Specialize? Diversify? Do patients care? The authors investigate the demand-side effects of a hospital's portfolio strategy, which entails decisions about the depth and breadth of its service offerings. Positing that both depth (focus) and breadth (related focus) signal expertise, the authors use both archival and experimental evidence to examine these effects. The archival study is based on Florida's State Inpatient Databases for 2006–2015 and spans all major departments in health care delivery. The empirical analysis exploits plausible exogenous variation from other health care markets and reveals that patient choice is positively influenced by a hospital's depth (focus) and breadth (related focus) of expertise in a department. Complementing the archival evidence, the authors also conducted online experiments to examine the signaling effects of hospital portfolio strategy on patient choice behavior. The results provide support for the idea that hospital portfolio strategy influences patients’ perceptions of hospital expertise in focal and related areas and, subsequently, their choice behavior. The authors also highlight potential synergistic effects between focus and related focus and heterogeneity in the effects across departments, payer types, and hospital profit status. These findings underscore the need for managers to adopt a targeted approach to portfolio decisions in health care.
AbaluckJasonAdams-PrasslAbi (2021), “What Do Consumers Consider Before They Choose? Identification from Asymmetric Demand Responses,” Quarterly Journal of Economics, 136 (3), 1611–63.
AilawadiKusumChanTatManchandaPuneetSudhirK. (2020), “Introduction to the Special Issue on Marketing Science and Health,” Marketing Science, 39 (3), 459–64.
4.
AngristJoshua D. (2014), “The Perils of Peer Effects,” Labour Economics, 30, 98–108.
5.
ArgoteLindaMiron-SpektorElla (2011), “Organizational Learning: From Experience to Knowledge,” Organization Science, 22 (5), 1123–37.
ChenYiweiLeeStephanie (2024), “User-Generated Physician Ratings and Their Effects on Patients’ Physician Choices: Evidence from Yelp,” Journal of Marketing, 88 (1), 77–96.
11.
ChenYixingLeeJu-YeonSridharShrihari (Hari)MittalVikasMcCallisterKatharineSingalAmit G. (2020), “Improving Cancer Outreach Effectiveness Through Targeting and Economic Assessments: Insights from a Randomized Field Experiment,” Journal of Marketing, 84 (3), 1–27.
12.
ChintaguntaPradeep K.DubéJean-PierreSinghVishal (2003), “Balancing Profitability and Customer Welfare in a Supermarket Chain,” Quantitative Marketing and Economics, 1 (1), 111–47.
13.
ClarkJonathan R.HuckmanRobert S. (2012), “Broadening Focus: Spillovers, Complementarities, and Specialization in the Hospital Industry,” Management Science, 58 (4), 708–22.
14.
DafnyLeemore S. (2005), “Games Hospitals Play: Entry Deterrence in Hospital Procedure Markets,” Journal of Economics & Management Strategy, 14 (3), 513–42.
DobrzykowskiDavid D.CallawayStephen K.VonderembseMark A. (2015), “Examining Pathways from Innovation Orientation to Patient Satisfaction: A Relational View of Healthcare Delivery,” Decision Sciences, 46 (5), 863–99.
17.
FangEric (Er)PalmatierRobert W.GrewalRajdeep (2011), “Effects of Customer and Innovation Asset Configuration Strategies on Firm Performance,” Journal of Marketing Research, 48 (3), 587–602.
18.
FreemanMichaelSavvaNicosScholtesStefan (2021), “Economies of Scale and Scope in Hospitals: An Empirical Study of Volume Spillovers,” Management Science, 67 (2), 673–97.
19.
GaynorMartinPropperCarolSeilerStephan (2016), “Free to Choose? Reform, Choice, and Consideration Sets in the English National Health Service,” American Economic Review, 106 (11), 3521–57.
20.
GoldfarbAviTuckerCatherineWangYanwen (2022), “Conducting Research in Marketing with Quasi-Experiments,” Journal of Marketing, 86 (3), 1–20.
21.
