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Up Front | Jun 2008

You Get What You Pay For

Premium vision correction—interesting terminology. All providers feel, I am sure, that they are premium centers, as they believe in their product. Each provider claims to have the best technology, best surgeons, and best medical directors. If this is true, what makes each center different? What is it that is premium? How much of an issue is price?

In reality, the differential in refractive surgery prices between providers is not huge. For instance, the average price for LASIK in the United Kingdom can be viewed online at www.lasik-eyes.co.uk, a laser vision correction portal and patient advocacy Web site. Bait and switch, or advertising with a low entry price, has become more commonplace. In my opinion, this strategy is poor practice and borders on misrepresentation. What I physically do during LASIK surgery on a -1.00 D spherical myope is identical to a -8.00 D patient with astigmatism, so why would I alter my price? Enhancements in my practice are typically a result of regression. Interestingly in our own practice, there is no difference in enhancement rates between high and low myopes, which defeats the argument that higher corrections require more care.

Consider added-value cataract surgery or refractive lensectomy: Do we charge more based on refractive correction? No. The only exception is astigmatism, where an additional procedure (eg, limbal relaxing incisions) might be required or because a more expensive toric IOL is used, the cost of which is passed on to the patient. As all accountants will tell you, cutting prices means having to do vastly more work to maintain the same absolute profit. This is an important lesson for all ophthalmologists in business!

From my perspective, the debate at hand is not about premium centers versus others, but rather corporate ophthalmology (Big Ophtha) versus practitioner-owned institutions that provide personalized services. The country-specific review in this issue of CRST Europe makes interesting reading and demonstrates the diversity of care provision based on a variety of issues, including legislation, culture, and the ability or inability to advertise.

Corporate ophthalmology adds to diversity; I do believe it has the ability to provide premium care. Big Ophtha certainly has the resources to acquire technology and in competition other providers tends to focus on pricing. Entering a price war means becoming leaner to maintain profits; however, the presence of Big Ophtha and its huge advertising budget serves to increase consumer awareness—benefiting others in the marketplace, including smaller practitioner-owned centers. Big Ophtha's business models are far more sensitive to the economy, which is likely to be a major issue in the near future with the ever-worsening credit crisis.

A catalog of one product is also a risk. Many centers are now branching out into intraocular surgery, a growth area that is considerably less forgiving and poses a higher risk. The United States has, from my observation, gone through the evolutionary process that we in the United Kingdom are now experiencing, and it is interesting that US practitioner-owned organizations provide vision correction more frequently than they did in the past. This same trend will probably happen in the United Kingdom, but it will take us longer to get there. Unlike in the United States, UK ophthalmologists salaried by the National Health Service are not wholly dependent on private practice; therefore they are not used to investing in technology and facilities. This is slowly changing, and perhaps as jobs get more competitive there will be a commensurate increase in ophthalmologist-entrepreneurs.

Patients make choices on a variety of factors, and price is only one driver. From my personal experience, many consumers resent the sales pitch that baits them with price. Just as there are a variety of providers, patients vary in terms of what they want. I am happy to look after the group of patients who do not wish to take any chances with their eyes and differentiate by seeking out highly personalized care. These patients are happy to pay the price. Ultimately, you get what you pay for.