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A Creative Solution to an Access Problem

Discussion in 'Topics in Healthcare' started by MollyMalone, Dec 1, 2005.

  1. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    From MSNBC (link ):

    Connection to pre-allo? It's a neat thing to talk about in interviews!
     
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  3. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    Awesome idea! My dad is a GP who has been practicing for 40 years. When he first started, he used to make house calls, do surgery, deliver babies, everything. Some of his patients did not have money to pay him, so they'd give him eggs, vegetables, etc. in exchange for medical care. Nowadays one couldn't imagine bartering with his/her physician, but it's cool that this hospital is doing it. :cool:
     
  4. CuddlyKumquat

    CuddlyKumquat simply scrumpcious
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    this might be one of the coolest things I've heard about in a while. Both my parents are artists, so im a bit biased. :laugh:
     
  5. doctorFred

    doctorFred intensive carer
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    that really is an amazing and innovative program.
     
  6. jebus

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    My aunt runs an indigent clinic in New Delhi and she still does this sort of thing, mostly because her patients have too much pride to take anything for free. She gets all of her clothes washed and pressed by some of her patients, too.
     
  7. chef_NU

    chef_NU G-Unit
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    Creative? Yes. Compassionate? Yes. Practical? No. The headline should simply read "hospital gives charity dollars to specific, arbitrary group". If the services of said artists were actually valuable, they wouldn't be in the economic hardship that brought them to such a situation.
     
  8. riceman04

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    my dad still kind of does it. He runs a private practice in an underserved community in Los Angeles. With the incr. cost of healthcare (especially for the elderly...and they make up his patient base) many of his patients have had to drop their coverage. But when they get sick it is imperative that they still see the doctor especially b/c of their age. So sometimes, he has patients who make baked goods for him (he has a serious sweet tooth...I think he is making up for all that time growing up when his family could only afford to get the good desserts on holidays). Others know people who can do maintenance on the house for free.
     
  9. odrade1

    odrade1 UASOM alum
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    Bartering isn't charity. It is a form of economic exchange. Also, the artists' contributions DO have a value: they are helping patients heal. (At least according to the physicians treating those patients & the director of that hospital).

    This is a great thing: it expands healthcare availability to a group that had little or no access before (the artisits), and it benefits the hospital as well as the patients who work with the artists.
    How does the fact that someone is poor--from working in a badly paid field, such as art, or even not working at all--affect the fact that they are suffering and have a need for healthcare?
     
  10. spot the cat

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    There's a doctor in my area who has a PA who is a musician...and the PA seems to know everyone in the music scene within a 50 mile radius. They have been really good about getting other musicians in to see them, and at a reduced rate.

    The doctor also works with the migrant workers who are here to work on farms and orchards.
     
  11. Apparition

    Apparition 1K Member
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    Cool idea but how would that apply to about 99.9999% people who aren't of much use to a hospital?
     
  12. little_late_MD

    little_late_MD Ready To Jump
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    lol, when I saw this thread title I thought it was about MS Access, the Microsoft Database program. I spend way too much time in front of a computer.
     
  13. Saluki

    Saluki 1K Member
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    Anyone ever watch Doc Hollywood, where he gets a pig in exchange for his services... It's a favorite movie for me, because I'm from Grady, AR (the movie features Grady, SC which is actually bigger than my town- ha!)
     
  14. Ranger47

    Ranger47 Doctor G
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    My mom is a voice teacher and has been exchanging lessons for dental care for years.
     
  15. almost_there

    almost_there Senior Member
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    Nope. I used to think that way, but I realized that this was too idealistic for the real world. NOT ALL MUTUALLY BENEFICIAL EXCHANGES OCCUR. Consider this example:

    Many times, we hear "time is money", and value our time according to how we are paid. When I was a software engineer, I was getting paid the equivalent of $40/hr. According to this maxim, I shouldn't bother with any sales or discounts that don't yield at least this cash/time efficiency. But when I was shopping for a computer, I used at least 20 hours looking for the best deal on Dell, monitoring coupons, etc., etc.. I probably saved $300 overall, but with a cash efficiency of < $15/hr. This seems irrational. But, in fact, it IS rational. The reason is because I _CANNOT_ easily work an additional hour and make an extra $40 (I was salaried). So I was actually increasing my OVERALL disposal income by $300 by spending this time, though decreasing my AVERAGE income/time.

