- Sharing the Load: Amish Healthcare Financing
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Sharing the Load: Amish Healthcare Financing
Many Amish work in construction and manufacturing, with farming becoming a smaller part of their employment. There are four main groups — the Old Order, the New Order, the Beachy Amish and Amish Amish hook up commercial — with many subgroups and different rules within these categories. Assimilated Mennonites are essentially indistinguishable within mainstream society.
They are allowed to wear contemporary clothing, use electricity and new technology, attain higher education, and do not live in community settings as do the Amish and Plain Mennonites. Since Amish learn English in school, the interviews could be conducted in English. The first author received assistance from an assimilated Mennonite male relative who has a year career in business and is well known in the Amish community for his integrity.
His heritage also provided valuable insight into the Amish culture e. He was able to advise the authors on factors critical to developing a rapport with Amish interviewees, including norms for appropriate dress ankle-length skirts for women , the prohibition on taking pictures of the Amish although photos of their homes are not forbidden , and scheduling norms e.
After receiving IRB approval from McDaniel College on 27 October , and in accordance with the rules of the Declaration of Helsinki of , the first author accompanied by her male relative interviewed 11 individuals after they signed an informed consent form. The sample consisted of seven men and four women from nine separate households who had experienced major medical expenses or were heavily involved in the Amish Hospital Aid program, including those in administrative positions.
The relative specifically recruited interviewees to provide a variety of perspectives, both in administering and receiving Amish Hospital Aid. One respondent not previously acquainted with the male relative—an Amish Hospital Aid administrator—sought additional clarification about the purpose of the study before he consented to the interview.
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The individuals were told that the purpose of the study was to collect and publish data documenting how the Amish manage health care needs within their own system given their exemption to coverage mandated by Obamacare. Ten of the 11 interviewees were members of the Amish Hospital Aid plan at the time of the interviews, although one had only joined Amish Hospital Aid subsequent to a major medical expense.
As is normal among the Amish, all of the respondents received a formal education only through 7th or 8th grade. Interview questions concerned their involvement in the program, participation in conventional medical care, and the operation of the Amish Hospital Aid program. Interviews lasted between 30—75 min and were documented by the first author with handwritten notes. Although much of the information shared during interviews has not been previously documented, existing literature when available corroborated the findings.
While the focus in the interviews was Amish Hospital Aid a type of Amish insurance , respondents also discussed traditional ways their community helps with unmanageable healthcare costs that at times operate in tandem with Amish Hospital Aid. Alms are tithes or offerings donated to the congregation by its members. Church deacons, who are in charge of both disciplinary and financial matters in the congregation, visit members in need of medical assistance to see how they are faring and then distribute the alms as they see fit.
Community collections are a form of alms that are gathered from the alms of other Amish congregations in the area. These funds can be requested at the discretion of a deacon. Community collections were used when a man was paralyzed from the waist down after a diving accident. In extremely rare cases, the government has covered medical costs e. Amish Hospital Aid covers only major medical needs. In serious cases normally when hospitalization is necessary , those who participate in the program contact the treasurer in charge of their district once they know the costs incurred or to be incurred.
Those requiring care typically pay the health care provider used, and Amish Hospital Aid then reimburses them. Members who are unable to pay upfront allow the board to make arrangements with the hospital or care facility, in order for the board to pay the provider directly. When ill, Amish seek treatment at their local hospital and are billed the same as non-Amish. The Amish Hospital Aid board also works closely with bill negotiators at different hospitals and facilities, just like commercial or governmental insurance companies, to negotiate discounts for individuals with specific needs [ 9 ].
Incentives to provide discounts include the promptness with which bills are normally paid within 30 days , less paperwork, as well as assurance that the facility will not be sued since doctors are seen as fallible but autonomous individuals doing their best [ 14 ]. Typically, participants of Amish Hospital Aid receive a discount slightly above Medicare rates, although each medical provider has its own particular discount. Not all care facilities offer a discount for members of the Amish community, however.
Hospitals sometimes refuse to consider lower rates beyond existing negotiated rates with government or commercial insurance companies [ 2 ]. On the other hand, health care facilities like the Clinic for Special Children provide pediatric care, especially for genetic disorders and syndromes in Strasburg, Pennsylvania for Amish and Old Order Mennonites, who may travel a great distance to reach the facility in order to receive state-of-the-art care and save money on treatment.
The Clinic offers substantial reductions in health care costs by such means as lowering the price of testing, gauging when expensive treatment is warranted, and sometimes by devising treatments that prevent costly disability [ 15 , 16 ]. A short video 3: This discourages routine and preventive medical services—particularly by family doctors—and is a source of discontent for some interviewees. In addition, Amish Hospital Aid does not cover physical disability costs, such as those for Cerebral Palsy. Another Amish-run organization, Disability Relief Aid , covers costs for necessary items such as wheelchairs, ramp installations, and special bathroom installations, in addition to supplying an annual check to help with personal care costs.
As with alms, Disability Relief Aid is funded by community donations. Neither Amish Hospital Aid nor congregational alms funding cover health care needs that result from prohibited activities within the Amish community. One interviewee mentioned an incident that occurred with a teenage boy in her congregation who was injured in a snowmobiling accident. The use of motor vehicles e.
Even though the boy was not yet baptized into the Amish congregation and therefore still under the aegis of his parents , the deacon would not provide alms money to help pay for his hospital care.
