A special system of medical care was created for the leadership of the party and the country. With limited resources allocated to health care, some priority was given to workers and children. Even today, all this does not prevent us from asserting that the availability of qualified medical care was provided by the state, regardless of the patient's social status, place of residence, etc.
The fundamental essence of the modern period of reforming the domestic health care system, along with others, is characterized by objective conditions under which a medical service becomes a commodity, and relations between producers and consumers medical services(in particular, the doctor and the patient) in essence begin to be defined as marketing with the predominant role of the patient.

Classical civilized market relations, as you know, are subject to economic laws, are specific in management and are in conflict with the methods of administration. In the field of market relations, medical care, as a kind of production activities, filled with economic characteristics. Prior to that, conditional groups of patients (patients of the same nosology, decreed contingents, persons from dispensary observation groups, etc.) begin to correlate with structures characteristic of the market. The field for the implementation of marketing relationships in medicine is certain segments of the medical services market, the diversity of which in form and content reflects in health care, as in social structure society, one of the principles of democracy. At the same time, with the equality of needs, generally referred to as medical, marketing relationships in health care give rise to fragmentation of the medical services market in accordance with certain, significantly different levels of needs for medical services. It is a wide range of medical needs, ranging from individual to group ones, their effective and high-quality satisfaction, taking into account diversity and commonality, that determine the essence of healthcare marketing systems. In this sense, the multistructural nature of health care systems, broad privatization, as an extreme form of decentralization, form the inalienable environment without which classical market relations are impossible.

The quality of medical care, free access to methods and forms of treatment, the natural possibility and implementation of the choice and access to any provider of medical services, the possibility of legal and economic influence in case of dissatisfaction or poor satisfaction of medical needs, earnings medical worker associated with the results of work and patient satisfaction, legal and economic security, both for the consumer and the provider of medical services, is by no means a complete list of positive characteristics inherent in healthcare marketing systems. At the same time, it is necessary to reveal and explore the negative components of the medical services market. In particular, the negative nature of marketing relationships in healthcare includes the weakening of preventive measures, the rejection of medical services with a high share of the humanitarian mission of healthcare and a low degree of direct economic benefit, fears of discrimination against sick socially vulnerable groups in need of medical care, etc. Some of the contradictions of such problems can be removed by methodological approach considering such groups of patients, their medical needs and needs as unique and specific market segments, determining their rightful place in the healthcare marketing system and finding forms and methods to meet the needs and demand of customers in these segments.

Market segmentation is commonly referred to as the process of classifying consumers into groups with different wants and needs, characteristics, or behaviors. Such a definition, although acceptable for the medical services market, can hardly fully reflect the specifics and differentiation of the provision of medical care.

It is known that for the consumer goods market, customer groups can be formed according to the following criteria: geographical, demographic, psychographic, behavioral.
To be economically useful, a market segment must have the following five characteristics.

1. It must be possible to measure it, i.e. information on the fundamental parameters of the buyer can be obtained.

2. The segment must be broad and/or profitable enough to warrant a specific marketing plan.

3. Possibility of access. The enterprise must be able to effectively carry out its commercial efforts in the field of the selected segment.

4. Segments must be truly distinct, i.e. differ from one another in terms of set variables.

5. It must be possible for the enterprise to fulfill its plan.
Closely related to market segmentation is the essence marketing.

The strategy of undifferentiated marketing of medical services is to minimize the differences between market segments, when first of all are taken into account General characteristics consumers of health services, and then their difference. The medical and preventive institution seeks to obtain a license and introduce to the market such medical services (types of medical care) that will attract as much as possible large quantity of patients and seeks to create a unique image in the mind of the consumer of medical services. Such a strategy is used if it can achieve cost reduction, but the company risks either getting into intense competition in this segment or incurring significant losses. economic costs. Conditionally undifferentiated marketing of medical services could include immunoprophylaxis, routine examinations of the population, etc. in essence, the state should be the buyer of such medical services.

Differentiated marketing of medical services- development various kinds medical services and directed programs of medical actions for each segment; using variations of medical services and changing them, the medical institution (physician) hopes to receive higher revenue with optimal results and quality of medical care (CMC).

The dynamism of the health care strategy lies in the intelligent and timely combination of differentiated and undifferentiated marketing of medical services. The possibility of transferring a consumer of medical services from one segment to another determines the dynamism and area of ​​market viability of a medical institution or medical practice, and the relative degree of accessibility of medical services is characterized by the specificity of the market segment.

A medical service, being a specific form of a product, essentially determines the specificity of the segmentation of the medical services market.

Taking into account the relatively equal characteristics of consumers of medical services, market fragmentation can be carried out in two main directions:

social needs,

medical needs.

The fragmentation of the market according to the possibilities of demand for medical procedures is carried out in accordance with economic groups, which are characterized by the type of medical service, medical diagnostic group, cost of the procedure, solvency and personality of the patient.

The development of a possible classification of segmentation of the medical services market is presented according to the following parameters:

by age and sex characteristics (men, women, children, adolescents, adults, the elderly);

· by types of medical care (outpatient, hospital, obstetrics, dental, drug provision, etc.);

by decreed groups (healthy, sick, working in conditions associated with occupational hazards, military personnel, students, etc.)

· by nosological groups (as a special case - by clinical examination groups);

by medical diagnostic groups;

by groups of equal medical standard;

by economic groups (well-being and solvency),

by types of medical services.

It is not possible to appeal to all health care buyers at once, as they have varied tastes and purchasing styles as well as income levels. From here, the direction of specialized segments of the medical services market emerges. In addition, competitors may well be located in some submarkets. Therefore, the health care institution (medical practices) should be interested in identifying those submarkets that will be most attractive to them and compatible with its goals and resources. With the same medical needs, needs, resources, geographical location, level of sanitary culture, purchasing attitudes, habits can be different. Any of these variables can be used as the basis for market segmentation. Ideally, a medical institution (the subject of medical practice) prefers to be the only one in its niche, the narrower this niche, the fewer competitors. But at the same time, the likelihood of large and wide sales of medical services also narrows.

The niche of the medical services market segment is the more attractive, the more it corresponds to the following characteristics:

A. Buyers of medical services (patients) have complex and specific needs in meeting medical needs;

B. they are willing to pay a high price in order to receive medical care of absolute quality, i.e. when medical procedures are absolutely adapted to their explicit and hidden needs;

B. the provider of medical services has a high, constantly improving professional and social competence;

D. the acquisition of this competence allows you to bypass competitors, hence “the ability of a medical worker to learn is becoming an increasingly important quality, even more important than practical experience which quickly becomes obsolete” (O.P. Shchepin).

There is no single method for segmenting the medical services market. It is necessary to test segmentation options based on different variables, one or more at once, to find the most useful approach to consider the structure of such a market. Thus, the restructuring of the healthcare industry, taking into account its emerging marketing functions, in our opinion, should be carried out in accordance with the segments of the medical services market.

Apparently, state guarantees in the protection of the health of citizens should cover those market segments that are associated with the unattractiveness of the sector for the manufacturer of medical services, relying on profitability.

In this way, marketing systems health care, based on objective economic laws with many determinants, are characterized by certain market segments. Segmentation of the medical services market makes it possible to provide medical care (to satisfy a specific demand) both taking into account the individuality of the patient and taking into account the mass consumption of medical services.

5. General characteristics Russian market medical services.

The transition to market relations in Russia put the issue of pricing in all areas of the national economy in one of the first places. Speaking about the price of a product in the health care system, we mean the price of a medical service that is fully endowed with commodity properties. Through market mechanism sellers and buyers interact to determine the price and quantity of goods produced. Therefore, demand, supply and price are the main elements of economic relations in the market.

key concept, expressing the essence of market relations, is competition. The pricing policy is formed in accordance with the structure of the market. Depending on the ratio between the number of producers and the number of consumers, there are the following types competitive structures:

Market of perfect competition;

Oligopoly;

Monopoly;

Monopolistic competition.

