The case of a free-standing psychiatric hospital moving into a small rural market as the sole provider of hospital-based psychiatric services is examined as an example of a first-mover strategy. The theoretical bases for a first mover advantage are considered together with an analysis of the situational factors necessary to the strategy's success. The case study illustrates some of the potential consequences of success, namely the attraction of a new competitor with a broader scope of services. The case also illustrates other lessons for market niche competitors in enhancing their likelihood of survival and success in their selected market.
{"title":"Big fish in a small pond: advantages and disadvantages of a first-mover strategy.","authors":"D. Fuller, D. Scammon, R. T. Davis","doi":"10.1300/J273V06N01_01","DOIUrl":"https://doi.org/10.1300/J273V06N01_01","url":null,"abstract":"The case of a free-standing psychiatric hospital moving into a small rural market as the sole provider of hospital-based psychiatric services is examined as an example of a first-mover strategy. The theoretical bases for a first mover advantage are considered together with an analysis of the situational factors necessary to the strategy's success. The case study illustrates some of the potential consequences of success, namely the attraction of a new competitor with a broader scope of services. The case also illustrates other lessons for market niche competitors in enhancing their likelihood of survival and success in their selected market.","PeriodicalId":79661,"journal":{"name":"Journal of ambulatory care marketing","volume":"6 1 1","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"1996-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66191542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The term "choice" has played an important role in the ongoing debate over health care reform in the United States. One of the major assumptions underlying reform efforts is that affordability drives consumers' choice of health care providers, particularly for the uninsured. In the state of Maryland, the issue of affordability is addressed by an "all-payor" system. In such a scenario, where enhanced choice opportunities are available for the uninsured, such consumers seem to be making choices which lead to the use of hospitals other than those which would be predicted based upon convenience or closeness of location alone.
{"title":"The uninsured consumer and hospital choice: an assessment of emergency department utilization.","authors":"D. Smith, S. Gooding, J. Hebb","doi":"10.1300/J273V06N01_06","DOIUrl":"https://doi.org/10.1300/J273V06N01_06","url":null,"abstract":"The term \"choice\" has played an important role in the ongoing debate over health care reform in the United States. One of the major assumptions underlying reform efforts is that affordability drives consumers' choice of health care providers, particularly for the uninsured. In the state of Maryland, the issue of affordability is addressed by an \"all-payor\" system. In such a scenario, where enhanced choice opportunities are available for the uninsured, such consumers seem to be making choices which lead to the use of hospitals other than those which would be predicted based upon convenience or closeness of location alone.","PeriodicalId":79661,"journal":{"name":"Journal of ambulatory care marketing","volume":"6 1","pages":"87-98"},"PeriodicalIF":0.0,"publicationDate":"1996-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66191232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite the fact that many women understand the value of preventive screenings in the early detection of breast cancer, and despite the fact that some women "know" the recommended guidelines for timing and frequency of screenings over a woman's life, less than 2/3 of the eligible women have ever had a mammogram. Among several factors that may inhibit women's adherence to recommended screening regimens, the cost of such screenings is often cited as a major problem, especially for low-income women and women from ethnic minorities. This study reports the results of a survey conducted with women who received a "Gift Certificate" for a no-cost mammogram at a hospital-based breast care center or its affiliated mobile mammography van. Data point to some important--both positive and negative--"side effects" of a no-cost screening. Implications for communications encouraging women to receive mammograms, for pricing and incentives, and for insurance reform are discussed.
{"title":"The role of \"free\" mammograms in motivating first-time screening: a community experiment.","authors":"D. Scammon, J. A. Smith, T. Beard","doi":"10.1300/J273V06N01_04","DOIUrl":"https://doi.org/10.1300/J273V06N01_04","url":null,"abstract":"Despite the fact that many women understand the value of preventive screenings in the early detection of breast cancer, and despite the fact that some women \"know\" the recommended guidelines for timing and frequency of screenings over a woman's life, less than 2/3 of the eligible women have ever had a mammogram. Among several factors that may inhibit women's adherence to recommended screening regimens, the cost of such screenings is often cited as a major problem, especially for low-income women and women from ethnic minorities. This study reports the results of a survey conducted with women who received a \"Gift Certificate\" for a no-cost mammogram at a hospital-based breast care center or its affiliated mobile mammography van. Data point to some important--both positive and negative--\"side effects\" of a no-cost screening. Implications for communications encouraging women to receive mammograms, for pricing and incentives, and for insurance reform are discussed.","PeriodicalId":79661,"journal":{"name":"Journal of ambulatory care marketing","volume":"6 1 1","pages":"59-71"},"PeriodicalIF":0.0,"publicationDate":"1996-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66191646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Health care services for the elderly: a study of the market and their needs.","authors":"Scott M. Smith","doi":"10.1300/J273V05N02_13","DOIUrl":"https://doi.org/10.1300/J273V05N02_13","url":null,"abstract":"","PeriodicalId":79661,"journal":{"name":"Journal of ambulatory care marketing","volume":"5 1","pages":"161-171"},"PeriodicalIF":0.0,"publicationDate":"1995-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66191458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A case study of the proposed development of a regional children's health care system in South Texas is described. Strategic plans for the system are overviewed and the community response to plans are presented. The political, social responsibility and fiscal viability issues raised are reviewed and the research literature base relevant to the health care needs of a key (Hispanic) market is summarized.
