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The Effect of Marketing Strategy and Marketing Capability on Business


Performance. Case Study: Iran's Medical Equipment Sector

Article  in  Journal of Medical Marketing · October 2009


DOI: 10.1057/jmm.2009.33

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Original Article

The effect of marketing strategy


and marketing capability on
business performance. Case
study: Iran’s medical equipment
sector
Received (in revised form): 25th September 2009

Shahriar Azizi
is an assistant professor of Marketing in the Department of Management and Accounting at Shahid Beheshti University, Tehran,
Iran. He has published more than 20 articles and three books on marketing topics in Iranian journals, and also serves as reviewer
of three Persian-language journals.

Sedigheh Ansari Movahed


is an MBA student at Allameh Tabatabai University, Tehran, Iran. She also works in the marketing department of a company, which
finances medical equipment in Iran.

Maryam Haghighi Khah


is an MBA student at Allameh Tabatabai University, Tehran, Iran.

ABSTRACT In this article, the relationship between marketing strategy and the
marketing capability of three categories of business performance – overall, financial
and non-financial – has been investigated using a questionnaire including 30
parameters. The acceptable Cronbach’s  in the questionnaire is considered to be
0.80. The multiple regression tests indicate that marketing strategy has no effect
on the overall performance (b = 0.001; t = 0.005), whereas it shows a positive effect
on non-financial performance (b = 0.412; t = 3.067), and a negative effect on financial
performance (b = − 0.293; t = − 2.081). The results also indicate that marketing capability
has positive effects on all three investigated categories, that is, the overall
performance (b = 0.727; t = 5.680), the non-financial performance (b = 0.481; t = 3.580)
and the financial performance (b = 0.649; t = 4.612).
Journal of Medical Marketing (2009) 9, 309–317. doi:10.1057/jmm.2009.33

Keywords: marketing capability; marketing strategy; performance; medical equipment

Correspondence:
Shahriar Azizi INTRODUCTION pre-requisites for running a proper health
Department of Business
Administration, IRAN-
Health care is among the essential system is to ensure the smooth supply of
Tehran-Evin-SBU University-
Faculty of Management and
concerns and challenges of societies necessary medical equipment for the
Accounting, Shahid Beheshti
University of Tehran,
worldwide, and it has a direct effect community. Companies involved in the
PO Box 1983963113, on the economic efficiency of the medical equipment sector are highly
Tehran 1967933759, Iran
E-mail: s-azizi@sbu.ac.ir community. One of the major affected by the ever-changing

© 2009 Palgrave Macmillan 1745-7904 Journal of Medical Marketing Vol. 9, 4, 309–317


www.palgrave-journals.com/jmm/
Azizi et al

technologies; hence, their business to financial transactions and sales of


environment is quite turbulent and their technology products to Iran. These
management needs to develop new tools, sanctions have resulted in difficulties
new concepts, new organizations and new in Letter of credit (LC) establishment;
ideas to meet the demand of market and the limitation of gaining credit facilities
maintain competitiveness.1 Iran is from producers and sometimes using
considered one of the fastest-growing a third-party middle-man to effect the
markets for medical equipment. Although transaction, hence increasing the time
there are a number of local producers in required; price/expenses; and risk in
Iran, the majority of market share (value- importation of medical equipment to
wise) is in the hands of large and Iran.
internationally reputable brands of medical 2. Smuggling: Owing to time-consuming and
equipment. In 2007, approximately 70 per complicated bureaucracy for importation
cent of Iran’s demand (quantity-wise) for procedures, and high custom duties,
medical equipment was met by domestic a large amount of medical equipment is
production, and 30 per cent by imported via illegal channels. No accurate
importation; however value-wise the data for the value of smuggled imports are
importation was exceeding the local available, but it is roughly estimated to be
production. The importation value of approximately $500 million. There are no
medical equipment grew considerably guarantees as to the quality of smuggled
from 2006 to 2007 at an average rate of equipment, and it may jeopardize the
25 per cent increase on US dollar basis, health of consumers.
while over the same period (2001–2007) 3. Lack of reliable databases: Statistical data
the average growth rate has been around are vital for proper planning of demand
6.5 per cent. Total value of importation is and managing the requirement of the
estimated at around US$3 billion between market for medical equipment. No
2001 and 2007. This figure does not reliable data on the usage of medical
include smuggling and illegal importation, equipment and the sectors where it is
which is assumed to contribute a large used are available.
part of the market (see Table 1). 4. Insufficient supervision of the market by
The major challenges for Iranian health authorities: There are numerous
medical equipment – which foreign companies active in the medical
companies need to consider – are as equipment sector of Iran. The activities
follows: of these companies need to be
monitored by health authorities on a
1. International sanction: The first obstacle is continuous basis, but at present this
international sanction and/or limitations supervision is far from satisfactory. In
2008, the Ministry of Health started
a program called ‘plan for issuing ID
Table 1: Official importation of medical equipment
(2001–2007) card’ for Iranian medical equipment
Year Value Annual growth companies.
(US$ million) (%)

