CONSUMER BEHAVIOR IN HEALTHCARE
Colonel Zulfiquer Ahmed Amin
M Phil, MPH, PGD (Health Economics), MBBS
Armed Forces Medical Institute (AFMI)

Remember Me?
I'm the fellow who goes into a restaurant, sits down and patiently waits while the
waitresses do everything but take my order. I'm the fellow who goes into a
department store and stands quietly while the sales clerks finish their little
chitchat. I'm the man who drives into a gasoline station and never blows his
horn, but waits patiently while the attendant finishes reading his comic book.
"Yes, you might say, I'm a good guy. But do you know who else I am? I am the
fellow who never comes back, and it amuses me to see you spending
thousands of dollars every year to get me back into your store, when I was
there in the first place, and all you had to do to keep me was to give me a little
service; show me a little courtesy."
Source: From a Better Business Bureau bulletin submitted by An Arkansas Reader
to Dear Abby

Who is a consumer?
In simple words a consumer can be described as:
A person or a group of people or an organization that is specifically
targeted to sell a products or a service of a company.
OR
Someone or group or an organization that pays a price to use the
goods and services of an organization.
OR
A person or a group or an organization who is the final user of the
goods and the services produced by a company.
OR
All of the three definitions above in combination, to define a
consumer.

Decision making is the power given to the consumer.
The consumer market is where the consumer has the right and the
power to make a decision of spending their money. Even buying a
packet of chips from a store is being a part of the consumer
market. Here you are also taking a decision. This is a decision of
buying goods and spending your money.

Consumer Behavior
Consumer Behavior is the process Involved, when Individuals or
groups select, purchase, use, or dispose of products, services, ideas
or experiences to satisfy needs and desires.
Consumer behavior is the study of individuals, groups, or
organizations and all the activities associated with the purchase,
use and disposal of goods and services, including the consumer's
emotional, mental and behavioral responses that precede or follow
these activities.

Consumers are unique in themselves; they have needs and wants
which are varied and diverse from one another; and they have
different consumption patterns and consumption behavior. The
marketer helps satisfy these needs and wants through product
and service offerings.
WHY STUDY CONSUMER BEHAVIOR

For a firm to survive, compete and grow, it is essential that the
marketer identifies these needs and wants, and provides product
offerings more effectively and efficiently than other competitors.
A comprehensive yet meticulous knowledge of consumers and
their consumption behavior is essential for a firm to succeed.

The consumption of health services has been considered as ‘process
consumption’ and is not simply viewed as the outcome of a
production process, as is the case in the traditional marketing of
physical goods. The service-dominant logic also supports that service
should be defined as a process (rather than a unit of output) and
refers to the application of competencies (knowledge and skills) for
the benefit of the consumer. Here, the primary goal of a business is
value co-creation as ‘perceived and determined by the customer on
the basis of value-in-use.

BACKGROUND
Consumer behavior emerged in the 1940s and 50s as a distinct sub-
discipline in the marketing area. Consumer behavior is an inter-
disciplinary social science that blends elements from psychology,
sociology, anthropology**, ethnography*, marketing*** and
economics.
*Systematic study of people and cultures
** Study of humans and human behavior and societies in the past and present.
*** Study and management of exchange relationships. Marketing is used to create, keep
and satisfy the customer.

It examines how emotions, attitudes and preferences affect buying
behavior. Characteristics of individual consumers such as
demographics, personality, lifestyles and behavioral variables, in an
attempt to understand people's wants and consumption are all
investigated in consumer behavior. The study of consumer behavior
also investigates the influences, on the consumer, from groups such
as family, friends, sports, reference groups, and society in general

Functions of Consumer Behavior:
-Provide value and customer satisfaction.
-Effectively target customers.
-Enhance the value of the company.
-Improve products and services.
-Create a competitive advantage.
-Understand how customers view their products versus their
competitors’ products.
-Expand the knowledge base in the field of marketing,
-Apply marketing strategies toward a positive affect on society
(Encourage people to support charities, promote healthy habits,
reduce drug use etc.)

