Between medicine and trade: Between medicine and trade: legitimation of prices in Moscow legitimation of prices in Moscow
commercial dentistrycommercial dentistry
Elena BerdyshevaElena Berdysheva
Higher School of EconomicsHigher School of Economics ( (Moscow, Russia)Moscow, Russia)
Lab for Studies in Economic SociologyLab for Studies in Economic Sociology
Legitimation of a sociological approach to studying price setting in Legitimation of a sociological approach to studying price setting in consumer markets consumer markets [[Alexander, Alexander 1991Alexander, Alexander 1991; Zafirofsky ; Zafirofsky 2000; BeckertBeckert 2011]2011]
Analysis of pricing for socially entangled commodities Analysis of pricing for socially entangled commodities [Callon 1998[Callon 1998; ; Velthuis 2005Velthuis 2005;; Karpik 2010, 2011] Karpik 2010, 2011]
Analysis of social norms and rules regulating practices of price Analysis of social norms and rules regulating practices of price setting on consumer markets [Smith 2002, 2011setting on consumer markets [Smith 2002, 2011; Thevenot, ; Thevenot, Boltamski Boltamski 19991999; Thevenot 2002; Thevenot 2002]]
Analysis of price as embedded in social relations between market Analysis of price as embedded in social relations between market actors actors [[Uzzi, Lancaster 2004; Zbaracki 2004Uzzi, Lancaster 2004; Zbaracki 2004]]
Analysis of the dependence of pricing behavior on the position of Analysis of the dependence of pricing behavior on the position of price-setters in the market structure and their place in the market price-setters in the market structure and their place in the market status hierarchy [White 1981status hierarchy [White 1981; ; Podolny 1991Podolny 1991; Aspers 2006; Aspers 2006]]
Studies on pricing in context of power and the cultural struggle Studies on pricing in context of power and the cultural struggle between market actors [Fligstein 1996between market actors [Fligstein 1996; ; Slater 2002 Slater 2002]]
ССonsiderable number of studies ononsiderable number of studies on market market pricing in New pricing in New Economic SociologyEconomic Sociology
What caused the rise of sociological What caused the rise of sociological interest to market price setting?interest to market price setting?
Some practical reasonsSome practical reasons Expansion of markets in social lifeExpansion of markets in social life Development of service economyDevelopment of service economy Worldwide financial crisis Worldwide financial crisis
Some methodological reasonsSome methodological reasons Special attention to problems of commodification, marketization and Special attention to problems of commodification, marketization and
calculationcalculation The rise of interest to markets of socially entangled goods (art, sexual The rise of interest to markets of socially entangled goods (art, sexual
services, surrogate motherhood and so on). Pricing “fictitious” commodities is services, surrogate motherhood and so on). Pricing “fictitious” commodities is a challengea challenge
The accumulation of empirical sociological data on consumer markets and The accumulation of empirical sociological data on consumer markets and new opportunities for generalizationnew opportunities for generalization
Seeking the new boundaries (sociological explanations of key phenomena of Seeking the new boundaries (sociological explanations of key phenomena of Economy instead “completing” the concepts given by Economics)Economy instead “completing” the concepts given by Economics)
Questions under discussionQuestions under discussion
How do market prices become socially How do market prices become socially legitimate?legitimate?
How are prices for socially entangled How are prices for socially entangled goods set?goods set?
Legitimacy of market price as a Legitimacy of market price as a latent social variablelatent social variable
Legitimate price is the price based on Legitimate price is the price based on “objective” factors without hints at “objective” factors without hints at artificial manipulation motivated by self-artificial manipulation motivated by self-interest of price-maker. interest of price-maker.
