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WOM

in the

Health care insurance market

Maaike Dijkstra

S1504517

Master Thesis

Master of Science in Business Administration

Marketing Management, Faculty of Economics and Business

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SUMMARY

The health care insurance market is a market of free choice, but only for a short period now. In this paper the difference between the health care insurance market and other insurance markets is investigated. Because this market is free for only a short period now, it is researched whether the marketing techniques used by companies in this market are suitable for this type of market. Some of the marketing techniques these companies are using are advertising and rewarding Word-of-Mouth. In this research the marketing technique

rewarding word-of-mouth recommendations is evaluated. Rewarding Word-of-Mouth is when an existing customer recommends a company to a potential customer and the existing

customer receives a reward for this recommendation. Topic of this study is the relationship between the company and the current customer.

In a set of two studies is looked at the difference between the health care insurance market and other insurance markets like furniture insurance. There will be looked at the kind of relationships people in these markets form with companies in these markets, and which type of rewards fit best with these markets. People can form many different relationships with each other. There are four fundamental forms of relationship types. When norms of one relational type are extended into the domain of another relational type people can experience

inconvenience, this is called a taboo trade-off. Reward campaigns are compared to the relational types people form in insurance markets, and if the campaign and the relational type have a good fit. And if they don’t fit if a taboo trade-off is created.

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PREFACE

This master thesis is written as my final assignment to finish my study Business Administration at the RuG in Groningen. I have done research about Word-of-Mouth communications in the health care insurance market. I decided to choose this topic while I was working at Menzis, a big health care insurance company in the Netherlands. My research is about rewarding Word-of-Mouth communications with symbolic and monetary rewards. I started to work on this thesis in March 2009. At first I struggled a lot to find a good and new topic to investigate. But thanks to my work at Menzis I found a market in which no Word-of-Mouth recommendations were researched before. And from that point I started working on my thesis. It wasn’t always easy, but finally here is my end product.

I would like to thank my supervisors Mirjam Tuk and Wander Jager for their feedback and help with my thesis. I would further like to thank my family and friends for helping me keeping my motivation and for motivating me to keep on working and not to give up.

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TABLE OF CONTENTS

Summary 3

Preface 4

Table of Contents 5

CHAPTER 1: INTRODUCTION AND PROBLEM STATEMENT 6

1.1 Managerial relevance 6

1.1.1 Word-of-Mouth 7

1.1.2 Rewarding Word-of-Mouth 8

1.1.3 Taboo trade-offs 8

1.2 Problem statement 8

CHAPTER 2: THEORETICAL BACKGROUND 10

2.1 Relations 10

2.2 Relations with brands 12

2.3 Taboo trade-offs 14

2.4 Rewards 17

CHAPTER 3: RESEARCH METHOD 20

3.1 Conceptual model and hypotheses 20

3.2 Study 1 21 3.2.1 Participants 21 3.2.2 Procedure 21 3.2.3 Results 22 3.2.4 Conclusion study 1 26 3.3 Study 2 28 3.3.1 Participants 28 3.3.2 Procedure 28 3.3.3 Manipulation check 29 3.3.4 Results 30 3.3.5 Conclusion study 2 33

CHAPTER 4: GENERAL DISCUSSION 35

4.1 General discussion 35

4.2 Marketing implications 38

4.3 Limitations and future research 38

References 40

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CHAPTER 1 INTRODUCTION AND PROBLEM STATEMENT

1.1 Managerial

relevance

A lot has changed in the health care insurance market in the Netherlands. The health care insurance market in the Netherlands is now a free market from January 2006. Before that the health care insurance market was arranged by region and lead by the government. Consumers weren’t able to choose their own health care insurance provider. They had no choice in the company they wanted to join.

From January 2006 the health care insurance market became a free market. Consumers were able to choose their own health care insurance. From this point the health care insurance companies needed to change their strategies to acquire new customers and to retain existing customers.

Other markets that are free for a longer time now are the energy supplier market and the phone supplier market in the Netherlands. The energy and phone network markets aren’t free. The energy and phone supplier markets were also first lead by the government and now have market forces. For the companies that work in these markets it is important to adapt to the market forces and to change their market strategies accordingly.

The markets in which these companies are operating changed from local markets to national markets. When the markets were local the consumers didn’t have a choice in which company to join. But when the market became free and became a national market the companies needed to change their strategies and marketing techniques.

When markets are changing like the energy, phone or health care insurance market this creates a lot of disorder for consumers. Consumers don’t know which companies are good at the services they provide and suddenly the consumers are faced with the choice of which company to join. Consumers will make their choice which company to join on the basis of their experience with companies, the way the companies are selling themselves and on the basis of word-of-mouth recommendations from friends and family.

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important when consumers have arranged the more important things in live. Energy and phone are more materialistic assets, and health of consumers is a key priority.

Because of this difference it is important to look if the marketing techniques used in the energy and phone market and other markets are appropriate for the health care insurance market. It is important to find out if consumers respond in the same way to the marketing techniques used in the energy and phone market as in the health care insurance market. It could be that consumers respond differently because health is more important to them than energy and phone.

The marketing techniques companies are using are advertising through different media channels like the newspapers and television, discounts when consumers are joining their company, and rewarding word-of-mouth recommendations. Companies are more and more using rewarding word-of-mouth recommendations because consumers generally trust such recommendations more than advertising or commercials from the companies themselves. Word-of-mouth has a large influence on consumer behavior and attitudes, larger than the effect of other marketing communications (Hoye & Lievens, 2004). In the next section word-of-mouth and rewarding word-word-of-mouth will be discussed in more depth.

1.1.1 Word-of-mouth

Word of Mouth (WOM) communication is a valuable way of passing information. Because of the personal nature of the communications between individuals, it is believed that product information communicated in this way has an added layer of credibility. The receiver of word of mouth referrals tends to believe that the communicator is speaking honestly and is unlikely to have an ulterior motive. This is also stated by Reicheld (2003) “Willingness to talk up a company or product to friends, family, and colleagues is one of the best indicators of loyalty because of the customer's sacrifice in making the recommendation. They put their own reputations on the line.” This is why products and services recommended by friends and other people are seen as more reliable than products and services recommended by advertising or television.

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Furthermore, WOM is likely to be perceived as credible, because consumers generally feel it is a trustworthy information source (Bone, 1995).

