How the public views hospital advertising: An empirical analysis

Abstract

This article represents the responses of 430 individuals to a mail survey examining views concerning advertising by hospitals. Historically, most professions prohibited licensed members from engaging in speech activities that proposed a commercial transaction, that is, advertising. However, the history of a hospital’s legal right to advertise is not the main focus of this article. A brief review of the past, present, and possible future of such rights might assist readers in understanding the revolutionary constitutional and commercial speech changes that have occurred over the past three decades. A hospital’s legal right to advertise has developed as part of the evolutionary interpretation of the First Amendment of the US Constitution. The purposes of this study were to determine (a) the public’s attitudes toward advertising by hospitals and (b) whether age, education, gender, marital status, number of children in household, occupation, race, and total family household income of an individual accounted for any significant differences in attitudes regarding hospitals that advertise.

Keywords

Routine service deception in advertising health-care professionals changing demographics health-care opinion leaders demographic factors professional code of ethics

Introduction

For the health professions, advertising has traditionally been a controversial issue, and the notion of using advertising to promote a professional’s practice is new and, to many, even startling. Many professionals find themselves ill-equipped to handle the dynamics of a changing environment, especially without some form of ongoing marketing plan. Most professional societies and associations have prohibited the marketing of their services, mainly because they considered themselves to be above the mainstream of the competitive marketplace.¹^–³

In 1975, the Federal Trade Commission (FTC) began an investigation into anticompetitive practices in the health-care profession.⁴ A FTC administrative law judge issued a decision that the American Medical Association (AMA) has caused substantial injury to the public by restricting advertising and other business practices of health-care providers. The decision says there is no doubt that the AMA has made substantial contributions toward improving the nation’s health care but that its restriction on advertising ‘serves to deprive consumers of the free flow of information about the availability of health-care services,’ has deterred ‘the offering of innovative forms of health-care,’ and has ‘stifled the use of almost every type of health-care delivery that would potentially pose a threat to the incomes of fee-for-service health-care providers in private practice.’⁵

Alfred F. Dougherty, Jr., deputy director of the FTC’s Bureau of Competition, said the commission’s complaint against the AMA was not designed to force health-care providers to advertise if they choose not to advertise. All the commission desired was to change the AMA’s code of ethics to permit enough advertising to give patients ‘a decisional basis for selecting one health-care provider as opposed to another.’^6,7 For hospitals who are currently advertising, as well as those who might be considering doing so, it would be helpful to have some insight as to how the public perceives advertising by hospitals.

Purpose of the study

During the past several years, hospitals have become highly competitive in marketing their services to the public. It has become common to see hospitals advertising their services via a number of media. The purposes of this study were to determine (a) the public’s attitudes toward advertising by hospitals and (b) whether age, education, gender, marital status, number of children in household, occupation, race, and total family household income of an individual accounted for any significant differences in attitudes regarding hospitals that advertise in the United States. Information discovered through this study can be used by hospitals to plan and improve the quality of their advertising.

Background and general research questions

Recently, many hospitals have begun to question the effectiveness of their marketing and advertising efforts. The researchers still find that hospital marketing has opponents as well as proponents. The opponents insist that advertising wastes money, is intrusive and manipulative, and will lower the quality of health care, cause health-care facilities to compete with each other, and create unnecessary demand. On the other hand, proponents maintain that marketing improves communication, pricing, efficient delivery of services, and target market satisfaction.^8,9

Often hospitals do not have well-defined products and services to offer the community. They have strategic directions but no products. Although some research indicates there is identifiable demand for hospital advertising, in the past, such advertising has primarily consisted of image-building designed to raise awareness of the hospitals among the general public. Now, the challenge is to implement a brand strategy to identify and promote whatever makes one hospital uniquely better than the competition.¹⁰

During the past 30 years, courts have often reviewed the issue of constitutional protection for professionals who advertise. The cases have addressed such issues as solicitation of patients in person, listing of professional practice specialties on letterheads, use of illustrations or photography in ads, and use of targeted direct mail solicitation. A review of these cases demonstrates that while the courts have permitted some state limitations on hospital advertising, the right of health-care professionals to engage in truthful commercial advertising has consistently been upheld.¹¹^–¹⁶

