Trust, image and credibility: dormant potential of GKVn supply management

In an increasingly volatile and fast-moving time, brands are becoming more and more important for consumers - also in their role as health insured people. However, if the brand image created by the company does not match the actual brand identity, dissonances occur with counterproductive effects. An aspect that is becoming more important than ever for statutory health insurance companies (GKVn), among other things due to the resulting market confusion and product diversity.

>> The reputation and thus the good standing of a statutory health insurance fund (GKV) as a significant marketing tool with an intensive trust function represents an important quality signal for policyholders to reduce uncertainty. Only in the event of a benefit (or illness) are policyholders able to form their own opinion. Therefore, differentiating output signals (brand, reputation, rankings, awards, etc.) play a significant role, especially for intangible trust goods (such as health insurance benefits), compared to input signals (e.g., services). The statutory health insurance funds (GKVs) have also recognized this and, since January 1, 1996, have increasingly evolved from the role of pure "payer" to "player." In this role, they increasingly seek to use branding to both compete successfully and fulfill their social solidarity mandate. They essentially employ two overarching strategies:
1. Influencing "soft" factors: Building image and brand worlds that, as in other industries, appeal to consumers and their "soft" needs through appeal, value impact, messaging, and language. Only in exceptional cases do statutory health insurance funds benefit from their own established image (e.g., TK, AOK). In the vast majority of cases, they participate (intentionally or unintentionally) in the image values of third parties (e.g., IKK = Handwerk, Siemens BKK = Siemens) or attempt to create a transfer to subliminal image worlds through regional or artificial names (e.g., BKK Pfalz, Die Bergische BKK, Sancura, Pronova).
2. Influencing „hard“ factors: Implementing product and service differentiations with hard criteria (e.g. securvita, BKK MOBIL, BKK vor Ort), which are quickly accessible to many consumers, for example via rankings in specialist journals, own advertising and internet presence or via widespread quality seals.

