Terence Kealey
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Last year Baba Shiv, a professor of marketing at Stanford University Business School, played a trick on a group of subjects. He gave them, on separate occasions, the same wine to taste, but at one time he told them that it cost $45 a bottle, and on another $5. And the subjects reported, as they often do in this type of study, that the more expensive wine tasted better.
But Professor Shiv went farther. Using a technique called functional magnetic resonance imaging (fMRI) he examined the deep pleasure centres of his subjects' brains, to discover that they really did light up more with the “expensive” wine. Consequently Professor Shiv entitled his paper Marketing Actions Can Modulate Neural Representations of Experienced Pleasantness.
This is a study with political implications. Politicians tell us that social services such as health or education must be free at the point of use because people are otherwise disincentivised. But the study suggests, rather, that people might dismiss free services as valueless.
Critics could argue the opposite, namely that because Professor Shiv had not charged his subjects - they got the wine for nothing - he had shown that people will value public services precisely because they are expensive but free. But his wine study is only part of a series: two years ago he charged a group of subjects different prices for so-called energy drinks such as Red Bull.
People believe that these “energy drinks” will help their brains to work better, yet subjects who were offered Red Bull at discounted prices managed to solve fewer brain teasers than did those who paid the full price: the price actually affected the purchasers' brain function. Professor Shiv entitled that paper You May Get What You Pay For.
So the political implication is confirmed: people value expensive goods, and - since paying for something reinforces the experience of price - only when people are charged for goods will they continue to value them. Today the gift of a bottle of $45 wine seems wonderful, but if a National Wine Service were to hand out free wine indefinitely, it would soon lose its value.
Private schools, therefore, are better than state schools, private houses are better than council houses, and Harley Street is better than the NHS, not only because the act of paying commands a better service but also because it infuses the consumer with a greater appreciation for that service. We do, indeed, get what we pay for.
Perhaps the saddest lesson of Professor Shiv's study is that it was performed in a business school. The politics departments of our universities, like our legislators, are stuck in 19th century world-views, but business and its schools are deepening our understanding of human nature.
Terence Kealey is a clinical bio-chemist and Vice-Chancellor of the University of Buckingham
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Surely, the logical lesson to be drawn from the above studies is that if you want people to appreciate the value of NHS healthcare, then NHS patients should be told by their doctors typically how much their consultations and treatments would have cost if they had gone private.
Jon, Hitchin,
A person suffering from a condition as painful as a shattered femur would be grateful for medical care. I doubt that receiving a bill for £20,000 for medical services would make the patient place any greater value on the care.
I wonder whether the experiments might have had somewhat different results if they had been done with students who were from a less money-obsessed culture than the US, and students who are less affluent than those from Stanford, one of Americaâs most expensive private universities.
The results of the Stanford University Business School studies can be summed up by a quotation from the American showman, P. T. Barnum: 'Thereâs a sucker born every minute'.
P. T. also said that 'A fool and his money are soon parted'. If I ever open a wine shop in California I know where to open it.
The US needs a national health system. When I shattered my femur in 1996 the costs totalled just under $190,000. I paid nothing because we had insurance. I was grateful.
Eilidh MacPherson, Burnham, Bucks
First, the author should more overtly declare his interest as Vice Chancellor of Britain's only private University!
A lot of what he says stands to reason (we all know about things being 'reassuringly expensive'). And making people literally buy into something surely reinforces their commitment and attachment to it.
But not all of this makes sense. First, there is an 'agency dilemma' with some of the examples. Private school pupils do not usually pay for their own education, so how can we account for their schools' superiority? Maybe the parents obtain a psychological boost which helps their child, but often scholarship pupils outpace their fully-funded contemporaries. Might it just be that private schools have better resources, therefore better results?
I'd have thought some calculation of affordability would be important, too. A billionaire might not get the same psychological boost as somone on average wages when drinking nice plonk?
John Allen, Oxford, UK
Would that be the University of Buckingham, Britain's only private university? Hmm, well he would say that, wouldn't he . . .
Joe, London,
This only works, for the time a person perceives they are getting 'better' service / goods / etc.
Once a person realises they are paying twice the amount for half the return, they very quickly refuse to pay more for it.
Once that bubble bursts, it cant be re-inflated.
Arthur, Newcastle,
thanks to jamie gilmour in his comments. The most succinct demolishment of the whole conclusions of the article that I have yet to read. In a few words he has separated all the diverse premises convered and put them in their place making a complicated arguement much clearer to me. Thank you.
anthony wong, london, uk
I used to sell goods to the NHS and my product was four times the price of a competing product sold at cost and supplied by the NHS. My product, and all those that were equally expensive outsold the NHS product by many times, to such an extent that the almost free NHS product was not evern considered valid competition. It could of course be because the NHS did not have people going around talking about it.
R Mason, London, UK
If a patient believes that he is getting a better service by paying for his hospital care, then it is not inconceivable that he will have a better chance of surviving his cancer. This is the basis of the placebo effect.
Chris Kirk, Loughborough, UK
I have long maintained that, if parents were obliged to pay for their offspring's schooling, attendance would reach 100% and that if patients had to pay to visit their GP's and consultants in hospital, then formal notification of canceling and/or attendance at those appointments would also bring around 100% results.
Some resteraunts now deduct a fee from those who have reserved a table from those who fail to show which has brought them good results
Liz Brown, Montmartin en Graignes, France
Well, when you show me that you have a better chance of recovering from cancer if you personally pay a lot for the treatment, I'll pay attention. (The studies you cite have no relevance to the effectiveness of health provision, since you imply that the effect of red bull is psychosomatic.) What they tell us is that people tend to react irrationally to the cost of goods. To conclude that we should provide services in a way that panders to this irrationality is to enshrine idiocy in place of reason. That's not much of an advert for the University of Buckingham. Thank goodness most politics departments are still wedded to reality.
Jamie Gilmour, Bolton, UK