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My father would see Amish patients, who would often have no currency with which to pay him for his time. Dad would, however, take that into consideration, and we would often as a family find ourselves with a half a pig, cow, or other something to pay for his medical time. That worked not just for the Amish, but for some of the poor in the same area who needed to see a doctor, but just couldn't afford it. The whole area is farming, so we would get produce and meat all the time.
That doesn't really contribute to the overall discussion, but Ustwo talking about adjusting fees reminded me of my childhood.
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