A comparison of pharmaceutical
promotional tactics between
Expanding multinational
business in the Pacific
Rim
The marketing dichotomy
of pharmaceutical firms
34 JOURNAL OF BUSINESS & INDUSTRIAL MARKETING VOL. 10 NO. 1 1995 pp. 34-43 © MCB UNIVERSITY PRESS. 0885 8624
Hong Kong and China
Sandra S. Liu
Introduction
Owing to the economic growth in the Pacific region and the squeeze on
pharmaceutical profits in the US market resulting from changes in the health
care system, namely HMOs (medical centres operated by major medical
insurance companies) and health care reforms, many multinational
pharmaceutical companies have been expanding their business into the
Pacific Rim countries. Pharmaceuticals in Hong Kong comprise a US$1.4
billion industry (IMSPacific, 1991) and have enjoyed an annual growth rate
of approximately 20-25% (Hong Kong Association of the Pharmaceutical
Industry, 1988). Investment in China by the pharmaceutical companies has
increased since 1980 (Miao, 1994). Today, there are nine pharmaceutical
joint ventures in China with investments of over US$10 million, half of
which are US-based companies. As China becomes more aware of the
protection of intellectual property (“Regulations on administrative protection
of pharmaceuticals and rules for the implementation of regulations on
administrative protection of pharmaceuticals” was legislated on January 1,
1994), more multinational pharmaceutical companies are joining in the arena
with Merck & Co., Inc. being a typical example. For the past decade during
the opening of the China market, Hong Kong has been regarded as the base
for exploring that market. A better understanding of the buying behavior of
the medical practitioners in these areas will allow multinational
pharmaceutical companies to formulate cost-effective promotional strategies
for the China market.
Pharmaceutical companies, in general, segment their target users on the
basis of their behavior and decision-making process. This marketing
dichotomy of industrial/consumer goods in their formulation of marketing
strategies has long been discussed among marketing scholars. The Industrial
Marketing Committee Review Board (American Marketing Association,
1960) and some scholars differentiated consumer goods marketing from
industrial goods marketing according to main distinctions in the ultimate
user/buyer’s behavior. Sheth (1973) in his theory of family buying decisions
implicitly recognized the similarity between industrial and household buying
behavior. Later, Wind (1978) showed the similarity in the consumer and
organization segmentation concepts by demonstrating that the buying
centers have been moving from individuals to multipersons.
The author gratefully acknowledges the comments of Professor Wesley J. Johnston
and two anonymous JBIM reviewers.

Previous product
experience is significant
The ethnic diversity of
China
JOURNAL OF BUSINESS & INDUSTRIAL MARKETING VOL. 10 NO. 1 1995
In the pharmaceutical industry, ethical products are considered to be
organizational buying, whereas over-the-counter (OTC) preparations are
categorized as consumer buying. Although the patient is generally the
ultimate end user, regardless of whether ethicals or OTCs are concerned,
medical practitioners have a rather unique and often multiple role in the
purchasing process of pharmaceutical products. They may be the deciders
who make the buying decision for their patients when prescribing ethicals,
or they may play the role of influencer and/or gatekeeper in the case of
OTCs or hospital dispensaries. In countries such as Hong Kong, where
medical practitioners are permitted to dispense ethicals in their clinics, their
buying motives can be even more complex and buying behavior becomes
consumer buying. It is therefore understandable that the bulk of marketing
efforts is directed toward medical practitioners.
Pitt and Nel (1988) studied the factors influencing the prescription behavior
of 210 general practitioners in Australia. A distinction was made between
the interpersonal/organizational determinants of prescribing decisions and
the marketing tools utilized by pharmaceutical firms. They concluded that
the former are stronger influences than the latter on prescribing decisions.
The most significant influence on the medical practitioners’ prescribing
decisions is their previous product experience. Of the marketing tools
available to the pharmaceutical firm, personal selling is most powerful. A
factor mentioned most often by their respondents (32.4%) was scholarly
articles by specialists in scientific medical journals. Unfortunately, this
factor was not included in their questionnaire, and the authors admitted that
this was the major weakness and limitation of their study. But other missing
factors, frequently mentioned by their respondents, were the reputation of
the company and price of the product.
A majority of other studies tended to concentrate on marketing tools utilized
by pharmaceutical firms. Conlan (1991) reported that pharmaceutical
companies in the USA spent more than US$165 million on gifts, trips and
cash awards to physicians when promoting brand name drugs. For private
practitioners, Baker (1992) suggested that more selective office-practice
items, such as prescription pads and patient record forms, would be more
effective not only because they provided a service to physicians and their
staff, but also offered an added benefit of being perceived as less
promotional. Williams and Hensel (1991) reported that the source of
information about pharmaceuticals considered to be important by physicians
has changed in rank order from direct mail, journal advertising and detailing
to colleagues, conventions, meetings, and conferences.
One of the major pitfalls in understanding the Chinese has been the tendency
of Westerners and other outsiders to overlook the ethnic and subethnic
diversity among the enormous population of China (Swanson, 1989).
Swanson delineates 12 “nations” of China that transcend political/provincial
boundaries. The buying behavior of medical practitioners from Hong Kong
and Mainland China may differ as a result of their distinct socioeconomic
environment. In addition, Hong Kong has both dispensing and prescription
markets, whereas China is mostly a prescription market viewed by Western
medicine. Private practitioners in Hong Kong are allowed to dispense
pharmaceuticals in their clinics. Their government counterparts, on the other
hand, are the same as the majority of the Mainland medical practitioners
who practice in a formulary situation (purchase of pharmaceuticals is
decided by the members of the therapeutic team) similar to that of the USA.
However, since a number of operations in China have basically adopted the
35
 “Hong Kong style”, it is important to follow closely the trend of their
medical practices.
This study investigated the relative importance of the various factors which
influence the buying behavior of medical practitioners in Hong Kong and
China. The intention was to provide a benchmark to pharmaceutical
marketers to enable them to focus and direct their effort cost-effectively in
marketing their products in both the Hong Kong and China markets.
Fundamental questions to be answered were:
● What do medical practitioners in Hong Kong and China perceive to be
the relative influence of promotional tools and interpersonal/
organizational factors on their prescribing decisions?
● To what extent is medical practitioners’ perception of the relative
influence of the influencing factors related to the dichotomy
(government versus private practice in Hong Kong) of the purchasing
process, and the subcultural environment of Hong Kong and China?

