How Sliding-Scale Pricing Models Are Making Health and Wellness Services More Accessible

Wellness has a reputation for being pricey. Sliding-scale or pay-what-you-can models are changing the narrative and making well-being more affordable to all.

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In-person wellness offerings can cost a pretty penny. While you may find the occasional donation-based yoga class, it's far more likely that you'll stumble into a $30-plus spin class (shoe rentals not included) or a day spa that charges $100 for a 30-minute massage. It may seem like NBD to drop that much cash in the name of health and self-care, but these premium costs can add up — and prevent many people from accessing them.

One way companies are making wellness accessible for all? Establishing sliding-scale pricing models, which allow customers and clients to pay what they can for the fitness, nutrition, and health services and treatments they need.

Here, experts break down what a sliding-scale payment model looks like and how to use them to ensure you don't have to choose between supporting your well-being and racking up a major credit card bill. Plus, find out exactly how this pricing model is making wellness more affordable to those who need it most.

What Is a Sliding-Scale Pricing Model?

In case you're unfamiliar with sliding-scale payment methods, the idea is that the customer or client has a say in what they pay for a given service — be it an acupuncture treatment, HIIT class, therapy session, or appointment with a primary care doctor. At East River Pilates, for example, a regular mat class will run you $25, but the New York City-based studio also offers weekly Community Classes that are priced with a sliding-scale model: When signing up for a session, you can choose to pay anywhere from $10 to $25. In other words, you'll get to determine the price point that makes sense for your budget within a given range, and that can feel like an empowering step in your wellness journey.

While East River Pilates' pay-what-you-can model is open to anyone who feels tight on cash, some studios and health centers do have applications and other eligibility requirements that must be met in order to access lower-priced services. You may be asked to provide proof of income via pay stubs — as is the case for medical and dental care at El Rio Health in Tuscon, Arizona — or fill out a questionnaire about your budget, wellness goals, and financial need, which is required for Current Wellness Raleigh's yoga and fitness classes, for instance. Based on that info, the provider may then recommend you pay a certain amount; at Current Wellness Raleigh, individuals earning less than the county's living wage are suggested to pay 5 to 50 percent of the membership or class-pack prices. (BTW, these health centers and businesses are often able to offer discounted classes and services thanks to donors and members who choose to pay more than the suggested price, as well as federal grants.)

The Impact of Sliding-Scale Pricing Models

Given their high price tag, wellness-promoting activities and services aren't readily available and accessible for all. Peer-reviewed studies digging into how much money folks spend on their health are few and far between, but some reports suggest that accessing health and well-being services is no cheap feat. In fact, the average consumer spends about $125 a month on fitness expenses, and about 40 percent of millennial and Gen Z individuals have been in credit card debt due to wellness spending, according to a 2021 Lending Tree survey of more than 1,000 Americans. What's more, the average cost of health care in 2020 amounted to $12,530 per person, according to data from the U.S. Centers for Medicare & Medicaid Services.

While significant for any individual, these costs can disproportionally affect folks with lower incomes and prevent them from receiving and paying off care. These individuals often use fewer preventive care services, partly because they can't afford it, according to 2018 research published by the Commonwealth Fund, a private foundation supporting independent research on health care issues. What's more, low-income individuals are much more likely to report delaying care and having difficulty paying medical bills compared to higher-income people, according to the Commonwealth Fund. When going to the doctor for a check-up feels out of the budget, a pricey CrossFit class or therapy session likely does too.

And there can be serious health consequences when wellness offerings and health services are financially out of reach. One-fifth of low-income adults report their health to be fair or poor, compared to just five percent of higher-income adults, according to the Commonwealth Fund. (That said, access to health care isn't the only factor; being able to afford adequate housing, food, and child care can also play a role in one's health condition.) By the same token, not getting enough physical activity — which some individuals may be able to do only from the comfort and safety of gyms or fitness studios — can increase the risk of heart disease, type II diabetes, and high blood pressure, according to the Centers for Disease Control and Prevention. And without treatment, folks with mental health conditions may face disability, substance abuse, and a poor quality of life, as well as be at risk of suicide, according to the National Alliance on Mental Health California.