2001 397.79 —
The large number of medical equipment
2002 423.56 0.065 companies present in this market indicates
2003 465.39 0.0985 that this is a fragmented industry. The
2004 363.14 − 0.22
2005 336.21 − 0.074 overall operation medical equipment
2006 425.98 0.267 market and smooth availability of the
2007 534.31 0.25
products for the patients is not satisfactory,

310 © 2009 Palgrave Macmillan 1745-7904 Journal of Medical Marketing Vol. 9, 4, 309–317
Effect of MKS and MC on business performance

and the performance of this sector needs performance through sales, physical
to be improved. A number of factors distribution, after-sale services and
affect the performance of companies, development of new market opportunities.
including medical equipment companies, With respect to the role of marketing
the parameters of which we can call strategy in the organization, four items
‘marketing capability’ and ‘marketing can be highlighted:
strategy’ of the involved company. By
‘marketing capability’ we mean a 1. Marketing strategy plays an essential role
company’s various marketing-related in higher performance.
abilities and capacities: the higher the 2. Rapid technological advances have
capability, the higher performance of the made the business environment of this
subject company is assumed to be. sector more complicated and difficult to
Marketing strategy – which reflects a predict.
company’s relationship and interaction 3. The main activities of the organization
with its business environment – can also are determined based on business
affect corporate performance. In this strategy, product life cycle and other
study, we have attempted to examine situational factors of the company/
and analyze the effects of these two product.
aforementioned factors on the (1) overall, 4. Business strategy and marketing strategy
(2) financial and (3) non-financial should be aligned, so that they present a
performance of Iran’s medical equipment common objective for the company.
companies.
To ensure an effective marketing strategy
BACKGROUND and performance of the organization, the
concept of ‘market orientation’ needs to
Marketing strategy and be highlighted. The four main aspects of
performance relationship market orientation include (1) continuous
A number of factors, including the market research and data collection from
increased competition among local and the environment, appropriate response to
international companies, the emergence customer requests, improved customer
of more demanding customers and great satisfaction and appropriate counter-
technological advances in medical activities against completion operation.
equipment, have led to a complex market Studies in hospitals in five US states
in this sector. In this complex market showed that higher market orientation
environment, the marketing strategy of leads to higher organizational performance,
the company could be a competitive as it clearly illustrates a company’s strategy
advantage versus other companies and increases the organizational
provided that they deliver services and commitment and customer satisfaction.2
values that not only meet the customer The studies on the effect of market
demands, but surpass them. Therefore, it orientation on the performance of
goes without saying that companies need pharmaceutical companies have also
to investigate and apply a differentiated shown that there is a positive relationship
strategy versus others to stand out in the among market orientation, innovation and
crowd. Six main corporate operations are performance.3 Different industries enjoy
usually categorized as follows: Marketing, different opportunities, successful strategies
R&D, Technology, Operations, HR and differ across industries, and strategic
Finance. The objective of marketing choices depend on situations.4 Another
activities is to increase organizational study revealed that in food and packaging

