An Old Tradition Solves A Current Crisis

By Ann Blackman/Farmington, Maine

A man's word, or a woman's, goes a long way in the pine-scented foothills of western Maine. In the rugged community of Farmington, pop. 7,400, where logging and farming provide seasonal work and unemployment is twice the national average, pride runs deep. A handshake binds a contract almost as often as a signature. So when a local writer walked unannounced into the office of Franklin Memorial Hospital president Richard Batt to explain that he could not pay for his son's hospitalization, Batt wanted to help the man meet his obligation honorably. After agreeing to adjust the bill, Batt asked--in an afterthought really--if the writer would help rework the hospital's brochures. "It was a transforming experience," Batt says. "This man arrived in tears and left feeling good that he could help us."

The incident got Batt thinking: How could his small, 70-bed community hospital offer low-income patients a way to pay for the rising cost of health care? Could they trade their skills for medical treatment? After all, barter may have fallen on hard times, but it's an American tradition: for decades people exchanged services for goods, not dollars. A country doctor's fee might be a bushel of potatoes or a freshly baked pie.

Batt tried out his idea on colleagues. Many were dubious. But hospital board chairman Darryl Brown, son of a Maine dirt farmer who cut brush on the county road to pay his property taxes, weighed in with his opinion. They would try it.

The first patient to benefit from the pilot program was Della O'Leary, 60, a part-time receptionist with no health insurance and an $8,000 bill for gallbladder surgery. Would she be interested in using her keyboard skills to enter data into a hospital computer? O'Leary agreed. After she worked 20 hours a week for four months, her debt was paid. "I was brought up to take care of my bills," O'Leary says. "Without this program, I was going to be paying little by little for the rest of my life."

Alisa and Christopher Everett faced a $14,000-plus bill following the birth last August of their son Alston. The pregnancy, complicated by Alisa's diabetes, had required numerous medical tests. And while Everett, 37, a $26,000-a-year mechanic in a local woolen mill, has health insurance, he was still responsible for almost $3,000 in unreimbursed expenses. The hospital's solution: to pay half the bill, Everett agreed to sand, repaint and refurbish hospital lawn chairs; Alisa is assembling a hospital photo album of doctors, staff and equipment to explain medical care to children who become patients. "I used to be ashamed to go to the post office and get all those hospital bills," Alisa says. "But when you give back a little something, you feel better about yourself."

Encouraged, the hospital last May formally launched Contract for Care, a program aimed at individuals who fall just above the federal poverty level--$1,138 a month for a family of three. So far, a dozen patients have enrolled. Nancy Cameron Dickinson, 49, whose family income was less than $16,000 last year, weeded the hospital's garden beds and helped with landscaping to pay $800 she owed after Fallopian-tube surgery. Scott Smith, 29, an uninsured ski instructor, painted the ambulance bays to pay the $5,300 surgical bill he incurred after breaking his leg in a ski accident. A local florist is working off $275 she owed for a colonoscopy by providing a bouquet for the lobby each week. A 39-year-old housewife whose family racked up more than $2,000 in family emergency-room visits paid her final $220 by donating a handmade baby quilt.

Dr. David Dixon, a surgeon in Farmington, thinks the program will encourage more people to seek medical help before they need acute care. "This is a fee-for-service with a different currency," he says. "Hospitals tend to concentrate on patients inside the building and not accept responsibility for the wellness of the entire community."

Maine attorneys and advocates for the poor have reacted skeptically to the program. Christopher St. John, executive director of the Maine Center for Economic Policy, says asking poor working families to take on another job is an imposition. "These families need every ounce of their effort to pay for rent and food," he says. "An extra job could be the straw that breaks the camel's back." Others fear that if the IRS rules the labor is revenue, some people may lose some of their Medicaid, food stamps or earned-income tax credit. To avoid that problem, hospital attorneys insisted that the program be voluntary. No money changes hands. A task not completed is the hospital's loss.

Would the program work elsewhere? "It can work anywhere," says Batt, who came to the region from Denver, where he ran a 565-bed hospital. "It's a way to help patients help themselves." O'Leary puts it this way: "It gives you a good feeling that you aren't a charity case."