global marketing research - Haymarket

GLOBAL
MARKETING
RESEARCH
PHOTO: JUPITER IMAGES
There’s more to conducting marketing research overseas than translating
survey questions and hiring local moderators to do interviews. Bart Weiner and
Brian Hull offer a guide to getting it right in the world’s biggest markets
One of the biggest developments in the pharmaceutical industry in
recent years has been the evolution and growth of markets
outside of the US. In just the past six years, the revenue attributed
to overseas markets has grown from 35% to 45% of total pharma industry
revenues. With this growth has come the need for marketers to
understand the top foreign markets with the same depth and clarity with
which they understand the US market.
Many issues that were once only local to the US are now viewed
broadly across the major markets throughout the world. To formulate
their strategies and tactics, marketing teams must now answer a more
complex set of questions:
What is the future need for our product in various countries? What
are the important clinical endpoints for our product on a global scale
and within specific countries of interest? What segmentation strategies
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PHOTO: JUPITER IMAGES
General Tips for Conducting International
Marketing Research
Time is relative and people in different
countries and cultures drum to their
own beat. If you try to change
people’s ingrained behavior, you
will only feel frustrated. For example,
Americans like the expression “time is
money” and prefer to get down to business
at a moment’s notice. Professionals in other
countries prefer to get to know each other
first and gain a feeling of trust prior to
conducting business.
Here are some general tips to consider:
■ Remind yourself of the need to be patient, flexible
and adaptable
• “As soon as possible” does not have universal meaning
■ Develop partnerships
• Good local qualitative moderators are hard to find
• Never underestimate the value of a quality research facility
■ Have a backup plan for everything
• Internet access is unpredictable (plan to use your personal
e-mail account)
• Bring extra versions of stimuli
■ Expect travel delays and manage jet lag
• Get to the first country a day early to adjust your sleep patterns
• Beware of labor strikes (airlines, taxis, buses and trains can
come to a halt)
• Have 24-hour access to a travel agent or contact
■ Always ask for directions from someone at the hotel
or facility
• Street names and building numbers can be very difficult to find
■ Hotel chains are not created equal from country to
country, so always ask colleagues for hotel
recommendations
■ Simultaneous interpreters can be inconsistent
• Ask for moderators and interpreters who frequently
work together
■ Look up the names of relevant pharmaceutical products
for each country
• Brand names frequently vary by country—generic names are
often the safest way to refer to a drug
■ Back-room management is critical
• Client teams get larger with the addition of local affiliates
• Different research priorities by country can sidetrack the research
■ Be aware of local holidays
• Always check local calendars when scheduling research
GLOBAL MARKETING RESEARCH
should we employ on a global level and within specific countries to optimize
our targeting efforts? What strategies should we employ in various
countries to maximize access to our product around the world?
What should be the global positioning and messaging strategies? What
country-specific refinements need to be incorporated? How is the
product performing in each country, e.g., tracking, and what local-level
adjustments need to be considered?
In order to support this increased need for information, savvy marketing
research agencies have broadened their offerings to ensure that
the quality of information for marketing decisions is consistently high
across the world.
When product teams contemplate conducting marketing research in
multiple countries, there are some key issues they should know before
initiating the project. Even more critical, they should be confident that
the marketing research agency or partner they choose to hire for each
and every international project helps them refresh their knowledge
about a number of key issues. This includes understanding:
■Medical and reimbursement systems: Provides the context for understanding
the level of access physicians and patients have to medications,
as well as how much influence the system has on the choices made by
prescribers
■Treatment practices: Ensures that the right respondents are recruited
in each region
■ How and at what pace the project-related logistics and tasks get accomplished
in each country:Allows for the management of expectations
for what can be collected in each country and within what time frame.
Just like well-prepared world travelers use guides that offer advice
on what sites to visit, which hotels to consider and how to take advantage
of the local cuisine, pharmaceutical marketing researchers need a
master guide of practical tips for effectively executing insightful, yet
inherently complicated, international studies.