© 2009 Palgrave Macmillan 1745-7904 Journal of Medical Marketing Vol. 9, 4, 309–317 311
Azizi et al

industries, marketing strategy had a more extend their existing product portfolio
significant effect on performance than with some modifications. Similar to
production strategy, while this did not market development, this strategy is more
apply to plastics and polymer industries.5 risky than market penetration.
‘Snow and Herbiniak’ found that there is
a strong positive relationship between Diversifica\tion: Companies initiate new
business-level strategies and performance.6 activities and operations that are irrelevant
Sharma indicates that marketing strategy to their existing markets and products.
plays an essential role in strengthening This is the most risky strategy because it
corporate performance, and it has third involves both new markets and new
ranking after production and R&D.7 products. It is useful when high profit is
guaranteed by taking higher risk.
ANSOFF’S MATRIX Nevertheless, some believe that
To illustrate the growth strategies, Ansoff diversification reduces the risk through
has developed a matrix focusing on a creating a diversified and more extensive
company’s product(s) and its existing and portfolio of products.
potential markets.8
Relationship between marketing
Existing New
product(s) product(s)
capability and performance
Marketing capability is an integrated
Existing Market Product process designed to make use of corporate
market(s) penetration development
New market(s) Market Diversification knowledge, skills and resources. It enables
development businesses to better meet their customers’
needs through added value services to
Considering the existing and new
their products. A company’s marketing
product(s) as well as the existing and new
capability refers to its ability to
market(s), four general strategies can be
differentiate its product(s) and service(s)
investigated:
from those of its rivals, as well as creating
Market Penetration: Companies can achieve and maintaining a strong profitable brand.9
their development goals through increasing Many marketing scholars believe that
the market share of their existing products. marketing capability should be considered
This is the least risky strategy. In growing a part of successful marketing.10 The
markets, maintaining the market share, in capability-based theories indicate that
itself, is considered growth. In this case, companies are a combination of resources
companies tend to reduce prices while they and capabilities,11,12 and that they should
increase sales, advertisement, distribution continuously invest in a unique manner to
channels and so on. maintain and expand their marketing
capabilities.13 A company with high
Market Development: Companies seek new marketing capability – a pioneer in
markets for their existing products. If the identifying customers’ needs and
company possesses a unique product(s), it recognizing the factors affecting their
will try to approach a niche market purchasing behaviors – is able to put its
matching the product. This is more risky product(s) in the best position compared
than market penetration because it involves to those of its rivals. A differentiation at
entry into new unexplored markets. this level will provide the companies with
higher profit.14 In a survey on the effects
Product Development: Companies develop of the marketing process on corporate
new products for their existing markets or performance, Morgan found that the

312 © 2009 Palgrave Macmillan 1745-7904 Journal of Medical Marketing Vol. 9, 4, 309–317
Effect of MKS and MC on business performance

companies that pay proper attention to Marketing capability


their inputs in strategic marketing process Performance
will achieve much higher performance.15 (Overall, financial,
non-financial)
Market-based organizational learning is
Marketing strategy
a proper managerial tool for obtaining
competitive advantage in marketing
Figure 1: The conceptual model.
capability. Marketing capability
benchmarking has been recognized as the
root of competitive advantage.16 in which marketing capability and strategy
Marketing capability-based competitive affect the different aspects of performance.
advantage theory asserts that companies In other words, aggressive marketing
that target differentiated capabilities will strategy will lead to higher performance,
achieve considerable competitive and higher marketing capability will result
advantage.17–19 Marketing capability will in higher corporate performance.
be valuable only when it relates to high
performance. There are a number of METHODOLOGY
scales for measuring marketing capability. In order to collect the required data for
Weerawardena identifies eight processes our study, a questionnaire was designed
for describing marketing capability: containing 30 items in which 27 items
customer service system; promotional were assigned to four latent variables and
activities for higher market share; sales three items to demographics variables
force quality; superiority in distribution (see Appendix). For investigation and
and sales networks; allocation of required analysis of marketing strategy, a
resources to advertisement; marketing questionnaire containing six statements
research; ability in product differentiation; (one statement for defensive strategy, four
and rapid introduction of new product(s). statements for four types of aggressive
He believes that marketing capability strategy, and one for focus strategy) was
plays a pivotal role in achieving designed. The questionnaires were
competitive advantage. In a survey on submitted to 50 large, well-reputed
1272 manufacturing companies in the companies involved in Iran’s medical
machinery and metal sector, equipment industry, and the investigation
Weerawardena found that marketing team was constantly and closely in contact
capability is a stimulus for obtaining with involved companies. Thirty-six
competitive advantage by which questionnaires out of 50 sent were
companies can enhance their performance received , which is equal to a response
considerably.20 Other studies identified rate of 72 per cent. Three replies were
some other factors as measures for excluded because of non-reply to most
evaluating the marketing capability. These of the questions. The final analysis was
include pricing, product development, performed based on 33 questionnaires.
distribution channel management, The Cronbach’s  in the questionnaire
marketing communications, sales, market was equal to 0.80, which is an acceptable
information management, marketing plan range (see Table 2).
and marketing implementation. In this
way, customer satisfaction, market ANALYSIS AND DISCUSSIONS
efficiency and current profitability are The conceptual analysis of the data
measures for performance. The conceptual collected (see Table 3) from the 33
model of this study – which is based on companies showed that 42.4 per cent of
previous ones – is presented in Figure 1, respondents were under 30 years of age,