{"title":"Social responsibility, politics, and fiscal viability: strategic issues in the development of a regional health care system for children in South Texas.","authors":"K. R. Robertson, M. Stefl","doi":"10.1300/J273V05N02_11","DOIUrl":"https://doi.org/10.1300/J273V05N02_11","url":null,"abstract":"A case study of the proposed development of a regional children's health care system in South Texas is described. Strategic plans for the system are overviewed and the community response to plans are presented. The political, social responsibility and fiscal viability issues raised are reviewed and the research literature base relevant to the health care needs of a key (Hispanic) market is summarized.","PeriodicalId":79661,"journal":{"name":"Journal of ambulatory care marketing","volume":"46 1","pages":"137-47"},"PeriodicalIF":0.0,"publicationDate":"1995-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66191451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Today's health care environment is characterized by burgeoning costs and increasing concern about service quality. Not surprisingly, researchers and practitioners are turning to Total Quality Management (TQM) in their quest for creating high quality health care delivery systems. Despite the central importance of TQM, there is practically no common definition of total quality in medical care research. In this paper, we trace the historical development of the quality concept, offer a valid definition of "total quality," and detail a comprehensive model of TQM for health care research. Implications of our model for academicians and practitioners are discussed.
{"title":"Total quality management in health services: historical development, conceptual meaning, and comprehensive model.","authors":"D. Mishra","doi":"10.1300/J273V05N02_03","DOIUrl":"https://doi.org/10.1300/J273V05N02_03","url":null,"abstract":"Today's health care environment is characterized by burgeoning costs and increasing concern about service quality. Not surprisingly, researchers and practitioners are turning to Total Quality Management (TQM) in their quest for creating high quality health care delivery systems. Despite the central importance of TQM, there is practically no common definition of total quality in medical care research. In this paper, we trace the historical development of the quality concept, offer a valid definition of \"total quality,\" and detail a comprehensive model of TQM for health care research. Implications of our model for academicians and practitioners are discussed.","PeriodicalId":79661,"journal":{"name":"Journal of ambulatory care marketing","volume":"5 2 1","pages":"27-46"},"PeriodicalIF":0.0,"publicationDate":"1995-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66191027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Never before has American society undergone such dramatic and pervasive changes as those currently effecting national health care needs. New strategies to meet the health care needs created by societal changes must be identified. Consumers, employers, providers, and third-party payers are calling for more cost effective health care, better access and better quality. Simultaneously, the United States has a shortage of primary care physicians. While many people claim that one strategy necessary for health care reform is to change the primary care physician/specialty mix of providers, there are some inherent fallacies in this argument. Training for primary care medicine has historically been available; however, the majority of physicians choose specialty practice. The financial rewards are much better in specialty practice than in primary care. If the U.S. were to alter the reward structure and make primary care more attractive to physicians, the objective of controlling costs could not be met. However, there is another alternative and that is to change the provider mix. Since advanced practice nurses (APNs) have a long and successful history of taking care of primary care patients, why not make them the point of first contact? APNs working collaboratively with physicians could more cost effectively manage care for large numbers of ambulatory patients than are being adequately handled at present. APNs, defined as nurse practitioners, certified nurse midwives and clinical nurse specialists, provide high quality, cost effective, and comprehensive primary care services. Increased use of APNs in disease prevention, illness management, and health education is one way of meeting health care needs of Americans. Innovative strategies for more effectively using APNs must also be identified and implemented. Also, artificial and politically imposed barriers to effective utilization of APNs must be removed.
