When one patient’s insurance benefits expired, he arranged to trade continued use of a pool for his work as a therapy assistant. (BIGSTOCK)

When Orly Avitzur first met the patient, a 59-year-old supermarket manager who had been injured years earlier in a fall at work, he had severe lower-back pain and was headed for spine surgery. He was 50 pounds overweight, had poorly controlled high blood pressure and was so out of shape that he was visibly short of breath.

Avitzur, who is medical adviser to Consumer Reports, recommended pool therapy, and the patient responded to it like the proverbial fish to water, shedding all his excess weight and experiencing periods of pain relief for the first time in years. But his insurance benefits for physical therapy ran out, and he couldn’t afford to continue. Avitzur suggested that he offer to help out as a therapy assistant in exchange for free use of the pool, and the pool manager accepted the deal.

Resorting to the age-old art of bartering has helped at least some of the nearly 49 million Americans who are uninsured and the millions more whose health benefits are so skimpy they often can’t afford care. (Happily, the situation for many of these people will change significantly in 2014, when the Affordable Care Act’s full implementation will give tens of millions of Americans access to comprehensive and affordable health insurance.)

Not just for country folks

Although historically more common in rural areas, where it was not unusual for doctors to be paid with chickens or cords of wood, bartering also happens in other settings. Avitzur has cared for a patient who traded his carpentry skills for physical therapy sessions and heard stories from colleagues who exchanged their services for those of contractors, electricians, hairdressers and even a chimney sweep.

While many deals between doctors and patients are one-to-one trades, organized barter exchanges appear to be growing. In Kingston, N.Y., the annual O+ Festival features performances by about 40 bands and exhibitions by dozens of artists who receive medical services over the course of a weekend. (This year’s festival is scheduled for Oct. 11-13, with an encore in San Francisco in November.) The festival doesn’t offer health care directly, but it serves as an intermediary. It hooks up artists with health services including general physicals; dental exams; testing for blood pressure, hearing and vision; and psychological screenings along with vouchers for follow-up visits.

In New York, Lincoln Medical and Mental Health Center allows eligible artists — actors, dancers, musicians, poets, writers and anyone else making a living through a creative means — to barter their services for doctor visits, lab tests, hospitalizations, emergency care, medical and surgical procedures, dental care, prescriptions and other services. A similar program has been in effect since 2005 at Woodhull Hospital in Brooklyn.

In Arkansas, the Bono Barter Clinic advertises that it will let you barter for health care with “something that you’ve made, grown, or produced, or a service that you provide.” At Maple City Health Care Center in Goshen, Ind., patients who can’t afford to pay for their medical care can instead volunteer their time at community organizations.

Bartering tips

If you want to take part in a medical barter, here are some suggestions on how to do it safely and legally:

●As with any medical service, make sure the doctor’s or clinic’s credentials are in order.

●Negotiate appropriate fees and make sure values are equal on both sides of the trade.

●Put your agreement in writing and keep track of all your transactions.

●Barter dollars are identical to real dollars for tax reporting. If you conduct any direct barter for products or services, you’ll have to report the fair market value of the deal you received on your tax return.

●If you’re in a business or trade, you might be able to deduct certain costs you incur to do the work that was bartered. Check with your tax preparer for details.

Copyright 2013. Consumers Union of United States Inc.

For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.