Kaiser Health News Reports On Bartering for Health Care
By Rochelle Sharpe
(This article shows the valuable health care services trade
exchanges offer their clients.)
With no health insurance and little money, Gilberto Carrasco, a Reno
(NV) auto mechanic, didn't see much point in getting a physical. At
50, he felt healthy and couldn�t afford treatment even if a doctor
found a medical problem.
But then his girlfriend, Eren Hernandez, figured out a way to get
Carrasco a free checkup. She found a family physician who was
willing to barter his services. During the physical, the doctor
discovered that Carrasco had prostate cancer, catching it before the
disease had spread. �We couldn�t have afforded Carrasco�s
examination,� said Hernandez, who also uses bartering to get
extensive medical and dental care for other family members.
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 Zimmelman, 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%. 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
products and services. 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.
Many of these exchanges are designed for small business owners
seeking to conserve cash. �Nearly 400,000 businesses participate in
about 500 trade exchanges in the United States,� reported Ron
Whitney, executive director of the International Reciprocal Trade
Association, which promotes the barter industry.
In Carrasco�s case, he used barter dollars to buy the services of
Quinn Pauly, a 44-year-old family physician who joined the barter
network six years ago to expand his practice. Like most doctors who
participate in exchanges, he accepts barter dollars only for his
services, not for lab tests or hospital expenses. Pauly said he
prefers being paid in cash, and now has plenty of paying patients.
But he continues to participate in the trade exchange. �I wasn�t
going to fire my patients who see me with barter,� he explained.
Debbie Lombardi, president of Barter Business Unlimited in Bristol (CN),
said she's fielding about 20 calls a day from members seeking
medical help, compared to just occasional calls in past years.
During the past six months, she pointed our that nearly every person
wanting to join her group has been looking for health care. One man
recently brought his Harley Davidson to Lombardi�s office, hoping to
trade it for orthodontia treatment for his daughter.
�People want to keep their standard of care up, even if they can�t
afford it,� she noted; adding that she has helped people get dental
implants, Lasik surgery, even the services of an obstetrician to
deliver twins. �In some cases, we�re their only health insurance.�
�In North Carolina, one woman bartered for more than $200,000 of
medical care in hopes of finding a cure for her fibromyalgia,� said
Maurya Lane, president of the Barter Business Exchange Inc., in
Cary. �At one point,� Lane said, �the woman gave her chiropractor a
$10,000 laser, which he then used to treat her.�
One of the doctor�s in Lane�s group is Ellen Gray, a psychiatrist in
Chapel Hill, who like many physicians joined the local barter
exchange to get more business referrals. But now, she feels she�s
doing her part �to expand access to therapy both for people who
don�t have insurance as well as for those who don�t want their
insurance companies to know they are struggling with mental-health
issues. Plus, I just like the idea that people are taking matters
into their own hands,� she said.
Many doctors, including Gray, will participate only in indirect
barter (trade exchanges), which typically charge members 6% fees on
all purchases and sales. She thinks direct barter violates medical
ethics because doctor-patient relationships should focus only on
healing. She said she would never want a patient who had cleaned her
carpets to think he was getting substandard care because the carpets
still looked dirty.
The American Medical Association has no specific policy on
bartering, but supports doctors� freedom to choose how they want to
be paid, a spokesman said. The government only bars doctors from
bartering for more than the cash value of their services from
Medicare, the federal program for the elderly, and Medicaid, the
state-federal program for the poor and disabled. Anyone who barters
more than $600 in goods and services a year must pay taxes on the
Direct bartering is conducted mostly on Web sites. A dentist in
Washington (DC), used Craigslist this past winter to offer his
services in exchange for tickets to President Barack Obama�s
inauguration. This spring, Peter Fountain, 50, of East Norton (PA),
posted a plea on Craigslist for a surgeon to remove a cataract. �I
will paint your house, refinish your antiques, anything in the
general maintenance field,� he wrote. �I need to regain my vision in
order to provide my employer with the skills I have.�
Fountain, who works as a maintenance superintendent at the Western
Union building in Philadelphia, said no one has responded. �I
figured a lot of people considered it a joke,� he said.
Last fall, Zeo Solomon helped launch a new direct-barter Web site
called Favorpals which has already had several successful health
care exchanges. A dermatologist did a checkup in exchange for having
his office cleaned; a psychiatrist saw someone a few times in
exchange for help on a Web site design, and a family doctor
conducted a physical in exchange for pastries from a famous New York
bakery. �More than 20% of the 10,000 people who joined the barter
site were seeking or offering health care,� Solomon said.
Direct barter appears to be most common in rural areas and in the
South. In Cambridge (VT), Deb Richter, a primary-care doctor, said
that she and her colleagues only barter with a few patients at any
given time, and that what they receive in trade rarely comes close
to compensating them for their work. �This is our way to make life a
little nicer and increase community spirit,� said Richter, whose
medical practice is the only one in a 25-mile radius. She has
received vegetables, cords of wood and lots of pies in trade for
medical services. She has also swapped Viagra samples for maple
Strengthening communities is the focus of another kind of exchange
system, called time banking, developed in 1980 by Edgar Cahn, a law
professor at the University of the District of Columbia law school.
In these groups, people trade their time rather than the
cash-equivalent of goods or services. With everyone's time
considered of equal value, one hour of medical care is equivalent to
one hour of painting.
Dozens of time banks operate across the country, with many offering
extensive health-related services, ranging from exercise classes to
medical appointments to help getting to the doctor. At Hour Exchange
in Portland, Maine, which has 171 medical practitioners, more than
one-fourth of the 20,000 hours that were exchanged last year related
to health care, according to member Lesley Jones.
few hospitals, meanwhile, have devised exchange programs of their
own. At Woodhull Hospital in Brooklyn, artists without health
insurance earn credits toward free care if they perform or work with
patients and staff. More than 400 people, including former Broadway
actors, have participated in Artist Access since it began in 2005,
painting murals on walls, drawing with sick children, and coaching
medical residents on breaking bad news to patients.
At Franklin Memorial Hospital in Farmington, Maine, indigent
patients can work off their bills by doing volunteer work. If the
patients are too ill, friends or relatives can do the volunteer work
for them. Valerie Taylor, 67, tried to pay off her $13,000 bill for
colon surgery a few years ago. But, because she had to retire early
due to health problems, she could only pay the hospital $50 a month.
She joined the hospital�s Contract for Care program, performing
about 300 hours of administrative chores over the course of a year
and worked off her bill. �People do want to pay their own way, and
sometimes circumstances prevent that,� she said.