The business practices of health-care professionals have undergone many changes in the past 30 years. Despite the high quality of the health-care delivery system in the United States, many Americans do not receive the health care they need. Equal access to quality health care is a crucial issue facing the United States.^17,18 Individuals are becoming more involved in their own health care, seeking the drugs or pharmaceutical products that best meet their needs, and taking more responsibility for obtaining adequate information for treatments than in the past.¹⁹^–²¹ Today, it is fairly common in most parts of the United States for people to see one of the many thousands of hospital advertisements shown on television every day, receive a spam e-mail advertisement from a hospital or a physician, view one of the many hundreds of yellow-page hospital ads, while using the telephone book, or even see some of the hundreds of highway billboards promoting a hospital’s or physician’s services that are permitted in some areas of the nation.^22,23 A marketing budget has become critical for most medical providers. Many health-care and legal professionals now use marketing consulting firms or have their own internal marketing or advertising committees.²⁴ According to a study by Sanchez,²⁵ yellow-page advertising has been one of the most popular forms of health-care professional advertising. This study revealed that yellow-page advertising is a $9.5 billion a year industry, ranking only behind newspapers, television, and direct mail.²⁵ A study conducted by Butler and Abernethy revealed that every month approximately 21.6 million adults in the United States refer to the yellow pages before obtaining medical care,²⁶ although Reade and Ratzan found that yellow pages are potentially misleading to the public and suggested that members of the American Board of Medical Specialties should consider ways to diminish this possible misrepresentation.²⁷ Such ads are now the top revenue category for the yellow-page telephone directory with hospitals and professionals such as lawyers and physicians spending more than $700 million annually to be listed. In the year 2000, these professionals spent $230 million on television advertising just in the nation’s top 75 TV markets.²⁸

While the attitude of health-care professionals toward advertising is mixed, and the attitude of most state regulators has generally been negative, the attitude of consumers has historically been fairly positive.²⁹ Today, professional advertising has become commonplace, and there have been many academic studies and studies sponsored by professional associations designed to measure the attitude of the public and health-care providers toward advertising. The results of a study conducted by Moncrief and Bush revealed that the public felt advertising by professionals was somewhat helpful in making a decision about health-care providers.³⁰ For example, in 2000 alone, aging ‘baby boomers’ spent approximately $72 billion of their own money on health care in America.³¹ Still another technological change occurring in the United States is the dramatic increase in the use of the Internet as an information source for health-care consumers.³² Parker reported that many marketing departments at health-care organizations now view the Web as an effective medium for being more proactive in marketing programs and services to present or potential patients.³³

Several academic studies have focused on the chief concern of practicing health-care professionals: whether advertising by hospitals attracts new patients.³⁴^–³⁶ The answer has been a definite ‘yes.’ These studies show that most hospitals that advertise will likely see an increase in the number of middle- to lower-income patients. Hospitals quickly discover that while advertising is usually very expensive it works if done properly and ethically. One study found that the return on dollars invested by professionals in advertising was four to six times the cost.²⁸

The above discussion shows that professional advertising usually produces an increase in patient flow, yields a good return on hospital advertising dollars, and is found to be protected by the First Amendment. It shows that historically the public has not always had a positive view of hospitals that advertise but believe hospital advertisements provide useful information.

This study explores opinions regarding the image of, informational function of, importance of price in, presence of deception in, and future of hospital advertising. It further examines whether age, education, gender, marital status, number of children in household, occupation, race, and total family household income of an individual account for any significant differences in attitudes toward hospitals that advertise.

Procedure

Data collection

Much of the initial planning of this study was based on Hite’s study at the University of Arkansas.³⁷ Acknowledgment is given to both Hite’s research instrument and Miller and Waller’s,³⁸ which served as bases for the questionnaire in the current study. Also, acknowledgment is given to the organization and writing style of Hite’s study, which served as a model for this article.^37,38

The first section of the questionnaire was used to collect the data focused on demographic characteristics of the respondents, including age, education, gender, marital status, number of children in household, occupation, race, and total family household income. The frequencies and percentages of the survey participants are presented in Table 1.

Table 1.

