Evaluating the significance and determinants of relationship marketing strategies within the former NHS internal market : a comparative analysis of NHS trust and district health authority perspectives in England

This thesis evaluates the extent to which relationship marketing (RM) strategies were prevalent within the former NHS Internal Market and the determinants of such strategies. The research achieves its aims through the analysis of a postal survey of NHS Trust hospitals and District Health Authorities in England and case studies of the Warwickshire and Dudley health markets. The impetus for the research is the paucity of literature evaluating RM in the NHS context, resulting from the predominance of the traditional economics perspective on the purchaser - provider relationship. The latter is unable to systematically evaluate relational behaviour within quasi - markets given its adversarial contracting focus. Subsequently, the Relationship Marketing Paradigm is used to design a framework appropriate to evaluating relational oriented behaviour within the NHS Internal Market. To further investigate the determinants of NHS Trust hospital's RM strategies a series of hypotheses were developed and tested using Logit modelling techniques. These hypotheses sought to explain contract augmentation, contract customisation, loyalty discounting, default contracting and the use of cost - sharing contracts. In addition the case studies further examined the role of 'trust' within the purchaser - provider relationship through evaluation of contractual, competence and goodwill trust typologies. Equally, the case studies investigated the negative impact of RM strategies from the perspective of purchasers, providers and service users. The key conclusion is that RM was significantly more widespread than the literature suggests, indicating the centrality of relational oriented contracting. Furthermore, the nature of and determinants of the identified relationship marketing strategies were found to be mature and complex. Moreover, this weight of evidence questions Government policy's success in generating a competitive environment within the NHS Internal Market based upon adversarial contracting. To explore the likelihood of RM remaining an important phenomenon within the "new" NHS arrangements, evidence is drawn from the case studies and predictions from the Logit analysis.