1.1.2 Rewarding WOM

Because consumers trust WOM communications more than marketing information sources companies tend to engage in rewarding WOM communications (Verlegh, ea, 2009). For the last 10 years or so, companies are using WOM communications to attract new customers and to reward existing customers. They do this by rewarding customers for a recommendation to a new customer (referral rewarding). There has been some research about this topic in the marketing literature. In a study done by Ryu & Feick (2007) they state that whether customers will engage in WOM communications depends on the perceived costs and benefits of the exchange. Reasons for customers to engage in WOM are: attempting to reduce anxiety from the purchase, a means for managing others’ impressions of them and a way to help others make better choices. An additional benefit is of course the (economic) gain from the referral. Costs of WOM communications are: the time and effort of communicating, the risk that the recommendation doesn’t turn out well and leads to dissatisfaction with the receiver, this could harm the relationship. So, whether consumers engage in WOM communications depends on the costs and benefits of the exchange.

1.1.3 Taboo trade-offs

People can form many different relationships with each other. There are four fundamental forms of relationship types. When norms of one relational type are extended into the domain of another relational type people can experience inconvenience, this is called a taboo trade-off McGraw & Tetlock (2005). In this research is determined which type of relations people form in the health care insurance market and in other insurance markets. Furthermore, these

relational types are then compared to the reward campaigns companies are providing. And in this context is determined if taboo trade-offs are created. In the next chapter relationships and taboo trade-offs will be discussed in more depth.

1.2

Problem statement

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Figure 1.1 Relationship

The problem statement of this research is:

Is rewarding recommendations in the health care insurance unacceptable? And if so, why?

There will be looked at the kind of relationships people form with health care insurance companies, and if the way companies reward recommendations in this market is acceptable. That is, if consumers find the reward campaign acceptable and if consumers are willing to recommend the company.

This research will examine the following underlying reasons:

o Is the risk of a wrong recommendation higher in the health care insurance market than in other insurance markets? Do customers find the reward campaign acceptable and are they willing to recommend?

o Is their a difference between providing a monetary or a symbolic reward?

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CHAPTER 2 THEORETICAL BACKGROUND

In this section of the report I will discuss the literature that is important to this research. First I will look at the different relations people have with each other. These relational types are important to look at because depending on the relational type WOM recommendations are more or less acceptable. Next I will discuss the relationships people form with brands. These relations are in some way comparable to the relations between people. The following section is about taboo trade-offs. Here I will discuss in more detail in which relational types WOM recommendations are acceptable and in which not. Then I will discuss the type of rewards that are provided for WOM recommendations and compare the reward types with relational types and markets.

2.1

Relations

Many people form relationships with each other. These relationships can have many different forms; examples of relationships are families, romantic loves, friends, colleagues and

business relationships. I will now discuss relevant relationship literature that points out what type of relationships people can form with each other and the influence these relationships have on objects received in these relationships.

In the consumer psychology has been done extensive research about the relations between people. Fiske (1992) came up with four prototypical relational forms that exist between people. These four relational types can be found across cultures and in different settings of everyday live. That is because people organize their social life in terms of their relations with other people. I will now describe these four prototypical relational forms.

Communal Sharing (CS) relationships are based on a concept of some bounded group of

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Authority Ranking (AR) relationships are based on an asymmetrical model among people who

are linearly ordered along some hierarchical social dimension. The reciprocal exchange in these relationships is based on that superiors appropriate what they wish, or receive tribute from inferiors. The higher a person’s rank, the more he gets, and more choice he has. Motivation is based on power. Groups are based on a hierarchical organization. An example of an AR relationship is a teacher, student relationship in which the teacher tells the student what to do. And because the teacher is higher in rank the student listens to the teacher.

Equality Matching (EM) relationships are based on a model of even balance and one-for-one

correspondence. People in these relationships are concerned about whether the relationship is balanced. Exchange is balanced. People give and get back the same thing in return, with appropriate delay. Groups are equal-status peer groups. An example of EM relationship is two neighbours, where they take turns in babysitting each others children.

Market Pricing (MP) relationships are based on a model of proportionality in social

relationships; people attend to ratios and rates. Exchange or pay for commodities is in proportion to what is received, as a function of market prices or utilities. Motivation is based on achievement. An example of a MP relationship is a mother who brings her children to the day-care, and pays the crèche for the service of babysitting. Objects people receive in these relationships are valued very low in relation to their objective value, and people easily part from these objects (McGraw, Tetlock & Kristel, 2003).

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Another author that looks at the relational types between people is Grayson (2007). Grayson compares business with friendships. This is much like market pricing versus communal sharing relationships. The friendship role can be seen as a CS relationship, whereas the business role can be seen as an MP relationship. Friendship has an exclusive intrinsic orientation and business has an instrumental orientation. These two orientations are likely to conflict. Because ideal friendships encourage a lack of instrumentality and because

commercial exchange usually encourages at least some instrumental considerations, friendship and business create expectations that are likely to conflict (Grayson, 2007).

In the study done by Grayson (2007) he found that the conflict between friendship and business or instrumentality negatively affects business outcomes. When friends do business together they sometimes feel that their business partner is taking advantage of their existing relationship for economic gain. The origin of these conflicts comes from

contradictory role requirements that are expected of a single relationship. An example from daily life could be two friends who run a business together. And one friend’s primary goal is to keep the friendship good, and the other friend’s goal is to run the business properly. This can create role conflict because one friend is trying to be useful and feels being used at some point.

Grayson (2007) also found that rewarding customers for referring friends may attract new business but may also dampen future customer commitment and negatively affect customers’ relationships with members of their social network. That is because when the

recommendation doesn’t turn out well the relationship between the receiver and the recommender may become disturbed.

Thus, when WOM is rewarded, friendship and business relationships face potential conflict. Because rewarding is an element of business and WOM used to be an element of friendship. And these relational types are also comparable to market pricing and communal sharing relationships. Friendship is a communal sharing relationship and business a market pricing relationship.

I have now discussed how people can form relationships with other people. But can people also form relationships with brands, companies or markets? This will be discussed in the next section.

2.2

Relations with brands

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other in a social context. This is comparable to the relationships people have with a close circle of friends and family, C S relationships (Aggarwal, 2004).

