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Bartering For Health Care: Yardwork For Treatment

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Deb Barth is raking leaves for Lesley Jones. But Barth isn't earning money for her yardwork, at least not in physical currency. She's earning "time dollars" — for every two hours she spends doing odd jobs, she'll earn a free visit with her doctor.

As a struggling artist, Barth's income qualifies her for the program at True North, a nonprofit health care clinic in Falmouth, Maine. She's one of 33 patients who pay with time dollars there.

"I do things like deep cleaning, organizing," Barth says. "I also offer caregiver support for people who may be caring for an older parent."

So how does her doctor cash in these time credits? By getting free services from any of the other hundreds of people who belong to The Portland Hour Exchange Program.

Tom Dahlborg, the executive director of True North, used to work in Medicaid, where he thought the patients weren't getting enough from their health care.

"People would come in for care and they would be like, 'OK, give me what you can, that's fine,' and they really weren't engaged in it," Dahlborg says. "It was almost like a guilt, like, 'Oh, it's free care, so I don't really deserve that much anyways.' "

But he says patients at True North who pay with time dollars are fully engaged.

"We'll hear from a landscaper [who] will say, 'I mowed five lawns in the last month so I could bring my children in to see your pediatric nurse practitioner. This darn well better be a good visit,' " Dahlborg says.

They certainly get a lengthy visit. Patients are allowed to spend up to an hour or more with their doctors.

"They're developing empathy and trust together, which by the way is in the Hippocratic oath, however most people see that as woo-woo stuff," he says.

"They don't just want to get just medical information from you, they want to get a spiritual background," Barth says. "It's not like, OK, what's your religion? But it's, 'OK, what does your life look like?' And as a result, I've learned how to negotiate my own health, which has been a huge value."

There's another reason why doctors here think that time-banking works well for low-income patients: no red tape.

Therapist Jennifer Lunden has worked with True North and MaineCare, the state's Medicaid program.

"That's actually not even a small deal," says Lunden. "For me, the biggest burden of taking especially MaineCare is the amount of paperwork and the amount of hoops that need to be jumped through. And I really love that I have a way that I can offer what I do to people who don't have any insurance or are underinsured."

But they can't meet all the needs of their patients. Barth doesn't have health insurance. If she goes to an emergency room or needs to see a specialist who isn't affiliated with True North, she's paying out of pocket. And if her income goes up, she won't be able to use time dollars at True North any longer.

But according to Dahlborg, the biggest problem isn't finding patients who want to take part in the program — it's finding doctors who are willing to go outside the system and barter for health care.

"It's still very difficult from a pragmatic perspective to go from a guaranteed salary where insurance is driving business to you," Dahlborg says. "It's also scary for younger physicians who still have debt load from their education."

The folks at True North know their model is very limited. But they still hope to inspire other health care clinics to consider alternative means of payment.

Copyright 2011 National Public Radio. To see more, visit


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