Website Marketing Activities in Healthcare Service Sector – A Case in Danang, Vietnam Phuong Truong (1), Huong Doan (2), Long Tran (2),(*) (1) University of Economics, Danang University, Danang, Vietnam * Correspondence: longtd@due.edu.vn Abstract: Studies in healthcare service have been received remarkable attention from both researchers and practitioners This specific topic is interesting because of not only its complexity in nature as highly customized, highly risk-taking but also the high extent of co-production in the value creation process This study was implemented with the involvement of more than 40 healthcare service providers to augment better understandings of the current marketing practices using websites within this specific sector Four dimensions including information, communication, transaction and relationship were deployed to evaluate the website marketing activities While the information and communication dimensions initiate the relationships between customer and provider, the communication and transaction ones maintain and develop these relationships Research findings suggested that in Danang, the transaction- and relationship dimensions should be received a better consideration due to their importance Keywords: Healthcare; marketing practice; website marketing activities Introduction Recently, the consumerism in healthcare has received much credence in researches Jaakkola and Halinen (2006) have implied in their study the upsurge of consumerism in the healthcare sector, in which the consumers seek information from the available sources including the Internet and online communities It is recognized that the Internet, online communities, and cloud computing technology are giving the patients more power, and transforming the traditional paternalistic approach towards patients to a more patientcentric one (Laing et al 2002; Taylor 2009) to satisfy the patient’s needs as a customer (OseiFrimpong et al 2016) Perceiving the patients as the clinics’ customers, we can better understand how the Internet can serve as an effective marketing tool between suppliers (hospitals and clinics) and customers (patients) for its capabilities of information dissemination, communication and online transaction (Chiappa 2013; Law et al 2010; Ting et al 2013) The healthcare service, however, is different from other service sectors Unlike the customers of other products and services who enjoy their status elevated under their potential purchases, the patients have their status reduced by the illness, injury or health concerns (Torpie 2014) Compared to other service industries like tourism or banking, the healthcare one is highly customized, contains high risk as well as the high extent of the coproduction in the value creation process – providers highly rely on information from the individual patient (Vogus & McClelland 2016) In order for the healthcare services to deliver better customer satisfaction, it is claimed that the health facilities should provide safe, effective clinical treatment and clean and comfortable to the patients (Torpie 2014), and that the care providers should be supported in coping with the stresses and traumas experienced at work and in making more accurate decisions (Vogus & McClelland 2016) When it comes to the technologies to take roles in the healthcare industry, the technologies themselves have to function in a way that meets all the expectations on how to deliver better satisfaction Studies on the technologies in the healthcare industry, as a result, should take into account the expectations of both patients and care providers to define how the e-healthcare should take place In Vietnam, the most severe issues of the healthcare system can be listed as (1) overcrowding and very high occupancy rates and (2) obsolete equipment and access to drugs (Gaskill & Nguyen 2015; Export 2018) The causes of the problems can be the inequality of care between the urban and rural areas, the low budget, and the shortage of qualified medical staff who work under stressful conditions and whose wages are relatively low To overcome the issue of overcrowding, some ideas to use online resources have been implemented The online services rate from online appointment making, to information providing, to interacting with doctors via websites or apps (eg Bacsinho.com, beestromed.com, homecare.com, etc.) Online healthcare services have arisen as a new trend of the century to connect care providers with patients and to face the current severe problems of the healthcare system in Vietnam Yet, the impacts of online services, or on their roles in the society have not received sufficient attention from the researchers Indeed, the technologies nowadays have shifted the healthcare services to a more customer-oriented approach However, the healthcare industry has its specific points, and technologies must meet the expectations of patients and care providers to take their roles in the industry In the case of Vietnam, online technologies are expected to provide patients more access to information and care providers, as well as to lighten the stress at work for the care-providers The new trends of using online resources in healthcare services, however, have not received