Journal of Marketing Management

Vol. 27, Nos. 34, March 2011, 199206

Value Marketing in the Health Care Industry

Adam Lindgreen, University of Birmingham, UK & IESEG School
of Management, France
Martin K. Hingley, Harper Adams University College, UK
Michael D.J. Antioco, EM LYON Business School, UK

Introduction
In business and industrial marketing, upstream and downstream alike, the creation of
value is paramount to any companys survival (Kotler & Keller, 2008) and even more
so at a time where dramatic changes in business and industrial marketings context
are leading to fundamental changes in what companies should be analysing, creating,
and delivering (Doyle, 2000; Hunt, 2000). Value has been examined in the marketing
management literature (e.g. Albrecht, 1992; Alderson, 1957; J.C. Anderson & Narus,
1999; P. Anderson, 1982; Doyle, 2000; Drucker, 1973; Woodruff, 1997), as well
as the purchasing and supply management literature (e.g. Carr & Ittner, 1992;
Ellram, 1995; Van Weele, 2001; Wouters, Anderson, & Wynstra, 2005). Two more
or less distinct research streams can be identified within this literature (Lindgreen
& Wynstra, 2005). The first of these streams deals with the value of products and
services, whilst the second stream focuses on the value of buyerseller relationships.
Despite its identified importance, value is a complex issue. In fact, the literature
remains scarce on studies examining how selling companies in reality analyse, create,
and deliver value to buying companies (Lindgreen, in press). This special issue seeks
to address this gap in the literature by examining various issues relating to the
different facets of value that result from the crossing of the two research streams
with the three themes of analysis, creation, and delivery.

Structure and context of the special issue

The special issue addresses value marketing within a particular setting that of
the health care industry (cf. Lindgreen, Antioco, Harness, & van der Sloot, 2009a;
Lindgreen, Antioco, Palmer, & van Heesch, 2009b). Competition in this industry
was previously limited. Over the past years, however, the health care industry in
many countries has changed dramatically, and market pressures have increased (Frost
& Sullivan, 2004; Pauly, 2005). At low cost, todays health care providers must
offer good value to customers who are prepared to exercise their choice. Also, with
increasing development costs, changes in demographics and disease patterns with
Western populations living longer but suffering from higher levels of chronic diseases
ISSN 0267-257X print/ISSN 1472-1376 online
2011 Westburn Publishers Ltd.
DOI: 10.1080/0267257X.2011.545668
http://www.informaworld.com

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and changes in government policy and health care provision; health-sector businesses
must identify new areas of opportunity and reorientate their new product and service
development activities (Friedman, Goes, & Orr, 2000; Pauly, 2005).
Eleven articles were selected that illustrate various ways in which organisations
have sought to analyse, create, and deliver value through the six different facets
discussed above. The articles cover a spectrum, from the more conceptual discussions
of value analysis, creation and delivery, and specific discussions of value initiatives to
discussions based on larger empirical samples from organisations. More specifically,
the special issue consists of five parts. Three articles (part one of the special issue)
discuss, in some way, value from a reputational point of view; two articles (part
two) consider value creation through alternative support networks; two articles (part
three) concern value from a cultural point of view; two (part four) concern value
from a societal viewpoint; and lastly, two (part five) concern value from a network
and supply-chain perspective.
In the first part of the special issue, the first article, The role of credibility
and perceived image of supermarket stores as valuable providers of OTC drugs
by Gianluigi Guido, Giovanni Pino, and Daniela Frangipane, investigates how
consumer value is developed in drug retailing. In Italy, as in many other countries,
recent legislative reforms have meant that supermarkets have entered the overthe-counter (OTC) drugs retailing sector. This kind of retailer can offer ease
of access and lower prices. However, such market liberalisation does raise the
question of the ability of retailers to deliver value to consumers, whereby cheap
prices are attractive, but this may be traded off against the benefits of relationship
engagement found with traditionally pharmacies. A review of literature is made
with reference to prior studies concerning credibility and image. Investigated are
consumer attitudes concerning trust in the retailer, the image projected, and service
quality perception. The study evaluates the impact of credibility and image on
customers purchase intentions to buy OTC drugs from supermarket stores. Findings
are that consumers are attracted to the utilitarian values inherent in supermarket
purchase, but study recommendations are made to supermarkets about their image
and service facilities in order to enhance the ability to create further value for
customers.
The second article, The impact of perceived innovativeness on maintaining a
buyerseller relationship in health care markets: A cross-cultural study by Christine
Falkenreck and Ralf Wagner, focuses on the importance of how different countries
and cultures comprehend innovation. The article challenges whether service is at
the heart of innovation in marketing or whether there are other impacts generating
customer service in non-product-based sectors. In this respect, the authors consider
that health care lacks empirical insight into reasons and motivations for monitoring
the buyerseller relationship. As a result, a conceptual model is extended within the
commitmenttrust framework. A set of research propositions is evaluated using data
from three Western markets (Finland, Germany, and Spain) and the Russian transition
economy. The study develops existing models on service quality expectations and
customer satisfaction in business exchange, and further challenges the importance of
innovativeness in business-to-business health care relationships on customer service,
customer relationships, and loyalty. The authors find that expectations in products
and services impact on perceived value for money in Russia and Germany only.
The perceived innovativeness of the vendors turns out to be relevant in three out of
four cultures. The studys managerial implications are that the cultural values of the