Frequencies and percentages of demographic categories

Demographic variable	Variable categories	Frequencies	Percentages
Occupation	Professional	199	46.3
	Nonprofessional	220	51.2
	Missing	11	2.6
Age	18–25	11	2.6
	26–35	36	8.4
	36–45	51	11.9
	46 or older	329	76.5
	Missing	3	0.7
Sex	Male	255	59.3
	Female	173	40.2
	Missing	2	0.5
Race	White	357	83.0
	Black	57	13.3
	Other minority	11	2.6
	Missing	5	1.2
Marital status	Single	54	12.6
	Married	283	65.8
	Divorced	39	9.1
	Widowed	49	11.4
	Separated	2	0.5
	Missing	3	0.7
Income	$15,000 or less	27	6.3
	$15,001–30,000	50	11.6
	$30,001–45,000	54	12.6
	$45,001–60,000	62	14.4
	Over $60,000	218	50.7
	Missing	19	4.4
Education	Less than high school graduate	10	2.3
	High-school graduate	82	19.1
	Some college	101	23.5
	College graduate	152	35.3
	Advanced degree	81	18.8
	Missing	4	0.9
Children	0 in household	293	68.1
	1 in household	47	10.9
	2 in household	53	12.3
	3 in household	15	3.5
	4 or more in household	13	3.0
	Missing	9	2.1

The second section of the questionnaire included 19 statements designed to measure how favorably individuals perceived advertising by hospitals. The respondents were asked to indicate the strength of their agreement on a scale ranging from ‘strongly agree’ to ‘strongly disagree.’ Tables 2 through 6 contain these 19 statements.

Table 2.

Frequency percentages of the public’s responses to attitude statements about the image of hospital advertising

Statement	Strongly agree	Agree	Undecided	Disagree	Strongly disagree
4. It is proper for hospitals to advertise	7.7	39.6	26.2	15.9	10.5
9. I presently have a high image of hospitals	6.6	47.5	23.0	17.6	5.4
10. In general, my image of hospitals would be lower as a result of their advertising	6.8	15.2	22.6	43.4	12.1
15. Advertising by hospitals would tend to lower the credibility and dignity of their services	4.0	14.8	20.7	49.1	11.5
19. I would use the services (if needed) of hospitals that advertise	7.5	62.4	19.5	7.0	3.5

The researchers asked the Marketing System Group to draw a random sample of 4000 individuals from the seven metropolitan statistical areas in Tennessee (TN): Memphis, Nashville, Clarksville, Chattanooga, Knoxville, Jackson, and the Tri-Cities (Bristol, Kingsport, and Johnson City). Appropriate numbers from each city were drawn according to the ratio of each city’s population to the total population of all seven urban areas. The research instrument was mailed to these individuals, and 430 usable questionnaires were received and used in this study. This sample of 430 respondents represents a subset of the United States, more specifically a subset of the residents of the state of TN.

Demographic variables

The frequencies and percentages of the 430 survey participants are presented in Table 1. Participants in the present study were mostly White, male, aged 46 or older, and married, with a college education and high income. Participants in this sample do not match the population perfectly.

Statistical tests and findings

The data obtained from the 430 respondents were initially analyzed by tabulating the frequency percentages for each item on the questionnaire. Cross-tabulations were calculated between the demographic factors (age, education, gender, marital status, number of children in household, occupation, race, and total family household income) and the 19 attitudinal statements in Section II of the questionnaire. Chi-square tests were performed to detect any significant differences in group proportions within the cross-tabulations. In general, the chi-square analysis is employed when researchers want to determine whether there is an association between two or more populations or variables on a specific characteristic being studied.

The point at which a relationship is significant lies between 0.0 and 1.0. Values closer to zero have greater significance. The overall chi-square probabilities, reported in Tables 7–10, are commonly called p values. The larger the chi-square probability is, the more likely that the group proportions are the same. The smaller the chi-square probability is, the more likely that the group proportions are not the same. A small level of significance is set to ensure that one does not conclude that group proportions are different, unless there is a very small probability that the group portions are equal. A chi-square probability of 0.05 is commonly used by social scientists doing business research.³⁹ The level of significance for all statistical tests for this study was set at 0.05.

Findings

The data obtained from the 430 respondents were initially analyzed by tabulating the frequency percentages for each item on the questionnaire.