That is, people may view brands or products in terms of a social relationship and behave as if the brand is a friend or partner, even bestowing human characteristics onto the brand (McGraw & Tetlock, 2005). The norms associated with brand relationships can influence people’s evaluation of and behaviour toward a brand (McGraw & Tetlock, 2005). Furthermore, people apply the same norms and values on interacting with brands and companies then they apply on interacting with other people. This is what Aaker (1997) defines as brand personality. Brand personality is the set of human characteristics associated with a brand. Brand personality is formed when humans interact directly or indirectly with a brand.

In exchange relationships the motivation for giving a benefit to the partner is to get something back in return, that is quid pro quo (Aggarwal, 2004). This is comparable to the market pricing relationship type defined by Fiske (1992). Examples of this relationships type are relationships between strangers or business partners. In communal sharing relationships people give benefits to others to demonstrate a concern for them and to attend to their needs, taking a perspective that transcends emphasis on self-interest alone (Aggarwal, 2004). This relationship type is much like the communal sharing relationship defined by Fiske (1992). Examples here are relationships between family and friends.

Consumers evaluate the brand and its actions depending upon whether the actions violate or conform to the norms of their relationship with that brand. When consumers form

relationships with brands, brands too are evaluated as if they are members of a culture and need to conform to its norms (Aggarwal, 2004). So depending on the type of relationship people form with a brand, exchange or communal, they evaluate the brand according to the norms that fit with the relational type. There is one important difference between the relationships between people and the relationships between people and brands. That is, relationships with brands almost always involve some degree of monetary exchange. The relationships between people and brands can be seen as a celebrity and a fan instead of two people who know each other intimately (Aggarwal, 2004).

When people have a communal relationship with a brand, the brand’s actions in this

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can be a free new product of a brand when buying a product. In this situation the consumer is not obligated to buy another product for a discount but receives a free product to get to know the new product.

What is important about these relationships between people and brands is that they are comparable to the relationships people form with people or markets. If these distinct relationship norms are present in an interaction with a brand or market, consumers will use these norms to guide their behaviour and their evaluations (Aggarwal, 2004).

The reason why consumers interact with brands in somewhat the same way as they interact with other people has two reasons. First, consumers usually do not distinguish between brands and the companies that produce the brands. For example, a service brand like an airline. People interact with other people that work for that brand and easily fall back on these social relationships as a guide in their interactions. Second, some consumers think of a brand or a company as a living being. When brands are associated with human characteristics people interact in ways that parallel social relations with humans (Aggarwal, 2004).

So, even though the relationships people form with brands do not have the same depth or richness as the relationships between people, the relationships are comparable because they share the same characteristics.

2.3

Taboo trade-offs

When market pricing norms are extended into the domain of communal sharing people may experience inconvenience. This is called a taboo trade-off.

McGraw & Tetlock (2005) define taboo trade-offs. Taboo trade-offs are trade-offs that extend market pricing norms into domains of life that people think of as having special, even sacred, status. In other words, a taboo trade-off is when MP norms are applied to CS relations. Another definition of a taboo trade-off is any explicit mental comparison or social transaction that violates deeply held intuitions about the integrity, even sanctity, of individual-to-individual or individual-to-society relationships and the values that animate those

relationships (Fiske & Tetlock, 1997).

In other words, people are highly resistant when the values of an MP relational schema are applied to another non-MP relational schema like CS. An example here is when you go to dinner at your parent’s house and at the end of the night you take out your wallet and give your parents money for the dinner, in stead of a kiss and thank you. Another

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is most common to happen in CS relationships and rewarding a recommendation is a feature that is more appropriate in an MP relationship (Tuk et.al, 2009).

People treat trade-offs as taboo whenever the trade-offs require assessing the value of

something governed by the socially meaningful relations of one relational model (for example MP) in the terms of a separate relational model (for example CS) (Fiske & Tetlock, 1997). Responses to taboo trade-offs vary from negative cognitive, emotional, and behavioral reactions. The most negative reactions come from MP norms into CS relationships (Fiske & Tetlock, 1997). To compare CS with MP is difficult, because CS and MP have very different characteristics. CS is about communal relations and MP is about monetary relations.

CS and MP do not meet the same needs or derive from the same motives, do not share a common affective tone, do not have corresponding moral foundations, and do not operate within a common metric (Fiske & Tetlock, 1997).

It is expected that taboo trade-offs can also be found in markets or with brands. When the behaviour of a company or a brand violates the norms that are expected of the relationship, people may experience distress and lower their evaluations of a brand or a company. This can be seen as a taboo trade-off. That is because the relationship norms are violated by bringing MP norms into CS relations.

When an MP schema is applied to possessions that have a symbolic significance due to an existing relationship people will see this as a taboo trade-off. This is a result of the unequal moral significance, social value and motivational strength of the four relational models (McGraw, Tetlock & Kristel, 2003).

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The energy or phone supplier market, car insurance or furnishing insurance market, are markets in which people form exchange relationships with the companies. It is expected that they form MP relationships. That is because people don’t have intimate and close

relationships with their electricity supplier, phone supplier, car or house insurance. That is why companies in the health care insurance market form different relations with their customers.

The intensity of the resulting distress, outrage and confusion people experience when facing trade-offs between relational models depends on the distance and direction of the move between the models in the trade-off. The sequence of the relationships is Communal Sharing> Authority Ranking> Equality Matching> Market Pricing. The biggest difference is between CS and MP. CS is most common in close groups like families, and MP is a typical exchange relationship based on money. AR and EM are in between these two relational models. An example of an AR relationship is a teacher student relation, and EM relationships are based on equality like housemates. The greatest taboo trade-off is created when MP norms are applied to CS relationships. People are more offended at trade-offs that move from MP to CS than transformations in the opposite direction (Fiske & Tetlock, 1997).

Taboo trade-offs are relationships norms from one relational model applied to another relational model. This can occur both between people that have relationships with each other and between a company and customers of this company. When a friend receives a monetary reward for recommending a company MP norms are applied to a CS relationship. That creates feelings of distress and is a taboo trade-off. In the same manner people have a CS relationship with their health care insurance company and when this company is rewarding their

customers with a monetary reward it is also applying MP norms into a CS relationship. That causes a taboo trade-off. The difference between these two forms of taboo trade-offs is that the first trade-off is between two people and the second trade-off is between a company and its customers.