The balance of this article shares some general knowledge, tips and
“best practices” for global marketing research. Keep the list handy to
remind yourself of its contents prior to every international study. We
provide focus on the top nine countries in terms of pharmaceutical
revenues: the United Kingdom, France, Germany, Italy, Spain, Japan,
Mexico, US and Brazil.
United Kingdom
When conducting medical marketing research in the UK, it is
important to account for how the National Health Service (NHS)
greatly influences the system, resulting in a very cost-conscious
environment.
Medical and Reimbursement System
■ The NHS (National Health Service) rules the day
• Most patients have government-sponsored insurance
• Being cost conscious dominates in a mostly public healthcare system
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• Physicians do not have much choice in trying to use expensive
medications when the NHS will not pay for them
• Generic alternatives are frequently used first line
■ A minority of patients have private insurance that gives them
access to a greater number of medications
■ Direct-to-consumer promotion is prohibited
Treatment Practices
■ All specialist physicians working as part of the NHS are
hospital-based
■ Internal Medicine physicians (IMs) do not exist
■ The dual Hematology/Oncology specialty does not exist
• Generally speaking,Oncologists treat solid tumors and
Hematologists treat liquid tumors
• Clinical Oncology specialty combines radiation and
medical oncology
■ Consultants and Specialist Registrars (SPRs) should be
considered for interviews
• SPRs are “junior”physicians with less clinical experience,
but still make decisions
• Consultants manage multiple SPRs
■ NICE (National Institutes for Clinical Excellence) guidelines
greatly influence treatment decisions as they may influence funding
decisions for medications
■ Physicians tend to be relatively conservative in their treatment
strategies and slower to adopt new therapies
Logistical Tips
■ London is a “must”city, but regional guidelines for specialty
areas, e.g., oncology, may necessitate the addition of other cities
such as Birmingham and Manchester
■ Morning research is virtually impossible
• Research can be conducted Monday through Friday
• Workloads in the hospital allow for a few afternoon interviews,but
evening time slots are preferable
• One-hour qualitative telephone interviews are possible
■ British English is not the same as US English
• English-version materials should be reviewed and adjusted
accordingly to account for British terminology
France
Conducting medical marketing research in France is relatively
easier than in other countries as participants are generally cooperative,
physicians’ prescribing choices are less regulated and there
are fewer limits placed on scheduling interviews.
Medical and Reimbursement System
■ Most patients have state health insurance
• Most drugs are included in the social security plan and reimbursed
■ Payers are difficult to interview and not worth the cost
• They refuse to answer a lot of questions due to confidentiality issues
GLOBAL MARKETING RESEARCH
• Interviewing Key Opinion Leaders (KOLs) about payer issues
is often a better option
Treatment Practices
■ Regional hospitals tend to specialize in treatment areas, e.g.,
leukemia versus lymphoma
• Recruiting multiple physicians from the same hospital is
necessary
• Budget issues vary dramatically from hospital to hospital
■ The dual Hematology/Oncology specialty does not exist
■ Sampling of drugs is illegal
Logistical Tips
■ Research locations to consider include Paris, Lyon and Marseille
■ There is a fair amount of flexibility for conducting research
• Morning,afternoon and evening interviews are possible
• On-time and show rates are very good
• 45- to 60-minute interviews are acceptable
• Scheduling up to eight studio interviews per day is possible
• Two to three focus groups per day is possible
■ Avoidance of mixing specialties in focus groups is of even greater
importance in France than in other countries
■ Telephone-depth interviews are becoming more popular
■ Average age of physicians is about 50 years old, so allow for at least
30 years in practice for screeners
■ Physicians generally have a distaste for projective techniques and
“emotional response”methodologies
■ Patient research can be interesting, but of minimal value because
they generally indicate that physicians entirely influence the final
decisions
Germany
Germany, it is important to remember that physicians are held
accountable for their own budgets, which clearly affects their decision
making. When conducting research in this country, Wednesday
is the most productive day of the week.