Important factors that influence consumer behavior

1. Consumer Behavior – Cultural factors
It is sub divided in to:
A. Culture
Culture refers to the set of values, ideas, and attitudes that are
accepted by a homogenous group of people and transmitted to the
next generation.
Culture needs to be examined as it is a very important factor that
influences consumer behavior. Culture determines what people
wear, eat, reside and travel. Cultural values in the US are good
health, education, individualism and freedom. Cultural values in
Bangladesh is in line with Islamic traditions.

How Culture Is Learned? :
Culture is learned through :- Enculturation, Acculturation, Language &
Symbols and Ritual.
-Enculturation:
The learning of one’s own culture is known as enculturation eg ; when
a mother teaches her child about their culture can be called as
enculturation.
-Acculturation:
The learning of a new or foreign culture is known as acculturation eg ;
when an american tries to learn about Bangladeshi culture would be
called as acculturation.

-Language and Symbols :
To acquire a common culture, the members of a society must be
able to communicate with each other through a common language.
Basically, the symbolic nature of human language sets it apart from
all other animal communication. Symbols can be verbal or
nonverbal.

-Ritual :
A ritual is a type of symbolic activity consisting of a series of steps
occurring in a fixed sequence and repeated over time. It is often
formal and scripted—i.e., proper conduct is prescribed. Important to
marketers, rituals tend to be replete with ritual artifacts (products)
that are associated with, or somehow enhance, performance of the
ritual.

B. Sub-Culture
Subcultures It is a distinct cultural group that exists as an identifiable
segment within a larger, more complex culture. eg, Age, Region,
Gender, Social Class, Religion etc.

C. Social Class-
Human Societies are socially stratified. The roles performed by
various people are valued differently. Differentiation among roles
and their relative evaluation leads to stratification of society. Social
Classes are easily identifiable market segments which can be
reached with relative ease since they have distinctively defined
habits. Consumer Behavior changes with the change in the social
class. Criteria of social class: Occupation, education, income,
wealth, race, ethnic groups and possessions.

Examples of Social Class in USA:
-Upper-upper class, 0.3%, inherited wealth, aristocratic names.
-Lower-upper class, 1.2%, newer social elite, from professionals
and corporate elite
-Upper-middle class, 12.5%, college graduates, managers and
professionals
-Middle class, 32%, average pay white collar workers
-Working class, 38%, average pay blue collar workers
-Lower class, 9%, working, not on welfare
-Lower-lower class, 7%, on welfare
Lower class people tend to stay close to home when shopping, do not engage in much
pre-purchase information gathering. Upper middle class Americans prefer luxury cars
Mercedes.

2. Consumer Behavior – Social Factors
Social factors are also subdivided into the following:
-Reference groups
Individual identifies with the group to the extent that he takes-on
many of the values, attitudes or behaviors of the group members.
Families, friends, sororities (Society for female students in a
university), civic and professional organizations (Military, doctor etc).
Any group that has a positive or negative influence on a persons
attitude and behavior.

-Family
The behavior of a consumer is also influenced by their families.
Family is the most basic group a person belongs to.
Marketers must understand:
-that many family decisions are made by the family unit
-consumer behavior starts in the family unit
-family roles and preferences are the model for children's
future family
-family buying decisions are a mixture of family interactions and
individual decision making
-family acts as an interpreter of social and cultural values for
the individual.

Because dual-income families are becoming more common, the
decision maker within the family unit is changing. Also, family has
less time for children, and therefore tends to let them influence
purchase decisions in order to alleviate some of the guilt. (Children
influence about $130 billion of goods in a year) Children also have
more money to spend themselves.

-Role and status
People who belong to different organizations, groups or club
members and families play roles and have a status to maintain.
These roles and status that they have to maintain also influences
consumer behavior as they decide to spend accordingly.
-Opinion leaders
Spokespeople etc. Marketers try to attract opinion leaders. They
actually use (pay) spokespeople to market their products. Michael
Jordon (Nike, McDonalds, Gatorade*etc.)
* Company, Inc. is an American manufacturer of sports-themed beverage and food products

3. Consumer Behavior – Personal factors
Unique to a particular person. Demographic Factors. Sex, Race, Age
etc. Young people purchase things for different reasons than older
people. Highlights the differences between male and female
shoppers in the supermarket.

