Chapter-3

Marketing Mix in Sample Hospitals I (4Ps)

The main aim of this chapter is to examine how the hospitals implementing the marketing techniques and diagnose the problems involved in marketing hospital services exploring the first four elements of marketing mix i.e. Product/Service, Price, Promotion and Place along with the results of opinions elicited from doctors, nurses and administrative personnel. First, we will discuss the product/service mix in hospitals.

Product/Service Mix in Hospitals

Most products of the hospitals are services. They include medical assessment, diagnostic and treatment services, medical rehabilitation services, preventive care services, health education, promotion and training services, industrial health services, and a vast array of related social services. They are a variety of tangible health care products as well; all are intended to benefit peoples health. With regard to the right service in the hospitals, it should be remembered that hospitals do not really sell services; rather they sell the benefits of satisfaction the patients get from receiving services. The product elements of hospitals consists of the actual medical treatment provided in the hospitals, education and training provided by medical colleges and nursing schools and R&D activities carried on by the research centers. In the case of hospitals, the product is contained in three broad areas viz. diagnosis, treatment, which may be pill oriented or surgery oriented, and post-operational care. This product also includes supplementary services like maintenance of the case history of patients, registration, billing and support operations like laundry, diet, pharmacy, stores, security etc. These services help to give a tangible effect to the intangible nature of the services provided.

Nature and Characteristics of Services in Hospitals

Services have four distinctive characteristics. In the case of hospital services that must be given special consideration when designing marketing stratagies1. They are

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Intangibility Services are intangible- that i.e, they cannot be seen, tasted, felt, heard, or smelled before they are produced. In the case of hospital, a patient purchasing cosmetic surgery cannot see the result before the purchase; and a patient receiving chemotherapy cannot know the value of the service in advance. Under the circumstances, purchase requires confidence on the provider. Inseparability A service is inseparable from the providers. Its very act of being created requires the sources, whether a person or machine, to be present. The dental services cannot be produced and delivered unless the dentist is here. And a patient can not be X-rayed unless the X-ray machine is there. Inseparability results in a limitation of the number of people who can receive a service. A dentist many work only eight hours a day, serving on average two patients an hour, or sixteen patients a day. Variability An artificial heart operation by a doctor is likely to be of higher quality than the same operation performed by a physician with little or no experience. And the doctor quality can vary depending on his energy and mental state at the time of the operation. Therefore a service can be highly variable, depending upon who is providing it, when it is being provided, and even who else is there as part the service experience. Hospitals should make an effort to provide not high consistent quality in their service offers, and to monitor the consistency of quality with customer satisfaction monitoring system. Perishability An unoccupied nursing home bed is lost forever. In the same way some physicians charge patients for missed appointments because the appointment time with no patient to serve is lost revenue for the physician. So services cannot be stored. When demand is study the perish ability of service is not a problem to the hospitals. When demand fluctuates significantly, hospitals have problems. The emergency service of a hospital must be staffed and equipped to handle emergencies at all times, even most of the time there are no real emergencies. Hospital can be matched demand and service capacity by following different strategies. Now we will see the services offered by hospitals.

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Classification of Hospital Services

Hospital services can be broadly classified to two types i.e. People based or equipmentbased/or a combination of both. This can be explained in the Fig. No: 3.1

Fig. No: 3.1

Classification of Hospital Services

Hospital services

People based

Combination of both

Equipment based

Professional Physicians Users Social workers Skilled & unskilled labor

Hospital services vary in the degree to which the clients presence is necessary to the service. Brain surgery involves the clients presence, but the repair of wheelchairs does not. To ex tent that the client must be present, the service provider has to be considerate of the clients needs. Inpatient rooms for example, need to be decorated and comfortable because they are part of the service for which the patient is present. Most of the hospitals are multi service firms. For example a consultation and guidance center offers individual therapy, group therapy, family therapy, marriage counseling, and psychological testing. The teaching hospitals have three product lines, each with many specific products. They are 1.teaching 2.research 3.patient care. Often teaching hospitals are accused of ordering the product lines in importance as listed. Some hospitals offers a wide product line including skilled nursing care, physical therapy, speech therapy, occupational therapy, medical social services, home health aide and home making services, hospice services, and the rental of durable medical equipment. The product mix in hospitals in terms of its length, width, and depth can be described in a hypothetical hospital in Fig. no: 3.2

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Fig. No: 3.2

Product Mix in Hospital

Product Mix Length
In patient Services
P R O D U C T L I N E W I D T H

Ambulatory Services Emergency (4 examining rooms)* Walk in clinic

Health Promotion Health education secessions (5 staff)*

Medical/surgical (45 beds)* Obstetrics (20 beds) Pediatrics (15 beds) Cardiac ICU (8 beds)

Health fair Out patient Therapies (30 exhibits)*

* Depth of services.

The product mix in a hypothetical hospital in terms of its length consists of three product lines: inpatient services, ambulatory services, and health promotion. Each product line has a certain width: the patient services include medical/surgical, pediatric, obstetric and cardiac intensive care. Finally each product item has a certain depth: the hospital contains 15 pediatric beds. Suppose the hospital is thinking of expanding its product mix. This could be accomplished in any of them ways. It could lengthen its product mix by adding, say, a free-standing mental health clinics, or the hospital could add another inpatient service, say, psychiatric: this extends the width of its inpatient service line, or the hospital could add additional beds, assuming it has regulatory approval; this deepens its number of beds. Various services in service mix are different in their relative contribution to the organization. Some constitute the core service of that hospital and others are ancillary services. Thus, inpatient services are the core product of the hospital and health promotion is an ancillary product (although this traditional focus on inpatient services is in the process of changing in many hospitals). Further more, certain services will play a major role in attracting patients: they are called product leaders or flag ship products. Most patients, for example, will use the emergency department at one patient or another. The emergency service is often viewed as the selling arm of

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the hospital and may be viewed as a product leader. Some hospitals also have crown jewels in their product mix which they promote aggressively as a symbol. Many hospitals promote their most sophisticated services as their crown jewels, hoping to convince the public that these services symbolize a general level of sophistication throughout the hospital.

Hospital Product Item

In developing a service by the hospital to offer to a market, the service planner has to distinguish three levels of the concept of a service i.e. core, tangible and augmented. This can be explained in the Fig. No: 3.3

Fig. No: 3.3

Hospital Product Item

Installation

Packing Brand Name Delivery And Credit Quality Core Benefit Of a Service Features After Service Styling

Warranty

Augmented Product Tangible Product Core Product

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Core Product The core product answers the questions like, what is the consumers really seeking? What need is the service really satisfying? Hospital produces surgery, but patients are really buying alleviation of pain. A medical school produces knowledge, but many studies are really buying marketability. A rehabilitation centre produces rehabilitation services, but the patients may be buying hope and the potential of a return to work. Here the hospital has to uncover the essential needs hiding under every service so that service benefits, not just service features, can be described. The core service stands at the center of the total service as shown in the above figure. Tangible Product A tangible product can be described as having up to five characteristics 1. Styling: Styling means giving a service a distinctive feel. Style is also expressed in the design of physicians officer, hospitals, HMOs, welfare offices, and other edifices where services are offered. Even the clinical aspects of medical services are styled. Some times hospitals may find that its style is no longer appropriate or effective with its target audience. A hospital that sticks with the traditional labor and delivery room where fathers are not allowed may find itself drawing fewer deliveries relative to hospitals providing birthing rooms, birthing chairs and so on. These hospitals may want to consider modifying its style to meet changing market wants. 2. Features: Features represent individual components of the tangible product/service that could be easily added or subtracted without changing style or quality. Consider a health maintenance organization that is seeking to expand membership. There are many features improvement it could offer Expanding its features of operation to include week day evenings. Adding dental service as optional features for additional fee. Offering a free ten-week smokers clinic for members wishing to quit smoking. The use of features has many advantages. Hospital can go after specific market segments by selecting those features that would appeal most to those segments. Features are a tool for achieving product differentiation vis--vis competitors. They have the advantages of being easy to add or drop quickly, or made optional at little expense. They may be news worthy and useful in attracting free media publicity2.

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Quality: Quality represents the perceived levels of performance in a product or service. As previously pointed out, service products in particular are tremendously variable, depending upon who is providing them and how much control the organization exercise over its providers. The quality of clinical care concern an important question to ask is how does sales response vary with the level of perceived quality?
Fig. No: 3.4

(A) Relationship between Sales and Quality Level (B) Three Strategies for Service Quality Management through Time.
Sales Sales
Quality improvement

(A)

(B)
Quality maintenance

Quality adulteration

Low

Avg

High

Superior

Time

A. Relationship between services B. Three strategies for service quality Quality level and sale Management through time.

Fig. No: 3.4 (A) shows a plausible relationship between sales and quality level. The curve says that higher perceived quality leads to higher. It also says that very high quality may not add much additional sales either because consumers can not perceive very high quality, or because they do not value it that sense that quality assurance activities do, rather, it refers to the markets perception of quality. Their perceptions may be incorrect from clinical standpoint but the market acts on the basis of what it perceives. The consumer market because it is unable to judge clinical care, will often judge the service aspects of what is offered; the friendliness of the providers, the design and atmosphere of the facilities, the house of service availability and so on.

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An organization must not only set an initial standard for quality, but must manage its quality level overtime. It has three options in figure no: 3.4 (B) it can attempt to improve its quality level over time through better selection, training, and rewarding of employers and through improving facilities. This strategy should lead to improved market interest and response. The second option is to maintain its present level of quality and emphasis other dimensions of the business. The third option is to allow quality to decline overtime. This may be done deliberately when the institution wants to withdraw from the business, otherwise it indicates poor management, makes little strategies sense, and may lead the organization down the road to extension.

Packaging: The packaging represents the contribution of the larger context in which the product is found. A teaching hospital offers to all its services the image of medical sophistication and state-of-the art technology, even through this may not be true across all services. In contrast many of the same services housed in a rural hospital, would be viewed as less sophisticated but more personal and more convenient. Packaging also covers the building of individual products. Diabetes clinics, Arthritics clinics, Glaucoma clinics, general social services, not lunches, Podiatry services, and scheduled social activities may be offered individually by a nursing home or health center, pulled together as one package they become elder care or day care services for the elderly. Many hospitals fail to recognize that repacking of existing services may allow them to offer what is ostensibly a new product to a new market place.

Branding: The service of a seller can be branded that is given a name, term, sign, symbol, or design which identifies them as the sellers to differentiate them from competitors offerings. For example there are thousands of mental health centers throughout the country. They have found that the term mental health center is offensive to many people, since it suggests mental illness. The whole industry is looking for another name that would create more positive feelings. The rush Presbyterian hospital of Chicago renowned its mental health center the institute for living, feeling that this brand name would work better. In a similar vein, the social movement known as birth control came under sharp attack from certain religious, ethnic, and economic groups that viewed it as a government attempt to dictate who can and cannot have babies. Advocates of birth control changed the name to family planning, since this eliminated the suggestion of out side control and replaced it with the notion that the family makes the decision. This has worked well,

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but today in some countries the term family planning has acquired a bad name in India because the government pushed birth control measures too harshly, and a new brand name is needed to fit the new approach to Indians population problem The creation of a brand name to symbolize the hospitals service can contribute a number of values. Hospital feels proprietary toward its brand name and therefore normally works hard to insure the quality and consistency of its services. It wants its brand name to create buyer confidence in its service and lead to brand preference and repeat purchase. Buyers benefit because they can identify the various brands acquires a stock of information about their respective quality, choose the best brand, and stick with it as long as satisfies them. Augmented product The hospital can, along with the birthing room, offer longer payment terms, a satisfaction guarantee, home visits to the new mother, and so on. The hospital can offer the consumers additional services and benefits that go beyond the tangible service, resulting in an augmented service. Hospitals augmented their tangible product to meet additional consumer wants and/or to differentiate their product from competition. As Levitt states: The new competition is not between what companies produce in their factories, but between what they add to their factory output in the form of packing, services, advertising, customer advice, financing, delivery arrangements, warehousing, and other things that people value3 Hospitals should examine each of its services and design them in a way that will distinguish them from competitor offers and carry the intended qualities to the intended target market. Product life cycle Product life cycle views products and services as having something like a biological life cycle. Products and services are viewed as being, born growing, living, and ultimately dying. The product life cycle theory says that a typical product exhibits an S-shaped sales curve marked by the following stages. This can be known with the following figure no: 3.5

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Fig. No: 3.5

Product Life Cycle

Sales

Introduction

Growth

Maturity

Decline

Time

Introduction stage: Introduction stage take place when the new products or service is first made available to the marketplace. Unfortunately, it is the norm in the health care environment to provide inadequate support to new products and services. As a result, insufficient demand is generated; leading managers to conclude the new product or service was not a good idea.

Growth stage: If the new product satisfies the market sales will start climbing substantially. The early adopters will continue their purchasing and other consumers will follow their lead, especially if there is favorable word of mouth. Same time new competitors may enter the market, attracted by the opportunity. During this stage the organization tries to sustain rapid market growth as long as possible. Maturity stage: At some point, a products rate of sales growth will slow, and the product will enter a stage of relative maturity. In healthcare, it is more likely to consist of recruiting more referrers and adding more product features. Some organizations resort to modifying their customers or product mix. Increasingly like commercial organizations health care organizations are turning to price cutting and promotion. But these steps results in higher costs. Some of the 119

weaker competitors starting dropping out. The industry eventually consists of a set of wellentrenched competitors whose basic orientation is toward gaining competitive advantage.

Decline stage: Many products forms and brands eventually enter a stage of sales decline may be slow or rapid. Sales may plunge to zero and the product may be withdrawn from the market, or they may petrify at a low level and continue there for many years. Sales decline for a number of reasons. Technical advances may give birth to new product classes, forms and brands which become effective substitutes. All of these factors have the effect of intensifying over capacity and competition. Some times carrying a weak product is very costly to the hospital. The weak product tends to consume a disproportionate amount of managements time, it may require price adjustment if it is a self-pay service, it may require full staffing ever it is chronically under capacity, it requires promotional attention that might better be diverted to making the healthy products more profitable and its very unfitness can cause customer misgiving and cast a shadow on the hospitals image. Finally, many organizations keep weak products too long, health care organizations seem particularly prone to do so, often a weak product is kept around because of the ardent support syndrome. If the ardent support is not also fiscally responsible for the program, the weak program is often apt to be kept too long. Weak programs are also kept because the patients need this program. The sufficient number of people need a program, the hospital might be able to strengthen utilization with sufficient promotion. Otherwise, not enough people may need the program to justify the cost of its existence. Let us discuss the product mix in sample hospitals.

Product Mix in Apollo Hospital

The product mix in Apollo hospital reveals that the different departments providing Medical Services & Surgical Services, ICU Services, Pain Relief Services, Emergency Services, Supportive Services, Special Services for patients and their family members, health check-up services, In-Patient Services, Diagnostic & Therapeutic Services, Blood Bank Services And Corporate Services. Medical and surgical services includes Anesthesia & Intensive Care, Respiratory Medicine, Dental Services, Dermatology, Emergency Medicine, Endocrinology, ENT, Gastroenterology, Surgical Gastroenterology, General Surgery, Immunology & Rheumatology, Internal Medicine,

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Nephrology,

Obstetrics

&

Gynecology,

Pediatrics,

Urology,

Aandrology

&

Renal

Transplantation etc. ICU services in Apollo include Medical Intensive Care Unit, Surgical Intensive Care Unit, Neuron Intensive Care Unit, Cardiac Intensive Care Unit etc. Chronic pain relief services in Apollo include OP consultation for chronic pain, pain relief treatment for chronic backache, neuralgias, cancer pain (head and neck, abdomen, pelvis, chest etc) and acupuncture. Each theater in the hospital is equipped with ECG, pulse oximeter, capnometer, NIBP, invasive BP monitoring, ventilators, fully equipped recovery rooms. Apollo emergency services providing services like Pre-Hospital Emergency Network, Quality Emergency Rooms, Academics like Fellowship of Emergency Medicine, Fellowship In Family Medicine, Diploma In Family Medicine, Diploma In Family Medicine (On Line And Contract Program) Life Saving Training Programme etc. Supportive services for patients and their family members in Apollo includes pre-operative and post operative counseling for patient and attendants, details on treatment plan and time, rehabilitation & diet counseling for patient. Apollo is offering special services like combination of DMARDs & Follow Up (Including Complicated New Regime For Treatment Of Arthritis & Spondylibs) Intra-Articular Injections, Entheseal Injection, I.V. Gammaglobulin (IVIG), IV Infliximals & Other Biological Response Modifiers, Plasmapheresis, Physiotherapy, Hydrotherapy, Splints, Braces etc, Occupational Therapy & Life Style Modification Service And Early Arthritis Clinic- To +Detect Arthritis In Earliest Stage etc. Apollo health check-up services includes Apollo Master Health Cheq, Apollo Executive Health Cheq, Apollo Heart Cheq, Apollo Well Women Cheq, Apollo Well Baby Cheq and Apollo Whole body Cheq etc. In-patient services in Apollo includes inpatient accommodation like general ward, semi private rooms, private rooms, private rooms, deluxe rooms, super deluxe rooms etc. Food & Beverages services includes assessment of patient diet with dieticians in association with doctors, wide choice of food to visitors, diet counseling, providing coffee caf and snacks to visitors and guest dining hall for visitors. Timings are as follows.

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Fig No: 3.6

Product Mix in Apollo Hospital

Product Mix Length In Patient Services Diagnostic Services & Pain Relief Services
Diagnostic services:
1.Anatomic Pathology and Cytology Lab Services 2. Bio-Chemistry: *Thyroid Testing, *Reproductive Hormone Testing, *Anemia Testing, *Vitamins, *Electrophoresis, *Triple Screen, *ADA, *VMA. 3. Transplant immunology: *Anti Nuclear Antibodies, *Anti-DNA Anti Bodies, Anti Smith/RNP Anti Bodies, *Anti Scleroderma70 Antibodies, *Anti Neutrophil Cytoplasmic Antibodies. 3. Hematology & Clinical Pathology: *Reporting Of Bone Marrow Aspiration Smears *Imunocyto Chemistry *ImmunoCytochemistry *Plateletagglegometry *Hematology Analysis *AB Olicos *Coagulation Analyzer. 4. Clinical Nutrition: *nutrition assessment *cardiac nutritional status *cancer nutritional status. 5. Psychiatry: *Out Patient Diagnostic Services *Counseling Services. 6. Radiology & Imaging Sciences: *Barium Baft *Bone Dexa *Ct Scan *Ivp *Litho *Mammography *Mri *Ultrasound Brochure *Pet-Ct Scan. 7. Molecular Medicine: *Molecular Diagnostic Of Infectious Diseases *Molecular Diagnosis Of Genetic Disorders *Transplantation Immunology *Cancer Genetics *Pcr Methods In Diagnosis *Dna/Rna Assessment *Cytogenetics Tests *Cancer Cytogenetics *Currently Chromosomal Analysis Etc. 8. Nuclear Medicine: *Bone Scan *Hepatobiliary Scan *Renogram *Thyroid Scan *Isotope Venogram *Muga Scan For LVEF *Ventilation-Perfusion Scan *LiverSpleen Scan. 9.Microbiology Lab Service: *Bacteriology *Urine Culture *Pus, Drainage Tube Culture *Throat Swab-Culture *Sputum *CSF/Fluids *Stool *Blood Culture *Fungus Culture *Antimicrobial Susceptibility Testing *Bacteriological Analysis Of Drinking Water *Surveillance Environment Dialysis *Serology *Widal Testing *Immunodiagnostics Of Infectious Mononucleosis *VDRL *Pregnancy Betal HCG In Urine *ASO *CRP *RA *Turbidometry etc.

Medical/Surgical Services

ICU Services & Emergency Services & Blood Bank Services

1. Intensive Care Unit Services: *52 beds *Medical intensive care * Surgical intensive care *Neuro intensive care *cardiac intensive care 2.Emergency Services: *Pre Hospital Emergency Net Work *12 Fully Equipped Ambulances *22 Emergency Rooms. *Air Ambulance Service. *Training On Emergency Medicine. *Training On Life Saving. *National network of emergency services *Emergency Rooms For *Emergency Stroke *Mi *Road Traffic Accidents *Domestic Accidents *Snake Bites *Paralysis *Head Injury *Drug Overdose *Poison Intake *Airway Obstruction 3.Blood Bank Services *Analysis of any blood group discrepancies *External quality check *HIV/HbSAg Screening *Pre-operative haemodilution autologous Blood. *Testing of blood for transfusion transmitted diseases with meticulous quality. *Depth analysis to clarify blood group discrepancies. *Supply of components during night. *24 hours pheresis. *Guidance and help to other blood banks. *Sensitive cross-marching procedure using Gel-Column Technology.

Corporate Services & Telemedicine Services

1.Corporate Services: *Computerized Health Scan *Health Counseling In Diet. *Exercise. *Stress Relief. *Gym. *Yoga. *Meditation. *Aerobics. *On-Line Health Services. *Occupational health checks. *On-Site Doctors. *Ambulance Service. *Screening Camps. *Training And Education. *Awareness Lectures On Telemedicine Facility. *Health And Wellness Workshops. *Dependent Health Care Programs. *Corporate Emergency Management Services *Preventive Health Checks. 2.Telemedicine Services: *Tele-Radiology. *Tele-Dermatology. *Tele-Cardiology. *Remote-ICU Monitoring. *Ambulance Monitoring. *Mobile Tele Medicine Unit. *Electronic Health Card.

Health Check-Up Services & International Patient Services & Other services
1. Health Check-Up Services: *Master Health Cheq *Executive Health Cheq *Heart Cheq *Child Health Cheq *Well Woman Cheq *Apollo Diet Test *Clinical Assessment And Specialized Consultation With Complimentary Nutritious Brunch *Lunch And A Comprehensive Medical Summary Card At Customer Door Steps 2. International Patient Services: *400 Beds * 50 Specialties *Total Knee Replacement *Birmingham Hip Resurfacing Procedure *Coronary Angioplasty *Stereotactic Radiotherapy And Radiosurgery. *Cosmetic Surgery *Cochlear Implants *Pediatric Cardiology *Medical Tour Plan *Medical Tour Packages *Credit Card Facilities *Foreign Currency Arrangements *Superlatives Services. *Guidelines For Health Tourists. *Arrangements, Pick Up At The Airport And Accommodation. *Medical Center at Air Port for Information. 3.Other Services: *Rehabilitation *physical therapy for orthopedic disorders *fractures/sprains/strains *pre and post surgical care *acute and chronic pain management *massage therapy *physical therapy for neurological disorders *education and training for patients to gain independence in their daily activities *speech therapy *speech training *nutritional counseling *nutrition therapy *Nutrition advice for faster recovery *psychosocial counseling *boost moral and motivate patients *aid patients to improve their quality of life *clinical psychology *help patients cope with psychological impact of disease *counseling and testing done by psychologists to identify and other mental Illnesses *pain and palliative care *pain management *end of life care *prolong life of patients through counseling *Physiotherapy *Occupational therapy

P R O D U C T

L I N E

W I D T H

*Depth of the Service

1. Anesthesia: *12 beds *ECG *Pulse * Oximeter *NIBP for Every bed. 3. Respiratory Medicine: *32 beds *ventilator support *Bronchoscopy 4. Dental: *Tooth extraction *Cavity Filling *Implants *cosmetic Dentistry 5. Cardiology: *52 beds *Angiogram *Angioplastry and Stenting *Temporary and permanent Pacemakers *Baloon Valvuloplastry *Cardiac Catheterization *Open Heart Surgery *Coronary bypass graft surgery *Valve replacement surgery *ASD&VSD 6. Dermatology: *16 beds *Clinical Dermatology *Dermato Surgery *Dermato Pathology 7. Endocrinology: *10 Beds *Diabetic clinic *Metabolic bone unit *Rental transplant *Radio iodine therapy 8. ENT: *18 Beds *General year problems *Nose and throat diseases *hearing disorders 9. Gastroenterology: *Variceal bleed and Hepatic Coma *Percutaneous Endoscopic Gastrostomies *TIPSS *ERCPS *Video Gastroscope 10. Surgical Gastroenterology: *Laparoscopic Surgery *Piles Clinic *Hernia Clinic *Obesity Clinic 11. General Surgery: *Laser Haemorroidectomy *Variety of Hernia repair procedures *APR with Staplers *Thyroid surgeries *Diabetic Ulcers *Gangrene Cases 12. Immunology & Rheumatology: *DMARDS *I.V.Gammaglobulin *IV Infliximals *Physiotherapy *Hydrotherapy *Hydrotherapy *Splints 13. Nephrology: *Dialysis *CAPD cycler *Renal Transplant *CRRT *Renalt Transplant *Endo Urology 14. Obstetrics & Gynecology *Neonatal Unit *Endoscopic Surgeries *Ovarian Cancer *Fallopian blocks 16. Pediatrics: *42 Beds *General Surgery *Dialysis *ENT*Cardiology *Cardio Thoracic Surgery*Ophthalmology*Gastroenterology *Urology *Orthopedic *Neurology *Nephrology *Ophthalmology 17. Urology & Aandrology: *Stone Service Management *ESWL *PCNL/URS *Non surgical removal of Kidney and ureteric stones *Laser Treatment *Laparoscopic surgery *Aandrology services *Prostate treatment *Pediatric and Reconstructive Urology

1.Accommodation: *General Ward: Semifoler beds, Central nursing station, Guest couch,Television, Air cooler, Pay phone, Water cooler, Bed side room,Light,24hourspharmacyservices Personal Medication Cabinets, Newspaper of choice *Semi Private Rooms: Semi foller beds, Individually controlled room airconditioning ,Total number of beds per room-2 ,Number of bath rooms per room1 ,Number of toilets per room-1, Television, Air cooler ,Pay phone*Water cooler ,Bed side room Light ,24 hours pharmacy services Personal Medication Cabinets ,Newspaper of choice *Private Rooms: Total number of rooms per room-1, Number of bath rooms per room-1,Number of toilets per room-1 Television, Air cooler Pay phone Water cooler Bed, side room Light 24 hours pharmacy services Personal Medication Cabinets Newspaper of choice *Deluxe rooms: Total number of beds per room-1, number of bath rooms,toilets-1, Semi foller beds, Individually controlled room air- conditioning, 24hours pharmacy services, Personal Medication Cabinets, Newspaper of choice. *Super Deluxe Rooms: Guest laundry, Locker facility, Electric Kettle, total number of beds per room-1, number of bath rooms, toilets per room-1, Personnel nurses calling system, Individually controlled, room air- conditioning, 24hours pharmacy services, Personal Medication Cabinets, Newspaper of Choice. 2.Other Medical Services: *Homeopathy *Ayurveda *Rehabilitation *Occupational Therapy *Cervical And Lumbar Traction *Treadmill *Stationary Exercise Bicycle *Weight Training 4.Food & Beverages: *Morning tea/Beverage, *Breakfast * Lunch * Evening Tea * Dinner *Diet Counseling * Caf Coffee. 5. Supplementary Services *Maintenance of the Case History of Patients *Registration (10 Counters) *Billing (25 Counters) 6.Supportive services *Laundry Services * Pharmacy Services (12 counters, 4 counters working round the clock and 365 days) *stores *security services(150 guards working) *parking services(15 acres of land)

Pain Relief Services:

*OP Consultation For Chronic Pain *Pain Relief Treatment For Chronic Backache *Neuralgias *Cancer Pain (Head And Neck, Abdomen, Pelvis, Chest) *Acupuncture.

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Morning Tea/ Beverage 6.45 am to 7.30 pm Breakfast Lunch Evening Tea Dinner 7.45 am to 8.30 pm 12.30 pm to 1.30 pm 4.00 pm to 5.00 pm 7.30 pm to 8.30 pm

Blood bank services providing services like analysis of any blood group discrepancies, quality check, HIV/HbSAg screening, pre-operative haemodilution autologous blood transfusion, supplying components during the night etc. Apollo corporate services includes preventive health checks, occupational health services, ambulance services, screening camps, training and education, awareness lectures, on site telemedicine services, health and wellness workshops, dependent health care programs, corporate emergency management services, preventive health checks etc. Fig. no: 3.6 explaining the complete product length, width and depth of Apollo hospital.

Product Mix in Care Hospital

The product mix in Care hospital broadly classified into Medical and Surgical Services, Laboratory Services, Imagine Services, Online Services, Blood Bank Services, Ambulance Services, Emergency Services, Pharmacy Services, Corporate Services. Home Health Care Services etc. Medical And Surgical Services Includes Critical Care Dermatology Emergency Medicine, Endocrinology, Gastro-Enterology Gastrointestinal Medicine General Medicine, Geriatrics and Home Care Medicine Immunology Internal Medicine Laboratory Medicine, Lifestyle Clinic, Medical, Oncology, Nephrology, Neurology, Pediatrics, Pediatrics Cardiology Pediatric & Neonatology Physiotherapy Psychiatry Pulmonology, Respiratory Medicine, Sports Medicine, Physiology, Transfusion Medicine, Chest Physician, Endoscope, Gastro Logy, Hematology, Physician Preventive And Wellness, Rheumatology, Hematology, Blood Bank Geriatrics, Cardiac Rehab Yoga, Cardio Thoracic Surgery, Dental & Facio Maxillary Surgery, ENT General Surgery, Gynecology Laparoscopic Surgery, Neuron- Surgery Obstetrics And Gynecology, Ophthalmology, Orthopedics, Otolaryngology, Cosmetic, Plastic and Hand Surgery, Pediatric Surgery, Robotic Surgery, Surgical Gastro-Enterology, Surgical

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Oncology, Urology, Vascular Surgery, Emergency Surgery, Traumatology, Endoscopic, Head & Neck Surgery. Laboratory Medicine or Diagnostic Services in Care Hospital Includes Bio-Chemistry, Lab Medicine, Pathology, Micro-Biology and Clinical Genetics, Hematology, Histopathology and Biochemistry. The non invasive labs includes ECG, TMT, TEE, Ambulatory BP Apparatus, 2D Echocardiography, Stress Echo (DSE) Holter, Pulmonary Function Test, Uroflometry, Sleep Test etc. Imagine services in Care hospital covers Radio-Diagnosis, Interventional Radiology, Nuclear Medicine Radiology and Interventional Neuroradiology. Home healthcare services in Care hospital includes Nursing Services, General Nursing, Catheter Care, Wound Care & Dressing, Injections, Intravenous Therapy, Tube Feedings & Care, Physician on Cell, Laboratory Services; Sample Collection from Home, Electrocardiogram Technician to take the ECG at the Home of the Patient, Physiotherapists well Trained in Orthopedic, Cardiovascular, Neurological, Respiratory and Rehabilitative Therapy, Medical Equipment Available on Rental Basis, Diabetic Care & Patient Education, Post Stroke Care, Disease Process Education, Nebulisation/Suction/Ostomy/ Care & Patient Education, Trained Staff will Impart Education to the Patients Attendants. Blood bank services at Care hospital located on first floor near other diagnostic lab facilities. The blood bank works 24 hours and 7-days- a-week. The blood bank operates a transfusion service providing blood for cardiac surgeries and therapy. The bank covers strong processing and banking blood. The bank conducts Post Donation Screening Tests, Rh Titre, Coombs Test Cold and Warm Antibodies, Blood Grouping and Typing as well as Hemoglobin Tests for Blood Donors Cross Matching Tests are Done by Automated Gel Technology. Ambulance services of Care hospital covers pre-hospital care for all the emergency calls that are received. The ambulances manned by well trained emergency medical technologists and drivers who provide pre-hospital care at home en route to the hospital. These ambulances are provides services for transfer of patients from long distances by road and air. A dedicated team of Anesthesiologists and Emergency Medical Technologists provide services. The emergency services in Care hospital include 24hr in-house cover by residents and specialists of all specialties. Key elements include 24-hour in-house coverage by consultants and prompt availability of care in varying specialties such as general surgery, orthopedic surgery,

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Fig No: 3.7

Product Mix in Care Hospital

Product Mix Length Medical & Surgical Services
1.Cardiology: *25 Beds *Cardiothoracic Surgery *Interventional Cardiology 2.Nephrology *15 Beds *Dialysis *CAPD cycler *Renal Transplant *CRRT 3.Urology *20 Beds *Stone Service Management *ESWL *PCNL/URS *Non surgical removal of *Non surgical removal of Kidney and ureteric stones 4.Orthopaedics & trauma *50 Beds 5.Gastroenterology & surgical Gastroenterology *15 Beds *Percutaneous Endoscopic Gastrostomies *TIPSS *ERCPS *Video Gastroscope *Laparoscopic Surgery *Piles Clinic *Hernia Clinic *Obesity Clinic 6.General & laparoscopy surgery *26 Beds 7.Organ transplantation *Heart *Kidney *Liver 8.Obstetrics & gynecology *50 Beds *Ovarian Cancer *Fallopian blocks 9.Anaesthesiology *ECG *Pulse * Oximeter *NIBP 7.Internal medicine *32 Beds 8.Dermatology *Dermato Surgery *Dermato Pathology 9.Endocrinology *12 Beds *Diabetic clinic *Metabolic bone unit *Rental transplant *Radio iodine therapy 10.Neurology *20 Beds *Neuro-surgery 11.Dentistry *Tooth extraction *Cavity Filling *Implants *cosmetic Dentistry 12.ENT *15 Beds *General year problems *Nose and throat diseases *hearing disorders 13.Opthalmology *15 Beds 14.Oncology *10 Beds *surgical oncology 15.Paediatrics *15 Beds *General Surgery *Dialysis *ENT*Cardiology *Cardio Thoracic Surgery *pediatrics surgery 16.Plastic & cosmetic surgery *15 Beds 17.Pulmonology 18.Psychiatry 19.Rheumatology