Medical and Reimbursement System
■ Budget issues are critical among physicians
• Healthcare system is mostly public
• Monthly cost for prescription drugs per patient is assigned to
physicians by the federal statutory health insurance or accredited
association
• If over budget,physicians need to defend themselves and be held
accountable
• Specialists generally get a larger budget than General Practitioners
■ Hospitals are increasingly being funded based on Diagnostic
Related Groups (DRGs)
• This system results in partial restrictions on products and earlier
hospital discharges
■ Direct-to-consumer promotion is prohibited
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Treatment Practices
■ Regional differences can be important due to local protocol,
especially in specialized treatment areas, e.g., HIV, oncology,
hepatitis
■ Many specialists are both hospital-based and office-based, e.g.,
Oncologists, Hematologists, Urologists, Gastroenterologists, etc.
■ Internal Medicine physicians (IMs) exist and are hospital-based
specialists
■ Hematologist/Oncologist is one dual specialty
• No separate specialties for hematology and oncology
Logistical Tips
■ Research locations to consider include Berlin, Munich, Hamburg
and Frankfurt
■ Wednesdays are desirable for research due to availability
• Wednesdays are reserved for research/administration or “days off”
• Scheduling research on Monday and Friday can be difficult
• Morning interviews are very difficult (start at noon)
• German physicians are punctual,and on-time and show rates are
excellent
• 45- to 60-minute interviews are acceptable
• Six to eight studio interviews per day is possible
• Summer research is easier than in other EU countries
■ Physicians generally have a distaste for projective techniques and
“emotional response”methodologies
• Responses tend to be literal
■ Recruiting pharmacists is increasingly difficult as pharmacies
become more centralized
• Fewer pharmacists
■ Patient empowerment is leading to increased research among
consumers, but keeping the interview length short (20 to 25 minutes)
is important
Italy
In Italy, citizens generally have open access to services and pharmaceuticals,
but it is important to note that numerous regions, as
well as different hospitals within them, create their own formulary.
Medical and Reimbursement System
■ Public access to healthcare is granted to every citizen
• Most hospitals are public and open to everyone,with most services
free or for a small fee
• The wait for public services can be long and patients can pay for
faster service,but it is expensive
• Private insurance is becoming more popular
■ General Practitioners (GPs) are warned by local healthcare
authorities when they prescribe too many expensive agents
• Physicians not held to a budget,but the government is expected to
employ budgets
■ The European Medicines Agency (EMEA) approves new drugs
for use in Italy
GLOBAL MARKETING RESEARCH
• 20 regions create their own formulary and each hospital in
each region creates its own formulary
■ Prescription drugs are divided into many classes for reimbursement
purposes when obtained at retail pharmacies
• Class A—fully reimbursed
• Class C—out-of-pocket
Treatment Practices
■ Regional differences can be important, especially in specialized
treatment areas
■ Specialists are typically hospital employees
• Most have a public and private practice
■ Oncologists treat solid tumors and Hematologists treat liquid tumors
Logistical Tips
■ Research locations to consider include Rome, Milan and Naples
■ In-person interviews are much preferred over telephone interviews
• Scheduling up to eight studio interviews per day is possible
• Morning interviews are very difficult (start at 1 p.m.) as are Fridays
• 60-minute in-person interviews are acceptable,but telephone inter
views should not exceed 15 minutes
• Internet surveys can take one to two weeks longer to field than in
other countries
• Physicians are routinely late, but do not mind waiting if asked
■ Research participants tend to skew responses toward the higher end
of scales as they do not want to appear negative
Spain
In Spain, behavioral and cultural differences by region are important
to consider, motivating researchers to ensure sample coverage
in Madrid and Barcelona at a minimum.
Medical and Reimbursement System
■ Most patients have state health insurance
■ The central government approves the commercialization of
pharmaceuticals, but regional governments can apply their own
restrictions
• Pricing and reimbursement strategies are decided on a national
level,and Key Opinion Leaders (KOLs) are consulted
• Clinical guidelines are important for reimbursement purposes
■ Hospital pharmacists assume the role of gatekeepers for access
to drugs
■ Primary Care Physicians (PCPs) get economic bonuses if at least a
minimum proportion of their prescriptions are for generic agents
Treatment Practices
■ Regional differences are important in highly specialized treatment
areas, e.g., acute leukemia, HIV
■ Most physicians are both office-based and hospital-based
• Many work in the hospital in the morning and in a private practice
in the afternoon
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■ Internal Medicine physicians (IMs) do exist, but they tend to
specialize in an area such as infectious disease, HIV, emergency care
and intensive care
■ Emergency room physicians do not exist as a specialty
■ Hematologist/Oncologists exist
• Hematologists treat liquid and solid tumors
• Oncologists treat only solid tumors
Logistical Tips
■ Research participants take their time to commit—filling the schedule
can take up to the day of research
• Scheduling up to eight studio interviews per day is possible
• Morning interviews are virtually impossible (start at 1 p.m.)
