How do Amish choose a hospital?

How do Amish decide where to get medical treatment?  There are multiple factors that go into that decision, but since Amish pay cash for medical care, a big factor is cost.

If you’ve ever traveled through Millersburg, the seat of Holmes County, you may have passed by Pomerene Hospital.  Amish are perhaps 40% of Holmes County’s population, one reason they make up a large part–20%–of the hospital’s annual business.  Last year Pomerene had over 1,100 “self-pay package customers” which for the most part are the Amish patients.

Pomerene has been trying to attract more Amish customers by responding to their needs.  The hospital has a “full-time Amish advocate” who speaks Pennsylvania German, has developed a hospital transport system, and even opened the “Amish House” for Amish relatives to stay overnight (more on the Amish House here).

Pomerene Hospital AmishThis recent story about Pomerene has a very free-market feel to it.  Since they don’t carry traditional insurance, Amish are motivated to shop for better deals and negotiate.  Pomerene CEO Tony Snyder comments: ‘“When we as individual citizens are responsible for a significant portion of our health care bill, we’re going to shop prices and quality,”… “Americans spend more time researching the purchase of a new car than they do health care providers.”’

I think Snyder has a point–that we are more apt to consider choice in purchasing consumer goods than we are in medical services.  Perhaps it has to do with the idea that health care involves a (sometimes quite intimate) personal relationship and thus a need to feel comfortable with the provider–probably one reason why family doctors treat generations of a single family for years and years.

Open-minded medicine

Amish do approach their health care with an openness to different solutions.  Besides conventional hospitals, they choose local clinics, birthing centers, alternative medicine, folk remedies, sympathy healing, and care in distant medical centers, sometimes even outside of the country.  As you’d imagine, not all Amish opt for all of these solutions, or even consider them as a serious option.

But across Amish society, there is a general willingness to reach into both alternative and conventional health arenas.  In a study* on the subject Anna Frances Wenger sees the Amish as having an “active involvement in health care and openness to choose from a broader array of types of health care than most persons in the dominant American culture.” Wenger found Amish in an Indiana community choosing from a full slate of options, from folk to professional providers.

If you’re interested you can also explore health care among Holmes County Amish in chapter 7 of An Amish Paradox (“Health along the Life Cycle”) which covers topics including birthing, diet, immunization, and alternative medicine. I quite enjoy the quote that opens that chapter, from a local physician: “They don’t come in every time they sneeze.”

(*See “Health and Health Care Decision-making: The Old Order Amish” in Internal and External Perspectives on Amish and Mennonite Life 4, 1994)

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    1. Kim in NY

      Is that Ohio, Florida, or Mississippi you are talking about? They all have Holmes County…..

      1. It is Ohio Kim. I probably could have noted that, but if someone says Holmes County in relation to the Amish, it’s 99% safe to assume they mean Ohio.

        I’m not aware of another Holmes County with an Amish population, though there are at least two Daviess Counties with Amish (MO and IN), and I’m sure other examples.

    2. Kim in NY

      Thanks, Erik! I am definitely not an expert in Amish locations, so it helps me to learn!

      1. My pleasure Kim, glad you asked.

        1. Kim in NY

          I just clicked on your link to “An Amish Paradox”–very interesting, and if I had done that at first, I would have seen that Holmes County is the one in Ohio. Looks like a really interesting book, thanks for including the link, Erik.

    3. LeeAnn

      Really interesting. Maybe if the rest of us took as much interest in the cost of our medical care, etc we could bring down the cost of healthcare. The Amish are on to something there.

      I know it pays to work out the cost with hospitals, etc. We had that experience a few years ago when we didn’t have insurance. We worked out a great deal with the hospital and got the bills reduced 30% or more.

    4. Tom Schulte

      The Amish are on to something here. Us “English” folk tend to canonize our health care providers rather than recognize them as tradesmen like any other field. Notice how an MD has a higher social standing that a DVM but the Vet sure has to know a lot more.
      I find it interesting how it is cheaper for the insurance companies than it is for the individual to pay for treatment in a hospital. Obviously, hospitals have room for adjusting the costs.

    5. Marilyn from NY

      How do Amish choose a hospital?

      An Old Order Mennonite friend of mine told me that the hospitals will give them a discount if they pay cash. She had been in for emergency surgery and because they paid cash they got the price that someone with medicare or medicaid would pay. If the bill is real high sometimes the hospital will put it on a payment plan for them if they make the payments every month. But the hospital prefers the cash as they don’t have to send bills every month, go through insurance forms, and alike. In their area there are no hospitals like Pomerene, birthing places, etc. They have to go the local Community Hospital.

