Tuesday, February 15, 2011

On dentists and dentistry

In Fubarnomics and Broken Buildings, Busted Budgets, I* show how we need to move toward fixed cost contracts if we ever want productivity in construction to improve. No more of this "I bid $3 [thousand, million, billion] but because of X, Y, Z [usually total b.s.] I need you to pay me $6 [thousand ...]" crap!

So when a local dentist advertised a price guarantee, I decided to check it out. That's when I confronted another problem, one of asymmetric information. The dentist said that I needed a filling in one of my molars. That's plausible -- I only brush, floss, and use mouthwash 4x a day, have missed only 1 cleaning in the last decade, and had only 3 small cavities as a child -- but the diagnosis rather took me by surprise. As advertised, the dentist gave me a firm quotation on the proposed work but while driving home from the appointment I heard another local commercial, this one by an auto mechanic who was making fun of mechanics who screw customers by coming up with screwy car ailments. Pretty funny: something about a muffler belt and a flux capacitor, the latter of which I am pretty sure is found only in certain time traveling cars. In any event, I thought what a nice racket this could be: appear to be a "good guy" by offering a firm quotation but do it on unnecessary work! Then an RDH friend of mine confirmed the validity (though of course not the veracity) of my fears.

So I've been musing about how to fix this problem and came to the following solution: instead of relying on "trust," as the dentist and the auto mechanic in question claimed I should, couldn't we devise a system where dentists, auto mechanics, and any other line of business where asymmetric information is heavy anonymously check each other's work? Say all dentists, or at least the ones that want to signal their quality, agree to review each others' diagnoses. (One for every patient of theirs reviewed by someone else in the group.) Upload the X-rays (c'mon, you should all be digital by now ... and if not, buy a scanner!) to a system that would randomly send them to another dentist in the region (or time zone) for review. Lacking any incentive to lie, the provider of the second opinion would be much more "trustworthy" than the first. The ADA or other association could spot check the diagnoses to keep everyone on the up and up and provide a third opinion in cases where the first two disagree.

The same could be done for automobile repair, I suspect, by creating short videos of the car experiencing problems when running, taking pics of the part(s) in doubt, etc. (And then give a firm price quotation, of course.)

Yes, these procedures would consume resources but they would probably pay for themselves with an increased volume of overall business as people learned that even though they can't trust their local service provider they can trust the second opinion system of which they are a part. For now, I'm leaving my tooth untreated and leaving the "check engine" light in my Saturn on for at least another month.

*And my co-authors on BBBB of course.

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