Indiana clinic lets patients pay off debt with volunteer work

The town of Goshen, Indiana was named one of CNNMoney's best places to live in 2008, and the Maple City Health Care Clinic may have played a role in that distinction.

The clinic, a not-for-profit community initiative, has an innovative program that allows the poorest of its patients to pay off their medical tab by doing volunteer work.

The clinic charges for its services on a sliding scale, from 100% to 10% based on patient income. For those who can't come up with the 10%, The More Than Money program was created.

Those who take advantage of this program fulfill their obligation by working at local charities such as Habitat for Humanity, The Center for Hope and Healing, and the local community market.

The Maple City Health Care Clinic was started in 1988 in an old fire station by a local group of citizens and Dr. James Nelson Gingrich as a not-for-profit service serving primarily the poor of the area. Sixty-nine percent of its patients are Hispanic or Latino.

Ninety-two percent have income less than twice the official poverty level, yet 70% of the clinic's income comes from patient payments and insurance. The rest is made up from donations and grants.

The concept would be difficult to apply in a for-profit setting, but could be a useful strategy to counter the tendency for people to discount the value of services that they receive for free. Our health care debate has made it clear that a large segment of the population believes that health care should be earned. For those too poor to pay, some volunteer work might meet this expectation.