Research methodology
Pitt and Nel’s mission The questionnaire was designed to investigate both interpersonal/
factors organizational influences and marketing/promotional tools as used in Pitt
and Nel’s study (1988). Some mission factors from their study were
included, notably scientific and clinical papers, reputation of the company,
and price of the product. Quality of the product was used to encompass the
positive connotation of the inert property of personal experience with the
product. Some commonly adopted sales promotional materials utilized in
Hong Kong were specified in the list.
In this study, samples of private practitioners in Hong Kong were drawn
from the IMS Directory of Private Practitioners. Only those who saw more
than 15 patients per week were included. The government counterparts were
randomly selected from the major government hospitals. All the selected
subjects were first contacted by telephone. Those giving consent were
personally interviewed using questionnaires printed in English. They were
asked to rate the factors influencing their buying decisions according to their
perception of importance from 1 (not important at all) to 6 (very important).
Difficulties in conducting A low response rate and questionable reliability of some responses tend to
surveys in China be major difficulties in conducting surveys in China (Steele, 1990). To
ensure the reliability of the responses, the samples of this study were
personal contacts in the teaching hospitals of the medical school of Zhong
Shan University. Two local medical practitioners, invited to be the study
coordinators (with prior training by the author), distributed and explained the
questionnaire to the medical practitioners who were willing to participate in
this study. In order to minimize subethnic diversities of language and
socioeconomic heterogeneity between Mainland China and Hong Kong
participants, the city of Guangzhou was selected to be the first trial of this
study because the people there share the same Cantonese dialect and TV
broadcast programs with Hong Kong residents. The English questionnaire
used in Hong Kong was translated by the author and verified by some
medical practitioners. Questionnaires in both English and Chinese were
distributed and the completed ones were mailed back through the local
representatives.
The association of the extent of perceived influence on prescribing behavior
was tested with the correlation analysis. ANOVA and Simultaneous

36 JOURNAL OF BUSINESS & INDUSTRIAL MARKETING VOL. 10 NO. 1 1995

 Comparison Tests (Tukey and Nair Tests) (Scheffé, 1959) were also
performed to test the significance of differences in their means:

Dt = qa ( m , fe ) MSE / r
where
m = number of independent variable; fe = degree of freedom of random
error; and r = sample size

Results and discussion

Demographics
A total of 384 responses from Hong Kong were analyzed. Among them, 89
were government and 295 were private (Table I). A majority of them were
general practitioners, 53.9% and 75.9% for the government and private
sectors, respectively. The private practitioners had more years of experience
in the medical practice than their government counterparts. The medians
were 15 and four years, respectively. The common practice in Hong Kong is
that medical practitioners start their career in government hospitals and later
establish their own private practices. As shown in Table I, 70.8% of
government doctors have fewer than eight years of experience in the field.
Respondents and There were only 22 responses from China. The respondents were in various
response rates fields of practice. The “others” in the specialty category were ophthal-
mologists and surgeons. These respondents had more years’ experience (14
years) than government practitioners in Hong Kong. The sample size of 22 is
admittedly small. However, a low response rate and possible questionable
reliability of some responses are typical and tend to be major difficulties in
conducting surveys in China (Steele, 1990). This study adopted the
convenient sampling with measures of personal relationship and personal
interviews which have been proven to be the most successful types of
fieldwork in China (Yau et al., 1986). Thus the findings of this study are
representative of the medical practitioners’ opinions, particularly in
Guangzhou.