enough attention from researchers in Vietnam The authors, therefore, would love to contribute to such a potential area The authors are well aware that before conducting any further researches to give the stakeholders recommendations to make the healthcare services more satisfying, we must write a serious paper on the status quo to understand how everything is functioning at the present In this paper, the authors aim to apply relevant and understandable methods to investigate the status quo of the online healthcare service activities in one of the biggest and most dynamic and innovative cities of Vietnam: Danang In this paper, the authors refer to online activities to those on the official websites of hospitals and clinics, because of their authenticity and popularity in the healthcare industry that the authors can observe Website marketing activities Regarding using the website as a marketing tool, there have been many kinds of research focusing on how the tool functions and supports the users Merono-Cerdan and Soto- Acosta (2007) identified that organizations could reinforce their performance by using websites to provide information to customers, business partners and other stakeholders (einformation), interact with both external and internal business agents (e-communication) and fulfill online orders (e-transaction) Chiou et al (2010) have analyzed a total of 83 articles on website evaluation and indicated that website marketing activities should be transactionoriented and serve each phase of the transaction process: information, agreement, and settlement through their functions as follow: product, promotion, price, place and customer relationship The information phase lasts from the moment when the customers access the website of the organization to when they decide to make an order or to leave the website The agreement phase is in charge of the negotiations between the buyers and the sellers and the contracts made Finally, the settlement one involves contract execution, product delivery, and after-sale interactions Another notable paper on functions of marketing websites is by Wang and Russo (2007), who argued that whether the commercial websites are successful or not depends on the integrative application of the following components: (1) up-to-date and accurate information provision, (2) effective and constant communication with customers, (3) reliable and seamless electronic transaction, and (4) appropriate and sustainable relationshipbuilding programs Li and Wang (2010) later added the 5th dimension, technical merit (the success of the lower technology deployment level is the prerequisite of the effective implementation of the higher one), and constructed a conceptual website evaluation model consisting of five dimensions: information, communication, transaction, relationship, and technical merit Overall, the researches mentioned focuses on the functions of the websites as a marketing tool of the organizations The studies agree on some roles of the websites as a marketing tool to connect the providers and buyers: a means of information providing, communication, transaction execution, and relationship maintaining There are some differences between the researchers in the problem For instance, Merono-Cerdan and SotoAcosta (2007) did not mention the relationship maintaining the role of the websites, while Li and Wang (2010) added the technical merit one Chiou et al (2010), on the other hand, approached the relationship between providers and customers as transactions and the websites through theirs marketing functions support each of the phase of the transaction process from the first phase as information accessing to the last one as contract execution and after-sale activities Because of these differences, the authors would love to review the roles of the websites in the healthcare industry to choose the most appropriate approach for this paper Website marketing activities of healthcare provider In the healthcare segment, because of the value co-creation between patients and care providers, the participation of the patients in the decision-making process is crucial It is claimed that patients who are better informed can communicate better with the care providers, leading to better healthcare service received (Osei-Frimpong et al 2016; Vogus & McClelland 2016) It is also claimed that the consumer health information technologies, which include websites, are expected to facilitate information access and exchange, enhance decision making, provide social and emotional support, and help behavior changes that promote health and well-being (Or & Karsh 2009) Powell, Darvell and Gray (2003) stated that the Internet could be a resource for health information, a medium for health interaction, and a tool for the delivery of healthcare It can be seen that most of the papers reviewed focus on the information and communication functions of the websites From the marketing perspective, the authors would love to figure out if the current healthcare websites in Danang provide the transaction and relationship (between the healthcare organizations and the patients) maintaining functions besides the information and communication ones Therefore, we would look for marketing