Sağlık Hizmetlerinde Bozulan Değişim İlişkileri: Kavramsal Bir Model Önerisi

Öz

Bu çalışma, dijitalleşme, değişen hasta davranışları ve sağlık sektörüne katılan yeni aktörlerin etkisiyle geleneksel sağlık pazarlama yapılarında ortaya çıkan kesintileri, “bozulan değişim ilişkileri” (disrupted exchanges) kuramsal çerçevesiyle analiz etmektedir. Araştırma, kuramsal bir çalışma olup, literatür incelemesine dayalı olarak özgün bir kavramsal model geliştirilmiştir. Literatürde, dijitalleşme ve yeni aktörlerin sağlık pazarlama ilişkilerine etkisi üzerinde bütüncül bir kavramsal model bulunmamaktadır. Önerilen model bu boşluğu, bilgi akışı, hasta güçlenmesi, kontrolün aşınması ve değer ortaklığı boyutları üzerinden doldurmaktadır. Çalışmada özellikle dijital teknolojilerin bilgiye erişimi kolaylaştırmasıyla birlikte sağlık hizmetlerinde geleneksel bilgi asimetrisinin giderek azaldığı ve hasta lehine dönüştüğü vurgulanmaktadır. Ayrıca influencer hekimler, dijital sağlık platformları ve perakende klinikler gibi yeni aktörlerin, hasta güveni ve iletişim süreçleri üzerindeki etkileri değerlendirilmiştir. Son olarak, dijital pazarlama faaliyetlerinin sağlık sonuçları üzerindeki etkisi, veri gizliliği ile marka güveni arasındaki ilişki ve tüketici temelli sağlık iletişiminin etik sınırları gibi konular, geleceğe dönük araştırma alanları olarak önerilmektedir. Bu yaklaşım, sağlık pazarlaması literatüründe dijitalleşme ve yeni aktörlerin bilgi ve değer akışlarını nasıl yeniden şekillendirdiğine dair bütüncül bir çerçeve eksikliğini gidermektedir. Çalışma, sağlık pazarlaması alanında teorik bir boşluğu doldurmayı ve disiplinlerarası ampirik araştırmalar için yönlendirici bir temel sunmayı hedeflemektedir.

Anahtar Kelimeler

• Sağlık pazarlaması
• Dijital sağlık
• Bozulan değişim ilişkileri
• Bilgi asimetrisi
• Hasta güçlenmesi

Disrupted Change Relationships in Healthcare: A Conceptual Model Proposal

Abstract

This study examines the disruptions occurring in traditional healthcare marketing structures due to digitalization, changing patient behaviors, and the involvement of new actors, using the theoretical lens of “disrupted exchanges.” Conceptual in nature, the research develops an original model based on an extensive literature review. Existing studies do not offer a comprehensive framework that systematically explains how digitalization and emerging actors transform healthcare marketing relationships. The proposed model addresses this gap by focusing on information flow, patient empowerment, erosion of provider control, and value co-creation. It highlights that as digital technologies increase access to information, traditional information asymmetry in healthcare is gradually diminishing in favor of patients. The study also evaluates the influence of new actors—such as influencer physicians, digital health platforms, and retail clinics—on patient trust and communication dynamics. In addition, it points to critical future research areas, including the effects of digital marketing on health outcomes, the interplay between data privacy and brand trust, and the ethical boundaries of consumer-driven health communication. Overall, the model offers a holistic framework for understanding how digitalization reshapes information and value exchanges in healthcare and provides a theoretical foundation to guide future interdisciplinary empirical research

Keywords

• Health marketing
• Digital health
• Disrupted exchanges
• Information asymmetry
• Patient empowerment

