Catholic Healthcare West co-led the task force that designed the nation's only public health care option for uninsured residents. It's not insurance in the traditional sense; it uses the medical home model to ensure that care is available (including hospitalizations) to all who need it.
The New York Times recently published a Q&A with William Dow, a health economics professor at the University of California, Berkeley, who is studying Healthy San Francisco. Here are a few excerpts:
Q. Healthy San Francisco is not a single-payer system, but it does seem to offer much more than is available to the uninsured in most U.S. cities. What were the origins of this program?
A. It was an initiative of Mayor Gavin Newsom and the San Francisco Board of Supervisors to provide universal access to health care for the uninsured.
Q. Has it done that?
A. There were about 60,000 uninsured adults in the city when Healthy San Francisco came into effect in July 2007. Since then, 45,000 have signed up.
Q. To be clear, this isn’t insurance per se.
A. No. The city is careful not to call it health insurance. It provides access only to health care within San Francisco and only at a specified set of providers, mostly safety-net providers. If you get sick outside the city, you’re in trouble. It’s more like an insurance plan with a geographically restricted network.
It started by covering only those under the poverty line. Then in January 2008, it expanded to those making up to 300 percent of the poverty level. Now that’s been extended to 500 percent of the poverty level, which qualifies the vast majority of uninsured individuals in the city. Five hundred percent would work out to an income of about $54,000 for an individual, or $110,000 for a family.
Q. What kind of fees do people have to pay to participate?
A. There is a participant fee, which is like a premium. Under 100 percent of the poverty line, you pay no participant fee. The next group — 100 to 200 percent of poverty — pay $60 per quarter, or $240 a year. That’s for an individual. It’s capped, so that no family has to pay more than 5 percent of income.
In addition, there is a co-pay of $10 for general care, $20 for specialty care, $5 for prescription drugs on the formulary, or $25 for those not on the formulary. For hospital admission, you have to pay $200. It’s not huge, but for those with the lowest income, it’s not trivial, so those under the poverty line are exempted from the co-pays.
Q. Are enrollees happy with the program?
A. The Kaiser Family Foundation did a survey and found people think they’re better off than they were before. Overall, 94 percent said they were satisfied with the program, which is quite impressive. But some of those people aren’t well informed about program restrictions. For example, about one-third did not know that the program does not provide access to care outside of San Francisco.
Q. How’s the quality of care?
A. The providers give high quality medical care. But the typical health-care user doesn’t rate health care on adherence to evidence-based medicine or the latest medical guidelines. They have different patient satisfaction metrics. The public has a perception that safety-net providers are lower quality because they have longer queues for service and a particular demographic uses them. These aren’t facilities that have invested in soaring atriums and beautiful physical plants. So the city is pleased that a few private providers, such as Kaiser Permanente, have now agreed to join the provider network.
Q. This obviously is a different type of public option than we’re discussing on the federal level. Do you see it as an alternative?
A. I’ve made the argument for that. The current versions of the public option in Congress are threatening to insurers. If a public option were designed to be attractive only to the lowest income individuals, it would be much less threatening to the health care industry. This could easily be accomplished by giving anyone the public option of buying into their state Medicaid program. It’s a very sensible way to craft a compromise around a public option, but it’s not gotten much traction at this point. Public-option supporters haven’t wanted to backpedal to something like this, but I fear that lower-income folks will lose out if we let the perfect be the enemy of the good.
Excellent Article. The answers to the questions are explained in a great way. I had learned lot of this thing like Quality of care from this article.
Posted by: discount supplements | November 01, 2009 at 08:12 PM