The public’s attitudes toward the advertising of hospital services

The percentages given in Table 2 illustrate the distribution of the responses to five statements in the questionnaire concerning attitudes toward hospital advertising. There are some general indications here. The responses to statement 9 indicate a somewhat favorable attitude toward hospitals, and responses to statements 10 and 15 indicate that advertising by hospitals will not lower that image. Whereas the responses to statement 19 indicate that most respondents would use (if needed) hospitals that advertise, slightly less than half agree that it is proper (statement 4) for hospitals to advertise with another fourth undecided.

Information function of advertising hospital services

The percentages given in Table 3 illustrate the importance of information in hospital advertising and show that opinions are somewhat mixed in this area. Whereas the respondents agree that advertising would be a useful means of informing potential clients about hospital services and specialties (statement 5) and makes the public more aware of the qualifications of hospitals (statement 16), only slightly more than half the respondents agreed with statement 1 that the public would be provided useful information through advertising by hospitals. Further, respondents are almost equally divided with respect to statement 11 that advertising would help the public make more intelligent choices between hospitals. What information is missing from hospital advertising that the public could use to make more intelligent choices among hospitals?

Table 3.

Frequency percentages of the public’s responses to attitude statements about the informational aspects of hospital advertising

Statement	Strongly agree	Agree	Undecided	Disagree	Strongly disagree
1. The public would be provided useful information through advertising by hospitals	11.7	40.6	19.5	17.8	10.3
5. Advertising by hospitals would be a useful means of informing potential patients about services and specialties	14.5	50.7	11.0	16.1	7.7
11. Advertising would help the public make more intelligent choices among hospitals	5.4	36.6	20.2	28.9	8.9
16. Advertising makes the public more aware of the qualifications of hospitals	8.0	50.0	12.9	21.4	7.7

Importance of price in advertising hospital services

The percentages given in Table 4 illustrate the importance of price in hospital advertising. Again, opinions are somewhat mixed in this area. Responses to statements 2 and 13 indicate the respondents generally agree that advertising increases costs to patients. However, respondents were almost equally split on statement 7 regarding using the lowest priced hospital for routine services. Yet, respondents, 2 to 1, favored contracting services from reputable hospitals rather than those offering the lowest price (statement 18). Not only does a hospital need a good reputation but that good reputation needs to be communicated to the public.

Table 4.

Frequency percentages of the public’s responses to attitude statements about the importance of price in advertising hospital services

Statement	Strongly agree	Agree	Undecided	Disagree	Strongly disagree
2. When hospitals advertise, the costs are passed on to their patients through higher prices	35.7	41.7	11.9	5.6	5.1
7. It is good to use the services of hospitals that offer the lowest price for routine services	10.5	29.2	22.2	29.0	9.1
13. When hospitals advertise, prices are lowered due to more competition	1.4	8.7	26.5	43.9	19.5
18. It is better to contract services from reputable hospitals rather than those that offer the lowest price	15.4	52.0	18.7	11.1	2.8

Deception in advertising hospital services

The percentages given in Table 5 illustrate the distribution of responses to statements in the questionnaire concerning deception in advertising hospital services. Most respondents did not agree with statement 17, that advertising by hospitals would benefit only quacks and incompetents, nor would they be suspicious of hospitals that advertise (statement 12). With respect to statement 6, that advertising by hospitals would be more deceptive than other forms of advertising, slightly more than half disagreed but over 30% were undecided. Respondents agreed (72.4%), however, with statement 8 that people can rely more on what friends tell them about hospitals than on advertising, although a recent study of 4531 adults found that 57% who receive health-care information do so through the Internet compared to 53% who receive information from friends and family.³²

Table 5.

Frequency percentages of the public’s responses to attitude statements about deception in hospital advertising

Statement	Strongly agree	Agree	Undecided	Disagree	Strongly disagree
6. Advertising by hospitals would be more deceptive than other forms of advertising	4.9	11.7	30.1	43.4	10.0
8. You generally can rely more on what a friend tells you about hospitals than on advertising	22.2	50.2	10.5	13.1	4.0
12. I would be suspicious of hospitals that advertise	3.8	15.5	18.4	50.1	12.2
17. Advertising by hospitals would benefit only quacks and incompetents	2.4	5.9	14.9	54.1	22.7

The future of hospital advertising

The percentages given in Table 6 illustrate the public’s responses to statements in the questionnaire concerning the public’s attitude toward the future of hospital advertising. Almost sixty per cent disagreed with statement 3 that advertising would increase the quality of hospital services in the future, and about half of the respondents disagreed with statement 14 that they would like to see more advertising by hospitals. The question to consider is how to change the nature of existing advertising to improve the public’s image of a hospital.