The medical services market has the following characteristics:

The number of sellers is limited, there is a restriction on entering the market;

The heterogeneity of the medical service, its individuality, uniqueness;

Imperfect consumer awareness of the service market;

Impossibility or difficulty of comparing price and quality;

The presence of a large number of public or private non-profit organizations;

For the sale of goods in most cases, a competent intermediary is required, which pays for a significant part of the medical service.

Thus, the market of medical services for the most part can be attributed in structure to the market of monopolistic competition and monopoly.

Public health care is an example of a monopsony in the medical services market, when the level of prices at which medical services are purchased is determined not by the real costs of service providers, which no one considers, but by the solvency of the state and its ideas about the value of such a good as the health of citizens.

Thus, one can be convinced that the peculiarity of the Russian market of medical services is that it is a strong alloy of monopoly and monopsony, when almost all medical workers and medical institutions are subordinate to the Ministry of Health. At the same time, the state, being a monopolist, also dictates clearly unfavorable conditions for financing the structures subordinate to it, without even covering their real costs. The patient in such a system is alone and absolutely powerless. Therefore, the goal of the health care reform is to demonopolize the system of medical services, the gradual transformation of the Russian market of medical services first into a "seller's market", when sellers have greater market power (dictating their terms to the buyer, imposing goods (services) and prices on them), and then into "buyer's market", when the consumer-patient will become the central figure that determines the position of medical services and their price.

On the way to this, one of the priority tasks is to determine the legal and economic status of medical institutions and ensure their financing, based, at a minimum, on the real costs of producing medical services provided to the population. Financing at the level of real costs will provide financial stability medical institutions of the country, will allow them to move from solving the problems of survival to the problems of improving the quality of medical services.

When considering the market of medical services, it is necessary to pay attention to the factors that determine the demand and supply of medical services, the main of which is the price. The prices can be divided into the following three groups:

1st group - high prices (first price) for the service reflect its uniqueness, technological patent protection, lack of demand (demand market) at the initial stage;

2nd group - low prices(breakthrough or penetration price) for a service, reflects the simplicity of technical and technological solutions, low costs, high and stable demand, durable financial position firms;

3rd group - experimental prices (when there is no such product on the market), reflect the novelty of the functional purpose, the lack of data on the emergence of a sales market and prices.

Also important is the interaction of the medical services market with the market of labor and material resources. On the one hand, the demand in the resource market is a derivative of the demand for medical services, on the other hand, the price level, and in general, the conjuncture in the resource market determines the potential opportunities and boundaries for the development of medical institutions.

The market consists of many types of consumers, goods, needs. The consumer market is formed by buyers who differ from each other in various parameters (place of residence, gender, age, income level, education, lifestyle, belonging to social class etc.).

It is difficult to find a consumer with the same reaction to the proposed product or service. The marketer must understand and anticipate what influences patient behavior. Patients behave differently when receiving different medical services, so it is necessary to understand how they make decisions. For example, before deciding which dental clinic to go to, people look through a lot of newsletters, listen to information on radio and television, and only then choose the one that suits them best.

Buying even the same product (service), patients are rarely guided by the same motives, although this specific item may be intended for different groups of consumers. In marketing terminology, these

consumer groups are called market segments, and the process of identifying them is called market segmentation.

Market segmentation is one of the most important marketing features that ensures the success of a medical institution. This is done in order to best meet the needs and requirements of patients and thereby ensure the sustainable functioning and profitability of the medical institution.

A segment of the market is a specially allocated part, which

or a group of patients, health care providers or medical,

having common characteristics

Segmentation is based on the following criteria:

1. Quantitative parameters of the segment - the volume of medical services that can be provided; number of potential patients; the territory in which they live, etc.

2. Availability of the segment for the medical sector, i.e. the presence of

the ability to obtain a sufficient number of channels for promoting medical services, to identify the power of these channels and their ability to ensure the implementation of the entire volume of services and medical goods - i.e. determine whether a medical institution is ready to promote its products to the market or whether something needs to be changed in its work.

3. Segment materiality - determination of how realistic this or that group of patients can be considered as a market segment and whether it is worth focusing one's activities on it.

4. Profitability - using this criterion, it is determined how profitable it will be for a medical institution to work on the basis of a selected market segment (return on invested capital, increase in profits of the institution, etc.)

5. Compatibility of the segment with the market of the main competitors - determines how the promotion of this service will affect the interests of competitors; otherwise, the medical institution may incur additional costs.

6. Security of the selected segment of the medical services market from competitors - it is determined who can become a potential competitor, what are its strengths and weak sides whether the medical institution has competitive advantages and what they are.

Only after receiving answers to all these questions, it is possible to decide whether or not this segment is suitable for a medical institution, whether it is worth continuing to study consumer demand for the services provided, collect information and invest additional funds.

The objects of segmentation can be patients, medical services and medical institutions. For example, patients can be grouped according to geographic or demographic characteristics, income level, professions, etc., that is, according to any of the significant characteristics. In accordance with this, the basic principles of segmentation of any consumer markets (including medical services markets) are.

CHAPTER 4. Some methodological approaches to regulation of relations in healthcare marketing systems

4.5. Segmentation of the medical services market as a typology of relationships in healthcare marketing systems

In health care systems built on the Soviet model, the volume and level of medical care, with all the declarations of equality and social justice, were distinguished by a high degree of privilege. A special system of medical care was created for the leadership of the party and the country. With limited resources allocated to health care, some priority was given to workers and children. Even today, all this does not prevent us from asserting that the availability of qualified medical care was provided by the state, regardless of the patient's social status, place of residence, etc.

The fundamental essence of the modern period of reforming the domestic health care system, along with others, is characterized by objective conditions under which a medical service becomes a commodity, and the relationship between producers and consumers of medical services (in particular, a doctor and a patient) essentially begins to be defined as marketing with a predominant role of the patient . Such manifestations of the relationship between a doctor and a patient characterize the system of compulsory medical insurance, the introduction of which in Russia has been carried out since 1991.

Classical civilized market relations, as you know, are subject to economic laws, are specific in management and are in conflict with the methods of administration. In the field of market relations, medical care, as a kind of production activity, is filled with economic characteristics.

Until then, conditional groups of patients (patients with one disease, decreed contingents, persons in dispensary observation groups, etc.) begin to correlate with structures characteristic of the market. The field for the implementation of marketing relationships in medicine are certain segments of the medical services market, the diversity of which in form and content reflects one of the principles of democracy in healthcare as in the social structure of society. One of the characteristics of the medical services market under conditions of liberal (marketing) healthcare systems is its segmentation, i.e. targeting the sale of medical services to certain consumer groups.

This section discusses some of the problems of segmenting the medical services market in the conditions of compulsory medical insurance as one of the possible liberal (marketing) healthcare systems.

4.5.1. The stratification of society as a factor in the segmentation of the medical services market

One of the characteristic moments of the current state and the successful functioning of the healthcare system in the changed conditions is the deep penetration into the area of ​​the system with humanistic priorities of methods and forms of the economy.

The spread and application of economic laws in the activities of medical institutions is determined by an objective necessity in the functioning of the healthcare system in the realities of marketing (market) relationships. In turn, the transformation of the system of providing medical care to the population into a systemic mechanism that regulates supply and demand in the medical services market is dialectically conditioned by the underlying processes taking place in the country, in particular, by a fairly clearly defined stratification of society. The latter fact is reliably confirmed by separate studies of domestic authors, according to which in modern Russian society the following layers are conventionally distinguished (data taken from the book “Fundamental Foundations of Health Policy”, edited by O.P. Shchepin, M., 1999):

• oligarchy and governing bureaucracy - up to 7%;
• middle class - up to 12%;
• a layer of conditional poor - more than 60%;
• the lower groups of the population - less than 12%;
• desocialized citizens - up to 9%.