Dental medical market as a Dental medical market as a socially entangled marketsocially entangled market
Substantive, vital importance of health Substantive, vital importance of health (health as a (health as a fictitious commodityfictitious commodity))
Information asymmetryInformation asymmetry Quality uncertaintyQuality uncertainty Weak material base for calculation of costsWeak material base for calculation of costs Crucial role of trust in patient-provider Crucial role of trust in patient-provider
relationsrelations Social interaction of service productionSocial interaction of service production
The goal of the studyThe goal of the study to analyze, describe and explain the social to analyze, describe and explain the social
mechanisms, which contribute to the formation mechanisms, which contribute to the formation and legitimation of prices for medical servicesand legitimation of prices for medical services
Two examples of medicine and market Two examples of medicine and market controversycontroversy
““Professional” and “mass production” types of Professional” and “mass production” types of clinicsclinics
““Nosological” and “marketing”Nosological” and “marketing” types of priceliststypes of pricelists
Different orders, different termsDifferent orders, different terms
Institutional logic - Institutional logic - a set of material a set of material practices, symbolic constructions and practices, symbolic constructions and systems of beliefs which constitute the systems of beliefs which constitute the principles of principles of market (market (fieldfield)) arrangements arrangements
What determines the content of What determines the content of institutional logic pursued by actorsinstitutional logic pursued by actors
The content of institutional logic as a The content of institutional logic as a function of group identity of its bearers and function of group identity of its bearers and the targets of their activitythe targets of their activity
Different actors, different logics – often Different actors, different logics – often controversial and competitivecontroversial and competitive
Empirical dataEmpirical data
Only commercial dental clinics of Only commercial dental clinics of Moscow (Russia)Moscow (Russia)
25 in-depth 25 in-depth interviews with managers interviews with managers and doctorsand doctors (pursued in 2008-2009) (pursued in 2008-2009)
Doctors Managers
Patients
Price-takers
Price-makers
Observing institutional logics of the market Observing institutional logics of the market via organizational formats of the firmsvia organizational formats of the firms
The choice of the organizational format is The choice of the organizational format is a significant milestone in defining the a significant milestone in defining the pricing behavior of a clinic at the market. pricing behavior of a clinic at the market.
Two ideal types of clinicsTwo ideal types of clinics
““Professional” Professional” (high medical standards, high costs, (high medical standards, high costs,
relatively higher prices)relatively higher prices)
““Mass production” Mass production” (attempts to optimize cost-profit (attempts to optimize cost-profit balance, relatively lower prices)balance, relatively lower prices)
organized by doctorsorganized by doctors organized as investment projectsorganized as investment projects
emphasis on professionalism in emphasis on professionalism in medicinemedicine
emphasis on gaining profitemphasis on gaining profit
take care of the medical stufftake care of the medical stuff medical staff changes frequentlymedical staff changes frequently
focus on custom patientsfocus on custom patients focus on patients who come on focus on patients who come on insurance programs insurance programs
reputation is in high priority reputation is in high priority patients turnover is in high prioritypatients turnover is in high priority
Two types of price lists – which one is more Two types of price lists – which one is more appropriateappropriate
Detailed (“marketing”)Detailed (“marketing”)(many separate manipulations which are (many separate manipulations which are summed up in the end of the treatment summed up in the end of the treatment
pursued)pursued)
““Nosological” Nosological” (the price is marked for complex treatment of (the price is marked for complex treatment of
some diagnosessome diagnoses ))
opportunity to tune the priceopportunity to tune the price diagnosis does the matterdiagnosis does the matter
opportunity to bargain opportunity to bargain doctor pricing behavior is restricted doctor pricing behavior is restricted
uncertainty of the final price at the uncertainty of the final price at the beginning of the treatmentbeginning of the treatment
the price is fixed and seems to be clearthe price is fixed and seems to be clear
confrontation with medical ethics – too confrontation with medical ethics – too close to “trade”, perceived as market close to “trade”, perceived as market
tooltool
perceived as professional toolperceived as professional tool
flexible flexible non-flexiblenon-flexible
widespread in the marketwidespread in the market less widespread in the marketless widespread in the market
Professional and managerial (market) Professional and managerial (market) logics in pricing of commercial dental logics in pricing of commercial dental
servicesservices Professional MarketProfessional Market
Legitimacy of price as a result of cooperation between
two institutional logics
trust and medical quality the balance between quality and costs
Thank you for your attentionThank you for your attention
Elena BerdyshevaElena Berdysheva
Higher School of EconomicsHigher School of Economics
Lab for Studies in Economic SociologyLab for Studies in Economic Sociology [email protected]@hse.ru
