National Consumer Agency Doctors and Dentists Survey



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National Consumer Agency

Doctors and Dentists Survey

May 2010



Table of Contents

1 Introduction 4

2 Methodology 7

3 Doctors Survey – Results 9

3.1 Price Display 10

3.2 Cost of a Routine Consultation /Examination 11

4 Dentist Survey – Results 13

4.1 Price Display 14

4.2 Cost of Routine Procedures 15

5 Key Findings 20

Appendix 1 GP Questionnaire 21

Appendix 2 Dentist Questionnaire 22



Table of Figures

Percentage of Doctors who Display Fees 10

Cost of a Routine Consultation / Examination 11

Percentage of Dentists who Display Fees 14

Cost of a Routine Examination 16

Cost of a Scale and Polish 17

Cost of a Simple Extraction 18



Combined Examination / Scale and Polish 19

1Introduction


This document presents the result of a National Consumer Agency (NCA) survey of general practice Doctors and Dentists premises, investigating levels of price display and fee levels charged for a short list of routine services. Fieldwork for the survey was conducted between March 18th & 26th 2010.
This is the second Doctor & Dentist price-related survey conducted by the NCA. A telephone-based survey conducted in March/April 2009 found that 69% of Dentists and 28% of Doctors declared they did not display prices.
Arising from the large proportion of Dentists reporting that they did not display prices at that time, the Agency engaged with the Irish Dental Association and with the regulatory body for the profession, the Dental Council. Both bodies volunteered to bring the matter of price display to the attention of their members via their Journal and Newsletter respectively. The Irish Dental Association also asked a number of its members to investigate the issue further on foot of a discussion of the survey at a Council meeting.
The proportion of general practice Doctors reporting that they did not display prices at the time of the 2009 survey was considerably lower than that for Dentists and, while no direct action was taken at the time by the Agency, it was concluded that this issue should be the subject of further monitoring and investigation.
The present survey follows-up on the 2009 study. The methodology has been strengthened on this occasion by conducting the survey on a face-to-face rather than a telephone basis.
The Doctors and Dentists surveyed by the Agency are not named in this report or in the accompanying spreadsheets. The purpose of the survey is not to provide details of the commercial practices of individual practitioners. It’s objective is to identify general trends in the area of price display and price levels amongst this group of professional service providers.
The National Consumer Agency acknowledges that price may not be the primary consideration for an average consumer when choosing a Doctor or Dentist. Personal history/relationship, opening hours, location etc. may also influence consumers’ decisions in selecting a medical or dental practice. However, the Agency views standard medical and dental procedures as being within the range of “commodity purchases” that the average consumer is likely to make in the routine conduct of their affairs. It further feels that this information is particularly important in the current economic climate and is of value to consumers moving to a new area, those seeking to save money and those seeking comparative price information.
In general, the Agency advocates the provision of pricing information wherever reasonable and possible as it believes that such information promotes competition, empowers consumers to make informed purchasing decisions and aids those seeking a fair deal. To track how service providers are responding to this consumer need, the Agency conducts periodic pricing surveys. For 2010, the Agency is expanding its activities in this area beyond grocery and personal care products to the examination of a range of professional services.
The report is divided into this introduction, a methodology section plus three further sections as follows:



  • Section 3 presents the results of the survey of 123 Doctors and

  • Section 4 contains the results of the survey of 128 Dentists.

Finally, section 5 presents a summary of the findings from the survey.
The Agency would like to thank the Dentists and Doctors surveyed for their cooperation in the course of this study.

2Methodology


The National Consumer Agency undertook a survey of general practice Doctors and Dentists between March 18th & 26th 2010. The survey sought to quantify:

  • the proportion of Doctors and Dentists who display a schedule of prices on their premises

  • the level of fees charged for a limited range of routine services.

This report records the findings of the survey. Spreadsheets with full details of all survey results are available on the Agency’s consumer website, www.consumerconnect.ie.


In total NCA staff visited 251 Doctors and Dentists surgeries in 11 urban locations across Ireland. Visits were not pre-notified. Face-to-face interviews were conducted lasting an average of 10 minutes each. Table 1 details the locations visited as part of the survey.


