Similarities with Other Service products Dr. Shih-Shin Chen Health Care Marketing Dept. Health Care Management NTUNHS

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3 Physical intangibility Mental intangibility 非實體性 心智上的無形性 Intangibility

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Core benefits ( 核心效益 ) of medical diagnosis, treatment, and patient education derive ( 導源於 ) primarily from performances 5

6  可能以無形的服務為主， 輔以有形的物品 如手術

7  可能以無形的服務為主， 輔以有形的物品 如手術  或以有形的物品為主， 輔以無形的服務 如批藥

8 Salt Soft drinks Detergents Wine Golf Clubs Tailored clothing Fast-Food Restaurant Plumbing Repair Health Club Airline Flight* Full service restaurants Consulting Teaching E banking Physical Elements HighLow High

9 Whether it’s service or goods depends on how much value come from each element Tangible elements Intangible elements

10 Often it is the intangible elements, e.g. the expertise and attitudes of service personnel, that create the most value in service performance Service advertisers need to makes intangible services attributes ( 服務產品的無 形特性 ) more tangible

Many ways to make intangible services attributes more tangible 11  E.g., use tangible objects as “tangible symbols” ( 有形的符號 ), such as CIS (Corporate Identity System 企業識別系統 ) Mittal & Baker (2002)

Many ways to make intangible services attributes more tangible 12 E.g., use metaphor ( 譬喻 ) and vivid ( 生動傳神的 ) images in advertisement Mittal & Baker (2002) EACH TIME YOU SLEEP WITH SOMEONE, YOU ALSO SLEEP WITH HIS PAST. GET TESTED FOR HIV AREYOUATRISK, CA l

 British Airways Club World’s “New York to London red-eye flight” TV commercial message  Sleep longer; save time 13 Mittal & Baker (2002)

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Health care is a credence ( 信用 ) service  Clinical quality and doctors’ expertise often are difficult for customers to judge even after services 16

 assume doctors are clinically capable  use visual ( 視覺 ) and experiential ( 體驗 ) clues to make judgment  concern more with physicians’ behavior (e.g., bed side manners) rather than medical skills 17 Tangible Intangible

18 和藹可親的 More than just a patient Try to understand and let you know he/she knows Caring and compassionate Assured manner engenders patients’ trust 同理心

19 詳盡徹底的 ( 戥真 ) 坦率的 Tell them what they need to know in plain language Take patients’ input seriously

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inseparable  Consumption is inseparable from production  Simultaneity ( 同時性 ) of consumption and production  Co-production ( 共同製造 ) between service providers and consumers 21

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23  (Usually) the presence ( 在場 ) of the customer at production  The customer’s role as a co- producer  Service providers play a role in customers’ consumption experience  Customer-to-customer effect

24  Treat customers as partial employees  Recruit, train, retain customers as they were your employees  High-performing customers are competitive advantages

25  Need to provide customers with useful information, orientation, training, and realistic service preview ( 服 務實境預告 )

Mammogram for breast cancer: What to expect 26 Realistic Service Preview

27  In compared with the control group, the preview women in the experiment 1.Pre-service feeling: have more realistic and accurate expectations for the mammography experience Bitner, Faranda, Hubbert, & Zeithaml (1997)

28 2.Service encounter feeling: less anxiety and greater perception of control 3.post-service satisfaction/outcome: more satisfied with actual service experience

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 Services are results of human interaction  Variability  Inconsistency  Non-standardization 30

31  Service providers  Customers  The interaction between providers and customers

32 醫療的 不確定性 醫療的 不確定性 醫師特性 執業場域與 地點 病人特性

33 醫療的 不確定性 醫療的 不確定性 醫師特性 執業場域與 地點 病人特性 臨床經驗 / 技術 分科訓練 / 科別 服務與溝通風格個人性格 臨床經驗 / 技術 分科訓練 / 科別 服務與溝通風格個人性格

34 醫療的 不確定性 醫療的 不確定性 醫師特性 職業場域與 地點 病人特性 性別 / 年齡 / 種族 社會經濟地位家族病史不同症候組合的出現 社會經濟地位家族病史不同症候組合的出現