criteria to investigate healthcare websites We would also critically and reasonably adapt the criteria to be suitable for the healthcare segment Evaluating website marketing activities of healthcare provider In the hospitality segment, Li, Wang, and Yu (2015) used the four dimensions of information, communication, transaction, and relationship to evaluate the hotel website marketing activities There are some reasons for the authors to adopt these four dimensions in this paper: (1) like hospitality, healthcare is a service industry, (2) the criteria used has been tested and was shown to be reliable, (3) the dimensions are fairly comprehensive, and (4) the scales is suitable for the objective of the paper, which is to evaluate the commercial healthcare websites However, the authors have to adapt the criteria, which is based on the four dimensions, to the healthcare perspective, which is way different from the hospitality one Because the healthcare websites are usually used by those who are in distress, users must be able to find the right health provider to get treatment, retrieve medical records (such as test results and other health information), and pay their bills easily As the effects of the provided healthcare service on the patients are severe, and the service-producing procedures are simultaneous to the receiving processes of the patients, the more the websites make the patients feel secure about what they are going to get through, the better DBS (2018) listed the applications that a website has to have to provide qualified online healthcare service: (1) navigation to the healthcare centers, (2) expert medical information (about health conditions, organisational news, health-oriented events and classes for example), (3) information about physicians and clinicians and links to them, (4) employees testimonials There also have been some criteria used in other papers to evaluate healthcare websites The authors have reviewed the papers by Sanchez & Sanchez (2011), Howitt et al (2002), Alpert (2015) to see how healthcare websites were evaluated in other papers It appears to the authors that although the papers have the same concepts of investigating if the current healthcare websites have the listed items, none of these papers use the four marketing dimensions to evaluate the websites Therefore, the authors will selectively use the items being used in the papers reviewed After reviewing the criteria used by Li et al (2015), and the must-have applications of a successful healthcare website from both academic papers and online articles from marketing websites with prestige, the authors have come up with criteria to evaluate the healthcare websites in Danang: Table Criteria to evaluate website marketing activities of healthcare providers Website Features Information Dimension Medical information DBS (2018); Alpert (2015); Howitt et al (2002) Information of Physicians and clinicians DBS (2018); Alpert (2015); Sanchez & Sanchez (2015); Howitt et al (2002) Links to physicians and clinicians DBS (2018); Sanchez & Sanchez (2015) Maps/ Driving directions DBS (2018); Li et al (2015); Alpert (2015); Sanchez & Sanchez (2015); Howitt et al (2002) Facilities Li et al (2015) Services offered Li et al (2015); Howitt, et al (2002); Sanchez & Sanchez (2015); Alpert (2015) Healthcare events information DBS (2018); Li et al (2015) Employment opportunities Li et al (2015) Communication Dimension Contact information Li et al (2015); Alpert (2015); Sanchez & Sanchez (2015); Howitt et al (2002) Interactive forms Li et al (2015); Alpert (2015); Howitt et al (2002) Search functions Li et al (2015) Other language options Li et al (2015); Alpert (2015) Frequently asked questions Li et al (2015); Alpert (2015) Transaction Dimension Online reservation Li et al (2015); Alpert (2015); Sanchez & Sanchez (2015); Howitt et al (2002) Relationship Dimension Patient reviews DBS (2018) Privacy policy Li et al (2015) Special deals Li et al (2015) Patient support Li et al (2015) Loyalty programs Li et al (2015); Alpert (2015) Personalization Li et al (2015); Sanchez & Sanchez (2015) Methodology For the evaluating criteria to be more reliable, the authors asked for opinions from two doctors from two top hospitals in Danang, a CEO and a founder of a healthcare startup As a result, the experts who we interviewed advised us to add some items to the criteria The items added include "Access to test results or personal medical records", "Chat online" Table Revised criteria to evaluate website marketing activities of healthcare providers Dimensions Items Information dimension - Medical information - Information of Physicians and clinicians - Links to physicians and clinicians - Maps/ Driving directions - Facilities - Services offered - Healthcare events information - Employment opportunities Communication dimension - Contact information - Access to test results or personal medical records - Chat online - Interactive forms - Search functions - Other language options - Frequently asked questions - Frequently asked questions Transaction dimension - Online reservation Relationship dimension - Patient reviews - Privacy policy - Special deals - Patient support - Loyalty programs - Personalization The