potrero view

April 2009

Healthy San Franciscans Find a Home at San Francisco General Hospital

By Herman Wong

 Federico Lauchengco represents the best of what Healthy San Francisco (HSF), the City’s universal health care program, hopes to achieve.  Last year the 54 year old enrolled in the program, and began receiving regular checkups at San Francisco General Hospital (SFGH).  Lauchengco’s cholesterol level and blood pressure were tested for the first time since he immigrated to the United States five years ago. His sister, Elvira Lazaro, who accompanied Lauchengco to the hospital, said HSF represented security against the unpredictability of illness.  “There’s a place to go if he is sick,” Lazaro said.  “It makes him feel secure that if anything ever happened he has a place to go.”

As of last month, a year and a half after its launch, HSF had enrolled more than 37,000 participants, providing health care access to roughly half of the City’s previously uninsured residents.  In February the program expanded its eligibility requirements, offering access to San Franciscans who make as much as 500 percent of the federal poverty level, about $54,000 for an individual or $110,000 for a family of four.  Up to 12,000 currently uninsured City residents fall into this category.

Under HSF, participants select a clinic or medical home to receive care.  SFGH is the second largest provider in HSF’s network of 31 clinics, which also includes the Potrero Hill and Southeast Health Centers.  Through three of its clinics, SFGH provides care to one-fifth of HSF participants, roughly 7,400 people.  Doctors at the hospital say that they’re seeing more patients, different patients, and, increasingly, patients seeking long-term, preventive care.   

But the program faces growing pains.  Anecdotal evidence indicates that wait times for care have lengthened. And the economic downturn threatens to swell the number of uninsured while further reducing City revenues.  “People are working harder with less right now,” said Dr. Hali Hammer, director of SFGH’s Family Health Center, which provides care to 11 percent of all HSF participants. “But I think we all feel really good to be part of this innovative new system and just hope that once it’s clear that when we need more resources we will be able to get them.”

The number of patients seeking care at the Family Health Center rose from 9,000 to 10,000 within the last year, Hammer said.  Most of the increase is due to HSF participants.  Of the 1,500 HSF members who chose the Family Health Center as their primary care provider, upwards of one-third have already come into the center for services.  The Family Health Center began offering evening hours in October 2007 to help accommodate the new patient load.

SFGH doctors say that they’re seeing a younger, previously uninsured, population that has traditionally eschewed regular check-ups as a way of avoiding what was seen as an unnecessary cost.  Individuals with chronic diseases, like diabetes or hypertension, are also coming in for regular care rather than just when symptoms flare. “Before there was more episodic care, but with HSF people can come in for regular, preventative care” said Dr. Ronald Labugeun, assistant medical director of SFGH’s urgent care center.  Nearly one in four HSF patients have a chronic illness.  During the program’s first 18 months, more than half of all participants sought primary or specialty care.  

HSF has been criticized recently for its increasing wait times. At SFGH, staff say that it takes longer to schedule specialty services, like x-rays.  And patients face delays in obtaining their first appointments at the Family Health Center. “It takes three months to get into primary care, where before it was more like six weeks” said Dr. Stephanie Tache, attending staff at the Center.

Tangerine Brigham, director of HSF, says that without comparable historical data to judge past patterns, it’s too early to speculate on whether the program has prompted patients to tap into previously unused services.  “We don’t have a baseline.  We don’t know if [usage patterns] are because of the system,” Brigham said.  Roland Pickens, SFGH senior associate administrator, says most of the hospital’s HSF patients are receiving the same care they’ve always obtained. “They are going to the same clinics and the same doctors,”  Pickens said.  He also denies that wait times have increased, saying that patient numbers have remained largely the same because most HSF participants had been using the hospital already. “Right now we’re holding steady in terms of volume,” Pickens said. About 76 percent of HSF participants have previously relied on the public health system.

SFGH doesn’t separately track the amount of county money it receives for uninsured patients, which is included in its overall budget. In 2008, 41 percent of the previously uninsured patients who came through SFGH were enrolled in HSF.  This fiscal year the program cost $113 million – $80 million after revenues are netted out – almost triple the previous year’s $45 million, when the program was just getting started.  HSF’s Brigham says that her staff is paying close attention to patient numbers and how much more the program’s clinic network can bear. “What we don’t want to happen is for people to actually get enrolled into the program and not be able to access services,” Brigham said.  

With the deep decline in tax revenues, the City has asked the Department of Public Health to trim $100 million from its budget, resulting in layoffs, staff reassignments, and hiring freezes at SFGH.   The Family Health Center has lost a nurse practitioner and is training a new set of clerks after their old ones were reassigned to another hospital unit.  

According to SFGH’s Pickens, the hospital has the resources to manage patient demand, though he’s unsure how the recent program eligibility expansion will affect patient levels.  Significant increases in HSF’s population could cause problems.  “I would be concerned if there were a desire to expand it beyond the people that it’s already expanded to,” Pickens said.  “I don’t think we would have enough resources.  I think we would need more then.”

Yet in the midst of these uncertainties are stories that the system is working, said Hammer.  Recently a man who hadn’t seen a doctor in years came into SFGH’s urgent care clinic with debilitating chest pains.  Hospital staff checked him out, decided he didn’t have a heart attack but still set him up for on-going care, as a HSF member.  “Now he’s a patient of ours,” Hammer said.  “Now he has his medical home.  And I don’t think that would have happened before.”

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