Med Ges Gesch. 1999 ; 18(): 149-67.

["Thus it passes from the patient's purse into that of the doctor without causing displeasure" - Samuel Hahnemann and medical fees]

Jutte R.

In 1834, Hahnemann gave the following advice to his pupil Dr. Karl Julius Aegidi: "We are not allopaths who have high medical fees and can legally demand high sums for evil deeds. We must take what we have earned on the spot, since we are not considered worthy of ordinary justice." In an earlier letter to the same addressee, Hahnemann wrote: "No one enters my house if he does not have with him the money to pay me, unless he is paying me monthly, in advance [...]." There can be no doubt that in Hahnemann's times, fees were the most important component in a physician's income. Dependency on fee income meant that the physician always had to worry about delayed and even avoided payments, and patients' reluctance to pay was notorious. Many doctors lost large parts of their nominal income through bad debts. In some cases, installments were accepted by both parties, to avoid costly legal action, which were usually a last resort. In these circumstances it is hardly surprising to find Hahnemann, the founder of a highly disputed new cure, stressing to his colleagues that for a successful medical practice, cash payments at the time of treatment or in advance were preferable to post-facto bills. Having been ostracized by the medical establishment, Hahnemann showed a remarkable professional awareness of patients' propensity to debt. Long before regular physicians propagated cash payment, Hahnemann derived his income solely from ready-money payments. However, he used a sliding fee structure to allow for the different economic circumstances of his patients, who came from all walks of life. The very poor he treated for free, while members of the rural and urban middle class had to pay considerable fees. In some cases, Hahnemann was able to charge very high fees, and his numerous enemies used this against him.