Health and medical care is complicated. Patients have a hard time figuring out the quality of information that a medical professional gives to them. They also have a hard time figuring out what appropriate treatment is. There is a pretty cool little study from Switzerland that quantifies the informational challenge for patients.**
In our study, a single test patient visits 180 randomly selected dentists for a checkup. At each dentist visit, the test patient asked for a diagnosis based on an examination and the same x-ray photograph, a treatment recommendation and a cost estimate. The test patient had a superficial caries lesion limited to the enamel which should not be treated with an invasive treatment such as a filling according to the Swiss Dental Guidelines and four cooperating reference dentists. Thus, we focus our analysis with the case at hand at the credence goods problem of overtreatment which wastes resources and may spur adverse health effects in the long run….
Our central result is an overtreatment recommendation rate of 28% (50/180). Conditional on an overtreatment recommendation, mean overtreatment costs taken from the collected cost estimates amount to CHF 535 (about $550), the median being lower at CHF 444 (about $455). Regarding the treatment the test patient has a supercial interproximal caries lesion that should not be treated by an invasive treatment such as a filling, the suggested number of fillings at a dentist ranges from 1 to 6. Furthermore, we observe that 13 different teeth to be treated with a filling appear across all cost estimates. Thus, besides our finding of
a considerable overtreatment recommendation rate, we also observe a striking heterogeneity in the treatment recommendations.
Almost three in ten dentists give the patient bad information and the quality of bad information varied greatly.
If the overtreating dentists all recommended that the same single tooth be filled then the information problem barely exists. It would be a uniform recommendation towards a single non-concordant standard of care. They might have been dentists that figure that sooner or later a cavity will need to be filled on a tooth and it might as well be them collecting the fee instead of their competitor. In that story, it would be a time and location shifting of costs.
But that is not the story being told in the data. The over-treating dentists made a wide range of recommendations. Some may have been merely slightly more aggressive than guideline concordant care. Others were taking advantage of the information problem as they recommended multiple fillings on multiple, varying teeth.
So what does this mean?
Fee for Service overtreatment recommendations:Post + Comments (11)