Diagnostic Services & Critical Care Services & Causality services

1.Diagnostic Services: * Laboratory medicine Pathology Hematology Microbiology Histopathology Biochemistry *Non-Invasive Labs ECG TMT TEE Ambulatory BP apparatus Stress echo (DSE) Hotler Pulmonary function test Uroflometry Sleep test *Radiology Dual source 128 slice CT scan CT coronary angiogram MRI with an add on facility of cardiac Imaging Ultrasonography/Doppler study Digital radiography Special radiological procedures Digital radiography Special radiological procedures Tele radiology *Nuclear Medicine Isotope scan Bone scan Stress thallium High dose iodine therapy Renogram *cardiac catheterization labs *post cath recovery rooms 2.Critical care services: *ICCU- (15 Beds) *MICU- (16 Beds) *PICU-(5 Beds) *NICU-(4Beds) *SICU-(7 Beds) *CTICU-(19Beds) *IMCU-(22 Beds) *PACU- (7 Beds) *Separate recovery room for post cath 3. Causality Services: *20 Beds *emergency room *physician provided services 24/7

Home Health Care Services & Blood Bank Services & Other Services
1. Home Health Care Services: *Nursing Services *General Nursing *Catheter Care *Wound Care & Dressing *Injections *Intravenous Therapy *Tube Feedings & Care *Physician On Call *Laboratory Services (Sample Collection From Home) *ECG At The Home Of The Patient *Physiotherapists Well Trained In Orthopedic, Cardiovascular, Neurological, Respiratory And Rehabilitative Therapy *Medical Equipment On Rental Basis *Diabetic Care & Patient Education *Post Stroke Care *Disease Process Education *Nebulisation/Suction/Ostomy Care & Patient Education *Trained Staff Will Impart Education To The Patients Attendants 2. Blood Bank Services: *600 Units Blood Capacity Per Month *24/7 Days Working *Trans Fusion Services *Post Donation Screening Tests *Combs Test *Cold And Warm Antibodies *Blood Grouping *Blood Typing *Hemoglobin Tests *Cross Matching Tests 3.Other Services: *Physiotherapy *Occupational Therapy *Rehabilitation *Speech Therapy *Speech Training *Nutritional Counseling *Nutrition Therapy *Nutrition Advice For Faster Recovery *Psychosocial Counseling *Clinical Psychology *Counseling And Testing Done By *Pain And Palliative Care *Pain Management *End Of Life Care *Fractures/Sprains/Strains *Pre And Post Surgical Care *Acute And Chronic Pain Management *Massage Therapy *Physical Therapy For Neurological Disorders

Emergency Services & Online Services

1. Emergency Services: *20 Beds *5 Levels Triage, Resuscitation And Observation Areas With Defibrillator Airway Equipment Oxygen Intravenous Lines And Fluids Emergency Drugs Ecg Machines X-ray Non-Invasive Ventilation (NIV) Portable Ultrasound Devices Radiology Ct And Angiography Thrombolysis Central Venous Access Invasive Hemodynamic Monitoring Chest Tube Insertions *24/7 Days Working *Emergency Call Centers (24/7) 2. Ambulance Services: *8 Ambulances With Defibrillator Monitors Ventilators Suction Oxygen Drugs *Access With Any Land Line Or Cell Phone *24/7 Service *Pre-Hospital Care *Transfer Of Patients By Air 3.Online Services: *Find Doctor Through On Line *Request On Estimate Of The Treatment Through Online *second opinion through online

In Patient Services & Day Care Services & Patient Education Services
1.Inpatient Services: Accommodation: *General Ward: (20 Beds In One Room) *Semi-Private Room: (5 Beds In One Room) *Single Room: (Non-Air-Conditioned) *Single Room : (Air-Conditioned) *Deluxe Room: (Air-Condition And Other Facilities *Executive Room : (Air-Condition And Other *Facilities *Care Suit: Air-Condition And Other Facilities) Diet Services: *Break Fast *Soup/Butter Milk *Lunch *Tea/Coffee/Milk *Dinner *nutritious meals through room service *special diet on request *counseling from clinical dietician *restaurant facility for attendants *special items on request *supply on special timings on request Supplementary Services *Maintenance of the Case History of Patients *Registration (8 Counters) *Billing (14 Counters) Supportive services *Laundry Services * Pharmacy Services (8 counters,4 counters working round the clock and 365 days) *stores *security services(63 guards working) *parking services(3 acres of land)

Corporate Services & Health Check-Up Services & International Patient Services
1.Corporate Services: *Corporate Partnering *Corporate Tie-Ups *Membership *On-Line Health Services. *Occupational health checks. *On-Site Doctors. *Ambulance Service. *Screening Camps. *Training And Education. *Awareness Lectures On Telemedicine Facility. *Health And Wellness Workshops. *Dependent Health Care Programs. *Corporate Emergency Management Services *Preventive Health Checks. *Computerized Health Scan *Health Counseling In Diet. *Aerobics 2. Health Check-Up Services: *Child Health *Cough Profile *Essential Heart Check *Gastro Check *Gynaec Check *Heart Check *Her Health Package *His Health Package *Master Cardiac Check *Master Health Check *Premium Diabetic Assessment Plan *Premium Health Assessment Plan *Pre-Placement Medical Check (Age >35) *Pre-Placement Medical Check (Age <35) *Prostrate Check *Well Women *Kidney Screening Package *Basic Health Package *Comprehensive Health Check *Total Body Health Check 3. International Patient Services: *Request On Estimate *Medical Tourism *Request On Estimate *International Patient Care *Cosmetic Surgery *Cochlear Implants *Pediatric Cardiology *Total Knee Replacement *Birmingham Hip Resurfacing Procedure *Coronary Angioplasty *Stereotactic Radiotherapy And Radiosurgery. *Superlatives Services. *Guidelines For Health Tourists. *Arrangements, Pick Up At The Airport And Accommodation. *Medical Tour Plan *Medical Tour Packages *Credit Card Facilities *Foreign Currency Arrangements

P R O D U C T

L I N E

W I D T H

2.Day Care services: *AV Fistula *Medical Termination *Diagnostic Laparoscopy *Circumcision *Cystoscopy *Debridement *Dialysis *Tonsillectomy 3. Patient Education Services: *Patients & Responsibilities *General Instructions *Financial & Insurance Advices *Legal

*Depth of the Service

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Neurosurgery, Anesthesiology, Emergency Medicine, Radiology, Internal Medicine, Oral and Maxillofacial Surgery and Critical Care. The resuscitation area is a key area of an emergency department. It usually contains several individual resuscitation bays. Each bay is equipped with a defibrillator, airway equipment, oxygen, intravenous lines and fluids and emergency drugs etc. The dietary services in care hospital includes meals through room services, breakfast, lunch and dinner apart from morning and evening coffee/tea. Counseling from clinical dietician, restaurant facility for the attendants etc. If the patient need special diets the ward nurses provide on request. Timings are as follows

Break Fast

7.00 am to 8.30 pm.

Soup/Buttermilk 10.30 pm to 12.00 pm. Lunch 12.15 pm to 2.00 pm.

Tea/Coffee/Milk 3.00 pm to 4.00 pm Dinner 7.00 pm to 8.00 pm.

Pharmacy services in Care hospital provides 24hr pharmacy services in hospital. Care hospital pharmacy provide free home delivery of drugs and medicines (Minimum purchase of Rs.300) and within the radius of a couple of kilometers. Further Care hospital providing corporate services, the hospital is recognized for providing quality healthcare to the employees of various organizations. Any business organization would be well advised to opt for a corporate tie-up with Care hospital. Online services in Care hospital provide assistance to find a doctor, request an estimation of treatment and second opinions from the doctors etc. Fig. no: 3.7 explaining the complete product length, width and depth of Care hospital. Now we will take up the perceptions of Doctors, Nurses and Administrative personnel on product mix of two sample hospitals.

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Perceptions of Doctors about the Product Mix of Sample Hospitals

Table no: 3.1 representing perceptions of doctors about the services of the sample hospitals
Table No: 3.1

Perceptions of doctors about the product mix of the sample hospitals

Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree

(1) S.L NO

(2) Statement

(3) Perception 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

Apollo % 27.99 37.33 32.02 1.33 1.33 100.00 37.32 22.66 26.66 3.99 9.37 100.00 22.66 17.33 22.66 23.99 13.36 100.00 39.90 30.81 9.37 11.97 7.95 100.00 25.39 27.99 22.66 13.30 10.66 100.00 35.91 23.94 14.66 18.66 6.83 100.00

care % 43.98 42.70 9.33 2.66 1.33 100.00 1.33 51.99 27.99 17.36 1.33 100.00 9.33 14.66 35.81 22.66 17.54 100.00 11.97 56.06 10.64 20.00 1.33 100.00 1.33 21.32 56.02 20.00 1.33 100.00 14.63 44.10 22.61 17.33 1.33 100.00

The services providing at your hospital are attracting the patients.

Case history of patients maintained by your hospital is always available and helpful to you in treatment.

In emergency situations you recommend the patients to go some other hospitals.

Your hospital operation theaters are helpful to you for conducting Operations.

In your opinion, the package services at your hospital are helpful to the patients.

The diet supplied by your hospital to the patients helps them for better recovery.

127

(1)

(2)

(3) 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

(4) 21.32 32.03 22.66 20.00 3.99 100.00 14.66 25.32 29.36 20.60 10.06 100.00 25.32 31.99 22.66 9.33 10.70 100.00 25.27 14.66 35.99 14.66 9.33 100.00 35.99 43.99 6.70 9.33 3.99 100.00 21.32 31.92 25.44 14.66 6.66 100.00 27.90 50.81 13.30 6.66 1.33 100.00

(5) 10.07 42.65 44.62 1.33 1.33 100.00 14.66 25.32 57.36 1.33 1.33 100.00 17.33 41.32 24.02 16.00 1.33 100.00 17.33 16.00 64.01 1.33 1.33 100.00 22.66 62.69 3.99 9.33 1.33 100.00 16.00 29.32 29.36 23.99 1.33 100.00 30.59 41.50 14.66 11.92 1.33 100.00

The ambulatory services of your hospital does great help to you for timely treatment of patients.

Same day surgery services increasing your hospital image.

You will believe that the equipment at Pathology, Radiology departments are latest and information supplied by them is helpful to you.

10

Hospital providing telemedicine services are useful to you for better treatment.

11

The nursing staff at your hospital is competent, and cooperative.

12

In your opinion, your housekeeping department is doing well.

13

Your ICU services are good and help the patients, who are in critical conditions.

128

(1)

(2)

(3) 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

(4) 31.99 28.08 13.30 14.66 11.97 100.00 14.88 25.27 39.90 11.97 7.98 100.00 30.65 42.74 11.97 7.98 6.66 100.00 35.99 42.73 11.97 7.98 1.33 100.00 44.06 35.98 11.97 6.66 1.33 100.00 25.33 27.99 30.72 7.98 7.98 100.00 22.66 17.33 20.00 25.35 14.66 100.00

(5) 16.00 42.77 16.00 23.90 1.33 100.00 1.33 25.27 52.07 20.00 1.33 100.00 16.00 57.35 9.33 10.66 6.66 100.00 43.99 41.38 5.32 7.98 1.33 100.00 18.66 53.38 11.97 14.66 1.33 100.00 17.33 35.99 44.02 1.33 1.33 100.00 6.66 26.66 26.66 38.69 1.33 100.00

14

Your hospital is having good patient care.

15

Your hospital transportation services are serving maximum number of patients.

16

Your hospital reception services are good.

17

Your hospital pharmacy services are providing required medicines in the hospital premises.

18

When compared to other corporate hospitals, this hospital is providing better services to the patients.

19

Centralized patient services are good and serving patients well in this hospital.

20

This hospital is more capable in developing and launching new services.

An opinion poll was conducted among the respondents about the product of the sample hospitals on various aspects. For the statement, services being provided at the hospital are attracting the patients, among the total of 75 respondents 21 respondents i.e. 27.99% expressed strongly agree opinion in Apollo and in Care 33 respondents with 43.98%. 29 respondents expressed agree opinion in Apollo was 29 with 37.33% and in Care 32 respondents with 42.70%.

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The neutral opinion was taken place among the 25 respondents with 32.02% in Apollo and in Care 7 respondents with 9.33%. 1.33% has expressed disagree opinion in Apollo and in Care 2 respondents with 2.66% expressed. Likewise 1.33% of the respondents also expressed strongly disagreed opinion in Apollo and in Care only 1 respondent with 1.33% expressed. All in all, the respondents in Apollo and Care are satisfied with the services being provided by the both hospitals. An attempt was made on the case history of patients maintained by the hospital is always available and helpful in giving treatment, 28 respondents with 37.32% expressed strongly agree opinion in Apollo whereas 1.33% in case of Care. Only 17 respondents with 22.66% expressed agree opinion in case of Apollo and in Care maximum number of 41 respondents with 51.99%. 20 respondents with 26.66% in Apollo and in Care 21 respondents with 27.93% expressed neutral opinion. 3 respondents with 3.99% expressed disagree opinion in Apollo and in Care 13 respondents with 17.36% expressed. 7 respondents with 9.37% expressed strongly disagree opinion in case of Apollo where as in Care 1.33% was there. From the above, it can be understood that a majority of the respondents are under the opinion, that the case history of patients maintained by the hospitals is always available and helpful in giving treatment. The survey has focused on emergency situations where the doctors recommend the patients to go to some other hospitals. On this statement 17 respondents with 22.66% expressed strongly agree opinion in Apollo and in case of Care only 7 respondents with 9.33% expressed. 13 respondents with 17.33% expressed agree opinion and in Care 11 respondents with 14.66%. The neutral opinion was taken place among 17 respondents with 22.66% in Apollo and in Care 27 respondents with 35.81%. 18 respondents with 23.99% in case of Apollo and in Care 17 respondents with 22.66% expressed disagree opinion. The strongly disagree opinion given by 10 respondents with 13.56% in Apollo and in Care 13 respondents with 17.54%. Finally it is observed that no respondent has supported the statement of recommending some other hospitals by the doctors ever in emergency conditions. With regard to hospital operation theatres are helpful in conducting operations, 30 respondents with 39.90% expressed strongly agree opinion in case of Apollo where as in Care 9 respondents with 11.97%. There were about 23 respondents with 30.81% in Apollo expressed agree opinion but in Care the maximum respondents of 43 with 56.06% expressed the same opinion. The neutral opinion was taken place among 7 respondents with 9.37% in Apollo and in

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Care 8 respondents with 10.64%. 9 respondents with 11.97 in Apollo expressed disagree opinion but in Care 15 respondents with 20.00% expressed. 6 respondents with 7.95% in Apollo and 1.33% in case of Care expressed strongly disagree opinion. From the above analysis, it can be understood that majority of respondents are under the opinion that the operation theatre are more helpful in conducting operations. The statement of analysis poses a query; the package services at your hospital are helpful to the patients. 19 respondents with 25.32% expressed strongly agree opinion in Apollo and 1.33% in case of Care. 21 respondents with 27.99% expressed agree opinion in Apollo where as 16 respondents with 21.32% in case of Care Hospital. The neutral opinion came up from among 17 respondents with 22.66% in Apollo and in Care 44 respondents with 560.2%. When the question of disagree comes 10 respondents with 13.30% in Apollo and in Care 15 respondents with 20.00% expressed. 8 respondents with 10.66% strongly disagree in Apollo and 1.33% in Care Hospitals. It can be observed from the above analysis of statement that difference of opinion was taken place in respect of package services helpful to the patients in the hospitals. For the statement relating to the diet supplied by the hospital to the patients helps them for better recovery. Out of 75 respondents participated, 27 respondents with 35.91% expressed strongly agree opinion in Apollo whereas 11 respondents with 14.63% in Care Hospital. 18 respondents with 23.94% expressed agree opinion in Apollo but in case of Care a large number of 34 respondents with 44.10% followed the same opinion. 11 respondents with 14.66% in Apollo and 17 respondents with 22.66% in Care Hospital expressed neutral opinion. 14 respondents with 18.66% in Apollo and 13 respondents with 17.33%have expressed disagree opinion.5 respondents with 6.83% strongly disagreed in Apollo, whereas 1.33% in Care Hospital. It can be understood from the above statement that a long number of respondents accept the diet supplied by these hospitals will certainly help the patients for better recovery. With regard to the ambulatory services being offered at the hospital are helpful for giving timely treatment to patients 16 respondents with 21.32% expressed strongly agree opinion in Apollo and 8 respondents with 10.07% as in case of Care Hospital. 24 respondents with 32.03% expressed agree opinion in Apollo Hospital where as in Care Hospital 32 respondents with 42.65% expressed the same. The neutral opinion was derived from among 17 respondents with 22.66% in Apollo but in Care it was 35 respondents with 44.62%. 15 respondents with 20.00% expressed disagree opinion in Apollo Hospital where as in Care no 1.33%. In case of strongly

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disagree opinion, only 3 respondents with 3.99% in Apollo and 1.33% in Care Hospital expressed. On examining the statement it is found that more number of respondents expressed that the ambulatory services of these hospitals does great help for timely treatment of patients. The survey has focused on the subject that the same day surgery services increases the hospital image, 11 respondents with 14.66% expressed strongly agree opinion in both the hospitals of Apollo and Care. The agreed opinion percentage of respondents also is same as in case of Apollo and Care as 19 respondents with 25.32%. 22 respondents with 29.36% expressed neutral opinion in case of Apollo but it was 45 respondents with 57.36% expressed in Care. The disagreed opinion came up from 15 respondents with 20.60% in Apollo where as 1.33% in Care Hospital. Likewise 8 respondents with 10.66% expressed the strongly disagree opinion where as 1.33% in Care Hospital. On going through the analysis of statement, the respondents are not in a position to take a decision on the subject. An attempt was made on the equipment at Pathology, Radiology departments are latest and information supplied by them is helpful. Out of 75 respondents, 19 respondents with 25.32% have expressed strongly agree opinion in Apollo but in case of Care only 13 respondents with 17.33%. 24 respondents with 31.99% agree opinion in Apollo and in case of Care Hospital 32 respondents with 41.32% expressed the same opinion. The neutral opinion was expressed among 17 respondents with 22.66% in Apollo, in Care 18 respondents with 24.02%. 7 respondents with 9.33% expressed disagree opinion in Apollo Hospital. Whereas 12 respondents with 16.00% in Care Hospital. The strongly disagree opinion was taken place among 8 respondents with 10.70% in Apollo and 1.33% in Care Hospital. From the above analysis it can be found that a large number of respondents are of the opinion that the equipment relating to Pathology and Radiology departments are latest and information supplied by then is useful. Pertaining to the usefulness of providing telemedicine services in the hospital for better treatment, 19 respondents with 25.36% in Apollo expressed strongly agree opinion and 13 respondents with 17.33% in case of Care Hospital. 11 respondents with 14.66% expressed agree opinion in Apollo Hospital and 12 respondents with 16.00% expressed the same opinion in Care Hospital. The neutral expression was arrived from among 27 respondents with 35.99% in Apollo and in Care 50 respondents with 64.01%. 11 respondents with 14.66% expressed disagreed opinion in Apollo Hospital and 1.33% in Care. Likewise 7 respondents with 9.33% expressed strongly disagreed opinion in Apollo and 1.33% in Care Hospital. It can be found from the above

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analysis statement; majority of respondents appears that they are not in a position to come to a conclusion on providing telemedicine services whether they are helpful for better treatment. The analysis of statement on the subject that nursing staff at hospital are competent and cooperative, 27 respondents with 35.99% in Apollo Hospital expressed strongly agree opinion whereas 17 respondents with 22.66% in case of Care. 33 respondents with 44.03% expressed agree opinion in Apollo Hospital and in case of Care 48 respondents with 62.69% expressed. 5 respondents with 6.70% in Apollo and in Care only 3 respondents with 3.99% expressed neutral opinion. The disagreed opinion was taken place among 7 respondents with 9.33% in Apollo and in Care also the same position appeared. 3 respondents with 3.99% in Apollo and 1.33% in case of Care has expressed strongly disagree opinion. In general the opinion of the respondents are very positive in respect of nursing staff of both the hospitals are competent and cooperative. The survey was taken place on the subject that the house keeping departments doing well, 16 respondents with 21.32% have expressed strongly agree opinion in Apollo Hospital and in Care 12 respondents with 16.00% expressed the same opinion. 24 respondents with 31.92% expressed agree opinion in Apollo and 23 respondents with 29.32% in Care Hospital. The neutral opinion was taken place among 19 respondents with 25.44% in Apollo and 22 respondents with 29.36%in Care Hospital. 11 respondents with 14.66% in Apollo and in care 18 respondents with 23.99% expressed disagreed opinion. 5 respondents with 6.66% has expressed strongly disagree opinion in Apollo Hospital and 1.33% in Care Hospital. From the above it can be under stood that major portion of respondents are under the opinion that the house keeping department is performing well in both the hospitals. Further, an attempt was made on the subject that the ICU services are good and help the patients, who are in critical conditions, 21 respondents with 27.90% expressed strongly agree opinion in Apollo and in case of Care 23 respondents with 30.59% expressed in same opinion. 39 respondents with 50.81% expressed agree opinion in Apollo Hospital and in Care 32 respondents with 41.50% expressed. 10 respondents with 13.30% in Apollo and in Care 11 respondents with 14.66% expressed neutral opinion. 5 respondents with 6.66% expressed disagreed opinion in Apollo and in case of Care 9 respondents with 11.92% expressed the same opinion. 1.33% in both the hospitals has expressed strongly disagree opinion. On going through above analysis of statement it appears that the respondents are under the opinion that the ICU services are good and help the patients, who are in critical conditions.

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The survey has been extended in respect of the hospitals having good patient care, 24 respondents with 31.99% have expressed strongly agree opinion in Apollo but in Care hospital only 12 respondents with 16.00%. 21 respondents with 28.08% expressed agree opinion in Apollo hospital where as in Care hospital 33 respondents with 42.77% expressed the same opinion. The neutral opinion was taken place in respect of Apollo hospital form 10 respondents with 13.30% and in Care Hospital. 12 respondents with 16.00%, 11 respondents with 14.66% in case of Apollo and in Care Hospital 18 respondents with23.90% expressed disagree opinion. 9 respondents with 11.97% have expressed strongly disagree opinion in Apollo and 1.33% in Care Hospital. From the above discussion, it reveals that majority of respondents are under the impression that both the hospitals are having good patient Care. In the aspect of hospital transportation services are serving maximum number of patients, 11 respondents with 14.88% have expressed strongly agree opinion in respect of Apollo Hospital where as 1.33% in Care Hospital. The equal number of 19 respondents with 25.27% have expressed agree opinion in both the hospitals of Apollo and Care. The neutral opinion was taken place among 30 respondents with 39.90% in case of Apollo and 41 respondents with 52.07% in Care. 9 respondents with 11.97% expressed disagree opinion in Apollo and in Care 15 respondents with 20.00% was expressed. In respect of strongly disagreed opinion 6 respondents with 7.98% in Apollo and 1.33% in Care Hospital. On the whole the statement reveals that the respondents are under neutral opinion about the transportation services are serving maximum number of patients. As regards the hospital reception services are good, 23 respondents with 30.65% in Apollo hospital have expressed strongly agree opinion and 12 respondents with 16.00% in Care Hospital. 32 respondents with 42.74% in Apollo and 43 respondents with 57.35% have expressed agreed opinion in Care Hospital. 9 respondents with 11.97% in Apollo and in Care 7 respondents with 9.33% expressed neutral opinion. 6 respondents with 7.98% expressed disagree opinion in Apollo and in Care 8 respondents with 10.66% expressed. Equal number of 5 respondents with 6.66% have expressed the strongly disagree opinion in both the hospitals of Apollo and Care. On going through the above analysis, it can be understood that a major portion of respondents are under the opinion that these hospitals reception services are good. An attempt was made about the hospital pharmacy services are providing required medicines in the hospital pharmacy, 27 respondents with 35.99% in Apollo where as in Care 34

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respondents with 43.99% have expressed strongly agree opinion. 37 respondents with 42.73% in respect of Apollo and in Care 31 respondents with 41.38% have expressed agree opinion. The neutral opinion came up from among 9 respondents with 11.97% in Apollo and in Care Hospital 4 respondents with 5.32%. The equal number of 6 respondents with 7.98% has expressed disagree opinion in both the hospitals of Apollo and Care. The strongly disagree opinion was noticed as 1.33% in both the hospitals. In conclusion, it is known that cancellation the major portion of respondents are under the opinion that hospital pharmacy services are providing required medicines in the hospital premises. It was surveyed whether this hospital is providing better services to the patients in comparison with other hospitals. 33 respondents with 44.06% have expressed strongly agree opinion in respect of Apollo whereas in Care Hospital it was only 14 respondents with 18.66%. 27 respondents with 35.98% have expressed agree opinion in Apollo and in Care Hospital it was form 41 respondents with 53.38%. The neutral opinion was arrived form an equal number of 9 respondents with 11.97% in both the hospitals of Apollo and Care. 5 respondents with 6.66% expressed disagreed opinion from Apollo and in Care 11 respondents with 14.66% .The strongly disagree opinion was arrived from a least percentage of 1.33% from Apollo and 1.33% in case of Care. When the above analysis is examined, it is revealed that a large number of respondents accept that both the hospitals are providing better services to the patients when compared to other corporate hospitals. On the subject of centralized patient services are good and serving patients well in this hospital, 19 respondents with 25.33% expressed strongly agree opinion against Apollo hospital and in case of Care hospital 13 respondents with 17.33% has taken place. 21 respondents with 27.99% have expressed agreed opinion in respect of Apollo and 27 respondents with 35.99% in case of Care hospital expressed. Most of 23 respondents with 30.72% in Apollo and 35 respondents with 44.02% in Care hospital expressed neutral opinion. 6 respondents with 7.98% expressed disagreed opinion in case of Apollo and 1.33% in Care Hospital. In the same way 6 respondents with 7.98% have expressed strongly disagree opinion in Apollo and 1.33% in Care hospital. From the above, it can be understood that major number of respondents are under the neutral opinion that the centralized patients are good and serving patients well in both the hospitals.

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The survey was under taken against this hospital is more capable in developing and launching new services,17 respondents with 22.66% in case of Apollo and in Care 5 respondents with 6.66% have expressed strongly agreed opinion.13 respondents with 17.33% have expressed agree opinion in Apollo and in care 20 respondents with 26.66% was shown. The neutral opinion was expressed from among 15 respondents with 20.00% in Apollo and in Care 20 respondents with26.66%. 9 respondents with 25.35% expressed their disagree opinion in Apollo and in care 30 respondents with 38.69% expressed. 11 respondents with 14.66% have expressed their strongly disagree opinion in case of Apollo, whereas in Care 1.33% has expressed the same opinion. On going through the above analysis it reveals that majority are of the opinion that both the hospitals are capable in developing and launching new services in both the hospitals. From the above discussion it can be concluded that, most of the respondents from Apollo hospital having good opinion about their products/services. But in some aspects they are not producing good services like ICU services, Pharmacy services, etc. they are concentrating especially on maintenance of patients case histories, operation theaters, diet supplies, nursing services, patient care aspects, transportation services, reception services etc. Further it is observed that Apollo paying interest in developing and launching new services in the market before their competitors. In the Case of care hospital as per the respondents opinion, they are not concentrating on service production, when compared to Apollo hospital. Care is not satisfactorily working in the aspects of emergency services, operation theaters maintenance, packaging services, dietary services, ambulatory services, telemedicine services, house keeping services, transportation services etc. but it is observed that the Care is doing well in producing services like same day surgeries, ICU services and Pharmacy services when compared to Apollo hospital. On the whole, it is observed that the product mix is good in two sample hospitals. Now we will take up the perceptions of nurses on product mix in two sample hospitals.

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Perceptions of Nurses about the Product Mix of Sample Hospitals

Table no: 3.2 representing perceptions of nurses about product of the sample hospitals
Table No: 3.2

Perceptions of nurses about product mix of the sample hospitals

Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree

(1) S.L NO

(2) Statement

(3) Perception 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

The services providing at your hospital are attracting the patients.

Case history of patients maintained by your hospital is always available and helpful to you in treatment.

In emergency situations you recommend the patients to go some other hospitals.

Your hospital operation theaters are helpful to you for conducting Operations.

In your opinion, the package services at your hospital are helpful to the patients.

The diet supplied by your hospital to the patients helps them for better recovery.

(4) Apollo % 45.03 33.66 0.66 19.99 0.66 100.00 17.96 49.75 11.32 14.31 6.66 100.00 17.98 35.82 24.42 15.18 6.60 100.00 44.80 47.28 6.60 0.66 0.66 100.00 25.30 28.15 32.63 7.32 6.6 100.00 33.30 44.26 6.60 7..92 7..92 100.00

(5) Care % 32.34 65.68 0.66 0.66 0.66 100.00 33.66 39.71 11.98 14.65 0.66 100.00 12.54 67.00 13.86 5.94 0.66 100.00 32.62 65.40 0.66 0.66 0.66 100.00 13.20 37.53 47.95 0.66 0.66 100.00 51.31 27.30 19.99 0.66 0.66 100.00

137

(1)

(2)

(3) 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

(4) 52.61 27.40 5.99 7.32 6.68 100.00 31.47 35.30 12.65 13.98 6.6 100.00 22.54 28.63 26.19 14.65 7.99 100.00 42.79 49.29 6.60 0.66 0.66 100.00 44.78 47.30 6.60 0.66 0.66 100.00 24.21 29.30 19.31 13.98 13.20 100.00 40.75 25.97 12.65 11.98 8.65 100.00

(5) 38.28 39.76 13.98 7.32 0.66 100.00 13.20 50.18 35.30 0.66 0.66 100.00 20.09 37.30 33.96 7..99 0.66 100.00 26.64 48.07 15.98 8.65 0.66 100.00 64.61 27.47 6.60 0.66 0.66 100.00 25.97 53.40 12.65 7.32 0.66 100.00 12.65 65.27 7.26 14.16 0.66 100.00

The ambulatory services of your hospital does great help to you for timely treatment of patients.

Same day surgery services increasing your hospital image.

You will believe that the equipment at Pathology, Radiology departments are latest and information supplied by them is helpful to you.

10

Hospital providing telemedicine services are useful to you for better treatment.

11

The nursing staff at your hospital is competent, and cooperative.

12

In your opinion, your housekeeping department is doing well.

13

Your ICU services are good and help the patients, who are in critical conditions.

138

(1)

(2)

(3) 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

(4) 27.30 26.76 25.97 11.98 7.99 100.00 25.97 26.64 20.76 12.65 13.98 100.00 36.74 29.97 17.98 7.99 7.32 100.00 38.58 39.96 13.20 7.60 0.66 100.00 44.08 45.96 7.32 1.32 1.32 100.00 19.49 32.63 27.30 13.98 6.60 100.00 20.64 26.13 26.64 19.99 6.60 100.00

(5) 50.08 27.30 13.98 7.32 1.32 100.00 31.30 32.64 20.76 13.98 1.32 100.00 26.76 37.96 20.64 7.32 7.32 100.00 33.41 43.30 13.98 7.99 1.32 100.00 33.98 40.07 23.31 1.32 1.32 100.00 25.68 39.30 27.30 6.40 1.32 100.00 34.14 32.63 20.64 5.99 6.60 100.00

14

Your hospital is having good patient care.

15

Your hospital transportation services are serving maximum number of patients.

16

Your hospital reception services are good.

17

Your hospital pharmacy services are providing required medicines in the hospital premises.

18

When compared to other corporate hospitals, this hospital is providing better services to the patients.

19

Centralized patient services are good and serving patients well in this hospital.

20

This hospital is more capable in developing and launching new services.