    6. Anne

      Thanks Erik, this is very interesting. I was just reading about alternative treatments for cancer. Medical centers in Mexico (among other places) are doing ground breaking cancer research, with high success rates. According to the book I’ve been reading the patients range from Hollywood stars to quite a few Amish, which represents quite a range!

      We ourselves are members of a medical cost sharing group that is fantastic. We negotiate prices for procedures, shop for doctors, and are free to “find the best”. It has changed my whole view of medical treatment providers. If everyone was encouraged to “shop around” we would go a long way towards solving most of our health care cost problems in this country.

    7. Alice Mary

      Makes you sick!

      Yes, it would be good to be able to pick and choose a hospital or doctor ahead of time, but sometimes it’s not possible (such as in an emergency situation). For one thing, it’s not easy finding prices for all procedures at a hospital—I noticed last time I was in an ER (within the last 2 years), there actually WERE prices listed on a chart on the wall, but I must say, looking at them, I felt even WORSE—already worrying what our insurance (very good & well-known insurance co.) would and wouldn’t pay. Even then, if it’s not “coded” correctly by hospital/doctor’s staff, you can be denied coverage/payment. Not too many years ago, my husband had an ongoing battle trying to get the insurance company we had to define what “reasonable and customary” charges were (since that’s how they based their coverage.) No one could really tell us—it was a big shell game.

      Where I live, you have to follow the doctors around to their different affiliated hospitals—most are affiliated with 2, 3, 4 or more hospitals. One doctor is only in my area on Tuesdays. Another on Fridays, but I can see him at a different hospital/office location if I don’t mind traveling another 15 miles. Some of my doctors have 3-month (or more) waits for appointments (and virtually every doctor is a “specialist). My GP/surgeon is 75 years old—he’s been our family doc for 23 years. I dread thinking of “shopping” for a new doctor when he retires!

      I end up taking sick days,not for being sick (or in surgery/recovery), but to make the trek to simply see the doctor/dentist.

      I’m sure my BP is going up as I write this…!

      Pomeren Hospital has the right idea. I wish local hospitals in my area would send out flyers with their “prices”—get some competition going, and hopefully bring down costs! (I’ve even considered, along with some co-workers, helping fund a medical student’s education if we could contract with him/her to treat us at a discount (or for free!) for the rest of our lives!

      Alice Mary

      1. Kim in NY

        You can do that now, Alice Mary, in some communities. Where my daughter lives in Alexandria, VA, some doctors are contracting with people to be available to them as their private physician for a monthly fee. My daughter found out about it because she went for an interview to possibly be a patient liaison for such a doctor.
        It’s a new way of “reserving” a family doctor.

    8. Richard from Amish Stories

      Cash is king!

      I know that if one tries to pay using cash that 9 times out of 10 you will always get the better deal, plus doctors really dont like dealing with health insurance companies either because they nickel and dime them to death (just like they do to us). So the health insurance company is something we the patient and most doctors themselves despise dealing with, but for us non doctors we need some sort of health insurance plain and simple to help cover health costs we sometimes must face . In my area of Pennsylvania I know of a few family health care clinics that cater to plain folks, and I’m pretty sure that cash is king when paying for your bill. Richard from

      1. Ed

        Richard, very interesting. My physician’s group won’t even take cash — it is credit cards (or direct billing to insurance) only.

        I like the idea of knowing exactly what a procedure will costs before you have it. At many hospitals, as I understand, the doctors themselves don’t know how much something will cost.

        1. OldKat

          Cash vs. Insurance

          Ed, in this case I think cash and a credit card is considered one & the same. The point is that you (or whoever is the consumer)is NOT using insurance to pay the bill. Insurance is fairly well considered a necessary evil by most health care provider and with good reason. Whether it is private insurance or “government run” health care, the cost of dealing with insurance is onerous on medical providers. I knew a doctor that claimed that once his 5 children were out of college (4 at the same time) he was going to stop taking insurance and accept cash (checks, credit cards) only. He said he would lose probably 20 % or more of his patients, but would actually net MORE money due to lower cost of doing business, plus have less headaches in dealing with insurance.

          Has anyone ever seen the graph that shows the rate of inflation in the general economy and the rate of inflation for medical products / services? They track each other fairly closely throughout history, but diverge sharply after the mid-1960’s to early 1970’s with medical inflation far outpacing general inflation.