    Let's say that I'm a doctor, and I'm seeing a patient who is an unemployed handyman with no insurance. I mention to the guy that I want to replace my sink, fix a few loose hinges, and stabilize a sagging cabinet. So I treat him in exchange for him coming in on the weekend and helping me out. We both benefit from this, since services are rendered/created which would otherwise not have happened. And we're both happy about it. Sure, it would be nice if he had the cash to pay me, then I would hire him to work on the weekend, but this exchange of goods/services wouldn't have happened if that was a strict requirement.

    I can see doing this with all sorts of professions. The benefit is that value is CREATED by the exercise of their talents and skills which might not otherwise happen.

    This is a great idea.

    a_t
     
  16. Apparition

    Apparition 1K Member
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    - Doctor, I'm having chest pains and I can't breathe
    - Hmmm, can you fix my sink?

    J/K I'm glad this hospital is at least trying something to alleviate the access problem. I guess it's better than nothing.
     
  17. almost_there

    almost_there Senior Member
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    :laugh:
     
  18. FictionalGirl

    FictionalGirl Senior Member
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    "If the services of said artists were actually valuable, they wouldn't be in the economic harship that brought them to such a situation"

    I"m going to be honest, that comment really bothers me on the most fundamental level. You're obviously not someone who does or cares about art, or you would know that most of the worlds beloved artists who are now dead hardly sold a painting in their lifetime. BRILLANT artists are starting, because its hard to bust into the industry. Its not all about talent. If it were, then there would be a lot less ****ty literature in the bookstores. If you think that artistic talent means a lot of money, you're sorely mistaken. We need artists in communities - as an artist AND a children's hospital volunteer, I can't tell you the difference that a one hour funny story writing class can make to a kid just trying to be a kid.
    And if being concerned about documenting creatively the culture of America and of human beings in this age means that you should be punished without healthcare, thats terrible. If you think its worthwhile to go into underserved communities and hold clinics, because poor people deserve the help, then you should feel the same way about artists who are trying to survive as well. You can say they should have been "practical" but not everyone is meant to be a doctor or a lawyer. I think the idea of barter is a wonderful one. And its not arbitrary, there are a ton of artists in new york who are a part of the underserved poor population. They are trying very hard, and if bartering means they get healthcare and making patients happy then i think its a great idea. So shame on you for being so small minded to think that if an artist was any good they'd be making plenty of money. Go tell it to every artist and writer you studied about in school who died in poverty.
    As a matter of fact, go to a museum, read a book, and make a friend whose passion is in art and see how important it is to people who love it.
    As someone who used to make her living writing, I can tell you that I was not only published, but I had to work a full time other job in order to pay my rent. So I was obviously good enough for people to read, but I wasn't making enough to cover my bills. But it was my passion, as medicine is my passion now. But don't punish people because a program helps them. Don't punish a group of people saying its "arbitrary aid" when it rewards peoples passions with basic help. We don't say things like "helping the poor in Philly is arbitrary because if they had higher paying jobs then they wouldn't be in the situation of being poor!" but because they chose to be artists, then they shouldn't be allowed the dignity of helping for their free aid? How is it any worse than a free clinic. Tell me you want free clinics in underserved areas to be shut down, because that's as logical a conclusion as this. Its practical because it serves a need AND DOES IT BY ALLOWING PEOPLE TO KEEP THEIR DIGNITY.

    .... now if you don't mind, i'm going to go submit a story to a lit journal and think about how if I were really any good, I would be filthy skinking rich by now and would have more money then I need to pay for my medical school costs.....

    :mad: :mad: :mad: :mad: :mad:
     
  19. Shredder

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    money was created to put the inefficient form of exchange known as bartering out of existence. money allows you to place an exact value on goods and services without having to rely on dual coincidence of wants. if the artists were really worth anything to society, they would be fetching money for their works and using that to pay for healthcare. fictionalgirl, value in american society is measured by dollars and cents in the end. if ppl really love something they will be willing to match that with a certain amount of money

    this is analogous to a doctor serving an indigent patient in exchange for free cooking and cleaning service for a month, or a year. its troublesome having to come up with schemes like these, and there comes a point where you run out of ideas. money eliminates all of that nuisance. introducing bartering is not an innovation--it is a step back in the progress of mankind. sorry if im stepping on any toes but this is the economic reality, barter sucks

    however i will say that barter is a great way to avoid taxes, and ive read that countries like sweden that are fed up with high taxes are increasingly engaging in it to screw the Man
     
  20. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    You know, Shredder, I like you and I think you're a decent guy who has sincere beliefs and I respect that.