-Age and life cycle stage
Age of a consumer and his life cycle are two most important sub
factors under personal factors. With the age and the life cycle the
consumers purchase options and the motive of purchase changes.
-Occupation
Occupation of a consumer affects the goods and services a
consumer buys. In fact organizations produce separate products for
different occupational groups.

-Life style
Lifestyles are the consistent patterns people follow in their lives.
People originating from different cultures, sub cultures, occupations
and even social class have different styles of living. Life style can
confirm the interest, opinions and activities of people. Different life
styles affect the purchase pattern of consumers.

4. Consumer Behavior – Psychological factors
A. Motivation
A motive is an internal energizing force that orients a person's
activities toward satisfying a need or achieving a goal.
Actions are effected by a set of motives.
MASLOW’s hierarchy of needs:
-Physiological
-Safety
-Love and Belonging
-Esteem
-Self Actualization
Need to determine what level of the hierarchy the consumers are at
to determine what motivates their purchases.

Nutrament, a product marketed by Bristol-Myers Squibb originally
was targeted at consumers that needed to receive additional energy
from their drinks after exercise etc., a fitness drink. It was therefore
targeted at consumers whose needs were for either love and
Belonging or esteem. The product was not selling well, and was
almost terminated. Upon extensive research it was determined that
the product did sell well in inner-city convenience stores. It was
determined that the consumers for the product were actually drug
addicts who couldn't not digest a regular meal. They would purchase
Nutrament as a substitute for a meal. These consumers were at the
Physiological level of the hierarchy.

B. Perception
Perception is sensing the world and the situations around and then
taking a decision accordingly. Perception is the process of selecting,
organizing and interpreting information inputs to produce meaning.
Every individual look as the world and the situations differently. This
is what separates the decision taking abilities.

Perception is influenced by:
-Selective Exposure
Refers to individuals' tendency to favor information which
reinforces their pre-existing views while avoiding contradictory
information. Selective exposure can affect the decisions people
make as individuals or as groups because they may be unwilling to
change their views and beliefs.

-Selective Distortion
Selective distortion is the tendency to interpret information in a
way that will fit our preconceptions. Consumers will often distort
information to be consistent with prior brand and product beliefs.
For example, one study found that consumers were equally split in
their preference for Diet Coke versus Diet Pepsi when tasting both
on a blind basis. When tasting the branded versions, however
consumers preferred Diet Coke by 65% and Diet Pepsi by only 23%
(with the remainder seeing no difference).

-Selective Retention
People will fail to register much information to which they are
exposed in memory, but tend to retain information that supports
their attitudes and beliefs. Because of selective retention, we are
likely to remember good points about a product we like and forget
good points about competing product. Selective retention again
works to the advantage of strong brands.
It also explains why marketers need to use repetition in sending
messages to their target market to make sure their message is not
overlooked.

C. Learning and experience
Learning is the process through which a relatively permanent
change in behavior results from the consequences of past behavior.
We will avoid foods that we consumed shortly before becoming ill.
We will avoid the doctor who behaved badly in our past encounter.

D. Attitude and beliefs
Attitude is a consumer’s favorable and unfavorable emotional
condition or emotional feeling - maybe tangible or intangible,
towards an object or activity.
Consumer attitudes toward a firm and its products greatly influence
the success or failure of the firm's marketing strategy.
Honda "You meet the nicest people on a Honda", dispel the
unsavory image of a motorbike rider, late 1950s.

E. Personality-
All the internal traits and behaviors that make a person unique.
Uniqueness arrives from a person's heredity and personal
experience. Examples include:
*Workaholism
Compulsiveness
Self confidence
Friendliness
Adaptability
Ambitiousness
Dogmatism
Authoritarianism
Introversion
Extroversion
Aggressiveness
Competitiveness.
* A person who works hard compulsively and long hours.

There is a association between personality and Buying Behavior. Nike
ads. Consumers buy products that are consistent with their self
concept.