          The reason? Simple: Medicare and Medicaid both came into being and the number of companies offering medical insurance to their employees increased dramatically. There are numerous reasons why this added to the cost. While everyone’s situation is different; in general people have become indifferent to the cost of medical services since they don’t view themselves as “paying for it” as their part of the premium (if they pay anything at all)remains constant regardless of how much they use the coverage. Plus the red tape and bureaucracy that doctors / hospitals must go through to deal with government and private insurance providers has added significantly to their cost of doing business.

          Prediction: If “Obamacare” ultimately survives, and maybe even if it doesn’t, we are headed for two types of medical care; a premium version for those who can and will pay for it and a, ahhhh, let’s say a note so premium version for everyone else. Maybe something akin to what SHOM is calling “OHIP” in the post below. Here is hoping “Obamacare” dies a swift & timely death in the near future.

    9. Kerry

      There has been a little bit of grumbling in the past about Pomerene making special concessions for the Amish in several ways, not just financially (i.e. the Amish house accomodations for family, which English don’t have). But they now offer these same elective “packages” to anyone who is self pay. There are a number of people who go there if they don’t have insurance for elective procedures or labor/delivery because the other local hospitals will not work kindly with them. They have a very nice community outreach service where they offer basic blood tests, several more specialized ones than what you normally see, at varying locations throughout the area and for a very, very good price.

      Many Amish still also choose to go to the other local hospitals because they are larger and have more specialists or have more experience. And daily you will see large packs of Amish even at the Cleveland Clinic. They vary in the type of care they feel most comfortable with and their choices, just like anyone else.

      On a side note, there are a number of physicians and dentists who do not take any insurance around here because they have a large Amish clientele anyway. I would like to go closer to home but I don’t because I don’t want to deal with the hassle of filing insurance myself and also paying more because none will join any “network”.

    10. Slightly-handled-Order-man

      What I've noticed in Ontario

      The Amish and the English are lucky in America, you can shop around and choose your care because you directly pay for it. In Ontario, insurance does get sold, and some private clinics operate. Many people rely on what’s called “OHIP”.

      In case your wondering, an Amish or Mennonite can object to having their picture taken for their “OHIP Card”, I know someone who couldn’t get to the office and because of the circumstances and was issued a card with a picture of a trillium flower on it. I’m sure the Old Order folks can be so accommodated.

      Anyhow, like the rest of us, the Old Order people will be shipped to whichever hospital fits their needs. If a person lives near Tilsonburg he, depending on the procedure, could be sent to Hamilton, which although not tremendously far, is still a quite a distance, and sufficiently out of town even for an English.

      I know because I met families from far a field when a relative was in a hospital in the Ontario “Steeltown” [sorry fans of Pittsburgh sports, an Ontario city more apt to sit in for 1950s Brooklyn New York in the movies uses the nickname too], and many people complain about going there when they used to be able to go somewhere nearer.

      I remember seeing an Old Order gent leaving the hospital, he looked frightened to be in the city, but relieved to be going home. The women he had hovering around him looked like they where going to get him back into shape quite quickly after whichever surgery he had.

    11. Yoder

      It’s amazing that in Mexico the total charges can be ready so that a patient pays when he leaves. Everything is totalled up – the hospital, surgery, doctors, tests, supplies, room, medication, and blood work. I think the medical offices work together. No other bill is sent; bills don’t keep dribbling in for six months. Maybe they use computers!

    12. Matt from CT

      >“When we as individual citizens are responsible for
      >a significant portion of our health care bill, we’re
      >going to shop prices and quality,”… “Americans spend
      >more time researching the purchase of a new car than
      >they do health care providers.”’
      >I think Snyder has a point–that we are more apt to
      >consider choice in purchasing consumer goods than we
      >are in medical services. Perhaps it has to do with
      >the idea that health care involves a
      >(sometimes quite intimate) personal relationship

      Personal relationship may be part of it; but I suspect to a VERY large degree Americans don’t know how to “shop” for medical care.

      We probably need something similar to Home Economics that teach people the fundamentals of personal health and what to look for in healthcare.

      Of course…Home Ec is a subject now sorely lacking in the U.S. as well — just look at the average basket in a supermarket.

    13. Louis Rosas

      Other options available for children with cancer

      I admire the Amish folks, they are very careful and devoted to their religion and life style. With this child who has leukemia I’m sure it hurts the family to make certain options. Since I just learned that they will use different facilities and services I would suggest they contact St. Jude’s in Memphis. They don’t charge a penny for their services and have over the years reached a high success rate with leukemia. The hospital accepts anyone regardless of race, or religion and the care is wonderful. I have a granddaughter who is a nurse at St. Jude’s and she loves her work. I’m suggesting the family look into St. Jude’s as a possible route to take with their daughter. We will remember this family in our paryers!