Toward a Model of Word-of-Mouth in the Health Care Sector

An important source of health information is word of mouth (WOM). Nevertheless, a model describing WOM in the health care sector does not exist. The aim of this paper is to contribute to research by providing concrete suggestions for a model of word of mouth in the health care sector. A conceptual framework comprising the theory of cognitive dissonance, the theory of the strength of weak ties, and the theory of perceived risk are used as a theoretical anchor. In order to gain a more precise knowledge of WOM in the health care sector, a literature review of leading health care journals is conducted. The findings are summarized in the form of a model proposal describing the creation, spread, and impact of WOM in the health care sector. As the model summarizes the current WOM literature, it seems to be a good starting point for further research by scholars. The paper also helps practitioners to better understand WOM and integrate the WOM aspects described into their daily work.     

A relationship maintenance model: A comparison between managed health care and traditional fee-for-service

This article proposes and tests a model of the patient-physician relationship maintenance process. The model is based on constructs from social exchange theory and Rusbult's investment model. A patient's commitment to their relationship with their physician is conceptualized based on a three-component model of commitment. The three components of commitment (affective, continuance, and obligation commitment) are examined in an interpersonal setting. A general model of the patient-physician relationship maintenance process is first tested. Then the model is tested separately on a traditional fee-for-service subsample and a managed health care subsample (HMO, PPO). The results indicate that the relationship maintenance process is different in the traditional fee-for-service group than the managed health care group. Specifically, affective commitment is more important for traditional fee-for-service patients and satisfaction and continuance commitment are more important for managed health care patients.     

Some conjectures about access to US health care for disposed people

This paper hypothesizes the extent of access to health care by disposed people, particularly in the US. The disposed are people ‘thrown away’ as used‐up commodities. This paper briefly examines the theoretical idea of disposability. It then presents the basic results of new research showing that a sample of Americans sees that people in several different occupations are equally liable to be disposed. The section that follows proposes that the access these disposed people have to the US health‐care system is minimal overall and is not likely to improve. Because this total grouping has not previously been studied as a whole, these hypothetical findings are partly based on subsets of the disposed: the poor; those without health insurance; and the unemployed.     

The Power of Social Network Construction and Analysis for Knowledge Discovery in the Medical Referral Process

The social network model is powerful enough to provide for the analysis and study of a variety of application domains from daily life, including health care and health informatics. After the widespread appearance of automated tools capable of deriving and analyzing social networks, social network analysis (SNA) and mining in the health care domain has recently received considerable attention for its key role in understanding how various bodies within the health care system form communities and how they are socially connected with each other. This understanding helps enhance the organizational structures and process flows, among others. In this article, we show how SNA techniques can solve issues in the medical referral system in the Canadian health care system and the like, by analyzing the social network of general practitioners (GPs) and specialists (SPs). One of the main targets is to optimize the communication between GPs and SPs with hopes of decreasing the waiting time of patients to be seen by SPs. Various SNA and mining techniques are described and analyzed, backed by reporting some experimental results.     

Evaluations of Tactics for Automated Negotiations

Automated negotiation under the infrastructure of e-commerce is becoming an important issue. However, although the communication protocols and frameworks of automated negotiation have been extensively investigated, the corresponding tactics and strategies are still underdeveloped and need to be evaluated further. Based on the negotiation model proposed by Faratin et al., this paper examines the performance of automated negotiation tactics and intends to provide concise suggestions for the users of automated negotiation. First, theoretical analysis is used to evaluate the behavior-dependent tactics. Constructive conclusions are obtained when single-issue negotiations are considered. Next, a new framework for applying single-issue tactics to multi-issue negotiation is proposed. Based on this framework, theoretical analysis is then extended to multi-issue cases. Finally, different from the previous work, exhaustive simulations based on two-issue negotiations are performed to evaluate the effectiveness of behavior-dependent and time-dependent tactics. The experimental results provide several important insights into negotiation tactics.     

Extended Framework for Modeling Choice Behavior

We review the case against the standard model of rational behavior and discuss the consequences of various anomalies of preference elicitation. A general theoretical framework that attempts to disentangle the various psychological elements in the decision-making process is presented. We then present a rigorous and general methodology to model the theoretical framework, explicitly incorporating psychological factors and their influences on choices. This theme has long been deemed necessary by behavioral researchers, but is often ignored in demand models. The methodology requires the estimation of an integrated multi-equation model consisting of a discrete choice model and the latent variable model system. We conclude with a research agenda to bring the theoretical framework into fruition.     