Nowadays some health care insurance companies are using rewarding referral techniques. That is they reward the existing customer with a reward when this customer refers the

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Other markets like energy supplier, phone supplier, furnishing or car insurance are markets that are expected to have less CS relations with people. The consumers that buy these

products don’t have a special relation with the companies and brands that sell these products. The relationship types these markets have are expected to be typical MP relations. The commodities are produced to sell for a profit, and consumers try to find the best bargain. They look at the costs and benefits of the exchange. So when companies in these markets would reward recommendations with money they apply MP norms in an MP relationship type. People find it normal that companies try to attract new customers in this way. In MP markets there is a strictly economic exchange. So in these markets no taboo trade-offs are created when recommendations are rewarded with a monetary reward. In the next section the rewards will be discussed in more depth.

2.4

Rewards

Companies are more and more rewarding existing and new customers with rewards. These rewards can have many different forms. Sometimes companies reward recommendations of customers with a reward. When recommendations are rewarded this can be done with a monetary or a symbolic reward. For the kind of reward provided it is important to look at the kind of relationship that exists between people or between people and brands, companies or markets.

In a study done by Verlegh, e.a. (2009) they find that consumers have less strong inferences of ulterior motives when the monetary reward is replaced by a symbolic reward such as a donation to charity. In the health care insurance market, an ulterior motive that consumers might have when a monetary reward is provided could be that the company is applying MP norms into a CS relationship. And consumers are highly resistant when exchange norms are applied to communal relations. In the study by Campbell & Kirmani (2000) they find that the accessibility of ulterior motives influences the likelihood that a consumer makes an inference of ulterior motives.

When incentives or rewards are provided people engage more in WOM behaviour, because rewards can function as an extrinsic motivator (Wirtz & Chew, 2002). Extrinsic motivation comes from outside a person, like for example a reward. When rewards are provided this causes satisfaction and pleasure that engaging in WOM without a reward would not provide. When companies are rewarding recommendations with a monetary reward they behave as in an MP relationship or exchange relationship. A symbolic reward fits best with a CS

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So, when the customer receiving the financial reward sees the relationship as a CS

relationship, the reward is morally unacceptable and creates a taboo trade-off. This may cause feelings of distress and anxiety. People feel uncomfortable or outraged at explicit trade-offs between models. People are more offended at trade-offs from CS to MP, than from MP to CS. Objects received in CS relationships were valued most highly relative to the objective prices, people were least likely to part with them. Objects received in MP relationships were valued least in relation to their objective value (McGraw, Tetlock & Kristel, 2003).So when we see the health care insurance market as a market with CS relations an object received in the form of a reward for a recommendation would be valued most highly relative to the objective prices. Thus when a symbolic reward is provide this could even be a cheaper reward than a monetary reward because people look at the reward differently. The health care insurance market is expected to form CS relationships with people, because people think that their health has a special valuable status. And expected is that when people get very sick they would do anything to get better. And in that case their health would become priceless. They don’t expect anything in return; they just want to get better. An element of a CS relationship is that people that engage in these relationships don’t expect anything in return. They give as they can and take only what they need.

When a monetary reward is provided in the health care insurance market, this leads to MP norms that violate the domain of the CS relations. Furthermore, a monetary reward places a price on the product. While health care is priceless for people or even sacred. When

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These are arguments why it is important to look at the kind of reward provided for

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CHAPTER 3 RESEARCH METHOD

3.1

Conceptual model and hypotheses

On the basis of the discussed literature, the problem statement and the research questions the following hypotheses will be tested in this research. In the discussed literature was established that people have different kinds of relationships with each other or with brands and

companies. It is expected that people have more CS like relationships with health care insurance companies than with other insurance companies, to test this, the first hypothesis is set up.

Hypothesis 1: People have relatively more CS like relationships with health care insurance

companies compared to other insurance companies like furnishing insurance. The second and third hypotheses depend on the first hypothesis.

Hypothesis 2: When a symbolic reward is provided in the health care insurance market

people find this reward campaign more acceptable then when a monetary reward is provided, this effect is expected to be smaller with other insurance companies, like furnishing insurance.

Hypothesis 3: When a symbolic reward is provided in the health care insurance market

people are more willing to recommend the company then when a monetary reward is

provided, this effect is expected to be smaller with other insurance companies, like furnishing insurance.

These hypotheses lead to the following conceptual model (figure 3.1).

Relationship towards Company Type Company CS / MP Acceptability

Figure 3.1 Conceptual model

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3.2 Study

1

The aim of the first study is to test whether people have relatively more CS like relationships with health care insurance companies compared to other (furnishing) insurance companies.

3.2.1 Participants

To test the first hypothesis an experiment is conducted. In this experiment a group of 50 students (39 male, 11 female) will be asked to fill in a questionnaire to test whether they have a more CS like relationship with their health care insurance company then with other

insurance companies (furnishing insurance). The average age of the respondents is 23. Off the 50 respondents that participated 64% have their own health care insurance and 36% is insured with parents. For furniture insurance 50% of the respondents have their own furniture

insurance, 24% is insured with parents and 26% had no furniture insurance.

3.2.2 Procedure

The experiment is a test in which is looked at the relationships towards the different insurance company types.

The questionnaire consists of two parts. In part one a few general questions are asked about gender, age, nationality, whether the participants have their own health care insurance company and furnishing insurance company, and the names of their health care and

furnishing insurance companies.

In part two questions are asked about the relationship the participants have with their health care insurance company (scenario 1, CS) or with their furnishing insurance company (scenario 2, not CS). The scenario describes in short the relationship people have with their health care or furnishing insurance company. Respondents had to think about the relationship they have with their health care insurance company, or the relationship they would like to have with their health care insurance company in time of need (when you get sick and need health care). For the respondents of the furniture insurance respondents had to think about the relationship they have with their furnishing insurance company, or the relationship they would like to have with their furnishing company in time of need (when you need new furnishing in case of a fire or a burglary).

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scale in which each stimulus object is scaled independently of the other objects in the stimulus set (Malhotra, 2004: 256). From question 5 the scale is reversed in order to prevent people to fill in the questionnaire without truly thinking about the answers.