A sample Hospital survey has been taken up among the nurses on the subject of the services being provided at the Hospital attracting the patients.150 respondents participated out of which 69 respondents with 45.03% expressed strongly agree opinion in respect of Apollo and 49 respondents with 32.34% in Care Hospital. 51 respondents with 33.66% expressed agree opinion

139

in respect of Apollo and in Care 99 respondents with 65.38% expressed the same opinion. In case of Apollo, 0.66% has expressed neutral opinion, in Care Hospital also a meager percentage of 0.66% expressed. The disagreed opinion has come from 30 respondents with 19.99% in Apollo and in Care it was only from one respondent with 0.66%. In both the Hospitals, 0.66% has expressed strongly disagree opinion. On the whole, it can be noticed that a large number of respondents are of the opinion that in both the Hospitals the services being provided are attracting the patients. Further, the survey was aimed at the case history of patients maintained by the hospital is always available and helpful to you in treatment. For these 27 respondents with 17.96% have expressed strongly agree opinion in Apollo Hospital but in Care it was 51 respondents with 33.66%. 73 respondents with 49.75% expressed agree opinion in Apollo where as in Care 59 respondents with 39.71%. The neutral opinion was arrived among 17 respondents with 11.32% in Apollo and in Care 18 respondents with 11.98%. 23 respondents with 14.31% in Apollo was expressed disagree opinion where as in Care it was 22 respondents with 14.65%. The strongly disagree opinion was taken place among 10 respondents with 6.66% in both the Hospitals. It is observed from the above analysis of statement that majority of respondents are under the opinion that the case history of patients maintained by the both Hospitals are always available and helpful in treatment. On the subject of recommending patients to go some other Hospitals in emergency conditions the opinion poll says 27 respondents with 17.98% have expressed strongly agree opinion in respect of Apollo Hospital and in case of Case 19 respondents with 12.65% have expressed the same opinion. 23 respondents with 35.82% have expressed agree opinion in Apollo as in case of Care it was 101 respondents with 67.00%. The neutral opinion has come up from 37 respondents with 24.64% and in Care 21 respondents with 13.98%. 23 respondents with 15.31% expressed disagreed opinion in Apollo and 9 respondents with 5.99% express the same opinion in case of Care Hospital. 10 respondents with 6.60% have expressed strongly disagree opinion in respect of Apollo and 0.66% in Care Hospital. It can be seen from the above analysis that the respondents are certainly suggesting the patients to go to some other Hospital in emergency conditions in respect of the both Hospitals. As regards the Hospital operation theatre is helpful in conducting operations, 69 respondents with 44.80% expressed strongly agree opinion in Apollo Hospital where as in Care Hospital 49

140

respondents with 32.62%. 71 respondents with 47.28% expressed agree opinion in Apollo where as in Care a large number of 101 respondents with 65.40% have expressed the same opinions. 10 respondents with 6.60% have express neutral opinion in case of Apollo but only 0.66% was in case of Care Hospital. The disagreed and strongly disagreed opinion was found as 0.66% in both the Hospitals. From the above analysis, it can be found that large number of respondents is under the opinion that the operations theatre is certainly helpful in conducting operations. On the subject of service packages at the hospital are helpful to the patients, 38 respondents with 25.30% expressed their strongly agree opinion in case of Apollo Hospital, where as in Care Hospital 20 respondents with 13.20%. 42 respondents with 28.15% expressed their agree opinion in Apollo but in case of Care Hospital, it was 58 respondents with 37.53%. The neutral opinions were taken place among 49 respondents with 32.63% in case of Apollo and 72 respondents with 47.95% in case of Care Hospital. 11 respondents with 7.32% expressed their disagree opinion in case of Apollo but 0.66% in the case of Care Hospital. 10 respondents with 6.60% have expressed strongly disagree opinion in Apollo but in Care Hospital 0.66% expressed the same opinion. In conclusion, it is understood that a large number of respondents are under neutral opinion about the aspect of package services of the Hospital are helpful to the patients. The survey has been directed on the subject of the diet supplied by the Hospital to the patients helps them for better recovery. 53 respondents with 35.30% expressed their strongly agree opinion in respect of Apollo and in case of Care a large number of 79 respondents with 51.31% expressed the same opinion. 63 respondents with 44.26% expressed their agree opinion in respect of Apollo Hospital where as in case of Care Hospital it was 41 respondents with 27.30%. The neutral opinion was taken place among 10 respondents with 6.60% in Apollo Hospital and in Care the 30 respondents with 19.99%. 12 respondents with 7.92% expressed their disagree opinion in Apollo and in case of Care Hospital 0.66% has expressed. In the same way the strongly disagree opinion also came up from 12 respondents with 7.92% in Apollo and 0.66% in Care Hospital. There by, the above said analysis shows that a large number of respondents are under the opinion that the diet supplied by these Hospitals certainly helps for the speedy recovery of the patients. Further study was made on the subject of the ambulatory services at the Hospital does great help in extending timely treatment of patients. 79 respondents with 52.61% expressed strongly agree opinion in Apollo and in Care only 58 respondents with 38.28% have expressed the same

141

opinion. 41 respondents with 27.40% expressed agreed opinion in Apollo and in Care only 58 respondents with 39.76% have expressed the same opinion. The neutral opinion came up from among 9 respondents with 5.99% in Apollo and 21 respondents with 13.98% appears in Care Hospital. The equal numbers of 11 respondents disagree with a percentage of 7.32% in both the Hospitals. In case of strongly disagreed opinion, 10 respondents with 6.68% expressed in Apollo and 0.66% in Care Hospital. On going through the above analysis it can be understood that majority of respondents are accepting that the ambulatory services of the Hospitals are helpful for the timely treatment of the patients. As regards the same day surgery services increasing the Hospital image, 47 respondents with 31.47% expressed their strongly agree opinion in respect of Apollo Hospital where as in Care Hospital it was from 20 respondents with 13.20%. The agree opinion came up from a large number of 53 respondents with 35.30% in Apollo and 77 respondents with 50.18% in Care Hospital. 19 respondents with 12.65% in Apollo Hospital and in Care 53 respondents with 35.30% expressed neutral opinion. The disagree opinion came up from among 21 respondents with 13.98% in case of Apollo and 0.66% was there in respect of Care Hospital. In the same way 10 respondents with 6.6% expressed strongly disagree opinion in Apollo and 0.66% in Care Hospital. It can be observed from the above analysis that majority of respondents are under the opinion that same day surgery services will help in increasing the image of Hospitals. An attempt was made on the subject of the equipment at Pathology, Radiology departments and information supplied by them is helpful, 33 respondents with 22.54% strongly agree in Apollo and 30 respondents with 20.09% in Care Hospital. 43 respondents with 28.63% expressed their agree opinion in respect of Apollo where as in case of Care Hospital 57 respondents with 37.30% was noticed. The neutral opinion came up from among 40 respondents with 26.19% in Apollo and 51 respondents with 33.96% respect of Care Hospital was noticed. 22 respondents with 14.65% expressed disagreed opinion in Apollo where as 12 respondents with 7.99% in Care Hospital. The strongly disagree opinion was taken place among 12 respondents with 7.99% in Apollo Hospital and 0.66% in Care Hospital. On the whole it can be observed that a large number of respondents believe that the latest equipment pertaining to Pathology, Radiology departments and information supplied is helpful. In course of opinion poll conducting, it was stressed on the telemedicine services being provided at the Hospital are useful for better treatment. 64 respondents with 42.79% in case of

142

Apollo Hospital have expressed strongly agree opinion where as in case of Care, it was from 40 respondents with 26.64%. A large number of 76 respondents with 49.29% have expressed agree opinion in respect of Apollo and 73 respondents with 48.07% in case of Care Hospital. The neutral opinion was given by 10 respondents 6.60% against Apollo and 24 respondents with 15.98% against Care Hospital. In case of Apollo Hospital 0.66% only has expressed disagreed opinion where as in case of Care 13 respondents with 8.65% expressed. There are 0.66% of respondents expressed the strongly disagree opinion in both the Hospitals. From the above analysis, it is noticed that large number of respondents are under the opinion that telemedicine services are useful for better treatment. The survey has been undertaken on the aspect of competence and cooperation of nursing staff at the Hospital. 67 respondents with 44.78% have expressed strongly agree opinion in respect of Apollo and 99 respondents with 64.61% in Care Hospital. 73 respondents with 47.30% have expressed their agree opinion in Apollo where as in Care 41 respondents with 27.47% expressed the same.. Equal numbers of 10 respondents with 6.60% have given neutral opinion in respect of both Hospitals. 0.66% has appeared to express disagreed opinion in respect of both the Hospitals of Apollo and Care. In the same way, the strongly disagree opinion was also expressed by 0.66% in both the Hospitals of Apollo and Care. It appears from the above, that the nursing staff is competent and cooperative in respect of both the Hospitals. As regards the house keeping department is doing well, 36 respondents with 24.21% in Apollo and in Care 39 respondents with 25.97% expressed strongly agree opinion. 44 respondents with 29.30% in Apollo Hospital expressed agree opinion and in Care 81 respondents with 53.40%. The neutral opinion came up among 29 respondents with 19.31% in Apollo and 19 respondents with 12.65% as in case of Care Hospital. 21 respondents with 13.98% in Apollo and 11 respondents with 7.32% in Care Hospital expressed disagrees opinion. The strongly disagrees opinion has taken place in respect of 20 respondents with 13.20% in Apollo and 0.66% in Care Hospital. It can be observed from the above decision that the house keeping department is doing well in both the Hospitals. The survey has been extended on the ICU services are good and help the patients, who are in critical conditions, 61 respondents with 40.75% expressed strongly agree opinion in case of Apollo and 19 respondents with 12.65% in respect of Care Hospital. 39 respondents with 25.97% in Apollo Hospital and 99 respondents with 65.27% in respect of Care Hospital expressed agreed

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opinion. The neutral opinion was expressed from 19 respondents with 12.65% in Apollo and in case of Care 11 respondents with 7.26%. 18 respondents with 11.98% in Apollo and 21 respondents with 14.16% expressed disagreed opinion in Care Hospital. 13 respondents with 8.65% expressed strongly disagreed opinion in Apollo and 0.66% in case of Care Hospital. From the above analysis of statement it reveals that majority that ICU services are good and help the patients, who are critical conditions. An attempt was made on the aspect that your Hospital is having good patient Care. 41 respondents with 27.30% expressed strongly agree opinion in Apollo Hospital where as 77 respondents with 50.08% in case of Care Hospital. 40 respondents with 26.76% expressed agree opinion in Apollo Hospital and in Care Hospital also 41 respondents with 27.30% expressed the same. The neutral opinion was expressed among 39 respondents with 25.97% in Apollo and in Care Hospital it was 21 respondents with 13.98%. The disagreed opinion has taken place among 18 respondents with 11.98% in Apollo where as in Care Hospital it was from 11 respondents with 7.32%. 12 respondents with 7.99% were expressed strongly disagree opinion in Apollo but 1.32% in Care Hospital. It can be noticed form the above analysis that large number of respondents were on the opinion of that both the Hospital are having good patient Care. As regards the Hospital transportation services are serving maximum number of patients, 39 respondents with 25.97% were expressed strongly agree opinion in Apollo where as in Care it was 47 respondents with 31.30%. 40 respondents with 26.64% in Apollo expressed agree opinion, but in Care Hospital 51 respondents with 32.64% have expressed the same opinion. Equal number of 31 respondents with 20.76% expressed the neutral opinion in both the Hospitals of Apollo and Care. 19 respondents with 12.65% in case of Apollo disagree, where as 21 respondents with 13.98% in Care Hospital expressed the same. 21 respondents with 13.98% expressed strongly disagrees opinion where as in Care 1.32% expressed the same opinion. On going through the above analysis it reveals that majority of respondents are under the impression that the Hospital transportation services are serving maximum number of patients. In continuation of the opinions gathered another step has made on the subject that the Hospital reception services are good, 55 respondents with 36.74% has expressed strongly agree opinion in Apollo but 40 respondents with 26.74% in case of Care Hospital. 45 respondents with 29.97% expressed agree opinion in respect of Apollo Hospital where as in Care Hospital 57 respondents with 37.96% was expressed. The neutral opinion was taken place among 27

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respondents with 17.98% in Apollo and in Care it was from 31 respondents with 20.64%. 12 respondents with 7.99% expressed disagrees opinion in respect of Apollo Hospital and in Care Hospital it was from 11 respondents with 7.32%. 11 respondents with 7.32% expressed strongly disagrees opinion in case of Apollo Hospital and 11 respondents with 7.32% in Care Hospital. Overall it is observed that a number of respondents are agreed that the Hospitals reception services are good. The survey has taken up on the Hospital pharmacy services providing required medicine in the Hospital pumices, 59 respondents with 39.58% has expressed strongly agree opinion in respect of Apollo and 50 respondents with 33.41% in Care Hospital. 60 respondents with 39.96% expressed agree opinion in respect of Apollo where as it was 67 respondents with 43.30% in Care Hospital. The neutral opinion has taken place in respect of Apollo Hospital was 20 respondents with 13.20% and in Care it was 21 respondents with 13.98%. 10 respondents with 7.60% has expressed disagree opinion in Apollo where as in Care 12 respondents with 7.99% in respect of Care Hospital. The strongly disagree opinion was taken place a meager percentage of 0.66% in Apollo and 1.32% in Care Hospital. On going through the analysis it is observed that majority of respondents are under the opinion that the Hospitals pharmacy services are providing required medicines in the Hospital pumices. On the subject of comparison with other corporate Hospitals, this Hospital is providing better services to the patients, 68 respondents with 44.08% in Apollo has expressed strongly agree opinion where as in Care it was from 53 respondents with 33.98%. 71 respondents with 45.96% has expressed agreed opinion in respect of Apollo Hospital where as 62 respondents with 40.07% has expressed the same opinion in Care Hospital. 11 respondents with 7.32% in Apollo Hospital and 35 respondents with 23.31% in Care Hospital have expressed neutral opinion. 1.32% has expressed disagree opinion in both the Hospitals. Likewise 1.32% has expressed strongly disagree opinion in respect of the Apollo and Care Hospitals. On the whole it is observed that a large number of respondents are under the opinion that no other cooperative Hospitals will provide better services than these Hospitals. On the subject centralized patient services are good and servicing patients well in this Hospital, 29 respondents with 19.49% have expressed strongly agreed opinion in respect of Apollo and in Care Hospital 38 respondents with 25.68% expressed the same opinion. 49 respondents with 32.63% in case of Apollo Hospital but in case of Care 61 respondents with

145

39.30% has expressed agree opinion. Equal number of 41 respondents with 27.30% has expressed neutral opinion in respect of the both Hospitals. 21 respondents with 13.98% has expressed the disagree opinion in respect of Apollo Hospital and in case of Care Hospital 10 respondents with 6.40% expressed. The strongly disagree opinion came up from 10 respondents with 6.60% in Apollo and 1.32% has expressed same opinion in Care Hospitals respectively. From the above it can be seen that majority respondents are under opinion that centralized patient services are good and servicing patients well in both the Hospitals. An attempt was made on the Hospital is more capable in developing and launching new services, 31 respondents with 20.64% has expressed strongly agrees opinion in respect of Apollo and in Care 51 respondents with 34.14% expressed the same. 39 respondents with 26.13% expressed the agree opinion in respect of Apollo and in Care 49 respondents with 32.63% expressed. The neutral opinion has come up among 40 respondents with 26.64% in Apollo and 31 respondents with 20.64% in Care Hospital. 30 respondents with 19.99% has expressed disagree opinion in respect of Apollo Hospital where as in Care 9 respondents with 5.99% expressed. 10 respondents with 6.60% expressed their strongly disagree opinion in Apollo and in Care Hospital the same opinion came up. On the whole majority of respondents are under the opinion of that these Hospitals are more capable in developing and launching new services. From the above discussion it is noticed that, Apollo is giving importance to same day surgeries, telemedicine services, and ICU services. Because most of the respondents are having positive opinion from Apollo when compared to Care hospital. Further it is observed that most of the respondents are having good opinion on the product mix of the Care hospital. As per their opinion the hospital is good in providing services like packaging services, dietary services, good operation theaters, ambulatory services, transport services etc. but some of the services are not gaining acceptance from the respondents like emergency services, same day surgery services, telemedicine services, ICU services, reception services, pharmacy services etc. By and large, it is found that the product mix is good in two hospitals. Now let us move on to the perceptions of administrative personnel.

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Perceptions of Administrative Personnel about the Product Mix of Sample Hospitals

Table no: 3.3 representing perceptions of administrative personnel about the product mix of the sample hospitals
Table No: 3.3

Perceptions of administrative personnel about the product mix of the sample hospitals
Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree

(1) S.L NO

(2) Statement

(3) Perception 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

The services providing at your hospital are attracting the patients.

Case history of patients maintained by your hospital is always available and helpful to you in treatment.

In emergency situations you recommend the patients to go some other hospitals.

Your hospital operation theaters are helpful to you for conducting Operations.

In your opinion, the package services at your hospital are helpful to the patients.

The diet supplied by your hospital to the patients helps them for better recovery.

(4) Apollo % 37.05 28.50 14.25 17.35 2.85 100.00 11.40 45.85 11.40 11.40 19.95 100.00 34.45 14.25 22.80 11.40 17.10 100.00 37.05 43.00 5.70 8.55 5.70 100.00 31.60 25.65 28.5 5.75 8.50 100.00 51.55 39.90 2.85 2.85 2.85 100.00

(5) Care % 22.80 39.90 31.60 2.85 2.85 100.00 48.70 31.35 2.85 14.25 2.85 100.00 31.60 22.80 25.65 17.10 2.85 100.00 14.25 43.00 14.25 14.25 14.25 100.00 28.50 48.70 8.55 8.55 5.70 100.00 54.45 25.65 8.50 5.70 5.70 100.00

147

(1)

(2)

(3) 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

(4) 45.85 42.75 2.85 5.70 2.85 100.00 39.90 45.85 2.85 5.70 5.70 100.00 37.30 39.90 11.40 5.70 5.70 100.00 39.90 48.70 5.70 2.85 2.85 100.00 39.90 51.55 2.85 2.85 2.85 100.00 37.30 42.75 8.55 5.70 5.70 100.00 45.85 39.90 2.85 5.70 5.70 100.00

(5) 14.25 39.90 17.35 14.25 14.25 100.00 48.70 25.65 11.40 8.55 5.70 100.00 62.95 11.40 11.40 5.70 8.55 100.00 43.00 28.50 17.10 5.70 5.70 100.00 54.40 25.65 14.25 2.85 2.85 100.00 42.75 42.75 2.85 8.80 2.85 100.00 28.50 51.55 2.85 14.25 2.85 100.00

The ambulatory services of your hospital does great help to you for timely treatment of patients.

Same day surgery services increasing your hospital image.

You will believe that the equipment at Pathology, Radiology departments are latest and information supplied by them is helpful to you.

10

Hospital providing telemedicine services are useful to you for better treatment.

11

The nursing staff at your hospital is competent, and cooperative.

12

In your opinion, your housekeeping department is doing well.

13

Your ICU services are good and help the patients, who are in critical conditions.

148

(1)

(2)

(3) 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

(4) 39.90 39.90 11.65 5.70 2.85 100.00 31.60 37.05 14.25 11.40 5.70 100.00 43.00 39.90 2.85 8.55 5.70 100.00 43.00 37.05 5.70 11.40 2.85 100.00 42.75 45.85 5.70 2.85 2.85 100.00 37.05 43.00 8.55 5.70 5.70 100.00 37.05 40.15 11.40 8.55 2.85 100.00

(5) 34.45 48.45 5.70 8.55 2.85 100.00 43.00 31.35 5.70 14.25 5.70 100.00 60.10 25.65 5.70 5.70 2.85 100.00 54.40 25.65 8.55 8.55 2.85 100.00 42.75 40.15 11.40 2.85 2.85 100.00 25.65 54.40 8.55 8.55 2.85 100.00 57.25 17.10 8.55 8.55 8.55 100.00

14

Your hospital is having good patient care.

15

Your hospital transportation maximum number of patients.

services

are

serving

16

Your hospital reception services are good.

17

Your hospital pharmacy services are providing required medicines in the hospital premises.

18

When compared to other corporate hospitals, this hospital is providing better services to the patients.

19

Centralized patient services are good and serving patients well in this hospital.

20

This hospital is more capable in developing and launching new services.

The survey has been extended to take opinions among the administration personnel on various aspects. There are about 35 personnel participated in each hospital. In the beginning, it went on the services being provided at the Hospital for attracting patients. 14 respondents with

149

37.05% expressed strongly agree opinion in Apollo where as only 9 respondents with 22.80% in case of Care expressed the same. 10 respondents with 28.50% expressed agree opinion in Apollo and 14 respondents with 39.90% expressed the above opinion in Care Hospital. The neutral opinion came up from among 5 respondents with 14.25% in respect of Apollo and in Care 12 respondents with 31.60% expressed. The disagreed opinion has been received from among 6 respondents with 17.35% in Apollo whereas in Care 2.80% was there. In both the Hospitals, 2.85% expressed the strongly disagree opinion. On analyzing the subject from the statement, it is revealed that large numbers of respondents are under the opinion that the services being provided by these Hospitals are attracting the patients. On the subject of case history of patients maintained by the Hospital are always available and helpful for treatment. 4 respondents with 11.40% expressed strongly agree opinion in case of Apollo and in Care 19 respondents with 48.70% expressed. 16 respondents with 45.85% expressed agree opinion in Apollo and in Care 11 respondents with 31.35% expressed the same opinion. Only 4 respondents with 11.40% expressed neutral opinion in case of Apollo and 2.85% in Care Hospital. The disagree opinion has come up from among 4 respondents with 11.40% in respect of Apollo Hospital and 5 respondents with 14.25% in case of Care Hospital. In the same way, 7 respondents with 19.95% have expressed strongly disagree opinion against Apollo Hospital but 2.85% only in Care Hospital. Thereby, the respondents in both the Hospitals are under the opinion that the Case histories of the patients maintained by the Hospitals are available and helpful for treatment. An attempt was made to know whether in emergency situations the patients will be recommended to go to some other Hospitals.12 respondents with 34.45% have expressed strongly agree opinion in case of Apollo and 11 respondents with 31.60% in Care Hospital. 5 respondents with 14.25% expressed agree opinion in case of Apollo and in Care 9 respondents with 22.80%. The neutral opinion was arrived from among 8 respondents with 22.80% in case of Apollo and 9 respondents with 25.65% in Care Hospital. 4 respondents with 11.40% in Apollo and 6 respondents with 17.10% in Care Hospital expressed disagreed opinion. Likewise 6 respondents with 17.10% have expressed strongly disagree opinion in case of Apollo and 2.85% came forward in Care Hospital. It can be concluded that respondents are under the opinion that the patients will be certainly recommended to go to some other Hospitals, when the position is critical.

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As regards that the operation theatres are helpful for conducting operations, 13 respondents with 37.05% have expressed strongly agree opinion in case of Apollo and 5 respondents with 14.25% in Care Hospital. 15 respondents with 43.00% expressed agree opinion in both Apollo and Care Hospitals. 2 respondents with 5.7% in case of Apollo Hospital and 5 respondents with 14.25% in case of Care Hospital expressed neutral opinion. 3 respondents with 8.55% expressed disagreed opinion in case of Apollo and 5 respondents with 14.25% in case of Care Hospital expressed disagree opinion. In case of strongly disagree opinion, 2 respondents with 5.7% in case of Apollo and 5.7% in Apollo and 5 respondents 14.25% in Care Hospital expressed their strongly disagree opinion. On the whole, most of the respondents are under the opinion that the operation theatres are helpful for conducting operations. The survey has turned against the package services at the Hospitals are helpful to the patients, 11 respondents with 31.60% expressed strongly agree opinion in case of Apollo whereas in Care 10 respondents with 28.50% expressed the same opinion. 9 respondents with 25.65% expressed agree opinion in case of Apollo and in Care 17 respondents with 48.70% expressed the same opinion. The neutral opinion was taken place among 10 respondents with 28.5% in case of Apollo and in Care 3 respondents with 8.55%. 2 respondents with 5.75% expressed disagree opinion in Apollo and 3 respondents with 8.55% in case of Care Hospital. 3 respondents with 8.55% in Apollo Hospital expressed strongly disagree opinion where as in Care Hospital it was from 2 respondents with 5.70%. The analysis of the above statement expresses that a large number of respondents are under the impression that the package services at the Hospital are helpful to the patients. An attempt was made towards the diet supplied by the Hospital to the patients help them for better recovery. 17 respondents with 51.55% expressed strongly agree opinion in case of Apollo and 19 respondents with 54.45% in case of Care Hospital expressed. 14 respondents with 39.90% expressed agree opinion in respect of Apollo and 9 respondents with 25.65% in Care Hospital. With a meager percentage of 2.85% in Apollo and 3 respondents with 8.50% in Care Hospital expressed neutral opinion. One respondent with 2.85% in respect of Apollo and two respondents with 5.70% in Care Hospital expressed the disagree opinion. The strongly disagree opinion also has taken place in respect of one respondent with 2.85% in Apollo and two respondents with 5.70% in respect of Care Hospital. Finally the analysis says that majority of

151

respondents are under the opinion that the diet supplied by these Hospitals certainly helps the patients for better recovery. As regards the ambulatory services of the Hospital do great help for timely treatment of patients, 17 respondents with 45.85% in Apollo and 5 respondents with 14.25% in Care Hospital expressed strongly agree opinion. 15 respondents with 42.75% in Apollo and in Care 14 respondents with 39.90% expressed agree opinion. There is 2.85% of neutral opinion found in case of Apollo, whereas 6 respondents with 17.35% expressed the same in Care Hospital. The disagree opinion also came up among two respondents with 5.70% in case of Apollo but 5 respondents with 14.25% expressed in Care Hospital. Only one respondent with 2.85% expressed strongly disagree opinion against Apollo Hospital whereas 5 respondents with 14.25% expressed the same in case Care Hospital. In conclusion, it is noticed that more respondents are under the opinion that the ambulatory services of the Hospital help for treatment to patients. The opinion poll further taken place on the area of providing same day surgery services increase the Hospital image. 14 respondents with 39.90% in Apollo Hospital expressed strongly agree opinion, whereas in Care Hospital 17 respondents with 48.70%. 16 respondents with 45.85% expressed agree opinion in Apollo and in case of Care Hospital only 9 respondents with 25.65% expressed. Only one respondent with 2.85% in Apollo Hospital and in case of Care Hospital 4 respondents with 11.40% expressed neutral opinion. The disagreed opinion was expressed by 2 respondents with 5.70% in Apollo Hospital and in Care 3 respondents with 8.55% expressed the same opinion. Equal number of 2 respondents with 5.70% expressed the strongly disagree opinion in respect of the both Hospitals. On going through the above analysis, it can be found that majority of respondents are under the impression that the same day surgery will increase the image of both the Hospitals. The survey further taken up in respect of the equipment at Pathology and Radiology departments are latest and information supplied by them is helpful. Out of 35 respondents 13 respondents with 37.30% expressed strongly agree opinion in case of Apollo whereas in Care 22 more number of respondents with 62.95% expressed same opinion. 14 respondents with 39.90% expressed agree opinion in Apollo but in case of care only 4 respondents with 11.40% expressed. In both the Hospitals of Apollo and Care equal number of 4 respondents with 11.40% expressed neutral opinion. In case of disagreed opinion also equal number of two respondents with 5.70% expressed in both the Hospitals of Apollo and Care. Two respondents with 5.70% in case of

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Apollo expressed strongly disagreed opinion where as in Care 3 respondents with 8.55%. Thus, it appears that more number of respondents are on the opinion that the equipment pertaining to Pathology and Radiology departments is latest and the information supplied by them is useful. On the subject of Hospital providing telemedicine services is useful for better treatment, 16 respondents with 39.90% in respect of Apollo and 15 respondents with 43.00% have expressed strongly agree opinion in case of Care. 17 respondents with 48.70% in Apollo and in Care 10 respondents with 28.50% have expressed agree opinion. The neutral opinion took place among two respondents with 5.70% in Apollo and in Care 6 respondents with 17.10%. Only 2.85% came forward to express disagree opinion in Apollo whereas in Care 2 respondents with 5.7% expressed. In the same way 2.85% only expressed strongly disagree opinion in respect of Apollo and in Care two respondents with 5.70% expressed. From the above analysis, it can be known that a large number of respondents are under the opinion that telemedicine services are useful for better treatment., As regards the nursing staff at your Hospital is competent and cooperative, 17 respondents with 39.90% expressed strongly agree opinion in respect of Apollo where as in Care 21 respondents with 54.40% expressed. 18 respondents with 51.55% expressed agree opinion in Apollo and in Care 9 respondents with 25.65% expressed. The neutral opinion was expressed by 2.85% in Apollo and in Care 5 respondents with 14.25%. only 2.85% has expressed disagree opinion in respect of both Hospitals. In the same way the strongly disagree opinion also expressed by only 2.85% in both the Hospitals of Apollo and Care. As such, it is very clear that the respondents are of the opinion that the nursing staff is competent and cooperative in both the Hospitals. Opinion poll was conducted on the house keeping department is doing well.13 respondents with 37.30% expressed strongly agree opinion in respect of Apollo and in case of Care 15 respondents with 42.75% expressed. Equal number of 15 respondents with 42.75% have expressed agree opinion in both the Hospitals of Apollo and Care. The neutral opinion came up from among 3 respondents with 8.55% in Apollo and 2.85% in case of Care Hospital. 2 respondents with 5.70% expressed disagree opinion in Apollo and in Care 5 respondents with 8.80% expressed the same opinion. 2 respondents with 5.70% expressed strongly disagreed opinion in Apollo and 2.85% only in the case of Care Hospital. It is evident from the above

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analysis that more number of respondent are of the opinion that the housekeeping department is doing well in both the Hospitals. Further, the survey has taken place in respect of ICU services are good and help the patients, who are in critical condition. Among 16 respondents with 45.85% expressed strongly agree opinion in Apollo and 12 respondents with 28.50% in case of Care Hospital expressed. 14 respondents with 39.90% expressed agree opinion in Apollo Hospital, whereas in Care, it was from among 18 respondents with 51.55%. Only one respondent with 2.85% expressed neutral opinion in both the hospitals. 2 respondents with 5.70% expressed disagreed opinion in case of Apollo where as in Care Hospital it was from 5 respondents with 14.25%. The strongly disagree opinion took place in respect of Apollo was 2 respondents with 5.70% and 2.85% in case of Care Hospital. Thereby, it is evident that a more number of respondents are of the opinion that the ICU services are good and help the patients, who are in critical conditions in both the Hospitals. A study was made on the subject of Hospital having good patient Care. 14 respondents with 39.90% have expressed strongly agree opinion in Apollo and in Care 13 respondents with 34.45% expressed. 14 respondents with 39.90% expressed agree opinion in respect of Apollo and in Care 17 respondents with 48.45% expressed. The neutral opinion has taken place among 4 respondents with 11.65% in case of Apollo and 2 respondents with 5.70% expressed in Care. 2 respondents with 5.70% expressed disagreed opinion in Apollo and in Care 3 respondents with 8.55% expressed. In the same way only one respondent with 2.85% has expressed strongly disagree opinion in respect of Apollo and 2.85% in case of Care Hospital. From this it is very clear that the respondents are of the opinion that patient care in these two Hospitals is good. As regards Hospital transportation services are serving maximum number of patients, 11 respondents with 31.60% expressed strongly agree opinion in respect of Apollo and in Care 15 respondents with 43.00% expressed. 13 respondents with 37.05% expressed agree opinion in respect of Apollo and in Care 11 respondents with 31.35% expressed the same opinion. 5 respondents with 14.25% in Apollo and in Care 2 respondents with 5.70% expressed neutral opinion. 4 respondents with 11.40% in Apollo and in Care 5 respondents with 14.25% expressed disagreed opinion. Two respondents with 5.70% in Apollo and also in Care expressed strongly disagreed opinion. On going through the above analysis of statement, it can be known that a large number of respondents are under the opinion that Hospital transportation services are serving number of patients.

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Further, survey was made on the Hospital reception services are good, 16 respondents with 43.00% in respect of Apollo and in Care Hospital 21 respondents with 60.10% expressed strongly agree opinion. In Apollo 14 respondents with 39.90% agreed and 9 respondents with 25.65% in case of Care Hospital. The neutral opinion was received as 11.65% in case of Apollo whereas in Care Hospital 2 respondents with 5.70% expressed. 2 respondents with 5.70% expressed disagreed opinion in Apollo whereas in Care Hospital 3 respondents with 8.55% expressed. Likewise 2 respondents with 5.70% expressed strongly disagreed opinion in both hospitals. It can be observed from the above analysis that majority of respondents are under the opinion that Hospital reception services are good On the aspect of Hospital pharmacy services are providing required medicines in the Hospital premises, 15 respondents with 43.00% in Apollo and in Care Hospital 19 respondents with 54.40% expressed strongly agree opinion. 13 respondents with 37.05% expressed agree opinion in Apollo and in Care 9 respondents with 25.65% expressed. In case of neutral opinion 2 respondents with 5.70% in Apollo and in Care Hospital 3 respondents with 8.55% expressed. 4 respondents with 11.40% in Apollo and in Care 3 respondents with 8.55% expressed disagreed opinion. The strongly disagree opinion came up from only one respondent with 2.85% from both the Hospitals of Apollo and Care. Thereby, it is evident that most of the respondents are of the opinion that Hospital pharmacy services are providing required medicines in the Hospital premises. The survey has been extended to know that this Hospital is providing better services to the patients in comparison with other corporate Hospitals. 16 respondents with 42.75% in both the Hospitals expressed strongly agree opinion. 17 respondents with 45.85% in Apollo and 15 respondents with 40.15% have expressed agree opinion. 2 respondents with 5.70% in Apollo and in Care 4 respondents with 11.40% expressed neutral opinion. In case of disagree and strongly disagree opinions 2.85% of respondents came forward. As such it can be noticed that a large number of respondents are under the opinion that both the Hospitals are providing better services to the patients when compared to other corporate Hospitals. On the subject of centralized patient services are good and serving patients well in the Hospital, 13 respondents with 37.05% in Apollo and 9 respondents with 25.65% in respect of Care Hospital expressed strongly agree opinion. 15 respondents with 43.00% in Apollo and in Care Hospital 19 respondents with 54.40% expressed agree opinion. The neutral opinion came

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up form three respondent with 8.55% in Apollo and 3 respondents with 8.55% in case of Care Hospitals. 2 respondents with 5.70% in Apollo and 3 respondents with 8.55% in case of Care Hospital expressed disagree opinion. Two respondent with 5.70% in Apollo Hospital and one respondent with 2.85% has expressed strongly disagree opinion in Care. It can be understood from the above statements that number of respondents are accepting that the centralized patient services are good and serving patients well in these Hospitals. As regards the compatibility of the Hospital in developing and launching new services, 35 respondents participated out of which 13 respondents with 37.05% in Apollo and 20 respondents with 57.25% expressed strongly agree opinion. In case of agree opinion, in Apollo 14 respondents with 40.15% and 6 respondents with 17.10% in Care expressed. The neutral opinion came up from among 4 respondents with 11.40% in Apollo and 3 respondents with 8.55% in Care expressed. 3 respondents with 8.55% in each Hospital of Apollo and Care expressed disagreed opinion. In case of strongly disagreed opinion, only one respondent with 2.85% in Apollo and 3 respondents with 8.55% in Care Hospital expressed. On the whole, it can be observed that most of the respondents are under the opinion that these Hospitals are more capable in developing and launching new services From the above analysis it can be stated that, most of the respondents in Apollo opinioned that, few services like packaging services, operation theater services, ambulatory services, telemedicine services, ICU and centralized patient services are good. In case of Care hospital most of the respondents are satisfied well about the product mix of the hospital except few. On overall the situation is up to the mark in two hospital regarding product mix. Let us examine the mean and standard deviation values of the perceptions of respondents about the product mix in sample hospitals.

