Pennsylvania’s Amish Community Plows New Ground in the Health Care Arena : Medicine: Sect disapproves of insurance, so it devised a plan to incorporate discounts for group purchases.

At least half of Dr. Nick Dragann’s family practice comes from the Old Order Amish, families who farm the broad fields of Lancaster County.

From Dragann, the Amish get homespun, quality medical care. From the Amish, Dragann gets patients who are prompt and pay cash.

Recognizing the success of doctors such as Dragann, a Lancaster hospital has fashioned a loosely structured health referral and payment program for the county’s plain people.

“Health care issues are touching everyone, and their community is not immune,” said Robert E. Lee, vice president for planning and marketing at Community Hospital of Lancaster.

The plan, which started in April, is not traditional health insurance, since Amish ways forbid taking out such policies. But it does incorporate one major element of managed care--discounts for large group purchases, even though these particular patients pay no premiums.

Community General was already in the good books of the 20,000-strong Old Order Amish, the region’s most conservative Anabaptist sect, because of its osteopathic approach to medicine, which focuses on the entire body’s interrelationships.

The patients receive all types of treatment, from vital obstetrics care for Amish women who typically have five or six children, to treatment for Maple Sugar Urine Disease, a rare blood sickness that strikes Amish children.

Hospital officials declined to discuss further specifics of the plan, citing competitive concerns.

“I’ve joked that I’ve had managed care for 20 years and each household has its own manager,” said Dragann, who sees about 125 patients a week, half of them Amish, at his office in Gordonville, 10 miles east of Lancaster.

“It just kind of fell in place. They don’t want to deal with anything governmental--anything that uses the word insurance--so we kind of approached it saying, ‘We want more of your business.’ ”

Lancaster County’s Amish have been self-insured longer than most health insurance has existed. Congregations traditionally offer “church aid,” earmarking part of their members’ tithes for health care and distributing money to ailing members.

The Amish are usually reluctant to discuss internal community matters with outsiders, but when Community Hospital President Mark C. Barabas approached a group of Amish bishops in March about provisions for their medical care, things clicked.

“I don’t think there are any barriers for using common-sense concepts when it comes to health care, to do what’s fair and what’s right for a particular constituency,” Barabas said.

“I think it sort of reflects the spirit of the times,” said Donald B. Kraybill, director of the Center for Anabaptist Studies at Elizabethtown College.

“Hospitals are looking for ways to develop loyalty, and the (Amish) objection historically has been to commercial health insurance, that it sort of merchandises your life,” Kraybill said. “This is a middle ground.”

Lou Gable, spokesman for the Hospital Assn. of Pennsylvania, said many hospitals in the state employ the same tactics in targeting different groups.

“It’s no different than what a lot of our hospitals do--direct contracting with self-insured groups, in most cases businesses,” Gable said.

Carlisle Hospital in central Pennsylvania has tried a similar discount approach with the less-conservative Mennonite population there, he said.

Administrators at Community Hospital, which serves 6,000 in-patients and 65,000 outpatients a year, hope the association with the Amish enhances both revenue and reputation.

“We’re not just the Amish hospital, but it certainly wouldn’t bother us if people thought of us that way,” Lee said. “Given their reputation for straightforwardness and solidity, that would be a very positive thing.”