    But I sure as hell wouldn't want to live in your ideal world.
     
  21. Shredder

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    i guess if it comes down to treating them via barter or treating them for free, the former is better. ill give it that much--not perfect but at least the hospital is gleaning something from them by making them indentured servants. why stop at painting though, why not make all indigent patients indentured servants? the problem is that the hospital has to create jobs for these people, and the hospital is not in the business of creating odd jobs for indigent patients to fill. its inefficient, thats really why money came about. i dont see whats so heinous about that. the painting incident isnt too big of a deal, but if it signifies any kind of trend that could be trouble.

    looking back through the thread, apparition's comment is very appropriate. in a way it could be seen as better than nothing...but is it really? especially since it seems to enjoy such broad support in the thread. do we want our patients to access healthcare at the cost of being our handymen? i think its awfully demeaning compared to using money

    this is an interesting thread and concept, ive thought about it before. indentured servitude wears out its welcome quickly, and after that youre still left with the problem of people wanting to consume more than they produce, with no means to accomplish that goal
     
  22. almost_there

    almost_there Senior Member
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    Why do you think that this is "indentured servitude"? When you say

    you seem to imply that they have no choice. You of all people should believe that there is always self-determinism.

    Flip it the other way. Say you're a handyman, who doesn't have health insurance, but you get sick and want to go to a doctor. So you go to the clinic, and say to the doc,"Hey, I don't have any money, but if you care for me now, I can do jobs for you later." If the doc agrees, great. If not, go somewhere else.

    You're right, money was invented to smooth the exchange of goods and services. This way, I can grow 100 tons of cabbage and sell 'em for cash vs. running around trying to find enough people who have things I want to exchange cabbages with. But barter ON TOP OF cash exchange allows services to be exchanged when one party HAS NO CASH. Sure, the doctor or hospital can say,"Hey, why don't you work for a couple weeks first, we'll pay you in cash, then you can come back for care with the money we pay you with," but why restrict yourself to that?

    Think that what we pay for in the health care system are all valuable services and the only valuable services? Nope. I bet regular patient visits with dogs improves outcome, but I doubt any health insurance pays for it. I bet painting with kids may be similar.

    a_t
     
  23. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    I don't think indentured servitude is at all an accurate characterization here. There's no need to be overly dramatic. These are free workers who have a choice whether or not to participate in this program. They are not under contract and can discontinue their work at any time.
     
  24. Shredder

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    youre both right in that it is free choice. but i dont think we should push this as a solution to a problem, as its inefficient and there must be better ways. barter and servitude, whether indentured or not, seem to be regressions and not something to look favorably upon

    oh, theyre not under any form of contractual obligations? what about all the credits and such? sorry i didnt read into great detail, i just saw barter and was unsettled. if the hospital continues this trend it will probably bog down the operations that a hospital is really meant to do--arranging acting and painting demonstrations is really pushing that distinction

    ive been thinking about it and maybe i will reneg on my original stance. should we strongly advocate indentured servitude as a solution to access to healthcare for the poor? ok maybe im flip flopping--as i said i think its an interesting concept and discussion. as for vehement oppositions i made, hey conversations are no fun when everybody goes around nodding ;)

    almostthere you proposed some kind of long term servitude agreement--to counter that, why not just implement medical loans? well good thread darkside, i rated 5 stars; its a neat thing to talk about in any context
     
  25. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    It's a good discussion, Shredder, and you're right, taking a stand does make the discussion more fun when people are polite and acknowledge each other's good points. :)

    My understanding of the deal is that you do the work and get credits which can be applied to health care proactively, not retroactively (i.e., they're not trying to work off a debt).

    I agree with you that a barter system is not ideal and that money was invented for a reason. :D That said, it has a long tradition in the medical community, as several other posters have pointed out, precisely because health care is not a luxury. You need it when you need it, which may not be when you can afford it. If you have a service that a hospital wants, why not be able to offer it to them in exchange for care?

