Dear all: Back in my public health days, often the determination of costs for services was based on analyses of "willingness to pay". This could vary widely from culture to culture. Sometimes free services were found to not be as valued by the target population as services that charged a nominal fee. I think it is important to realize that running groups are not always necessarily free - there are the costs of the facility - rental fees, utilities, etc, and the salary costs of the person running the group. When I worked at Elizabeth Seton before it closed, they took a fair number of Medicaid clients. These clients were covered for as many lactation consultant visits as needed. Our "Mommy and Me" groups and our "Breastfeeding Support Groups" were on a suggested donation basis which worked quite well. Suggested donations were $5 - $10 and we generally covered the salary costs. Women who didn't contribute often just forgot to bring money along. There didn't seem to be any correlation between income and donations. In fact, I have noticed the same phenomenon with my private clients - income does not seem to bear any relationship to their perception of the fee. For those without insurance or on Medicaid, I always tell them what my fees are, what Elizabeth Seton used to get from Medicaid when I had a mechanism for Medicaid billing and then ask them to pay what they feel comfortable paying. The range that they have decided to pay is $60-$100. Here in Manhattan, I actually have discovered that there is a small subsegment of my medicaid clients who are middle class, but opt to use medicaid for insurance - living in gorgeous huge apartments that they probably bought at a very low price and renovated themselves. Sort of gives me pause when we write our checks for our health insurance which is higher than our rent because both my husband and I are self-employed and we live in a rent stabilized dilapidated pre WWI building. Now that the educators from Elizabeth Seton have joined Realbirth, there is more of an incentive to make sure it works financially - so our fees for groups are $10. I haven't heard any complaints. So, from my experience, both the suggested donation basis and the flat nominal fee work well. Perhaps a flat fee with a sliding scale for extremely destitute clients would work as well and help out the truly destitute clients. Best, Susan Burger *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html