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Mean and Standard Deviation values of Doctors Perceptions on the Product Mix of Sample Hospitals
Table no: 3.4 representing mean and standard deviation values of perceptions of doctors about the product mix of the sample hospitals.
Table No: 3.4 Mean and S.D values of Doctors Perceptions on the Product Mix of the Sample Hospitals

(N=75) Sl.No
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Statement
The services providing at your hospital are attracting the patients. Case history of patients maintained by your hospital is always available and helpful to you in treatment. In emergency situations you recommend the patients to go some other hospitals. Your hospital operation theaters are helpful to you for conducting Operations. In your opinion, the package services at your hospital are helpful to the patients. The diet supplied by your hospital to the patients helps them for better recovery. The ambulatory services of your hospital does great help to you for timely treatment of patients. Same day surgery services increasing your hospital image. You will believe that the equipment at Pathology, Radiology departments are latest and information supplied by them is helpful to you. Hospital providing telemedicine services are useful to you for better treatment. The nursing staff at your hospital is competent, and cooperative. In your opinion, your housekeeping department is doing well. Your ICU services are good and help the patients, who are in critical conditions. Your hospital is having good patient care. Your hospital transportation services are serving maximum number of patients. Your hospital reception services are good.

Apollo
1.97 2.20 2.60 2.20 2.46 2.33 2.40 2.73 2.40 2.66 2.00 2.56 2.00 2.46 2.69 2.10 1.93 1.86 2.42 2.93 0.82 1.05 1.46 1.28 1.21 1.25 1.09 1.18 1.20 1.14 1.16 1.16 0.82 1.41 1.07 1.15 1.06 0.89 1.14 1.34

Care
1.66 2.53 3.20 2.33 3.00 2.40 2.41 2.38 2.36 2.46 1.94 2.56 2.00 2.46 2.93 2.40 2.02 2.20 2.33 2.94 0.70 0.72 1.11 0.94 0.63 0.88 0.61 0.76 0.96 0.81 0.65 0.96 0.90 1.09 0.68 1.09 0.73 0.91 0.70 0.97

Mean S.D Mean S.D

Your hospital pharmacy services are providing required medicines in the hospital premises. When compared to other corporate hospitals, this hospital is providing 18 better services to the patients. Centralized patient services are good and serving patients well in this 19 hospital. 20 This hospital is more capable in developing and launching new services. 5 Point Scale: 1-strongly agree.5-strongly disagree

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Table no: 3.4 shows the item-wise analysis of perceptions of doctors on product mix in the sample hospitals. Regarding perceptions of doctors on product mix in Apollo hospital reveals that providing services (1.97), maintenance of case history of patients (2.20), maintenance of emergency services (2.60), providing surgical services (2.20), packaging services (2.46), diet services (2.33), ambulatory services (2.40), image on providing same day surgeries (2.73), quality of diagnostic services (2.40), usefulness of telemedicine services for timely treatment (2.66), nursing services (2.00), house keeping services (2.56), ICU services (2.00), patient care (2.46), transportation services (2.69), reception services (2.10), pharmacy services (1.93), availability of special services (1.86), centralized patient services (2.42), developing and launching new services (2.93). Thus the dimension product mix has got positive rating by the respondents in all aspects. In the respect of Care hospital, the perceptions of doctors exploring providing services (1.66), maintenance of case history of patients (2.53), maintenance of emergency services (3.20), providing surgical services (2.33), packaging services (3.00), diet services (2.40), ambulatory services (2.41), image on providing same day surgeries (2.38), quality of diagnostic services (2.36), usefulness of telemedicine services for timely treatment (2.46), nursing services (1.94), house keeping services (2.56), ICU services (2.00), patient care (2.46), transportation services (2.93), reception services (2.40), pharmacy services (2.02), availability of special services (2.20), centralized patient services (2.33), developing and launching new services (2.94). From this it can be conclude that the product mix has got positive rating by the respondents in all aspects.

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Mean and Standard Deviation values of Nurses Perceptions on the Product Mix of Sample Hospitals
Table no: 3.5 representing mean and standard deviation values of perceptions of nurses about the product mix of the sample hospitals.
Table No: 3.5 Mean and S.D values of Nurses Perceptions on the Product Mix of the Sample Hospitals (N=150) Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Statement The services providing at your hospital are attracting the patients. Case history of patients maintained by your hospital is always available and helpful to you in treatment. In emergency situations you recommend the patients to go some other hospitals. Your hospital operation theaters are helpful to you for conducting Operations. In your opinion, the package services at your hospital are helpful to the patients. The diet supplied by your hospital to the patients helps them for better recovery. The ambulatory services of your hospital does great help to you for timely treatment of patients. Same day surgery services increasing your hospital image. You will believe that the equipment at Pathology, Radiology departments are latest and information supplied by them is helpful to you. Hospital providing telemedicine services are useful to you for better treatment. The nursing staff at your hospital is competent, and cooperative. In your opinion, your housekeeping department is doing well. Your ICU services are good and help the patients, who are in critical conditions. Your hospital is having good patient care. Your hospital transportation services are serving maximum number of patients. Your hospital reception services are good. Apollo Mean 1.93 2.46 2.34 1.60 2.40 1.99 1.86 2.26 1.68 1.48 2.60 2.32 2.46 2.60 2.14 2.14 1.60 1.61 2.53 2.68 S.D 1.12 1.09 1.30 0.62 1.14 1.14 1.20 1.24 0.60 0.63 1.36 1.18 1.20 1.36 1.20 1.20 0.71 0.62 1.15 1.21 Care Mean 1.66 2.06 2.13 1.66 2.32 1.68 1.86 2.20 2.26 2.00 1.38 2.00 2.20 1.73 2.13 2.26 1.42 1.67 2.12 2.20 S.D 0.47 1.00 0.72 0.47 0.69 0.79 0.87 0.65 0.85 0.81 0.60 0.81 0.83 0.93 1.02 1.12 0.61 0.79 0.88 1.17

Your hospital pharmacy services are providing required medicines in the hospital premises. When compared to other corporate hospitals, this hospital is providing better 18 services to the patients. Centralized patient services are good and serving patients well in this 19 hospital. 20 This hospital is more capable in developing and launching new services. 5 Point Scale: 1-strongly agree.5-strongly disagree

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Table no: 3.5 reveals that the item-wise analysis of perceptions of nurses on product mix in the sample hospitals. The perceptions of nurses on product mix in Apollo hospital reveals that providing services (1.93), maintenance of case history of patients (2.46), maintenance of emergency services (2.34), providing surgical services (1.60), packaging services (2.40), diet services (1.99), ambulatory services (1.86), image on providing same day surgeries (2.26), quality of diagnostic services (1.68), usefulness of telemedicine services for timely treatment (1.48), nursing services (2.60), house keeping services (2.32), ICU services (2.46), patient care (2.60), transportation services (2.14), reception services (2.14), pharmacy services (1.60), availability of special services (1.61), centralized patient services (2.53), developing and launching new services (2.68). Thus the dimension product mix has got positive rating by the respondents in all aspects. In the respect of Care hospital, the perceptions of nurses exploring providing services (1.66), maintenance of case history of patients (2.06), maintenance of emergency services (2.13), providing surgical services (1.66), packaging services (2.32), diet services (1.68), ambulatory services (1.86), image on providing same day surgeries (2.20), quality of diagnostic services (2.26), usefulness of telemedicine services for timely treatment (2.00), nursing services (1.38), house keeping services (2.00), ICU services (2.20), patient care (1.73), transportation services (2.13), reception services (2.26), pharmacy services (1.42), availability of special services (1.67), centralized patient services (2.12), developing and launching new services (2.20). From this it can be conclude that the product mix has got positive rating by the respondents in all aspects.

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Mean and Standard Deviation values of Administrative personnels Perceptions on the Product Mix of Sample Hospitals
Table no: 3.6 representing mean and standard deviation values of perceptions of Administrative personnel about the product mix of the sample hospitals.
Table No: 3.6 Mean and S.D of Adm.People Perceptions on the Product Mix of the Sample Hospitals (N=35) Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Statement The services providing at your hospital are attracting the patients. Case history of patients maintained by your hospital is always available and helpful to you in treatment. In emergency situations you recommend the patients to go some other hospitals. Your hospital operation theaters are helpful to you for conducting Operations. In your opinion, the package services at your hospital are helpful to the patients. The diet supplied by your hospital to the patients helps them for better recovery. The ambulatory services of your hospital does great help to you for timely treatment of patients. Same day surgery services increasing your hospital image. You will believe that the equipment at Pathology, Radiology departments are latest and information supplied by them is helpful to you. Hospital providing telemedicine services are useful to you for better treatment. The nursing staff at your hospital is competent, and cooperative. In your opinion, your housekeeping department is doing well. Your ICU services are good and help the patients, who are in critical conditions. Your hospital is having good patient care. Your hospital transportation services are serving maximum number of patients. Your hospital reception services are good. Your hospital pharmacy services are providing required medicines in the hospital premises. When compared to other corporate hospitals, this hospital is providing better services to the patients. Centralized patient services are good and serving patients well in this hospital. This hospital is more capable in developing and launching new services. Apollo Mean 2.08 2.82 2.62 2.05 2.37 1.80 1.68 1.88 1.94 1.57 1.54 1.97 1.85 1.91 2.20 1.85 1.94 1.54 2.05 2.00 S.D 1.12 1.36 1.49 1.16 1.21 1.05 0.96 1.10 1.08 0.55 0.56 1.12 1.11 1.01 1.20 1.08 1.08 0.56 1.18 1.05 Care Mean 2.00 1.42 2.48 2.71 2.14 1.77 2.62 1.94 2.71 2.02 1.57 1.85 1.94 1.94 2.08 1.68 2.00 1.65 1.91 1.94 S.D 0.76 0.50 1.37 1.29 1.11 1.16 1.23 1.16 1.04 1.17 0.73 1.00 0.96 0.93 1.26 1.02 1.08 0.68 0.78 1.34

5 Point Scale: 1-strongly agree.5-strongly disagree

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Table no: 3.6 reveals that the item-wise analysis of perceptions of administrative personnel on product mix in the sample hospitals. The perceptions of administrative personnel on product mix in Apollo hospital; providing services (2.08), maintenance of case history of patients (2.82), maintenance of emergency services (2.62), providing surgical services (2.05), packaging services (2.37), diet services (1.80), ambulatory services (1.68), image on providing same day surgeries (1.88), quality of diagnostic services (1.94), usefulness of telemedicine services for timely treatment (1.57), nursing services (1.54), house keeping services (1.97), ICU services (1.85), patient care (1.91), transportation services (2.20), reception services (1.85), pharmacy services (1.94), availability of special services (1.54), centralized patient services (2.05), developing and launching new services (2.00). Thus the dimension product mix has got positive rating by the respondents in all aspects. In Care hospital the perceptions of administrative personnel; providing services (2.00), maintenance of case history of patients (1.42), maintenance of emergency services (2.48), providing surgical services (2.71), packaging services (2.14), diet services (1.77), ambulatory services (2.62), image on providing same day surgeries (1.94), quality of diagnostic services (2.71), usefulness of telemedicine services for timely treatment (2.02), nursing services (1.57), house keeping services (1.85), ICU services (1.94), patient care (1.94), transportation services (2.08), reception services (1.68), pharmacy services (2.00), availability of special services (1.65), centralized patient services (1.91), developing and launching new services (1.94). From this it can be conclude that the product mix has got positive rating by the respondents in all aspects.

Conclusion
From the discussion, it can be concluded that a product is a set of attributes assembled in an identifiable form. The product is the central component of any marketing mix. The product component mix deals with a variety of issues relating to development, presentation and management of the product which is to be offered to the market place. It covers issues such as service package, core services and peripherals, managing service offering and developing service offering. In Apollo the importance is giving to developing and launching new services in the market. But in Care hospital they are unable to produce new services. In emergency situations

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Apollo hospital authorities are not accepting to send the patient to some other hospitals but in Care some times the doctors are accepting the patients to go some other hospitals in emergency situations, this is may be lack of facilities in the hospital. Comparatively operation theaters are comfortable for conducting operations in Apollo but not in Care hospital. Case history maintenance in Care hospital is good and providing services up to the mark but in Apollo the case history of patients is always not available to the doctors, this creating some problems in providing better treatment to the patients. The packaging service are playing key role in Apollo for their marketing of their services. Whereas in Care they are not paying much interest on packaging services so nurses only positively responded for their packaging services. The dietary services in Care hospital are good in opinion of the nurses and administrative personnel. But in Apollo hospital the dietary services are not satisfactory, so the doctors only responded positively. The ambulatory services in Apollo are providing maximum services to the patients but the Care hospital have to improve ambulatory services because only nurses responded positively about their ambulatory services. In the case of ICU services Care hospital is having good reputation because all the respondents accepted positively. But in Apollo hospital ICU services are not maintaining well. It is also observed that, there are some complaints on house keeping department in Apollo hospital. But in Care hospital all the respondents gave positive opinion about their house keeping department. In conclusion, it can be stated that the product mix is good in two sample hospitals. Now we will take-up the price mix in hospitals.

Price Mix in Hospitals

Pricing is most often used to describe the actual charge made by an organization. Prices go by various names. Health insurance companies and health maintenance organizations charge premiums. Individual clinicians require the payment of fees. Inpatient facilities have historically billed for charges. However, they are often reimbursed on the basis of costs, resulting in a constant confusion in the health care field between costs and prices. In hospitals the term cost and price used interchangeably. For example an article entitled Are consumers sensitive to hospital costs?4 In hospitals what price means and where and how it can be used as a strategic tool remains because of third party reimbursement, the constant threat of change in reimbursement policies, regulated structures, apparent consumer price insensitivity, and

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characteristic lack of price awareness. The role of price according to whether one is considering a reimbursed or no reimbursed service. In addition to the price, customers face three other costs i.e. effort costs, psychic costs and waiting costs. In handling the complex issue of pricing, hospital should proceed through four stages. First, it should determine the pricing objective to maximize surplus or profit, usage, or some other objective, second, it should determine the pricing strategy- whether price should be cost-based, demand based, or competition based, third it should determine pricing in situations such as self-pay markets and reimbursed markets, finally it should anticipate possible charges in reimbursement procedures in the future and how to respond to them. The term price must be redefined according to the specific situation. In self-pay markets price is the appropriate term, representing the amount consumers pay out-of-packet to the organization. In some reimbursed markets the relevant issue is revenue, whether revenue is determined by costs or charges. Hospitals often allocate fixed costs so as to maximize revenue when reimbursement is cost based. In other reimbursement situations, price is the term used to describe a dictated charge based on costs or a negotiated charge based on competitive bids. An understanding of pricing objectives in hospitals must take these definitions of price into account. Pricing objectives are Surplus or Profit Maximization: Surplus is the difference between net patient service revenue and expenses. In most business, the term used for this difference is profit. Historically, most hospitals were not-for-profit, meaning that they did not seek to make a profit and often operated at a loss. When their net revenues did by chance exceed expenses, it was called a surplus. When they operated at a loss, they anticipated that external funds from donors, grants and other sources would compensate. Net Patient Service Maximization: Traditional cost-based reimbursement does not motivate a hospital to cut cost, nor does it allow much opportunity to demand a higher percentage of surpluses per unit of service. Therefore, most hospitals operating under these conditions implicitly operate by the objective of maximizing net patient service revenue. From marketing perspective maximizing net patient service revenue can be achieved through attracting not just the highest possible volume of patients able to be served by the hospitals, but by drawing in the most financially attractive patients. This objective must be meshed, nevertheless, with the ethical consideration of serving the poor or non reimbursed patient.

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Cost Recovery: Many hospitals seek a price or effective revenue per unit of service that allows them to recover all or a reasonable part of these costs. Cost based reimbursement was developed with this pricing objective in mind. Some hospitals have traditionally provided for full cost recovery and some other hospitals seek only partially cost recovery because they rely on external sources to compensate for un-recovered costs. Usage Maximization: Whenever the variable costs are low, and there are no revenue caps, and if each user represents additional revenue to the hospitals, may wish to maximize utilization. Health promotion programs often fit this model. Hospitals which feel that users and society profit from their services sometimes lower their prices in order to maximize utilization. Market Disincentivization: There are many hospitals might want to discourage as many people as possible from purchasing a particular service. There are many reasons to do this, it might consider the service to be bad for people or it might want to discourage people from overtaxing a facility or it might be trying to solve a temporary shortage or it might want to discourage the patronage of certain classes of buyers. Public Relation Enhancement: Healthcare organizations, which increasingly operate in the public eye, must consider now their prices lack to the public. Hospitals may choose to set prices based on a public relations objective. For example, room rates reserve more publicity than changes for other services. If the room rates must be kept low because of its publicity value, then the hospital may compensate by organizing on services that do not reserve such publicity. Cross-Subsidization Services like the ambulatory care department, ICU, obstetric service, and pediatric service of a full service hospital generally produce a loss, but it is often important for clinical, public relations, and other reasons for a hospital to keep these services. The hospital must crosssubsidize them using surplus generated by profitable services such as the medical-surgical service, i.e. hospital must balance the surplus and losses of varying market segments and services through cross-subsidization.

Pricing Strategies for Hospitals

Pricing hospital services is done keeping in view the cost of running the hospital the overheads, salaries and wages of the doctors, nurses and the administrative staff, cost of equipment and infrastructure, bed occupancy, quality of service and the income levels of the patients. Many hospitals follow differential pricing policies. After the hospital has defined its

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pricing objective, it can consider the appropriate pricing strategy. Pricing strategies trend to be cost oriented, demand-oriented, or competition oriented. In the reimbursed healthcare market, an additional pricing strategy is maximizing reimbursement oriented. Cost Oriented Pricing Cost oriented pricing refers to setting prices largely on the basis of costs. The charges are usually determined on the basis of costs with a small markup on the cost added to create the charge. The most popular form of cost-oriented pricing is known as break even analysis. It determine for any proposed price, how many units of a service would have to be sold to cover the costs fully, is popularly known as the break even volume. Most reimbursed formulas are cost- oriented. Cost-oriented pricing is also used in settings where reimbursement is not an issue. Demand Oriented Pricing This is pricing strategy consider the demand rather than the level of costs to set the price. This hospital might change Rs.500 a day for a single room and Rs.300 a day, for a double room. The premise is that price should reflect the perceived value in the buyers head. A consumer form of demand-oriented pricing is discrimination, in which a particular service is sold at two or more prices. Price discrimination takes various forms i.e. pricing that discriminates on a patient basis or on a product version basis. Product version price discrimination is not true price discrimination, which assumes an identical product. Pricing that discriminates on a time basis occurs when a physician changes a patient more for a weekend than a weekday medical visit. For price discrimination to work, the market be segment able and the segments must show different intensities of demand.5 Demand oriented pricing also assumes that some segments of the market are both aware of and sensitive to price. This is often hot the case in the health care field. Consumers are more likely to be aware of and sensitive to prices for health care services that are not well covered by third-party reimbursement and have low perceived risk. An interesting subset of a demand-oriented pricing strategy is one which recognizes that in certain situations, consumers equate price with quality6. If they seek to assume themselves that they are receiving high-quality medical care they may choose the higher priced care. Thus, demand-oriented pricing need not necessarily mean that demand will increase as price falls, because of the price-quality equation.

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Competition-Oriented Pricing The distinguishing characteristic of competition oriented pricing is that the hospital does not seek to maintain a rigid relation between its price and its own costs or demand. Its own costs or demand may change, but the hospital maintains its price because competitors maintain their prices. So the hospitals sets its prices on the basis of what competitors are changing conversely, the same organization will charge its price when competitors change their, even if own costs or demand have not altered. The most popular type of competition- oriented pricing is that under which an organization tries to keep its prices at the average level charged by the competition. This is called going rate or initiative pricing. Physicians are encouraged by their professional association and by commercial insurers to use a going-rate competition-oriented pricing strategy by charging usual customary and reasonable fees. Many hospitals engage in competitionoriented pricing by offering a service at a price lower than competitive prices. As trade journal headlines such as same-day surgery competes with flat rate7. The continued focus on cost containment by hospitals is likely to increase the amount and intensity of competitive bidding. This is true not only for hospitals, but also for physician groups, nursing homes, home health agencies, and other providers from which these organizations might want to contact for services8. Maximum- Reimbursement-Oriented Pricing Many hospitals charge maximum allowed by reimbursement agencies. This may be viewed as a perverted form of demand pricing, or charging what the market will bear. It is only human nature that a provider will seek to charge as much as other hospitals providing the same service. The Relationship of Price and Demand in Hospitals In the hospitals, it is safer to say that demand (D) is function of supply (S) and health insurance coverage (C)

f (S, C)

A classic study in 1961 by Romer9 has focused on the supply of his hospital beds and services. He was the first to demonstrate that health can demand expands to meet the supply, regardless of price. Other studies have found the same demand response to the supply of physicians10. More recent studies, in scientific American and health affairs11 stated that the number of physicians, their medical specialization, and styles of practice were primary determinants of health care

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demand. Thus, rather than being determined by price, demand for health care services appears to be heavily determined by suppliers. It is difficult for consumers to act in a price-sensitive manner when the control of health care purchase decisions is not usually in their hands12 because medicines are inherently a sellers market. The customer (patient) has no bargaining power; he initiates only one decision- to see a doctor. The sellers (doctors and hospitals) them take over; they decide what services the patients needs, and do not ask but order him to buy, unable to diagnose his own illness, the patient has little choice but meekly to obey13 It is an interesting phenomenon in the health care field that the physician may be both suppliers and the demander of health care services in their situations, price can not easily function to regulate demand. Health care demand is also a function of health insurance or third-party coverage. Third-party reimbursement covers roughly 60% of physicians fees and well over 90% of hospitalization costs. The demand for services increases with increasing third-party coverge14. Third party coverage may be a determinant not only of demand, but also of price, that is

P = f (c)

Juba suggests that, by lowering the real out-of-pocket price to the consumers, third-party coverage increases demand.15 On a more practical level, physicians and hospitals often find their prices set for them by third-party coverage. The prices, fees, or changes are set as a maximum, but the incentive of the health care provider is to change the maximum allowed by the third party. Thus we find positive correlations between prices and third party coverage.16 As result of the relationship among demand supply, coverage, and price, an interesting phenomenon in the health care field occurs infrequently elsewhere. In order to increase revenues, suppliers in other fields may raise their prices or attempt to increase their sales through gaining new customers or generating more sales from existing customers. However, health care providers and suppliers often do not have the freedom to raise prices as they choose because of third-party coverage fee or charge ceilings, negotiated per unit fees, or prospective payment systems. In addition, strong professional and peer norms against promotion and advertising have made it difficult for health care providers to develop strategies to attract new customers. The relationships between price, demand, supply and third- party coverage suggest that, in the near term, price to the consumer may not have the power as a marketing tool it has in other

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industries. Moreover, the freedom health care providers have in setting price is less than in other industries due to third-party reimbursement, cost-containment measures, and professional norms, thereby limiting prices usefulness as a marketing tool. On the other hand, the rapid rise in costs has caused the government and business to become more sensitive to pricing. Self-Pay Market When patients are covered for the recommended service, they rarely ask how much the service costs. They are much more likely to ask, Will it cure me? patients are generally unaware of hospital charge rates, but have somewhat greater familiarity with office visit fees, since they are more likely to self-pay for office visits. Therefore the role price plays as a regulator of demand varies according to how the consumers are covered for the service in question. Healthcare consumers engage in many self-pay purchases, ever if they are covered by a typical health insurance benefit package. These purchases may include dental care, psychiatric care, physician office visits, and cosmetic surgery that is not medically required, nursing home care, and most home making/home health aide services. When the consumer self-pays, price may not act as a regulator of demand. There are at least four reasons for this. First the price of health care services is often unknown or unknowable17 Second, health care providers have traditionally had little price sensitivity18 Third, may physicians charge usual and customary fees, meaning they charge approximately what other physicians charge. This means that consumers have little chance to choose on the basis of price, even if they know what the prices are, because all prices may be relatively similar. A fourth reason why price may not regulate demand in what have traditionally beer self-pay markets is due to the nature of the patients for certain self-pay services such as hospital outpatient services and the vast array of services offered by social services agencies. These services have catered primarily to the indigent, who uses them without paying. Price therefore has no effect on usage. Self-Pay Ambulatory Settings Most self-pay health care services are ambulatory i.e. seeing a physician or a dentist versus being an inpatient overnight in a hospital; exceptions to this include nursing home and home health care for certain classifications of payment. In the ambulatory setting following factors will influence the role of price arise. The patient-physician relationship is presumably based on trust and the belief that the physician is acting in the patients best interests.

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The canons of ethics of medical and clinical professionals have historically frowned upon advertising of any kind, but especially price advertising. Consumers are unable to judge the quality of medical care19 In the absence of other ways to judge the quality of medical care, they are likely to rely on price as an indicator. Waiting time and convenience issues i.e. no monetary prices may out weigh and substitute for monetary prices in influencing demand. Physicians fees have been noted to be higher in areas where there are more physicians per population contrary economic theory20

Price Setting In Hospitals

Historically, hospitals have used cost to charge ratios to arrive at average costs. However, hospital financial experts think in the environment in which hospitals now operate this method of costing and setting changes is not an effective one. Generally, hospitals priced inpatient surgery and day surgery at the same rate despite the fact that there were variations in cost in different settings. More importantly, hospitals can not make the concept of day surgery popular and attract patients in large numbers as day surgery is expected to do unless the charges are made competitive. In many settings, day surgery does cost less, and to charge the same amount for it as for inpatient surgery is missing the whole point. Pricing hospital services is not as simple as many of us are inclined to think. Many hospitals believe that the complicated exercise of pricing is an expensive investment in terms of specialist personnel, time and many which most hospitals can ill-afford rightly. Therefore hospitals adopt short costs, or blindly follow what prevails in the region or in the industry with little or no variations. But hospitals while pricing their services, they should know the cost of providing those services and the scientific way of computing and fixing them, some times it is called as rate setting. Direct and Indirect Costs There are several components comprising the total cost of a product. The major components are direct costs which include fixed and variable costs. Fixed costs are constant for each procedure. These include equipment and administrative costs for each procedure, and department overhead. Variable costs vary from procedure to procedure, and include cost of supplies and labor needed for the procedure. In addition to direct costs, there are indirect costs consisting of building depreciation, capital needs and the departments share of the hospitals administrative

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costs. Once pricing is done scientifically on the basis of actual cost of service or procedure, or charges are set because of other considerations or compulsion, it is very important that hospitals should know how much a service or procedure costs, and if they subsidize, to what extent they subsidize. Most of the Indian hospitals follow a variable pricing structure for inpatients on the basis of the category of bed a patient occupies. By and large, there are three categories of beds i.e. general ward beds, semi-private rooms and private rooms. However these are not the same in every hospital. Besides, there are other categories such as deluxe rooms, executive suits etc. Graduated Charges Graduated charges are followed for any procedure or operation. Here there is no standard which all hospitals follow. Some of them are arbitrary. For example the patient in the general ward may be charged Rs.300 for an appendectomy whereas the patient in a bed semi-private room may be charged Rs.600, and the one in the private room Rs.900. It is a measure of social justice and also because the patient in the private room enjoys better facilities and greater comfort, not to mention the fact he has the ability to pay more. The second important point in pricing of hospital services is that the charges are by and large much lower than they are in others, and are subsidized to varying degrees, some of them heavily. For example, the charge for a bed in general ward may be Rs.20 per day but the cost of maintaining a general ward bed may be anywhere between Rs.50 and Rs.80, even higher, depending on many factors. Here there is no much logic on what basis prices are fixed. Some other hospitals which follow another pricing policy have no scientific basis either, except the economic viability of the hospital. There are usually the hospitals which have no outside sources of funds to subsidize patient care, and yet they want to care for a certain percentage of indigent patients by subsidizing their care. In the present due to increasing the cost of operations, hospitals for increasing their revenue in order to meet the rising cost, many hospitals have in recent times increased the number of private and semi-private rooms particularly the latter as they bring in more revenue, thereby reducing the number of general ward beds. Now let us move on to price mix in two sample hospitals.

Price Mix in Apollo Hospital

In Apollo hospital the pricing mix includes three heads: 1.Fees 2.Inpatient charges 3.Third party reimbursement. These three heads are based on the costs of producing concern different services. In addition in Apollo the prices includes subsidiary elements, and the price may be greater or smaller, depending up on the discounts. The discounts are offering to the special

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groups such as employer groups and senior citizens etc. While fixing the prices of the services, the management of Apollo considering the actual charges made by the hospital, but the hospital is not finalizing those costs as final prices. Because the hospital is thinking, in patients point of view i.e. what the customer facing costs like effort costs, psychic costs and waiting costs. It is observed in Apollo hospital, there are heavy fixed costs to the services those are mostly utilizing by the third party reimbursed patients only. Some of the services are pricing by the Apollo with a view to maximizing short-run rather than long run benefits. Apart from this certain heart related services are pricing independently by the Apollo without considering the market forces. In this case the hospital believes that they are providing better services when compared to other hospitals. Some services in Apollo, prices are made by estimating demand of the service and its supply by the other producers. Especially this is happening when the hospital is going to launching new services. Most of the services are in Apollo cost based that seeks effective revenue per individual service and allows to recover all or reasonable part of the total cost of producing the concern service. Apollo is fixing this method of prices for third party reimbursement patients. Because in Apollo 40% of the total patients are having third party reimbursement facility i.e. medical insurance. Apollo is providing different categories of rooms for patients depending up on their paying capacity. Table no: 3.7 reveals the pricing structure for different categories of rooms, with facilities in Apollo hospital.

Table No: 3.7

Pricing Structure of Different Categories of Rooms Along With Facilities in Apollo Hospital
1 Sl No 1 2 3 4 2 Category of Room Apollo Suit Executive Room Deluxe Room Single Room 3 Facilities Air-conditioning, dining room, waiting room, patient cot, attendant cot, two televisions, sofa seat, two telephones, refrigerator, dining table, computer with inter-net, ward robe, microwave oven, massage chair. Air-conditioning, television, refrigerator, sofa seat, ward robe, patient cot, attendant cot, computer with inter-net, ward robe, microwave oven. Individual air-conditioned room large than a single room, patient cot, an attendant cot, television, refrigerator, cupboard and sofa. Individual air-conditioned room with attached wash room, specially designed floor, television, telephone and a couch. 4 Price Per Day (Rs)

10,000-00 8000-00 6000-00 5000-00

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1 5

7 8

2 Semiprivate room Double Sharing Room Special General Ward General Ward

3 Two air-conditioned rooms inter connected by a wash room, each room has a television, telephone and a couch. Air- conditioned room with two beds separated by a screen and a wash room with a television, telephone and a couch. Non-air conditioned room with three beds and a wash room attendant couch.

4 3000-00

1000-00

450-00 Room with six to ten beds and a wash room, every bed are provided with a cupboard, foot stool, food trolley, a screen between each bed a washroom. Exclusive for custom-built services for patients being admitted for Hip surgery. The facilities are: private suit with fully automated cot, easy access to bath/toilet, wall mountain plasma T.V with 50 channels & over 1,000 English DVD movies available for rent, laptop with Wi-Fi internet connection, extra couch for an accompanying persons to sleep, kitchenette with microwave, refrigerator, coffeemaker, Hip Corridor for patient to practice walking after surgery, lounge to relax or receive visitors. 350-00

Platinum Ward

15000-00

There are nine categories of rooms at different prices are available to the patients in Apollo hospital. Platinum ward, Apollo suit, executive rooms, deluxe rooms, single rooms are planned for high level income people and single room, semi-private rooms and double sharing rooms are arranged in view to arrange facility for middle income group and special general ward, general ward arranged for lower income group. For maximizing the utilization of services, Apollo fixing lower prices for certain services, especially this is happening for health promotion programs. Some times Apollo offering some services at free of cost. It is observed in Apollo hospital cutting basic emergency room charges in half and also eliminating its cash deposit requirements. When the researcher asked one senior administrative person, he responded as, they are concerning emergency room charges and cash deposits requirements may become barriers to good medical care for persons who need it. In some cases Apollo is charging higher prices for non-appointments and walk-in visits and to encourage appointment-setting behaviour. On the other hand Apollo setting lower prices for certain period. For this, when the researcher asked the doctors, they responded as low room rates receive more publicity than charges for other services. On certain services like ambulatory service, pediatric service Apollo hospital following cross-subsidization methods for fixing prices to balance the surpluses and losses.

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On the whole, Apollo hospital is following four pricing strategies for fixing prices for their services. Apollo is setting its prices on the basis of costs. In marketing this pricing strategy is called as cost oriented pricing. There are fixing prices on the basis of costs, with a small markup on the cost added to create the price. This strategy is following by the hospital for setting prices where reimbursement is not an issue, like prices for blood bank service, ambulance or transportation service etc., on this issue, the administrators of Apollo hospital saying three important reasons for following this pricing strategy: first there is generally less uncertainty about costs than about demand. By basing the price on cost, the hospital simplifies the pricing task considerably; there is no need to make frequent adjustments as demand conditions change. Second, when all the hospitals use this approach, their prices are similar if their costs and markups are similar price competition can be minimized. Third, there is the feeling that costmarkup pricing is socially fairer to patients and hospital. Finally they opinioned that the cost oriented pricing administrative simplicity, competitive harmony and social fairness, so they are preferring this strategy for fixing prices for certain services in Apollo hospital. When the demand for certain services rather than the level of costs to set the price, Apollo is following demand-oriented pricing strategy for fixing the prices. For this marketing people of the hospital collecting information regarding how much value buyers see in the market offer and price accordingly. For this Apollo is considering the other hospital prices for the same services. Unfortunately Apollo is changing higher prices comparatively with other hospitals. For this, the hospital authorities saying that the higher prices are for their reputation for excellent, quick and responsive care. Apollo fixing for certain services on the basis of what competitors are charging. This pricing method is called in marketing as competition oriented pricing Here the Apollo hospital trying to keep its prices at the average level charged by the competition. This is especially Apollo is following certain service where costs are different to measure and also the hospital is believing that the going price represents the collective wisdom of the industry concerning the price that yields a fair return.