Hong Kong
Government Private China

Total 89 295 22
Specialty
GP 48 224 3
Obstetrician/gynecologist 11 19 2
Pediatrician 18 20 0
Neurologist 0 1 0
Psychiatrist 1 4 0
Rheumatologist 1 0 0
Cardiologist 0 4 4
Others 10 23 13
Years of experience (%)
0-7 70.8 15.5 13.6
8-12 15.7 25.4 50.0
13-20 11.3 35.1 18.2
21 and more 2.2 24.0 18.2
Median (years) 4 15 10

Table I. Demographics

JOURNAL OF BUSINESS & INDUSTRIAL MARKETING VOL. 10 NO. 1 1995 37

 Perception of promotion tactics
Hong Kong practitioners Hong Kong medical practitioners from private or government sectors
perceive tools differently perceive promotion tools differently owing to the nature of their practice
(Liu et al., 1991). Therefore, this study considers government and private
practitioners in Hong Kong to be distinct categories. Table II lists the results
of ANOVA for all the respondents. It indicates that the overall ranking of
each motivator is significantly different from all the others (p < 0.000).
Tables III, IV, and V delineate the 16 factors considered in the study and also
the mean influence score for each, based on the ratings received from all
respondents. The factors are presented in descending order according to their
extent of perceived influence on prescribing decision. Figure 1 depicts the
interrelationship of the three groups of respondents.
For all the respondents from both Hong Kong and China, the most dominant
influences on prescribing behavior were quality of the product and

Source of Sum of Degree of Mean

Respondents variation squares freedom square F ratio
Hong Kong – Between 1,502.92 15 136.63 75.21
private influencers
practitioners Error 6,409.27 3,528 1.82
Total 7,912.20 3,539
Hong Kong – Between 513.27 15 46.66 30.02
government influencers
practitioners Error 1,641.46 1,056 1.55
Total 2,154.73 1,067
Chinese Between 263.77 15 17.98 9.81
practitioners influencers
Error 602.23 336 1.79
Total 866.00 351

Table II. ANOVA results

Mean Standard
Rank Factors scorea deviation

1 Quality of the product 5.46 0.77

2 Reputation of the company 4.55b 1.13
3 Accuracy of promotional literature 4.47 1.30
4 Personal selling 4.39 1.30
5 Scientific and clinical papers 4.38b 1.15
6 Seminar or lecture 4.18 1.14
7 Symposium or conference 4.16b 1.12
8 Price of the product 3.89 1.11
9 Samples 3.82 1.24
10 Slides or video 3.38 1.15
11 Attractiveness of the promotional literature 3.37 1.21
12 Medical journal advertising 3.25 1.18
13 Promotional items and gimmicks 3.18 1.17
14 PC programming and support 2.69 1.46
15 Direct mail 2.63 1.28
16 Sales bonus 2.30 1.49
Notes:
n = 89
a
Mean score is the average score on a 6-point scale, where 6 is very important, and 1 is not
important
b
Parameters are significantly different from the following ones based on Tukey-Nair Test at α
= 0.05

Table III. Factors influencing prescribing decisions – government practitioners’

perceptions

38 JOURNAL OF BUSINESS & INDUSTRIAL MARKETING VOL. 10 NO. 1 1995

 Mean Standard
Rank Factors scorea deviation
1 Quality of the product 5.77 0.58
2 Reputation of the company 5.10b 1.24
3 Accuracy of promotional literature 4.81 1.22
4 Personal selling 4.61 1.33
5 Scientific and clinical papers 4.57b 1.26
6 Price of the product 4.57 1.34
7 Samples 4.32 1.37
8 Sales bonus 4.31b 1.34
9 Symposium or conference 4.24 1.35
10 Seminar or lecture 4.23b 1.42
11 Medical journal advertising 3.61 1.30
12 Attractiveness of the promotional literature 3.45 1.39
13 Slides or video 3.39 1.37
14 Promotional items and gimmicks 3.33 1.39
15 Direct mail 3.13 1.39
16 PC programming and support 2.54 1.38
Notes:
n = 295
a
Mean score is the average score on a 6-point scale, where 6 is very important, and 1 is not
important
b
Parameters are significantly different from the following ones based on Tukey-Nair Test at α
= 0.05

