What exactly is sliding scale?
Community acupuncture is based around the principles of providing accessible and affordable acupuncture and often other holistic health services to the public in a group setting. At the core of it is intersectional justice work. Private acupuncture sessions in NYC can be out of reach for a majority of people ranging broadly in price from $100-350 a session. Sometimes insurance will cover acupuncture benefits allowing for easier approachability for those that have such plans. However that leaves a lot of people unable to even conceive the idea of seeking out acupuncture as not everyone has insurance or plans that cover these services. Another thing to consider within that is that acupuncture is cumulative and works best with consistency, so often ongoing treatments are recommended depending on the severity and duration of the conditions. If this is cost prohibitive, then it is more difficult to realize the true efficacy of this medicine. The community setting allows such opportunity for a wider range of people to try acupuncture and other holistic modalities as well as receive them regularly when needed. Anyone who is already utilizing acupuncture in their healthcare regiment knows the absolute power and magic of this medicine. Healthcare in this day and age is extremely complicated and in need of some major overhauls. The community acupuncture model serves as an action-oriented solution already in working process.
The sliding scale payment system is a part of the community acupuncture model that allows for that accessibility of offerings to a wide scope of people. Sliding scale is an alternative payment method that allows for multiple price points adjusted in order to meet the needs, circumstances and incomes of a variety of individuals as an exchange for services. Often an income model is used as a guide for people to make their choice of payments at time of services. At times it seems if people are confused or misinformed about this part of the process. Income models are not fully comprehensive but a simple method utilized for convenience. At times it can even be stressful or confusing for people to choose what to pay. One of the major intentions of this blog post is to help elucidate any mysteries or misconstrued ideas around this topic so that everyone involved can move from a more educated and expanded concept about each person’s role and involvement in such a structure. Sliding scale does not really work if all levels of the pricing scale are not used. In other words if the top portion of the scale is not helping to fill out and offer some balance with the lower end, then there remains some big gaps. In a capitalist society money is a bottom line for the sustainability of anything, so this reality and that part of the conversation cannot be omitted even from the best of intentions.
You, the clients are a huge consideration in this wheel as you are the ones keeping the business flowing with your patronage. Everyone deserves health care, and it should not be a luxury to have access to that. Again the basic laurels of community acupuncture hold this premise high and work from this basic standpoint. Everyone also has complex socio-economic statuses, which at times interfere with accessibility to healthcare. Community acupuncture is not conducive for every person’s needs, but it does address these inequalities within our society and provides an important service for those that seek it out. At times people choose this style of offering to just check out acupuncture or because they don’t know who to go to for acupuncture. Again a myriad of reasons are behind why one would come to such an establishment. You are all complex humans who also have basic needs to be met. You are asked to pay on a system that reflects your current economic standing in this world. This is a multi faceted placement.
At BAP we do not ask for income verification and rely on the honesty of each individual to self-select their payment. An income guide is offered as a basic indication of what you should pay. However that is more complex than just the actual income in a number of ways. There are a lot of questions within this guide that are left out such as:
Who else are you supporting? Are you supporting kids, dependents, family, etc? Who else is supporting you? Do you have family money and inheritances available to you? What kinds of debts (personal loans, student loans, health care debt, mortgages, etc.) are you working with? Are you working/not working? Is working a choice (versus a necessity) to you? What are your life expenses? How many of those expenses are necessities versus non-necessity items/services/expenditures? How are you spending and budgeting your money? What levels of privilege to earning do you have (ie race, class, sexual identity, gender, education, able bodied, etc)? How frequently do you need acupuncture or other services to maintain your health? What other costs are involved in your healing process such as herbs, supplements, medications, healthy food ,etc.? What is your personal budget for health care related things?
So the time comes for you to pay for your session and there are all these questions and contemplations to take into account. This can look a little different every time, but it needs to be an ongoing conversation as an integral part of the community model. You are choosing to seek out affordable and accessible acupuncture and other holistic health services for yourself so you need to pay in a way that serves you. However, it is not just about you when you are a part of a community. It is not enough to only take into consideration the business, the practitioners, and the workers that keep it going which is of vital importance in this examination, but it is necessary that you also consider the other patrons as well. If you are paying at the low end of the scale but truly are able to pay on the middle or higher end, then you are doing a great disservice to the community itself by limiting access to those that truly have need of financial adaptability as well as the integrity and viability of the business itself. You might be that person in need someday so in a way it is also a way of paying forward for yourself and others. Sliding scale relies on and works optimally when people are being honest, mindful, respectful, and accountable.
To simplify even more I will offer a few ideas to work from. Keep in mind these are working examples and nothing is absolute.
Higher end payments- This reflects the actual cost (in a group setting) of the service without a sliding scale. These are for people who have higher incomes, financial flexibility, assets, investments, inheritances, trust funds, adequate savings, little to no debt, property ownership, car ownership, recreational travel, eat out frequently, spend money lavishly, buy new items, have access to health care, and have access to resources when in need.
Middle end payments- This reflects a discount on services. These are for people who have median range incomes, no major stress about basic needs being met, access to healthcare, some savings, some resources available to them if in need, manageable debt, financial support from family or other sources, have some levels of expendable money, buy some new items, and are somewhere in between the other levels of payment.
Lower end payments- This reflects the biggest discount on services that the business is able to extend. These are reserved for people who struggle to have their basic needs met, have no savings, have no safety net of financial support or resources available to them, are concerned about housing and food stability, have trouble covering the cost of transportation to work or childcare, cannot afford vacations or any non necessity activities or expenditures, qualify for government assistance and programs, are unemployed or underemployed (not by choice), have tremendous debt, and are generally scraping together the cost for the low end of the scale.
Again this is a very generalized and basic way to check in, and this is an ongoing dialogue. This is healthcare you are accessing and it has great worth. Your input and accountability for your own participation will have a greater impact on not only the community model itself but also on your own healing process. If you are moving from a place of honesty and integrity then you are providing more alignment for your own personal healing journey. We tend to place value and worth monetarily on things, whether it is a conscious choice or not. This is a part of the reality of capitalism and of a society that promotes such values. What are acupuncture sessions worth to you? Recognizing your own part in this narrative and holding yourself accountable is not only a necessary approach to this specialized form of care but can also elevate your own health and well being outcomes.