1. Between medicine and trade: legitimation of prices in Moscow commercial dentistry Elena Berdysheva Higher School of Economics (Moscow, Russia) Lab for Studies in Economic Sociology

2.  Legitimation of a sociological approach to studying price setting in consumer markets [Alexander, Alexander 1991; Zafirofsky Beckert 2011]  Legitimation of a sociological approach to studying price setting in consumer markets [Alexander, Alexander 1991; Zafirofsky 2000; Beckert 2011]  Analysis of pricing for socially entangled commodities [Callon 1998; Velthuis 2005; Karpik 2010, 2011]  Analysis of social norms and rules regulating practices of price setting on consumer markets [Smith 2002, 2011; Thevenot, Boltamski 1999; Thevenot 2002]  Analysis of price as embedded in social relations between market actors [Uzzi, Lancaster 2004; Zbaracki 2004]  Analysis of the dependence of pricing behavior on the position of price-setters in the market structure and their place in the market status hierarchy [White 1981; Podolny 1991; Aspers 2006]  Studies on pricing in context of power and the cultural struggle between market actors [Fligstein 1996; Slater 2002] Сonsiderable number of studies on market pricing in New Economic Sociology

3. What caused the rise of sociological interest to market price setting? Some practical reasons  Expansion of markets in social life  Development of service economy  Worldwide financial crisis Some methodological reasons  Special attention to problems of commodification, marketization and calculation  The rise of interest to markets of socially entangled goods (art, sexual services, surrogate motherhood and so on). Pricing “fictitious” commodities is a challenge  The accumulation of empirical sociological data on consumer markets and new opportunities for generalization  Seeking the new boundaries (sociological explanations of key phenomena of Economy instead “completing” the concepts given by Economics)

4. Questions under discussion  How do market prices become socially legitimate?  How are prices for socially entangled goods set?

5. Legitimacy of market price as a latent social variable Legitimate price is the price based on “objective” factors without hints at artificial manipulation motivated by self- interest of price-maker. Legitimate price is the price based on “objective” factors without hints at artificial manipulation motivated by self- interest of price-maker.

6. Dental medical market as a socially entangled market  Substantive, vital importance of health (health as a fictitious commodity )  Information asymmetry  Quality uncertainty  Weak material base for calculation of costs  Crucial role of trust in patient-provider relations  Social interaction of service production

7. The goal of the study  to analyze, describe and explain the social mechanisms, which contribute to the formation and legitimation of prices for medical services Two examples of medicine and market controversy  “Professional” and “mass production” types of clinics  “Nosological” and “marketing” types of pricelists

8. Different orders, different terms Institutional logic - a set of material practices, symbolic constructions and systems of beliefs which constitute the principles of market (field) arrangements Institutional logic - a set of material practices, symbolic constructions and systems of beliefs which constitute the principles of market (field) arrangements

9. What determines the content of institutional logic pursued by actors  The content of institutional logic as a function of group identity of its bearers and the targets of their activity  Different actors, different logics – often controversial and competitive

10. Empirical data  Only commercial dental clinics of Moscow (Russia)  25 in-depth interviews with managers and doctors (pursued in 2008-2009)

11. Doctors Managers Patients Price-takers Price-makers

12. Observing institutional logics of the market via organizational formats of the firms  The choice of the organizational format is a significant milestone in defining the pricing behavior of a clinic at the market.

13. Two ideal types of clinics “Professional” (high medical standards, high costs, relatively higher prices) “Mass production” (attempts to optimize cost-profit balance, relatively lower prices) organized by doctors organized as investment projects emphasis on professionalism in medicine emphasis on gaining profit take care of the medical stuff medical staff changes frequently focus on custom patients focus on patients who come on insurance programs reputation is in high priority patients turnover is in high priority

14. Two types of price lists – which one is more appropriate Detailed (“marketing”) (many separate manipulations which are summed up in the end of the treatment pursued) “Nosological” (the price is marked for complex treatment of some diagnoses ) opportunity to tune the price diagnosis does the matter opportunity to bargain doctor pricing behavior is restricted uncertainty of the final price at the beginning of the treatment the price is fixed and seems to be clear the price is fixed and seems to be clear confrontation with medical ethics – too close to “trade”, perceived as market tool perceived as professional tool perceived as professional tool flexiblenon-flexible widespread in the market less widespread in the market

15. Professional and managerial (market) logics in pricing of commercial dental services Professional Market Professional Market Legitimacy of price as a result of cooperation between two institutional logics trust and medical quality the balance between quality and costs

16. Thank you for your attention Elena Berdysheva Higher School of Economics Lab for Studies in Economic Sociology eberdysheva@hse.ru