Discounts, dentistry and ethics
Have you have seen dental offices advertising discounts on treatment?
Something like,"this month only, $1000 off Invisalign." Or perhaps offering coupons? Or even joining Groupon?
This may not seem like a big deal in the world of business, as we see this all of the time in other industries.... but in the world of HEALTH CARE, promotions such as these bring up many ethical questions. So many that the College of Dental Surgeons of British Columbia prohibits dentists from advertising discounts. Period. Yet we still see them all of the time.
See section 12.11 in the bylaws here: https://www.cdsbc.org/Documents/bylaw-12-nov-2017.pdf
One may wonder, well whats the big deal on discounts in dentistry?
As health care providers, dentists should be making treatment recommendations after a comprehensive dental examination and review of the medical history, and a discussion with the patient. Advertising discounts on specific procedures puts the treatment decisions before the diagnosis.
There are also concerns that dentists may be advertising discounts on products or procedures in order to "sell a case", perhaps to help convince a patient to choose a more expensive treatment, or to push procedures that the dentist has just taken a course in and wants to start doing more of in order to improve production. Maybe the initial discount is recouped in the form of other fees and the ultimate price ends up the same.
These again may be all fair game in the business world, but in health care, patients are to have AUTONOMY in their decisions, and these discounts can influence their choices, perhaps not based on what is best clinically, or health wise, but on what they can get a better deal on (which is different than what is cheaper btw). I do not know if patients expect to be "upsold" at their dentist's office, but there are hundreds of "sell more implants" type seminars that teach techniques that are supposed to bring in bigger cases. Is this what you want from your health care provider?
From a business and competition perspective, offering discounts is also affecting patient decisions in choosing who provides them their dental care. Perhaps someone has a complicated orthodontic situation, or is considering a dental implant in an aesthetic zone, and they go see a dental specialist, or an experienced general dentist for a consultation, and well.....that can be expensive. Then they check the newspaper and find a coupon for $500 off braces at a dental office that just opened up. That patient is going to be tempted to go and see that dentist because of the $500 off, without consideration that this dentist may not actually be trained or experienced enough to take on their case....but are advertising that they perform that type of care.
An honest dentist would then have to say, sorry, you need to go see the specialist (or experienced general dentist) which the patient may not want to do because they want to take advantage of a discount. We can wish that everyone in society be ethical and fair, but the reality is if someone is offering discounts to get people in the door, do you think that they are going to turn a potential paying client away?
The College of Dental Surgeons of BC is SWAMPED with complaints from the public on improperly completed advanced dental procedures such as orthodontics, so you can draw your own conclusions as to whether or not this is a real concern.
Read the complaint summaries here: https://www.cdsbc.org/Public-Protection/public-notification/complaint-summaries
Those are more business related ethical issues, but there are also several philosophical medical/dental ethical considerations when it comes to discounts.
Imagine a patient has an infected tooth with a facial swelling; they need treatment ASAP.....but what if they see that your office had offered discounts on root canals 2 months ago......and they say, nah, I will wait until you are offering that price reduction again. Patients may choose to defer treatment and wait for the discounts to come around again.
Then there are the concepts of equality and fairness. Why should one patient pay more or less than another just because their disease was diagnosed at a time when the dentist was offering discounts? How would the patients that have already begun treatment at regular price feel when they see that the same treatment that they are doing is being offered $1000 off?
Again, in business, not a big deal! People love bargain hunting. But in health care, these are more sensitive ethical debates that go beyond simple marketing techniques.
Thanks for reading this long one......
Dr. Dave
drdave@alfaropros.com