I want to test whether relatively more CS like relationships exists with health care insurance companies compared to furnishing insurance companies. Based on Aggarwal (2004) I made questions that measure whether a communal (CS) or exchange (MP) relationship exists between people and brands or companies. The first four questions were constructed to measure the relationship with the insurance company as if it is a real person. High (low) ratings on the company as a friend or family member, and low (high) ratings of the brand as a businessperson or supplier/seller would be consistent with communal (exchange) norms (Aggarwal, 2004).

The following questions are statements about the attitude of the respondents towards the company: I have warm feelings when I think of my company (CS), my company helps me in time of need (CS), I would miss my company if I had to choose another company (CS), My company treats me special (CS), My company cares about me (CS), My company likes me (CS), I care about my company (CS), My company provides good value for money (MP), My company gives me service in order to get business (MP), My company is my money worth (MP), I feel involved with my company (CS), My company is there for me in time of need (CS), My health/ furniture is valuable (CS), I chose my company on the basis of quality (CS), I chose my company on the basis of price (MP), My company is responsive/ not responsive to my emotional state (CS/MP), My company is taking a personal interest in me (CS), My company does what I pay them for (MP), My relationship with company is an intimate family like relationship (CS), a monetary relationship (MP). These statements measure whether a communal (CS) or exchange (MP) relationship exists. All statements are measured on a 7-point Likert scale (1= strongly agree, 7= strongly disagree). These questions are based on the research of Aggarwal (2004) in which he constructed questions that measure the communal relationship norms and exchange relationship norms.

3.2.3 Results

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related and therefore suitable for structure detection. If the significance is lower than 0,05 the dataset is suitable for factor analysis. In this case the significance is .000 thus suitable for factor analysis.

The Kaiser-Meyer-Olkin (KMO) is an index used to examine the appropriateness of factor analysis. Values between 0,5 and 1,0 indicate factor analysis is appropriate. In this case the value is .767 thus suitable for factor analysis.

Method of analysis

For the method of analysis I chose the principal components analysis method. This method is appropriate when the primary concern is to determine the minimum number of factors that will account for maximum variance in the data. This method is useful when data reduction is the purpose. The factors are called ‘principal components’. In the analysis I used all the 25 statements.

Number of factors

To see how many factors are in the data I looked at the eigen values, they should be above 1. This is the case with 6 factors. From the scree plot the number of factors can also be

determined. The place where the line breaks and changes from vertical to horizontal is the number of factors that should be extracted. The scree plot gives 5 factors that are in the data (see scree plot figure in appendix A). Finally I looked at the percentage of variance. The factors extracted should account for at least 60 % of the variance, and every factor should account for at least 5 % of the variance. The total percentage of variance explained by 4 factors is 61,308 %. Five factors have variance of at least 5 %. When looking at the total variance explained by 6 factors it is 71,004%. So based on the eigen values, the scree plot and the percentage of variance, the number of factors to be analyzed is 6.

Factor Eigen Value % Variance % Cumulative variance

1 7,644 30,578 30,578 2 3,549 14,197 44,775 3 2,310 9,240 54,016 4 1,823 7,292 61,308 5 1,312 5,247 66,554 6 1,112 4,449 71,004

Table 3.1 Summary factor analysis

Interpretation factors

Factor 1 – communal sharing attitude

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- I have warm feelings when I think of my company; - I miss my company when I have to choose another; - My company treats me special when I have contact; - My company cares about me and my H/F; -My company likes me; - I care about my company; -I feel involved with my company; -My company is taking a personal interest in me; - My relationship with company is intimate family like.

Chronbachs α = 0,9339

Factor 2 – market pricing attitude

Exists of the following variables:

- My company provided good value for money; - My company is my money worth; - My company is there for me in time of need; - My health/furniture is valuable to me; - My company does what I pay them for; - My relationship with company is monetary/exchange. Chronbachs α = 0,8009

Factor 3 – real person CS attitude

Exists of the following variables:

- My company is like a close friend; - My company is like a family member; - My company gives me service in order to get business.

Chronbachs α = 0,6596

Factor 4 – emotional company attitude

Exists of the following variables:

- My company helps me in time of need; - Company is responsive to my emotional state. Chronbachs α = 0,3407

Factor 5 – real person MP attitude

Exists of the following variables:

- My company is like a business person; - My company is like a supplier/seller. Chronbachs α = 0,6927

Factor 6 – reasons to join company attitude

Exists of the following variables:

- I chose my company on provided quality; - I chose my company on price. Chronbachs α = 0,3564

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pricing attitude, real person CS attitude, real person MP attitude. In this dataset are two dimensions, CS and MP. The two dimensions can be divided into a general CS or MP attitude towards the company and a real person CS and MP attitude (attitude towards company as if it is a real person). The other statements will be analyzed separately. That is, because values below 0.6 mean that the statements that belong to a factor cannot be analyzed together.

Testing factor scores

The absolute factor scores are summarized in the following table.

Factor Factor name Mean health care Mean furniture

1 communal sharing attitude 5,12 5,16 2 market pricing attitude 2,83 3,09 3 real person CS attitude 4,44 5,17 4 emotional company attitude 3,76 3,54 5 real person MP attitude 3,80 3,72 6 reasons to join company attitude 3,52 3,96

Table 3.2 Absolute factor scores

To test whether health care insurance is more CS than furniture insurance an independent T-test is done. This independent T-T-test is done for all the four factors that are internally consistent.

The CS attitude and MP attitude score did not significantly differ based on company type (CS attitude, t(48)= -.097, p= .923; MP attitude, t(48)= -0.885, p= .381). The real person CS attitude had a significant difference t(48)= -2.303, p= .026. Health care is more CS (M=4,44) than furniture (M=5,17). The real person MP attitude had no significant difference t(48)= -0.219, p= .828.

Testing statements independently

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because of provided quality (M: 3,44) than furniture insurance (M: 4,44), t(48)= -2.068, p= .044.

3.2.4 Conclusion study 1

The aim of this study was to test whether people have relatively more CS like relationships with health care insurance companies compared to furnishing insurance companies. To test this hypothesis a questionnaire was distributed and analyzed with a factor analysis. With an independent T-test was tested if the factors explain a significant difference between the two groups, health care insurance and furniture insurance. The factor real person CS attitude showed a significant difference between health care and furnishing insurance companies. Health care is more CS (M=4,44) than furniture (M=5,17). On the other factors no significant difference was found. Further was found that health care insurance is more valuable to respondents than furniture insurance, and that health care is more chosen because of provided quality than furniture insurance.