© 2009 Palgrave Macmillan 1745-7904 Journal of Medical Marketing Vol. 9, 4, 309–317 313
Azizi et al

Table 2: Questionnaire items The results of the ‘correlation analysis’


Variables Number of Source (see Table 4) indicate that marketing
questions strategy has a positive relationship with
Marketing 10 Weerawardena non-financial performance (r = 0.509,
capability (2003)20 P < 0.001). In other words, more
Marketing strategy 6 Ansoff (1965)8
Financial 7 Vorhies (1998)10 aggressive/effective marketing strategy will
performance lead to higher non-financial performance.
Non-financial 4 Vorhies (1998)10
performance Marketing capability has positive
relationships with overall performance
(r = 0.727, P < 0.001), non-financial
Table 3: Sample’s demographics performance (r = 0.564, P < 0.001) and
Variables Frequency Percentage Valid financial performance (r = 0.590,
percentage P < 0.001). Higher marketing capability
Age (years) leads to better marketing techniques in the
< 30 14 42.4 42.4 company, and hence results in better
31–40 10 30.3 30.3
41–50 6 18.2 18.2 performance. The overall performance has
>50 3 9.1 9.1 positive relationships with financial
Gender
performance (r = 0.862, P < 0.001) and
Men 28 84.8 84.8 non-financial performance (r = 0.702,
Women 5 15.2 15.2 P < 0.001). No relationship was found
Work experience (years) between financial and non-financial
4–8 4 12.1 12.1 performance. The positive relationship
9–12 18 54.5 54.5
>12 11 33.3 33.3 witnessed in our study indicates that the
more aggressive the marketing strategy
deployed by the company, the greater the
30 per cent were between 31 and 40, 18 result of non-financial performance.
per cent were between 41 and 50, and Corporate performance has been
the remainder were above 50. This broken down into overall, financial and
indicates that most of the respondents non-financial, to identify the effects of
tended to be young and middle-aged. By marketing strategy and capability on
gender, approximately 85 per cent of corporate performance, and multiple
respondents were men, which indicates regression analysis has been applied, as
that much fewer women are employed in presented in Table 5.
the managerial/supervision positions of the Using the overall performance model,
concerned companies. Considering the marketing strategy has no effect on overall
date of establishment of the studied performance, but marketing capability
companies, approximately 55 per cent of shows a high positive effect ( = 0.727,
the sample companies had experience P < 0.0001). In the non-financial
of 9–12 years of operation, and 33 per performance model, both marketing
cent experience of above 12 years. strategy and marketing capability have
The following reputable Iranian medical positive effects on non-financial
companies participated in this research: performance ( = 0.412, P < 0.01 and
Tajhizat Pezeshki Pishrafteh co. (GE),  = 0.481, P < 0.01, respectively). In the
Electro Pezeshk Afzar co. (Philips), financial performance model, marketing
Fanavari Azmayeshgahi co. (Siemens), strategy has a negative effect on financial
Tajhizat Pezeshki pars co. (Toshiba), performance ( = − 0.293, P < 0.01),
B.N.M co. (Hitachi), and Shima Parto co. whereas marketing capability has a positive
(Shimatzo). effect ( = 0.649, P < 0.001). In this

314 © 2009 Palgrave Macmillan 1745-7904 Journal of Medical Marketing Vol. 9, 4, 309–317
Effect of MKS and MC on business performance

Table 4: Means, standard deviations, and correlation of variables


Means SD MKS MC PE NFP FP

MKS 2.69 0.683 1 0.202 0.147 0.509* − 0.162


MC 3.74 0.482 — 1 0.727* 0.564* 0.590*
PE 3.60 0.377 — — 1 0.702* 0.862*
NFP 4.2 0.484 — — — 1 0.245
FP 3.27 0.390 — — — — 1

*P < 0.01.
Abbreviations: FP – Financial performance; MC – Marketing capability; MKS – Marketing strategy; NFP – Non-financial performance;
PE – Overall performance.

