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Executive Summary
If you were born in 1900, it is likely that you were born at home, not in a hospital. Your mother would have been attended to by a midwife, not a doctor. If there were complications, no ambulance would be available to pick you up, no emergency room would await, and no obstetrician or surgeon would have been on call. Childbirth was a dangerous proposition: In 1900, the infant mortality rate in the United States was 16.5%, and 850 of every 100,000 women died in childbirth. In contrast, if you were born at the end of the twentieth century, you were almost certainly born in a hospital and under the care and supervision of a doctor. A surgical team would be on call in case of complications, or perhaps you would be one of the more than 30% of babies born by cesarean section. Your chance of survival would exceed 99.9%, as would your mother’s. The ordinariness of your birth is one of the triumphs of modern medicine.

Why is there such a difference? What was missing in 1900 was a health care system—a provisioning system—that delivered health care to the majority of citizens. Viewed from a marketing systems perspective, investments in the functions of the health care delivery system have improved the capacity and assortment of health care to the point that medical procedures that were once rare are now routine. The great advance of the last century was not just the progress of medicine but the emergence of a health care system.

In the United States, as elsewhere, health care is a marketing system. As with any market-based provisioning system, the output of the health care marketing system is improved assortment, which is the precursor to consumer choice. As with any system, the dimensions of the health care marketing system are a function of its antecedents and organizing principles and, as such, define consumer choice either by expanding or limiting access and assortment.

The purpose of this essay is to explore the effects of marketing systems on provisioning and constraining consumption and to understand the role of public policy in overcoming constraints in marketing systems. It offers a brief overview of the theory of marketing systems. Then, it examines the nature of consumption constraints in the context of marketing systems and the role of public policy in mediating the effects of these constraints, and it reflects on how a marketing systems perspective contributes to the understanding of constrained consumption.

Biography
John D. Mittelstaedt (PhD, University of Iowa) is Associate Professor of Marketing in the Department of Marketing at Clemson University, and he is president of the Macromarketing Society.

Charles R. Duke (PhD University of Texas at Arlington) is Professor of Marketing in the Department of Marketing at Clemson University. He serves as associate editor of the Journal of Marketing Education.

Robert A. Mittelstaedt (PhD, University of Minnesota) is Professor Emeritus in the Department of Marketing at the University of Nebraska–Lincoln. For 30 years, he served as the Nathan J. Gold Distinguished Professor of Marketing at Nebraska.

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