.7 0.000
Outpatient 15.2±4.34 11.56±3.34 0.000
Place Inpatient 17.98±5.2 16.08±3.77 0.000
Outpatient 15.41±4.34 12.58±2.81 0.000
Promotion Inpatient 28.08±6.52 27.1±5.88 0.173
Outpatient 28.75±8.63 21.08±3.14 0.000
Personnel Inpatient 23.78±6.03 23.6±7.18 0.814
Outpatient 20.63±5.4 17.99±3.25 0.000
Physical
evidence
Inpatient 16.27±4.56 17.07±4.81 0.141
Outpatient 15.35±3.74 12.3±3.04 0.000
Process Inpatient 17.83±5.79 17.7±5.53 0.927
Outpatient 15±3.78 15.53±4.75 0.29
model was R2 = 0.072. Eventually, the Productions (P
= 0.038) and promotion (P = 0.003) variables in inpa-
tient ward of the social security hospital signi cantly
correlated with patients’ tendency, but other variables
did not signi cantly correlate with tendency. The good-
ness of t of the model was R2 = 0.333. Table 3 provides
in uential variables along with their OR and con dence
interval.
DISCUSSION
The results showed that ‘personnel’ were the most in u-
ential factor in outpatients’ tendency to the university
hospital and signi cantly correlated with patients’ ten-
dency to that hospital, and other variables did not sig-
ni cantly in uence patients’ tendency. However, the
signi cance level the variables decreased in the follow-
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS EFFECT OF MARKETING MIX (7 PS) ON PATIENTS’ TENDENCY TO UNIVERSITY 779
Samereh, Ghahraman and Mohammadali
ing order: personnel, process, price, promotion, place,
productions, and physical evidence. Ahmad et al s study
showed a signi cant correlation between personnel and
patients’ level of satisfaction (Ahmed et al 2014). How-
ever, results of Zare et al’s study on personnel’s contri-
bution to the productions market showed that the per-
sonnel were the third in uential factor among elements
of marketing mix in attraction of a certain patient to a
hospital (Zare et al 2013). According to the results of this
study, it seems that the reason outpatients chose a uni-
versity hospital was because of medical technical fea-
tures, mainly the presence of various specialists in out-
patient clinics in morning and evening shifts. Patients’
tendency to such hospitals was actually because they
had one specialty and did not have many choices for
patients.
However, the results about inpatient ward of the uni-
versity hospital showed that Productions and process
variables were the most in uential factors in patients’
tendency to that hospital and signi cantly correlated
with patients’ tendency to that hospital, but other vari-
ables did not signi cantly in uence inpatients’ ten-
dency. Furthermore, the signi cance level of the vari-
ables decreased in the following order: Productions,
process, price, personnel, promotion, physical evidence,
and place.
In this regard, Sreenivas’s study found productions as
the most important element, among the seven elements
of marketing mix, in hospital marketing, and other
factors gained relative scores (Sreenivas et al., 2013).
Regarding the results of this study, it can be argued
that the process in the medical services marketing mix
emphasizes familiarity with ease and clarity of methods
used to provide Productions to customers. It seems that
patients in university hospital are aware of details and
procedures of how services are provided. Furthermore,
there are educated personnel, necessary consultations,
instruction manuals, and appropriate signs for directing
and guiding patients. In this respect, patients cooperate
with the hospital without stress and would be satis ed.
Regarding services, it should be noted that the qual-
ity beyond patients’ expectation is one of the factors
in uencing type of services, and ful llment of patients’
expectations normally contributes to patients’ choice of
the hospital again and satisfaction with the services. It
seems that the university hospital could highly ful ll
patients’ expectations through provision of various ser-
vices.
The results of outpatient ward of the social security
hospital showed that none of the elements of marketing
mix signi cantly affected patients’ tendency. The sig-
ni cance level of the variables decreased in the follow-
ing order: Productions, physical evidence, promotion,
price, place, process, and personnel. However, studies
performed by Yaghubi (Yaghoubi et al., 2011), Abedini
(Abedini et al., 2014), Abedi (Abedi, Rahmani, Abedini,
& Rostami, 2014), Sreenivas (Sreenivas et al., 2013),
and Ahmad (Ahmad et al., 2013) con rmed the in u-
ence of one or more elements in this regard. The lack of
in uence of the elements in outpatient ward of Valiasr
hospital might reveal that the patients might not have
answered the questionnaire appropriately, and thus, the
study could not show the main cause of outpatients’ ten-
dency well.
The results of inpatient ward of the social security
hospital showed that the Productions and promotion
were the most in uential elements in patients’ tendency
and signi cantly correlated with patients’ tendency. In
this regard, price was the least in uential element, and
the order of elements regarding the signi cance level of
the test was as follows: promotion, Productions, process,
physical evidence, personnel, place, and price.
Jabbari et al.’s study showed that more attention to
medical promotion and provision of more facilities can
improve hospitals’ status in the area of medical tour-
ism according to the elements of marketing mix (Jab-
bari et al., 2013). Furthermore, promotion and quality of
services are among the 6 main marketing strategies for
health programs managed in the United States (Angela,
1993).Gopinath showed that promotion, especially elec-
tronic promotion, was in uential in attraction of patients
in Indonesia (Gopinath, 2015). Ahmad et al.’s study also
found that two factors, Productions and promotion, of
the ve factors in uencing patients’ satisfaction signi -
cantly correlated with patients’ satisfaction and were the
rst and the second in uential factors (Ahmad et al.,
2013). However, Zelena’s study revealed that failure to
attend to promotion for medical services could be attrib-
uted to observing ethical codes (Zelená, 2014), so they
did not agree with promotion for medical services.
RECOMMENDATIONS
Given that the people, Productions, promotion, and pro-
cess were determined as the most in uential marketing
mix elements in patient’s tendency, senior managers of
hospitals are recommended to take into account mar-
keting in their plans in order to promote the quality of
Productions and increase their achievements from the
market through establishing stable relations besides ful-
lling patients’ needs and satisfying them.
LIMITATIONS
The limitations of this study include the following:
some authorities and personnel of the hospitals failed
to cooperate with this study, patients did not have ade-
quate information about hospital marketing, and some
patients did not cooperate well.
780 EFFECT OF MARKETING MIX (7 PS) ON PATIENTS’ TENDENCY TO UNIVERSITY BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS
Samereh, Ghahraman and Mohammadali
CONCLUSION
According to the results, the major cause of patients’
tendency to each admission ward of both hospitals is
its appropriate Productions, and senior managers of
the hospitals have emphasized the ef ciency and pro-
ductivity besides improving the quality of Productions
and thus have satis ed the patients to the extent that
the patients accept to pay more money and even travel
long distances from other cities in order to receive high
quality Productions regardless of the price or place of
services.
The social security hospital could show the effect of
promotion besides appropriate Productions on attraction
of inpatients through making advantage of appropriate
promotion for starting up multiple specialized centers
and wards and the presence of experienced physicians.
However, modi cation of methods and specialized pro-
cesses, training managers of different levels, and ease
of treatment in inpatient ward of the university hospital
have made the process element more in uential than
other elements besides appropriate Productions. Moreo-
ver, the presence of famous experienced physicians who
suitably communicate with patients with the help of
competent nurses depicts the effectiveness of personnel
in outpatient ward of the university hospital.
ACKNOWLEDGEMENTS
The researchers appreciate managing authorities of
Social Security Organization in Mazandaran and per-
sonnel of the university hospital and social security hos-
pital for their sincere cooperation with this study.
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