Table IV. Factors influencing prescribing decisions – private practitioners’

perceptions

Mean Standard
Rank Factors scorea deviation
1 Quality of the product 5.86 0.47
2 Reputation of the company 5.82b 0.39
3 Accuracy of promotional literature 5.18 0.96
4 Scientific and clinical papers 5.05 1.25
5 Samples 4.86 1.21
6 Seminar or lecture 4.59 1.40
7 Symposium or conference 4.55 1.34
8 Attractiveness of the promotional literature 4.41b 1.22
9 Medical journal advertising 4.09 1.23
10 Price of the product 3.91 1.57
11 Personal selling 3.86 1.64
12 Slides or video 3.73 1.32
13 Direct mail 3.68 1.73
14 Promotional items and gimmicks 3.55 1.50
15 Sales bonus 3.23 1.88
16 PC programming and support 2.68 1.39
Notes:
n = 22
a
Mean score is the average score on a 6-point scale, where 6 is very important, and 1 is not
important
b
Parameters are significantly different from the following ones based on Tukey-Nair Test at α
= 0.05

Table V. Factors influencing prescribing decisions – Chinese practitioners’

perceptions

reputation of the company. These two factors were significantly more

important than the other influences (α = 0.05). It would benefit
pharmaceutical marketers if they ascertained to what extent the company
marketing effort is reaching the interpersonal/organizational determinants.
A well-recognized influencing factor on medical practitioners’ buying
decisions, personal selling, was perceived by private and government

JOURNAL OF BUSINESS & INDUSTRIAL MARKETING VOL. 10 NO. 1 1995 39

 Quality of product

Company reputation

Accuracy of literature

Personal selling

Clinical reports

Seminar

Symposium/conference

Price of product

Samples

Slides or video

Promotional literature

Medical journal advertisements

Promotional gimmicks

PC programs/support

Direct mail

Sales bonus
0 1 2 3 4 5 6 7

Key :
Hong Kong government
Hong Kong private
China practitioner

Figure 1. Factors influencing prescribing decisions

practitioners in Hong Kong to be as important as accuracy of the

promotional literature and scientific and clinical papers (α = 0.05). But this
was not true for practitioners in China. They considered personal selling to
be less influential than most of the commonly utilized promotional tools,
such as seminars or conferences sponsored by pharmaceutical companies
and sales promotional material. This might be due to the centralized
Government providing fewer opportunities for free communication between
medical practitioners and salespeople. This phenomenon has already shown
variations in different parts of the country. More interactions between
medical practitioners and salespeople can be observed in cities with a more
open policy, such as Guangzhou and Beijing.
Major source of A major source of information on current therapeutic regimens, such as their
information advancement in pharmacological activities, precautions, adverse effects, and
dispensing and prescribing instructions, is from pharmaceutical companies.
In China, particularly, owing to limited resources, medical practitioners rely
heavily on the printed media, such as medical journal articles, papers or
reports of clinical studies, and promotional literature provided by
pharmaceutical companies. Direct mail, therefore, was considered to be
more influential than promotional gimmicks by the participants in China, but
not their Hong Kong counterparts. Accuracy of information is imperative for
successful treatment of patients. All the participants in this study apparently
agree with this view.
Seminars and lectures arranged by pharmaceutical firms and their sponsored
symposia or conferences are regarded as being more influential by all the