  1. Survey Locations and Number Surveyed







Area

Doctors Number Visited

Dentists Number Visited

1

Dublin City - South

13

20

2

Dublin City - North

10

10

3

Ballsbridge/Sandymount

7

4

4

Tallaght/Walkinstown

11

11

5

Waterford City

16

14

6

Cork City

9

13

7

Limerick City

10

10

8

Galway City

13

12

9

Ennis/Gort/Loughrea

10

12

10

Tralee/Killarney

11

11

11

Dundalk/Drogheda

13

11




123

128

Total




251

These locations were chosen as they were identified by the latest Census1 as having the largest populations; it is therefore a reasonable assumption that they will have a high concentration of Doctors and Dentists. In the Dublin area, four areas were selected in order to represent a reasonable cross-section of the city.


An NCA staff member visited each of the 251 Doctors and Dentists with a short list of questions to determine:

  • the level of price display for GPs and Dentists

  • In the case of a Doctor, the amount charged for a routine examination

  • In the case of a Dentist, the charge for an examination, a scale and polish and a simple extraction.

Both questionnaires are appended to this report.
The fees charged have not been audited in any way. All responses in this survey were recorded verbatim. It transpired that a small number of those visited practice in specialist areas of medicine and dentistry. To maintain consistency in terms of the consultations and procedures included in the analysis, these practitioners have been excluded from the results.


3Doctors Survey – Results


This section presents the results of the survey of general practice Doctors (GPs). The questionnaire for GPs addressed the level of price display and the fee charged for a routine consultation/examination. Doctors were also asked if a separate price was charged for a child’s consultation.
Note that the fees recorded in the survey relate to private patients only.
Where relevant, the questionnaire sought information on the reasons why prices were not displayed. This was deemed reasonable to ask given that the Irish Medical Council’s Guide to Ethical Conduct and Behaviour, 6th edition, states “3.6 “Doctors’ fees should be appropriate to the service provided. Patients should be informed in advance of the consultation and treatment what the costs are likely to be” and 7.4 “The Council welcomes the use of appropriate information (including professional fees) for patients. This is most suitable for display or distribution in the place of practice by the doctor or practice staff”.
The Agency notes that the 7th edition of the guide contains a variant of 3.6 but paragraph 7.4 or similar is no longer included.
The results in this section are a summary of the returns from 123 Doctors. 1 GP declined to provide information and 4 others declined to give specific price information. As mentioned in Section 2, a small number of specialist Doctors were excluded from the results to ensure consistency and they are not included in the figure of 123.
A detailed results table for each area is available in the file entitled Doctors Survey Results, available on the Agency’s website www.consumerconnect.ie.

3.1Price Display


Figure 1 illustrates the level of price display at national level and for each of the 11 areas surveyed. Overall, 50% of GPs display prices (61 out of 122 Doctors). It can be seen that there is wide variation in the level of price display, ranging from 80% in Tallaght/Walkinstown to 22% in Cork City.


  1. Percentage of Doctors who Display Fees


Various reasons were given for not displaying prices on the premises. Examples included:

  • “prices are available on the website”

  • “did not get around to displaying it”

  • “not required”

  • “list behind reception desk for staff only”

The NCA welcomes indications that some GPs are making prices available via their websites, as this can significantly assist consumers who are researching prices for comparison purposes, however this should not be a replacement for the prominent display of prices accessible by consumers on the medical practitioners premises.


Of the 61 Doctors who did not display prices, 33 (54%) offered no reason for this practice.

3.2Cost of a Routine Consultation /Examination


Results in this section pertain both to Doctors who display prices and those who do not, but who were willing to give prices when asked by the NCA staff member conducting the survey. 5 Doctors out of the total were not willing to give a price for a routine consultation/examination.
Figure 2 illustrates the cost of a routine consultation/examination, showing the overall/national average price as well as the maximum and minimum for the country as a whole. It further shows the same information in respect of each of the 11 areas surveyed. The average price, across all survey locations, for a routine examination is €51. At national level the range is significant, from €35 to €70.


  1. Cost of a Routine Consultation / Examination


Fee level information provided shows:

  • the lowest price (€35) was found in Tralee/Killarney

  • the highest overall price (€70) and the highest average price (€59) were both recorded in Ballsbridge/Sandymount in Dublin

  • the lowest average price (€46) was recorded both in Ennis/Gort/Loughrea and Tralee/Killarney

  • Ballsbridge/Sandymount recorded the largest difference between the maximum and minimum price (€25) in an individual location

  • the smallest difference between maximum and minimum price in a single location was recorded in Cork, at €5.