The results of this study show that respondents evaluated health care more CS than furniture for constructs that measure the company as a real person CS attitude. The reason that a result was found for the factor real person CS attitude could be because when people think of their insurance company as a real person they think about the times they had contact with the company. When they have contact with a company they in fact have contact with real persons, this could lead to opinions about the people that work for that company. And those opinions are then translated to evaluations of the company itself, thus as a real person CS attitude. Constructs measuring a more general relation attitude (CS or MP) did not show the expected difference. A reason why these construct did not show the expected results could be because when answering the questions the people thought about their insurance company in a more general way. And were thinking about there opinions about their company in general. Perhaps in general people don’t evaluate insurance companies as CS because they think of insurance companies as an obligation. That is, in the Netherlands people are obligated to have an insurance for their health. This could lead to less CS like characteristics for these insurance companies.

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between health care and furniture insurance. I further looked at the differences between the respondents with their own health care insurance and the respondents with insurance with their parents. The respondents with their own insurance (M: 2,84) thought their company was more their money worth than the respondents that are insured with their parents (M: 3,89). Another reason for the little difference that is found between health care and furniture could be the age of the respondents. The average age of the respondents is 23. This could be another reason why respondents aren’t very involved with their insurance company. Young people aren’t very involved because they aren’t sick often and therefore don’t have much contact with their health care insurance. They don’t have much involvement with their furniture insurance because many young people still live with their parents or don’t have furniture insurance.

The final conclusion is that the first hypothesis (People have relatively more CS like relationships with health care insurance companies compared to other insurance companies like furnishing insurance) is partially accepted. That is the hypothesis is accepted for real person CS attitude. And for the following independent statements health care insurance is more valuable to respondents than furniture insurance, and that health care is more chosen because of provided quality that furniture insurance. The hypothesis is not supported for the constructs that measure a more general relation attitude, and for the construct measuring real person MP attitude.

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3.3 Study

2

The aim of the second study is to test whether providing a symbolic reward compared to a monetary reward in the health care insurance market is more acceptable and leads to more willingness to recommend the company as with furnishing insurance companies.

3.3.1 Participants

In order to test hypotheses 2 and 3 a second experiment is done. In this experiment a group of persons is asked to fill in a questionnaire. This questionnaire tests whether providing a symbolic reward compared to a monetary reward in the health care insurance market is more acceptable and leads to more willingness to recommend the company as with furnishing insurance companies. Because in the first study the results might have been influenced by the age of the respondents, I used older respondents is the second study. For this experiment I asked people that were travelling by train to fill in the questionnaire. The average age of the respondents is 38. In total 100 respondents participated (36 male, 64 female). In this sample of 100 respondents 84% had their own health care insurance, and 16% is insured with parents. For furniture insurance 80% has their own insurance, 7% is insured with parents and 13% has no furniture insurance.

3.3.2 Procedure

The experiment is a 2 (Company type: CS, not CS) x 2 (Reward type: symbolic, monetary) between subjects design.

The questionnaire consists of two parts. In part one a few general questions are asked about gender, age, nationality, whether the participants have their own health care insurance company and furnishing insurance company, and the names of their health care and

furnishing insurance companies.

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respondents know how much the reward is worth. And because the monetary and symbolic rewards are better comparable in this situation.

I want to test whether providing a symbolic reward compared to a monetary reward in the health care insurance market is more acceptable and leads to more willingness to recommend the company as with furnishing insurance. Based on the article of McGraw & Tetlock (2005) about taboo trade-offs I constructed the questions. That is because monetary rewards are more taboo trade-offs than symbolic rewards and will therefore lead to lower acceptability and willingness to recommend a company in a CS market.

The first statements are about the acceptability and willingness to recommend: - I find the proposal strange or out of the ordinary; - I am happy with the proposal made by company; - I would accept the proposal; - I would recommend my company, were 1= strongly agree and 7= strongly disagree. Other statements that measure acceptability and willingness to recommend are: - What is your attitude towards company (1= very positive, 7= very negative); - What is your opinion about reward campaign (1= very positive, 7= very negative); - How did reading this scenario make you feel (1= very happy, 7= very angry). Further there are statements that ask the respondents what they think the average customer would think of this reward campaign: - will customers accept reward campaigns of this sort; - will customers complain about this reward campaign; - opinion of average person about this reward campaign. That is to see whether the opinion of themselves differs from what the respondents think the average customer thinks. These statements are measured on a 7-point Likert scale, were 1= strongly agree and 7= strongly disagree.

In order to check whether health care is more CS than furniture insurance in this sample six statements are added that were also tested in the first study. The statements added are: - warm feelings when I think of my company (CS); - my company treats me special when I have contact (CS); - my company has good value for money (MP); - my company is my money worth (MP); - I feel my company is taking a personal interest in me (CS); - I feel my

company does what I pay them for (MP). I chose these statements because they represent CS and MP best. These statements are measured on a 7 point Likert scale, were 1= strongly agree and 7= strongly disagree.

3.3.3 Manipulation check

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these statements no effect was found, respondents did not think different about health care and furniture for the following questions: I have warm feelings when I think of my company t(98)= -1.301, p= .196; I feel my company is taking a personal interest in me t(98)= -1.109, p= .270; and I feel my company does what I pay them for t(98)= -1.549, p= .125.

However a significant effect was found for the other three statements. Health care is less MP (M: 3,70) than furniture (M: 2,96) for my company has good value for money t(98)= -2.424, p= .017; and also for my company is my money worth health care (M: 3,52) is less MP than furniture (M: 2,90), t(98)= -2.221, p= .029. This is in line with the expected results that health care is less MP than furniture.

Unfortunately, health care is less CS (M: 4,80) than furniture (M: 4,14) for my company treats me special when I have contact t(98)= -2.136, p= .035. This effect is in unexpected direction. However the difference is not very large. And both means are between neutral and disagree a little.

