Potrero View: Healthy San Franciscans Find a Home at San Francisco General Hospital

Healthy San Franciscans Find a Home at San Francisco General Hospital

By Herman Wong

Federico Lauchengco represents the best of what Healthy San Francisco, 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.  For the first time since he immigrated to the United States five years ago Lauchengco had his cholesterol level and blood pressure tested. His sister, Elvira Lazaro, who accompanied Lauchengco to the hospital, said Healthy San Francisco 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, Healthy San Francisco had 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 of the City’s currently uninsured residents fall into this category.

Under Healthy San Francisco, participants select a clinic, or medical home, to receive care.  SF General is the second largest provider in Healthy San Francisco’s network of 31 clinics, which also includes the Potrero Hill and South East Health Centers.  Through three of its clinics, SFGH provides care to one-fifth of Healthy San Francisco 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 also 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 also forcing the city to cutting budgets, even at the hospital.  “People are working harder with less right now,” said Dr. Hali Hammer, director of SF General’s Family Health Center, which provides care to 11 percent of all Healthy San Francisco 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 Healthy San Francisco participants.  Of the 1,500 new patients who enrolled in HSF since the program began and chose the Family Health Center as their primary care provider, upwards of one-third have already come in for service.  The Family Health Center began offering evening hours in October 2007, which has helped absorb some of the new patient load.

Doctors at SF General 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 only went symptoms flare. “Before there was more episodic care, but with Healthy San Francisco people can come in for regular, preventative care,” said Dr. Ronald Labugeun, assistant medical director of SF General’s urgent care center.  Nearly one in four Healthy San Francisco patients have a chronic illness, according to Healthy San Francisco statistics.  During the program’s first 18 months, more than half of all participants sought primary or specialty care.

Healthy San Francisco has been criticized recently for its increasing wait times for care. At SF General, 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 Healthy San Francisco, says that without comparable historical data to judge past patterns, it is too early to speculate on whether patients have tapped into previously unused services because of the program.  “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 Healthy San Francisco patients at SF General are receiving the same care they have always received. “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 Healthy San Francisco participants had been using the hospital already. “Right now we’re holding steady in terms of volume,” Pickens said. About 76 percent of Healthy San Francisco participants have previously relied on the public health system, according to program statistics.

SF General does not separately track the amount of county money it receives for uninsured patients, which is included in its overall budget, said hospital spokesperson Rachel Kagan. In 2008, 41 percent of the previously uninsured patients who came through SF General were enrolled in Healthy San Francisco.  This fiscal year the program cost $113 million, almost triple the previous year’s $45 million, when the program was getting started.  Healthy San Francisco’s Brigham says that her staff is paying close attention to patient numbers and how much more their 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 tax revenue dropping, 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 must train a new set of clerks after their old ones were reassigned to another section of the hospital, said Hammer.

According to SF General’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 Healthy San Francisco’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 SF General’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 Healthy San Francisco 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.”