The interaction of all subjects of the healthcare system, especially in the system of compulsory health insurance, the definition of their functions, and, consequently, the formation of types and forms of relations between a doctor and a patient, is naturally associated with the specific characteristics of the population as a consumer of medical services. And such characteristics, as noted by A.V. Reshetnikov (2000) are gender, age, marital status, occupation, level of education and income of certain social groups, as well as psychographic data: belonging to a particular social stratum, lifestyle, personal and behavioral qualities.

It is on the basis of the real stratification of society that it is necessary to determine approaches to the specificity of the medical services market, its segmentation, especially in matters of characterizing industrial relations in these segments.

The field for the implementation of marketing relationships in medicine are certain segments of the medical services market.

Objectively, in the activities of medical institutions, there was a process of classifying patients into groups with different needs and requirements, characteristics or behavior. It is these criteria, along with some others, that determine segmentation of the medical services market in marketing systems, i.e. specification medical technologies and medical procedures that satisfy a certain demand of the patient (client), is objectively and naturally focused on specific potential consumers of a certain market segment. And all this, in turn, determines, in particular, the economic specificity of the doctor-patient relationship.

Given the above classification of the stratification of society (or, in principle, relying on any other possible classification), it is methodologically justified to single out segments of the medical services market that meet these conditional criteria.

In the study of this problem, in search of solutions to the outlined contradiction between the needs for medical services and the satisfaction of demand, the use of the medical services marketing model, a fragment of which is shown in Figure 4.5, helps.

Fig.4.5. A fragment of the medical services marketing model with elements characterizing the market segment.

The model, with a certain degree of assumption, in a generalized form, allows you to reveal and trace the patterns of relationships between elements and states of subjects (doctor and patient) in the medical services market. This segment of the model is used to search for specific characteristics that distinguish one segment of the medical services market from another. When studying the relationship between the elements of the model, an attempt was made to clarify the criteria for distinguishing the essence of medical care and medical services, as well as to outline the essence of a medical procedure in the corresponding market segment. In any of the segments of the medical services market, the medical needs and needs for medical care of a patient (client), regardless of belonging to a particular social stratum, are not related to his personal or social well-being: pathological conditions (illness) and the need to be healthy are species categories more biological than social. In this sense, regardless of social status patient (client), a specific type of medical service that meets a certain standard is interpreted by a specific psychosomatic state and the purpose of the appeal. At the same time, the demand and the possibility of acquiring a specific medical procedure from the variety of procedures that are adequate for a certain type of medical service are directly related to the patient's well-being and ability to pay. It is for this reason that in marketing systems a medical service, on the one hand, in its essence, remaining generally adequate to the specific psychosomatic state of the patient, regardless of its economic ability to meet demand, on the other hand, reflects some economic specificity of the patient. Otherwise, the medical service ceases to characterize the marketing essence of medical care. It is quite clear that the patient (client) from the layer of the ruling bureaucracy and the patient (client) social bottom- are not at all equivalent in the real demand for a medical procedure. Simply put, as patients, these two persons in unequivocal conditions requiring medical care are identical. But how do the clients of the marketing system of medical services, correlated with specific medical offers, differ from each other in their medical economic entity and belong to different segments of the medical services market. In the marketing system of medical services, it is the medico-economic group that primarily characterizes a specific segment of the health market, with unambiguous medico-diagnostic groups, which include patients (clients) of any socio-economic stratum of society.

At the same time, the assignment of a patient to a certain segment of the medical services market is also based on the characteristics of the client's personality, his well-being, which in the marketing system is described by the solvency and cost of the procedure with a possible specific demand. These characteristics, leaving unchanged the medical diagnostic group to which the patient is assigned according to his condition (diagnosis), determine the characteristic and specific case of medical care. It is in a specific case of medical care that medical activity, certain technologies and procedures are concentrated. It is the set of specific medical technologies and medical procedures, their economic essence with efficiency criteria that ultimately determine the appropriate price of a medical service. Thus, the price of a medical service in marketing systems is characterized by cost characteristics various medical procedures adequate to this specific service. While the cost of a specific medical procedure, among others, adequate to a medical service, is characterized by a corresponding demand. It is clear that the demand for a particular type of medical procedure in different market segments is different and, as noted above, depends on the personality and solvency of the client.

The diversity of demand for medical services (procedures), in accordance with the needs of patients (clients) of various social strata, in essence, gives rise to a variety of medical (medical) offers, their forms and content. The objective stratification of society according to the degree of well-being, apparently, should give rise to a variety of forms of medical institutions that provide medical services exclusively to contingents of a certain social group. Simply put, in a certain sector of the medical services market, medical institutions with relatively similar technologies for providing medical care will be competitive. Such a “stratification” of outpatient clinics and hospitals will lead to a natural division of medical, in particular, medical personnel according to professional qualifications. It can be assumed that the positive role of such differentiation is in the emergence of natural competition, both between medical institutions providing medical services in various market segments, and between specialists from these institutions who have the potential, within the framework of professional growth, to apply for work in medical institution, serving a more profitable, in economic terms, market segment. With such an approach, it seems possible to look at the problems of restructuring the healthcare industry from the standpoint of social demand for medical services and economic characteristics its (demand) satisfaction.

Based on the objective essence of the social stratification of society, highlighting the segments of the medical services market that correspond to the demand in a certain medical and economic group of patients (clients), it is possible to establish points of targeted social protection and support for those who need medical care, but are unable for certain reasons pay for the necessary medical procedure.

State guarantees in the protection of the health of citizens should cover those market segments that are associated with the unattractiveness of the sector for the manufacturer of medical services.

With such a methodological approach to segmenting the medical services market, it seems possible to develop mechanisms for correlating and redistributing funds between preferred (economically profitable) and non-preferred (economically unprofitable) segments.

4.5.2. Segmentation of the medical services market

With the equality of needs, generally referred to as medical, marketing relationships in health care give rise to fragmentation of the medical services market in accordance with certain, significantly different levels of needs for medical services. It is a wide range of medical needs, ranging from individual to group ones, their effective and high-quality satisfaction, taking into account diversity and commonality, that determine the essence of healthcare marketing systems. In this sense, the multistructural nature of health care systems, broad privatization as an extreme form of decentralization form the inalienable environment without which classical market relations are impossible.

The quality of medical care, free access to methods and forms of treatment, the natural possibility and implementation of the choice and appeal to any provider of medical services, the possibility of legal and economic influence in case of dissatisfaction or poor satisfaction of medical needs, the earnings of a medical worker associated with the results of work and patient satisfaction, legal and economic security of both the consumer and the provider of medical services is far from a complete list of positive characteristics inherent in healthcare marketing systems.

At the same time, it is necessary to reveal and explore the negative components of the medical services market. In particular, the negative nature of marketing relationships in healthcare includes the weakening of preventive measures, the rejection of medical services with a high share of the humanitarian mission of healthcare and a low degree of direct economic benefit, fears of discrimination against sick socially vulnerable groups in need of medical care, etc. Some of the contradictions of such problems can be overcome. remove with a methodological approach that considers such groups of patients, their medical needs and needs as peculiar and specific market segments, determines their rightful place in the healthcare marketing system and finds forms and methods to meet the needs and demand of customers of these segments.

Market segmentation is commonly referred to as the process of classifying consumers into groups with different wants and needs, characteristics, or behaviors.

Such a definition, although acceptable for the medical services market, can hardly fully reflect the specifics and differentiation of the provision of medical care.