8 Doctors specifically reported that they charge a lower fee for children and a number of Doctors indicated that they use discretion in relation to the charge for children. Some also reported that they operated a family fee.


4Dentist Survey – Results


This section presents the results of the Dentist survey. A detailed results table for each area is available in the file entitled Dentists Survey Results, available on the Agency’s website www.consumerconnect.ie.
The questionnaire was kept as short as possible in order to minimise the burden on respondents. In this case, the survey was designed to assess both the current level of price display and the fees charged for:

  • a routine examination

  • a scale and polish

  • a simple extraction.

Intuitively it might be assumed that a filling would be a natural procedure for inclusion in this survey, however fillings were not included as a different price is usually charged for front teeth, pre-molar and molar fillings, plus separate prices apply depending on whether the filling is amalgam or composite.


The results in this section are a summary of the survey relating to 128 Dentists. 6 Dentists declined to co-operate and a further 9 declined to give specific price information. A small number of specialist Dentists were excluded from the results to ensure consistency and so are not included in the figure of 128.
Note that the fees recorded are in relation to private patients and they do not include the PRSI Scheme2 or medical cardholders.
In common with the Doctors survey, Dentists who did not display prices were asked why, given that the Dental Council of Ireland’s Code of Conduct Pertaining to Public Relations and Communications states that “Greater transparency in fees is advocated and a list of private fees should be prominently displayed in dental practices. It is accepted that a detailed estimate of the cost of treatment can only be given following a full oral examination but it should be possible to give an indication of the fees charged by the practice for routine procedures.”
In the current survey, a number of reasons were given for not displaying prices, these are set out in section 4.1 hereafter.


4.1Price Display


Figure 3 illustrates the level of price display at a national level and for each of the 11 areas surveyed. Overall 32% of Dentists surveyed display prices (39 out of 122 Dentists). It can be seen that there is wide variation in the level of price display identified. Waterford City topped the list with 54% of Dentists surveyed displaying prices. In Cork City, recorded price display stood at 9%.


  1. Percentage of Dentists who Display Fees

On enquiry, reasons given for not displaying prices on the premises included:



  • “fees vary”

  • “available upon request”

  • “drafting a new list”.

Of the 83 Dentists who did not display prices, 42 (51%) did not offer a reason for doing so.



4.2Cost of Routine Procedures


Results in this section pertain to both Dentists who display prices and those that do not, but who were willing to give prices when asked by the NCA staff member conducting the survey. All but 15 Dentists were willing to supply at least some price information. Not all Dentists gave prices for each of the three services included in the survey. It is worth noting that some Dentists advised that they now display prices on their websites, which is particularly helpful for consumers wishing to shop around, however as per statements from Doctors that they make prices available on their websites, it is also important for consumers to have easy access to price information on the practitioners premises.
Figure 4 presents the results of the survey in relation to the fee charged for a routine examination, showing:

  • the average price charged overall

  • the range of prices overall

  • the average price charged for each of the 11 areas surveyed

  • the range of prices for each of the 11 areas surveyed.




  1. Cost of a Routine Examination


The main points are that

  • nationally, the average price for an examination was €44

  • the range is significant, from free to €86 (Dublin City South)

  • the highest average price (€52) was recorded in Dublin City South and Galway City

  • the lowest average price was found in Ennis/Gort/Loughrea area (€36)

  • a free examination was available from 7 Dentists in 6 locations.

Note that in Ballsbridge/Sandymount area only one Dentist provided a price for a routine examination, therefore the range is zero.

The cost of a scale and polish is illustrated in Figure 5.


  1. Cost of a Scale and Polish




  • nationally, the average price for a scale and polish was €61

  • the national or overall maximum was €90 and the national or overall minimum €25

  • the highest average was recorded in Tralee/Killarney (€75)

  • the highest recorded charge (€90) was surveyed in two locations, Tralee/Killarney and in Dublin City South

  • the lowest price (€25) for a scale and polish was found in Dundalk/Drogheda

  • Dublin City South, Cork City and Ennis/Gort/Loughrea all recorded the largest difference between the highest and lowest price, a difference between highest and lowest of €50.

Figure 6 presents the results relating to the cost of a simple extraction.