authors also surveyed the top 40 hospitals and clinics in Danang and figured out that only 23 of them have official websites After that, the authors investigated how the websites were doing using the criteria The result would be discussed in the coming section Results As can be seen from the table, the items that are used the most by the websites in Danang are Contact information (95.65%), Interactive forms (91.30%), Search functions (82.61%) from the Communication dimension and Services offered (86.96%) and Medical information (73.91%) from the Information dimension There are no Loyalty programs or Personalisation 65.22% of the healthcare centers have Online reservation Only 8.7% of them have Patient reviews, 4.5% have a Privacy policy and 4.35% have access to test results or medical records The availability of other items on the websites ranges from 13.04% to 52.17% It appears to the authors that the websites from the private healthcare centers have more items, especially ones related to customer care, than the public ones Most of the centers from the public segment have similar items to each other The private ones, on the other hand, vary in designing the dimensions and items for their websites Another thing that should be put into consideration is that there is no clear difference between the websites of the centers in the urban and suburb areas of Danang To the authors’ observation, the differences lie mostly between the websites of the public and private centers Table Website marketing activities of healthcare providers in Danang Dimensions Items % of healthcare centers Information dimension - Medical information - Information of Physicians and clinicians - Links to physicians and clinicians - Maps/ Driving directions - Facilities - Services offered - Healthcare events information - Employment opportunities 73.91 21.74 21.74 43.48 47.83 86.96 34.78 52.17 Communication dimension - Contact information - Access to test results or personal medical records - Chat online - Interactive forms - Search functions - Other language options - Frequently asked questions 95.65 4.35 17.39 91.30 82.61 30.43 17.39 Transaction dimension - Online reservation 65.22 Relationship dimension - Patient reviews - Privacy policy - Special deals - Patient support - Loyalty programs - Personalization 8.70 4.5 13.04 17.39 0 Conclusions and discussion The paper has reviewed the healthcare websites in Danang and given the idea of how the websites are doing in terms of website marketing dimensions such as Information dimension, Communication dimension, Transaction dimension, and Relationship dimension It appears to the authors that most of the healthcare websites in Danang focus more on the Information and Communication dimensions than the other two Among the four dimensions, the one that is least focused on is the Relationship one, leading to the question of whether the healthcare centers should invest more in maintaining relationships with their patients and how they can that To answer this question, research on the bargaining power of the patients in the Danang market is needed, so that we can figure out if the healthcare centers must spend their resources on keeping the patients coming back to them whenever they need healthcare services One achievement of this paper is to create criteria to evaluate the healthcare website by reviewing the articles about healthcare websites and ones about other types of services This set of criteria can be further developed and tested in the future so that healthcare website operators or healthcare centers managers can acknowledge what items they should have to create and maintain a good website about healthcare Besides, this paper has facilitated another research using Importance-Performance Analysis to consolidate the criteria and figure out which items are considered important and how they are perceived to be performing by the healthcare providers and patients Another contribution of this paper is a brief review of how the healthcare websites in Danang are doing so that we can make them better In the future, based on the results of this paper, another research using Change Propensity Analysis to predict the future trends of the healthcare website marketing activities in Danang can be conducted The results in this paper can also be used in further researches on the online healthcare field Some of the suggestions can be the studies on how the patients accept the online services from the healthcare centers, how the healthcare centers better marketing via the Internet, and so on This paper still contains some limitations First, the authors believe that more academic papers on website marketing activities, especially the healthcare website marketing ones, should be reviewed to make the evaluating criteria more valuable Another thing that should be improved in further researches is that the similarities and differences between healthcare services and other services should be clarified so that we can have a set of greater accurate criteria The authors expect to overcome these limitations so that the next studies can have better quality References Alpert, J (2015) Evaluating the Content of Family 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