The surgeon had practiced in the early decades of the 20th century, a time when healthcare practice and funding was vastly different than it is today, and it was more common for patients to pay out of pocket for medical services than to rely on medical insurance. When discussing a required surgical procedure with patients and caretakers, this surgeon would inquire about the family’s income and then set the price for performing the surgery at one month of the family’s income. This story was related as a way of demonstrating this surgeon’s sensitivity when working with patients from diverse backgrounds.
This method seems completely foreign today, when reimbursement levels are established by the policies of governmental and private-payer organizations. The policy changes that occurred over the course of this surgeon’s career were related to broad shifts in economic conditions, political philosophies, and public opinion. P&O practitioners are impacted by this system daily, yet many of us are unaware of the factors that contributed to the development of this complex system.