35 醫療的 不確定性 醫療的 不確定性 醫師特性 執業場域與 地點 病人特性 診斷 (Diagnosis) 治療 (Treatment) 醫療成效 (Outcome) 診斷 (Diagnosis) 治療 (Treatment) 醫療成效 (Outcome)

 For a certain disease, 1 out of 1,000 people will be contracted  For those who are confirmed to have this disease, 99 out of 100 will be tested positive with a test agent  For those who do not have the disease, 2 out of 100 will be tested positive with the same test agent  What is the probability of a person who are tested positive to have the disease?  P(A | B) =

37 每項都是必要的 Everything that is necessary 沒有一項是不必要的 Nothing that is inappropriate Overutilization過度利用 Under-utilization利用不足 Mirvis (2003) 醫學實證、醫療共識的多寡 『醫療的適當性』是「選擇題」而不是「是非題」 適當的醫療 檢驗、診斷、治療、預後、追蹤

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39 醫療不確定性低醫療服務異質性低 醫療不確定性高醫療服務異質性高

40 From Bakwin (1945) 1,000 5th graders were randomly selected 61% of the schoolboys already had their tonsils removed The rest of the 389 schoolboys were screened by a panel of doctors What % should be judged to need their tonsils removed? 45% (174) judged to need their tonsils removed

 215 who were judged not to need their tonsils removed were examined by a new panel of doctors  What % should be judged to need their tonsils removed? 41 46% (99) judged to need their tonsils removed

 116 boys judged twice not to need their tonsils out were judged by a new panel of three doctors  44% (51) judged to need their tonsils removed  Only 65 (6.5%) schoolboys were judged not to need their tonsils removed 42 Pseudodoxia pediatrica Pseudodoxia pediatrica 小兒科醫學 vs. 小兒民俗療法 Pseudodoxia pediatrica Pseudodoxia pediatrica 小兒科醫學 vs. 小兒民俗療法

43 醫療的 不確定性 醫療的 不確定性 醫師特性 執業場域與 地點 病人特性 醫院規模 / 專科醫師多寡 教學 / 非教學醫院 當地醫療資源 保險給付 / 自費 醫院規模 / 專科醫師多寡 教學 / 非教學醫院 當地醫療資源 保險給付 / 自費

44 血管造影術 心導管 ( 擴張 ) 術 冠狀動脈繞道術冠狀動脈血管成形術

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 Goes back over 200 years to Adam Smith ( ) perishable  Services are different from goods because they are perishable (The wealth of nations, 1776)  Can not be stored  Can not be resold  Can not be returned 46

要交通部研議，不過，卻被行政院長毛治國當場否決，直言尖 峰時間應該加價，以價制量，才不會使得更多車上國道，讓壅 塞問題更無解！但民眾倒是支持打折，認為如果加價，根本是 搶錢。 47 作者： 吳茜洋 TVBS – 2015 年 3 月 10 日 下午 6:55 高速公路在上下班尖峰時間， 容易塞車，立委想修法，只要 是車速未達 60 公里， ETC 就該打 折，要求交通部應比照高鐵、 鐵路延誤作法，給予折扣優惠，

Balancing demand and capacity 48 Wasted production capacity Turn away customers or have to wait  Capacity Mgt. (S)  Demand Mgt. (D)  Capacity Mgt. (S)  Demand Mgt. (D)

49 Emergency surgeries Hard to predict Can’t wait Social benefits Elective surgeries Can prearranged Can wait Monetary gain Balance E.g., a senior OPD nurse is entrusted ( 賦予責任 ) with the process of allocating hospital beds to the patients waiting in the system Rule of thumb approach ( 經驗法則 ) Backlog 候補量 ( 積壓 ) 兩種病人

Backlog 50 L(s t, x t ) = r 2 · Emin{x t, D t } + r 1 · Emin{M t } - w 1 · ( s t + x t –C) + - w 2 · E [D t – x t ] + 候補量 ( 積壓 )

51 供給 需求 產量 ‧ 供需均衡點 ‧ ‧ ‧ ‧ 短缺 剩餘 Wasted production capacity Lower prices Service providers withdraw ( 退出 ) from market