    Hospitals do a lot of things that are not directly physically patient care based, like spending millions of dollars on remodeling to make themselves more attractive. I can actually see a program like this being an advertising draw for a hospital... "come to us, where you can listen to professional music and have your kids work with artists! See how wonderful we are and how much we care for your holistic needs??? Don't go across town, where it's all icky and sterile and there's no beauty or art!" In the right community, hospitals might actually wind up making money on a deal like this.
     
  26. jebus

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    That made me laugh. I had to say it.
     
  27. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    :laugh: Thanks! Wish I could take credit for the idea, but they do it all the time over in the Everyone forum. My favorites are the posts from dead people, like when they go on a Federalist Papers rampage and James Madison is posting all over the place.
     
  28. chef_NU

    chef_NU G-Unit
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    Fictiongirl and others... you seem to have missed my point.

    You all seem to think that barter is a great thing. "Barter + cash" is the way to go right? After all, barter allows for a greater amount of exchanges. However, I am contending that any form of barter in a cash-based environment is either (1) illegal, (2) charity, (or 3, dumb and inefficient).

    In the above case, it is (2) charity. I'm saying that the hospital is basically being a charity to these artists because the services they perform are not useful. Another way of saying this is that they do not have a market value. Were the services valuable, the artists could exchange them for money like any other economically useful person and then use that money to pay for healthcare. This situation is very simple: the hospital is giving free healthcare and at the same time presenting a facade that they actually care about what the artists are doing. In a sense, they are appealing to the artists' vanity. You may want to call it dignity, or whatever, but thats what it is. Of course, I'm sure the hospital derives SOME benefit from the dancing, singing, yodeling and whatnot. But it's not nearly worth the market value of health services rendered.
     
  29. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    I happen to know how much my hospital spent on its latest remodeling project, so I think you're just dead wrong that these artists' contributions have little market value. Just to give an example, we spent $15,000 on ONE sculpture for our "healing garden." We'd have been way better off buying the artist's raw materials and giving him/her a hernia repair.

    And, even if it were charity, what's wrong with that? Businesses participate in charity all the time! I thought this was one of the arguments for a free market economy... that individuals in themselves and as business owners will provide the charity needed for the less fortunate members of society.

    I just don't see who loses here. The hospital gets free PR (how many local hospitals do you see getting mentioned in national media in a POSITIVE light), goodwill in the community, training for its interns, and services for its patients. The patients get nice services at a time when such things can actually make a big difference. The artists get the opportunity to practice their crafts, make contacts in the community and potentially increase their customer base, and access health care they might not otherwise be able to afford.
     
  30. chef_NU

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    Darkside I'm not saying that it's bad in any way. It's a good thing that these types of things go on. A great example of private social conscience. I'm just asking that we not misinterpret what is actually going on here.
     
  31. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    Oh. Well, good. :)
     
  32. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    I can vouch for hospitals spending ridiculous sums of money on cosmetic things, too. My sister is the Public Relations director of a hospital. She just spent $20,000 on the hospital's Christmas decorations (not buying them; paying someone to HANG THEM UP!). That is more money than I earn in an entire year. I told her that I'd hang those decorations for $10k if she'd buy me a $20 ladder. :smuggrin:
     
  33. FictionalGirl

    FictionalGirl Senior Member
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    Chef, I think you miss MY point, its really sad if the only thing you consider "useful" is something that can pull in a buck. You're speaking in too many absolutes...Not everything of value has a large market value. I understand that you're speking in economic terms, but you seem to be expressing an overall value system on what is worth doing and what is not. So you can say that being a doctor does have more of a market value than being an artist, but do the people have more value? You need doctors AND artists, so if one wants to give the other a little charity, so be it. Of course this is charity, its not masquerading as anything but charity. So its charity with a little dignity, big deal. Getting an underserved group more healthcare is the goal, it seems, here. It looks like barter, but its not, its just charity that gets them some more volunteer hours and everybody wins, including the patients. Because, i'm sorry, but its really nasty to comment about "yodeling or whatever" helping people, when art is a fantastic therapy. Or what the heck, maybe i'm just blind to watching people at the hospital I work at respond with such high spirits to an art lesson or two. Yeah, its not going to cure them, but their spirits will lift. So its charity will a little giving back. its not perfect, but they're just trying something out.