Stages of the Consumer Buying Process

1. Problem Recognition (Awareness of need)-
Difference between the desired state and the actual condition.
Hunger--Food. Hunger stimulates your need to eat. Can be
stimulated by the marketer through product information. I.E.,
see a commercial for a new pair of shoes, stimulates your
recognition that you need a new pair of shoes.
6 stages of consumer buying process:

2. Information search–
- Internal search, memory.
- External search; if you need more information. Friends
and relatives (word of mouth). Marketer dominated
sources; comparison shopping; public sources etc.
A successful information search leaves a buyer with possible
alternatives, the evoked set (When a customer wants to make a
purchase and narrows down a product to a few brands, these
brands are called an evoked set). Hungry, want to go out and eat,
evoked set is:
-Bangla food
-Chinese food
-Indian food
-Burger king etc

3. Evaluation of Alternatives—
Need to establish criteria for evaluation, features the buyer wants
or does not want. Rank/weight alternatives or resume search. May
decide that you want to eat something spicy, ‘deshi Food’ gets
highest rank etc. Marketers try to influence by "framing"
alternatives.

4. Purchase decision- Choose buying alternative, includes
product, package, store, method of purchase etc.
5. Purchase- May differ from decision, time lapse between
purchase decision and real purchase, product availability etc.
6. Post-Purchase Evaluation-outcome: Satisfaction or
Dissatisfaction.
Cognitive Dissonance, have you made the right decision. This
can be reduced by warranties, after sales communication etc.
After eating an Indian meal, may think that really you wanted a
Thai meal instead.

Stages of Consumer Decision Making Process

Types of Consumer Behavior
Types of consumer buying behavior are determined by:
-Level of Involvement in purchase decision.
-Importance and intensity of interest in a product in a particular
situation.
-Buyers level of involvement determines why he/she is
motivated to seek information about a certain products and
brands but virtually ignores others.

The level of involvement reflects how personally important or
interested you are in consuming a product and how much
information you need to make a decision.
Involvement denotes:
-Social risk
-Personal risk
-Economic risk

4 Types of Consumer Behavior
1. Programmed or routine behavior
There are items consumers are used to purchasing every day, once
a week or monthly. These can range from a morning cup of coffee
from a nearby convenience store, to milk, eggs and cheese from
the supermarket. Customers spend very little time deciding
whether or not to purchase these items and don't typically need to
read reviews or consult with friends for their opinions before they
make routine purchases.

2. Buying products occasionally or limited decision making
Buying product occasionally. When a consumer tries to gain
information about unfamiliar brands of familiar products of not
very high value goods. The time required to gather such
information is quite moderate for example buying of goods like
clothes and cosmetics.

3. Complex and involvement or extensive decision making
High involvement, unfamiliar, expensive and/or infrequently bought
products. Buying of products such as computers, laptops, property,
cars, education, etc which requires a huge amount of research and
economic involvement comes under this category or type.
Consumers spend substantial amounts of time researching a high
number of potential options before they buy. They speak with
trusted friends, family, colleagues and sales professionals, and read
reviews and ratings online and in consumer magazines. The decision
making process lasts longer. Go through all six stages of the buying
process.

4. Impulse buying
Some low-involvement purchases are made with no planning or
previous thought. These buying decisions are called impulse buying.
Spur of the moment, unplanned decision to buy, made just before a
purchase. Emotions and feelings play a decisive role in purchasing,
triggered by seeing the product or upon exposure to a well crafted
promotional message.
When a consumer stands at the checkout and notices lip moisturizer,
magazines and gum, and adds one of the items to his cart of
groceries, it's often referred to as an impulse purchase. In most
instances this happens with low-priced items.

Categorization of Buying Behavior basing on
‘Involvement’ and ‘differences between brands’

High involvement:- the term means when the consumer is highly
involved while buying a product. Generally this situation happens in
case of expensive or luxuries goods. Like while buying a diamond
necklace a consumer is highly involved.
Low involvement:- this term means when the consumer is not
highly involved while buying a product. It happens in case of low
price goods. Like while buying toothpaste a consumer is not highly
involved.

Significant differences between brands:- it means when there are
significant differences between brands.
Few differences between brands:- it means when there are very
little differences between brands.

1. Complex buying behavior:- when the consumer is highly involved
in the buying and there is significant differences between brands
then it is called complex buying behavior. So in this case the
consumer must collect proper information about the product
features. eg. Consumer while buying a car, property, education etc.