52  Will the surplus capacity of doctors result in  lower fees?  fewer hospitals and clinics?  better health care with a greater input of doctor time? not really  The answer is not really

53 Roemer, M.I. (Nov.,1961). Bed supply and hospital utilization: a natural experiment. Hospitals, 35, A positive correlation between capacity and utilization in health care

Wennberg & Fisher (2006) 54  Supply increases demands  More physicians or hospital beds mean more medical services rendered ( 導致 更多的醫療服務 ) per capita ( 每人均量 )  No improvement in the overall health status of population  No significant improvement in medical outcomes and quality of care

55 Richardson (2001) FTE: Full time equivalent ( 全時約當數 )

56 GP use GP supply SP supply SP use

57 Richardson (2001)  Doctors tend to make medical decisions for their patients  asymmetry of medical information and knowledge ( 醫療資訊與知識的不對等 )  asymmetry of in the capacity to make medical judgmen t ( 醫療判斷能力的不對等 )  almost impossibility for the patients to evaluate what doctors can or cannot do in the current state of medical uncertainty Abdication ( 退位 ) of consumer sovereignty ( 主權 )

 依健保法就特定範圍的醫療服務，如牙醫門診、 中醫門診、西醫門診或住院服務等，預先以協定 方式，訂定未來一段時間內（通常為一年）健康 保險醫療服務總支出（預算總額），以酬付該服 務部門在該期間內所提供的醫療服務費用，並藉 以確保健康保險維持財務收支平衡的一種醫療費 用支付制度。 58

59 In-class exercise

 Physical intangibility  Tangible and intangible elements?  Mental intangibility  Understand and evaluation? 60 In-class exercise

 Providers  Customers  The interaction between providers and customers 61 In-class exercise

62  Simultaneous production and consumption?  Customers as co-producers?  Provider-to-Customer interaction?  Customer-to-customer interaction? In-class exercise

63  Can be saved?  Can be stored?  Can be re-broadcasted? In-class exercise

TeamIntangible Heterogeneou s InseparablePerishable 1 Y Sw N Total 64

65  Many services involve tangible performance or activities  Users experience these activities through one or more of their five senses  E.g., Surgery, haircuts, massage, house cleaning Physical intangibility

66  Easiness to visualize, understand, and evaluate before and/or after purchase  Search attributes  Experiences attributes  Credence attributes Mental intangibility

67  An inherent characteristic of labor-intensive services  Need to standardize service delivery processes  Clinical paths  Service quality control  Physician Order Entry Systems

68  Not true for machine intensive service operations  E.g., internet-based services, training & education, ATM

69  Many services are produced and consumed separately  Freight vs. public transportation  Laundering clothes vs. spa  Routine maintenance of equipment vs. health check- up

70  Some services can be saved, stored for reuse, resold, or returned

71 Who or What Is the Direct Recipient of the Service? PeoplePossessions Tangibility of the Service Act Tangible Intangible

72 Who or What Is the Direct Recipient of the Service? PeoplePossessions Tangible Intangible Tangibility of the Service Act

73 Who or What Is the Direct Recipient of the Service? PeoplePossessions Tangible Intangible Tangibility of the Service Act

74 Who or What Is the Direct Recipient of the Service? PeoplePossessions Tangible Intangible Tangibility of the Service Act

75 Intangibility Heterogeneity Inseparability Perishability Intangibility Heterogeneity Inseparability Perishability Intangibility Heterogeneity Inseparability Perishability Intangibility Heterogeneity Inseparability Perishability                 Who or What Is the Direct Recipient of the Service? PeoplePossessions Tangible Intangible Tangibility of the Service Act

Service Recovery Paradox 76

77 Time Customer loyalty Customers without service failure Customers with service failure and successful recovery Service failure Service recovery

78 J. of Marketing Research. 2007; 21(3):  It doesn’t work as well for customers who have prior failures  It doesn’t work as well for big failures  It works just as well for old customers as new customers  It works better if the customer believes it was beyond your control

79 Characteristics of Services Products (Similarities)