GoldsteinSusan MeyerWardPeter T.LeongG. KeongButlerTimothy W. (2002), “The Effect of Location, Strategy, and Operations Technology on Hospital Performance,” Journal of Operations Management, 20 (1), 63–75.
22.
GowrisankaranGautamNevoAvivTownRobert (2015), “Mergers When Prices Are Negotiated: Evidence from the Hospital Industry,” American Economic Review, 105 (1), 172–203.
23.
HamiltonRebeccaPriceLinda L. (2019), “Consumer Journeys: Developing Consumer-Based Strategy,” Journal of the Academy of Marketing Science, 47 (2), 187–91.
HausmanJerry A.BresnahanTimothy F. (1997), “Valuation of New Goods Under Perfect and Imperfect Competition,” in The Economics of New Goods, BresnahanTimothy F.GordonRobert J., eds. University of Chicago Press, 209–48.
26.
HayesAndrew F. (2022), Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach, 3rd ed.Guilford Press.
27.
HerzlingerRegina E. (2004), Consumer-Driven Health Care: Implications for Providers, Payers, and Policymakers, 1st ed.Jossey-Bass.
28.
HsuGretaHannanMichael T.KoçakÖzgecan (2009), “Multiple Category Memberships in Markets: An Integrative Theory and Two Empirical Tests,” American Sociological Review, 74 (1), 150–69.
KCDiwas SinghTerwieschChristian (2011), “The Effects of Focus on Performance: Evidence from California Hospitals,” Management Science, 57 (11), 1897–1912.
31.
KeT. TonyShinJiwoongYuJungju (2022), “A Model of Product Portfolio Design: Guiding Consumer Search Through Brand Positioning,” Marketing Science (published online December 30), https://doi.org/10.1287/mksc.2022.1424.
32.
KeelerEmmett B.MelnickGlennZwanzigerJack (1999), “The Changing Effects of Competition on Non-Profit and For-Profit Hospital Pricing Behavior,” Journal of Health Economics, 18 (1), 69–86.
33.
KekreSunderSrinivasanKannan (1990), “Broader Product Line: A Necessity to Achieve Success?” Management Science, 36 (10), 1216–32.
34.
KetokiviMikkoJokinenMikko (2006), “Strategy, Uncertainty and the Focused Factory in International Process Manufacturing,” Journal of Operations Management, 24 (3), 250–70.
35.
KimTongil “TI”KCDiwas Singh (2020), “The Impact of Hospital Advertising on Patient Demand and Health Outcomes,” Marketing Science, 39 (3), 612–35.
36.
KirmaniAmnaRaoAkshay R. (2000), “No Pain, No Gain: A Critical Review of the Literature on Signaling Unobservable Product Quality,” Journal of Marketing, 64 (2), 66–79.
37.
KuntzLudwigScholtesStefanSülzSandra (2019), “Separate and Concentrate: Accounting for Patient Complexity in General Hospitals,” Management Science, 65 (6), 2482–501.
38.
LimLeon GimTuliKapil R.GrewalRajdeep (2020), “Customer Satisfaction and Its Impact on the Future Costs of Selling,” Journal of Marketing, 84 (4), 23–44.
39.
LindlbauerIvonneSchreyöggJonas (2014), “The Relationship Between Hospital Specialization and Hospital Efficiency: Do Different Measures of Specialization Lead to Different Results?” Health Care Management Science, 17 (4), 365–78.
40.
McDermottChristopher M.StockGregory N. (2011), “Focus as Emphasis: Conceptual and Performance Implications for Hospitals,” Journal of Operations Management, 29 (6), 616–26.
41.
MiedanerFelixSülzSandra (2020), “Boundaries of Focus and Volume: An Empirical Study in Neonatal Intensive Care,” Production and Operations Management, 29 (2), 298–308.
42.
MoonJihwanShuganSteven M. (2020), “Nonprofit Versus For-Profit Health Care Competition: How Service Mix Makes Nonprofit Hospitals More Profitable,” Journal of Marketing Research, 57 (2), 193–210.
43.
MorganNeil A.RegoLopo L. (2009), “Brand Portfolio Strategy and Firm Performance,” Journal of Marketing, 73 (1), 59–74.