2. Variety seeking behavior:- In this case consumer involvement is
low while buying the product but there are significant differences
between brands. Consumers generally buy different products not
due to dissatisfaction from the earlier product but due to seek
variety. Like every time they buy different washing detergent just for
variety.

3.

Post-Purchase Dissonance:
It is "after the sale discomfort". Post-Purchase Dissonance will
begin once a consumer begins to "notice" any disadvantages of
their purchase, and begin to hear "good" things about the other
products they did not buy.
To counter these feelings, marketers should be running after-sale
communication campaigns with focused targeted messaging. These
campaigns should give encouragement and help support
consumers, convincing them to continue to "feel good" about their
brand choice.

4. Habitual buying behavior:-
In this case there is low involvement of the consumer and there are
few differences between brands. The consumer buys the product
quickly. eg. Toothpaste.

Simple Model of Consumer Behavior

Marketing Mix is a combination of factors that can be controlled by
a company to influence consumers to purchase its products.
It is about putting the right product or a combination thereof in the
place, at the right time, and at the right price.

A marketing expert named E. Jerome McCarthy created the
Marketing 4Ps in the 1960s.

Marketing 4Ps:
1. Product: A product is an item that is built or produced to satisfy
the needs of a certain group of people. The product can be
intangible or tangible as it can be in the form of services or goods.
Marketers must ensure right type of product that is in demand in the
market.

2. Price: The price of the product is basically the amount that a
customer pays for to enjoy it. It is also a very important component of
a marketing plan as it determines firm’s profit and survival. This is
inherently a touchy area though. Both high and low prices are risky.
Always remember that a low price usually means an inferior good in
the consumers eyes. Again, prices too high will make the costs
outweigh the benefits in customers eyes.

3. Place: Placement or distribution is a very important part of the
product mix definition. You have to position and distribute the
product in a place that is accessible to potential buyers.
4. Promotion: Promotion is a very important component of
marketing as it can boost brand recognition and sales.

Relevance of Consumer Behavior in Healthcare

For a variety of reasons ranging from the purely humanitarian to the
purely economic, marketing has become an accepted activity in
many health care institutions and settings. The functions that
marketing is expected to serve in the health care field are not
dissimilar to the functions marketing is expected to fulfill in the
commercial sector of the economy. And it is not surprising that the
marketing problems faced by many health care institutions are
similar to those faced by firms in the commercial sector.
Health Behavior Model is a classical example of how different stages
of Consumer Behavior fits with decision making about health-
seeking behavior.

HBM

Consumer Behavior in Healthcare
Problem
• Perceived Susceptibility
• Perceived Severity
Information
• Perceived Threat
Evaluation
• Perceived Benefits
• Perceived Barriers
Purchase
• Seeking Healthcare Services
Post
Purchase
• Satisfaction or Dissatisfaction
• Continue of Discontinue

HBM and Consumer Behavior

Conclusion
Health strategies cannot be achieved without a deep knowledge of
consumer behavior towards health services and factors of its
influence. Some of these factors related to policy applied by health
legislation, which limits consumer access to certain services and on
the other hand, there are a number of cultural factors, social,
personal and psychological factors that determine health care
consumer behavior.

In addition, consumer behavior is the result of various stakeholders,
such as doctors recommending or prescribing consumption or use of
services, opinion leaders, people who by their social position, and
influence the behavior of consumers, family members or groups who
individual belongs.

It is true, that health services consumers differ from consumers of
other types of goods and services, because of certain particularities
arising from the specific character of the market, of the supplier -
consumer relations, of the manner how the health system is
organized. Unlike other fields, in which the number of consumers is
usually limited, in the field of health services, in theory, anybody can
become a consumer at a particular moment, and consequently the
potential market is very large.

On the basis of the needs, healthcare-consumers can be divided into
four categories: The first category consists of persons who face
severe health problems that require specialized staff and
equipment; the second category consists of persons who attend
routine investigations, persons who go to doctors' offices for
treatment voluntarily; the third category consists of persons who
need optional services; the fourth category consists of persons who
do not turn to medical services, who, most of the times, treat
themselves on their own.

Study on consumer behavior can identify those in need of care,
bring them under service-care through persuasion and ensure
satisfaction of the consumers.