In this sample of 100 respondents 84% had their own health care insurance, and 16% is insured with parents. For furniture insurance 80% has their own insurance, 7% is insured with parents and 13% has no furniture insurance. Compared to the first study here 20% more have their own health care insurance and 30% more have their own furniture insurance. This could indicate that as expected respondents with their own insurances are more involved with their company.

The conclusion from this manipulation check is that health care is less MP than furniture for statements that measure MP. But for my company treats me special when I have contact health care is less CS than furniture.

3.3.4 Results

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Factor Eigen Value % Variance % Cumulative variance

1 7,207 42,391 42,391 2 2,135 12,556 54,948 3 1,843 10,843 65,790 4 1,073 6,314 72,104

Table 3.3 Summary factor analysis

Interpretation factors

Factor 1 – acceptability campaign attitude

Exists of the following variables:

- What do you think of the reward campaign (moral- immoral); - What do you think of the reward campaign (positive- negative); - I find this reward campaign (normal-abnormal); - I find this reward campaign (positive-negative); - I find this reward campaign (acceptable- unacceptable).

Chronbachs α = 0,9164

Factor 2 – average person acceptability campaign attitude

Exists of the following variables:

- Do you think customers accept campaigns of this sort; - The average person finds this reward campaign (normal- abnormal); - The average person finds this reward campaign (positive- negative); - The average person finds this reward campaign (acceptable- unacceptable); - An average person would recommend the company to a friend. Chronbachs α = 0,8852

Factor 3 – willingness to recommend attitude

Exists of the following variables:

- Happy with proposal made by company; - I would accept proposal made by company; - I would recommend my company to a friend.

Chronbachs α = 0,8866

Factor 4 – company attitude

Exists of the following variables:

- Attitude towards your company; - How did reading this scenario make you feel. Chronbachs α = 0,3963

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ANOVA for factors

Next a 2-way ANOVA is conducted; this test shows if there is a significant difference between company type, reward type and if there is an interaction effect.

Factor 1 – acceptability campaign attitude

For the acceptability campaign attitude I examined whether people evaluated a symbolic reward as more acceptable than a monetary reward, and if this effect is smaller for furnishing insurance than for health care insurance. Unfortunately, no significant effect was found for company type F(1,96)= .285, p= .595. For reward type also no effect was found F(1,96)= .000, p= .990. The interaction effect (company x reward) is not significant F(1,96)= .000, p= .990.

Factor 2 – average person acceptability campaign attitude

The average person acceptability campaign attitude gave the following results for company type F(1,96)= .436, p= .510, this was not a significant effect. For reward type there was also no significant effect found F(1,96)= 1.746, p= .190. The interaction effect (company x reward) is also not significant F(1,96)= .436, p= .510.

Factor 3 – willingness to recommend attitude

For the willingness to recommend attitude the following results were found. For company type, no significant effect was found F(1,96)= 1.082, p= .301. For reward type a significant effect is found F(1,96)= 15.377, p < .001. Symbolic rewards (M: 5,69) lead to less willingness to recommend than monetary rewards (M: 4.39). This means that respondents with a

monetary reward are more willing to recommend the company than when a symbolic reward is provided. The interaction effect (company x reward) is not significant F(1,96)= .519, p= .473.

ANOVA all items

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symbolic reward (M: 4,60) is provided customers will complain less than when a monetary reward (M: 3,82) is provided, F(1,96)= 4.697, p= .033. The last finding is that when a monetary reward (M: 3,68) is provided the average person would recommend more than when a symbolic reward (M: 4,58) is provided, F(1,96)= 6.919, p= .010. Partial Eta Squared was below .142 in all cases, this means that there was a moderate difference in all cases.

3.3.5 Conclusion study 2

The aim of the second study was to see whether symbolic rewards provided in the health care insurance market lead to more acceptability of the reward campaign and to more willingness to recommend the company then when a monetary reward is provided. This effect is expected to be smaller for furnishing insurance companies (H2 and H3). The assumption here was that health care is CS and furniture is MP. This assumption was not really proven in the first study. That is why in the second study a manipulation check was done. The respondents found that their health care insurance company was less MP than furniture insurance for “my company has good value for money”. Also for “my company is my money worth” the results showed that health care is less MP than furniture insurance. Unfortunately, for “my company treats me special when I have contact with them” health care is less CS than furniture

insurance. These results are in line with the first study. Only for some constructs can be said that health care is more CS than furniture.

The 2-way ANOVA analysis on the factors showed that there is a difference between monetary and symbolic rewards for the factor willingness to recommend attitude. But this effect does not support the hypothesis. That is because providing a monetary reward leads to more willingness to recommend the company than a symbolic reward. This is the opposite as expected. There was no significant effect found for company type. This could be a result of the fact that health care is not really CS, and that therefore symbolic rewards aren’t a better fit with this market.

Company type did not have any effect on the propositions tested. It remains unclear whether this is the result of the fact that health care is not a typical CS market, or that both health care and furniture markets have the same relational context. It could also be that there is a

difference between these two insurance markets, but that the difference just wasn’t found in this research.

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monetary rewards are more acceptable than when a symbolic reward is provided. People also were more willing to recommend the company when a monetary reward is provided as when a symbolic reward is provided.

An interesting result found is that respondents think that customers will complain less when a symbolic reward is provided instead of a monetary reward. This is interesting because respondents are less willing to recommend when a symbolic reward is provided and also the reward campaign is evaluated as less acceptable when a symbolic reward is provided. But the respondents do think that providing symbolic rewards leads to less complaining.

The hypotheses that were tested are:

• When a symbolic reward is provided in the health care insurance market people find this reward campaign more acceptable then when a monetary reward is provided, this effect is expected to be smaller with other insurance companies, like furnishing insurance.

• When a symbolic reward is provided in the health care insurance market people are more willing to recommend the company then when a monetary reward is provided, this effect is expected to be smaller with other insurance companies, like furnishing insurance.