44.
NairHarikeshManchandaPuneetBhatiaTulikaa (2010), “Asymmetric Social Interactions in Physician Prescription Behavior: The Role of Opinion Leaders,” Journal of Marketing Research, 47 (5), 883–95.
45.
NevoAviv (2001), “Measuring Market Power in the Ready-to-Eat Cereal Industry,” Econometrica, 69 (2), 307–42.
46.
PalepuKrishna (1985), “Diversification Strategy, Profit Performance and the Entropy Measure,” Strategic Management Journal, 6 (3), 239–55.
47.
PisanoGary P.BohmerRichard M.J.EdmondsonAmy C. (2001), “Organizational Differences in Rates of Learning: Evidence from the Adoption of Minimally Invasive Cardiac Surgery,” Management Science, 47 (6), 752–68.
48.
PorterMichael E.LeeThomas H. (2013), “The Strategy That Will Fix Health Care,” Harvard Business Review, 91 (10), 50–70.
49.
RavalDeveshRosenbaumTed (2021), “Why Is Distance Important for Hospital Choice? Separating Home Bias from Transport Costs,” Journal of Industrial Economics, 69 (2), 338–68.
50.
RumeltRichard P (1982), “Diversification Strategy and Profitability,” Strategic Management Journal, 3 (4), 359–69.
51.
SahniNavdeep SNairHarikesh S (2020), “Does Advertising Serve as a Signal? Evidence from a Field Experiment in Mobile Search,” Review of Economic Studies, 87 (3), 1529–64.
52.
SfekasAndrew (2020), “Focus, Uncertain Needs, and Consumer Choice in the Hospital Industry,” Manufacturing and Service Operations Management, 22 (3), 446–60.
53.
ShapiroBradley T. (2020), “Advertising in Health Insurance Markets,” Marketing Science, 39 (3), 587–61.
54.
ShiHuanhuanGrewalRajdeepSridharHari (2021), “Organizational Herding in Advertising Spending Disclosures: Evidence and Mechanisms,” Journal of Marketing Research, 58 (3), 515–38.
55.
SilvermanElaineSkinnerJonathan (2004), “Medicare Upcoding and Hospital Ownership,” Journal of Health Economics, 23 (2), 369–89.
56.
SkinnerWickham (1974), “The Focused Factory,” Harvard Business Review.
57.
SorescuAlina B.ChandyRajesh K.PrabhuJaideep C. (2003), “Sources and Financial Consequences of Radical Innovation: Insights from Pharmaceuticals,” Journal of Marketing, 67 (4), 82–102.
58.
SucciMelissa J.LeeShoou-YihAlexanderJeffrey A. (1997), “Effects of Market Position and Competition on Rural Hospital Closures,” Health Services Research, 31 (6), 679–99.
59.
SunderSarangKimKihyun HannahYorkstonEric A. (2019), “What Drives Herding Behavior in Online Ratings? The Role of Rater Experience, Product Portfolio, and Diverging Opinions,” Journal of Marketing, 83 (6), 93–112.
60.
ThirumalaiSriramDevarajSarv (2023), “Mitigating the Curse of Complexity: The Role of Focus and the Implications for Costs of Care,” Journal of Operations Management (forthcoming), https://www.doi.org/10.1002/joom.1278.
61.
TuckerAnita L.NembhardIngrid M.EdmondsonAmy C. (2007), “Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units,” Management Science, 53 (6), 894–907.
62.
YoonTae Jung (2020), “Quality Information Disclosure and Patient Reallocation in the Healthcare Industry: Evidence from Cardiac Surgery Report Cards,” Marketing Science, 39 (3), 636–62.
63.
YoonTae JungKimTI Tongil (2024), “The Role of Advertising in High-Tech Medical Procedures: Evidence from Robotic Surgeries,” Journal of Marketing, 88 (1), 97–115.
64.
YuShanGhoshMrinalViswanathanMadhu (2022), “Money-Back Guarantees and Service Quality: The Marketing of In Vitro Fertilization Services,” Journal of Marketing Research, 59 (3), 659–73.
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