{"title":"Reform of primary health care: effective use of advanced practice nurses.","authors":"J. Lancaster, W. Lancaster, L. Onega","doi":"10.1300/J273V05N02_09","DOIUrl":"https://doi.org/10.1300/J273V05N02_09","url":null,"abstract":"Never before has American society undergone such dramatic and pervasive changes as those currently effecting national health care needs. New strategies to meet the health care needs created by societal changes must be identified. Consumers, employers, providers, and third-party payers are calling for more cost effective health care, better access and better quality. Simultaneously, the United States has a shortage of primary care physicians. While many people claim that one strategy necessary for health care reform is to change the primary care physician/specialty mix of providers, there are some inherent fallacies in this argument. Training for primary care medicine has historically been available; however, the majority of physicians choose specialty practice. The financial rewards are much better in specialty practice than in primary care. If the U.S. were to alter the reward structure and make primary care more attractive to physicians, the objective of controlling costs could not be met. However, there is another alternative and that is to change the provider mix. Since advanced practice nurses (APNs) have a long and successful history of taking care of primary care patients, why not make them the point of first contact? APNs working collaboratively with physicians could more cost effectively manage care for large numbers of ambulatory patients than are being adequately handled at present. APNs, defined as nurse practitioners, certified nurse midwives and clinical nurse specialists, provide high quality, cost effective, and comprehensive primary care services. Increased use of APNs in disease prevention, illness management, and health education is one way of meeting health care needs of Americans. Innovative strategies for more effectively using APNs must also be identified and implemented. Also, artificial and politically imposed barriers to effective utilization of APNs must be removed.","PeriodicalId":79661,"journal":{"name":"Journal of ambulatory care marketing","volume":"5 2 1","pages":"101-14"},"PeriodicalIF":0.0,"publicationDate":"1995-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66191405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Market planning: the key to ambulatory care success.","authors":"A. Zuckerman","doi":"10.1300/J273v05n02_06","DOIUrl":"https://doi.org/10.1300/J273v05n02_06","url":null,"abstract":"","PeriodicalId":79661,"journal":{"name":"Journal of ambulatory care marketing","volume":"5 2 1","pages":"69-74"},"PeriodicalIF":0.0,"publicationDate":"1995-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66191115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The research presented focuses on an examination of the relative importance of word-of-mouth, expert opinion, external communication, and past experience in the context of hospital choice. Past research has examined the effect of each individually and various combinations of the four sources, but not all four simultaneously. Results of the present study suggest that past experience plays a greater role in hospital choice than other information sources, including expert opinion. The strength of word-of-mouth as a source of information is also verified. The implications of this research include the following: (1) health care researchers need to incorporate word-of-mouth when investigating informations sources, and (2) local hospitals need to be aware of "negative perceptions" and strive for consumer satisfaction. Health care delivery systems incorporating consumer-based choice render these findings especially valuable as researchers and practitioners address the challenges that these evolving systems will bring.
{"title":"The relative importance of information sources in consumers' choice of hospitals.","authors":"S K Gooding","doi":"10.1300/j273v06n01_07","DOIUrl":"https://doi.org/10.1300/j273v06n01_07","url":null,"abstract":"<p><p>The research presented focuses on an examination of the relative importance of word-of-mouth, expert opinion, external communication, and past experience in the context of hospital choice. Past research has examined the effect of each individually and various combinations of the four sources, but not all four simultaneously. Results of the present study suggest that past experience plays a greater role in hospital choice than other information sources, including expert opinion. The strength of word-of-mouth as a source of information is also verified. The implications of this research include the following: (1) health care researchers need to incorporate word-of-mouth when investigating informations sources, and (2) local hospitals need to be aware of \"negative perceptions\" and strive for consumer satisfaction. Health care delivery systems incorporating consumer-based choice render these findings especially valuable as researchers and practitioners address the challenges that these evolving systems will bring.</p>","PeriodicalId":79661,"journal":{"name":"Journal of ambulatory care marketing","volume":"6 1","pages":"99-108"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21042452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Changing macroenvironmental factors have caused hospital administrators to reassess their positions across all service lines and market segments. This pilot study explores relationships among the service experience, satisfaction and future patronage decisions among 368 Medicare patients, an often overlooked segment, who were recent users of a hospital emergency room. Results show widespread dissatisfaction with aspects of care. Many of these patients report that they do not intend to return to the same emergency room and would discourage others from choosing it.
{"title":"Factors associated with emergency room choice among Medicare patients.","authors":"J L Mack, K M File, J E Horwitz, R A Prince","doi":"10.1300/j273v06n01_03","DOIUrl":"https://doi.org/10.1300/j273v06n01_03","url":null,"abstract":"<p><p>Changing macroenvironmental factors have caused hospital administrators to reassess their positions across all service lines and market segments. This pilot study explores relationships among the service experience, satisfaction and future patronage decisions among 368 Medicare patients, an often overlooked segment, who were recent users of a hospital emergency room. Results show widespread dissatisfaction with aspects of care. Many of these patients report that they do not intend to return to the same emergency room and would discourage others from choosing it.</p>","PeriodicalId":79661,"journal":{"name":"Journal of ambulatory care marketing","volume":"6 1","pages":"45-58"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21042446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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