It is known that for the consumer goods market, customer groups can be formed according to the following criteria: geographical, demographic, psychographic, behavioral.

To be economically useful, a market segment must have the following five characteristics:

1. it should be possible to measure it, i.e. information can be obtained on the fundamental parameters of the buyer;
2. the segment must be broad enough and/or profitable that it is worth developing a specific marketing plan for it;
3. accessibility: the enterprise must be able to effectively carry out its commercial efforts in the field of the selected segment;
4. the segments must be truly distinct, i.e. differ from one another in terms of set variables;
5. it must be possible for the enterprise to carry out its plan.

Closely related to market segmentation is the essence marketing.

Strategy undifferentiated marketing of medical services is to minimize differences between market segments, when first of all the general characteristics of consumers of medical services are taken into account, and then their difference. The medical and preventive institution seeks to obtain a license and introduce to the market such medical services (types of medical care) that will attract as many patients as possible, and strives to create a unique image in the mind of the buyer of medical services. Such a strategy is used if it can achieve cost reduction, but the company runs the risk of either getting into intense competition in this segment or incurring significant economic costs. Conditionally undifferentiated marketing of medical services could include immunoprophylaxis, preventive examinations of the population, etc.

Differentiated Marketing medical services- development of various types of medical services and directed programs of medical actions for each segment; By using variations of medical services and changing them, the medical institution (physician) hopes to receive higher revenues with optimal results and quality of care (CMC).

The dynamism of the health care strategy lies in the intelligent and timely combination of differentiated and undifferentiated marketing of medical services. The possibility of transferring a consumer of medical services from one segment to another determines the dynamism and area of ​​market viability of a medical institution or medical practice, and the relative degree of accessibility of medical services is characterized by the specificity of the market segment.

A medical service, being a specific form of a product, essentially determines the specificity of the segmentation of the medical services market.

Taking into account the relatively equal characteristics of consumers of medical services, market fragmentation can be carried out in the following main areas:

• social needs,
• medical needs,

The fragmentation of the market according to the possibilities of demand for medical procedures is carried out in accordance with economic groups, which are characterized by the type of medical service, medical diagnostic group, cost of the procedure, solvency and personality of the patient.

The development of a possible classification of segmentation of the medical services market is presented according to the following parameters:

1. by age and sex characteristics (men, women, children, adolescents, adults, the elderly);
2. by types of medical care (outpatient, hospital, obstetrics, dental, drug provision, etc.);
3. by decreed groups (healthy, sick, working in conditions associated with occupational hazards, military personnel, students, etc.)
4. by nosological groups (as a special case - by clinical examination groups);
5. by medical diagnostic groups;
6. by groups of equal medical standard;
7. by economic groups (well-being and solvency),
8. by types of medical services.

It is not possible to appeal to all health care buyers at once, as they have varied tastes and purchasing styles as well as income levels. From here, the direction of specialized segments of the medical services market emerges. In addition, competitors may well be located in some submarkets. Therefore, medical institutions (medical practices) should be interested in identifying those submarkets that will be most attractive to them and compatible with its goals and resources. With the same medical needs, needs, resources, geographical location, level of sanitary culture, purchasing attitudes, habits can be different. Any of these variables can be used as the basis for market segmentation. Ideally, a medical institution (the subject of medical practice) prefers to be the only one in its niche, the narrower this niche, the fewer competitors. But at the same time, the likelihood of large and wide sales of medical services also narrows. The niche of the medical services market segment is the more attractive, the more it corresponds to the following characteristics:

1. purchasers of medical services (patients) have complex and specific needs in meeting medical needs;
2. they are willing to pay a high price in order to receive absolute quality medical care, i.e. when medical procedures are absolutely adapted to their explicit and hidden needs;
3. the provider of medical services has a high, constantly improving professional and social competence;
4. the acquisition of this competence allows you to bypass competitors, hence “the ability of a medical worker to learn is becoming an increasingly important quality, even more important than practical experience, which quickly becomes obsolete” (O.P. Shchepin, 1999).

There is no single method for segmenting the medical services market. It is necessary to test segmentation options based on different variables, one or more at once, to find the most useful approach to consider the structure of such a market. Thus, the restructuring of the healthcare industry, taking into account its emerging marketing functions, in our opinion, should be carried out in accordance with the segments of the medical services market.

Apparently, state guarantees in the protection of the health of citizens should cover those market segments that are associated with the unattractiveness of the sector for the manufacturer of medical services, relying on profitability.

Thus, health care marketing systems, based on objective economic laws with many determinants, are characterized by certain market segments. Segmentation of the medical services market makes it possible to provide medical care (to satisfy a specific demand) both taking into account the individuality of the patient and taking into account the mass consumption of medical services.

4.5.3. The health market as one of the forms of specific marketing relations in the health care system

Adaptation traditional systems health care to the conditions of market relations, in particular, the implementation of a system of compulsory medical insurance, research of medical medical activity from the point of view of the production and sale of medical services, revealing the effect of economic laws in the organization and implementation of the treatment and diagnostic process - the objective realities of the modern stage of end-of-life medicine XX-beginning XXI centuries in terms of its developing essence and the search for new organizational forms to preserve and improve the health of the population.

Despite modern technocratic approaches in the assessment of medical activity and consideration of health care systems from the point of view of one of the production sectors of the state economy - the basis of the methods and techniques of healing, as in past historical periods public relations, there remain manifestations of fundamental contradictions in the relationship between the human organism and the environment.

It is the factors external environment and the internal state of a person give rise to a certain range of needs and lead to the formation of a system of appropriate proposals to meet the needs.

As you know, the social and hygienic significance of the medical problems of the individual can be considered from a variety of positions, the three main of which are: 1) mortality as a process of dying; 2) loss of health and disability (illness, temporary and permanent disability); 3) restriction of the freedom of the individual's life activity (loss of "quality of life").

In accordance with these conditional levels of medical and social problems, an individual has one or another feeling that a person feels as a lack of something: the ability to live, work, be healthy, etc. Such feelings in marketing systems are characterized by the element “need” and, in accordance with with the individuality and cultural level of the individual, give rise to certain individual or collective needs.

The target function of medical medical activity always has social utility if it represents an objective benefit for an individual, i.e. individually beneficial to his personal health, and therefore beneficial to public health. Health itself is not in market circulation. Specific medical needs lead to the need for medical care, some of which, acquiring the marketing essence of demand, generate a health market with its target functions and corresponding medical offers and actions.

Human needs, conventionally referred to as medical, can be legitimately correlated with the designated three levels of social and hygienic problems.

With this approach, three groups (complexes) of basic needs and needs are singled out, one way or another related to the need to purchase medical services: 1) the need to live; 2) the need to be healthy with the ability to work (a - the desire to return to normal with a temporary loss of ability to work, b - the desire to maintain a certain “niche” of working capacity in the presence of disability); 3) the need for the highest degree of freedom of life (physiological, psychosomatic, social), i.e. in this case, the state of need is characterized by the desire to achieve the highest degree of “quality of life”.

The above logic makes it possible to outline the boundaries of a kind of socio-economic field of the relationship between the patient and the doctor, in other words, to designate, although conditional, but quite definite boundaries of the medical services market and, within these boundaries, it is natural to correlate natural human needs and needs with the categories of the healthcare marketing system.

It is known that modern marketing includes, on the one hand, a certain environment for the functioning of a particular social - economic structure to meet consumer demand, on the other hand, the essence and form that determine the essence of the marketing system itself.

The market of medical services, on the one hand, is integrated within certain limits of specific needs and needs, on the other hand, it acquires a real opportunity, in a certain way, to be logically divided into segments.

Thus, in the system of medical marketing (offers of medical care) at the highest level of segmentation of the medical services market, it is legitimate to single out three main areas with specific forms of offering medical services and meeting medical needs (it is clear that the boundaries between these market segments are to some extent arbitrary) .