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While members of the Amish community are not required to participate in Amish Hospital Aid and may just rely on alms, a growing number of Amish want the extra security provided by Amish Hospital Aid. HHS provided each deacon with the forms to be distributed to members of their church congregations. Members gathered at the usual Sunday service, with men sitting in groups of ten at round tables. One man explained the meaning of the forms to the others before they all signed the forms.
The Amish Hospital Aid plan is run by an all-male board consisting of a chairman, vice chairman, and four treasurers. Each treasurer is in charge of the funds for approximately 50 congregations. The leaders appoint a Committee Man for each congregation to act as a liaison between the members and the administration. The Hospital Aid committee including an estimated Committee Men and the 6 board members meets annually to discuss the program. The entire committee participates in voting, with board members holding six-year terms with no limit on reelection.
Current Committee Men are candidates for members of the board, by recommendation. Those with Amish Hospital Aid typically contact their treasurer once they receive their medical bill. In some cases, the treasurer actually contacts whoever receives the bill. All members of the Committee are men, since there are no women in administrative positions in the Amish Hospital Aid program, as is consistent with organizations in the Amish community. However, women are allowed and often encouraged to have their own personal businesses selling quilts, fabrics, baked goods, etc. The Amish system of paying health care bills has existed very informally, driven partly by the notable fact that administrators are not paid for their time.
All respondents in this study were aware of and supported a lack of paid administrators. Members pay a flat rate per person on a monthly basis. This interviewee was very surprised to hear that the costs for non-Amish who use conventional insurance are in fact significantly higher than what he was paying for Amish Hospital Aid although the type of coverage provided by conventional insurance varies.
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The funds are payable to the Committee Men on the first day of every month. Members tend to be very punctual with their payments and are contacted sometimes by phone if their check does not arrive by the due date. Respondents were asked about ways they stayed healthy and minimized the need for health care. They mentioned attention to good nutrition and exercise, including their vigorous farm work. In addition, unmarried Amish youth often participate in sports such as softball and volleyball.
They frequently take natural vitamins and probiotics in order to minimize health problems, such as Vitamin C for a bad cough. Home remedies are typically used for less serious ailments such as colds, minor burns, and infections, etc. Nonetheless, there is a lot of variability in opinion: The continued used of complementary medicine in the Amish community, however, does not preclude mainstream medical treatment perhaps in part an acknowledgement of the limits of complementary care which is not always beneficial.
Amish should not be confused with other groups loathe to seek modern health care for themselves or their children e. Chiropractic care including for infants and phenology are especially popular [ 20 ]. They avoid only technology that they believe detracts from their relationship with God, or family and community life. Many interviewees expressed a willingness to benefit from modern health care, without moral if not financial reservations.
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Many indicated that they would seek conventional care: Additional related comments included: Some Amish only visit their family doctor for an annual check-up, while others wait until an injury occurs. One woman whose young daughter had a genetic disorder that required her to be in and out of the hospital for the first few months of her life spoke highly of the extra care that her doctors from the above-referenced Clinic for Special Children provided to the family, including monthly visits directly to their family farm to check on her daughter.
The Amish approach to seeking conventional medical care also takes religion into account:. Interviewees referred to Amish independence in explaining the need for having their own system for health care payments. Respondents also mentioned the benefits of assisting others and helping others while helping themselves: Their belief that a communal approach to covering health costs is morally right is consistent with their strong commitment to community members looking after one another.
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The Amish Hospital Aid program is not without challenges, however, as more conservative Amish who tend to reside in the southern areas of Lancaster County are less likely to participate in the program, reflecting a well-known north—south divide in Lancaster County roughly represented by Route Northern Lancaster County Amish e. Relative to much more conservative Amish in other parts of Pennsylvania, however, the difference between northern and southern Lancaster County Amish is much less prominent.
Some of the more conservative Amish see the Amish Hospital Aid plan as inappropriately progressive and institutionalized. Many believe it detracts from neighbors helping each other completely voluntarily with its set monthly fees, etc. Part of the appeal of alms is the reliance on voluntary donations, which bears no resemblance to standard health insurance.
Nonetheless, the extent of participation in Amish Hospital Aid is growing in southern settlements of Lancaster County. The question of wealth is complicated for Amish who have assets in land but few liquid assets, such as cash or things they could sell quickly to pay a medical bill. One respondent frowned on wealthier Amish whom he believed would be exploiting alms if they have significant funds tied up in land.
He gave a hypothetical example of someone who owned a couple of farms who had a bad accident. He claimed that the congregation would not expect an individual to sell one of their farms to make the payments, so the deacon would provide alms money. This hypothetical example has similarities with the publicized case of Jesse Martin, an Old Order Mennonite farmer from Denver, Pennsylvania who received national news coverage in because of his struggles to pay for healthcare.
Because Martin did not sell any part of his two valuable farms, he was unable to pay bills totaling hundreds of thousands of dollars for nine of his 11 children who had serious genetic disorders including Hirschsprung disease and maple syrup urine disease [ 17 ]. In cases where there are many high medical bills, even a combination of personal resources, alms, and Amish Hospital Aid can be insufficient [ 17 ]. Nevertheless, these cases are the exception.
This research relies on a small but select sample of individuals in a limited geographical area who were able and willing to discuss the administration of Amish Hospital Aid and its advantages and shortfalls. Data from a random sample would likely have revealed different reactions to Amish Hospital Aid, although a random sample would have yielded a significantly lower response rate from those outside of the social network of the community shared by Amish and Mennonites.