Why do patients select a hospital? A conjoint analysis in two German hospitals

Patients decide on where to consume hospital services in Germany. Thus, the understanding of the exact hospital selection criteria and their weights is important. This research reviews the antecedents of hospital selection utilizing the conjoint methodology with regard to six questions. (1) Which are the relevant choice criteria, and (2) what are their weights? (3) Which criteria receive an increased importance in the absence of experience? (4) Do differences between compulsory and privately insured patients, (5) between hospitals with regard to their size, and (6) between female and male patients exist? The relevance and importance of nine pre-selected criteria are determined through two conjoint analyses. Experience is found to be most important followed by referral by general practitioner, certified quality management system, positive press coverage, recommendation by relatives and acquaintances and distance to the hospital. Reception area design and the personnel's friendliness, the website quality and the published quality report are less relevant. Without experience, reception area design, personnel's friendliness and distance to the hospital receive an increased importance. In addition, for some criteria notable discrepancies between female and male patients and between patients with different insurance policies are found.     

Editors’ note

Portuguese Economic Journal -     

Do People Always Pay Less Than They Say? Testbed Laboratory Experiments with IV and HG Values

Hypothetical bias is a long‐standing issue in stated preference and contingent valuation studies—people tend to overstate their preferences when they do not experience the real monetary consequences of their decision. This view, however, has been challenged by recent evidence based on the elicitation of induced values (IV) in the lab and homegrown (HG) demand function from different countries. This paper uses an experimental design to assess the extent and relevance of hypothetical bias in demand elicitation exercises for both induced (IV) and homegrown (HG) values. For testbed purpose, we use a classic second‐price auction to elicit preferences. Comparing the demand curve we elicit in both, hypothetical bias unambiguously (i) vanishes in an IV, private good context and (ii) persists in HG values elicitation context. This suggests hypothetical bias in preference elicitation appears to be driven by “preference formation” rather than “preference elicitation.” In addition, companion treatments highlight two sources of the discrepancy observed in the HG setting: the hypothetical context leads bidders to underestimate the constraints imposed by their budget limitations, whereas the real context creates pressure leading them to bid “zero” to opt out from the elicitation mechanism. As a result, there is a need for a demand elicitation procedure that helps subjects take the valuation exercise sincerely, but without putting extra pressure on them.     

The Effect of Pricing and Advertising on Customer Retention in a Liberalizing Market

This study investigates the drivers of customer retention in a liberalizing market. The authors address key retention issues that allow them to contribute to existing retention research in several critical ways. They (1) examine the effects of pricing and mass advertising, (2) account for (new entrants) competitors' actions, (3) investigate the dynamic impact of marketing tactics, and (4) study the proposed relationships in a market recently opened to competition. Using longitudinal data for a sample of 650 mobile phone consumers and a split-population hazard model that accounts for the notion that some customers are never at risk of defection, the authors show that both the focal firm's (incumbent) and the competitors' price and mass advertising exert a significant influence on the probability of terminating an existing incumbent relationship. They find that the relationships between marketing variables and retention are not static but vary over time. Price is generally less effective in the early stages of market liberalization, which suggests that customers become more price sensitive in later stages. Finally, the study findings can have important strategic implications on designing customer management and marketing resource allocation strategies, as well as on providing a competitive regulatory framework in liberalizing markets.     

Investigating the gap between citizens' sustainability attitudes and food purchasing behaviour: empirical evidence from Brazilian pork consumers

Consumers worldwide are increasingly concerned with sustainable production and consumption. Recently, a comprehensive study ranked 17 countries in regard to their environmentally friendly behaviour among consumers. Brazil was one of the top countries in the list. Yet, several studies highlight significant differences between consumers' intentions to consume ethically, and their actual purchase behaviour: the so‐called ‘Attitude‐Behaviour Gap’. In developing countries, few studies have been conducted on this issue. The objective of this study is therefore to investigate the gap between citizens' sustainability‐related attitudes and food purchasing behaviour using empirical data from Brazil. To this end, Brazilian citizens' attitudes towards pig production systems were mapped through conjoint analysis and their coexistence with relevant pork product‐related purchasing behaviour of consumers was investigated through cluster analysis. The conjoint experiment was carried out with empirical data collected from 475 respondents surveyed in the South and Center‐West regions of Brazil. The results of the conjoint analysis were used for a subsequent cluster analysis in order to identify clusters of Brazilian citizens with diversified attitudes towards pig production systems, using socio‐demographics, attitudes towards sustainability‐related themes that are expected to influence the way they evaluate pig production systems, and consumption frequency of various pork products as clusters' background information. Three clusters were identified as ‘indifferent’, ‘environmental conscious’ and ‘sustainability‐oriented’ citizens. Although attitudes towards environment and nature had indeed an influence on citizens' specific attitudes towards pig farming at the cluster level, the relationship between ‘citizenship’ and consumption behaviour was found to be weak. This finding is similar to previous research conducted with European consumers: what people (in their role of citizens) think about pig production systems does not appear to significantly influence their pork consumption choices. Improvements in the integrated management of this chain would better meet consumers' sustainability‐related expectations towards pig production systems.     

Mixed oligopoly, optimal privatization, and foreign penetration

This paper examines the impact of foreign penetration on privatization in a mixed oligopolistic market. In contrast to the simple framework of single domestic market with foreign entry by entry mode of foreign direct investment (FDI) or exports, our result shows that government should increase the degree of privatization along with increasing proportion of domestic ownership of multinational firms. Furthermore, we show that an increase in domestic ownership of multinational firms raises all domestic private firms' profit and social welfare, while it may either increase or decrease public firm's profit. With the aid of numerical example, intensive competition from private firms in general will enhance the degree of privatization gradually; in particular, the degree of privatization is lower in the presence of multinational firms.     

Competition among banks and the pass-through of monetary policy

This paper introduces monopolistically competitive financial intermediaries into the New Keynesian DSGE setting. Modelling bank market power explicitly contributes to understanding two empirical facts: (i) The short-run transmission of changes in money market rates to bank retail rates is far from complete and heterogeneous. (ii) Stiffer competition among commercial banks implies that loan rates correlate more tightly with the policy rate. In my model, the degree of monopolistic competition in the banking sector has a sizeable impact on the pass-through of changes in the policy rate. In particular, a more competitive market for bank credit amplifies the efficiency of monetary policy.     

Cultural legitimacy and framing struggles in innovation journeys: A cultural-performative perspective and a case study of Dutch nuclear energy (1945-1986)

This article contributes to the field of innovation studies by addressing the role of cultural legitimacy in technical innovation journeys. The article develops a new perspective that connects insights from discourse theory, interpretive approaches to culture, cultural sociology and social movement theory. In contrast to functionalist and structuralist approaches (which tend to conceptualize culture in a top-down deterministic manner), our cultural-performative perspective emphasizes agency, collective sensemaking and framing struggles. Cultural change is a contested process, in which various groups perform on public stages to influence the attitudes and opinions of relevant audiences who provide financial resources, protection or support relevant for innovation journeys. We demonstrate the usefulness of this perspective with a longitudinal case study of nuclear energy in the Netherlands (1945-1986), which encompasses both the creation of legitimacy in the 1950s and 1960s, and its contestation by an anti-nuclear movement in the 1970s, which halted the innovation journey.