THE EVOLUTION OF PAYMENT BY KIRK
SWEIGARD
by Kirk Sweigard
Reprinted with permission from Dentaltown Magazine, Dentaltown.com
Recently, I was listening to an “oldies”
station that plays hits from the 1970s and
’80s when Cyndi Lauper’s song “Money
Changes Everything” came on. The song
made me think about how money itself has
changed over the years and how it has
changed people’s purchasing behavior, even
when it comes to dentistry.
The practice of dentistry was first
documented in 2600 B.C. By 500–
300?B.C., elite thinkers such as
Hippocrates and Aristotle wrote about
dentistry, including the eruption pattern of
teeth, treating decayed teeth and gum
disease, extracting teeth with forceps, and
using wires to stabilize loose teeth and
fractured jaws.
In those ancient times, when it came time
for people to pay, we’re fairly certain they
didn’t have insurance to contribute to the
cost of care, or the ability to pull out a
piece of plastic and say, “Charge it.”
Happily, the profession of dentistry and the
way people pay have evolved.
EARLY HISTORY: FROM BARTERING TO
PERSONAL LOANS
Over the centuries, not only has the
practice of dentistry evolved but the way
people pay for treatment has, too. In fact,
the way people pay for all types of goods
and services has evolved, although “money”
has been a part of human history for almost
3,000 years. Bartering was one of the first
ways humans exchanged goods and
services. In 600 B.C., King Alyattes created
the first known currency in order to
facilitate trade. From there, coins have
evolved into bank notes, personal loans,
bank loans and “e-money” provided via
telegram through Western Union.
Although every step in the evolution of
money greatly affected commerce, the idea
of credit—loans made by banks and
businesses—may have been one of the most
important, because it became how people
bought bigger-ticket items such as houses,
cars and furniture. Credit also made these
items accessible to mass consumers who
might not have been able to purchase them
if “paid in full in cash” had been the only
payment option. This precursor to credit
cards has been used by retailers for
decades; think of your hometown
restaurant where you ordered “the usual”
and had them “put it on your tab,” which
was settled, typically, at the end of the
month.
In 1946, personal credit evolved into the
first bank-issued “charge-it” credit card.
John C. Biggins, who worked for the
Flatbush National Bank in Brooklyn, New
York, came up with an idea that would help
local stores give bank patrons a new way to
pay for purchases, effectively taking store
merchants out of the banking business.
The first universal credit card to be used at
a variety of establishments, Diners’ Club,
was introduced in 1950 by Fred
McNamara. A few years later, in 1958, the
American Express travel and entertainment
card was introduced. Others followed,
including Visa and Mastercard, and are
widely accepted at all types of businesses.
THE EVOLUTION OF MONEY IN
DENTISTRY
Possibly because of the personal
relationships that exist between dentists
and their patients, the adoption of credit
cards was slower at dental practices than at
department stores. This could also be why
some dentists even today provide “personal
loans” to patients by billing them at the
end of the month. In the past, allowing
patients to pay a little to the practice each
month was especially important for higher-
cost treatment, such as orthodontics. It was
common practice for orthodontists to bill
patients monthly, timing full payment with
completion of treatment, so that the
incentive to pay was removed at the same
time the braces were.
As the way people pay evolved, so did
dentistry. Dental implants came about in
the 1960s and, similar to orthodontics,
their cost was higher than that of most
general dental procedures. But unlike
orthodontics, implants took less than two
weeks to complete and required upfront lab
fees, which were paid by the dentist.4
Billing patients over time for this
procedure would put dentists in the
position of managing negative cash flow,
collections and bad debt.
In 1987, CareCredit was introduced
specifically to give patients another way to
pay for implant cases. Paying with a health
care credit card was more convenient and
helped patients fit dentistry into their
budgets, and by this time, people were used
to paying for larger purchases with
monthly installments. As the cost of care
increased while dental benefits remained
mostly unchanged, even more patients
found themselves with unplanned out-of-
pocket dental expenses and often hesitated
to accept treatment as a result.
Today, most dentists accept health care
credit cards, which often offer unique and
valuable benefits that general-purpose
credit cards may not, such as promotional
financing and practice support. Dentists
have found that if they present the cost of
care along with a monthly payment, it
often makes dentistry more accessible by
increasing patients’ purchasing power—
and in some cases, their trust. My own
dentist has earned my trust over the years
partly because he is upfront with
information, including payment options. I
knew when I walked in the door what was
available to me, so cost was not a barrier to
treatment. You may find that including all
payment options—on your website, on
social media and in your marketing—can
help patients overcome cost concerns and
begin to build trust.
So, what’s next? A recent study found that
we are moving toward a cashless society
and the way people will primarily pay
businesses and each other will be through
contactless cards and mobile phone digital
wallets. In fact, the study found 34 percent
of people in the United States rarely use
hard-currency dollars and cents, and 38
percent would be willing to go cash-free.
At the same time, a few businesses across
the country are eliminating cash and checks
as payment options.
Ultimately, when it comes to a way to pay
today—whether it’s by paper, plastic or
digital—giving patients options so they can
choose what works best for them can help
increase treatment acceptance. 䡲
Los Angeles Dental Society Explorer