The final conclusion of the second study is that for both hypotheses no significant difference was found for health care and furniture insurance companies. For reward type a significant difference was found for willingness to recommend attitude and for five statements. The results showed that a monetary reward leads to more acceptability and willingness to recommend in stead of a symbolic reward. Thus, hypothesis 2 and 3 are not accepted, for the health care and furniture insurance market

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CHAPTER 4 GENERAL DISCUSSION

4.1

General discussion

The hypotheses were not confirmed in a set of two studies. Results were found but these results were minimal so that the hypotheses cannot be fully confirmed. The first study did not confirm that people have generally more CS like relationships with health care insurance companies compared to other insurance companies. The claim that symbolic rewards in the health care insurance market lead to more acceptability of the reward campaign and to more willingness to recommend the company compared to monetary rewards, was build on the assumption that the health care market has more CS like relationships. It could be that because in the first study this claim was not supported, the reward provided in the second study did not match with the kind of market as expected. This therefore changes the second study. Because an assumption of the second study was that health care is a CS market and furniture is an MP market. The results of the first study confirmed this hypothesis only for the construct real person CS attitude. The second study looked at the reward type provided and at the acceptability of the reward campaign and the recommendation likelihood. Expected was that in the health care insurance market symbolic rewards would lead to more acceptability of the reward campaign and to more willingness to recommend, compared to furnishing

insurance companies. The results showed that monetary rewards in both insurance markets lead to more acceptability and willingness to recommend. This could be because people don’t see the health care insurance market as a typical CS market. Another reason for these results could be that the world is in a financial crisis at the moment and people therefore favor monetary rewards more than symbolic rewards.

Relations

Rewarding WOM is originally most found in CS relationships. But companies found that rewarding WOM recommendations is a successful marketing technique. It led to more customers, because people generally trust WOM recommendations more than advertising or commercials (Verlegh, ea, 2009). But when WOM recommendations are rewarded with money, which is a typical MP characteristic, the CS relationship becomes disturbed. It is argued that people apply the same norms and values on to brands as on to human

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more CS like relationships with health care insurance companies than with other insurance companies.

The results of the first study show that the general attitude towards insurance companies doesn’t differ for health care or other insurance companies. Thus, people evaluate health care insurance companies the same as other insurance companies. Therefore, it can not be said that people in the health care insurance market have more CS like relationships with companies in that market than in the furnishing insurance market. That is an unexpected result because health care is so important to people, and people choose their health care insurance company on the basis of quality. Health care has a special valuable status to people and would therefore be more likely to be a market in which CS relationships are formed. It was expected that people treat their health care insurance in the same way as they look at their health, because health is so important for people. And that people for this reason want the best possible health care insurance available and don’t look at the costs of their health care insurance but at the quality. That is why a CS relationship was expected.

In the whole insurance market people form relationships with insurance companies, it remains unclear if there is a difference between health care and furniture insurance markets. It could be that health care is more CS than furniture, or that both markets have the same relational characteristics but that just in this research no results were found.

When people had to evaluate their relationship with their insurance company on the basis that their company is a real person, people found that they had more CS like relationships with their health care insurance company than with their furnishing insurance company.

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translated the relationships people have with brands to relationships people form with companies and even markets. Perhaps when was looked at different brands in the insurance market more results were found. The contribution that this study made to the existing literature about relationships is that next to human relationships and brand relationships people also form relationships with companies and markets.

Taboo trade-offs and rewards

Taboo trade-offs are created when norms of a typical relational type are applied to another relational type. The greatest taboo trade-offs are created when MP norms are applied to CS relationships. Taboo trade-offs in the insurance market were expected when monetary rewards are provided in the health care insurance market. Expected was that health care is a market where typical CS relationships are formed. And therefore symbolic rewards seemed better fit for this market.

The results of the second study show that there is no difference between health care insurance and furniture insurance for the reward type provided. That is in line with the first study because only a small difference was found between the two company types. Health care is not a market that forms more CS like relationships with people than other insurance markets. The whole insurance market can be seen as one market with no difference per company type. Contrary to what was expected, providing a monetary reward leads to more willingness to recommend the company than a symbolic reward. Because no difference was found between the two insurance markets in the first study, this result is in line with the first study. Other results are that people are less happy when a symbolic reward is provided in stead of a monetary reward. People will accept the proposal by the company more when a monetary reward is provided and would also recommend their company more. This is in line with the article by Verlegh, e.a. (2009). Another result was that respondents think that customers will complain less when a symbolic reward is provided instead of a monetary reward. This is interesting because respondents are less willing to recommend when a symbolic reward is provided and also the reward campaign is evaluated as less acceptable when a symbolic reward is provided. But the respondents do think that providing symbolic rewards leads to less complaining.

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market in which people like to be rewarded with symbolic rewards, because the market is a typical exchange market. Another reason why a monetary reward is evaluated as more

acceptable and leads to more willingness to recommend could have another cause. That is, the world is in a financial crisis at the moment. This could cause the effect why respondents like monetary rewards better than symbolic rewards. For WOM theory this has the implication that in the insurance market monetary rewards lead to more acceptability and willingness to recommend compared to symbolic rewards.

4.2 Marketing

implications

When companies in the insurance market are developing marketing strategies they have to keep in mind that people on a daily basis don’t think of their insurance companies as real persons. People only think in that direction when they are triggered by a question or a scenario that they have to keep in mind when thinking of their company. For developing marketing strategies it is important to look at the market the insurance companies are in and to do more research in this field. From the results of this study it cannot be said that health care is a more CS market than furniture or that both markets do have the same relational type. But that in this research just no results were found.

When companies are providing rewards when recommendations are given by their customers it is important to look at the kind of market these companies are in. In both the health care and the furnishing insurance market, monetary rewards seem better fit then symbolic rewards. The insurance market is a market were monetary rewards fit best. This is a contribution to the literature of taboo trade-offs by McGraw & Tetlock (2005).

4.3

Limitations and future research

This research has some limitations. The number of respondents is in the first study 50 and in the second 100. This number of respondents does give an indication but more respondents could however provide different results. Further it could be that because of the symbolic rewards provided people favoured monetary rewards more. Perhaps they didn’t like the symbolic rewards.

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humans and brands. This could be done by setting up a research that compares brands and markets and looks at the differences and similarities between these two.

Another direction for future research could be a study that looks further into the type of market the insurance market is, if it is an MP market or that health care insurance is different from other insurance companies. This could be interesting for companies in this market because the health care insurance market is recently a market of free choice, and therefore it is important for companies to look at which marketing techniques to use. And which techniques provide the best results. This can be done by a study that asks people about there associations with the insurance market. These associations could then be analyzed by relational type to see how people evaluate the insurance market, and which type of relations people form in the insurance market.

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