News/Commentary

Every time I felt as if the health care reimbursement system was broken beyond repair in the 1990s, I would grumble to my colleagues, “I swear the day will come when we are back to patients paying doctors in chickens.”

That day is now. Sort of.

Fewer people raise chickens for their families. More people are bartering for their health care. A good example of a service doctors will accept in lieu of payment would be car repairs.

Where I grew up in the Arkansas Delta, our doctor took the chickens.

People shared tomatoes or green beans from their small gardens in their back yards, if they had them, anyway.  The patients who paid him in food were told to slip in his back door to deposit their payments in his private office. They came bearing their treasures—-yes, sometimes chickens. In addition to the chickens,  he received fresh peaches, which he adored, or pie, cake and home-made rolls.

That was his way of caring for the patients who could not pay. I never knew how many of them there were. Between the tradition of sharing extra with neighbors and friends and those who were paying with food,  you could not tell who was giving and who was bartering. A peach is a peach just as a $1 bill is a $1 bill.

That is exactly how he wanted it.

Of course, in small towns, everyone knew who had trouble paying their bills. To our doctor, this was his way of preserving the dignity of people he would have taken care of for free anyway. Doctors did that back then. He told me that letting them pay what they could meant that they would come see him when they needed to. They could pay in the only way they could,  but they could pay him something he valued.

So, he ate well.  His wife loved to read. She did not love to cook. This worked out well for everyone.

The bartering for care, then, is not new, and is not yet on any scale that suggests a Chickens  Health Care Reimbursement System is emerging.

However, in the story below, a network of barter exchanges reports demand for health care has jumped by more than 20 percent. To date, the company has 551 doctors and 618 dentists who are in its current 100 groups. These numbers do not include one-to-one bartering, which is common even in good times. It is not possible to estimate how much bartering is going on, but it is growing.

I know a big-name physician who treats a difficult, chronic disease. He has a patient whose art sells but the man always is cash-strapped. This specialist takes this man’s art in payment for his care, which takes a lot of time. Both men are more that satisfied with the art-for-care plan. My doctor friend  gets to choose what he wants, of course. He also says, “I’d take care of him anyway. He knows that. This man would have no life if I didn’t. Still, we both like it like this. He feels as if he is paying in the way he can. I am delighted to have his work.”

This deal was made by a big city doctor in the 2000s, not one in a rural area in the 1950s.

Some things don’t change. They may go out of sight when no one needs them, only to return when they do.

Barter for medical care seems to be one of them. This recession has brought it back.

Kaiser Health News

“With the economy in recession and many people strapped for cash, bartering of various kinds has increased. But now health care is surpassing auto repair and advertising as the service in most demand, say people who run local barter exchanges. Alan Zimmerman, a spokesman for ITEX Corporation, the largest network of barter exchanges in North America, says in the past two years the demand for health care has jumped by more than 20 percent. The company has 551 physicians and 618 dentists who participate in its 100 local barter groups.

“Barter is little more than a stopgap solution for the uninsured. But with doctors, dentists, psychiatrists, chiropractors and even cosmetic surgeons offering their services, bartering is providing a temporary safety net of sorts for some workers who have lost their jobs and health coverage. And in some cases, people who have inadequate insurance are using barter to get critical services, such as dental and vision benefits.

“There are two main types of bartering: direct and indirect. In the former, people engage in direct trades of goods and services without using money. In the latter, small-business owners and individuals accumulate credits, or barter dollars, by providing specific services ranging from painting a porch to putting on a dance performance. Those barter dollars can be used to buy the services of any other network member. That way, a barber with a toothache can barter for dental work, without having to find a dentist who wants a haircut.”

The story reports that indirect bartering works something like this. People pay in time, which members of a barter network can deposit or draw on.

Source: Kaiser Health News, June 17, 2009