40 JOURNAL OF BUSINESS & INDUSTRIAL MARKETING VOL. 10 NO. 1 1995


The validity of
advertising
Importance of image of
credibility and reliability
JOURNAL OF BUSINESS & INDUSTRIAL MARKETING VOL. 10 NO. 1 1995
respondents than both advertising and sales promotional material, such as
slides or video, promotional literature, and gimmicks. Samples, which in
general are considered as sales promotional material, have a greater
influence on both private practitioners in Hong Kong and the respondents of
China than do other types of promotional materials. Samples are often used
in trials of new treatments in both China and Hong Kong. An additional
benefit for private practitioners in Hong Kong though is that some may
dispense samples in separate containers to patients and charge for them.
There is no legislative control over this practice. Because private
practitioners are mostly profit oriented, they regard samples, price of the
product and sales bonus as equally influential and more influential than
seminars, conferences, advertising, and other sales promotional material.
The grouping of these three categories differentiates private practitioners in
Hong Kong from those in Hong Kong government hospitals or the
Mainland. Yet the emphasis on samples parallels private practitioners in
Hong Kong with medical practitioners in China.
Major pharmaceutical companies have invested significant promotional
budgets in advertising in medical journals and other publications. Recently,
there has been some perpetuating controversy in this concern; the impact of
advertising on demand is one of them (Baudot, 1991). The findings of this
study indicate that this tactic is considered “less important”, which coincides
with the findings of Williams and Hensel’s study (1991). In fact, many
developing countries have adopted legislation to regulate pharmaceutical
advertising. When the Chinese government reinstated advertising as a
legitimate business tool in 1979 (Rice and Tang, 1990), the Janssen
pharmaceutical company in China was able to capture a large market share
by being the first to broadcast their advertisements on television (personal
communication, 1992). However, owing to a tremendous increase of
exposure, the effectiveness of advertising in China should be reevaluated.
Managerial implications and recommendations
This study has attempted to discern the factors which influence medical
practitioners’ prescribing behavior. In summary, the interpersonal/
organizational determinants are stronger influences on prescribing decisions
than marketing tools utilized by pharmaceutical firms. This is similar to the
findings in Pitt and Nel’s study (1988). Each marketing tool has a distinct
extent of influence on medical practitioners in different practices, namely
private versus government, or legislative/political domains. Of the marketing
tools available to pharmaceutical firms, personal selling is the most
influential in Hong Kong but not in China. Table VI lists and contrasts major
influencers for the prescription behavior of medical practitioners in Hong
Kong and China based on the findings of this study.
The perception of quality of the product and reputation of the company are
related to the company’s image of credibility and reliability. The
interpersonal/organizational exchange of this information among colleagues
may not be under direct control of pharmaceutical marketers. It would be
beneficial for companies to identify the structure and strength of these
influences in their target product/markets. The identification and influencing
of “opinion leaders” have long been an accepted marketing strategy
(Montgomery and Silk, 1971). By combining the effects of the two
interpersonal/organizational determinants (product experience and word of
mouth), the pharmaceutical marketers could gain a synergistic effect
(Holmes and Lett, 1977).
41
 Private Government Medical
practitioners practitioners practitioners
in Hong Kong in Hong Kong in China

Primary influencers Quality of the Quality of the Quality of the

product product product

Reputation of the Reputation of the Reputation of the

company company company

Secondary influencers Personal selling Personal selling Credible scientific

and clinical reports
Credible scientific Credible scientific Samples
and clinical reports and clinical reports Seminar and
conferences
Attractive
promotional
literature

Tertiary influencers Price of the product Seminar and Advertising in

conferences medical journals
Samples Price of the product
Sales bonus Personal selling
Promotional
materials and
support
Sales bonus

Table VI. Major influencers for medical practitioners in Hong Kong and China

A major finding of this study which may deviate from the common belief of
the pharmaceutical industry is the relatively low importance of influence
accorded to sales representatives, particularly in China. Nevertheless, no
promotional tools other than personal selling can identify and exploit
directly the sources of influence. In addition, relationship is the most
important determinant in doing business in China (Redding and Ng, 1983;
Yau, 1987). It is important for pharmaceutical companies to place more
emphasis on quality of sales calls when salespeople can only have limited
direct interactions with medical practitioners. Since sales promotional
materials have lower influence ratings, planning and usage of them require a
more cautious evaluation of cost-effectiveness. When needed, proper
selection of them should provide exposure of the products, leads for the
salespeople and reinforce their selling effort.
Personal selling is less Specialties of medical practices were not restricted when selecting the
important sample for this study. The findings in principle are no different from those of
Pitt and Nel’s study which concentrated only on general practitioners.
However, owing to the distinct social system in China, the influence of
personal selling is much less important. This is an issue which requires
further study with a larger scale and continuing follow-up, particularly when
a trend of more frequent contacts between salespeople and medical
practitioners has started to be observed in China recently. A further
comparative study in other provinces is recommended for attaining a
comprehensive profile of the factors influencing the prescribing behavior of
the medical practitioners in China. The impact of years of experience in
medical practice and the gender of practitioners will also be interesting to
explore and to be compared with studies in other cultures.

42 JOURNAL OF BUSINESS & INDUSTRIAL MARKETING VOL. 10 NO. 1 1995

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Sandra S. Liu, having had several years’ experience in the pharmaceutical industry, is
currently a Lecturer in the Department of Marketing, Hong Kong Baptist University,
Kowloon, Hong Kong.

JOURNAL OF BUSINESS & INDUSTRIAL MARKETING VOL. 10 NO. 1 1995 43