1. Medical offers of life-saving medical services (in particular, in the perinatal period, in case of extreme urgent conditions that threaten the life of the patient, in old age, etc.). Let's conditionally call this segment of the health market - “ marketing segment of life”.
2. Medical offers of medical services for the purpose of restoring health, restoring and maintaining a certain level of ability to work in case of its temporary loss. Detailing the types of medical services in this segment is carried out in the following areas: a) medical services aimed at treating acute and preventing exacerbations chronic diseases; b) medical services aimed at preventing the transfer of temporary disability into permanent disability (disability); c) medical services for the preservation and maintenance of a certain degree of chronic conditions and disabilities. We will conditionally call this segment of the health market “ disease marketing segment”.
3. Medical services that preserve and maintain the state of a relatively healthy body (immune prophylaxis, clinical examination, etc.). This segment is described as health marketing segment”.

Based on such a methodological approach, it seems rational to correlate, on the one hand, a certain segment of the market with the specific functions of medical (medical) work, on the other hand, to characterize these functions not only from the point of view of the humanitarian mission of health care (doctoring), but also to give types and a certain set of medical services economic characteristics corresponding to a specific market segment. Such segmentation of the health market seems to be justified precisely from the point of view of economic feasibility, a certain unification and, in particular, a prospective calculation of the profitability of medical medical activity,

Thus, when providing medical services aimed at saving the patient's life, the humanitarian mission of healthcare and the ethical side of medical activity, apparently, in modern society far superior to economic feasibility. Although any type of activity must be expressed by economic characteristics, if this activity is considered within the framework of marketing relations. It is in this segment of the market that the contradictions of the entities defined by the categories “medical care” and “medical service” are noticeably exposed.

Opening and searching for the resolution of objective internal contradictions between these categories leads individual researchers to a seemingly logical conclusion: medical services are subject to payment, and not medical care. And within the framework of measures to provide medical care, losses incurred as a result of a combination of certain medical (medical) actions are subject to compensation. In our opinion, such a methodological approach is fundamentally erroneous. Firstly, in this case, it will be necessary to distinguish in detail the types of medical activities into medical care and medical services, which is not always unambiguous, and one of the criteria for the difference is to determine the economic component, i.e., apparently, initially do not correlate the category “medical care ” with marketing characteristics, which immediately eliminates the market contradictions of these categories. Secondly, with the obligatory objective decision of the economic side of the provision of medical care in the form of compensation for material and resource losses, it will be impossible to determine the necessity and sufficiency of this particular volume of medical procedures by any qualimetric criteria. With this approach competitive advantages types and methods of medical care are fundamentally excluded. Thus, the category of “medical care” within the framework of the marketing relationship between the doctor and the patient, in accordance with the economic laws of meeting the needs and demand of the patient (client), begins to be characterized by the concept of “production and consumption of medical services”. Medical actions in the form of medical procedures universally and unambiguously characterize the target functions of the health market.

It must be recognized that in healthcare marketing systems such a concept as medical care, without detailing its essence and form, cannot always reflect, in particular, the economic component of the relationship between a doctor and a patient in the medical services market. At best, in the field of market relations, a certain set of medical services and other elements of the marketing system adequate to them can be generally described as medical care.

When providing medical services in the marketing segment of diseases, in which the needs and demand for medical procedures are determined by temporary needs in case of deviations in the psychosomatic state of the client (disease) - economic forces begin to play their part. The task of researchers is to characterize this market essence of medical care, to substantiate the place, degree of influence and predominance of marketing relationship factors in the system of other elements that characterize the “non-market” relationship between a doctor and a patient.

Finally, medical services aimed at meeting the needs of improving the “quality of life” in a modern civilized society in the health market can be characterized by a highly economic degree of profitability. AT modern conditions, the structure of the tariff for such medical services, in essence, should include the economic costs of producing medical services, which are possible in two other segments of the health market - the “marketing segment of life” and the “marketing segment of diseases”. In addition, the full satisfaction of the needs of consumers in this segment of the health market is largely associated not with medical medical activity, but is determined by other individual, natural and socio-economic factors.

The identification and study of the health segment in the medical services market allows, in particular, in the system of compulsory health insurance, to determine the essence and designate the place of preventive medical activity in the market conditions of doctor-patient relations.

The proposed approach to the basics of segmentation of the health market makes it possible to carry out further research within the indicated areas, to study the types of demand for a certain type of medical services in each of the segments; determine the size, growth and attractiveness of the segment in the health market according to objective criteria, using traditional medical and statistical indicators, reasonably correlating them with the economic characteristics of the doctor-patient marketing relationship.

4.5.4. Marketing essence of relations in the provision of preventive medical activities

The functioning of medical and preventive institutions in the system of market relations, in particular, in the field of compulsory medical insurance with its economic essence, forces the heads of hospitals and clinics, as well as private practitioners, to focus on the marketing processes of providing medical services and meeting the demand for various types of medical procedures, including preventive ones.

The variety of types and forms of medical care gives rise to certain problems in the conditions of market relations between a doctor and a patient. Such relationships, in addition to classical pre-market definitions, such as “providing medical care” or “seeking treatment,” acquire specific marketing features. Each of the directions of various types of medical (medical) activities, such as treatment, diagnosis, preventive examination, obstetric care, alleviating the suffering of a hopeless patient, etc., with the production essence of healthcare, acquires a marketing essence and must be formalized and uniquely defined in a peculiar way. In addition, in the course of research it turns out that various types of medical (medical) activities in the market relations of a doctor as a producer of medical services and a patient as a consumer of medical procedures are extremely unequal, and sometimes contradictory from the point of view of the economic feasibility of the market.

Thus, medical activities for the prevention of diseases in the field of market relations, at first glance, are not compatible with economic feasibility in the production and sale of medical services. In fact, the more healthy people, the less classical medical needs (need for treatment), the lower the demand for curative medical procedures - the less preferable this market is.

Medical activities of a preventive orientation, and in marketing relations - the production and sale of preventive (“non-curative”) medical services, can be legitimately associated with market segmentation.

As you know, market segmentation is understood as the process of classifying consumers into groups with different needs and requirements, characteristics or behavior.

Thus, the preventive orientation of medicine in marketing relations is realized within a certain segment of the medical services market. When operating with material, technical, personnel and financial resources in the system of compulsory medical insurance, as is known, the specifics of medical activity in this area are taken into account.

When forming and saturating with medical services aimed at preventing diseases and maintaining the health of the healthy, the characteristic and specific features of this market segment are highlighted, which include the following.