References

1. Acıbadem Sağlık Grubu. (t.y.). Ameliyat öncesi ikinci görüş. Retrieved September 27, 2025, from https://www.acibadem.com.tr/ameliyat-oncesi-ikinci-gorus
2. Acquisti, A., Gritzalis, S., Lambrinoudakis, C., & di Vimercati, S. (Eds.). (2007). Digital privacy: Theory, technologies, and practices. CRC Press.
3. Adler, S. R. (2003). Relationships among older patients, CAM practitioners, and physicians: the advantages of qualitative inquiry. Alternative Therapies in Health and Medicine, 9(1), 104–110. https://pmc.ncbi.nlm.nih.gov/articles/PMC2754707/
4. Affinito, L. (2018). Empowering the connected physician in the E-patient era: How physician’s empowerment on digital health tools can improve patient empowerment and boost health (care) outcomes. Routledge.
5. Alderman, M., & Edberg, D. (2011). Information systems and biopower: Evaluating the exchange of health information through Foucault’s philosophy. In AMCIS 2011 Proceedings-All Submissions, 288 (pp. 1-8). Detroit, Michigan August 4th -7 th. http://aisel.aisnet.org/amcis2011_submissions/288
6. Anadolu Ajansı (AA). (2023, 15 Kasım). Hacettepe Üniversitesi’nden çevrimiçi ikinci görüş hizmeti. https://www.aa.com.tr/tr/isdunyasi/saglik/one-dose-health-ve-hacettepe-universitesinden-tibbi-ikinci-gorus-anlasmasi/687794
7. Atanasova, S., & Petric, G. (2019). Collective empowerment in online health communities: scale development and empirical validation. Journal of Medical Internet Research, 21(11), 1–16. https://doi.org/10.2196/14392
8. Barile, S., Saviano, M., & Polese, F. (2014). Information asymmetry and co-creation in health care services. Australasian Marketing Journal, 22(3), 205–217. https://doi.org/10.1016/j.ausmj.2014.08.008