Table 5: Regressions tests results


Dependent Independent  t Significance R2 FANOVA
variables variables

PE MKS 0.001 0.005 0.996 0.529 16.824**


MC 0.727 5.680 0.000 — —

NFP MKS 0.412* 3.067 0.005 0.481 13.894**


MC 0.481* 3.580 0.001 — —

FP MKS − 0.293* − 2.081 0.046 0.430 11.324**


MC 0.649** 4.612 0.000 — —

*P < 0.01; **P < 0.001.


Abbreviations: FP – Financial performance; MC – Marketing capability; MKS – Marketing strategy; NFP – Non-financial performance;
PE – Overall performance.

model, we witness a negative effect of and positive effects, respectively. Iranian


marketing strategy on financial medical companies usually make use of
performance, and this can be explained by physicians and engineers as field force for
the fact that an aggressive marketing their marketing and sales activities, and
strategy requires high investment on they need to be trained for marketing and
marketing expenses (field force, promotion sales skills. Many companies try to gain
and so on). In all three models, R2 was at more market share by aggressive
acceptable range. marketing strategies, but for this purpose
highly trained and professional marketing
CONCLUSION staff are required, which means a
There are limited studies on the marketing considerable financial investment for the
aspects of the medical equipment industry company.
worldwide. The majority of companies in The results show that the higher
this industry cannot disclose their data management of the medical companies
owing to business confidentiality reasons. should pay more attention to analyzing
The results show that both marketing their marketing capability and its
strategy and marketing capability have improvement. High marketing capability
relatively high positive effects on the non- will encompass better use of marketing
financial performance of the sample tools and the application of creative and
companies. In the overall performance novel marketing plans and ideas.
model, only the marketing capability Recruitment of marketing staff from
shows an effective impact. In the financial graduates of related disciplines such as
performance model, marketing strategy marketing, business, human resources,
and marketing capability have negative law and so on will increase the company’s

© 2009 Palgrave Macmillan 1745-7904 Journal of Medical Marketing Vol. 9, 4, 309–317 315
Azizi et al

marketing capability; otherwise the performance relationship: A study of the hospital


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316 © 2009 Palgrave Macmillan 1745-7904 Journal of Medical Marketing Vol. 9, 4, 309–317
Effect of MKS and MC on business performance

APPENDIX current customers (aggressive marketing


strategy)
Questionnaire items • Our company tries to increase its sales
Marketing Capability: volume via selling current products to
new customers (aggressive marketing
• Quality of customer service strategy)
• Effectiveness of promotional activities • Our company tries to increase its sales
(for example advertising) in gaining volume via selling new products to new
market share/sales growth customers (aggressive marketing strategy)
• Quality of salespersons • Our company tries to concentrate on
• Strength of distribution networks profitable segments and give up other
• Advertising expenditure as percentage of segments (focus marketing strategy)
sales
• Firm’s market research efforts Financial Performance:
• Ability to differentiate products
• Speed of new product introduction • High market share compared to our
• The extent of marketing activities competitor
• The extent of firm’s marketing • Increasing profit
capabilities enabling it to compete • Increasing sales volume to current
successfully customers
• Profitability of our standard business units
Marketing Strategy (please mark only one • High return on investment
option): • High profit:sale ratio
• Achieving financial objectives
• Our company tries to retain its current
market share (defensive marketing Non-financial Performance:
strategy)
• Our company tries to increase its sales • Our customers are satisfied
volume via increasing sales to current • Our customers receive value
customers (aggressive marketing strategy) • Our customers receive what they want
• Our company tries to increase its sales • My company has the ability to absorb
volume via selling new products to new customers

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