Table 6.

Frequency percentages of the public’s responses to attitude statements about future aspects of hospital advertising

Statement	Strongly agree	Agree	Undecided	Disagree	Strongly disagree
3. Advertising will increase the quality of hospital services in the future	3.5	14.5	24.0	38.5	19.6
14. I would like to see more advertising by hospitals	2.4	14.4	32.5	29.9	20.9

Impact of demographic characteristics on the public’s attitudes

Significant differences in the public’s attitudes were found with regard to education, income, occupation, and race of the respondents for two or more of the 19 statements. Because the cross-tabulations of age, sex, marital status, and number of children in household were significant for at most 1 of the 19 statements, it appears that the perceptions or attitudes within these demographics toward hospital advertising are similar to the responses for all respondents. Findings follow for cross-tabulations of education, income, occupation, and race for all statements, for which significant differences (0.05 level) in attitudes were found.

Education of respondents and advertising by hospitals

The 430 respondents were divided into a low-education group and a high-education group. The low-education group was defined as having less than a college degree and the high-education group as having a college degree. As shown in Table 7, three areas were found in which a significant difference existed between the attitudes of the two groups. Their overall opinion of the three statements was the same, but a difference was found in the level of agreement or disagreement on certain questions. Both education groups agreed that when hospitals advertise, the costs are passed on to their patients through higher prices (statement 2), but the percentage of agreement was higher in the more-educated group. Both education groups disagreed that advertising would increase the quality of hospital services in the future (statement 3) and that advertising by hospitals would benefit only quacks and incompetents (statement 17), and for both statements the higher percentage of disagreement was in the more-educated group.

Income of respondents and advertising by hospitals

The sample of 430 respondents was divided into three groups based on the level of annual household income: families earning $30,000 or less, families earning $30,001 to $60,000, and families earning more than $60,000. As shown in Table 8, three areas were found in which a significant difference existed in the attitudes of the two groups. All three income groups agreed that when hospitals advertise, the costs are passed on to their patients through higher prices (statement 2), but the percentage of agreement was progressively higher as income increased. All three income groups disagreed that advertising would increase the quality of hospital services in the future (statement 3) and that advertising by hospitals would benefit only quacks and incompetents (statement 17), and for both statements the higher percentages of disagreement tended to be in the higher income groups. Note that the statements in Table 8 for income are the same statements as in Table 7 for education. A cross-tabulation of income and education showed that lower education was associated with low income and higher education was associated with high income.

Table 7.

Differences in the public’s attitudes toward advertising by hospitals based on education*

Education significance	Attitude response
Education significance	Agree or strongly agree	Undecided	Disagree or strongly disagree	Overall chi-square probability
2. When hospitals advertise, the costs are passed on to their patients through higher prices
Lower	138 (71.9)	27 (14.1)	27 (14.1)	0.0417
Higher	191 (82.0)	23 (09.9)	19 (08.2)	—
3. Advertising will increase the quality of hospital services in the future
Lower	41 (21.4)	54 (28.1)	97 (50.5)	0.0117
Higher	34 (14.6)	48 (20.6)	151 (64.8)	—
17. Advertising by hospitals would benefit only quacks and incompetents
Lower	23 (12.3)	24 (12.8)	140 (74.9)	0.0233
Higher	12 (05.2)	39 (16.8)	181 (78.0)	—

Values in parentheses indicate row percentages.

Table 8.

