As millions of Americans struggle in the worst economic times since the Great Depression, keeping up with rising healthcare costs has become an all-too-common problem.

Low-income residents in the northeastern state of Maine who do not have insurance, however, have found a novel way of getting access to healthcare services: they earn time credits which can be exchanged for time with a doctor by doing yard work or other everyday chores.

To find out more, I joined midwife Lindsay Bushnell as she arrived at Abbey Morgan's apartment, on the outskirts of the city of Portland. Bushnell was there to carry out a routine check-up on Morgan, whose baby is due in May.

She is paid for her services partly in cash, and partly in time credits that she will exchange for healthcare for her own toddler, Solomon.

"I spend my time to help other people with their pre-natal and birth and post-partum care, so I'm giving that to someone and then in return receiving healthcare for my child. So it feels really balanced," she told me.

Alternative system

I travelled with Lindsay and 18-month-old Solomon to the True North Clinic in Falmouth, to the north of Portland.

Lindsay says that by exchanging the time credits at True North, she and Solomon get to see her first choice of paediatric nurse practitioner.  It is a visit she would not be able to afford if she had to find the money herself, she says.

True North has around 30 patients who get healthcare using this alternative monetary system.

While politicians in Washington continue to argue over the future direction of US healthcare, True North and clinics like it in Maine and elsewhere across the US feel they are making a difference to the lives of people who need healthcare at the community level.

Patients earn their time credits from the Portland Hours Exchange, mostly by working a variety of odd jobs, like raking leaves or driving the elderly.

Dignity of patients

Dr Bethany Hays, the medical director at the hospital, says exchanging time credits for healthcare preserves the dignity of patients with limited or non-existent insurance.

"You watch them kind of blossom as they learn that they are people of value in the community, they have something of value to offer and that what they have of value to offer can be converted into a monetary system that then allows them to go out and purchase what they need.  In this case healthcare," she said.

The clinic puts the time credits it takes in from patients to help run the office,  exchanging them with someone who will water the plants in the office, or help with paperwork.

At the end of his visit to True North, young Solomon passed his check-up with flying colours.

His mother, meanwhile, is just happy that the time credits she earned mean her son is cared for by her first-choice doctor ... without breaking the family's bank.