1. An extremely unattractive market segment in terms of the healthcare manufacturing mission. “Economic returns” from financial and resource costs in this segment are usually pushed back in time.
2. The needs of a potential buyer of medical preventive services in this market segment are highly dependent on his personal, individual, cultural and national qualities and traditions, as well as on a specific medical and social problem that interprets the corresponding drop or increase in demand. During a period of complete relative health potential consumer health care provider (patient, client) is convinced that he has nothing to buy from health care providers. Indeed, in a relatively healthy person, as a rule, there is no clear need to strengthen and maintain this particular healthy state and there is no consumer demand for any medical procedures. Such is the objective psychological essence of a healthy person.
3. A large proportion of these needs potential clients preventive medical services are classified as hidden and negative. The physiology of the human body, the pathogenesis of the course of diseases with the presence of a latent (latent) phase, the absence of symptoms perceptible by a person, a possibly existing or potential pathological process - all this unequivocally confirms the postulate that the need for disease prevention (acquisition of preventive medical services) is to a greater extent hidden need.
4. Based on the previous statement, in the market segment of preventive medical services, to a certain extent, there is a lack of consumer demand, or this demand is extremely low, and the inactive presence of a medical services provider in this market turns out to be extremely unprofitable.
5. For the manufacturer and seller of preventive medical services, the actual task is to generate demand, to translate hidden and negative needs into open and positive ones. Hence, in marketing activities with a similar market segment, the organizational forms of information and educational work acquire a paramount role, i.e. an extremely high share of costs in the cost of preventive medical services for advertising and other well-thought-out ways of influencing the buyer is objectively determined.
6. A potential client is characterized by a vaguely expressed satisfaction of hidden needs and the extreme remoteness of the medical services provided from the results of evaluating their effectiveness. For example, it is sometimes difficult for a patient to prove the need and expediency of immunoprophylaxis (prophylactic vaccination), and prophylactic medical checkup when confirming the healthy state of the prophylactic and not detecting pathology - at the household level, it seems to be ineffective.
7. Within this market segment, there is a high degree of differentiation of potential customers (children with a wide need for immunoprophylactic services, elderly people with the needs of dynamic monitoring and preventive measures to prevent exacerbations of existing diseases, etc.). In fact, effective marketing activity in this market segment is the implementation of the relationship of a medical worker with each specific individual client. Figuratively speaking, segmentation is reduced to the level of the individual.
8. A strong influence on the effectiveness of the provided preventive medical service by factors that are not directly related to medical activities. According to various scientific sources, the share of active effective influence on the preservation of the state of health of the population of organizational forms and methods of the health care system is, according to various authors, from 8-35% in a number of other natural factors and social institutions.

Relying on marketing concept, which argues that the key to achieving the goals of the organization is to determine the needs and requirements of target markets and provide the desired satisfaction in a more efficient and more productive way than competitors, it must be concluded that the marketing essence of a medical institution (medical practice) within the framework of preventive work is this is the study of certain contingents of the population, dynamic monitoring of the health status of these contingents for the purpose of early detection of diseases, registration, dynamic monitoring and comprehensive treatment, taking measures to improve working and living conditions, preventing the development and spread of diseases, strengthening the quality of life.

As you know, such a specific medical activity, within the framework of a preventive focus, is called medical examination.

In fact, the marketing essence of health care not only does not cancel the preventive orientation of medicine, but gives it one of the defining places and values ​​in market relations. Medical services of a preventive orientation, the target function of the marketing system, called clinical examination, forms its own specific niche in the segmented space of the medical services market.

Medical prophylaxis and its mighty conductor - prophylactic medical examination (N.A. Semashko) in the conditions of market relations is nothing but a specific marketing essence of a certain segment of the medical services market with the identification of the client's hidden medical needs.

Investigating and comparing two segments of the medical services market - treatment and diagnostic and preventive, we come to the conclusion that the true formation of consumer demand occurs to a greater extent with proposals for the provision of preventive medical services, while the target function of the market for treatment and diagnostic is paradoxically related to a decrease in consumer demand, i.e. reducing the incidence of potential buyers. It is the objective inverse relationship between supply and demand in the market of medical services of a medical orientation that is the specific essence of such a market segment. Its viability and necessity, and hence the desire of medical service providers to work in this market segment, is interpreted and based, first of all, on a firm belief in the natural and practically indestructible level of pathological conditions of the population, which in turn gives rise to medical needs.

In its own way marketing entity With economic incentives, the supply and demand for curative medical procedures are in conflict with the offers of preventive medical services.

The conditions for the implementation of medical preventive services require effective organization outreach and sales of these services by highly trained health professionals. Studies show that the essence of medical information in the framework of information-educational (advertising) and explanatory work in the conditions of market relations is fundamentally different from similar activities used in the classical system of medical education, and has its own objective marketing specifics.

Success factors in proposing to sell medical preventive services is the concept that health care facilities (physicians) are able to develop persuasive sales and demonstration methods, and thereby dispel the patient's doubts and inhibiting motives. It is necessary to highlight the hidden qualitative characteristics of preventive activities. Hence, the definition of strategic and tactical goals of medical institutions (medical practices) in the field of marketing of medical preventive services is seen in the field of Public Relation (public relations), the creation of organizational forms that provide the main ways to achieve the goals. Such activities, along with the medical institutions themselves, within the framework of marketing relations, could be successfully carried out by the structures of advertising agencies and PR agencies. It is trivial that a special role in propaganda healthy lifestyle life should be devoted to the media.

Considering that the activity in the field of providing preventive medical services within the framework of marketing relations is extremely undesirable for the provider of such services from an economic point of view and is not always positively unambiguous for a person, disease prevention, maintaining the quality of life should have the status of a national task. It is necessary to support any constructive organizations and associations of citizens aimed at maintaining health.

It is necessary to agree with the opinion and support the ideas of those who offer part of the profits received from the sale of alcohol, cigarettes, gambling business to be used for the needs of health prevention. The share of costs for unprofitable preventive medical activities should also be taken into account when setting tariffs for curative medical services.

Deserve attention and become extremely relevant in the light of the considered problem of the marketing essence of medical activity, proposals for the structure of the health care system, which would provide for three main areas:

• preservation and strengthening (improving the quality) of existing health;
• offer and provide medical services for the provision of medical care to the sick and injured;
• restoration of lost health and maintenance of life.

From the standpoint of dividing the humanitarian and economic missions of healthcare marketing systems, such an approach to the structure of the industry is quite logical: in activities to preserve health, support life, the priority is given to the humanitarian mission, at high economic costs (this market segment is highly undesirable); it should be recognized that when delivering medical services to the sick and injured within the framework of market relations, economic factors begin to play a predominant role (at best, the economic mission of healthcare is compared with the humanitarian one).

Division of the market of marketing systems of health care into certain segments, marketing research of these segments, the share ratio of supply and demand levels in them - to a certain extent, can characterize consumers of medical services in this segment in accordance with their state of health, and also describe the specificity of a particular healthcare system. Thus, health marketing systems (“health markets”) can be unambiguously represented and, in some way, correlated with objective demographic data, morbidity and physical development.

Comparing the volumes of supply and demand in the health markets, one can have a certain idea of ​​their features.

The preventive segment of the health market can be called such a market, which is dominated by supply and demand for preventive medical services. Consumers in this health market are characterized by a high degree of quality of life and a desire to improve this degree.

The medical segment of the health market is the type of market in which the need, demand and supply for medical and diagnostic procedures prevail, i.e. the share of demand and offers of medical care is extremely high. Such a market is most correlated with the incidence and morbidity of the population and, in turn, is subject to specific segmentation.

The social segment of the health market can be conditionally called a market where offers of medical and social services are aimed at maintaining the level of such conditions of consumers of medical services, in which it is objectively impossible to change them in the direction of improving the quality of life.

The ratio of preventive, curative and social segments generates a variety of health markets and health marketing systems.

The study of health markets, in particular, the allocation and study of the ratio of market segments, methodologically allows you to correlate the activities of the subjects of marketing systems of medical services. With such an approach, the priorities of offers and consumer demand for certain sets of medical services, from preventive to curative, are logically determined. There is an opportunity to consider and focus health markets on a specific demand, whether it be an individual consumer (patient) or state-level structures: local, regional, federal.

In our opinion, such is the dialectic of the functioning of marketing health care systems and the relations between the subjects of these systems. Studies show that elements of such specific relationships are inherent in the system of compulsory medical insurance introduced in the country.

The separation of interests (including financial ones) of the individual and the state in maintaining health contributes to an increase in the degree of “quality of life”, to the provision of treatment for each individual person, determines the specifics of offers and demand in the medical services market.

Environmental factors and the internal state of a person give rise to a certain range of needs and lead to the formation of a system of appropriate proposals to meet the needs.