Price Mix in Care Hospital

Price mix in Care hospital largely based on costs, broadly divided in to direct and indirect costs and graduated charges. Before pricing services Care hospital is trying to know the cost of providing those services and searching for the scientific way of competing and fixing them but not fixing prices arbitrarily or following what prevails in other hospitals in the region. Because

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the financial experts of Care hospital think that, in the environment in which hospital how operative, this method of costing and setting charges is not an effective one. For this they are explaining as generally hospitals priced inpatient surgery and same day surgery at the same price despite the fact that there were variations in cost in different settings. More importantly, hospitals can not attract patients in large numbers as day surgery is expected to do unless the charges are made competitive. Before fixing the prices, Care hospital considering several components to comprise the total cost of a service. Usually the first component is fixed cost, comprises equipment and administrative costs for each procedure, and department overheads etc. the second component is variable costs, which vary procedure to procedure and includes cost of supplies and human service needed for the procedure. In addition to, Care considering building depreciations, capital needs and the departments share of the hospitals administrative costs. Later what remains is a policy decision by the top management, whether a procedure or service should be priced by adding a mark up profit or the price should be marked down for any reason or reasons to attract volume sales. After fixing the prices scientifically on the basis of actual cost of service procedure, finally Care hospital deciding how much a service or procedure is priced, and if they subsidize services, to what extent they subsidize them. Most of the services for inpatients in Care hospital are pricing based on variable pricing structure and on the basis of the category of bed a patient occupies. In Care there are three categories of beds, namely general ward beds, semi-private rooms and private rooms. Besides, there are other categories such as single rooms with air conditioned and non-air-conditioned, deluxe rooms, executive suits. Table no: 3.8 shows the prices of different categories of rooms in Care hospital.
Table no: 3.8

Room Charges in Care Hospital

Sl.No 1 2 3 4 5 6 7 Price For One Day (Rs) General Ward Twenty Beds In One Room 250-00 Semi-Private Room Five Beds In One Room 500-00 Single Room Non-Air-Conditioned (Individual) 750-00 Single Room Air-Conditioned (Individual) 1000-00 Deluxe Room Air-Conditioned, Other Facilities 2,000-00 Executive Room Air-Conditioned, Other Facilities 3,500-00 Care Suit Air-Conditioned, Other Facilities 5,000-00 Type of Room Facility

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For any operation or procedure, Care hospital following graduated charges. In this case, the charges for any procedure go higher and higher as one goes higher in the category of beds. In this regard, in Care the patient in the general ward charging Rs.350 for any appendectomy, whereas the patient in a five bed semi private room charging Rs.450 and the one in the private room Rs.600 (non-air-conditioned) Charging in the ratio of 1:2:3. It can be 1:1.5:2, not that the operation done on the private room patient in any different or more complicated. It is a some measure of social justice following by the Care hospital, and also the patient in the private rooms like deluxe, executive and suit enjoys better facilities and greater comfort. Here the researcher understood that the surgery does in fact costs as much as it is charged to higher categories of beds, only in the case of lower category beds, charges are subsidized. Apart from the above price mix of the Care hospital, they are following some other pricing methods for certain services. Especially in the area of cardiology departments they are fixing relatively high entry price. This is called in marketing skimming pricing strategy. On this issue the researcher asked why they are fixing high prices comparatively other hospitals to the concern people, they expressed following reasons. This strategy will allow the hospital to recover the huge investment made in establishing the centre as quickly as possible. Second, it will help them to maximize their revenue before other heart centers come up in that area and offer competition. Third argument was that if the local patients were to go other cities which in this case were quite a distance away, they would spend much more on their surgery anyway, and finally, it was always easies to lower the price than to raise it. Pricing of some other services in Care like cataract operations, sigerion operations etc, where the competition is huge, hospital charging lower prices when compared to other hospitals with good staff, good equipment and facilities etc, because the hospital fill its beds within an unusually short period of time. Let us see the perceptions of doctors, nurses and administrative personnel on the price mix of sample hospitals.

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Perceptions of Doctors about the Price Mix of Sample Hospitals

Table no: 3.9 representing perceptions of doctors about the price mix of the sample hospitals
Table no: 3.9

Perceptions of doctors about price mix of the sample hospitals

Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree

(1) S.L NO

(2) Statement

(3) Perception 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

This hospital is offering services at affordable prices.

In your hospital the quality of treatment depends on price.

Most of your patients are from higher income level.

Your hospital follows charges, what the other hospitals follows.

The charges for conducting, laboratory tests at your hospital are reasonable.

Your hospital follows stabilized pricing policies.

(4) Apollo % 26.70 20.00 20.00 20.00 13.30 100.00 1.33 18.66 46.65 21.39 11.97 100.00 2.66 30.74 45.32 13.30 7.98 100.00 11.97 14.66 25.32 28.05 20.00 100.00 2.66 24.06 11.97 34.65 26.66 100.00 14.63 18.76 31.99 21.32 13.30 100.00

(5) Care % 1.33 45.32 13.30 33.39 6.66 100.00 1.33 6.66 64.02 26.66 1.33 100.00 1.33 20.00 76.01 1.33 1.33 100.00 1.33 26.66 13.30 38.71 20.00 100.00 1.33 20.00 1.33 64.04 13.30 100.00 1.33 6.65 26.66 58.71 6.65 100.00

The survey has been taken up among the doctors about the Hospital offering services at affordable prices, 20 respondents with 26.70% in Apollo and in Care 1.33% expressed strongly agree opinion. 15 respondents with 20.00% in Apollo and in Care 35 respondents with 45.32%

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expressed agree opinion. The neutral opinion came up from 15 respondents with 20.00% in Apollo and 10 respondents with 13.30% in Care Hospital. 15 respondents with 20.00% in Apollo and in Care 25 respondents with 33.39% expressed disagreed opinion. 10 respondents with 13.30% in Apollo and 5 respondents with 6.66% in Care Hospital expressed strongly disagreed opinion. It is understood from the above analysis of statement that respondents are under the opinion that the Hospital is offering services at affordable prices. An attempt was made about the quality of treatment depends on price in the hospital, only one respondent with 1.33% has strongly agreed in Apollo and 1.33% expressed this opinion in Care Hospital. 14 respondents with 18.66% in Apollo and 5 respondents with 6.66% in Care Hospital expressed agree opinion. The neutral opinion was expressed by 35 respondents with 46.65% in Apollo and 50 respondents with 64.02% in case of Care Hospital. 16 respondents with 21.39% in Apollo and 20 respondents with 26.66% in Care Hospital expressed disagreed opinion. 9 respondents with 11.97% expressed strongly disagreed opinion in Apollo and in case of Care 1.33% expressed. On going through the above analysis of statement, it can be understood that large number of respondents are with neutral opinion in respect of both the Hospitals. The survey attempted to know that most of the patients in the hospitals are from higher income level. Out of 75 participates 2 respondents with 2.66% strongly agreed in Apollo Hospital and only 1.33% in Care Hospital express the same. 73 respondents with 30.74% expressed agreed opinion in respect of Apollo where as in Care 15 respondents 20.00% expressed. The neutral opinion came up from 34 respondents with 45.32% in case of Apollo and 60 respondents with 76.01% in case of Care Hospital. 10 respondents with 13.30% expressed disagreed opinion in Apollo and in Care 1.33% expressed. 6 respondents with 7.98% have expressed strongly disagree opinion in Apollo and where as in Care Hospital only 1.33% expressed the same opinion. From the above, it reveals that majority of respondents are with neutral opinion in case of the patients coming to these Hospitals are from higher income level. The subject was turned against the Hospital charges. For this statement of hospital collecting the same charges as the other Hospital follows, 9 respondents with 11.97% expressed strongly agree opinion in respect of Apollo and 1.33% expressed the same opinion in case of Care Hospital. 11 respondents with 14.66% expressed agree opinion in Apollo and in Care 20 respondents with 26.66% expressed the same. The neutral opinion came up from 19 respondents with 25.32% in Apollo and in Care 10 respondents with 13.30% expressed. 21 respondents with

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28.05% in Apollo expressed disagreed opinion and in case of Care 30 respondents with 38.71% expressed. Equal number of 15 respondents with 20.00% expressed strongly disagree opinion from both the Hospitals of Apollo and Care. On going through the above analysis, it can be understood that a large number of respondents are of the opinion that both Hospitals are not collecting the charges what other Hospitals follow. An attempt was made on the charges for conducting laboratory test at the Hospitals are reasonable. For this 2 respondents with 2.66% expressed strongly agree opinion in Apollo and 1.33% in Care Hospital. 18 respondents with 24.06% expressed agree opinion in Apollo and in Care it was15 respondents with 20.00%. The neutral opinion expressed among 9 respondents with 11.97% in Apollo and only 1.33% in Care Hospital. The disagreed opinion was expressed by 26 respondents with 34.65% in Apollo and 50 respondents with 64.04% in Care Hospital. As in case of strongly disagreed opinion, 20 respondents with 26.66% in Apollo and 10 respondents with 13.30% in case of Care Hospital expressed. On the whole, it can be seen from the analysis that majority of respondents are under the opinion that the charges for conducting laboratory tests at both the Hospitals are not reasonable. On the subject of following stabilized pricing policies by the hospital, the survey reveals that 11 respondents with 14.66% expressed strongly agree opinion in respect of Apollo and 1.33% in Care Hospital. 14 respondents with 18.76% agree in Apollo and 5 respondents with 6.65% in respect of Care Hospital. The neutral opinion arrived among 24 respondents with 31.99% in Apollo whereas in case of Care it was from 20 respondents with 26.66%. The disagreed opinion came up from among 16 respondents with 21.32% in Apollo and in Care it was 45 respondents with 58.71%. 10 respondents with 13.30% expressed strongly disagree in respect of Apollo whereas in Care it was only from 5 respondents with 6.65%.On going through the above analysis, it came to understand that large number of respondents are with disagree opinion about the Hospital following stabilized pricing policies. From the discussion it is observed that in Apollo the respondents believe that the hospital quality of treatment depends on price and only higher income group peoples are coming to the hospital even the hospital is fixing the charges depending up on what the other hospital following charges. But Apollo is unable to change the prices according to the market situations. In the case of Care hospital the pricing structure is framing by keeping the patients from lower income people and the respondents believe that the treatment quality will not depend on price. But Care

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frequently changing the prices according to the market needs. Further Care hospital charging prices at high for conducting laboratory tests. Let us see the perceptions of nurses.

Perceptions of Nurses about the Price Mix of Sample Hospitals

Table no: 3.10 representing perceptions of nurses about the price of the sample hospitals.
Table No: 3.10

Perceptions of nurses about price mix of the sample hospitals

Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree

(1) S.L NO

(2) Statement

(3) Perception 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

This hospital is offering services at affordable prices.

In your hospital the quality of treatment depends on price.

Most of your patients are from higher income level.

Your hospital follows charges, what the other hospitals follows.

The charges for conducting, laboratory tests at your hospital are reasonable.

Your hospital follows stabilized pricing policies.

(4) Apollo % 39.29 0.66 19.31 26.76 13.98 100.00 5.94 13.98 26.15 31.96 21.97 100.00 5.99 7.32 39.29 27.41 19.99 100.00 6.78 13.98 12.65 40.62 25.97 100.00 39.29 14.12 13.30 21.31 11.98 100.00 19.99 21.31 38.79 12.65 7.26 100.00

(5) Care % 20.78 39.29 12.65 13.98 13.30 100.00 0 13.98 19.31 46.81 19.90 100.00 12.65 20.75 39.29 7.32 19.99 100.00 0.66 19.99 19.40 39.96 19.99 100.00 19.99 33.66 12.65 26.38 7.32 100.00 7.32 39.29 33.96 13.30 6.13 100.00

Opinion poll was conducted among the nurses about price mix at of sample Hospitals. There were about 150 respondents participated. On the subject of offering services at affordable prices

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in the hospital 59 respondents with 39.29% have expressed strongly agree opinion in Apollo and in Care 31 respondents with 20.78% expressed. Only one respondent with .66% expressed

agree opinion in Apollo whereas in Care 59 respondents with 39.29% expressed. The neutral expression was given by 29 respondents with 19.31% in Apollo and in Care 19 respondents with 12.65%. 40 respondents with 26.76% expressed their disagreed opinion in respect of Apollo and in Care 21 respondents with 13.98% expressed. The strongly disagree opinion has taken place among 21 respondents with 13.98% in Apollo and in Care 20 respondents with 13.30% expressed. On going through the above analysis, it is understood that most of the respondents are under the opinion that these Hospitals are offering services at affordable prices. As regards the quality of treatment depends on price, 9 respondents with 5.94% strongly agree in Apollo and none in Care Hospital. 21 respondents with 13.98% expressed agree opinion in Apollo and in case of Care Hospital also 21 respondents with 13.98% expressed. The neutral opinion was taken place among 39 respondents with 26.15% in Apollo and in Care Hospital 29 respondents with 19.31%. 48 respondents with 31.96% expressed disagree opinion in Apollo and in Care Hospital 70 respondents with 46.81% expressed. 33 respondents with 21.97% have expressed strongly disagree opinion in Apollo and in Care Hospital 30 respondents with 19.99% expressed. It is evident that most of the respondents in both the Hospitals are of the opinion that the quality of treatment is not depended on the price. The survey was turned to the aspect that the most of the patients are from higher income level, 9 respondents with 5.99% expressed strongly agree opinion in Apollo, where as 19 respondents with 12.65% expressed in Care Hospital. 11 respondents with 7.32% expressed agree opinion in Apollo and 31 respondents with 20.75% in case of Care hospital. Equal number of 59 respondents with 39.29% expressed neutral opinion in both the Hospitals of Apollo and Care. 41 respondents with 27.41% expressed disagreed opinion in case of Apollo and in case of Care 11 respondents with 7.32% expressed the same opinion. In case of strongly disagreed opinion also equal number of 30 respondents with 19.99% expressed in both the Hospitals. From the above analysis, it is known that majority of respondents are not in position to come to a conclusion that the patients are coming to the hospital from higher income level. On the subject of Hospital charges, it was asked that the hospital follows charges, what the other hospitals follows, 10 respondents with 6.78% expressed strongly agree opinion in respect of Apollo only 0.66% in case of Care Hospital. 21 respondents with 13.98% expressed agree

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opinion in Apollo and in 30 respondents with 19.99% in Care expressed the same opinion. The neutral opinion has come up from among 19 respondents with 12.65% in Apollo and in Care 29 respondents with 19.40% expressed. Majority of 61 respondents with 39.96% expressed disagree opinion in respect of both the Hospitals of Apollo and Care. 39 respondents with 25.97% in Apollo and 30 respondents with 19.99% expressed strongly disagreed opinion in Care hospital. On going through the above analysis of statement, it can be seen that a large number of respondents are under the opinion that these Hospitals are not following charges, what the other Hospitals follow. As regards the charges for conducting laboratory tests at the Hospitals are reasonable, 59 respondents with 39.29% expressed strongly agree opinion in respect of Apollo and 30 respondents with 19.99% expressed the same opinion in case of Care. 21 respondents with 14.12% expressed agree opinion in case of Apollo and in Care 51 respondents with 33.66% expressed the same opinion. The neutral opinion was taken place in respect of 20 respondents with 13.30% in Apollo and in Care 19 respondents with 12.65% expressed. 32 respondents with 21.31% have expressed disagree opinion in Apollo and in Care 39 respondents with 26.38%. 18 respondents with 11.98% in Apollo and 11 respondents with 7.32% in Care expressed strongly disagree opinion. From the above analysis it is understood that the majority of respondents are under the opinion that the charges for conducting laboratory tests at both the Hospitals are reasonable. As regards the Hospital follows stabilized pricing polices, 30 respondents with 19.99% in respect of Apollo have expressed strongly agree opinion whereas in Care 11 respondents with 7.32% expressed the same. 32 respondents with 21.31% have expressed agree opinion in respect of Apollo and 59 respondents with 39.29% in case of Care Hospital. The neutral opinion has taken place among 58 respondents with 38.79% in Apollo and in case of Care 51 respondents with 33.96% expressed. 19 respondents with 12.65% expressed disagreed opinion in respect of Apollo and 20 respondents 13.30% expressed the same. 11 respondents with 7.26% have expressed strongly disagree opinion in respect of Apollo and 9 respondents with 6.13% have expressed the same opinion in case of Care. It is noticed from the above statement that a more number of respondents are unable to express their opinion about the stabilized pricing policies that the Hospital follows.

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From the above discussion it is noticed that most of the respondents from Care hospital accepted that the hospital is following affordable prices and the quality of the treatment will not depend up on the price. But majority of respondents believe that the hospital is gaining attention from the higher income people only. In the case of hospital charges, two hospitals are observing the other hospitals for price fixing. For conducting laboratory tests Apollo is following reasonable prices but Care is charging comparatively more prices. On overall the two sample hospitals are having good price mix and gained positive response from the respondents. Let us see the perceptions of administrative personnel about price mix of the sample hospitals.

Perceptions of Administrative Personnel about the Price Mix of Sample Hospitals

Table no: 3.11 representing perceptions of administrative personnel about the price mix of the sample hospitals
Table No: 3.11

Perceptions of administrative personnel about price mix of the sample hospitals

Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree

(1) S.L NO

(2) Statement

(3) Perception 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

This hospital is offering services at affordable prices.

In your hospital the quality of treatment depends on price.

Most of your patients are from higher income level.

(4) Apollo % 45.60 5.70 31.35 11.65 5.70 100.00 44.28 1.32 37.30 2.85 14.25 100.00 31.35 31.35 23.05 8.55 5.70 100.00

(5) Care % 50.23 34.20 1.32 5.70 8.55 100.00 5.70 8.55 5.70 48.70 31.35 100.00 28.50 28.50 28.75 8.55 5.70 100.00

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3 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

4 31.35 34.45 11.40 11.40 11.40 100.00 44.53 34.20 17.10 2.85 1.32 100.00 37.05 37.05 17.35 5.70 2.85 100.00

5 2.85 8.55 5.70 39.90 43.00 100.00 37.05 43.00 5.70 8.55 5.70 100.00 31.35 45.85 8.55 5.70 8.55 100.00

Your hospital follows charges, what the other hospitals follows.

The charges for conducting, laboratory tests at your hospital are reasonable.

Your hospital follows stabilized pricing policies.

Opinion poll was under taken about the Hospital offering services at affordable prices, 35 respondents are involved. Out of which 16 respondents with 45.60% expressed their strongly agree opinion in respect of Apollo and in Care 18 respondents with 50.23% has expressed the same. 2 respondents with 5.70% expressed agree opinion in respect of Apollo and in case of Care 12 respondents with 34.20% has expressed the same. 11 respondents with 31.35% expressed neutral opinion in case of Apollo where as 1.32% in case of Care Hospital. 4 respondents with 11.65% expressed disagree opinion in case of Apollo and in Care Hospital 2 respondents with 5.70% expressed the same opinion. 2 respondents with 5.70% expressed strongly disagreed opinion in respect of Apollo and in case of Care 3 respondents with 8.55% expressed the same opinion. The analysis of statement shows that major part of respondents are on the opinion, that these Hospitals offering services at affordable prices. The survey was conducted on the subject that the quality of treatment depends on price, 16 respondents with 44.28% has expressed strongly agree opinion, in case of Care 2 respondents with 5.70% expressed the same. 3 respondents with 8.55% expressed agree opinion in respect of Care Hospital and 1.32% in Apollo. The neutral opinion was taken place in respect of Apollo from 13 respondents with 37.30% and in Care only 2 respondents with 5.70%. Only one respondent with 2.85% expressed disagree opinion in Apollo and in Care 17 respondents with 48.70%. The strongly disagree opinion has come up from among 5 respondents with 14.25% in

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Apollo and in Care 11 respondents with 31.35% expressed. On going through the analysis, it is observed that different opinions have come up. Majority of respondents strongly agree in respect of Apollo, where as in Care majority of respondents disagree in respect of the quality of treatment in the hospital depends on price. On the subject that most of the patients are from higher income level, the survey reveals the following responses. 11 respondents with 31.35% expressed strongly agree opinion in Apollo and 10 respondents with 28.50% in Care Hospital. 11 respondents with 31.35% in Apollo expressed agree opinion and in Care 10 respondents with 28.50% expressed the same opinion. Neutral opinion has come up from among 8 respondents with 23.05% in Apollo and in Care Hospital 10 respondents with 28.75% expressed. 3 respondents with 8.55% expressed disagreed opinion in respect of Apollo and in Care also the same response has come. Likewise 2 respondents with 5.70% have expressed strongly disagree opinion in both the Hospitals of Apollo and Care. In conclusion of the analysis it is noticed that majority of respondents are under the opinion that the patients are from higher income level in both the Hospitals. The opinion poll was diverted at the aspect of collecting charges what the other Hospitals follow. For this 11 respondents with 31.35% expressed strongly agree opinion in Apollo and in Care only one respondent with 2.85% expressed the same opinion. 12 respondents with 34.45% expressed agree opinion in Apollo and in Care three respondents with 8.55% expressed. The neutral opinion came up from among 4 respondents with 11.40% in Apollo and in Care 2 respondents with 5.70% expressed. As regards the disagreed opinion, 4 respondents with 11.40% in Apollo and 14 respondents with 40.15% in Care Hospital expressed. 4 respondents with 11.40% expressed strongly disagreed opinion in Apollo and in Care 15 respondents with 42.75% in respect of Care. From the above, it can be noticed that different opinions have came up. In case of Apollo Hospital majority of respondents are agreeing that the Hospital follows charge what the other Hospitals follow. At the same time in respect of Care Hospital more respondents are disagreeing with the above statement. The survey has turned against the charges for conducting laboratory tests at the Hospital are reasonable. For this, 16 respondents with 44.53% expressed strongly agree opinion in Apollo whereas 13 respondents with 37.05% in Care expressed. 12 respondents with 34.20% agree in respect of Apollo and in case of Care 15 respondents with 43.00% expressed the same. The neutral opinion has come up from among 6 respondents with 17.10% in Apollo and in Care 2

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respondents with 5.70% expressed. Only one respondent with 2.85% expressed disagree opinion in respect of Apollo where as in Care 3 respondents with 8.55% expressed. Only 1.32% came forward to express strongly disagreed opinion in Apollo and in Care two respondents with 5.70% expressed. From the above, it can be understood that a large number of respondents are under the opinion that the charges for conducting laboratory tests at both the Hospitals are reasonable. As regards the Hospital following stabilized pricing policies, 13 respondents with 37.05% expressed strongly agree opinion in Apollo and in Care Hospital 11 respondents with 31.35% expressed the same. Agreed opinion expressed by 13 respondents with 37.05% in Apollo and 16 respondents with 45.85% expressed the same in Care.. The neutral opinion came up from 6 respondents with 17.35% in Apollo and in Care 3 respondents with 8.55% expressed. Two respondents with 5.70% expressed disagreed opinion in both the hospitals. Only one respondent 2.85% has expressed strongly disagree opinion in case of Apollo and in Care Hospital 3 respondents with 8.55% have expressed. On the whole the majority of respondents are under the opinion that both the Hospitals are following stabilized pricing prices From the above discussion it is observed that the most of the respondents in Apollo believe that the hospital is not offering services at affordable prices. This is because the Apollo is fixing prices by keeping higher income people only. But in Care hospital the respondents believe, hospital is fixing charges individually those are affordable. On the other hand laboratory charges are reasonable in the two hospitals. The two hospitals are following stabilized pricing policies. On the whole, it is observed that the price mix is good in two sample hospitals. Now we will take up the Mean and S.D of Doctors Perceptions on the Price Mix of the Sample Hospitals

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Mean and Standard Deviation values of Doctors Perceptions on the Price Mix of Sample Hospitals
Table no: 3.12 representing mean and standard deviation values of perceptions of doctors about the price mix of the sample hospitals.
Table No: 3.12 Mean and S.D of Doctors Perceptions on the Price Mix of the Sample Hospitals (N=75)

Sl.No
1 2 3 4 5 6

Statement
This hospital is offering services at affordable prices. In your hospital the quality of treatment depends on price. Most of your patients are from higher income level. Your hospital follows charges, what the other hospitals follows. The charges for conducting, laboratory tests at your hospital are reasonable.
Your hospital follows stabilized pricing policies.

Apollo

Care

Mean S.D Mean S.D

2.73 3.26 2.92 3.14 3.60 3.00 1.39 0.93 0.86 1.36 1.15 1.21 3.00 3.22 2.80 3.53 3.73 3.66 1.03 0.53 0.40 1.09 0.93 0.70

5 Point Scale: 1-strongly agree.5-strongly disagree

Table no: 3.12 shows that affordability of services (2.73), quality of services depends on price (3.26), serving only higher income level (2.92), follows charges what the other hospital follows (3.14), chargers for laboratory tests (3.60), stabilized pricing policies (3.00). From this it can be concluded that the price mix in Apollo hospital gained positive response by the respondents. In the same way the perceptions of the respondents on the price mix in care hospital; affordability of services (3.00), quality of services depends on price (3.22), serving only higher income level (2.80), follows charges what the other hospital follows (3.53), chargers for laboratory tests (3.73), stabilized pricing policies (3.66). From this it can be understood that the price mix in care hospital reveals positive response by the respondents.

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Mean and Standard Deviation values of Nurses Perceptions on the Price Mix of Sample Hospitals
Table no: 3.13 representing mean and standard deviation values of perceptions of nurses about the price mix of the sample hospitals.
Table No: 3.13 Mean and S.D of Nurses Perceptions on the Price Mix of the Sample Hospitals (N=150)

Sl.No
1 2 3 4 5 6

Statement
This hospital is offering services at affordable prices. In your hospital the quality of treatment depends on price. Most of your patients are from higher income level. Your hospital follows charges, what the other hospitals follows. The charges for conducting, laboratory tests at your hospital are reasonable.
Your hospital follows stabilized pricing policies.

Apollo

Care

Mean S.D Mean S.D

2.73 3.46 3.46 3.66 2.52 2.66 1.53 1.15 1.09 1.19 1.50 1.14 2.60 3.73 3.00 3.60 2.47 2.72 1.31 0.93 1.26 1.02 1.09 1.01

5 Point Scale: 1-strongly agree.5-strongly disagree

Table no: 3.13 shows that affordability of services (2.73), quality of services depends on price (3.46), serving only higher income level (3.46), follows charges what the other hospital follows (3.66), chargers for laboratory tests (2.52), stabilized pricing policies (2.66). From this it can be concluded that the price mix in Apollo hospital gained positive response by the respondents. In the same way the perceptions of the respondents on the price mix in care hospital; affordability of services (2.60), quality of services depends on price (3.73), serving only higher income level (3.00), follows charges what the other hospital follows (3.60), chargers for laboratory tests (2.47), stabilized pricing policies (2.72). From this it can be understood that the price mix in care hospital reveals positive response by the respondents.

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Mean and Standard Deviation values of Administrative personnels Perceptions on the Price Mix of Sample Hospitals
Table no: 3.14 representing mean and standard deviation values of perceptions of Administrative personnel about the price mix of the sample hospitals.
Table No: 3.14 Mean and S.D of Administrative Personnel Perceptions on the Price Mix of the Sample Hospitals (N=35)

Sl.No
1 2 3 4 5 6

Statement
This hospital is offering services at affordable prices. In your hospital the quality of treatment depends on price. Most of your patients are from higher income level. Your hospital follows charges, what the other hospitals follows. The charges for conducting, laboratory tests at your hospital are reasonable.
Your hospital follows stabilized pricing policies.

Apollo

Care

Mean S.D Mean S.D

2.40 2.22 2.37 2.40 1.77 2.00 1.45 1.16 1.35 1.45 0.84 1.02 1.85 3.91 2.34 4.11 2.08 2.11 1.24 1.12 1.16 1.05 1.19 1.20

5 Point Scale: 1-strongly agree.5-strongly disagree

Table no: 3.14 shows that affordability of services (2.40), quality of services depends on price (2.22), serving only higher income level (2.37), individual pricing (2.40), chargers for laboratory tests (1.77), stabilized pricing policies (2.00). From this it can be concluded that the price mix in Apollo hospital gained positive response by the respondents. In the same way the perceptions of the respondents on the price mix in care hospital; affordability of services (1.85), quality of services depends on price (3.91), serving only higher income level (2.34), follows charges what the other hospital follows (4.11), chargers for laboratory tests (2.08), stabilized pricing policies (2.11). From this it can be understood that the price mix in care hospital reveals positive response by the respondents

Conclusion
Price is one of the most prominent elements in the marketing mix. Price charged must be acceptable to target customers and it should co-ordinate with other elements of the marketing mix. Price charged by the hospital usually depends on treatment prescribed by the respective

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consultants and the facilities offered to the patient. As a service is intangible, it is very hard for determining the price of the particular service rendered. Pricing strategy adopted does not depend on the price offered by competitors. The pricing strategy is formulated after consulting heads of departments. Price of various facilities are revised every year depending on the change in technology. Before fixing prices, government controls are also taken consideration. The observation regarding price mix of two hospitals under study indicating that the two hospitals are not following stabilized pricing policies, they are changing prices, when other hospitals changing prices. In most of the cases Care hospital is not gaining the attention from the higher income people this indicating their prices are concentrating on lower income group only. This is because the quality of treatment will not follow the price in Care hospital. In Apollo price is influencing the quality of the treatment, further most of the patients are coming from higher income group only. The laboratory charges are not reasonably fixed in Care hospital so the patients are going to other laboratories. In this issue Care has to take serious action. On the whole, it is observed that the two hospitals are marinating good price mix for marketing their services. Now let us move on to the place mix in hospitals.

Place Mix in Hospitals

Place is one of the key elements, in the sense that the hospital should be easily accessible to the patients but at the same time should be adequately protected from pollution. Corporate hospitals can distribute their services using the services of doctors and private clinics. Doctors, who have their private practice, work as visiting/consultant doctors for corporate hospitals. They can refer their patients to these hospitals for diagnosis, surgeries etc. other doctors too can refer their patients to corporate hospitals, as they do not have adequate facilities for specialized services. Corporate hospitals can also use ambulances to offer immediate care to patients in emergency conditions. Every hospital should consider how it will make its services available and accessible to its target consumers. It has two aspects. The first is the availability of the service at a time and place convenient to the patients. So the hospital must have community outreach programmes, satellite clinics and the like which deliver health care right at the peoples doorstep, and industrial, corporate or occupational medicine at the work place. The second aspect of this component is the hospitals place in the entire health care system involved in marketing. To distribute health care, one needs more than the hospital which is only one link in the system. We need physicians,

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allied health care personnel, hospital administrators, donors, government, insurance companies, employers, and others. These from the distribution channels for health care. Hospitals whose primary products are services have three major distribution decisions. These involve Physical access ( channels, location and facilities) Time access Promotional access (including referrals) Physical Access In the past decades there has been an explosion in the types of channels used to deliver medical care and health promotion. Fig. no: 3.8 show some hospital channels.
Fig. No: 3.6

Controlling Channels into and out of the Hospital

Private M.D. Transport system PPO/HMO Industrial health Diagnostic care centre Primary care centre (Surgicenter, emergicenter) Ambulatory Hospital
Hospital
Intake Diagnosis Treatment Care

Geriatric day care Skilled nursing facility Hospice Private M.D Home health care Rehabilitation center

After care/chronic care

Source: Jeff Goldsmith, Health Futures, Chicago, Illinois.

The channels used for health promotion and early disease detection have also expanded rapidly. The unexciting four basic foods chart used to hang in every elementary school classroom has given way to health fairs in the community, computerized health information banks in public libraries, the cable health network (a cable television network devoted exclusively to disseminating health-related information), health education videotapes to be rented for home use, hospital based television systems providing patient education information and telephone hotlines covering every conceivable aspect of health care including suicide hotlines, elder health hotlines, and explanations ( reach out and touch someone)21 Where as surgery used to be performed

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only in a hospital on an inpatient basis, patients can now have surgery, performed at the hospital on an inpatient or out-patient basis or in free-standing one-day surgicenters. One noticeable trend in the use of new channels is the tendency to bring healthcare to the consumers, rather the consumer to come the source of health care delivery. Mobile vans, now deliver medical care and health screening tests to shopping malls, schools, and worksites.