Lindgreen et al. Value marketing in the health care industry

customers are a strong influence on exchange values and use. The authors conclude
with a guide for practitioners.
The third article, entitled Value marketing through corporate reputation: An
empirical investigation of Thai hospitals by Nopporn Srivoravilai, T.C. Melewar,
Martin J. Liu, and Natalia Yannopoulou, examines the value proposition through
corporate reputation, as the authors contend that corporate reputation best
communicates to consumers and the public the companys commitment to a value
offer. Research is undertaken in the private sector Thai hospital industry. The authors
offer a model of corporate reputation based on multifaceted theoretical influences. In
this, they contend a difference from prior studies, which employ a single approach in
researching corporate reputation, and offer findings concerning social construction
and validation, as well as that based on economic modelling. Implications for
practitioners and commentators are made concerning the legitimacy of corporate
reputation with regards to value.
In the first article of the second part of the special issue, Understanding the
nature of value in the word-of-mouth referral equation for health care, Angela
Dobele and Adam Lindgreen1 investigate the importance and influence of trusted,
non-professional opinion in health care. Through a qualitative and exploratory
approach, the study considers the content of informal communications (word-ofmouth referrals) offered by mothers to other mothers who are potential patients
of the same health care provider. Referral is used to confirm available information,
understand options for choice, and reduce information search anxiety and time.
Mothers offer a rationalisation of health care received and of the environment and
personal involved. The article makes a contribution concerning value attribution to
the credence of source according to experience of key reference figures and direct
personal communication.
The second article, entitled Service value and virtual communities: Participation
and utilisation of communal online space by Angus Laing, Debbie Keeling, and
Terry Newholm, continues the theme of alternative networks and value creation,
this time via the growing online medium. The authors argue that the Internet has
revolutionised the service encounter, whereby consumers are able to engage in multidirectional exchanges concerning health care rather than being in one-way receipt
of information and advice from knowledge gatekeepers, and that the formation
of virtual communities transcends the normal boundaries of geographic distance
and status/authority. Empirical, longitudinal investigation was used to track the
development of online discussion groups concerning specific health care issues, and
this led further to a series of depth semi-structured interviews devised to understand
user perspectives of the nature and functioning of online discussion groups. These
groups are observed to provide information and user network support independent of
health care professionals. The article draws on theory concerning service encounters
in order to provide a framework for consumer engaged and controlled virtual
communities in support of their regular service consumption. The article debates
the influences of the virtual network on the physical service encounter.
In the third part of the special issue, the first article, Exchanging value within
individuals networks: Social support implications for health marketers by Haider
Ali, investigates value created in patients social networks and discusses how value
is exchanged on a personal basis within a specific cultural context. In this article,
1 Martin