New directions in injury surveillance: Development of a model for continuous monitoring of direct medical costs

Information on the costs of injuries is an important additional instrument in setting priorities for injury prevention. The importance of this instrument is increasingly being recognized by health policy makers. The objective of this study was to develop a model which continuously monitors the direct medical costs of injuries in The Netherlands. This model should provide information on the direct medical costs of injuries at any time and for any selection of injury categories. It is an incidence-based model according to the ‘bottom up’ principle. Homogeneous patient groupings with respect to health care use are defined. The groupings are based on existing classifications from the literature and the experience of medical experts, and are defined by means of seven criteria: nature of care provided, body region of the injury, type of injury, severity of injury, age, complications, and sex of the patient. Several cost elements are distinguished (e.g., general practitioner help, hospital care, nursing home care). For each cost element, relevant patient groupings are determined. The new Dutch Injury Surveillance System (LIS) for injuries treated in an A&E department is an important source for incidence data. This article presents the design of the model as adopted by the Working Group on the Costs of Injuries of the European Consumer Safety Association (ECOSA).     

How do you feel today? Managing patient emotions during health care experiences to enhance well-being

Health care customers (patients) experience heightened emotions due to high stakes from risks to life, health, and well-being. Understanding and managing emotions during service experiences is an important area of inquiry because emotions influence customer perceptions, future intentions and behaviors. Yet despite its significance, research focusing on the impact of emotions on customer experiences remains fragmented, lacking a theoretically based conceptual framework. The authors attempt to fill this gap by addressing two important research questions contextualized in health care: (1) How can health care organizations better understand patient and family emotions during health care experiences? and (2) How should health care organizations use this understanding to design and better manage patient experiences to enhance patient well-being? The authors propose a new theoretically based framework on emotional responses following triggering events to enhance outcomes. Recommendations designed to enhance health care customer well-being are provided, as are directions to guide future work.     

基础设施投入对服务贸易结构影响的实证研究——来自跨国面板数据的证据

本文基于要素禀赋理论和动态比较优势理论,将基础设施投入引致的要素积累效应纳入H.Oniki和H.Uzawa(1965)的分析框架,探讨了广义基础设施投入影响服务贸易结构的理论作用机制,并在此基础上建立动态面板模型,采用系统GMM两步法对80个不同收入水平国家及其分群组在1996-2010年的数据进行了实证分析。研究发现,交通、能源和通讯等经济性基础设施变量与服务贸易结构水平呈显著正相关;社会性基础设施变量中,研发基础设施具有正向作用,医疗、教育和环保基础设施却呈负向作用,同时研发、医疗和教育基础设施变量均有显著的滞后效应;进口贸易有利于服务贸易结构优化,而FDI和服务业发展水平作用不显著。对于不同收入水平的国家,不同基础设施投入的影响作用存在差异。     

Purchasing natural personal care products in the era of fake news? The moderation effect of brand trust

Natural personal care products are gaining popularity due to their benefits in terms of health and well-being. However, consumers are wary of these products and are guided by the fake news circulating about them. Since natural product consumption offers several personal and environmental benefits, it would be worthwhile to understand consumers’ tendency to let fake news influence their consumption decisions. Accordingly, the current study examined the association of fake news and purchasing behaviour towards natural personal care products, utilising Stimulus-Organism-Behaviour-Consequence (SOBC) as the theoretical framework. The study proposed openness to change as the stimulus, perceived benefits and perceived risks as organismic internal states, purchase intentions as the behaviour, and the propensity of believing and acting on fake news as the consequence, which is further associated with system trust. The model was tested by analysing data collected from 390 existing consumers, considering the moderation effect of brand trust and controlling the effect of age and gender. The findings confirmed that openness to change is associated with perceived benefits and risks. Furthermore, perceived benefits and system trust are associated with purchase intentions, which are, in turn, associated with the propensity of believing and acting on fake news. The study presents several novel contributions to theory and practice.     

