The Advertising Landscape in Italy

By Francesco Carones, MD

In Italy, regulations regarding medical advertising are slowly moving forward to conform to the European Commission’s rules and laws. Until a few years ago, even a plaque outside the office indicating more than the doctor’s name and specialty was not accepted. Now, although still in a conservative way, it is possible for doctors, hospitals, and private organizations to advertise in the most common communications media.

In theory, all advertising materials must be approved by the local board of physicians before release, presentation, or publication. The board checks for conformity to rules related to integrity and consistency of the messages, and it screens for the presence of claims not supported by medical evidence. In reality, it is possible to advertise without submitting to the board; however, the board may then intervene later, if an advertisement infringes the rules, by censoring the advertising and imposing penalties (up to the suspension of license to practice). Advertisements must not be directed only to the final consumer; instead, they should include informative content on general topics so as to hold the interest of the entire population.

As for ophthalmology, in Italy, most services, including routine visits, diagnostic exams, and surgeries, are provided at no cost to the patient by the national health system. Therefore, only private doctors and institutions have motivations to advertise and enjoy the benefits of advertising, such as attracting more patients. Competition arises either in trying to provide better quality service, such as shorter waiting lists and better experience at the office, or in offering premium procedures not provided by public hospitals, such as refractive surgery, premium IOLs, and laser-assisted cataract surgery. However, advertising through major media channels such as newspapers, radio, and television channels has not been seen to provide significant return in terms of investment. The greatest marketing tool is still word of mouth, ie, referral of new patients by existing patients.

In view of this, the primary marketing strategies I employ for my private practice are mostly directed toward expanding and complementing any word-of-mouth communication strategy. For example, we offer discount gift cards for any surgical procedure at our office to patients who have undergone cataract or refractive surgery, to be given to friends and relatives. We use social media platforms such as Facebook and Twitter to expand our network and spread messages to existing and prospective patients. We routinely send a newsletter to all of our customers, highlighting new procedures and therapy devices.

In addition to expanding our word-of-mouth network, we also advertise using Google, Facebook, and other Internet-based resources. Locally, we rent spaces on big multimedia advertising screens on the principal streets of Milan, and we routinely appear in local newspapers with informative pieces on new technologies, concepts, and solutions for eye diseases.

A Look at Advertising in Hong Kong

By John S.M. Chang, MD

In Hong Kong, doctors are not permitted to advertise themselves. They cannot publicly claim superiority over other doctors. However, they are allowed to hold seminars or appear in magazines and on television for public educational purposes. In these appearances, generic names can be used, but names associated with a specific company or companies cannot be mentioned. Therefore, a surgeon can claim that he or she has a strong laser that runs at 1,050 Hz, but the name of the laser cannot be mentioned.

 Hospitals and clinics can advertise, but, again, they cannot claim superiority over other clinics or mention affiliations with specific companies. Advertisements cannot promote a doctor’s practice.

 There are also regulations and guidelines on any display or information made available to the public. For example, there are guidelines governing the style of a practice’s name and logo, and only qualifications and specialist titles approved by the relevant medical council can be printed on a business card, letterhead, or other stationery. The size, location, information on, and number of a clinic’s signboards are also regulated. No more than one piece of information sized larger than 300 cm² can be published. Letters of appreciation from patients cannot be made available to the public.

 With all this considered, my primary marketing strategy involves a three-pronged approach:

1. Holding seminars, as we can advertise through this channel;
2. Appearing in magazines and on the radio; and
3. Contributing to publications.

I endeavor to derive the most benefit possible from these three available means of promotion.

Regulations in Ireland: A Light Touch

By Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin); and Ed Toland, MBA

Regulations regarding advertising and marketing in Ireland have a light touch in comparison with other international markets.

There is an anomaly in that, if a doctor advertises in a manner that the Medical Council of Ireland regards as inappropriate, that doctor can face sanction. However, a laser eye clinic that merely employs doctors to undertake the same surgery can advertise without the same restraints. For this reason, it is not uncommon to see advertisements in Ireland by some clinics that feature, for example, celebrity testimonial endorsements or advertising with claims of a superlative nature that would not be permitted from a surgeon-owned clinic.

The mandate of the Advertising Standards Authority of Ireland in the area of promotion of elective surgery is unclear. As a result, the Irish College of Ophthalmologists has taken an interest in this situation. After running a number of workshops and actively canvassing opinion of stakeholders, the College recently published guidelines in relation to the promotion of ophthalmic services.¹

Further, last month, the College issued a report and press releases calling for regulation of direct-to-consumer advertising of medical and surgical procedures. Amid significant media interest in the report, it was noted that the same issues also apply in the fields of plastic surgery and dermatology. Among media commentators and in the wider community, unfortunately, there is a significant degree of cynicism in regard to advertising in the medical space.

At this point, any surgeon-led clinic in Ireland might be best served by concentrating on delivery of high-quality service to generate word-of-mouth awareness and referrals and using digital technology and social media to communicate directly to prospective patients in a manner that better reflects the ethos and values of the clinic.

1. Advertising and marketing guidelines. Irish College of Ophthalmologists. http://www.eyedoctors.ie/medium/files/ICO_Advertising_Marketing_Guidelines-x.pdf. Accessed March 1, 2016.

Strategies in Greece

By A. John Kanellopoulos, MD

In Greece, advertising is forbidden for individual practitioners. Some medical facilities may advertise their services, but understanding which practices are allowed and which are not can be confusing. This is a hypocritical system, as physicians and medical centers are business entities abiding by all taxation and regulatory provisions for commercial businesses. The state system offering so-called free public care is known to require significant under-the-table payments to providers who receive state funds and salaries to practice. In Greece, there is no provision for research funds from the European Union to be allocated based on scientific merit and performance. State academicians enjoy unequal higher status than private-sector academicians, regardless of true scientific and academic merit.

At The Laservision.gr Research & Clinical Institute, we do not have an advertising policy per se, but we are quite busy with regular media attention from Greek reporters who follow international media and advances that our team has made. It is clear that such scientific and academic accomplishments act as an indirect public awareness tool for our practice.

Although nearly 12 million people inhabit Greece, the country functions as a small society. Each clinician has his or her reputation, which functions as the most powerful marketing and advertisement tool. We find that other strong marketing tools include honest and competent customer service, continual refinement of outcomes, use of high-quality technologies and techniques, and, lastly, showcasing of services and academic endeavors on the practice’s website and social media.

Francesco Carones, MD
• Medical Director, Carones Ophthalmology Center, Milan, Italy
• Member, CRST Europe Editorial Board
• fcarones@carones.com

John S.M. Chang, MD
• Director, GHC Refractive Surgery Centre, the Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
• Member, CRST Europe Global Advisory Board
• johnchang@hksh.com

Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin)
• Consultant Ophthalmologist, Wellington Eye Clinic and Beacon Hospital, Dublin, Ireland
• Associate Chief Medical Editor, CRST Europe
• abc@wellingtoneyeclinic.com

A. John Kanellopoulos, MD
• Medical Director, The Laservision.gr Research & Clinical Eye Institute, Athens, Greece
• Clinical Professor of Ophthalmology, NYU Medical School, New York
• Associate Chief Medical Editor, CRST Europe
• ajkmd@mac.com

Ed Toland, MBA
• General Manager, Wellington Eye Clinic
• ed.toland@wellingtoneyeclinic.com