K. Hingley undertook the editorial role for this paper.

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the cultural and social environment of support, particularly emotional support from
network members, is assessed and areas for further study identified. This exploratory
research was undertaken among an immigrant South Asian community in the UK,
and the findings highlight rich areas for further research in other cultural contexts
concerning the important influence of the creation of social capital. The investigation
is of cardiac patients and their subsequent care and recuperation. The research
identifies culturally bound dimensions such as obligations, sacrifice, and motivations,
which influence what patients believe is the nature of the support they receive from
their family and close network. This case is used to recommend information and
resources to health marketers, which could be applied in similar communities with
strong social networks, such as those found within multicultural communities.
In the second article Prescription drug communication strategies: A comparative
analysis of physician attitudes in Europe, the Middle East, and the Far East, Jon
Reast, Adam Lindgreen, Dayananda Palihawadana, and Graham Spickett-Jones2
examine the influence of direct-to-consumer (DTC) advertising of prescription
drugs and the influence of culture and context on the relative acceptability of
this practice in different countries. The study uses Hofstedes classification to
select countries in order to conduct surveys of physicians and their attitudes to
direct marketing communication and advertising of drugs to consumers. Greece,
the United Arab Emirates, and Taiwan are the chosen countries for investigation.
Canvassed physicians are satisfied with physician-targeted communication strategies
and see merit in engagement. However, there is not common agreement concerning
DTC communications. Greek physicians were the most opposed, believing that the
physicianpatient relationship is undermined by this approach. Research implications
surround the issues of conflicts of loss of value created from key stakeholders
engagements from suppliers (in this case manufacturer drug companies) and
physicians; and although there may be some merit in marketing directly (generic)
drugs to consumers, the physicians role is the pivot of the network.
The fourth part of the special issue consists of two articles. In the first, A
social marketing approach to value creation in a well-womens health service,
Nadia Zainuddin, Josephine Previte, and Rebekah Russell-Bennett argue for a social
marketing approach in the building of value, where they argue that there has been
little prior research on consumer perception of value in the context of free state
services. So, while there is available research into health care from an economic
approach to value, this article investigates a non-financial exchange. The study
focuses on the concept of wellness (proactive and preventative health care services
early detection), as opposed to the mainstream emphasis on treating illness, and
investigates where value for consumers can be added. A societal marketing approach
is used and outcomes are assessed for the individual, organisation, and society. The
investigation uses an experiential investigation, and data from 25 depth interviews are
analysed to demonstrate how social marketing thinking has guided the identification
of six themes that represent four dimensions of value (functional, emotional, social,
altruistic). The authors contribute to theory concerning value and social marketing
and make recommendations for more socially supported decision making in public
health care policy.
This sections second article, Developing a novel health and wellbeing service:
The value of utilising the restorative benefits of nature in the UK by Paul Custance,
2 Martin

K. Hingley undertook the editorial role for this paper.

Lindgreen et al. Value marketing in the health care industry

Martin Hingley, and Debbie Wilcox3 , identifies the value that people place on many
of the attributes of the countryside, particularly tranquillity and peacefulness. Natural
settings have been shown to be effective in assisting the restorative process, and some
would go further to argue for the development of the practice of active engagement in
social and therapeutic horticulture and agriculture as a form of therapy, particularly
in regard to the benefits to health, well-being, and improved recovery times. This
phenomenon is utilised in the development of a novel service (CaRE Care and Rural
Enterprise) against the background of care farming, which has emerged in recent
years. The research method is action research. Modern health care provision has
come to emphasise delivery of value for patients as consumers, often placing them at
the centre of stakeholder networks. This article reviews the progress of an approach
to respite care that linked social provision to rural entrepreneurial activity, and charts
development from what was envisaged initially as private-sector niche opportunities
in health and recuperative care, evolving into social care in the rural environment.
The study resulted in the initiation and development of the CaRE service, providing
a network of rural community-based care facilities in the UK.
There are two articles in the special issues fifth part. The first, Understanding the
UK hospital supply chain in an era of patient choice by Michael Bourlakis, Fintan
Clear, and Louise Patten, investigates the UK hospital supply chain in light of recent
government policy reform where patients will have greater choice of hospital for
elective surgery. As a result, the hospital system should become far more competitive,
with supply chains having to react to changes initiated by greater choice as patient
demand becomes less predictable. The research method is qualitative and hospital
managers are interviewed concerning their opinions on a range of issues. Views on
the development of the hospital supply chain in different phases are derived, and
are used to develop a map of the current hospital chain. The findings show hospital
managers anticipating some significant changes to the hospital supply chain and its
workings as patient choice expands. The research also maps the various aspects of the
hospital supply chain as it moves through different operational phases and highlights
underlying challenges and complexities. The hospital supply chain as discussed and
mapped in this research is original work given there are no examples in the literature
that provide holistic representations of hospital activity. Specific recommendations
are provided that will be of service to health-service managers, researchers, and policy
makers.
The second article in the final section is Value, power and health care services
in the UK: A business-to-business service network approach by Judy Zolkiewski.
This article considers the influence of power of stakeholders in both a dyadic and
a network interaction context and what bearing this has on value creation. The
article draws on business power and network theory and makes application to
health care service provision concerning buyers and providers in networks. The
empirical investigation is through application to the UK context of community
health care. Power is seen to be derived from access to resources, network linkages,
and actor bonds and also a determining feature of atmosphere and environment of
interaction, and where motivation for power is in appropriation of value. Findings
identify a turbulent environment of power, where its expression may not be uniform,
consistent, or expressed from expected quarters, and that this influences the search
for value by participants. Hence, the situation for participants (particularly in a
3 Adam

Lindgreen undertook the editorial role for this paper.