Luckily, some studios, gyms, and health centers are starting to wake up to the idea that payment options should be as diverse as their clientele, and they're offering a range of pricing options for services and memberships. In turn, they're setting the tone that wellness isn't just for people with endless disposable income; it's for everyone. Just look at Memphis Rox, a non-profit climbing gym in Memphis, Tennessee, that has offered a "pay-what-you-can" model since it first opened in 2018.

"We decided to do this [pricing model] because we wanted to create access to recreation and fitness to a community [of climbers] who couldn't afford it by traditional means," says Jon Hawk, Memphis Rox's director of gym operations. "Typically, rock climbing gyms cost $20 to $30 a day or $100 a month to participate. Our model allows people to either pay the 'suggested' day rate [of $12], which is already much cheaper than other climbing gyms, or they can pay less if they can't afford it." Memphis Rox doesn't require any proof of income to use the sliding-scale payment method, and folks who can't afford a membership — period — can also volunteer five hours a month to earn unlimited access to the facility.

Hawk has heard first-hand from members how impactful flexible wellness prices can be. "We have had hundreds of folks express how happy they were with the pay-what-you-can model because they would never have been able to experience rock climbing without it," he says.

Sarah Chase Natan, the founder of Brooklyn Acupuncture Project — a holistic medicine practice that offers sliding-scale pricing for acupuncture, herbal consultations, and cupping — echoes the impact of the unique payment model. "I am proud to say that Brooklyn Acupuncture Project has never turned anyone away from treatment for lack of funds. No matter where someone lands on the sliding scale, they receive the same services," she says. "This is a gesture of meeting people where they are and recognizing the fact that systems of society simply don't allow for all of us to thrive in the same way. Anyone seeking healing deserves to be met with dignity and respect regardless of what has been possible for them."

Plus, sliding-scale payment models offer community members who have greater means the opportunity to support the people around them, says Natan. "People who can pay more allow for those that need to pay less to come in, and it is a very beautiful thing to witness our shared humanity in action like that," she adds.

How to Utilize Sliding-Scale Payment Options

Looking for a yoga class that allows participants to pay what they can or a therapist who's flexible with pricing? Google will be your best friend. Most studios and wellness spaces that offer sliding-scale pricing models will advertise it directly on their pricing page, so do your research before you show up for a session. For low-cost or free health care, you can also reference the Health Resources Services Administration's directory, which features only health centers that have sliding-scale pricing options available, according to the U.S. Department of Health and Human Services. If the business or provider does offer pay-what-you-can or discounted services and treatments, read up on its eligibility requirements and any applications or forms you need to fill out beforehand. In some cases, you may need to call the business and speak with the service provider to go over the payment options available to you.

If the website is unclear and you're still unsure if a business offers sliding-scale or pay-what-you-can pricing options, just ask the providers themselves, says Melody Li, L.M.F.T., the founder of Inclusive Therapists, an online resource for finding mental health professionals who offer sliding-scale payment options. "I encourage folks needing sliding-scale options to ask boldly and to be transparent about their financial situation when interviewing with therapists they desire to work with," she says.

"How a therapist responds to your request will inform you about their values and practice. Many social justice-oriented therapists, such as those on the Inclusive Therapists directory, reserve a certain number of sliding scale spots in their practice. Those spots may fill up quickly, but some may have a waitlist, so it never hurts to ask." The same guidance applies when it comes to seeking out a fitness coach, dietitian, or other wellness professional: If you're looking for a discounted treatment or service, simply inquire about a pay-what-you-can option or if you can work out another payment schedule.

Hopefully, the more times a therapy practice, gym, or other wellness spot gets questions about sliding-scale pricing options, the more normalized these models will become. Everyone's budget for well-being spending rings up to a different dollar amount, and no one should be cut off from the health care, fitness activities, and even self-care practices they need because of it.

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