Coordination and prevention improve care, but as businesses resist, some costs are borne by one-time grants and struggling clinics
Four years ago, San Francisco launched a grand experiment, becoming the first city in the nation to offer comprehensive health care to its growing ranks of uninsured. Stitching together two-dozen neighborhood health clinics and an array of hospitals, the city bet that two reforms — emphasis on primary care and a common electronic enrollment system — could improve outcomes and buffer the city against soaring health care costs. By many measures, San Francisco’s effort to provide universal health care has been a huge success. The initiative, Healthy San Francisco, has over time treated more than 100,000 city residents. But the city’s grand plan has not solved the central problem dogging health care across the country: figuring out who pays for it.
Clinics scramble for money to switch to electronic health records
The San Francisco Department of Public Health says it is ahead of the curve in rolling out databases that keep tabs on tens of thousands of patients across a citywide network of clinics and hospitals. The rollout is needed not just to make a local form of “universal health care” work, but also to meet a 2014 deadline under national health reform. And the city says it spent just $3.4 million on new patient-tracking technology. Not bad for an unprecedented charity care initiative whose total budget has grown to $177 million just this past year. But while clinics and hospitals across the city are now linked up to a common intake tool that eliminates overbilling and duplicated medical appointments, that is only the first step in making the Healthy San Francisco program successful, directors of local health centers and technology experts say. A separate and much more complex piece of technology — electronic health records — is proving difficult and expensive.
Customer service is a problem as patient load continues to grow
Most participants in Healthy San Francisco, the city’s 2007 initiative to expand care to more than 50,000 uninsured patients, appreciate the overall access to preventative care and treatment for chronic health conditions. A 2009 survey showed that more than nine in 10 are “very” or “somewhat” satisfied with the program. Patients cite the affordability of the program and the quality of care they receive from the health care practitioners. But program participants and medical care providers also note the inconsistency in the services they receive under Healthy San Francisco.
Unintended consequences of city’s effort at universal health care
A San Francisco requirement that businesses pay for their employees’ health needs has led to more workers having some form of health care. But after businesses initially stepped up to buy private health insurance for more of their workers, there has been a steady retreat. Since 2008, a growing percentage of employers have ditched private insurance for a cheaper way of meeting the law’s requirements: city-engineered reimbursement accounts, which cost companies half or less what they previously paid for traditional insurance.
It’s been almost five years since San Francisco launched its innovative, universal health plan — Healthy San Francisco — and last night a panel of public health experts and care providers gathered at the Tenderloin’s Glide Foundation to provide a snapshot of how the program is faring. The panel was co-sponsored by the San Francisco Public Press (which produced a team reporting project on Healthy San Francisco in the Winter print edition and online), Glide and the UC Berkeley School of Public Health.
Healthy SF growing costs and demographic information in a graphic by Tom Guffey
A version of this story appeared in the Spring 2012 print edition of the San Francisco Public Press.
It’s no wonder there is a hue and cry about an uneven playing field among businesses as they comply with San Francisco’s Health Care Security Ordinance. The law requires most employers to provide health care benefits to workers who put in at least eight hours a week. But an analysis of compliance reports submitted by 15 randomly selected employers to the city’s Labor Standards Enforcement Office finds that they spent wildly different amounts on health benefits per employee in 2010, the most recent year reported.
Local, state officials must develop new models for care by 2014
This story appeared in the Spring 2012 print edition of the San Francisco Public Press.
San Francisco’s experiment in universal health care, which grew over the last five years to cover an estimated 85 percent of the city’s uninsured, may need to partly return to its origin as a network of safety net clinics and hospitals for the poor as national reforms syphon off middle-class patients. Healthy San Francisco provides medical services to more than 50,000 city residents. But the program could take a financial blow within the next two years as cities and counties adapt to national health reform.
San Francisco’s civil grand jury on Thursday chastised many of the city’s restaurants for profiting from surcharges they add to customers’ bills under the name of paying for health care and recommended that the city ban the practice.
Government shutdown temporarily aside, effective Jan. 1, 2014, most people need to carry health insurance or pay a fine. It’s called the “individual mandate.” If you’re signed up with Healthy San Francisco, there’s one very important thing you need to know: Healthy San Francisco is not health insurance. So, it’s not going to get you off the hook for that individual mandate.
San Francisco is offering a new, subsidized plan and expanding Healthy San Francisco for city residents who need — but cannot afford — health insurance.
Ten years after it was launched, Healthy San Francisco today predominantly serves Spanish speakers and people living in the city’s southeast neighborhoods. Because some clients may be here illegally, city officials have vowed to shield them if the Trump administration launches a deportation campaign.
California appears to be successfully implementing the Affordable Care Act. Insurers are staying in the exchanges and prices are relatively stable.