     
  34. Saluki

    Saluki 1K Member
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    Tell her I'll do it for 5k and buy my own ladder... :laugh:
     
  35. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    I have kind of grown to like you, so I will actually regret that unfortunate "accident" you will have while on that ladder of yours.... :p :smuggrin:
     
  36. Shredder

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    20k seems like a lot but it must be approximately the value of the services that were performed. in a competitive market, the price will be competed down to a reasonable level that is near costs. one thing to consider is time--the decorating firm might have been able to complete a smashing job in 1 week, whereas a lone entrepreneur working for 10k might take ages to finish the job, and the quality of work might be questionable. some hospitals are truly enormous--the cost of taking things down factors in too, as well as transporting them here and there. so regardless of who offers low prices, the most important element is the time frame for special events and seasons

    just doing a little vouching for the seemingly extravagant hospital
    [​IMG]
     
  37. almost_there

    almost_there Senior Member
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    I disagree. Again, consider the hypothetical case where there are two parties (say, hospital + broke handyman with a hernia) who have mutually beneficial services to offer each other. It would be nice if the broke handyman had cash to pay for medical care, then earn it back from the hospital by doing jobs, but constraining the transaction that way seems pointless and inefficient. ("We'll treat the hernia after you work for us for a few weeks.") Allowing this "barter" lets the transaction occur, with net positive outcomes for both. This is neither (2) charity, (1) illegal (as far as I know), nor (3) dumb or inefficient, as this transaction would NOT occur in a cash-only system where the handyman needs to have cash in hand FIRST.

    An analogy to this (and Shredder mentioned this) in cash-only terms is to denote the service's values in terms of dollars, and call it a "medical loan", that the handyman pays off in terms of paid service. But once you start calling things "loans", you automatically begin to think of credit-worthiness, etc.., which is a direction we may not want to go.

    I disagree. And, for what it's worth, your statements are contradictory. If there is no market value to these services, the hospital will derive NO value from these services. Do you care to argue that? :)

    The argument that the artists' work has no value because if they did, they could sell them and use the cash for other purposes relies on VERY STRONG assumptions which are not satisfied in the real world. For one, buyers who WOULD buy the art don't get a chance to learn about the work. (side bar: one of the reasons why the internet is so powerful and revolutionary is because it allows connection between buyers/sellers that are hugely separated). Simply because the transaction doesn't happen (in the real world) does NOT mean that there is no market for it. Especially for unique, non-commodity goods such as art.

    Now, if you take the argument there _IS_ some benefit to the services these artists provide, but the exchange is not nearly equal, <shrug>. That's an empirical question. I don't know what the impact on patients of exposure to music, art, drawing... things that make them happy and engaged. But I wouldn't so easily dismiss it. (e.g. I think there are a few studies of regular dog visits to patients and the positive impact on outcome)

    a_t
     
  38. njbmd

    njbmd Guest
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    Hi there,
    My solution for getting pregnant ladies into prenatal care in some populations is to pay the mom $1,000 if she makes all prenatal visits and testing according to need and stays drug-free. After all, if a mom delivers one child without pre-natal care, the hospital bill for that child can be upwards of $300,000. I believe it is more cost-effective to give 300 moms $1,000 each and increase the chance of delivering a healthy baby than treat drug-withdrawing sick preemie at $300,000+. Mom can use the money for supplies and diapers after giving birth. Unfortunately, the free clinic can be down the street and moms will not come in for pre-natal visits or show up for required testing. If you offer money, you can induce them to come in. The city government doesn't agree with me on this one but it does work.

    njbmd :)
     
  39. EvoDevo

    EvoDevo Forging a Different Path
    Moderator Emeritus 15+ Year Member

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    Attending Physician
    I like that solution. It's creative and gets to the heart of the problem. :)

    It always amazes me how groups of ppl [city, state, federal govts] freak about spendin $$ upfront, but seem to have no problem paying 10X as much on the back end. Like paying for immunizations. It's hard to find $ for that, but just wait until the person shows up to the ED w/o insurance....:thumbdown:
     

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