9. Bekbolatova, M., Mayer, J., Ong, C. W., & Toma, M. (2024, January). Transformative potential of AI in healthcare: Definitions, applications, and navigating the ethical landscape and public perspectives. Healthcare, 12(2), 1-31. MDPI. https://doi.org/10.3390/healthcare12020125
10. Blomqvist, Å. (1991). The doctor as double agent: Information asymmetry, health insurance, and medical care. Journal of Health Economics, 10(4), 411–432. https://doi.org/10.1016/0167-6296(91)90023-G
11. Cleveland Clinic. (n.d.). Virtual Second Opinions. Retrieved September 26, 2025 from https://my.clevelandclinic.org/online-services/virtual-second-opinions
12. Çavdar, P. (2024). Hekimlerin hastalarına ilişkin sosyal medya paylaşımlarından doğan sorumluluğu. Sakarya Üniversitesi Hukuk Fakültesi Dergisi, 12(1), 429-453. https://doi.org/10.56701/shd.1462767
13. Çoban, M. (2023). Türkiye’de e-sağlık uygulamalarında mevcut durum. Bingöl Üniversitesi Sağlık Dergisi, 4(1), 197-204. https://doi.org/10.58605/bingolsaglik.1249681
14. Debon, R., Coleone, J. D., Bellei, E. A., & De Marchi, A. C. B. (2019). Mobile health applications for chronic diseases: A systematic review of features for lifestyle improvement. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 13(4), 2507-2512. https://doi.org/10.1016/j.dsx.2019.07.016
15. Demirel Değirmenci, S. (2024). Asymmetric information and privatization of health care. Bulletin of Economic Theory and Analysis, 9(1), 171–184. https://doi.org/10.25229/beta.1399218
16. DiMaggio, P. J., & Powell, W. W. (1983). The iron cage revisited: Institutional isomorphism and collective rationality in organizational fields. American Sociological Review, 48(2), 147-160. https://www.jstor.org/stable/2095101?origin=JSTOR-pdf
17. Emory Healthcare. (n.d.). Patient portal (MyChart: Your easy-to-use patient portal). Retrieved September 25, 2025, from https://www.emoryhealthcare.org/patients-visitors/patient-resources/patient-portal
18. Fortune Business Insights. (2024, January). Retail Clinics Market Size, Share and Analysis by Location (Departmental Stores, Shopping Malls, Retail Stores, Others) By Ownership (Standalone, Hospital-owned, Investor-owned, Others), By Mode of Payment (Insurance, Out-of-Pocket) and Regional Forecast, 2025-2032. https://www.fortunebusinessinsights.com/industry-reports/retail-clinics-market-101111
19. Future Market Insights. (2024, January). Retail clinics market outlook for 2024 to 2034. https://www.futuremarketinsights.com/reports/retail-clinics-market
20. Galetsi, P., Katsaliaki, K., & Kumar, S. (2023). Exploring benefits and ethical challenges in the rise of mHealth (mobile healthcare) technology for the common good: An analysis of mobile applications for health specialists. Technovation, 121,331–334. https://doi.org/10.1016/j.technovation.2022.102598
21. García López, P. (2024). Foucault and digital technologies of power: Studying resistance as decentralization. Universitat Oberta de Catalunya (UOC). https://hdl.handle.net/10609/151013
22. General Medical Council. (2024). Using social media as a medical professional. Retrieved September 26, 2025, from https://www.gmc-uk.org/professional-standards/the-professional-standards/using-social-media-as-a-medical-professional/using-social-media-as-a-medical-professional
23. Ghose, A., Guo, X., Li, B., & Dang, Y. (2021). Empowering patients using smart mobile health platforms: Evidence from a randomized field experiment.1–68. https://arxiv.org/pdf/2102.05506
24. Göğce, H., & Özmen, M. (2020). Hizmet baskın mantık ve ortaklaşa değer yaratımı: Pazarlama disiplini için bütüncül bir değer yaklaşımı. Pazarlama Teorisi ve Uygulamaları Dergisi, 6(1), 1-18.
25. Growth Market Reports. (2023). Retail health clinic chains market—Global industry analysis, size, share, growth, trends, and forecast 2023–2031. https://growthmarketreports.com/report/retail-health-clinic-chains-market
26. Gümüş, C., & Aksoy, R. (2022). Hizmet baskın mantık çerçevesinde değerin birlikte yaratımı kavramına genel bir bakış. Sosyal, Beşeri ve İdari Bilimler Dergisi, 5(3), 324–334. https://doi.org/10.26677/TR1010.2022.936
27. Hamine, S., Gerth-Guyette, E., Faulx, D., Green, B. B., & Ginsburg, A. S. (2015). Impact of mHealth chronic disease management on treatment adherence and patient outcomes: A systematic review. Journal of medical Internet research, 17(2), e52. https://doi.org/10.2196/jmir.3951
28. Hau, L. N., Tram Anh, P. N., & Thuy, P. N. (2017). The effects of interaction behaviors of service frontliners on customer participation in the value co-creation: a study of health care service. Service Business, 11(2), 253-277. https://doi.org/10.1007/s11628-016-0307-4
29. Herper, M. (2018, July 25). 23andMe gets $300 million boost from Glaxo to develop new drugs. Forbes. https://www.forbes.com/sites/matthewherper/2018/07/25/23andme-gets-300-million-boost-from-glaxo-to-develop-new-drugs/
30. IBISWorld. (2025). Alternative healthcare providers in the US—Market size and growth dynamics 2019–2025. IBISWorld Industry Report, 1565. https://www.ibisworld.com/united-states/market-size/alternative-healthcare-providers/1565/