Differences in the public’s attitudes toward advertising by hospitals based on income*

Income significance	Attitude response
Income significance	Agree or strongly agree	Undecided	Disagree or strongly disagree	Overall chi-square probability
2. When hospitals advertise, the costs are passed on to their patients through higher prices
Low	49 (64.5)	15 (19.7)	12 (15.8)	0.0142
Middle	85 (73.3)	15 (12.9)	16 (13.8)	—
High	181 (83.0)	19 (08.7)	18 (08.3)	—
3. Advertising will increase the quality of hospital services in the future
Low	19 (25.0)	23 (30.3)	34 (44.7)	0.0494
Middle	26 (22.4)	24 (20.7)	66 (56.9)	—
High	31 (14.2)	52 (23.9)	135 (61.9)	—
17. Advertising by hospitals would benefit only quacks and incompetents
Low	13 (17.6)	9 (12.9)	52 (70.3)	0.0322
Middle	8 (07.0)	16 (13.9)	91 (79.1)	—
High	13 (06.0)	36 (16.7)	167 (77.3)	—

Values in parentheses indicate row percentages.

Occupation of respondents and advertising by hospitals

The 430 responses were divided into two groups by respondents’ occupation: professional and nonprofessional. Table 9 shows the significant differences between the attitudes of these two groups with regard to advertising by hospitals. As shown in Table 9, three areas were found in which a significant difference existed between the attitudes of the two groups. In one area there was disagreement in overall opinions between the two groups. Both groups tended to disagree with statement 3 that advertising will increase the quality of hospital services in the future and statement 15 that advertising by hospitals would tend to lower the credibility and dignity of their services. However, the level of disagreement with statement 3 was more pronounced in the professional group than the nonprofessional group, whereas the level of disagreement with statement 15 was about the same for both occupation groups. In response to statement 11 that advertising would help consumers make more intelligent choices between hospitals, more of the nonprofessional respondents agreed, while more of the professional respondents disagreed. What information can be provided by advertising to help more professionals choose among hospitals?

Table 9.

Differences in the public’s attitudes toward advertising by hospitals based on occupation*

Occupation significance	Attitude response
Occupation significance	Agree or strongly agree	Undecided	Disagree or strongly disagree	Overall chi-square probability
3. Advertising will increase the quality of hospital services in the future
Nonprofessional	46 (21.0)	65 (29.7)	108 (49.3)	0.0003
Professional	27 (13.6)	35 (17.6)	137 (68.8)	—
11. Advertising would help the public make more intelligent choices among hospitals
Nonprofessional	103 (47.7)	37 (17.1)	76 (35.2)	0.0474
Professional	72 (36.2)	47 (23.6)	80 (40.2)	—
15. Advertising by hospitals would tend to lower the credibility and dignity of their services
Nonprofessional	33 (15.3)	53 (24.5)	130 (60.2)	0.0466
Professional	45 (22.6)	33 (16.6)	121 (60.8)	—

Values in parentheses indicate row percentages.

Race of respondents and advertising by hospitals

The sample of 430 respondents was divided into two groups: White and non-White. Table 10 shows the two areas in which a significant difference existed between the attitudes of the two groups. In response to statement 7 that it is good to use the services of hospitals that offer the lowest prices for routine services, more of the non-White respondents agreed, while more of the White group disagreed. Both groups tended to agree with statement 18 that it is better to contract services from reputable hospitals rather than those that offer the lowest price, but the level of agreement was stronger for the White group compared to the non-White group. Should hospitals use advertising of low prices in markets that are predominately non-White?

Table 10.

Differences in the public’s attitudes toward advertising by hospitals based on race*

Race significance	Attitude response
Race significance	Agree or strongly agree	Undecided	Disagree or strongly disagree	Overall chi-square probability
7. It is good to use the services of hospitals that offer the lowest price for routine services
White	130 (36.5)	81 (22.8)	145 (40.7)	0.0126
Non-White	37 (55.2)	13 (19.4)	17 (25.4)	—
18. It is better to contract services from reputable hospitals rather than those that offer the lowest price
White	246 (69.9)	65 (18.5)	41 (11.6)	0.0025
Non-White	35 (53.0)	13 (19.7)	18 (27.3)	—

Values in parentheses indicate row percentages.