There are three groups (complexes) of basic human needs and needs associated with the need to purchase goods and services:

o the need to live;

o the need to be healthy while maintaining working capacity, which forms the desire to restore health in the event of temporary disability and the desire to maintain partial working capacity in the presence of disability;

o the need for the highest degree of freedom of life (physiological, psychosomatic, social), when the need is characterized by the desire to achieve the highest degree of "quality of life".

The healthcare industry market is a set of existing and potential goods and services aimed at protecting and restoring health.

AT medical business the term "market" is used to define a group of consumers united on a common basis and distributed into several interconnected markets. These include:

1. Market of medical services.

2. Market of medicines.

3. Market for items and services in the field of sanitation and hygiene.

4. The market of non-traditional methods of treatment and rehabilitation.

5. Medical equipment market.

6. Market of medical technologies.

7. Health insurance market.

8. Market of scientific medical ideas.

9. The labor market of medical personnel.

10. The market of educational services in the field of health protection.

Characteristics of the medical services market

In the marketing systems of healthcare in Ukraine there is no place for such a concept as medical care, but there is an element of the market - a medical service. Medical care is a category of non-market relations between a doctor and a patient. According to the Constitution of Ukraine, medical care is provided to every citizen of the country free of charge in the network of state and municipal healthcare institutions. According to the legislation of Ukraine, in healthcare institutions of non-state form of ownership, emergency medical care is provided free of charge.

Features of the medical services market lie in the specificity of the work of medical workers, when saving the patient's life, the humanitarian mission of healthcare and the ethical side of medical activity far outweigh the economic feasibility and profitability of medical activity.

On the other hand, in a modern civilized society, medical services aimed at meeting the needs of improving the "quality of life" are characterized by a highly economical degree of profitability. The structure of the tariff for such medical services, in fact, includes the economic costs of producing medical services in two other segments of the health market: the "marketing segment of life" and the "marketing segment of diseases." Full satisfaction of the needs of consumers in this segment of the health market, to a greater extent, is not associated with medical medical activity, but is determined by other individual, natural and socio-economic factors. Except. The aforementioned medical services market has the following features:

o qualification requirements leading to a limitation in the number of practicing physicians;

o specific requirements leading to a limit on the number of hospitals that can dictate a certain pricing policy;

o imperfection and specificity of competition, which makes it impossible to attract buyers by reducing the price;

o medical services are heterogeneous and difficult to compare;

o there is no direct connection between the price and the costs of the consumer, a significant part of which is paid by a third party (relatives, employers, subject to voluntary medical insurance or the provision of a social bonus);

o the presence of external effects (externalities), the provision of medical services effectively affects not only the buyers of these services, but also other persons. For example, in connection with the development of spa treatment, access to healing springs is being developed, the infrastructure of the settlement (roads, supplies, etc.) is being developed, which is used not only by vacationers. Preventive vaccinations improve the overall epidemic situation.

In Ukraine and other countries of Eastern and Central Europe, the medical services market is characterized by an oligopoly, which has the following characteristics:

o a small number of competitors with significant entry barriers in the industry of new medical institutions;

♦ medical service within the framework of economic characteristics can be both standardized and differentiated;

♦ the effectiveness of medical care requires that the volume production capacity each medical institution occupied a large share of the total market of medical services. In this regard, there is a rather high degree of concentration of medical institutions within the region, in which the total share of cho-tirioh-eight medical institutions is not less than 60% of the total volume of needs for medical services;

♦ it is beneficial to expand the material and technical base of a medical institution to a large size due to weakness or lack of an attractive and moderate competition;

♦ absolute vertical interdependence of medical institutions, neutralizing effective mechanisms of competitiveness;

♦ predominantly non-price competition in the production and consumption of medical services in the system communal form providing medical care.

There are three main areas with specific forms of offering medical services and meeting medical needs.

I. Medical offers of life-saving medical services (in particular, in the perinatal period, in case of extreme urgent conditions that threaten the life of the patient, in old age, palliative medical services for incurable diseases, etc.). Conventionally, this segment of the health market is called the "marketing segment of life."

II. Medical offers of medical services for the purpose of restoring health, restoring and maintaining a certain level of ability to work in case of its temporary loss. This segment of the health market is conditionally called the "disease marketing segment". The types of medical services in this segment are distributed in the following areas:

♦ medical services aimed at the treatment of acute and prevention of exacerbations of chronic diseases;

♦ medical services aimed at preventing the transition of temporary disability to permanent disability (disability);

♦ medical services for the preservation and maintenance of a certain degree of chronic conditions and disabilities.

III. Medical services that preserve and maintain the state of a healthy body.

This segment includes immunoprophylaxis, clinical examination, cosmetic services, and so on. This segment is characterized as the "health marketing segment".

In the system of market relations, 4 groups of market counterparties are distinguished, between which the main types of economic relations and economic relations are implemented. With the development of elements of market relations, the concept of a medical subject appeared as a producer of medical services.

Medical entity - provider of medical services - a registered and duly licensed medical institution of any legal form and form of ownership that provides medical services.

Counterparties of the medical services market are:

♦ other healthcare institutions involved in the implementation of a complex medical and diagnostic process (suppliers medicines, medical products, companies that sell and maintain medical equipment, healthcare organizations, which, if necessary, are contacted to get advice from narrow specialists, and the like);

o financial and credit organizations that provide banking services such as leasing and factoring, provide loans, perform intermediary services of voluntary medical insurance;

o the state involves healthcare institutions in the implementation of government programs in the field of healthcare, provides tax incentives;

o citizens - a group that is heterogeneous in composition, functions in the implementation of economic relations in the market.

Positive features of the medical services market:

o improving the quality of medical care, in particular medical services;

o free access to methods and forms of treatment;

o the possibility and implementation of the choice of any provider of medical services;

o the possibility of legal and economic influence in case of dissatisfaction or poor-quality satisfaction of medical needs;

o healthcare worker earnings related to performance and patient satisfaction;

o legal and economic security, both for the consumer and the provider of medical services.

Negative features of the medical services market:

o relaxation of preventive measures,

o rejection of medical services with a high proportion of the humanitarian health mission and a low degree of direct economic benefit;

o Discrimination of sick socially vulnerable groups in need of medical care.

Some negative features of the medical services market can be removed with a methodological approach that considers various groups of patients, their medical needs and needs as unique and specific market segments, determines their rightful place in the healthcare marketing system and finds specific forms and methods to meet the needs and demands of customers. these segments.

Segmentation of the medical services market According to the possibilities of demand for medical services, it is carried out in accordance with economic groups, which are characterized by the type of medical service, medical diagnostic group, cost of the procedure, solvency and personality of the patient.

There is no single method for segmenting the medical services market. Therefore, health care institutions in the management marketing activities testing different segmentation options based on different variables, one or more at once, in order to find the most useful approach to consider the structure of such a market.

Classification of segments of the medical services market carried out according to the following parameters:

o age and gender characteristics (men, women, children, adolescents, adults, the elderly);

o by types of medical care (outpatient, hospital, obstetrics, dental, drug provision, etc.);

o for decrees to groups (healthy, sick, people working in occupationally harmful conditions, military personnel, students, etc.);

o for nosological groups (as a special case - for clinical examination groups);

o medical diagnostic groups;

o groups of equal medical standard;

o economic groups (well-being and solvency);

o by types of medical services.

It is not possible to reach out to all health care buyers at once, as they have different needs in terms of maintaining and restoring health, differ in the style of receiving services, as well as in income levels. This determines the direction of specialized segments of the medical services market.

On the other hand, some submarkets may well have competitors. Therefore, health care institutions (medical practices) should be interested in identifying those submarkets that will be most attractive to them and compatible with goals and resources. With the same medical needs, there may be different needs, resources, geographical location, level of sanitary culture, purchasing power, habits. Any of these variables can be used to segment the market.