Location
Physical access decisions also raise considerations of location. The majority of hospitals operate out of one facility. Those which do not encounter all the classic distribution problems faced by retail business firms: how many branches or outlets to operate, of what size, where located, and what specialization at each branch. The location of hospitals often such a dominant factor that it dictates what the rest of the marketing mix looks like. A neighborhood health center in a lower-income neighborhood (location) usually attracts poor clienteles, so prices must be kept low. Because people from higher-income neighborhoods are unlikely to come to a poorer neighborhood for medical care, the health center limits its promotion to those who are likely to use the center. Location decisions are made all the time in hospitals. Group patients and practices and hospitals setup satellite clinics. Physicians and dentists who are setting up practices must select office locations. Too frequently, these decisions are made with little consultation of relevant factors. These factors, formulated as questions, include area underserved medically? Or is there already significant competition in the area? Is the area anticipating population growth or decline? What is the current and projected demographic makeup of the community? Does the location have to be in a high traffic area? Should it be accessible to public transportation or to parking facilities? Does it need to be near other medical facilities or near a referral base? Choice of location is an important marketing decision because the patient market often segments itself according to proximity to the source of medical care22 One study found that the second most important reason for choosing a hospital is proximity to home (location)
23

The

importance of distance from the source of care lessens as the risk of the medical problem decreases, as the patients level of education and income rises, and as the medical visit/admissions moves from unplanned to planned24

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Facilities
Designing of the facilities is third physical access consideration. Hospitals that operate inpatient or ambulatory facilities or whose consumers use the facility in some other way have to make decisions on the look of their facilities, because the look can affect consumer attitudes and behavior. Many hospitals have an institutional look, with long narrow corridors, drab wall colors, and badly work furniture, all contributing a depressed feeling to patients who are already depressed about their condition. New hospitals are designed with colors, textures, furnishings, and layouts that reinforce positive feelings. They may have circular or rectangular layouts with centralized nursing stations, permitting nurses to monitor the patients better. Single-care units are replacing the traditional semi-private rooms based on the over whelming preference for such units by both patients and physicians. Hospital facilities designing face at least four major design decisions. What should the facility look like on the out side? What should be the functional and flow characteristics of the facility? What should the facility feel like on the inside? What materials furnishings, and so on, would best support the desired feeling of the facility? Hospital facility has a look that may add to or detract from consumer satisfaction and employee performance. The later point deserves special emphasis. Since employees work in the facility all day long, it should be designed to support them in performing their work with ease and cheerfulness. The risk in falling to attend to physical access issues is that the hospitals will create patient dissatisfaction. If patients receive treatment in a rundown facility, they are likely to demean not only the facility, but the treatment as well. Therefore hospitals should pay attention to the details of the present facility and take ever minor steps to improve comfort or effectiveness. Every facility conveys something to users about the attitudes toward them felt by the service providers.

Time Access
Time access deals with two distinct issues. 1. The hours during which services are provided 2. The length of waiting time in the services providers waiting areas and the length of time between calling for and having an appointment.

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1: Hospitals generally keep bankers hours. Most physicians, dentists, neighborhood health centers, social service agencies, mental health clinics, and other ambulatory service providers were available from 8 A.M to 5P.M one week days, with an occasional evening session that ran until 7 P.M. Hospitals also had limited time access. Surgical and diagnostic procedures were generally limited to weak days, when operating room staff and medical technicians were available. Again, this meant that inpatient diagnostic and surgical care could be received only at the expense of the patients work time. However, these time access barriers have often been developed with little consideration for the needs of the patients. When the consumer uses the hospital inappropriately due to being denied reasonable time access to proper care, the tendency is to be balance the consumer rather the hospital services delivery system. Many new channels have developed to address this problem and older channels have modified their hours. The walk-in medical clinics and the 24-hour telephone information services and hotlines are further indications that health services are increasingly responding to access barriers. Private practice providers have expanded their hours in order to remain competitive, and hospitals are operating the equivalent of walk-in medical clinics. 2: Hospital waiting area or between the time of the call for the appointment and the appointment it self, is another area that is potential source of great dissatisfaction and where some provider exchanges have already occurred. A study of waiting times in different medical settings reported the following: How long people must wait for a physician appointment and how long they must wait in the physicians office or other medical setting to see the physician reflects the scheduling patterns of physicians and outpatient facilities and judgments about how quickly they should be seen. Waiting time for an appointment can be a source of dissatisfaction with the delivery of medical care if the patients view of the appropriateness of the wait differs from that of the physician or the person scheduling the appointment. Waits in the office or outpatient department can likewise be a source of dissatisfaction if people must wait beyond their scheduled time or if those making unscheduled or emergency visits wait longer than they consider reasonable.25 An article specifically recommends that no patient should have to wait more than 15 minutes beyond the time of the appointment. The provision of health care does require some lee ways in timing, because the time required for each visit or unit of service may not be able to be known in advance. A chest pain could be indigestion or a heart attack. One obviously requires more time than the others.

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Managing a hospital service to minimize waiting time involves not just actual waiting time, but also psychological waiting time. People may not mind waiting if they are enjoying themselves or are able to make productive use of the time. For this hospitals can maintain video equipment and tapes available for waiting patients, having a big toy box and play area for children, and having constantly updated magazines on nearby tables etc.

Hospital Service Referral Process

The distribution of hospital services is the reverse to the distribution of tangible products. How to get consumer to the service provider so that the service can be produced. The process of getting the service producer or provider and the consumer together so that the service can be delivered is called referral. The purpose of referral is to provide promotional and informational access to the consumer. Fig. no: 3.9 Explains the contrasting distribution flows of products and services.
Fig. No: 3.7

Contrasting Distribution Flows of Products and Services

The product distribution process: Product Producer wholesalere rerer Product Retailer Product Market

The hospital service referral process: Hospital Services Patient Primary Care Physicia n Specialist Hospital

Source: Phllip Kotler, Robert N.Clarke Marketing For Health Care Organizations

The process of referral involves the use of intermediaries who distribute information on and promote the organization. The most obvious intermediary in the hospital industry is the physician. Hospitals rely on physician to promote the hospitals services to patients. Physicians are also intermediaries for pharmaceutical companies, which rely on them to recommend and prescribe certain drug products to their patients. Along with physicians, hospital discharge 195

planners are the intermediaries for all the health care organizations populating the hospital aftercare market i.e. nursing homes, home health agencies, homemaking services rehabilitation centers etc. The choice to use or not use intermediaries is encompassed by the choice between two strategies marketers commonly call push versus pull. A push strategy is one that relies on intermediaries to inform and promote or push the organization to the consumer. The essence of a push strategy is the use of personal selling. A pull strategy employs no middlemen, relying instead on substantial advertising and related promotion directed to pull the consumer in to use the organizations services. A pull strategy involves no personal selling and employs only impersonal promotional. Hospitals that rely on referral and the use of intermediaries to generate demand is using a push strategy. It is the strategy traditionally used by hospitals, and it is likely to remain so. A push strategy is particularly appropriate for hospitals that are sensitive in nature and thus difficult to advertise, or for services for which the consumers must rely on an intermediary professional, clinics, or authority to decide on the appropriate purchase. Many hospitals lack of financial resources to carry out a program to direct marketing. The government of India adopted family planning as an official cause and set up a department to disseminate birth control information and contraceptives. The departments goal was to make contraceptives available to the smallest, remotest villages in that nation26 Hospitals are beginning to recognize their ability to implement marketing strategies involving physicians as intermediaries. Many hospitals actively seek to expand their medical staff in specialties in which additional patient volume is sought. They may also identify communities on the fringes of their service area from which they wish to attract patients and place physicians in practice there. This may be viewed as staking out territory, protecting it from competing hospitals. Effective use of referral requires recognizing that the intermediaries are a market. Not only do they serve the interest of the organization through the promotional and informational access they provide, but the organization must also provide value to them.

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Place or Distribution Mix in Apollo Hospital

Place or distribution mix in Apollo hospital can be described in terms of physical access of the Apollo hospital, time access, informational and promotional access of the hospital. In Apollo physical access comprises the channels which the hospital using for distributing the health services. Location of the Apollo hospital includes the branches or outlets to operate, size, where located and what are the specialization at each branch they are offering etc, and designing of the facilities. Apollo is utilizing different channels for delivery of health services to the needy. In Apollo the patients now can get the surgery on an inpatient or out-patient basis or in freestanding one-day surgery centers. Apollo offering house visits in some areas where an oversupply of physicians motivates a higher level of service to the patients. Apollo changing channels in obstetrics, some which are not clinically accepted, have moved the birth process out of traditional labor and delivery rooms in to hospital-based alternative birth centers and on occasion in to the home. The channels using by the Apollo for health services promotion and early disease The channels using by the Apollo for health services promotion and early disease detection have also expanding rapidly. For this Apollo displaying food charts that used to hang in every elementary school class rooms in the Hyderabad city, computerized health information in public libraries, health education CDs sold to the patients and tele- medicine services covering every conceivable aspect of the health care including suicide hotlines, elder hotlines and sexplanations etc,. Table no: 3.15 shows the Tele-medicines service of the Apollo hospital.
Table No: 3.15

Apollo Telemedicine Services

1 Sl.No 1 2 3 4 5 2 Name Tele-Radiology Tele-Dermatology Tele-Pathology Tele-Cardiology Remote-ICU Monitoring 3 Description Transferring digitized images like X-Rays, MRIs and CT scans From one location to another for diagnostic reports. Exchanging digital images of skin for interpretation. Sharing microscopic images with pathologists sitting in diverse location for instant report. Transferring data from modalities such as ECG, Echo cardiogram expert opinion. An excellent solution for providing critical care to patients located in remote areas with basic health care facilities.

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1 6

2 Ambulance Monitoring

Mobile Tele Medicine Unit Electronic Health Card

3 A life saving solution in cases where patients need to be transferred overlong distances to reach the nearest hospital. The vital signs of the patient can be monitored by a team of specialists and valuable as well as timely health care can be provided even before the patient reaches the hospital. A solution aimed at providing healthcare where hospitals are unavailable. Using a telemedicine van, video conferencing and satellite communication, medical care is provided to people in remote areas. It also acts as a life saver providing timely health aid in times of large scale disaster or natural calamities. A web based solution enabling health care professionals to access a patients medical information any where and any time.

One important trend noticed by researcher in Apollo hospital, in the use of new channels to bring health services to the consumer, rather than forcing the consumer to come to the hospital. For this Apollo arranging mobile vans for delivering medical care and health screening tests at shopping malls, schools and worksites. On the aspect of location of the Apollo hospital, Jublihills, Hyderabad located at film nager, heart of the city spread over a campus area of 35 acres, the hospital has a built-up area of 190,000 sft with a patient serving capacity of 1, 00,000 per year. The other outlets located at various areas of Hyderabad are shown in the table no: 3.16
Table No: 3.16

Other Outlets of Apollo Hospital

Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Location Ahmedabad Banglore Bilaspur Chennai Bhubaneswar Delhi Kakinada Kolkata Madurai Vishakapatnam Republic of Mauritius Dhaka Ludhiyana Indore Ranchi Pune Raichur Mysore Ranipet Area (Acres) 10 8 17 25 7.5 12 5 12 10 13 18 11 6 8 5 13 9 16 10 No.of.Beds 400 250 290 455 350 550 60 425 200 250 200 450 65 140 130 305 422 170 100 Patients Serving Per year 10,000 98,000 2,78,000 1,20,000 82,000 1,32,000 11,000 1,12,000 15,000 20,000 15,000 29,000 18,000 23,000 24,000 70,000 28,800 62,000 23,000

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It is observed in Apollo hospital, they are considering some important factors before starting the new branch in some other locations, the factors are competition, medical facilities availability, population, transportation, parking facilities etc,. While selecting location of the hospital, Apollo giving importance to the proximity to residential areas. On this issue when the researcher asked the hospital people, they responded as proximity is important in the case of emergency situation. Researcher has observed that the Apollo Jublihills was located at highly populated area and the hospital can be reached with in 10 minuets to half an hour. There are different transportation modes are available to reach the hospital with in short time. For the parking place Apollo have arranged 5 acres of place at two different locations in the hospital. Apollo is providing better time access, but the timing of different services varies from one to another. Services in Apollo like ambulatory services, dental, mental health etc. are available from 8 A.M to 5 P.M. on week days with an occasional evening section that run until 8 P.M. depending up on the need. To receive the important services, patients have to take appointment from the concern doctor at least before one week. Patients can take appointments from various appointment centers which are located at various cities, towns and other areas in the state. Through appointments, patients can get the appointment date and timing letter, with it they can directly approach the doctor on that date at Hyderabad Apollo health city. However the researcher observed that the Apollo hospital had limited time access for surgical and diagnostic procedures which were generally limited to week days. It is also observed that some times due to unavailability of operating staff and medical staff, patients has to wait even days to get the required services. Especially the patients from out side the country to get the surgery they have to wait minimum one month to three months. When the researcher observed the waiting time for patients in Apollo, it was noticed that they are taking at least half an hour to get the call in the hospital. Some times it is crossing more than two hours, occasionally four to five hours. On the aspect of promotion of health services, Apollo hospital using intermediaries to distribute the information and promote the services of the hospital. For this Apollo is relying on physicians to promote the hospitals services to patients. Along with hospital discharge planners, nursing homes, home health agencies, home making services, rehabilitation centers etc, are using as intermediaries for promoting the services.

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Place or Distribution Mix in Care Hospital

The place or distribution mix of Care hospital can be explained in terms of two aspects. The first one is location of the hospital and its channels using for distribution of services and the second aspect includes the facilities, branches located in the same city and over the country with its bed capacity and specializations, community out reach programmes, satellite clinics which deliver health services at the peoples doorsteps and hospitals industrial, corporate or occupational medicine at the work place. Care hospital located at Banjarahills Road No: 10 Hyderabad, which is the heart of the city, spread over 10 acres with 55,000 Sft. of built up area. At present Care hospital having 430 beds, including 120 critical care beds with annual inflow of 1, 80,000 patients for consultations and 16,000 patients for admission. The hospital is having good transportation facility from all the corners of the city; usually it will take 15 to 45 minuets to reach the hospital. But it is noticed that, the hospital is not concentrated for arranging parking place for the visitors and others. In order to provide better services and to reach nearer to the needy, Care hospital started its outlets at different places in the city includes, Nampally, Secunderabad, Musheerabad and out side the city includes Visakhapatnam, Vijayawada, Nagpur, Pune, Raipur, Bhubaneswar, and Surat with different bed capacities. Table no: 3.17 depicts this information.
Table No: 3.17

Other Outlets of Care Hospital

Sr. 1 2 3 4 5 6 7 8 9 10 11 Place of Business Unit CARE Heart Institute Nampally CARE Hospitals Secunderabad CARE Hospitals Visakhapatnam ( Two units) Care Hospitals, Banjarahills , Hyderabad CARE Hospitals, Vijayawada CARE Hospitals, Nagpur CARE Hospitals, Musheerabad CARE Hospitals, Pune (Two units) CARE Hospitals, Raipur CARE Hospitals, Bhubaneswar CARE Hospitals, Surat State Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Maharastra Andhra Pradesh Maharastra Chattisgarh Orissa Gujarat Year of Starting 1997 1998 1999 2002 2004 2006 2007 2007 2007 2007 2008 No. of. Beds 310 40 230 460 150 105 130 170 125 105 110

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As a part of distribution mix, Care hospital providing Care clinics. These clinics are unique offering from care hospital. Through these low cost models, care hospital aims to spell convenience to patient through easy accessibility of a health services just around the corner. Each care clinic is equipped with diagnostic centre, operational with state of art facilities, pharmacy, out-patient departments, apart from the advanced wellness-centers. In addition to the routine checks, care clinics offers disease management programs, wellness programs and allows the patients to choose from more than one thousand health checks. Along with these, care clinics also offering the exceptional concept of home healthcare for patients who are unable to come to the hospital for a variety of reasons. The home healthcare covers post hospitalization, home monitoring by nurses, and home visiting by doctors etc. Now let us move on to the perceptions of Doctors, Nurses and Administrative Personnel on place mix of the sample hospitals.

Perceptions of Doctors about the Place Mix of Sample Hospitals

Table no: 3.18 representing perceptions of doctors about the place mix of the sample hospitals
Table No: 3.18

Perceptions of Doctors about Place Mix of the Sample Hospitals

Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree

(1) S.L NO

(2) Statement

(3) Perception 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

Your hospital attracting patients from all the places.

The hospital still to extend its services to some other areas.

Your hospital is adequately protected from pollution.

(4) Apollo % 12.09 34.65 31.94 14.66 6.66 100.00 6.66 14.66 31.99 34.65 12.04 100.00 21.41 34.65 20.00 11.97 11.97 100.00

(5) Care % 6.66 18.73 41.32 18.66 14.63 100.00 14.66 18.70 41.32 18.66 6.66 100.00 14.66 50.69 23.99 9.33 1.33 100.00

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3 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

4 26.68 20.00 1.33 31.99 20.00 100.00 25.27 34.83 15.96 11.97 11.97 100.00 14.70 25.32 20.00 25.32 14.66 100.00 14.66 25.32 20.00 25.36 14.66 100.00

5 1.33 1.33 7.98 44.04 45.32 100.00 11.97 46.80 7.98 31.92 1.33 100.00 1.33 38.73 39.99 7.98 11.97 100.00 1.33 38.71 39.99 7.98 11.99 100.00

You are a visiting or consulting employee in some other place.

Your hospital is well noted to other hospitals to refer their patients for better treatment.

Your hospital is having convenience to the patients.

time

and

place

Your hospital is located at a right place.

The survey has taken place in respect of the Hospital attracting patients from all the places. Out of 75 respondents participated only 9 respondents with 12.09% expressed strongly agree opinion in respect of Apollo and in Care 5 respondents with 6.66% expressed. 26 respondents with 34.65% expressed agree opinion in Apollo and in Care 14 respondents with 18.73% expressed. The neutral opinion has taken place among 24 respondents with 31.94% in respect of Apollo and in Care 31 respondents with 41.32% expressed. The disagreed opinion was expressed by 11 respondents with 14.66% in Apollo and in Care 14 respondents with 18.66% expressed. 5 respondents with 6.66% expressed strongly disagreed opinion in Apollo and in Care 11 respondents with 14.63% expressed. It can be noticed from the above that majority of responses are unable to express their opinion. As regards the Hospital still to extend its services to some other areas, 5 respondents with 6.66% expressed strongly agree opinion in Apollo and in Care 11 respondents with 14.66% expressed. 11 respondents with 14.66% expressed agree opinion in case of Apollo and in Care 14

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respondents with 18.70% expressed. The neutral opinion arrived among 24 respondents with 31.99% in Apollo and in Care 31 respondents with 41.32% expressed. In the case of disagreed opinion, 26 respondents with 34.65% expressed in Apollo and in Care 14 respondents with 18.66% expressed. The strongly disagree opinion appears among 9 respondents with 12.04% in Apollo and in Care only 5 respondents with 6.66% expressed. It is observed from the above analysis that different opinions have appeared i.e. majority of respondents expressed disagree opinion in Apollo and in Care neutral opinion came up. Thereby it can be concluded that the expansion of services at both the Hospitals are of negative attitude. A study was made on the aspect of the Hospital being adequately protected from pollution, 16 respondents with 21.41% expressed strongly agree opinion in Apollo and in Care 11 respondents with 14.66% expressed. 26 respondents with 34.65% expressed agree opinion in aspect of Apollo and in case of Care 39 respondents with 50.69% expressed. The neutral opinion was arrived from among 15 respondents with 20.00% in Apollo and in Care Hospital it was from 18 respondents with 23.99% expressed. 9 respondents with 11.97% expressed disagreed opinion in Apollo where as in Care 7 respondents with 9.33%. The strongly disagree opinion expressed among 9 respondents with 11.97% in Apollo and 1.33% expressed in Care Hospital. On going through the analysis, it reveals that most of the respondents are under the opinion that both the Hospitals are having adequate protection from pollution. On the aspect of you are a visiting or consulting employee in some other places, 20 respondents with 26.68% expressed strongly agree opinion in Apollo and in Care 1.33% only was there. 15 respondents with 20.00% expressed agree opinion in Apollo and in case of Care Hospital 1.33% expressed. Only one respondent with 1.33% in Apollo and 6 respondents with 7.98% in Care expressed neutral opinion. 24 respondents with 31.99% in Apollo and in Care 34 respondents with 44.04% expressed disagreed opinion. The strongly disagree opinion was expressed by 15 respondents with 20.00% in Apollo and in Care 35 respondents with 45.32%. On the whole the analysis shows that a large number of respondents are under disagreed opinion in both the Hospitals. The opinion poll was diverted on the subject that the Hospital is well noted among other Hospitals to refer their patients for better treatment, 19 respondents with 25.27% expressed strongly agree opinion in Apollo and in Care 9 respondents with 11.97% expressed the same opinion. 26 respondents with 34.83% expressed agree opinion in Apollo and in Care 36

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respondents with 46.80% expressed. The neutral opinion came up from among 12 respondents with 15.96% in Apollo and 6 respondents with 7.98% in case of Care Hospital. 9 respondents with 11.97% in Apollo have expressed disagree opinion and in Care Hospital 24 respondents with 31.92% expressed. 9 respondents with 11.97% have expressed strongly disagree opinion in case of Apollo and in Care 1.33% has expressed. On the whole, it can be seen from the analysis of statement that a large number of respondents are under the opinion that these Hospitals are well noted among the other Hospitals to refer their patients for better treatment. An attempt was made on the aspect that the Hospital is having time and place convenience to the patients. 11 respondents with 14.70% expressed strongly agree opinion in Apollo and in Care 1.33% was there to express. 19 respondents with 25.32% expressed agree opinion in respect of Apollo and in Care 29 respondents with 38.73% expressed. The neutral opinion expressed by 15 respondents with 20.00% in Apollo and in Care 31 respondents with 39.99% expressed. 19 respondents with 25.36% expressed disagreed opinion in Apollo and in Care 6 respondents with 7.98% expressed. 11 respondents with 14.66% expressed strongly disagreed opinion in Apollo and in Care 9 respondents with 11.97% expressed. On going through the above analysis it is under stood that most of the respondents are accepting that these Hospitals are convenient to the patients in all respects. In the aspect that the Hospital is located at a right place, 11 respondents with 14.66% expressed strongly agree opinion in Apollo and in Care only 1.33% has expressed. 19 respondents with 25.32% expressed agree opinion in Apollo and in Care 29 respondents with 38.71%. In case of neutral opinion 15 respondents with 20.00% in Apollo and in Care 31 respondents with 39.99% expressed. 19 respondents with 25.36% in Apollo and in 6 respondents with 7.98% in Care expressed disagree opinion. 11 respondents with 14.66% in Apollo and in Care 9 respondents with 11.99% expressed a strongly disagree opinion. On the whole, the analysis says that majority of respondents are under impression that both the Hospitals are located at right place. From the discussion it is observed that the two hospitals are attracting the patients from the all locations. But they believe, still the hospitals extend its services to some other locations. Care hospital is located at central location and nearer to the main road, so it is suffering from pollution but in this issue Apollo hospital far away from the main road so it is protected from the pollution. It is observed that in Care hospital very few doctors only working as consultants in some other

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hospitals. The two hospitals are well noted for reference purpose to the other hospitals. In two hospitals most of the respondents believing that the hospitals are located at right place. Therefore it is concluded as the two hospitals are having right place mix.

Perceptions of Nurses about the Place Mix of Sample Hospitals

Table no: 3.19 representing perceptions of nurses about the place mix of the sample hospitals
Table No: 3.19

Perceptions of Nurses about Place Mix of the Sample Hospitals

Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree

(1) S.L NO

(2) Statement

(3) Perception 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

Your hospital attracting patients from all the places.

The hospital still to extend its services to some other areas.

Your hospital is adequately protected from pollution.

You are a visiting or consulting employee in some other place.

(4) Apollo % 20.69 52.79 6.60 13.98 5.94 100.00 5.99 13.98 6.60 52.79 20.64 100.00 47.49 19.31 13.30 6.60 13.30 100.00 1.98 1.98 1.98 49.18 45.54 100.00

(5) Care % 26.75 51.96 12.65 7.32 1.32 100.00 1.32 7.31 12.65 51.96 26.76 100.00 20.64 52.61 7.95 12.20 6.60 100.00 1.98 1.98 1.98 19.14 76.24 100.00

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3 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

4 32.60 32.13 13.98 19.31 1.98 100.00 27.30 40.73 19.99 5.99 5.99 100.00 27.30 40.73 19.99 5.99 5.99 100.00

5 50.77 32.63 13.30 1.32 1.98 100.00 13.98 51.41 20.64 12.65 1.32 100.00 13.98 51.42 20.64 12.64 1.32 100.00

Your hospital is well noted to other hospitals to refer their patients for better treatment.

Your hospital is having convenience to the patients.

time

and

place

Your hospital is located at a right place.

The survey was conducted on the Hospital attracting patients from all places. Out of 150 participants in giving their opinion, out of which 31 respondents with 20.69% in Apollo expressed strongly agree opinion, and in case of Care 40 respondents with 26.75% expressed. 79 respondents with 52.79% expressed agree opinion in Apollo and in Care 80 respondents with 51.96% expressed. 10 respondents with 6.60% in Apollo and 19 respondents with 12.65% in Care expressed neutral opinion. The disagree opinion expressed by 21 respondents with 13.98% in Apollo and in Care 11 respondents with 7.32% expressed. 9 respondents with 5.99% in Apollo and 1.32% in Care Hospital expressed strongly disagree opinion. On going through the analysis it reveals that majority of respondents are under the impression that both the Hospitals are attracting patients at all places. An attempt was made on the Hospital still to extend its services to some other areas. The responses are 9 respondents with 5.99% expressed strongly agree opinion in case of Apollo and in Care 1.32% came forward to express the same. 21 respondents with 13.98% expressed agree opinion in Apollo whereas in Care 11 respondents with 7.31% expressed. The neutral opinion came up from among 10 respondents with 6.60% in Apollo whereas in Care 19 respondents with 12.65% expressed. 79 respondents with 52.79% expressed disagreed opinion in Apollo, in Care 80 respondents with 51.96% expressed. The strongly disagree opinion expressed among 31

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respondents with 20.64% in Apollo and in Care 40 respondents with 26.76% expressed. From the above analysis of statement it can be observed that most of the respondents are of the opinion that majority of respondents are not interested to extend its service to some other areas. In the aspect of Hospital was being adequately protected from pollution, 71 respondents with 47.49% expressed strongly agree opinion in Apollo and 31 respondents with 20.64% in Care Hospital expressed. 29 respondents with 19.31% expressed agree opinion in Apollo whereas in Care 79 respondents with 52.61% expressed. The neutral opinion was expressed by 20 respondents with 13.30% in Apollo and in Care Hospital 12 respondents with 7.95% expressed. 10 respondents with 6.60% expressed disagreed opinion in case of Apollo and in Care Hospital 18 respondents with 12.20% expressed. The strongly disagree opinion was expressed by 20 respondents with 13.30% in case of Apollo and in Care Hospital. 10 respondents with 6.60% expressed. From the above analysis, it can be noticed that both the Hospitals are adequately protected from pollution. As regards the visiting or consulting employee in some other place, the respondents pertaining to Apollo and Care Hospitals, 1.32% only came forward to express their opinion against. Strongly agree, agree and neutral opinions. 81 respondents with 50.50% expressed disagreed opinion in Apollo and in Care Hospital 29 respondents with 19.14% expressed. In case of strongly disagreed opinion, 69 respondents with 45.54% expressed in Apollo and in Care 121 respondents with 76.90% expressed. In conclusion, it is evident that the respondents of both the Hospital are disagreeing strongly against the recommendation. On the subject that the Hospital is well noted to among other Hospitals to refer their patients for better treatment, 49 respondents with 32.60% expressed strongly agree opinion in Apollo and in Care 81 respondents with 50.77% expressed. 51 respondents with 32.13% expressed agree opinion in respect of Apollo whereas in Care 49 respondents with 32.63% expressed. The neutral opinion came up from 21 respondents with 13.98% in Apollo and 20 respondents with 13.30% in Care Hospital expressed. 29 respondents with 19.31% expressed disagree opinion in Apollo and 1.32% has expressed in Care. In the same way 1.98% respondents in both the Hospitals to express strongly disagree opinion. From the above, it can be noticed that majority of respondents are of the opinion that both the Hospitals are well noted among other Hospitals to refer their patients for better treatment.

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The survey has further taken place in respect of Hospital having time and place convenient to the patients. 41 respondents with 27.30% expressed strongly agree opinion in respect of Apollo and in Care 21 respondents 13.98% expressed. 61 respondents with 40.73% in Apollo and in Care 79 respondents with 51.41% expressed agree opinion. The neutral opinion was expressed by 30 respondents with 19.99% in Apollo and 31 respondents with 20.64% in case of Care Hospital. 9 respondents with 5.99% in Apollo Hospital and 19 respondents with 12.65% have expressed disagree opinion in Care Hospital. 9 respondents with 5.99% expressed strongly disagreed opinion and 1.32% expressed the same opinion in Care Hospital. From the analysis of statement, it can be seen that most of the respondents are under the opinion that both the Hospitals are having time and place convenient to the patients. The survey was made about the Hospital being located at a right place, 41 respondents with 27.30% expressed strongly agree opinion in Apollo and in Care 21 respondents with 13.98% expressed. 61 respondents with 40.73% expressed agree opinion in respect of Apollo and in Care 79 respondents with 51.42% expressed. The neutral opinion has taken place in respect of Apollo from 30 respondents with 19.99% and in Care 31 respondents with 20.64% expressed. 9 respondents with 5.99% expressed disagreed opinion in Apollo and in Care 19 respondents with 12.64% expressed. 9 respondents with 5.99% expressed strongly disagreed opinion in respect of Apollo and in Care only 1.32% came forward to express. On going through the analysis that more number of respondents are of the opinion that both Hospitals are situated at right place. From the discussion it is noticed that the respondents in two hospitals accepted that the hospital is attracting the patients from all the places. In Apollo hospital few of the respondents proposed, the hospital still extent its services some other places but in Care there is no need to extend its services. As per the respondents opinion in two hospitals there is no problem of pollution and they are located at right place. Further it is observed in two hospitals no respondent working in some other hospitals. On the whole, it is observed that the two sample hospitals are having right place mix for marketing their services. Let us see the perceptions of administrative personnels about the place mix of sample hospitals.

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Perceptions of Administrative Personnel about the Place Mix of Sample Hospitals

Table no: 3.20 representing perceptions of administrative personnel about the place mix of the sample hospitals
Table No: 3.20

Perceptions of Administrative Personnel about Place Mix of the Sample Hospitals

Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree

(1) S.L NO

(2) Statement

(3) Perception 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

Your hospital attracting patients from all the places.

The hospital still to extend its services to some other areas.

Your hospital is adequately protected from pollution.

You are a visiting or consulting employee in some other place.

Your hospital is well noted to other hospitals to refer their patients for better treatment.

Your hospital is having convenience to the patients.

time

and

place

Your hospital is located at a right place.

(4) Apollo % 37.05 51.55 5.70 2.85 2.85 100.00 2.85 2.85 5.70 51.55 37.05 100.00 48.70 37.05 5.70 5.70 2.85 100.00 2.85 2.85 14.50 46.60 33.20 100.00 39.90 45.85 2.85 8.55 2.85 100.00 39.90 45.85 8.55 2.85 2.85 100.00 38.90 46.85 8.55 2.85 2.85 100.00

(5) Care % 37.30 31.35 14.25 14.25 2.85 100.00 2.85 14.25 14.25 31.35 37.30 100.00 42.95 39.95 5.70 8.55 2.85 100.00 2.85 2.85 14.50 39.90 39.90 100.00 45.85 42.75 5.70 2.85 2.85 100.00 34.20 51.55 5.70 2.85 5.70 100.00 34.20 51.55 5.70 2.85 5.70 100.00

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The survey has taken place in respect of Hospital attracting patients from all the places, 13 respondents with 37.05% expressed strongly agree opinion in respect of Apollo and in Care 14 respondents with 37.30% expressed. 18 respondents with 51.55% expressed agree opinion in Apollo and in Care 11 respondents with 31.35% expressed. Two respondents Apollo and in Care 5 respondents with 5.70% in

with 14.25% expressed neutral opinion. One respondent with 14.25% in Care Hospital expressed disagree

with 2.85% in Apollo and 5 respondents opinion. Only one respondent

with 2.85% in both the hospitals have expressed strongly

disagreed opinion. Ongoing through the above analysis it can be understood that a large number of respondents are of the opinion that both Hospitals are attracting patients from all the places. Opinions were gathered about the Hospital still to extend its services to some other areas, only one respondent with 2.85% expressed strongly agree opinion in Apollo and Care. One respondent with 2.85% expressed agree opinion in Apollo and 5 respondents with 14.25% in case of Care hospital. The neutral opinion was expressed by 2 respondents with 5.70% in

Apollo and in Care 5 respondents with 14.25%. 18 respondents with 51.55% in Apollo and in Care 11 respondents with 31.35% expressed disagreed opinion. The strongly disagree opinion came up from 13 respondents with 37.05% in Apollo and in Care 14 respondents with 37.30% expressed. The above analysis of statement reveals that majority of patients are of disagree opinion on the aspect of Hospital still to extend its services to some other places. The survey has taken place in respect of the Hospital being adequately protected from pollution 17 respondents with 48.70% expressed strongly agree opinion in Apollo and in Care 15 respondents with 42.95% expressed. 13 respondents with 37.05% expressed agree opinion in Apollo and in Care 14 respondents with 39.95% expressed. Equal number of two respondents with 5.70% expressed neutral opinion in case of Apollo and Care Hospitals. Two respondents with 5.70% expressed disagreed opinion in Apollo and in Care 3 respondents with 8.55% expressed. The strongly disagree opinion expressed in both the Hospitals of Apollo and Care by only one respondent with 2.85%. The analysis reveals that more numbers of respondents of both the Hospitals are of the opinion that both the hospitals are adequately protected from pollution. In respect of visiting or consulting employee in some other place, strongly agree and agree opinions in respect of both Apollo and Care Hospitals, 2.85% of respondents only come forward to express. The neutral opinion came up among 5 respondents with 14.50% in Apollo and in

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Care also 5 respondents with 14.50% expressed. Equal number of 16 respondents with 39.90% expressed disagree opinion in both the Hospitals in the same way 14 respondents with 33.20% expressed strongly disagree opinion in both the Hospitals. It shows that the respondents are of the opinion that they are not working elsewhere. On the subject that the Hospital is well noted to other Hospitals to refer their patients for better treatment 14 respondents with 39.90% expressed strongly agree opinion in Apollo and in Care 16 respondents with 45.85% expressed the same. 16 respondents with 45.85% in Apollo and in Care 15 respondents with 42.75% expressed agree opinion. One respondent with 2.85% in Apollo and in Care 2 respondents with 5.70% expressed neutral opinion. 3 respondents with 8.55% expressed disagreed opinion in Apollo and in Care only one respondent with 2.85% expressed. Only one respondent with 2.85% expressed strongly disagree opinion in both of the Hospital of Apollo and Care. From the above analysis, it is evident that more number of respondents are under the opinion that both the Hospitals are well noted to other Hospitals to refer their patients for better treatment. The survey has taken place in respect of Hospital having time and place convenient to the patients 14 respondents with 39.90% expressed strongly agree opinion in Apollo and in Care 12 respondents with 34.20% expressed. 16 respondents with 45.85% expressed agree opinion in Apollo whereas in Care 18 respondents with 51.55% expressed. Three respondents with 8.55% in Apollo and in Care 2 respondents with 5.70% expressed neutral opinion. Only one respondent with 2.85% from Apollo and Care Hospitals expressed disagree opinion. One respondent with 2.85% in Apollo and in Care 2 respondents with 5.70% expressed strongly disagree opinion. On the whole, the analysis says that most of the respondents are under the opinion that both the Hospitals are having time and places convenient to the patients. An attempt was made on the aspect of Hospital being located at a right place, 14 respondents with 38.90% expressed strongly agree opinion in Apollo and in Care 12 respondents with 34.20% expressed. 16 respondents with 46.85% in Apollo and in Care 18 respondents with 51.55% expressed agree opinion. 3 respondents with 8.55% in Apollo and 2 respondents with 5.70% in Care Hospital expressed neutral opinion. Only one respondent with 2.85% from Apollo and Care expressed disagree opinion. One respondent with 2.85% in Apollo and 2 respondents with 5.70% in Care Hospital expressed strongly disagreed opinion. On the whole, it is observed

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from the analysis that both the hospitals are located at a right place in the opinion of the many respondents. From the above discussion it is observed that the two hospital attracting the patients from all the places. Still Apollo has to extend its services to some other places but in Care there is no need. Two hospitals are adequately protected from the pollution. But no people in two hospital working as consultants at some other places. Care hospital is well noted to other hospital for refer their patients comparatively with the Apollo. Apollo hospital is treated as place time convenient hospital but Care is having some inconveniences. But two hospitals are treated that they are located at right place. On the whole, it can be stated that the two hospitals are good in their place mix. Now let us move on to the Mean and S.D values of doctors perceptions on the place mix of the sample hospitals.