• Scheduling research on Fridays can be difficult
• 45- to 60-minute in-person interviews are acceptable,but telephone
interviews should not exceed 20 minutes
• Internet surveys can take one to two weeks longer to field than in
other countries
■ Conducting research among seriously ill patients is considered
unethical
■ Privacy issues with patients can be a serious issue, e.g., HIV patients
typically ensure they are not being videotaped
Japan
One can conduct excellent research in Japan and obtain extremely
insightful results, but you must adapt your expectations about costs and
timing. Research typically requires twice the time and money than any
other country.
Medical and Reimbursement System
■ One national health insurance system where patients pay 30 percent
of the total cost up to a maximum amount per year and then are fully
covered
• Those with severe chronic conditions or elderly are fully reimbursed
■ A small amount of treatments are not reimbursed—“lifestyle
treatments,”e.g., cosmetics, plastic surgeries, erectile dysfunction
treatments, smoking cessation
■ Hospital/clinics dispense prescription drugs either directly or
through dispensing pharmacies as part of their infrastructure
■ Off-label prescribing is much less common than in other countries
Treatment Practices
■ Two general treatment settings—hospitals (20-plus beds) and
clinics (0-19 beds)
■ Patients can choose their own doctor and treatment setting without
cost differences
■ Patients go to small clinics for relatively mild and short-term
conditions and go to large hospitals for more severe diseases
■ Generics are not widely acceptable—first, there are not enough
incentives for generic prescribing, and second, questions of
quality linger
GLOBAL MARKETING RESEARCH
■ All physicians are trained to be “specialists”—there are Internal
Medicine physicians (considered specialists), but no General
Practitioners
■ Cancer is generally treated by the “body part”specialist, e.g.
Gastroenterologists treat stomach cancer, Urologists treat prostate
cancer, Breast Surgeons treat breast cancer
Logistical Tips
■ Doctors are considered key authority figures and addressed with
reverence, on par with lawyers and politicians—as a result, it is often
difficult for moderators to probe or challenge respondents on their
ideas, and answers must often be obtained through indirect
questioning
■ Acceptable times for conducting in-studio interviews with physicians
is limited to weekday evenings and occasionally Saturdays
■ For quantitative research with physicians, the best approach is to
have local field interviewers visit physician offices and fill out the
questionnaire on paper
■ A typical 45-minute interview will take 60 to 75 minutes in Japan
■ Focus group sizes are generally small—typically made up of six
respondents who are similar demographically, e.g., ages, position, etc.
■ Phone interviews must be short (five minutes or less) since it is
culturally more appropriate to talk in person
■ Videotaping respondents typically does not happen because of
privacy laws
Mexico
Medical marketing research is not conducted as often in Mexico as it is
elsewhere, but a recent increase in requests to consider it for a greater
number of research studies suggests that could change.