An integrative model of customers' perceptions of health care services in Taiwan

As the health care service gets more competitive, health care practitioners and academic researchers are increasingly interested in exploring how patients perceive the quality and value of their care before building up their satisfaction levels and generating behavioural intentions. Drawing some theories from marketing and health care service literature, this study tries to propose an integrative model of customers' perceptions of health care services based on the established relationship among four key constructs (service quality, perceived value, satisfaction, and behavioural intentions). Structural equation modelling is then used to validate the model. As Taiwan's universal health insurance offers every citizen equal financial access to all health care providers, Taiwan offers a good opportunity to study how the patients' perception model is structured. The findings reveal both perceived quality and value as antecedent variables in this model illustrating direct and indirect paths from perceived quality and value to patient satisfaction and behavioural intentions.     

Why do not you read the label? – an integrated framework of consumer label information search

This article facilitates deeper insight into label‐related consumer information acquisition behaviour. An integrated framework of label information search (LIS) has been developed based on a synthesis of related literature and explorative research conducted by analysing online discussions among customers (netnography). The framework focuses on three main groups of personal factors that serve as antecedents of LIS: general personal factors (e.g. health consciousness and socio‐demographics), label‐related personal factors (e.g. label‐related self‐efficacy, trust in labels and the perceived usefulness of labels) and product category‐related personal factors (trust in food products, enduring involvement, experience and perceived quality differences). Important characteristics of the framework are its process‐oriented nature and the dynamically changing relationships among its concepts. LIS is an antecedent to and a consequence of influencing factors. This article offers managerial implications and serves to incite future inquiry in this field.     

Beyond Technology Adoption: An Embeddedness Approach to Reduce Medication Errors

Medication errors are causing harm, and even death, to hospital inpatients. These preventable errors occur at the hands of the same individuals who are charged to protect and provide care to patients—health care professionals. While decision support technologies are available to assist health care providers, patients continue to experience incorrect medications, inaccurate doses/rates of medication, duplicate doses, medication interactions, and other medication errors. This article investigates the reasons that health care professionals in hospital environments underutilize medication administration technologies and argues that a fusion view can provide guidance to increase their use. A Fusion Model is developed using the concept of embeddedness, the Technology Acceptance Model, the Task-Technology-Fit Model, and drawing on ethnographic fieldwork conducted at a modern hospital in the United States. The most important findings of this research are: (1) the concept of embeddedness can be used to study and frame fusion of technology in an environment; (2) four constructs (i.e., task characteristics, technology characteristics, individual use behavior, environmental characteristics) are identified and used to describe system characteristics needed to support medication decisions; and (3) guidance is provided for design and evaluation of decision support technologies for medication administration in hospitals.     

A critical review of primary health care reform in Bulgaria: impact on consumers

The Health Care System in Bulgaria is in a period of transition and is undergoing profound changes in financing, organization and ownership. A priority of this reform is to shift the focus of healthcare to the primary sector and to emphasize general practice. New legislation in support of this health care reform has been passed over the last few years. However, this legislation, although consistent with the global aims to be achieved, has proven to be contradictory in terms of its practical implementation. This has had a negative impact on health care consumers’ interests and rights. This paper evaluates the effects of primary health care reform in Bulgaria from the perspective of patient satisfaction. For this purpose, a major task to be fulfilled is to identify the contradictions emerging between the legislation outlining the reforms and the realities of practical implementation with respect to its impact on consumers. The methods applied include: a review of the legislation, a review of the practical progression of the reform process, and an assessment of the new developments in health care consumers’ interests and rights. Considerable contradictions have been found between the legal framework of health care reform in primary care and existing experiences, traditions and expectations. The legislation is inconsistent with the existing realities of healthcare provision. This is leading to turmoil in the health care system during its present transformation and is infringing upon consumers’ rights. Problems emerging in the process of reform need to be identified, and solutions need to be found and worked out as the reforms progress. An assessment system has to be developed to monitor the overall reform process and to evaluate the effectiveness and efficiency of the changes introduced. The impact on consumer and patient satisfaction should be an area of prime concern during these assessments.     

Anatomy of competitive advantage: towards a contingency theory of entrepreneurial marketing

Entrepreneurial marketing (EM), born out of the practice of firms operating in conditions of uncertainty, is emerging as a powerful alternative to cope with the decreasing effectiveness associated with traditional marketing. In this article, the authors provide their collective position regarding the field of EM. A brief history and conceptual background of EM is presented and the contextual differences that have shaped its evolution are considered. Distinctions between traditional and EM are derived based on discussions of the concepts of size, speed, market, opportunity, risk, and uncertainty. The perspective of value co-creation in uncertainty is used to develop a contingency framework to serve as the foundation towards a general theory of EM. Operand and operant resources and environmental conditions are proposed to moderate the EM process from opportunity recognition to entrepreneurial organization, EM, and temporary competitive advantage. The theoretical facets are illustrated with seven propositions and directions for future research.     