31. Insight Ace Analytic. (2025). Retail clinics in-store healthcare market size, share & trends analysis report, by location (stores, malls), ownership type (retail owned and hospital owned), application (clinical chemistry & immunoassay, point of care diagnostics, vaccination), by region, forecasts, 2025–2034 (Report No. 1314). https://www.insightaceanalytic.com/report/global-retail-clinics-in-store-healthcare-market/1314
32. Jaakkola, E. (2020). Designing conceptual articles: Four approaches. AMS review, 10(1), 18-26. https://doi.org/10.1007/s13162-020-00161-0
33. Karakethüdaoğlu, M. (2019). Sistemlerin geliştirilmesinde mobil uygulamalarda kullanıcı geri bildirimlerinin önemi: Türkiye e-nabız örneği. (Tez no. 560392) [Yüksek lisans tezi, Sakarya Universitesi].
34. Kayserili, A., & Tefiroğlu, E. Ç. (2023). Dijital sağlık hizmetlerinin hastane idarecileri tarafından değerlendirilmesi. Abant Sağlık Bilimleri ve Teknolojileri Dergisi, 3(2), 26-38. https://dergipark.org.tr/en/pub/sabited/issue/79593/1293076
35. Letafati, M., & Otoum, S. (2023). Digital healthcare in the metaverse: Insights into privacy and security. IEEE Consumer Electronics Magazine, 13(3), 80-89. doi: 10.1109/MCE.2023.3334494.
36. MacInnis, D. J. (2011). A framework for conceptual contributions in marketing. Journal of Marketing, 75(4), 136–154. https://doi.org/10.1509/jmkg.75.4.136
37. Mahadik, S. S., Pawar, P. M., Muthalagu, R., Prasad, N. R., Hawkins, S. K., Stripelis, D., ... & Hecht, B. (2024). Digital privacy in healthcare: State-of-the-art and future vision. IEEE Access, 12, 84273-84291. 10.1109/ACCESS.2024.3410035
38. Mandel, J. C., Kreda, D. A., Mandl, K. D., Kohane, I. S., & Ramoni, R. B. (2016). SMART on FHIR: a standards-based, interoperable apps platform for electronic health records. Journal of the American Medical Informatics Association, 23(5), 899-908.
39. Mascarenhas, O. A. J., Kesavan, R., & Bernacchi, M. D. (2013). On reducing information asymmetry in U.S. health care. Health Marketing Quarterly, 30(4), 379–398. https://doi.org/10.1080/07359683.2013.847338
40. Mattioni, F. C., Nakata, P. T., Dresh, L. C., Rollo, R., Brochier, L. S. B., & Rocha, C. F. (2021). Health promotion practices and Michel Foucault: A scoping review. American Journal of Health Promotion, 35(6), 845-852. https://doi.org/10.1177/0890117121989222
41. Meingast, M., Roosta, T., & Sastry, S. (2006, August). Security and privacy issues with health care information technology. In 2006 international conference of the IEEE engineering in medicine and biology society (pp. 5453-5458). IEEE. https://doi.org/10.1109/IEMBS.2006.260060
42. Mesko, B., DeBronkart, D., Dhunnoo, P., Arvai, N., Katonai, G., & Riggare, S. (2025). The evolution of patient empowerment and its impact on health care’s future. Journal of Medical Internet Research, 27, 1-9. https://doi.org/10.2196/60562
43. Miller, A. R. (2022). Privacy of digital health information. Economics of Privacy, 1077-1093. https://conference.nber.org/confer/2022/EPTf22/MillerSlides.pdf
44. Miyamoto, S., Henderson, S., Fazio, S., Saconi, B., Thiede, E., Greenwood, D. A., & Young, H. M. (2019). Empowering diabetes self-management through technology and nurse health coaching. The Diabetes Educator, 45(6), 586-595. https://doi.org/10.1177/0145721719879421
45. Moorman, C., van Heerde, H. J., Moreau, C. P., & Palmatier, R. W. (2024). Marketing in the health care sector: disrupted exchanges and new research directions. Journal of Marketing, 88(1), 1-14. https://doi.org/ 10.1177/00222429231213154
46. Ng, I. K., Thong, C., Tan, L. F., & Teo, D. B. (2024). The rise of medical influencers: The pros and the cons. Journal of the Royal College of Physicians of Edinburgh, 54(3), 231-235. https://doi.org/ 10.1177/14782715241261736
47. NHS Digital. (n.d.). NHS App features. NHS. Retrieved September 25, 2025, from https://digital.nhs.uk/services/nhs-app/nhs-app-features
48. O’Neill, R. (2025). Rethinking the ‘wellness influencer’: Medical doctors, lifestyle expertise and the question of credentials. International Journal of Cultural Studies, 28(3), 685-701. https://doi.org/ 10.1177/13678779241307032
49. Penn Medicine (t.y.). Second opinions.https://www.pennmedicine.org/second-opinion
50. Peres da Silva, J. (2023, May 4). Privacy data ethics of wearable digital health technology. Brown University, School of Engineering, Center for Digital Health. https://cdh.brown.edu/news/2023-05-04/ethics-wearables?utm
51. Perez, M. V., Mahaffey, K. W., Hedlin, H., Rumsfeld, J. S., Garcia, A., Ferris, T., ... & Turakhia, M. P. (2019). Large-scale assessment of a smartwatch to identify atrial fibrillation. New England Journal of Medicine, 381(20), 1909–1917. https://www.nejm.org/doi/full/10.1056/NEJMoa1901183
52. PharmiWeb. (2024, October 15). Global retail clinic market set to revolutionize healthcare accessibility with substantial growth in 2024 [Press release]. https://www.pharmiweb.com/press-release/2024-10-15/global-retail-clinic-market-set-to-revolutionize-healthcare-accessibility-with-substantial-growth-us