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network rather than is normally understood from just a dyadic context) is complex
and often confusing. The author recommends that the influence of network power
(e.g. where power bases lie and how they evolve) needs to be understood in a given
context as much as efforts to understand bonds, ties, and activities, and that this
would enable practitioners to understand the underlying and changing conditions in
which they act.

Acknowledgements
We take this opportunity to thank first all those who have contributed toward this special
issue of Journal of Marketing Management. The reviewing was a double-blind process, and we
greatly appreciate the work of the reviewers who have taken time to provide timely feedback to
the authors, thereby helping the authors improve their manuscripts: Lus Kluwe Aguiar, Sean
Beer, Michael Beverland, Ross Brennan, Lorraine Brown, Tove Christensen, Paul Custance,
Kirsti Dautzenberg, Johan Fischer, Wolfgang Chr. Fischer, Vanessa Fonseca, John Guthrie,
Jon H. Hanf, Sally Hibbert, Andrea Insch, John Knight, Rob Lawson, Sheena Leek, Juliana
Mansvelt, Franois Maon, Morten Raun Mrkbak, Brian Revell, Valrie Swaen, Christine
Vallaster, Ivo A. van der Lans, Jolle Vanhamme, and Keith Walley.
We also extend special thanks to the editor, Susan Hart, for giving us the opportunity
to guest edit this special issue of Journal of Marketing Management. Last but not least, we
warmly thank all of the authors who submitted their manuscripts for consideration in Journal
of Marketing Management. We appreciate and are grateful for the authors desire to share
their knowledge and experience with the journals readers and for having their views put
forward for possible challenge by their peers. We are confident that the articles in this special
issue contribute to a greater, more detailed understanding of value marketing in the health
care industry. As well, we hope the selected articles will generate the kind of dialogue that is
necessary to further understanding in this important area.
Adam Lindgreen, Martin K. Hingley, and Michael M.D. Antioco
Special Issue Guest Editors

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About the authors

Dr. Adam Lindgreen is professor of strategic marketing at University of Birmingham and
Affiliated Professor at IESEG School of Management. He received his PhD from Cranfield
University. Dr. Lindgreen has published in Business Horizons, Entrepreneurship and Regional
Development, European Journal of Marketing, Industrial Marketing Management, International
Journal of Management Reviews, Journal of Advertising, Journal of Business Ethics, Journal of
Business and Industrial Marketing, Journal of Marketing Management, Journal of Product and
Innovation Management, Journal of the Academy of Marketing Science, and Psychology and
Marketing, among others. His most recent books are Managing Market Relationships, Market
Orientation, Memorable Customer Experiences, The Crisis of Food Brands, and The New
Cultures of Food. His research interests include business and industrial marketing, experiential
marketing, and CSR. He serves on the boards of many journals.
Corresponding author: Professor Adam Lindgreen, University of Birmingham, Edgbaston,
Birmingham, B15 2TT, UK
E

Adam_Lindgreen@hotmail.com

Dr. Martin K. Hingley is reader in marketing based at Harper Adams University College in
Shropshire, the leading university in the UK specialising in agri-business. He has published
in British Food Journal, Entrepreneurship and Regional Development, Industrial Marketing
Management, and Journal of Marketing Management, among others. His primary research
interests focus on marketing and the applied areas of food industry marketing and supplychain relationship management. He has presented and published widely in these areas and
serves on the editorial boards of several journals.
E

mhingley@harper-adams.ac.uk

Dr. Michael D.J. Antioco is associate professor in marketing at EMLYON Business School.
He is also a visiting faculty with TiasNimbas Business School, Tilburg University. His main

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research interests are new product development, organisational behaviour, cross-functional

communication, and decision-making. His work features in European Journal of Marketing,
Journal of Business and Industrial Marketing, Journal of Business Ethics, Journal of Product
Innovation Management, and Journal of the Academy of Marketing Science, among others.
E

antioco@em-lyon.com

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