A fool, it is said, knows the price of everything and the value of nothing. And so it seemed to many dentists when the General Dental Council insisted that every practice must display a list of prices charged to private patients. That is, of course in addition to the (English and Welsh) contractual duty to display current NHS banding costs.
Don’t get me wrong. I think it is right and proper that each patient should know, in advance of the start of treatment, what their likely costs should be, with as much precision as is possible, and that it’s entirely right that patients should know whether their treatment is to be provided privately or under the NHS. I’m not arguing either with the concept that the cost of an initial examination (again, NHS or private) should be identified, as without this, the prospective patient has no ‘gateway’ to further detail at all. It’s more the concept of whether we, as dentists, are in the business of selling goods or providing a service for a fee. When we are buying a house or having our accounts drawn up, we accept that the exact costs of providing those services will be elastic, and dependent on the individual requirements of each case.
It reminds me of an initial discussion with the Office of Fair Trading (now superseded by the Competition and Pricing Authority) whose view was that a patient should be able to have a dental examination and treatment plan which they could then take with them and hawk around all the dental practices in the neighbourhood for comparative purposes. Very consumerist, but how naive can you be?
So in addition to the varying needs of each patient, we have to factor in the experience and qualifications of the dentist, the clinical assessment of each case, the preferences of the patient, the quality of the materials used... the list is endless.
Whether it is dentistry, law or accountancy, physiotherapy or garden design (to take some extremes), the essence of a service is not only that it is an individual contract, but also that in general an inequality of knowledge exists between the purchaser and the provider. In healthcare this is dealt with through the ethics of professionalism and the requirements to put the interests of the client first, to be honest and truthful and to secure informed consent.
Where the OFT went wrong of course is to confuse the above with “proactive consumerism” whereby a concerned minority (apparently still a minority) constantly search for the cheapest utility tariff or bank account. These are commodities. I know that I want 240 volts AC, with relative consistency. What I don’t know is whether I need a root canal, an implant or a bonded bridge.
It’s for that reason that I find extensive price lists and voucher offers depressing. They commoditise our profession and encourage the belief that healthcare is all about the exchange of cash (or payment by taxation).
Sadly, we are sometimes caught in a three-way relationship, whereby an external party decides, and often restricts, our professional services by emphasising the economics of the exchange. This inevitably distorts the market and more importantly sets undue priority on cost over value and worth. Where this also introduces a monopoly on pricing, there is further disadvantage since loyalty counts for less.
Loyal patients deserve a better deal, not only because they have displayed trust in their dentist (which is a form of payment), but because they are our ultimate advocates. Patients gained on recommendation are still one of the
best and most cost-effective forms of marketing.
So a long price list, even of “from... to....” format, doesn’t really help our patients or ourselves. Unfortunately it is a “must do” requirement of the current Standards for Dental Professionals. Fortunately by the time we have displayed all the required announcements in our waiting or reception areas, it will sort of merge into the background as people’s eyes glaze over, and for all the wrong reasons, that’s probably the right answer.