Mean and Standard Deviation values of Doctors Perceptions on the Place Mix of Sample Hospitals
Table no: 3.21 representing mean and standard deviation values of perceptions of doctors about the place mix of the sample hospitals.
Table No: 3.21 Mean and S.D of Doctors Perceptions on the Place Mix of the Sample Hospitals (N=75)

Sl.No
1 2 3 4 5 6 7

Statement
Your hospital attracting patients from all the places. The hospital still to extend its services to some other areas. Your hospital is adequately protected from pollution. You are a visiting or consulting employee in some other place. Your hospital is well noted to other hospitals to refer their patients for better treatment. Your hospital is having time and place convenience to the patients. Your hospital is located at a right place.

Apollo

Care

Mean S.D Mean S.D

2.62 3.37 2.66 2.80 2.56 2.78 2.78 1.08 1.08 1.30 1.47 1.35 1.26 1.26 3.13 2.86 2.26 4.38 2.60 2.93 2.93 1.09 1.09 0.77 0.61 1.09 1.00 1.00

5 Point Scale: 1-strongly agree.5-strongly disagree

Table no: 3.21 shows that receiving patients from the all places (2.62), need to extend services some other places (3.37), hospital adequately protected from pollution (2.66),

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visiting/consulting employee at some other hospital (2.80), hospital well noted to other hospitals (2.56), time and place convenience to the patients (2.78), right location of hospital (2.78) As such, it can be said that the place mix of Apollo hospital perceived good by the respondents. In care hospital; receiving patients from the all places (2.62), need to extend services some other places (3.37), hospital adequately protected from pollution (2.66), visiting/consulting employee at some other hospital (2.80), hospital well noted to other hospitals (2.56), time and place convenience to the patients (2.78), right location of hospital (2.78) Therefore it can be concluded that the place mix is having positive response by the respondents. Next see the Mean S.D values of nurses perceptions on the place mix of the sample hospitals.

Mean and Standard Deviation values of Nurses Perceptions on the Place Mix of Sample Hospitals
Table no: 3.22 representing mean and standard deviation values of perceptions of nurses about the place mix of the sample hospitals.
Table No: 3.22 Mean and S.D of Nurses Perceptions on the Place Mix of the Sample Hospitals (N=150)

Sl.No
1 2 3 4 5 6 7

Statement
Your hospital attracting patients from all the places. The hospital still to extend its services to some other areas. Your hospital is adequately protected from pollution. You are a visiting or consulting employee in some other place. Your hospital is well noted to other hospitals to refer their patients for better treatment. Your hospital is having time and place convenience to the patients. Your hospital is located at a right place.

Apollo

Care

Mean S.D Mean S.D

2.33 3.66 2.20 4.45 2.20 2.26 2.26 1.13 1.13 1.42 0.49 1.11 1.12 1.12 1.99 3.98 2.32 4.80 1.61 2.34 2.34 0.80 0.84 1.13 0.40 0.72 0.88 0.88

5 Point Scale: 1-strongly agree.5-strongly disagree

Table no: 3.22 shows that receiving patients from the all places (2.33), need to extend services some other places (3.66), hospital adequately protected from pollution (2.20),

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visiting/consulting employee at some other hospital (4.45), hospital well noted to other hospitals (2.20), time and place convenience to the patients (2.26), right location of hospital (2.26) As such, it can be said that the place mix of Apollo hospital perceived good by the respondents. In care hospital; receiving patients from the all places (1.99), need to extend services some other places (3.98), hospital adequately protected from pollution (2.32), visiting/consulting employee at some other hospital (4.80), hospital well noted to other hospitals (1.61), time and place convenience to the patients (2.34), right location of hospital (2.34) Therefore it can be concluded that the place mix is having positive response by the respondents. Now we will see the Mean and S.D values of the administrative personnels perceptions on the place mix of the sample hospitals.

Mean and Standard Deviation values of Administrative personnels Perceptions on the Place Mix of Sample Hospitals
Table no: 3.23 representing mean and standard deviation values of perceptions of Adm.People about the place mix of the sample hospitals.
Table No: 3.23 Mean and S.D of Adm.People Perceptions on the Place Mix of the Sample Hospitals (N=35)

Sl.No
1 2 3 4 5 6 7

Statement
Your hospital attracting patients from all the places. The hospital still to extend its services to some other areas. Your hospital is adequately protected from pollution. You are a visiting or consulting employee in some other place. Your hospital is well noted to other hospitals to refer their patients for better treatment. Your hospital is having time and place convenience to the patients. Your hospital is located at a right place.

Apollo

Care

Mean S.D Mean S.D

1.82 4.17 1.77 4.51 1.94 1.82 1.82 0.89 0.89 1.00 0.50 1.16 0.92 0.92 2.00 4.00 1.91 4.25 1.74 1.88 1.88 1.08 1.08 1.12 0.70 0.91 0.90 0.90

5 Point Scale: 1-strongly agree.5-strongly disagree

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Table no: 3.23 shows that receiving patients from the all places (1.82), need to extend services some other places (4.17), hospital adequately protected from pollution (1.77), visiting/consulting employee at some other hospital (4.51), hospital well noted to other hospitals (1.94), time and place convenience to the patients (1.82), right location of hospital (1.82) As such, it can be said that the place mix of Apollo hospital perceived good by the respondents. In care hospital; receiving patients from the all places (2.00), need to extend services some other places (4.00), hospital adequately protected from pollution (1.91), visiting/consulting employee at some other hospital (4.25), hospital well noted to other hospitals (1.74), time and place convenience to the patients (1.88), right location of hospital (1.88) Therefore it can be concluded that the place mix is having positive response by the respondents

Conclusion
Place refers to the contact point between the service provider and the customer, who gets the benefit of the service. This element in the marketing mix leads to the identification of a suitable location. The two main issues considered regarding the decision of a place are accessibility and availability of the service to customers. Accessibility refers to the ease and convenience with which a service can be purchased, used or received. Availability refers to the extent to which a service is obtainable or capable of being purchased, used and received. Factors influencing the placing decision are market size and structure by geographical regions, number and types of competitors in the region, location of potentially attractive consumer segments, local infrastructure, good road access facilities and public transportation network. A hospital must be ideally located and must be easily accessible to all. Apollo and Care hospitals are having time and place convenience because they are located at central location so the people having accessibility by different transportation systems. The same thing revealed in survey by accepting Majority of respondents in two hospitals. But there is no clarity in the aspect of attracting patients from all the places, the majority of respondents in two hospitals can not judge this thing. Comparatively Care is having good reputation and attracting the patients from all the places. But practically it is observed that there is no time convenience to the Care hospital. Providing consultancy services in some other hospitals, Apollo is in front than the Care hospital. But, for refer their patients the other hospitals are giving equal importance to

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the two hospitals. In conclusion, it can be stated that the two hospital having good place mix for marketing their services. Now we will take up the promotion mix in hospitals.

Promotion Mix in Hospitals

Promotion is the hot topic in marketing of hospital services. By the promotional activities hospitals should be able to communicate the right message to patients and service seekers. The information can be regarding the treatment and auxiliary arrangements like transport, communication, diet facilities for attendants of the patients, price etc, apart from this, direct promotion includes inpatient-doctor interaction and the care taken by the support staff. Promotion is basically communication. Public relations, publicity, advertising, lobbying, fund raising educational programs are the various devices used for promoting a service, or idea. Some other methods such as word-of-mouth, rumor, gossip, opinion polls and endorsement of opinion leaders. The effective promotion needs surprise. Therefore, anything that is stereotype or imitation should be avoided. It is good to innovate and be creative in promotion. Advertising by hospitals was not only unheard of a decade or two ago, it was also strongly objected to and censured as unethical27 Gradually, things got better, but the traditional Warm, Fussy, image oriented advertisement (e.g. we are a caring hospital, your health is our business, your familys health is safe in our hands, etc) gave place to price, service and quality-competitive advertisements. In hospital services promotion, the important thing to remember is need to carefully balance and co-ordinate the advertising messages and the management of the hospitals image for the long term effectiveness of the hospitals public relation program.

Promotional Tools and Process in Hospitals

In broad sense, the five tools of the marketing mix-service, price, place, promotion, and people are communication tools. Messages are carried to the market by the services styling and features, its offering price and the places and times where and when it is available. Here we will confine our attention to the subset of marketing tools that are primarily promotional in nature, that are classified as promotion as promotion. These promotional tools are extremely numerous and varied. Classification of the various promotional tools is desirable to facilitate analysis and planning. These tools fall into four groups28. They are Advertising Sales promotion 216

Personal selling Publicity To be used effectively, these tools should be viewed in a communication framework. Fig. no: 3.8 explain the elements in the communication process.

Fig. No: 3.8

Elements in the communication process

Sender

Encoding

Message Media

Decoding

Receiver

Feedback

Response

Source: Phllip Kotler, Robert N.Clarke Marketing For Health Care Organizations

The above figure shows the eight elements involved in every communication. There are two parties-a sender and receiver. One or both send a message through media. They also engage in four communication functions: Encoding, Decoding, Response, and Feedback. This model underscores the key factors in effective communication. Senders must know what audiences they want to reach and what responses they want. They must be skillful in encoding messages that take in to account how the target audience tends to decode messages. They must transmit the messages over efficient media that reach the target audience. They must develop feedback channels so that they can know the audiences response to the message. Hospital services marketers must also recognize that the importance of promotional tools varies when directed to a consumer and to an industrial market. Conversely, personal selling can and does make a strong contribution to the marketing of many hospital services to consumers. Physicians engage in personal selling when recommending a specific hospital, physician specialist or pharmaceutical product to a patient. Discharge planners do personal selling when recommending specific nursing homes, care facilities, home health agencies, and rehabilitation centers.

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Advertising
A question that is often asked is what should the hospital advertising be? Should the hospitals concentrate on advertising the hospitals image or the service?
29

opinions vary greatly. Many

experts say both are necessary. Advertising health care services is very different from advertising commodities. For one thing, people do not buy health care as they do other goods. Health care is not a good or service which, under normal conditions, people seek after and want to buy. Secondly, illness naturally comes in episodes which mean that health care is bought episodically. When people do need to buy health care, they often make decisions under stress. These decisions are made easy if they have developed trust in the hospital and the services it offers. That trust is fostered and built by image advertising over a period of time, and in order that people will go to a particular hospital when the time comes, the good image of the hospital should remain in their minds.

Studies have shown that consumers are not likely to remember image advertising, simply because it gives no information. The hospital ads that are remembered most are those which contain specific information about services as, for example, information about bypass surgery, kindly transplant, lithotripsy, emergency care, obstetrics and birthing centers, substance abuse facilities, alcohol and drug treatment, quit smoking clinic, etc. consumers respond to products rather than to the hospitals overall good image. Balancing the relative merits and value to the hospital of the two kinds of advertising, hospitals should opt for both image and product advertising in an optimum mix. In developing an advertising program hospital services marketing managers must make five important decisions. As shown in the following Fig. no: 3.9

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Fig. No: 3.9

Major Decisions in Advertising Management

Message decision

Advertising objectives setting -Targetmarket -Target response -Target reach and frequency

Advertising budget determination -Affordableapproach -Percent ofsales -Competitive parity -Objective and task

-Message generation -Message evaluation and selection -Message execution

Advertising evaluation

Media selection

-Copy testing Media testing Advertising expenditure level testing

Major media categories Specific media vehicles Media timing

Source: Phillip kotler and Roberta N.Clarke, Marketing for Health Care Organizations, p.439.

Before an advertising program and budget can be developed, objectives must be set. These objectives must flow from prior decisions on the target market, market positioning, and marketing mix. The marketing mix strategy defines advertisings job in the total marketing mix. Developing advertising objectives calls for defining the target market, target response, and target reach frequency.

Target Market
A market communicator must start with a clear target audience in mind. Target audience will critically influence the communicators decision what is to be said, how it is to be said, when it is to be said, when it is to be said, and who is to say it. The audience may be potential buyers of the organizations services, current users, deciders, and/or influencers. The audience may consist of individuals, groups, particular publics, or the general public.

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Target Response
The marketing communicator must define the target response. Marketing communicator needs to know in which state the target audience is at the present time and to which state is should be moved. The target audience may be in one of six buyers readiness states with respect to the service or hospital. These states: awareness, knowledge, liking, preference, convector, or purchase30 1. Awareness: The first thing to establish is how aware the target audience is of the service or hospital. The audience may be completely unaware of the entity, know only its name, or know one or two things about it. If most of the target audience is unaware, the communicators task is to build awareness, perhaps even just name recognition. This calls for simple messages repeating the name. Building awareness takes time. 2. Knowledge: The target audience may be aware of the entity, but may not know much about it. In this case, the goal will be to transmit some key information about the entity. The particular set of beliefs that make up the audiences picture of an entity is called image. Hospitals are becoming more attuned to image issues. 3. Linking: if the target audience members know the entity, the next question is, how do they feel about it? If the audience holds an unfavorable view, the communicator has to find out why and then develop a communication program to build up favorable feeling. Good communications call for good deeds followed by words 4. Preference: The target audience may like the entity, but may not it to others. It may be one of several acceptable entities. In this case, the communicators job is to build consumer preference for the entity. The communicator will have to tout its quality, value, performance, and other attributes. 5. Conviction: A target audience may prefer a particular entity, but may not develop a conviction about buying it. The communicators job is to build conviction that choosing quality care is the right thing to do. Building conviction that one should buy a particular entity is a challenging communications task. 6. Action: A number of the target audience may have conviction, but may not get around to making the purchase. He or she may be waiting for additional information, may plan to act later, and so on. A communicator in this situation must lead the consumer to take the final step, which is called closing the sale31

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The six states simplify to three stages known as the cognitive (awareness, knowledge), affective (liking, preference, conviction), and behavioral (purchase). The communicator normally assumes that buyers pass through these stages in succession on the way to purchase. In this case, the communicators task is to identify the state most of the target audience is in and develop a message or campaign that will move them to the stage. Some marketing scholar has challenged the idea that a consumer passes through cognition to affect to behavior in this order. Ray has suggested that some consumers pass from cognition to behavior to affect32 Colley has distinguished 52 possible advertising objectives in Defining Advertising Goals for Measured Advertising Results (DAGMAR) 33 the various advertising objectives can be stored in to whether their aims to inform, persuade, or remind. The inform category includes such objectives as telling the market about a new service, informing the market of a price change, explaining how the service works, describing various available services, correcting false impressions, reducing consumer fears, and building hospital image. The persuade category includes such objectives as building brand preference, encouraging switching to the advertisers brand, trying to change the customers perception of the importance of different attributes, persuading the customer to purchase now, and persuading the consumer to receive a sales call. The remind category includes such objectives as reminding customers that the service must be needed now or in the future, and reminding them where to obtain it.

Target Reach and Frequency

The third decision is to determine the optimal target reach and frequency of the advertising. Funds for advertising are rarely so abundant that everyone in the target audience can be reached, and reached with sufficient frequency. Hospital managers must decide what percentage of the audience to reach with what exposure frequency per period. The issue is largely one of how many exposures are needed to create the desired response, given the markets state of readiness. One exposure might be enough to convert residents from being unaware to being aware. It would not be enough to convert them from awareness to preference. It is unfortunately typical hospitals to assume that one exposure per target audience member is enough. Rarely, with the exception of organizations set realistic target frequency objectives or engage in advertising other than in uninsured short bursts.

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Budget Determination
There are different major ways that the hospitals can set their marketing budgets i.e. affordable method, percentage-of-sales method, competitive basis method, and objective-andtask method. For estimating the total size of the required advertising budget, a determination must be made of how the budget should be allocated over different market segments, geographical areas, and time periods. In practice, advertising budgets are allocated to segments of demand according to their respective populations, sales levels, or some other indicator of market potential. Hospitals especially have difficulty moving to paid advertising, even though they may acknowledge its potential value. The ostensible reason is that they are the beneficiaries of donated or public service advertising which they fear will be with drawn if they engage in paid advertising.

Message Decisions
Always hospitals have to develop a creative message. An ideal message is one that manages to get attention, hold interest arouse desire, and obtain action. In making the message decision, advertisers and their agencies go through two steps. 1. Message generation 2. Message evaluation and selection, and message execution.

Message Generation
Message generation involves, developing a number of alternative messages (appeals, theme, motifs, and ideas) that will conceivably help produce the desired response in the target market. Message generation can be handled in a number of ways. One approach is to talk with members of the target market and other influential to determine the way they see the service, task about it, and express their desire about it. A second approach is to hold a brainstorming meeting with key personnel in the hospital to generate advertising ideas. A third method is to use some formal, deductive framework for teasing out possible advertising messages. One frame work is to generate a set of possible themes falling in to three categories 1.Rational 2.Emotional 3. and Moral. Rational appeals aim at passing on information and/or serving the audiences self-interest. Emotional appeals are designed to stir up some negative or positive emotion that will motivate consumer. Moral appeals are directed to the audiences sense of what is right and proper.

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Message Evaluation and Selection

The task of selecting the best message out of a large number of possibilities calls for evaluation criteria. Twedt has suggested that messages be rated on three scales, i.e. desirability, exclusiveness, and believability34 The message must first say something desirable or interesting about the service. This is not enough, however, since many brands will be making the same claim. Therefore the message must also say some thing exclusive or distinctive that does not apply to every brand in the service category. Finally the message must be believable or provable.

Message Execution
The impact of a message depends not only upon what is said, but also upon how it is said. The advertiser has to put the message across in a way that will win target audience attention and interest. It is the task of the creative people to find a style, a tone, words, an order, and a format that make for effective message execution. Different messages can be put across in different execution styles. Some times the execution belies the intent of the message. The communicator must also choose a tone for the ad. The ad could be serious, chatty, numerous, and so on. On the other side the order of ideas in an ad can important. In the order the first issue is the question of conclusion drawing, the extent to which the ad should draw a definite conclusion for the audience or leave it to them. The second is the question of one-versus two-sided arguments i.e. whether the message will be more effective if one or both sides of the argument are presented. The third issue is the question of order of presentation, whether communicators should present the strongest arguments first or last. Format elements can make a difference in an ads impact, as well as in its cost. If the message is to be carried in a print ad, the communicator has to develop the elements of headline, copy, illustration, and color. If the message is to be carried over the radio, the communicator has to choose words, voice, qualities, and vocalizations carefully. If the message is to be carried on television or given in person, then all of these elements plus body language have to be planned. Presentation has to pay attention to facial expressions, gestures, dress, posture, and hairstyle.

Media selection
Hospital industry historical reliance on broachers as the primary form of advertising ways symptomatic of a failure to consider other media. The expansion of hospital industry in to the vast array of other media has been quit dramatic in the past few years. Therefore media selection is another major step in advertising planning. It is essential to determine which media are used 223

by the target audience and which are most efficient in reaching them. This information affects the advertising budget and given the type of appeal to use. In this connection there are three basic steps in the media selection process i.e. choosing among major categories, choosing among specific vehicles, and timing. Choosing Among Media Categories: In order of hospital advertising volume, they are news papers, television, direct mail, radio, magazines, and outdoor. Media planners make their choice among these major media types by considering the following variables. Target Audience Media Habits: Radio and television are not preferable media by audience. Service: Media types have different potentialities for demonstration, visualization, explanation, believability, and color. Message: A message containing a great deal of technical data might require specialized magazines or mailings. Cost: The cost of thousand exposures rather than the total cost. Selecting Specific Vehicle: Here the specific vehicle selected within each media type that will produce the desired response in the most cost-effective way. The media planner evaluates the different magazines on qualitative characteristics such as credibility, prestige, geographic editions, reproduction quality, editorial climate, lead time, and psychological impact. The planner makes a final judgment as to which specific vehicles will deliver the best reach, frequency, and impact for the money. Media planners normally calculate the cost per thousand persons reached by a particular vehicle. Deciding On Timing: The next step in media selection is timing which breaks down into a macro and micro problem. The macro problem is that of seasonal timing. For most services, there is a natural variation in intensity of interest at different times of the year. For example, the hospital campaigns discussed earlier were all taking place in the spring because most employers offering more than one kind of health plan allow employees to change only once or twice a yearJuly- 1 and Jan-1. Therefore, advertising picks up in the spring and again in late fall as health managing organizations vie for new group business35 The problem relating to timing is how should advertising be spaced during a short period, say a month? Consider there possible patterns. 1. Burst advertising: this consists of connecting all the exposure in a very short space of time, say all in one day.

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2. Continuous advertising: in which the exposures appear evenly throughout the period. 3. Intermittent advertising: in which intermittent small bursts appear in succession with no advertising in between. Advertising Evaluation: This is the final step in advertising evaluation. The most important components are copy testing, media testing, and expenditure level testing. Copy Testing: The purpose of copy testing is to make improvements in the copy to the fullest extent prior to its release36 there are three methods of pre-testing. Direct Rating: A panel of target consumers or advertising experts examine alternative ads fill out rating questionnaires. Portfolio Tests: Respondents are given a dummy portfolio of ads and asked to take as much time as they want to read them. After putting them down, the respondents are asked to recall the ads they saw. The results are taken to indicate on ads ability to stand out and understood. Laboratory Tests: Under this method the potential affect of an ad by measuring physiological reactions i.e. heart beat, blood pressure, pupil dilation, perspiration using such equipment as galvanometers, tachistroscopes, size-distance tunnels, and pupil dilation measuring equipment. There are two popular post testing methods, the purpose of which is to assess whether the desired impact is being achieved or what the possible weaknesses are. Recall Tests: This involves finding people who are regular users of the media vehicle and asking them to recall advertisers and products contained in the issue under study. Recognition Tests: Recognition tests call for sampling the readers of a given issue of the vehicle, say a magazine, asking them to point out what they recognize as having seen and/or read. All these efforts rate the communication effectiveness of the ad, and not necessarily its impact on attitude or behavior.Another advertising element that is normally tested is media. Media testing seeks to determine whether a given vehicle is cost-effective in reaching and influencing the target audience. A common to test a vehicle is to place a coupon ad and see how many coupons are returned. Another testing device is to compare the ad readership scores in different vehicles as a sign of effectiveness. Finally, the advertising expenditure level itself can be tested. Expenditure-level testing involves arranging experiments in which advertising expenditure levels are varied over similar markets to see the variation in response.

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Sales Promotion
Sales promotion comprises a wide variety of tactical promotional tools of a short-term incentive designed to stimulate earlier and/or stronger target market response. Hospitals have turned increasingly to service promotions in recent years. The reasons are 1. They are under greater pressure to obtain a quick reason 2. Increasing competition. 3. Increasing use of promotion by competition 4. Consumer made more incentive oriented by recession and inflation37 5. A lingering resistance to using advertising. Incentives are an important means of promotion. Incentives may be defined as something of financial or symbolic value added to an offer to encourage some overt behavioral response38 Incentives require several steps of analysis and research. Therefore, finally incentives as part of promotional plan require several steps of analysis and research. Similar knowledge is accumulating on the use of incentives in other health-related areas, such as nutrition, immunization, and self-medication practices. Because the increasing use of incentives, in hospital services marketing. Now we will discuss the promotion mix in sample hospitals.

Promotion Mix in Apollo Hospital

The promotion mix of Apollo hospital based on advertisement of services, promotion of services, publicity of service, personnel selling and public relations. It is observed that the Apollo hospital broadly using media as magazines, news papers, television and posters, singe, skywriting, calendars, cards, catalogs, directories, programmes, circulars, internet etc, for the promotion of their services ( See Exhibit No: 3.1 & 3.2) Apollo is mainly trying long-term build up of a particular services or brand. In this connection Apollo successfully build up brand image of their services like bypass surgeries, diagnosis, pharmacy etc. For promoting some of their services, Apollo following incentives as part of their promotional plans. These incentives are using some time to create long run response and some times are offered to create an immediate behavior response from the users. The researcher has observed Apollo is using these incentives to fill the empty beds in different departments which haves the seasonal importance. On the other hand Apollo offering incentives to not only individuals but also to the groups includes employee groups and economically backward classes in the society. Apart from above promotional mix likes advertising, sales promotion, public relations, Apollo is also concentrating personnel selling as apart of promotional mix. In this context Apollo is

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Exhibit No: 3.1 Apollo Promotional Activities-1

Apollo Advertisement on Internet

Apollo Video Clippings on Internet

227

Exhibit No: 3.2 Apollo Hospital Promotional Activities-2

228

following pull strategy (advertising and sales promotion) as well as push strategy (personnel selling), and some times combination of both for promoting their services. For personnel selling, Apollo recruiting sales representatives by following systematic procedure. These people are acting not only as sales forces but also act as the account managers who initiates and facilitates interaction between various people in the two hospitals. Apollo providing long number of services, therefore they are organizing selling activity by product line. But the researcher observed here, Apollo is suffering with high traveling costs. Because instated of sending one sales person for representing all the services and products, they are sending several persons each representing a different a different products or services, such as durable medical equipment, parenteral nutrition and hospice-home services. Each will come with more knowledge of the relevant products or services at the cost of high sales force expenses. Apollo is following customs structure strategy for sales promotion. Here Apollo is specializing their sales force according to the customer type i.e. some sales force persons will concentrate on government employee groups and other will concentrate on business groups. In order to attractive compensation plans that provide income regularity, rewards for above average performance and fair payments for experienced people. In a view to increasing reputation of the hospital in society, Apollo is participating several social services programmes. Table no: 3.24 represents various social service programmes of Apollo.
Table No: 3.24

Apollo Hospital Social Service Programmes

Sl.No 1 Name Of The Programme Save A Childs Heart (SACH) Apollo Hospital Cancer Care Initiative (CURE) Society to Aid The Hearing Impaired (SAHI) DISDISHA Description It is a community service initiative from the Apollo hospital with the aim of providing quality pediatric cardiac care and financial support to children from underprivileged sections of society suffering from heart diseases. It is aimed to bring cancer care to those who cannot afford it. It is aimed to identify hearing impaired children, mainly in rural areas, with little or no access to modern medical treatment. It is a novel telemedicine initiative to providing long distance healthcare to the under served population.

3 4

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Apollo hospital providing timely and efficient assistance in the form of medical support and financial aid whenever disasters and calamities strike the community. Table no: 3.25 reveals this fact.
Table No: 3.25

Apollo Hospital Helped in Various Disasters

Sl.No 1 2 3 4 5 6 Name of The Disaster Cyclone relief at Andhra Pradesh Earthquake relief at Maharastra Cyclone relief at Andhra Pradesh Earthquake relief at Gujarat Tsunami relief at Chennai Disaster relief floods in Chennai Year May-1990 May-1994 November-1996 January-2001 December-2004 November-2005

As a part of promotional activities, Apollo started a separate public relation department for delivering functions of developing media relations, publications, and community relations. This department is planning important role in implementing the strategic plans of the hospital. Apollo public relation department working with objectives of: to emphasize the expertise of the staff as a leader in patient care, research and education. Let us see the promotion mix in Care hospital.

Promotion Mix in Care Hospital

Care hospital giving equal importance to the image advertising and product advertising in their promotional campaign. For this purpose Care hospital preferring electronic media, and web based advertisements. Along with, Care hospital is advertising through news papers, magazines and bill boards, displays, posters, traveling displays, station posters, direct mail advertising etc ( See Exhibit No: 3.3 & 3.4). Apart from the above methods Care hospital is following some other methods like distributing souvenirs, brief presentations by the surgeons on kidney transplant and other critical surgeries on the screen, distributing portfolio (a flat portable case for carrying loose papers) called as family health manager, to keep all of a familys health records and papers. Among other things, it contains information regarding medical insurance, immunization and other health records, health facts, health related articles, up-to-date papers one would want to keep handy about the entire familys health care. Care hospital is also distributing among special room patients and others in the community beautifully crafted desktop items such as digital clocks, letter openers and scissors with the hospital name super scribed on them. As part of promotional activities Care hospital offering discounts on certain

230

Exhibit No: 3.3

Care Hospital Promotional Activities-1

Ads on Internet

Care Web Site

231

Exhibit No: 3.4 Care Hospital Promotional Activities-2

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services like Mammography and Osteoporosis screening examinations, nutritional and exercise counseling etc,. It is observed that in Care hospital, cash discounts are offering on some special services only. For promoting certain advanced services like MRI (Magnetic Resonance Imaging Equipment which is used to see soft tissues without the use of X-Ray) Care hospital is following mails to all physicians and hospitals in the whole state informing them of the availability of MRI and also they are arranging continuing medical educational programmes. Let us see the perceptions of Doctors about promotion mix of the sample hospitals.

Perceptions of Doctors about the Promotion Mix of Sample Hospitals

Table no: 3.26 representing perceptions of doctors about the promotion of the sample hospitals
Table No: 3.26

Perceptions of doctors about promotion Mix of the sample hospitals

Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree

(1) S.L NO

(2) Statement

(3) Perception 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

Your hospital is able to propagate its services to patients and their relatives.

You are feeling yourself as a direct promoter of your hospital services.

Your hospital special promotional campaigns are gaining the attention of the needy.

In your opinion special campaigns like, heartcheckup, dental checkup at concession rates are getting good response from patients.

(4) Apollo % 21.37 38.66 14.66 18.66 6.65 100.00 27.99 18.73 13.30 25.32 14.66 100.00 11.97 33.46 14.66 27.94 11.97 100.00 14.66 33.32 11.97 25.29 14.76 100.00

(5) Care % 6.66 53.38 6.66 25.32 7.98 100.00 20.00 27.99 38.71 5.32 7.98 100.00 1.33 45.32 26.72 11.97 14.66 100.00 1.33 45.32 25.38 11.97 16.00 100.00

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3 1 2 3 4 5 Total 1 2 3 4 5 Total 20.00 21.38 45.32 11.97 1.33 100.00 33.32 34.72 18.66 5.32 7.98 100.00

4 1.33 31.99 52.04 7.98 6.66 100.00 14.66 45.72 25.32 11.97 2.33 100.00

In your opinion, the talk by doctors in T.V and radio programs of this hospital is successful to increase the reputation of hospital.

This hospital is having strong brand image in the patients.

The survey has taken up in respect of the Hospital being able to propagate its services to patients and their relatives Among 75 respondents involved in the survey, 16 respondents with 21.37% expressed strongly agree opinion in Apollo and in Care 5 respondents with 6.66% expressed. 29 respondents with 38.66% expressed agree opinion in respect of Apollo where as in Care 40 respondents with 53.38% expressed. The neutral opinion came up from among 11 respondents with 14.66% in Apollo and in Care 5 respondents with 6.66% expressed. The disagreed opinion has also taken place among 14 respondents with 18.66% in Apollo and in Care 19 respondents with 25.32% expressed. 5 respondents with 6.65% expressed strongly disagreed opinion in Apollo and in Care Hospital 6 respondents with 7.98% expressed. From the above table, it can be concluded that more number of respondents are under the impression that these Hospitals are able to propagate its services to patients and other relatives. A study has taken place in respect of you are feeling yourself as a direct promoter of your Hospital services 21 respondents with 27.99% expressed strongly agree opinion in Apollo and in Care 15 respondents with 20.00% expressed. 14 respondents with 18.73% expressed agree opinion in Apollo and in case of Care 21 respondents with 27.99% expressed. The neutral opinion came up among 10 respondents with 13.30% in Apollo and in Care 29 respondents with 38.71%. 19 respondents with 25.32% expressed disagree opinion in Apollo and in Care 4 respondents with 5.32% expressed. 11 respondents with 14.66% expressed strongly disagree opinion in Apollo and in Care 6 respondents with 7.98% expressed. It can be seen from the above discussion that majority of respondents are feeling themselves as a direct promotion in both the Hospitals.