The importance of the consistency of the brand message and the actions of statutory health insurance providers arises from the broad sanction mechanisms with which insured persons and the general public (as a market barometer and a medium for social reflection) are equipped. This is because not only declining customer loyalty (i.e., cancellations and switching insurers), but also mass media (blogs, forum entries, wikis, and social networks, etc.) are causing previously (weak) stakeholder or customer groups to gain power. According to a representative survey by the Gottlieb Duttweiler Institute (GDI), consumers are no longer looking for pure facts when searching for information, but rather for the experiences of (complete strangers) (Frick/Hauser 2007). While the influence of independent experts (e.g., Stiftung Warentest) remains significant, consumers are increasingly networking online to exchange experiences. User-generated testimonials (e.g., Ciao, Dooyoo) are also enjoying increasing popularity in the statutory health insurance market. Consumer advocates sometimes warn against inadequate and vulnerable opinions from laypeople.
Brand building in the statutory health insurance system
While the power of the brand as an image driver does not directly influence company value, it does have an indirect impact through factors such as higher customer loyalty, easier customer acquisition, more positive effects on action, higher pricing, easier recruitment of employees, and cross-selling effects. Active participation in preventive and health-promoting measures can also be indirectly influenced through the attributes of credibility, trust, etc., in the form of a positive, overarching incentive climate (Scherenberg 2011). Furthermore, emotional events are processed better by the brain than neutral events. Emotionally charged brands, like celebrity ambassadors, contribute to greater attention and improved recall among policyholders (Fanderl 2005). The values and moods are conveyed through brand slogans, which, as a kind of "mission statement," are intended to firmly anchor the brand or even the mission and vision of the health insurance fund in the public eye (Schmidt 2007). This form of long-term recognition can provide clues as to the brand strategy a health insurance fund is pursuing. Positioning is either subject-oriented or object-oriented, meaning different target groups are addressed (e.g., "The Women's Health Insurance Fund" – BKK Salvina) and/or a clear value proposition (e.g., "More performance, more service, more humanity" – BKK mhplus) is conveyed (Haeneck/Laukamp 2006). A comprehensive survey of all statutory health insurance brand slogans from July to September 2009 (see Figure 1) revealed that, in the current status quo, an object orientation (focus on services, value proposition) is more important in branding than a subject orientation (or a specific target group for the health insurance funds).
However, this focus on a clear value proposition has not been sufficiently successful so far. According to a representative survey, for example, 64.2% of insured persons who have switched their health insurance at least once do not recognize any differences between the individual funds (Dostal/Dostal 2010). This is not surprising given that just 14 years after the liberalization of the statutory health insurance market and the resulting intensified competition, more than a third of the statutory health insurance funds (37.9% of them) operate without a slogan (ibid.). At the same time, the upheavals in the market are reflected in the short lifespan of numerous slogans: quite a few slogans are "changed" at short intervals or fall victim to mergers. It should be noted that the presence or absence of a slogan alone is an expression of a company's brand awareness, but rather whether consumers understand the slogan and what content they associate with it. For this purpose, a telephone consumer survey (n = 704) was conducted in spring 2010 in eleven European metropolitan regions in Germany – which, with approximately 54 million inhabitants, cover approximately 66% of the population – asking respondents to use 17 randomly selected slogans from 16 health insurers. The survey was representative in terms of age, gender, and regional distribution.
Slogans were read out to the test subjects without naming the respective health insurers. The 17 slogans revealed significant differences in the perception of the insured (Fig. 2). The percentage of consumers who were able to associate specific characteristics/services (products) with the health insurers based on slogans fluctuated between 6.9% and 55.4%. This clearly shows that many of the selected health insurers missed the opportunity to convey specific performance, service, or image claims and to steer their company beyond "interchangeability" (i.e., the market does not need this health insurer at all). The question of positive influence, for example, on the health awareness and preventive care behavior of their own or potential insured persons does not even arise under these conditions.
The results show that statutory health insurers can differentiate themselves from competitors with a coherent slogan – supported by selected offers for specific target groups. The size of the insurer, measured, for example, by the number of members (statutory health insurance) or fully insured individuals (private health insurance), plays no discernible role in the quality of its market presence. At the same time, it becomes clear that brand strength and conceptual strength are significantly underutilized as positioning and marketing opportunities, even though one in two insured individuals – and almost two-thirds of those with voluntary or private insurance – desires a targeted, "hard" product focus. This desire for differentiation clashes with the actual "brand landscape." Only about 301,030 consumers indicate that they perceive "very large/large" differences between health insurers.
Of the consumers who perceive differences, almost one-third (30.1% of respondents) perceive different benefit arguments, followed by service (23.8% of respondents), price (22.0% of respondents), and image (20.6% of respondents). The still high level of price differentiation, despite the standard contribution rate, reflects the general lag in consumer perception in low-interest markets: "Old" experiences often shape consumer attitudes. The discussion about additional contributions is therefore finding a receptive audience here.
Importance of sustainable value communication through branding
Marketing strategies are often criticized for not being sufficiently focused on addressing societal challenges. This neglects the psychosocial costs of marketing (e.g., loss of image), the importance of a positive image or reputation, and a strong focus on society and the customer. Since trust in brands and companies can be seen as a driver of personal and collective trust, the behavior of statutory health insurance funds should always be consistent with the brand mission statement and public values. Brand images, as overarching anchors of trust (depending on the design of the brand attributes), can convey and influence both company-specific (marketing) and socially relevant messages (prevention and health promotion). The brand, as a crucial communication tool, also encompasses social commitment and shapes not only how the respective statutory health insurance fund is perceived by the public as a responsible member of society. Strong statutory health insurance brands can also convey social recognition for individuals, for example, through self-responsible health care and preventive behavior.
It should be noted that the reform policy, which is geared toward reducing the number of statutory health insurance funds while simultaneously leveling the range of care offered, sometimes hinders rather than promotes the fulfillment of consumer demands and also the competitive branding process on the part of the statutory health insurance funds. Statutory health insurance funds face the challenge of using their "brand" more than before as a recognizable "anchor" to support their insured and for sustainable positioning. The conceptual integration of companies from the primary and secondary healthcare markets could provide additional momentum.