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Charity‑care report: citywide patient counts rose while hospital trends varied
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Summary
DPH presented a FY2019–2021 charity‑care report showing a 13% increase in charity‑care patients and a 19% increase in expenditures citywide; ZSFG and UCSF drove the net rise through policy changes while several hospitals saw decreases related to COVID‑era utilization and coverage gains.
Max Gara, senior health program planner, presented the San Francisco Department of Public Health’s combined FY2019–2021 charity‑care report to the Health Commission.
Gara summarized the ordinance framework (San Francisco’s 2001 charity‑care ordinance requires hospital reporting), explained that eight hospitals submitted data, and described several drivers behind observed trends. Citywide, the number of unduplicated charity‑care patients increased roughly 13% between the pre‑pandemic baseline and the combined 2019–2021 reporting window; charity‑care expenditures rose about 19% over the same span.
Important nuance: Two large providers — Zuckerberg San Francisco General (ZSFG) and UCSF — accounted for much of the citywide increase. ZSFG changed its charity‑care and discount policies in February 2019 to add protections that ended patient balance billing; UCSF began applying charity‑care adjustments proactively in 2021 without requiring patient applications. Those policy shifts increased documented charity‑care counts at those hospitals. Several other hospitals recorded decreases over the period, likely driven by pandemic‑related declines in utilization and temporary increases in insurance coverage due to pandemic policies.
Why it matters: Charity care continues to serve a mix of uninsured patients and insured people unable to afford care; data in the report show higher representation of Hispanic/Latinx and Black patients among charity‑care recipients and concentration in lower‑income supervisorial districts (Tenderloin, SoMa, Bayview). Gara said the department will continue refining metrics — including cost‑to‑net‑patient‑revenue ratios and charity‑care‑to‑operating‑expense measures — to compare hospitals more accurately.
Next steps: The department will track changes as pandemic policy unwinding proceeds (Medi‑Cal redeterminations and potential disenrollments), evaluate additional metrics requested by the commission, and monitor how state law changes requiring automatic financial‑assistance notices affect charity‑care requests.