53. Press Ganey. (2024, February 22). Millennials and Zoomers vs. Boomers: How different generations seek out and choose healthcare providers. https://info.pressganey.com/press-ganey-blog-healthcare-experience-insights/millennials-and-zoomers-vs-boomers-how-different-generations-seek-out-and-choose-healthcare-providers
54. Rajendrakumar, G. D. (2025). Enhancing patient-centric care through API-driven integrations. Journal of Computer Science and Technology Studies, 7(5), 702-708. https://doi.org/10.32996/jcsts.2025.7.5.78
55. Rodriguez, R. (2024, March 14). The ethics and concerns of biometric data collection. Daon. https://www.daon.com/resource/the-ethics-and-concerns-of-biometric-data-collection/
56. Salas-Groves, E., Galyean, S., Alcorn, M., & Childress, A. (2023). Behavior change effectiveness using nutrition apps in people with chronic diseases: scoping review. JMIR mHealth and uHealth, 11(1), 1-29. https://doi.org/10.2196/41235
57. Sands, D. Z. (2023). Beyond the EHR: how digital health tools foster participatory health and self-care for patients with diabetes. American Journal of Medicine Open, 10, 1-7. https://doi.org/10.1016/j.ajmo.2023.100043
58. Schleiter, K. E. (2009). Retail medical clinics: Increasing access to low cost medical care amongst a developing legal environment. Annals Health L., 19, 527. https://heinonline.org/HOL/LandingPage?handle =hein.journals/anohl19&div=65&id=&page=
59. Sener, C. (2023, May 2). Online reviews are becoming more important to patients in choosing their care: How to manage your online reputation in health care. https://www.medicaleconomics.com/ view/online-reviews-are-becoming-more-important-to-patients-in-choosing-their-care-how-to-manage-your-online-reputation-in-health-care
60. Serbest, S. (2024). İnovasyon ve hastane bilgi sistemleri. Eurasian Journal of Health Technology Assessment, 8(1), 38-64. https://doi.org/10.52148/ehta.1423859
61. Sharma, S., Conduit, J., & Rao Hill, S. (2014). Organisational capabilities for customer participation in health care service innovation. Australasian Marketing Journal, 22(3), 179-188. https://doi.org/10.1016/j.ausmj.2014.08.002
62. Sharon, T. (2018). When digital health meets digital capitalism, how many common goods are at stake? Big Data & Society, 5(2), 1–12. https://doi.org/10.1177/2053951718819032
63. Sreejesh, S., Sarkar, J. G., & Sarkar, A. (2022). Digital healthcare retail: Role of presence in creating patients' experience. International Journal of Retail & Distribution Management, 50(1), 36-54. https://doi.org/10.1108/IJRDM-12-2020-0514
64. T.C. Resmî Gazete. (2014, Ekim 27). Geleneksel ve tamamlayıcı tıp uygulamaları yönetmeliği. 29158. https://www.resmigazete.gov.tr/eskiler/2014/10/20141027-3.htm
65. T.C. Sağlık Bakanlığı. (t.y.) e-Nabız. 27.09.2025 tarihinde https://www.saglik.gov.tr/TR,11519/e-nabiz.html adresinden erişildi.
66. Tran, B., & Attorney, P. (2025, Aug. 08). Medical vs. consumer wearables: Adoption stats. https://patentpc.com/blog/medical-vs-consumer-wearables-adoption-stats?utm_source
67. TRT Haber. (2025). e-Nabız'ın kullanıcı sayısı 78,5 milyona ulaştı. https://www.trthaber.com/haber/saglik/e-nabizin-kullanici-sayisi-785-milyona-ulasti-911037.html
68. Valaei Sharif, N., & Ghasemzadeh, P. (2024). Digital health equity and patient education: A new paradigm in patient empowerment. Management Strategies in Health System, 9(3), 188–191. https://doi.org/10.18502/mshsj.v9i3.17294
69. Van Andel, T., & Carvalheiro, L. G. (2013). Why urban citizens in developing countries use traditional medicines: the case of Suriname. Evidence‐Based Complementary and Alternative Medicine, (1), 1–13. https://doi.org/10.1155/2013/687197
70. Van Dijk, J. (2020). The digital divide. John Wiley & Sons.
71. Vargo, S. L. (2009). Toward a transcending conceptualization of relationship: A service‐dominant logic perspective. Journal of Business & Industrial Marketing, 24(5/6), 373-379. https://doi.org/ 10.1108/08858620910966255
72. Vargo, S. L., & Lusch, R. F. (2008). Service-dominant logic: Continuing the evolution. Journal of the Academy of marketing Science, 36(1), 1-10. https://doi.org/10.1007/s11747-007-0069-6
73. Vargo, S. L., & Lusch, R. F. (2016). Institutions and axioms: An extension and update of service-dominant logic. Journal of the Academy of marketing Science, 44(1), 5-23. https://doi.org/10.1007/s11747-015-0456-3
74. Vega, R. A. (2024). Physicians of the future: Doctor-influencers, patient-consumers, and the business of functional medicine. University of Texas Press.
75. Weave. (2023, April). Online reviews play a vital role in attracting and retaining patients for small healthcare practices, survey reveals. https://www.getweave.com/survey-online-reviews-new-healthcare-patients/
76. Williams, C. A. N., Khanfar, N. M., Harrington, C., & Loudon, D. (2011). Marketing retail health clinics: Challenges and controversies arising from a health care innovation. Health Marketing Quarterly, 28(3), 270–285. https://doi.org/10.1080/07359683.2011.595648
77. Willis, E., & Delbaere, M. (2022). Patient influencers: The next frontier in direct‑to‑consumer pharmaceutical marketing. Journal of Medical Internet Research, 24(3), 1–9. https://doi.org/10.2196/29422