  1. Cost of a Simple Extraction




  • the national average price for a simple extraction was €82

  • the national/overall maximum price for a simple extraction was €150 and the minimum was €40

  • the highest average price was recorded in Dublin City South (€99)

  • the lowest average price for a simple extraction (€65) was recorded in Dundalk/Drogheda

  • the highest charge for this service, €150, was recorded in Dublin City South

  • the lowest price, €40, for an extraction was found in Cork City

  • Dublin City South recorded the largest difference between the highest and lowest prices for a simple extraction, €85.

Finally, figure 7 presents the charge for a combined examination and scale and polish. This was not part of the original questionnaire but has been included as a proportion of Dentists volunteered these prices. Note that some other Dentists in the survey may also offer a combined fee for an examination/scale and polish but Dentists were not specifically asked this question.




  1. Combined Examination / Scale and Polish




  • The national/overall price for a combined examination and a scale and polish was €76

  • the national/overall maximum price recorded for a combined examination and a scale and polish was €110 in Ballsbridge/Sandymount and the minimum, €50, was recorded in Dundalk/Drogheda

  • the highest average price for a combined examination, scale& polish was recorded in Ballsbridge/Sandymount (€90)

  • the lowest average price for this service (€66) was recorded in Waterford City.

  • The largest difference between maximum and minimum (€40) was recorded in Ballsbridge/Sandymount

Note that none of the Dentists surveyed in Tralee/Killarney gave a combined price for an examination and scale and polish.


5Key Findings


  • Overall 50% of the Doctors surveyed display their prices




  • The level of price display varies greatly across the areas surveyed. 80% of Doctors surveyed display prices in the Tallaght/Walkinstown area; 22% in the Cork City area




  • The overall/national average price for a routine examination/consultation for a GP was €51, prices recorded nationally ranged from €35 to €70




  • Overall, 32% of the Dentists surveyed display their prices




  • The level of Dentist price display varies greatly across the areas surveyed. 54% of Dentists displayed prices in the Waterford City area; 9% in the Cork City area




  • The overall/national average price surveyed for a routine examination by a Dentist was €44, the range of prices recorded varied from free/no charge applicable to €86




  • The overall/national average price surveyed for a scale and polish was €61. The minimum overall price recorded for this service was €25. The highest price recorded was €90




  • The overall/national average price for a simple extraction was €82, the range of prices recorded varied from €40 to €150




  • The average price recorded for a combined examination and scale & polish was €76.

Appendix 1 GP Questionnaire


Questionnaire for GP Survey - Spring 2010

Survey Carried Out By:

 

Date of Survey:


 

Name of Practice (if applicable)

 

Name(s) of Doctor(s) (Note: If there is more than one Doctor at this practice/location list all the Doctors in the practice/location providing they are charging the same fees and have same status re price displays. If the Doctors at the practice/location charge different fees and have different status re price displays then use a separate questionnaire sheet for each Doctor where different.)

 

 

 

 

Address

 

Q.1 Are Prices Displayed? (Yes/No)

 

 

 

 

If Yes, where

 

 

If No, why not (any reason given)

 

Q.2a Routine Consultation Fee (€) - Adult

 

 

 

Q.2b Routine Consultation Fee (€) - Child

 

 

 

 

Maximum Age allowed for child fee

 

Additional Comments

 







Note: The fees to be recorded relate to the fees charged in relation to private patients.


Appendix 2 Dentist Questionnaire


Questionnaire for Dentist Survey - Spring 2010

Survey Carried Out By:

 

Date of Survey:


 

Name of Practice (if applicable)

 

Name(s) of Dentist(s) (Note: If there is more than one Dentist at this practice/location list all the Dentists in the practice/location providing they are charging the same fees and have same status re price displays. If the dentists at the practice/location charge different fees and have different status re price displays then use a separate questionnaire sheet for each Dentist where different.)

 

 

 

 

 

Address

 

Q.1 Are Prices Displayed? (Yes/No)

 

 

 

 

If Yes, where

 

 

If No, why not (any reason given)

 

Q.2 Examination Fee (€)

 

 

 

Q.3 Scale & Polish Fee (€)

 

 

 

Q.4 Simple Extraction Fee (€)

 

 

Additional Comments

 

Note: The fees to be recorded relate to the fees charged in relation to private patients and not in relation to the PRSI Scheme or medical cardholders.




1 Central Statistics Office, Census 2006 www.cso.ie/census

2 Under this scheme, individuals with appropriate PRSI contributions are entitled to one free dental examination a year. Private dentists who are on a Department of Social and Family Affairs’ panel provide the examination.



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