Does the Patient Really Act Like a Supermarket Shopper?
A Semiotic Typology of Patients’ Attitudes and Expectations towards the Health-Care
System and the Consumption of Medicines
Isabelle Chalamon
Groupe ESC Dijon-Bourgogne
29, rue Sambin, BP 50608,
21006 Dijon Cedex
France.
Email: isabelle.chalamon@escdijon.eu
Benoit Heilbrunn
ESCP-EAP
79, avenue de la République, 75011 Paris
France.
Email: bheilbrunn@escp-eap.net
Inès Chouk
IUT de Cergy-Pontoise,
Département Techniques de Commercialisation,
Site de Cergy Saint-Christophe,
49, avenue des Genottes –
BP 8428, 95806 Cergy-Pontoise cedex
France.
Email: ines_chouk@yahoo.fr
Does the Patient Really Act Like a Supermarket Shopper?
A Semiotic Typology of Patients’ Attitudes and Expectations towards the Health-Care
System and the Consumption of Medicines
Abstract
The purpose of this paper is to propose a general typology of patients’ attitudes and
expectations towards the health-care system and medicines consumption. Four types of values
expressed by patients are identified via a semiotic analysis of patients’ expectations. These
value types are labelled functional, existential, critical, and hedonistic. Based on these values
we then empirically identify four patient profiles. From a managerial point of view, this
research provides a segmentation tool relevant for the health-care sector and enables
managers in the health-care industry to identify communication strategies which are adapted
to the different types of patients.
What do patients expect of the health-care system? How can we explain the diversity of these
expectations and how can we classify them? The purpose of this paper is to answer these
questions by proposing a general typology of patients’ attitudes and expectations towards the
health-care system and medicines consumption.
In the health-care sector, the patient occupies a more and more central place. Increasingly
active in health-care decision making (Shaffer and Sherrell 1995; Charles, Gafni, and Whelan
1999; Stevenson, Barry, Britten, Barber, and Bradley 2000), the patient is often treated as a
"participant actor", as a "patient-expert" (Barbot 2002; Fox, Ward, and O’Rourke 1999), or as
a "consumer" of medicine and health-care. He (or she)’s involved in his/her own diagnosis
and treatment, (Herzlich and Pierret 1984) and is actively in search of information (Risker
1996; Wagner, Hu, and Hibbard 2001). The patient, as a final user of the health care system,
is thus emerging as an increasingly pivotal research object.
The existing literature presents many typologies such as patients’ preferences for various
attributes of the doctor-patient relationship (Vick and Scott 1998), patients’ participation in
healthcare decision-making (Flynn, Smith, and Vanness 2006), patient’s behaviours in healthcare services (Shaffer and Sherrell 1995) and of patients’ satisfaction (Singh 1990). Two
main limits of these approaches can be identified. Firstly, these typologies focuse only on one
dimension of the relationship between patients and the health-care system. A more global
approach is required in order to really understand patients’ preferences and expectations with
respect to the health-care system and medicines consumption. Secondly, these typologies are
based on "fixed" positions: each patient of the sample is "classified" in one cluster. But the
points of view expressed are largely dependant on situational variables. We need to identify
"virtual positions" and, based on theses positions, built situational "scenarios". In this context,
our research objective is to develop a general conceptual framework to understand and
classify patients’ expectations towards the health-care system and medicines consumption.
Furthermore, from a managerial point of view, there is no clear market "segmentation" of
patients behaviours in this sector. Thus, the aim of our research, is to propose a relevant
"segmentation tool" in the health-care context. It will provide professionals in this sector with
a global vision of the final consumer’s expectations. Based on this segmentation,
improvements in service quality and patients’ global satisfaction could be made. Indeed, the
proposed classification will help doctors and institutional organizations to better understand
patients’ expectations and hence to meet their preferences more accurately. Moreover, based
on this typology, pharmaceutical firms and actors in the field of health-care could provide a
better positioning of their offers and develop more adapted communication strategies.
In order to develop a typology based on virtual positions, we carried out a semiotic analysis
(Greimas 1983; Greimas and Courtès 1983) of patient's representations and expectations of
the health-care system and medicines consumption, on the base of 38 semi-structured
interviews. Four types of values expressed by patients were identified: the functional, the
existential, the critical and the hedonistic values. The "functional" patient has a
problem/solution logic and a functional approach towards health-care. On the other hand, the
"existential patient" values health-care in a more global way: his definition of good health is
more than just "not to be ill". This kind of patient trusts the system greatly and has a social
approach to medicine: he feels that dialogue is a part of treatment and his choice may be
influenced by peers or professional advice. The "critical patient" has a consumerist approach
towards medicine. He is in a logic of comparison and budget-optimisation. Hedonistic
valorisation is the negation of practical values. For this type of patient, health-care is a kind of
"game" in which only the ludical dimension of the service is considered. Based on these
values, a quantitative study was carried out in order to identify a typology of patients: data
were collected on 200 patients. We identified four patient profiles: Hedonist, Functional,
Optimizer, and Skeptic.
This study has two main contributions. First, this research underlines the interest of a
structural semiotic approach to study the behaviour of health-care consumers. This approach
provides an analytic tool to understand the variety of patients’ attitudes and behaviours
regarding health, health-care and medicines consumption. From a theoretical point of view,
we can conclude that patients may be studied as consumers, and that medicine and health-care
services are evaluated and valorised in the same way as other products or services. Second,
this study provides a segmentation of patient behaviours. Based on patients’ values, a
typology of four patient profiles was proposed: hedonists, functionals, skeptics and
optimizers. Based on the real-world heterogeneity of health-care consumers, our analysis
should permit the development of a more targeted approach for each patient-type, and indeed
a more global, uniform, yet accurately partitioned communication strategy. Depending on the
cluster characteristics, different communication strategies should be adopted. For example, for
skeptics, communication should be concentrated on the benevolence of the pharmacist/doctor.
Optimizers, on the contrary, are more interested in cheaper products. Functionals are sensitive
to the promptness of service, and hedonists to the benefits of the products on their welfare.
Given the specificity of the context (France) and the size of our sample, additional research
should be realized to determine the extent to which the results can be generalized.
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