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September 2022

Clio Med. 1983 ; 18(1-4): 113-29.

[Fees and compensation for therapy in foreign populations. A contribution to medical ethics from the history of medicine and ethnomedical point of view]

Weinert T.

The 'Human Relations Area Files' (Yale) have been looked through in respect of the medical data on 220 peoples, tribes or ethnic groups. Concerning our theme data for 162 ethnies (73.6%) were available. In 26 ethnies of 162 ethnies (16%) no compensation has been demanded but in 11 ethnies gifts were accepted. Only 15 ethnies or less than 1/10 do not know any compensation for therapy. Payment is mentioned with 144 ethnies (89%). This outspoken opinion of the Ojibwa near the great lakes of Canada is widespread in the world: "You can't have anything for nothing". (1932) In 55 ethnies (34%) a 'very high' fee was paid, with another 47 ethnies (29%) a 'fair' fee was paid, this is altogether about 2/3. In 21 ethnies (13%) only a 'small' fee was paid. With another 30 ethnies (19%) the compensation could not be rated. In 43 ethnies (27%) a fee was paid only in case of success, this is more than 1/4. 12 times deposits are reported, this is especially common in central and southern Africa. 4 times refusal of payment is reported. Recourse (Regress) was positively absent in 9 ethnies but reported with 39 ethnies, this is 1/4 (24%). In 24 ethnies (15%) the recourse turns out sometimes or mostly with the death of the therapist, this is 1/6. This deadly recourse is obviously more common in the New World. Simple recourse or recourse with strokes were reported with 25 ethnies (15%). Because mortal and non-mortal recourses were reported twice with 10 ethnies the total of recourses is 39. Recourse does not depend on any fee at all. In the Middle East and in islamic Africa fees in general are small. There is a tendency towards very high fees in the less civilized ethnic groups. Typical in this respect is an observation in the bushnegroes of Guayana in Latin-America, where with free medical aid the reputation of the (white) doctor dwindles to the mind of everyone (1948).

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