An economic perspective on health politics and policy

This article uses a self-interest model to explain health care legislation. Seemingly uncoordinated, contradictory, inefficient, and inequitable legislative outcome are shown to be the result of a rational process in which the participants, including legislators, act according to their calculation of costs and benefits. Those groups able to offer political support receive net benefits at the expense of those who are less politically powerful. This framework is used to examine different types of health legislation with the emphasis on explicit redistributive policies such as Medicare and Medicaid.     

Eco-Enterprise Strategy: Standing for Sustainability

Enterprise strategy provides an accepted theoretical framework for integrating the moral responsibilities of organizations into their strategy formulation and implementation processes. We argue that, when extended to the ecological level of analysis, enterprise strategy provides a sound theoretical framework for ethically and strategically accounting for the ultimate stakeholder, planet Earth. Within the framework of enterprise strategy, a value system based on sustainability can provide a sound ethical basis for developing ecologically sensitive strategic management systems which allow organizations to satisfy the demands of the myriad green stakeholders that represent the planet in the immediate business arena. This provides a new "flavor" of enterprise strategy in which organizations "stand for sustainability." We call this new flavor "eco-enterprise strategy."     

Exploring creative marketing thought: Divergent ideation processes and outcomes

Most marketing professionals deem creativity vital to successful marketing performance. However, while previous research has advanced an understanding of creative organizations, much less is known about the cognitive processes that direct the creative thinking of marketing professionals. This article presents a theoretical framework, the Divergent Marketing Thought Model (DMTM), that explores the ideation modes, processes, and outcomes involved in the generation of divergent marketing thought. The proposed model, which is based on a synthesis of research from psychology, marketing, and creativity, offers insight into specific divergent ideation processes that mediate the generation of creative marketing thought. Informed by the DMTM, several formal research propositions are advanced.     

The nature and extent of service user involvement in critical care research and quality improvement: A scoping review of the literature

The importance of involving patients and the public in health care research is globally recognized, but how best to do this in critical care is unclear. The aim of this first published review was to explore the extent and nature of evidence on service user involvement in critical care research and quality improvement. Using the scoping review framework described by Arksey and O'Malley ( 2005 ), a team of service user and critical care researchers searched eleven online databases, reviewed relevant web sites, conducted forward and backward citation searching and contacted subject experts. Extracted data were subjected to a narrative synthesis based on the objectives of the review. Findings from a broad range of evidence support that involvement is becoming more commonplace and that experiences are generally positive. Data extracted from 34 publications identify that involvement is most commonly reported at the level of consultation or participation in project teams, however, the extent to which involvement impacts on projects output remains unclear. Key barriers and facilitators relate to the challenge of recruiting a diverse group of service users, dealing with power hierarchies, being adaptable and effective consideration of the resource requirements. More research is required to identify the most effective methods to support the opportunity for involvement and more thorough reporting of service user involvement practices is strongly recommended.     

A Responsibility Ethics for Audit Expert Systems

To effectively pursue ethical action, the business community must recognize that the fundamental form of human association is not the "social contract" into which persons enter as atomic individuals, making partial commitments to each other for the purpose of gaining limited common ends or of satisfying certain laws. The fundamental form of human association is rather the face to face community in which ongoing commitments are the rule and in which aspects of every individual's experience are conditioned by the continuing membership. The following discussion initiates a preliminary phase in the consideration of what constitutes ethical issues associated with the business applications of expert systems. The focus is on knowledge based expert system applications in public accounting, specifically in the audit domain. Prior research on the development and use of expert systems in auditing has focused on a limited set of ethical issues. Niebuhr's theory of the "the responsible self" is used here to broaden the scope of what constitutes an ethical issue and provides a framework for identifying responsible action. Within this framework, an action is responsible if it takes into consideration ongoing relationships among the stakeholder groups affected. Actions prior to the development of the system along with the potential consequences for the system must be considered. The discursive requirements that provide the context and conditions necessary for implementing the proposed theoretical framework are presented and an illustration of how the responsibility ethic can be implemented in the audit expert system domain is developed.