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Unusual arrangement: Bartering for health care

High unemployment and the struggling economy has made it more difficult for Americans to get the health care they need. According to studies the number of uninsured adults reached an estimated 52 million last year, and 49 million Americans between the ages of 19 and 64 reported they did not seek medical treatment in 2010 because of cost-related access problems.

As Erica Hill reports, to help make health care more accessible, a medical center in Maine is offering a different payment plan: bartering for treatment.

Debra Barth spends time cleaning a local theater and its grounds. It's time she'll eventually trade for medical care.

"I never imagined I'd be going to the doctor and paying them by raking leaves at someone else's house," she said.

For nearly a decade, True North Medical Center In Falmouth, Maine, has been offering its patients the option of paying with their time - part of its goal to make care accessible to everyone.

For each hour of service patients offer to the community, like Debra's afternoon cleaning at the theater, they earn an hour time credit, which they bank with the "Hour Exchange Portland."

Members of the exchange then use those hours to barter for different services in the community. At True North, two time credit hours equal one doctor visit.

"It's a really brilliant concept," True North's medical director, Dr. Bethany Hays, said. "There is an added benefit, besides just being able to get care. Using time credits actually helps our patients to see themselves differently, to see themselves as human beings with valued and valuable skills and services to offer."

Barth agrees: "It's an empowering model versus feeling ashamed. It's not just me going to the hospital and saying 'I can't afford to pay, I need free care."

Doctors and patients don't directly barter - both must belong to the exchange. It's up to the physicians how they use the time credits they receive as payment.

"I've had people come in and fix my radiators in my house. I've had some house-cleaning work done, and things of that nature. I think it's kind of a neat collaboration," True North's associate medical director, Dr. Peter Knight, explained.

"You're creating a community where people believe time is just as valuable as cash, and you're working with people who feel like it's important to give back," Barth said.

While the community building is undeniable, it's not the only benefit: Both doctors and patients say the accessibility is good for their health.

"I find that when patients are somewhat invested in their health care, they tend to respond better," Dr. Knight said.

"I would've stopped seeking care even though I may have needed it because financially it became more and more of a burden," Barth said.

Today, Barth says she is healthier and, in many ways, so is her community. "The exchanges I've made with people, no matter what they are, if it's raking leaves or helping organize, there's this feeling of camaraderie," she said.

At True North, 10 percent of the patients belong to the hour exchange program and pay for their health care with time credits. To qualify for the program at True North a patient must be within 225 percent of the poverty level.

Related reading: AMA article on adults going without medical care due to costs

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