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On the query of hospital special campaigns by the Hospital are gaining the attention of the needy, 9 respondents with 11.97% expressed strongly agree opinion in Apollo and in Care only one respondent with 1.33% expressed. 25 respondents with 33.46% expressed agree opinion in respect of Apollo and in Care 34 respondents with 45.32% expressed. The neutral opinion was expressed by 11 respondents with 14.66% in Apollo and in Care 20 respondents with 26.72% expressed. 21 respondents with 27.94% expressed disagreed opinion in case of Apollo and in Care 9 respondents with 11.97% expressed. As regards the strongly disagree opinion, 9 respondents with 11.97% in Apollo and 11 respondents with 14.76% in Care expressed. In conclusion of the above data, it came to understand that many respondents are of the opinion that promoting campaigns are gaining the attention of the needy in both the hospitals. As regards the opinion on special campaigns like, checkup, dental checkup at concession rates are getting good response from patients 11 respondents with 14.66% expressed strongly agree opinion in Apollo and in Care only one respondent with 1.33% expressed. 25 respondents with 33.32% expressed agree opinion in Apollo and in Care 34 respondents with 45.32% expressed. The neutral opinion came up from among 9 respondents with 11.97% in Apollo and in Care 19 respondents with 25.38% expressed. The disagreed opinion also came up from among 19 respondents with 25.39% in Apollo and in Care 9 respondents with 11.97%. 11 respondents with 14.66% expressed strongly disagreed opinion in Apollo whereas in Care 12 respondents with 16.00% expressed. On the whole, it can be understood that most of the respondents are under opinion that special campaigns at concession rates will certainly get good response from the patients. The survey was undertaken on the aspect of public talk by the doctors of the hospital on T.V and Radio programs are helpful to increase the reputation of Hospitals 15 respondents with 20.0% expressed strongly agree opinion in Apollo and in Care only one respondent with 1.33% expressed. 16 respondents with 21.38% expressed agree opinion in Apollo and in Care Hospital 24 respondents with 31.99% expressed. The neutral opinion has taken place among 34 respondents with 45.32% in Apollo and 39 respondents with 52.04% in Care Hospital. 9 respondents with 11.97% expressed disagree opinion in Apollo and 6 respondents with 7.98% expressed. only one respondent with 1.33% expressed strongly disagree opinion in Apollo and in Care 5 respondents with 6.66% expressed. From the above analysis, it can be understood that

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most of the respondents are of neutral opinion in respect of the talk by doctors on T.V. and Radio programs of both the Hospitals. Finally survey was conducted on the subject of Hospital having brand image among the patients 25 respondents with 33.32% expressed strongly agree opinion in Apollo and in case of Care Hospital 11 respondents with 14.66% expressed. 26 respondents with 34.72% expressed agree opinion in respect of Apollo and in case of Care 34 respondents with 45.72% expressed. The neutral opinion has taken place among 14 respondents with 18.66% in Apollo and in Care 19 respondents with 25.32% expressed. 4 respondents with 5.32% expressed disagreed opinion in Apollo, whereas in Care 9 respondents with 11.97% expressed. 6 respondents with 7.98% expressed strongly disagreed opinion in Apollo and in Care only one respondent with 2.33% expressed. On the whole, it is understood that majority of respondents are of the opinion that these Hospitals are having good image among the patients and others. From the above discussion it is noticed in Apollo, respondents are feeling that the hospital was successfully propagating it services to patients and their relatives but not feeling them selves as direct promoters. In two hospitals the special programmes are getting attention from the needy. Comparatively special campaigns like heart-checkups, dental checkup at concession rates are getting attention from patients in Care hospital. Respondents in two hospitals are believe that the programmes conducted by the two hospitals like T.V. and radio programs increasing reputation of the hospitals. In brand image point, Apollo hospital is creating strong brand image in the market than the Care hospitals. On overall most of the cases two hospitals are having good promotion mix in their marketing their services. Let us see the perceptions of nurses about promotion mix of the sample hospitals.

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Perceptions of Nurses about the Promotion Mix of Sample Hospitals

Table no: 3.27 representing perceptions of nurses about the promotion mix of the sample hospitals
Table No: 3.27

Perceptions of Nurses about Promotion Mix of the Sample Hospitals

Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree

(1) S.L NO

(2) Statement

(3) Perception 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

Your hospital is able to propagate its services to patients and their relatives.

You are feeling yourself as a direct promoter of your hospital services.

Your hospital special promotional campaigns are gaining the attention of the needy.

In your opinion special campaigns like, heartcheckup, dental checkup at concession rates are getting good response from patients.

In your opinion, the talk by doctors in T.V and radio programs of this hospital is successful to increase the reputation of hospital.

This hospital is having strong brand image in the patients.

(4) Apollo % 19.99 34.96 12.65 20.75 11.65 100.00 26.64 39.29 22.09 5.99 5.99 100.00 32.63 34.07 19.99 7.32 5.99 100.00 32.63 33.96 19.49 7.32 6.60 100.00 26.76 25.97 13.98 32.63 0.66 100.00 40.08 25.97 13.98 12.65 7.32 100.00

(5) Care % 27.43 39.29 19.31 12.65 1.32 100.00 13.44 53.94 25.97 5.99 0.66 100.00 19.99 40.73 25.97 12.65 0.66 100.00 20.64 39.41 26.64 12.65 0.66 100.00 12.65 40.80 25.97 13.98 6.60 100.00 53.40 27.30 5.99 12.65 0.66 100.00

An opinion poll was conducted on the subject that Hospital is being able to propagate its services to patients and their relatives. Out of 150 respondents, 30 respondents with 19.99% expressed strongly agree opinion in Apollo and 41 respondents with 27.43% expressed in Care.

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51 respondents with 33.96% expressed agree opinion in Apollo and in Care 59 respondents with 39.29% expressed. The neutral opinion was expressed by 19 respondents with 12.65% in Apollo and in Care 29 respondents with 19.31% expressed. The disagreed opinion was expressed by 31 respondents with 20.75% in Apollo and in Care 19 respondents with 11.65% expressed. 19 respondents with 12.65% expressed strongly disagreed opinion in Apollo and only one respondent with 1.32% expressed in Care. On examining the above analysis, it reveals that most of the respondents are of the opinion that these Hospitals are able to propagate their services to patients and their relatives. On the aspect of feeling yourself as a direct promoter of your Hospital services 40 respondents with 26.64% expressed strongly agree opinion in Apollo and 20 respondents with 13.44% expressed in Care Hospital. 59 respondents with 39.29% expressed agree opinion in Apollo and in Care 81 respondents with 53.94% expressed. The neutral opinion took place among 31 respondents with 20.09% in Apollo and in Care 39 respondents with 25.97% expressed. Disagree opinion in Apollo and in Care, 9 respondents with 5.99% expressed. The strongly disagree opinion expressed by 9 respondents with 5.99% in Apollo and in Care Hospital it was only one respondents with 0.66%. On going through the analysis, it can be understood that majority of respondents are of the opinion that they are feeling themselves as a direct promotion in both the Hospitals. An attempt was made the Hospital special promotion campaigns are gaining the attention of the needy 49 respondents with 32.63% expressed strongly agree opinion in Apollo and in Care Hospital 30 respondents with 19.99% expressed. 51 respondents with 34.07% expressed agree opinion in Apollo and 61 respondents with 40.73% in Care Hospital expressed. The neutral opinion was expressed by 30 respondents with 19.99% in Apollo and in Care 39 respondents with 25.97% expressed. 11 respondents with 7.32% expressed disagreed opinion in Apollo in Care 19 respondents with 12.65% expressed. 9 respondents with 5.99% expressed strongly disagreed opinion in Apollo and in Care only one respondent with 0.66% expressed. On going through the above analysis of statement it is revealed that most of the respondents are of the impression that these Hospital promotion campaigns are gaining the attention of the needy. The survey was directed on the Hospital special campaigns like, heart checkup, dental checkup at concession rates are getting good response from patients 49 respondents with 32.63% expressed strongly agree opinion in Apollo and in Care 31 respondents with 20.64%

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expressed. 51 respondents with 33.96% expressed agree opinion in Apollo and in Care 59 respondents with 39.41% expressed. The neutral opinion came up from among 29 respondents with 19.49% in Apollo and in Care 40 respondents with 26.64% expressed. 11 respondents with 7.32% expressed disagreed opinion in Apollo and in Care 19 respondents with 12.65% expressed. 10 respondents with 6.60% expressed strongly disagreed opinion in Apollo and only one respondent with 0.66% expressed in Care. On going through the above statement, it says that most of the respondents are of the opinion that the special campaigns at concession rates are getting good response from patients. On the subject of talk by doctors of the hospital on T.V. and Radio programs is helpful to increase the reputation of Hospitals 40 respondents with 26.76% expressed strongly agree opinion in Apollo and in Care 19 respondents with 12.65% expressed. 39 respondents with 25.97% expressed agree opinion in Apollo and in Care 61 respondents with 40.80% expressed. The neutral opinion has come up from 21 respondents with 13.98% in Apollo and 39 respondents with 25.97% in Care Hospital. The disagreed opinion was expressed by 49 respondents with 32.63% in Apollo and in Care 21 respondents with 13.98%. Only one respondent with 0.66% expressed strongly disagree opinion in case of Apollo and in Care 10 respondents with 6.60% expressed. It can be seen from the above analysis that most of the respondents are of positive nature on doctors addressing on T.V. and Radio programs are helpful to in increasing the reputation of hospitals. Further, the survey went on the Hospital having brand image among the patients. 60 respondents with 40.08% expressed strongly agree opinion in Apollo and in Care 80 respondents with 53.40% expressed. 39 respondents with 25.97% have expressed agree opinion in Apollo whereas in Care 41 respondents with 27.30% expressed. The neutral opinion was expressed by 21 respondents with 13.98% in Apollo and in Care 9 respondents with 5.99%. 19 respondents with 12.65% expressed disagree opinion in Apollo and in Care Hospital also the same opinion arrived. 11 respondents with 7.32% expressed strongly disagreed opinion in Apollo and in Care only one respondent with 0.66% expressed. From the above analysis of statement, it can be understood that more umber of respondents are of the opinion that these Hospitals are having grand image among the patients. From the above discussion it is observed that in Care hospital the respondents are believe that the hospital is able to propagating successfully its services in the market, and they are not feeling

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them selves as direct promoters of the services. Two hospitals are able to gain the attention of the needy through their promotional campaigns and also the T.V. and radio programmes getting good response from the patients. Two hospital are having brand image in the market for their special services. On the whole, it can be stated that the two hospitals are having right promotion mix. Now we will take up the perceptions of the administrative personnel about the promotion mix of the sample hospitals.

Perceptions of Administrative Personnel about the Promotion Mix of Sample Hospitals

Table no: 3.28 representing perceptions of administrative personnel about the promotion mix of the sample hospitals
Table No: 3.28

Perceptions of Administrative Personnel about Promotion Mix of the Sample Hospitals

Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree

(1) S.L NO

(2) Statement

(3) Perception 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total 1 2 3 4 5 Total

Your hospital is able to propagate its services to patients and their relatives.

You are feeling yourself as a direct promoter of your hospital services.

Your hospital special promotional campaigns are gaining the attention of the needy.

In your opinion special campaigns like, heart-checkup, dental checkup at concession rates are getting good response from patients.

(4) Apollo % 37.05 43.00 5.70 2.85 11.40 100.00 39.90 43.00 8.55 5.70 2.85 100.00 43.00 39.65 2.85 8.80 5.70 100.00 39.90 43.00 2.85 8.55 5.70 100.00

(5) Care % 48.70 28.50 11.40 8.55 2.85 100.00 37.05 37.05 11.65 8.55 5.70 100.00 37.05 45.85 8.55 5.70 2.85 100.00 37.05 45.85 8.55 5.70 2.85 100.00

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3 1 2 3 4 5 Total 1 2 3 4 5 Total 37.05 40.15 5.70 14.25 2.85 100.00 43.00 39.90 2.85 8.55 5.70 100.00

4 43.00 28.50 11.40 8.55 8.55 100.00 34.20 51.55 2.85 8.55 2.85 100.00

In your opinion, the talk by doctors in T.V and radio programs of this hospital is successful to increase the reputation of hospital.

This hospital is having strong brand image in the patients.

The survey has taken place on the Hospital being able to propagate its services to patients and their relatives Among 35 respondents participated,13 respondents with 37.05% expressed strongly agree opinion in Apollo and in Care 18 respondents with 48.70% expressed. 15 respondents with 43.00% expressed agree opinion in Apollo and in Care 10 respondents with 28.50% expressed. The neutral opinion was arrived from the 2 respondents with 5.70% in Apollo and in Care 4 respondents with 11.40% expressed. Only one respondent with 2.85% expressed disagree opinion in Apollo and in Care 3 respondents with 8.55% expressed. The strongly disagree opinion was expressed by 4 respondents with 11.40% in Apollo and 2.85% only in case of Care. From the above analysis, it can be known that a large number of respondents are under the opinion that these Hospitals are able to propagate their services to patients and their relatives. On the aspect of administrative personnel the feeling that they themselves are direct promoters of their Hospital services 14 respondents with 39.90% expressed strongly agree opinion in Apollo and in Care 13 respondents with 37.05% expressed. 16 respondents with 43.00% in Apollo and in Care 13 respondents 37.05% expressed agree opinion. 3 respondents with 8.55% in Apollo and in Care 4 respondents with 11.65% expressed neutral opinion. Two respondents with 5.70% in Apollo and 3 respondents with 8.55% in Care Hospitals expressed disagreed opinion. Only 2 respondents with 5.70% expressed strongly disagreed opinion in Care Hospitals where as 2.85% only expressed in Apollo. On going through the analysis it can be noticed that majority of respondents are under the impression that themselves feel as a direct promotion to these Hospital services. An attempt was made to know that the Hospital promotion campaigns are gaining the attention of the needy.15 respondents with 43.00% in Apollo and in case of Care Hospital 13

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respondents with 37.05% expressed strongly agree opinion. 15 respondents with 39.65% expressed agree opinion in case of Apollo Hospital and in Care Hospital 17 respondents with 45.85% expressed. Only 2.85% came forward to express neutral opinion in case of Apollo and in Care 3 respondents with 8.55% expressed. 3 respondents with 8.80% expressed disagreed opinion in respect of Apollo and in Care 2 respondents with 5.70% expressed. 2 respondents with 5.70% expressed strongly disagree opinion in Apollo and 2.85% in respect of Care Hospital expressed. From the above, it can be understood that special promotional campaigns are gaining the attention of the needy. On the subject of special campaigns like, heart checkup, dental checkup at concession rates are getting good response from patients 14 respondents with 39.90% expressed strongly agree opinion in respect of Apollo and in Care 13 respondents with 37.05% expressed. 16 respondents with 43.00% expressed agree opinion in Apollo and in Care 17 with 45.85% expressed. Only 2.85% expressed neutral opinion in case of Apollo whereas in Care 3 respondents with 8.55% expressed. 3 respondents with 8.55% expressed disagreed opinion in respect of Apollo and in Care 24 respondents with 5.70% expressed. Two respondents with 5.70% expressed strongly disagree opinion and 2.85% in case of Care. As expressed in the above statement, most of the respondents are of the opinion that special promotional campaigns at concession rates will certainly get good response. The survey has taken place on the talk by doctors of the hospital on T.V. and Radio programs are helpful to increase the reputation of Hospital 13 respondents with 37.05% expressed strongly agree opinion in Apollo and in Care 15 respondents with 43.00% expressed. Agree opinion in Apollo by 15 respondents with 40.15% and in Care 10 respondents with 28.50% expressed. The neutral opinion was expressed by 2 respondents with 5.70% in Apollo and in Care 4 respondents with 11.40% expressed. 5 respondents with 14.25% expressed disagreed opinion in case of Apollo whereas in Care 3 respondents with 8.55% expressed. 3 respondents with 8.55% expressed strongly agree opinion in case of Care Hospital and only 2.85% in Apollo. Majority of respondents are of the opinion that talk by doctors on T.V. and Radio will certainly increase the reputation of these Hospitals. In the aspect of the Hospital having brand image among the patients 16 respondents with 43.00% expressed strongly agree opinion in case of Apollo Hospital and in case of Care Hospital 12 respondents with 34.20% expressed. 14 respondents with 39.90% expressed agree opinion in

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Apollo and in Care 18 respondents with 51.55% expressed. Only 2.85% has come forward to express neutral opinion in case of Apollo whereas in Care only one respondent with 2.85% expressed. Equal number of 3 respondents with 8.55% expressed disagree opinion in both the Hospitals of Apollo and Care. Two respondents with 5.70% expressed strongly disagreed opinion in respect of Apollo and in case of Care only one respondent with 2.85% expressed. On the whole, it can be observed that respondents are of the opinion that these Hospitals are having grand image among the patients. From the above discussion it is noticed that, most of the respondents in Care hospital are believe that the hospital able to propagate its services to patients and their relatives. In two hospitals as per the respondents opinion, they are feeling them selves as direct promoters of the hospital services. As a part of promotion activities two hospitals are gaining the attention from the market by giving radio and T.V. programmes. Two hospitals having brand image for their services. By and large it is found that the two hospitals are having good promotion mix. Now Let us move on to Mean and S.D values of Doctors perceptions on the promotion mix of the sample hospitals.

Mean and Standard Deviation values of Doctors Perceptions on the Promotion Mix of Sample Hospitals
Table no: 3.29 representing mean and standard deviation values of perceptions of doctors about the promotion mix of the sample hospitals.
Table No: 3.29 Mean and S.D of Doctors Perceptions on the Promotion Mix of the Sample Hospitals (N=75)

Sl.No
1 2 3 4

Statement
Your hospital is able to propagate its services to patients and their relatives. You are feeling yourself as a direct promoter of your hospital services. Your hospital special promotional campaigns are gaining the attention of the needy. In your opinion special campaigns like, heart-checkup, dental checkup at concession rates are getting good response from patients. In your opinion, the talk by doctors in T.V and radio programs of this hospital is successful to increase the reputation of hospital. This hospital is having strong brand image in the patients.

Apollo
2.53 2.82 2.94 2.94 1.21 1.41 1.29 1.29

Care
2.73 2.53 2.93 2.93 1.13 1.09 1.06 1.06

Mean S.D Mean S.D

5 6

2.53 2.20

0.96 1.17

2.86 2.40

0.81 0.88

Point Scale: 1-strongly agree.5-strongly disagree

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Table no: 3.29 reveals that hospital is able to propagate services (2.53), feeling yourself as a direct promoter of hospital services (2.82), special promotional campaigns are gaining the attention of the needy (2.94), response of patients on special campaigns (2.94), special programs in T.V and radio increasing reputation of hospital (2.53), strong brand image of the hospital (2.20). From this, it can be stated that the promotion mix of the Apollo hospital perceived well by the respondents. In the case of Care hospital, hospital is able to propagate services (2.73), feeling yourself as a direct promoter of hospital services (2.53), special promotional campaigns are gaining the attention of the needy (2.93), response of patients on special campaigns (2.93), special programs in T.V and radio increasing reputation of hospital (2.86), strong brand image of the hospital (2.40). Therefore, it can be said that the promotional mix in the hospital are well perceived by the respondents. Let us see the Mean and S.D values of nurses perceptions on the promotion mix of the sample hospitals.

Mean and Standard Deviation values of Nurses Perceptions on the Promotion Mix of Sample Hospitals
Table no: 3.30 representing mean and standard deviation values of perceptions of nurses about the promotion mix of the sample hospitals.
Table No: 3.30 Mean and S.D of Nurses Perceptions on the Promotion Mix of the Sample Hospitals (N=150)

Sl.No
1 2 3 4

Statement
Your hospital is able to propagate its services to patients and their relatives. You are feeling yourself as a direct promoter of your hospital services. Your hospital special promotional campaigns are gaining the attention of the needy. In your opinion special campaigns like, heart-checkup, dental checkup at concession rates are getting good response from patients. In your opinion, the talk by doctors in T.V and radio programs of this hospital is successful to increase the reputation of hospital. This hospital is having strong brand image in the patients.

Apollo
2.73 2.26 2.20 2.20 1.34 1.12 1.17 1.17

Care
2.19 2.26 2.33 2.33 0.98 0.77 0.94 0.94

Mean S.D Mean S.D

5 6

2.52 2.46

1.20 1.09

2.59 1.81

1.08 1.05

5 Point Scale: 1-strongly agree.5-strongly disagree

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Table no: 3.30 shows that hospital is able to propagate services (2.73), feeling yourself as a direct promoter of hospital services (2.26), special promotional campaigns are gaining the attention of the needy (2.20), response of patients on special campaigns (2.20), special programs in T.V and radio increasing reputation of hospital (2.52), strong brand image of the hospital (2.46). From this it can be stated that the promotion mix of the Apollo hospital perceived well by the respondents. In the case of Care hospital, hospital is able to propagate services (2.19), feeling yourself as a direct promoter of hospital services (2.26), special promotional campaigns are gaining the attention of the needy (2.33), response of patients on special campaigns (2.33), special programs in T.V and radio increasing reputation of hospital (2.59), strong brand image of the hospital (1.81). Therefore it can be concluded that, the respondents in the hospital having positive impression on the promotional mix of the hospital. Now observe the Mean and S.D values of administrative personnels perceptions on the promotion mix of the sample hospitals.

Mean and Standard Deviation values of Administrative personnels Perceptions on the Promotion Mix of Sample Hospitals
Table no: 3.31 representing mean and standard deviation values of perceptions of Adm.People about the promotion mix of the sample hospitals.
Table No: 3.31 Mean and S.D of Adm.People Perceptions on the Promotion Mix of the Sample Hospitals (N=35)

Sl.No
1 2 3 4

Statement
Your hospital is able to propagate its services to patients and their relatives. You are feeling yourself as a direct promoter of your hospital services. Your hospital special promotional campaigns are gaining the attention of the needy. In your opinion special campaigns like, heart-checkup, dental checkup at concession rates are getting good response from patients. In your opinion, the talk by doctors in T.V and radio programs of this hospital is successful to increase the reputation of hospital. This hospital is having strong brand image in the patients.

Apollo
2.08 1.80 1.91 1.91 1.26 0.83 1.14 1.14

Care
1.77 1.80 1.82 1.82 0.97 1.27 0.82 0.82

Mean S.D Mean S.D

5 6

1.94 1.88

1.02 1.15

2.17 1.94

1.38 0.99

5 Point Scale: 1-strongly agree.5-strongly disagree

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Table no: 3.31 shows the perceptions of administrative personnel on the promotional mix of Apollo hospital; hospital is able to propagate services (2.08), feeling yourself as a direct promoter of hospital services (1.86), special promotional campaigns are gaining the attention of the needy (1.91), response of patients on special campaigns (1.91), special programs in T.V and radio increasing reputation of hospital (1.94), strong brand image of the hospital (1.88). From this it can be stated that the promotion mix of the Apollo hospital perceived well by the respondents. In the case of Care hospital, hospital is able to propagate services (1.77), feeling yourself as a direct promoter of hospital services (1.80), special promotional campaigns are gaining the attention of the needy (1.82), response of patients on special campaigns (1.82), special programs in T.V and radio increasing reputation of hospital (2.17), strong brand image of the hospital (1.94). Therefore it can be concluded that, the respondents in the hospital having positive impression on the promotional mix of the hospital.

Conclusion
Promotion function of any service organization involves the transmission of message to present, past and potential customers. Customers need to be made aware of the existence of the service provided. Promotion includes advertising, sales promotions, personal and publicity. Hospitals do not normally undertake aggressive promotion, they rely a lot on a favorable word of mouth. To increase the cliental, a hospital may continuously introduce different health services like the acupressure clinic, master health programs and diabetes health checkups apart from annual health check ups provided to different companies i.e. corporate clients. Hospitals conduct camps in rural areas to give medical check ups at a reasonable price so that the rural people approach the hospital again in the future. They also sponsor frequent visits to the spastic society, old age homes, etc. hospitals generally advertise in health and fitness magazines. The promotional activities in Apollo gaining the attention of the patients for this Apollo following the special campaigns like heart check-ups, dental checkups at concessional rates etc. Care is also giving these types of campaigns but apart from these campaigns they are giving radio and T.V. programmes like talk by doctors about specific ailment etc. comparatively Apollo paying attention on services at concessional rates and Care giving importance on media. In two hospitals most of the doctors, nurses and administrative personnel are feeling themselves as direct promoters of the hospital services. This indicating that the people are paying attention

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about, what they are delivering services. These hospitals are having branded services in specific areas. Care for heart surgeries and the Apollo for organ replacements. On the whole it is observed that the two hospitals are having good promotion mix for marketing the services. Now let us move on to the Grand Mean and S.D Values of perceptions of respondents on marketing mix (First 4Ps).

Perceptions of Respondents on the Marketing Mix (First 4Ps) of Sample Hospitals

(Grand Mean and S.D) Following tables (Table no: 3.32, 3.33 and 3.34) indicating the Grand Mean and S.D of perceptions of respondents on marketing mix i.e. first 4Ps of sample hospitals.
Table No: 3.32

Perceptions of Doctors on the Marketing Mix (First 4Ps) In Sample Hospitals (Grand Mean and S.D)
(N= 75)

Sl.No
1 2 3 4

Statement

Apollo Mean S.D Mean

2.42 3.32 3.01 2.73

Care S.D
0.20 0.31 0.34 0.48

Product 2.34 0.28 Price 3.10 0.42 Place 2.79 0.48 Promotion 2.66 0.61 5 Point Scale: 1-strongly agree.5-strongly disagree

Table No: 3.33

Perceptions of Nurses on the Marketing Mix (First 4ps) In Sample Hospitals(Grand Mean and S.D)
(N= 150)

Sl.No
1 2 3 4

Statement

Apollo Mean S.D Mean

1.94 3.02 2.76 2.25

Care S.D
0.21 0.48 0.32 0.46

Product 2.13 0.33 Price 3.08 0.51 Place 2.76 0.47 Promotion 2.39 0.54 5 Point Scale: 1-strongly agree.5-strongly disagree

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Table No: 3.34

Perceptions of Administrative Personnel on the Marketing Mix (First 4ps) In Sample Hospitals (Grand Mean and S.D)
(N= 35)

Sl.No
1 2 3 4

Statement

Apollo Mean S.D Mean

2.01 2.73 2.52 1.88

Care S.D
0.28 0.53 0.36 0.44

Product 1.94 0.29 Price 2.19 0.59 Place 2.55 0.38 Promotion 1.92 0.42 5 Point Scale: 1-strongly agree.5-strongly disagree

Rating of Marketing Mix Table no: 3.32 shows the perceptions of doctors on marketing mix (first 4 Ps) The Ps entire are positively opinioned by the respondents in two sample hospitals. The mean scores are in the range of 2.34 to 3.10 and 2.42 to 3.01 in Apollo and Care hospitals respectively, on a 5 point scale indicating marketing mix (first 4 Ps) of the sample hospitals is agreeable to the respondents. Table no: 3.33 indicating the perceptions of nurses on marketing mix (first 4 Ps) The Ps entire are positively opinioned by the respondents in two sample hospitals. The mean scores are in the range of 2.13 to 3.08 and 1.94 to 3.02 in Apollo and Care hospitals respectively, on a 5 point scale indicating marketing mix (first 4 Ps) of the sample hospitals is agreeable to the respondents. Table no: 3.34 indicating the perceptions of administrative personnel on marketing mix (first 4 Ps) The Ps entire are positively opinioned by the respondents in two sample hospitals. The mean scores are in the range of 1.92 to 2.55 and 1.88 to 2.01 in Apollo and Care hospitals respectively, on a 5 point scale indicating marketing mix (first 4 Ps) of the sample hospitals is agreeable to the respondents. Finally it is concluded as the respondents (Doctors, Nurses and Administrative Personnel) perceptions are agreeable to the respective item.

248

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1. Doris Van Doren, Louise Smith, and Ronald Biglin, The Challenges of Professional Services Marketing Journal of Consumers Marketing, 2, 2 (spring 1985), pp. 19-27. 2. Christopher H.Lovelock and Robert F.Young, Look to Consumers to Increase Productivity Harvard Business Review (May-June 1979), for a discussion of consumer involvement in the production of services. 3. Theodore Levitt. The Marketing Mode (New York: Mc Grawhill, 1969), p.2. 4. Joe M. Inguanzo and Mark Harju Are Consumers Sensitive to Hospital Costs? hospitals feb-1, 1985, pp. 68-69. 5. George Stigler, The theory of price rev. ed. (New York: Macmillan, 1952), pp.215ff. 6. Benson P.Shapiro, The Psychology of Pricing Harvard Business review (July 1968). 7. Same Day Surgery Competes With Flat Rate Hospitals (November 1, 1948), p52. 8. For An In-Depth Discussion of the Future of Competitive Bidding in Health Care, Jon B.Christianson. The Challenge of Competitive Bidding. Health care management review (Spring 1985), pp.39-54. 9. Milton I.Rormer, M.D. Bed Supply and Hospital Utilization Hospitals (November 1, 1961), pp.36-42. 10. M.Redish, J.Gabel, and M.Blaxell, Physician Pricing, Cost And Income proceedings of the western economic association meeting, Anaheim, CA, June 20, 1977; and V.E.Reinhardt, A Production Function For Physicians Services Review of economics and statistics (Feb 1972). 11. John Wnnberg and Alan Gittelsohn, Variations in Medical Care among Small Areas Scientific American (April 1982), pp.120-34; John E.Wennberg, Dealing with Medical Practice Variations: A Proposal for Action, Health affairs (Summer 1984), pp.6-32. ( The whole summer 1984 issue of health affairs was a special issue dedicated to variations in medical practice). 12. Richard M. Bailey, An Economists View of the Health Sciences Industry Inquiry, VI, 1 (1981), pp. 3-18. 13. Health Costs: What Limit? Time, May 28, 1979, p.60 copyright 1979 Time Inc. all rights reserved. Reprinted by permissions from TIME.

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14. Donald N. Musk, Darwin Sawyer, The Medicare and Medicaid Date Book, 1981, Health Care Financing Program Statistics published by the health care financing administration, U.S department of health and human services, april1982. 15. David A. Juba, Price Setting In The Market For Physicians Services: A Review Of The Literature, health care financing grants and contracts reports, published by the health care financing administration, U.S department of health, education and welfare Sep-1979 16. Marion Gornick, Marilyn Newton, and Carl Hackerman, Factors Affecting Differences in Madicare Reimbursements for physicians services Health care financing review, published by the health care financing administration, department of health and human services, 1, 4 (spring 1980). 17. B.Ehrenreih and J.Ehrehreih, The American Health Empire: power, profits and politics (New York: vintage books, 1974). 18. Alain C.Enthoven, Cutting Cost Without Cutting the Quality of Can New England journal of medicine (June1, 1978). 19. Joseph P.Newhouse, A Model of Physician Pricing the southern economic journal (October 1970), pp. 174-83. 20. J.R.Lave, Forecasts of Physicians prices and Expenditures 1978 paper presented at health care for American Economy: Issues and Forecasts, a Blue Cross and Blue Shield Sponsored Conference, Miami, January 1978. 21. Reach Out and Touch Someone Boston Magazine, August 1982, p. 29. 22. Klaus J.Roghmann and Thomas R.Zastowny, Proximity as a factor in the selection of health care providers social science and medicine, 13D (Great Britain: pergamon press, 1979), pp. 61-69. 23. Joe M.Inquanzo and Mark Harju, What Makes Consumers select a hospital? Hospitals (March 16, 1985), pp. 90-94. 24. Richard L.Morrill, Robert J. Earickson, and Philip Rees, Factors Influencing Distance Traveled to Hospitals Economic Geography 26(1970), pp.161-71. 25. Judith A. Kasper and Mare L.Berk, Waiting Times in Different Medical Setting: Appointment Waits and Office Waits National Health Care Expenditures Study, Data

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Preview 6, U.S. Dept.of Health and Human Services Publication No. (PHS) 81-3296, March 1981, p.1. 26. Nicholas J.Demerath, Organization and Management Needs of a National Family Planning Program: The Case of India Journal of Social Issues, 4(1967), pp. 179-93. 27. How to Market Your Hospital without Selling Your Philosophy G.D.Kunder, Prism Publications, Prism books pvt. Ltd,. P. 97. 28. These definitions, with the exception of the one for sales promotion, came from Marketing Definitions: A Glossary of Marketing Terms (Chicago: American Marketing Association, 1960). 29. How to Market Your Hospital without Selling Your Philosophy G.D.Kunder, Prism Publications, Prism books pvt. Ltd,. P. 97. 30. There are several models of buyers readiness states See, for example, Robert J.Lavidge and Garry A. Steiner, A Model for Predictive Measurements of Advertising Effectiveness Journal of Marketing (October 1961), pp.59-62. 31. Marketing for Health Care Organizations Philip Kotler, Roberta N.Clarke. Prentic Hall, Englewood Cliffs, New Jersey 07632. p. 447. 32. Michael L.Ray, Marketing Communication and the Hierarchy of Effects (Cambridge, MA: Marketing Science Institute, November 1973.). 33. Russell H.Colley, Defining Advertising Goals for Measured Advertising Results (New York: Association of National Advertisers, 1961). 34. Dick Warren Twedt, How to Plan New Products, Improve Old Ones, and Create Better Advertising journal of Marketing (January 1969), pp. 53-57. 35. Wendy Fox, The HMO Ad Campaign.Its Healthy, Hot and heavy The Boston Globe, May 17, 1985, p.82. 36. William D.Naovelli, Copy Testing Message on Health a presentation to the advertising research conference on the American marketing Association, New York chapter, may 16, 1978. 37. Roger A. Strange, Sales Promotion-Fast Growth, Faulty Management Harvard Business Review (July-August 1976), Pp. 115-24.

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