Limitations

As with most empirical studies, one should be cautious in making inferences to the population based on the survey sample. The sample must be representative of the population; this is the reason that random samples rather than convenience samples are used. The researchers attempted to get a random sample that represented the residents of the state of TN, part of the southeastern portion of the United States of America. In particular, when compared to 2000 census data for the state of TN regarding age, education, income, marital status, race, and sex, the sample is overrepresented with respect to older (TN – 45.3% 46 or older), more educated (TN – 24.3% college or advanced degree), higher income (TN – 25.7% over $60,000), married (TN – 52.6%), White (TN – 79.2%), and male (TN – 48.7%) groups.⁴⁰ With the exception of race, the demographics of the respondents to the survey do not closely match those of residents of the state of TN. If the survey sample tended to be quite a bit younger than expected for TN, it could be an issue; young people typically do not have as many health issues as older people. If the survey sample contained a larger percentage of people with lower incomes (which correlates with lower education) than expected for TN, it could be an issue; lower income patients do not always have a choice of which hospital. Any application of the results of this research should also reflect that the survey sample contains more men and more married individuals than expected for a random sample from the population of TN residents.

Conclusions

A number of conclusions can be drawn from the results of this study. First, the public looks for and favors advertising as a means of obtaining certain types of information about hospital services. The responses in Table 2 suggest the public has a favorable attitude toward hospitals that advertise. The responses in Table 3 indicate the public feels that advertising by hospitals could help them learn about hospital services and specialties and qualifications of hospitals, but the public is split as to whether hospital advertising provides useful information or would help them choose among hospitals. Yet, the analysis of Table 9 demonstrates that nonprofessionals use advertising more than professionals to help them choose a hospital.

Responses in Tables 4 and 10 make it clear that the public values reputation over price. Although the analysis provided in Table 10 suggests that members of the non-White group are more likely to use the services of hospitals offering the lowest price for routine services than members of the White group, marketing low prices for routine services to the non-White group is not recommended due to the small number of non-White respondents in the survey group.

The results in Table 5 show that, even though the majority of the public does not consider hospital advertising to be deceptive, most members of the public trust their friends more than advertising; and analysis of Table 10 shows that members of the White group, more so than the non-White group, trust their friends more than advertising.

These results suggest that hospitals that are currently advertising should probably replace some of their advertising about prices with information advertising but not just about hospital services, specialties, and qualifications. The overall implication seems to be that the public wants hospital advertising to provide some other type of information. Yet, the responses in Table 6 imply that the public does not want that other type of information to be provided via additional advertising.

One possible replacement for some of these more traditional forms of advertising is some form of ‘patient-centric’ advertisement.⁴¹ Rather than touting the new building or the latest technological marvel of diagnostic equipment, try to persuade potential patients that the doctors and nurses really care about their patients. Show potential patients how the hospital provides innovative services that make the hospital stay easier on patients and their families.

Footnotes

Author's Biographies

H. Ronald Moser is a professor of marketing and business administration in the Labry School of Business & Technology at Cumberland University, Lebanon, Tennessee. He earned a B.S. from Tennessee Technological University, M.B.A from Middle Tennessee State University, and doctorate from the University of Tennessee, Knoxville. He is the co-author of a textbook: William E. Warren and H. Ronald Moser, Marketing Management Text and Cases, Prentice Hall Custom Business Resources 2008, and the author of more than 100 basic and applied research articles, published presentations, and cases in marketing management and related areas. His articles have appeared in the International Journal of Advertising, Journal of Professional Services Marketing, Services Marketing Quarterly, Health Marketing Quarterly, Journal of Hospital Marketing & Public Relations, Regional Business Review, Journal of Medical Marketing, Journal of Promotional Management, Journal of Marketing for Higher Education, and National Social Science Journal.

Gordon L. Freeman is an associate professor of computer information systems in the Jennings A. Jones College of Business at Middle Tennessee State University, Murfreesboro, Tennessee. He earned a B.S. and M.S. from Tennessee Technological University, M.S. from Middle Tennessee State University, and Ph.D. from Vanderbilt University. He has also earned professional certifications as a C.D.P and C.C.P. His articles have appeared in the Academy of Information and Management Sciences Journal, Business Journal for Entrepreneurs, International Journal of Business Disciplines, Journal of Business and Economic Perspectives, Journal of Education for Business, Journal of Medical Marketing, Journal of Promotion Management, Journal of Systems and Software, National Social Science Journal, and Services Marketing Quarterly.

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