Ideally, a medical institution (a subject of medical practice) should be the only one in its niche, the narrower this niche, the fewer competitors. But at the same time, the likelihood of large and wide sale of medical services also narrows. The niche of the medical services market segment is the more attractive, the more it corresponds to the following characteristics:

♦ purchasers of medical services (patients) have complex and specific needs in meeting medical needs;

♦ patients are willing to pay a high price in order to receive medical care of absolute quality, that is, when medical procedures are absolutely adapted to their explicit and hidden needs;

♦ the provider of medical services has a high professional and social competence, which is constantly being improved. Since the healthcare industry is knowledge-intensive, the ability of medical workers to continuous improvement their qualifications and focus management personnel medical institution for implementation innovative technologies in diagnostic and therapeutic processes.

Thus, the segmentation of the medical services market has the ability to provide medical care (to satisfy a specific demand) both taking into account the individuality of the patient and taking into account the mass consumption of medical services.

The fundamental essence of the modern period of reforming the domestic health care system, along with others, is characterized by objective conditions under which a medical service becomes a commodity, and the relationship between producers and consumers of medical services (in particular, a doctor and a patient) essentially begins to be defined as marketing with a predominant role of the patient .

Classical civilized market relations, as you know, are subject to economic laws, are specific in management and are in conflict with the methods of administration. In the field of market relations, medical care, as a kind of production activity, is filled with economic characteristics.

Prior to that, conditional groups of patients (patients of the same nosology, decreed contingents, persons from dispensary observation groups, etc.) begin to correlate with structures characteristic of the market. The field for the implementation of marketing relationships in medicine is certain segments of the medical services market, the diversity of which in form and content reflects in healthcare, as in the social structure of society, one of the principles of democracy.

At the same time, with the equality of needs, generally referred to as medical, marketing relationships in health care give rise to fragmentation of the medical services market in accordance with certain, significantly different levels of needs for medical services. It is a wide range of medical needs, ranging from individual to group ones, their effective and high-quality satisfaction, taking into account diversity and commonality, that determine the essence of healthcare marketing systems. In this sense, the multistructural nature of health care systems, broad privatization, as an extreme form of decentralization, form the inalienable environment without which classical market relations are impossible.

The quality of medical care, free access to methods and forms of treatment, the natural possibility and implementation of the choice and appeal to any provider of medical services, the possibility of legal and economic influence in case of dissatisfaction or poor satisfaction of medical needs, earnings of a medical worker associated with the results of work and patient satisfaction, legal and economic security, both for the consumer and the provider of medical services - this is not a complete list of positive characteristics inherent in marketing healthcare systems.

At the same time, it is necessary to reveal and explore the negative components of the medical services market. In particular, the negative nature of marketing relationships in healthcare includes the weakening of preventive measures, the rejection of medical services with a high share of the humanitarian mission of healthcare and a low degree of direct economic benefit, fears of discrimination against sick socially vulnerable groups in need of medical care, etc. Some of the contradictions of such problems can be overcome. remove with a methodological approach that considers such groups of patients, their medical needs and needs as peculiar and specific market segments, determines their rightful place in the healthcare marketing system and finds forms and methods to meet the needs and demand of customers of these segments.

Market segmentation is commonly referred to as the process of classifying consumers into groups with different wants and needs, characteristics, or behaviors.

Such a definition, although acceptable for the medical services market, can hardly fully reflect the specifics and differentiation of the provision of medical care.

In the literature available to us, scientific developments were not found to be an acceptable classification of segments of the medical services market.

It is known that for the consumer goods market, customer groups can be formed according to the following criteria: geographical, demographic, psychographic, behavioral.

To be economically useful, a market segment must have the following five characteristics.

1. It must be possible to measure it, i.e. information on the fundamental parameters of the buyer can be obtained.

2. The segment must be broad and/or profitable enough to warrant a specific marketing plan.

3. Possibility of access. The enterprise must be able to effectively carry out its commercial efforts in the field of the selected segment.

4. Segments must be truly distinct, i.e. differ from one another in terms of set variables.

5. It must be possible for the enterprise to fulfill its plan.
Closely related to market segmentation is the essence marketing.

The strategy of undifferentiated marketing of medical services is to minimize differences between market segments, when first of all the general characteristics of consumers of medical services are taken into account, and then their difference. The medical and preventive institution strives to obtain a license and introduce to the market such medical services (types of medical care) that will attract as many patients as possible and strives to create a unique image in the mind of the buyer of medical services. Such a strategy is used if it can achieve cost reduction, but the company runs the risk of either getting into intense competition in this segment or incurring significant economic costs. Conditionally undifferentiated marketing of medical services could include immunoprophylaxis, routine examinations of the population, etc. in essence, the state should be the buyer of such medical services.

Differentiated marketing of medical services- development of various types of medical services and directed programs of medical actions for each segment; using variations of medical services and changing them, the medical institution (physician) hopes to receive higher revenue with optimal results and quality of medical care (CMC).

The dynamism of the health care strategy lies in the intelligent and timely combination of differentiated and undifferentiated marketing of medical services. The possibility of transferring a consumer of medical services from one segment to another determines the dynamism and area of ​​market viability of a medical institution or medical practice, and the relative degree of accessibility of medical services is characterized by the specificity of the market segment.

A medical service, being a specific form of a product, essentially determines the specificity of the segmentation of the medical services market.

Taking into account the relatively equal characteristics of consumers of medical services, market fragmentation can be carried out in two main directions:

• social needs,
• medical needs,

The development of a possible classification of segmentation of the medical services market is presented according to the following parameters:

• by age and sex characteristics (men, women, children, adolescents, adults, the elderly);
  
• by types of medical care (outpatient, hospital, obstetrics, dental, drug provision, etc.);
• by decreed groups (healthy, sick, working in conditions associated with occupational hazards, military personnel, students, etc.)
• by nosological groups (as a special case - by clinical examination groups);
• by medical diagnostic groups;
• by groups of equal medical standard;
• by economic groups (well-being and solvency),
• by types of medical services.

A. Buyers of medical services (patients) have complex and specific needs in meeting medical needs;
B. they are willing to pay a high price in order to receive medical care of absolute quality, i.e. when medical procedures are absolutely adapted to their explicit and hidden needs;
B. the provider of medical services has a high, constantly improving professional and social competence;
G. the acquisition of this competence allows you to bypass competitors, hence “the ability of a medical worker to learn is becoming an increasingly important quality, even more important than practical experience, which quickly becomes obsolete” (O.P. Shchepin).

There is no single method for segmenting the medical services market. It is necessary to test segmentation options based on different variables, one or more at once, to find the most useful approach to consider the structure of such a market. Thus, the restructuring of the healthcare industry, taking into account its emerging marketing functions, in our opinion, should be carried out in accordance with the segments of the medical services market.

Apparently, state guarantees in the protection of the health of citizens should cover those market segments that are associated with the unattractiveness of the sector for the manufacturer of medical services, relying on profitability.

Thus, health care marketing systems, based on objective economic laws with many determinants, are characterized by certain market segments. Segmentation of the medical services market makes it possible to provide medical care (to satisfy a specific demand) both taking into account the individuality of the patient and taking into account the mass consumption of medical services.

Literature index.

1. G. Zharkovich et al., / Health policy issues in the former socialist countries (Strategy for improving health systems in the former socialist countries), M., - 1998 - pp. 18-19.
2. O.P. Shchepin, Modern stage health care reforms and ensuring the availability of medical care in Russian Federation. // Problems of social hygiene, health care and the history of medicine, No. 3 - 1999 - p. eight.
3. R.A. Galkin et al. / Marketing, lysine, logistics in health care. - "Perspective". - Samara - St. Petersburg, - 1998 - p.32.