Medical and Reimbursement System
■ There are two main healthcare systems:
• IMSS (Instituto Mexicano del Seguro Social)—attends to private
company workers
• ISSSTE (Instituto de Seguridad y Servicios Sociales de los
Trabajadores del Estado)—attends to government workers
• Drugs are generally dispensed to those patients at no cost
(some hospitals require a minimum payment)
■ Private patients (non-IMSS and non-ISSSTE) pay out-of-pocket
for their medications, and deductibles can be more expensive than
the cost of the medication
■ To sell more medications, pharmacies may not ask to see an actual
prescription when dispensing, but they do require seeing
prescriptions for restricted drugs, e.g., opioids
Logistical Tips
■ Extra personal attention is required during recruiting efforts,
e.g., recruiters need to treat physicians as very important people
■ Over-recruiting is necessary as physicians often cancel at the
last minute
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■ Physicians tend to require more time to complete surveys and
interviews than in other countries
• A 45-minute survey may take 55 to 60 minutes
• Morning interviews are possible
• Recruiting/scheduling up to eight respondents in one day is possible
• Physicians are slowly adopting the practice of completing Internet
surveys;they would rather speak to a moderator than sit in front of a
computer
■ Asking income questions is unacceptable
• Surrogate questions are asked,e.g.,type of car owned,number of
rooms in house,level of education for the head of the household
■ Physicians tend to skew their ratings toward the higher end of the
scale, e.g., they are very receptive to new products
Brazil
In Brazil, although participants are slower than their counterparts in
other countries to adopt the practice of completing Internet-based
surveys, they are still very willing and eager to take part in studies.
Medical and Reimbursement System
■ The Agencia Nacional de Vigilancia Sanitaria (ANVISA) is the
governing body for pharmaceuticals
■ There is no reimbursement for medication
• Patients do not require a prescription,except for a few “controlled”
medications
Treatment Practices
■ Physicians frequently work across multiple settings, e.g., hospitals,
clinics, offices
■ Many physicians prescribe “compounding”medications and
refer to them as “formula”
• Cheaper than generics and therefore more affordable
• Problem:Patients do not know if the dosage of the medication is
exactly as it is supposed to be
Logistical Tips
■ Physicians are open and willing to participate in marketing research
• Respondents accept and answer all types of questions
• Recruiting/interviewing up to eight studio interviews per day
is possible
• Early morning research is possible
• Friday research is very difficult
• July and December are difficult months for research
• Physicians are very slowly adopting the practice of completing
surveys on the Internet,thus in-office interviews are done for
quantitative surveys
■ Asking income questions is unacceptable
• Surrogate questions are asked in order to approximate respondent’s
income,e.g.,number of bathrooms in house,types of appliances,level
of education for the head of the household,whether they employ a
maid,type of car owned,etc.
GLOBAL MARKETING RESEARCH
United States
By way of comparison, the United States is arguably the easiest country
in the world to conduct pharmaceutical marketing research. The
culture is very conducive for all kinds of qualitative and quantitative
studies. As such, when conducting primary research in multiple
countries where you include the US, it is important to remember to
manage (not lower) expectations for the other countries where timelines
are longer.
Logistical Tips
■ Money can solve a host of problems, including recruiting issues
and tight timelines
■ Many good facilities exist in most markets across the country
(convenient, experienced recruiters and facility managers, very
customer-focused)
■ Facilities are state-of-the-art and comfortable
(excellent Internet access)
■ Research is conducted faster and with more flexibility than in
other countries
• All data collection methods acceptable,e.g.,in-person,in-office,
phone,Internet,etc.
• Easier to recruit all types of physicians (Generalists,Specialists,
Key Opinion Leaders)
■ The greatest risk is over-researching a finite population
• Beware of recruiting “professional”respondents time after time,
especially in the top markets
■ Beware of regional differences
• Some markets are much more concerned about cost as a result
of different levels of managed care influence
• Some markets can be more “academic”or more “aggressive”than
are others
Conclusion
As primary marketing research professionals continue to span the
globe conducting and managing international studies, living with the
“When in Rome…”philosophy in mind will greatly increase the probability
that the research will be successful. To effectively manage expectations
among everyone, including senior management, research
professionals should spend time before each international project
reminding themselves of the local medical systems, treatment practices,
and how and at what pace things get accomplished in the particular
countries of interest.
It is critical to be flexible, listen to the locals and build partnerships.
Additionally, while the technology exists to observe research in most
countries via videoconferencing, there is no substitute for physically
being there to observe and develop a rich understanding of the research
results. ■
Bart Weiner is president of GfK V2 and Brian Hull is president
of GfK Strategic Marketing. Both companies are pharmaceutical
marketing research and consulting firms and part of the GfK US
Healthcare Companies.
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