The Cost Price of Medicine


I usually only read Polite Dissent for medical reviews of episodes of House, so I can watch with the smug feeling that I know where the medicine goes wrong. However, Dr. Scott has a great post about the mandated price of medicine in colonial Virginia:

Update: Table of prices adjusted to today’s dollars.

Surgeons and apothecaries, who have served an apprenticeship to those trades, shall be allowed,
costs For every visit, and prescription, in town, or within 5 miles 5 shillings
costs For every mile, above five, and under ten 1 shilling
costs For a visit, of ten miles 10 shillings
costs And for every mile, above ten sixpence
To Surgeons,
costs For a simple fracture, and the cure thereof 2 pounds
costs For a compound fracture, and the cure thereof 4 pounds
 
But those persons who have studies phisic in any university, and taken any degree therein, shall be allowed,
costs For every visit,and prescription, in town, or within 5 miles 10 shillings
costs For every mile, above five, and under ten 1 shilling
costs For a visit, of ten miles 1 pound
costs And for every mile, above ten 1 shilling

As he notes:

A couple of things should be obvious looking at this table. First, housecalls were common in the colonial era, and the practitioners charged accordingly. Second, there were two classes of medical practitioners: those who learned the trade by serving an apprenticeship (the surgeons and the apothecaries), and those who learned the trade through years of schooling (the phisic, or physician). Which was better? It varied, and probably depended a lot on both the practitioner and the patient. (Today’s system of medical training combines both methods: multiple years of college and medical school followed by a residency — which is really nothing more than an apprenticeship.) Back in the colonial times, you’ll also notice the surgeons seem to be the only ones who really got their hands dirty.

There are a few things that I note while looking at this table:

  • Medical outcomes during this time were a veritable crap-shoot. As I understand it, “doctors” mostly just got paid to go watch people die. I don’t know offhand whether these prices are high or low, but at least they’re explicit, so people could make a more informed decision about whether they wanted to pay to have someone watch them die.
  • If you look at the language used for surgeons, they were paid based on medical outcome, not simply treatment.
  • Even back in colonial times, the government was picking winners.
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  • 2 thoughts on “The Cost Price of Medicine

    1. I believe some argument during the health care debate touched on compensating doctors for solutions instead of procedure after procedure. I’m not sure exactly how that kind of system would work since one doctor can say a patient is cured where another might say otherwise–and so could the patient.

      Watch this video on a TED presentation on “perspectives.”

      The speaker mentions a system practiced in Japan, I believe it is, where doctors are paid when patients are well but if the patient is not feeling well, the doctor doesn’t get paid. That’s a much more radical form of the above mentioned compensation scheme but it’s worth a look into.

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