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Charity-care patients rise in San Francisco; new demographic data shows concentration in lower-income neighborhoods
Summary
A combined 2018–2019 charity-care report presented April 6 showed a roughly 51% increase in charity-care patients over two years, driven mainly by traditional charity-care (not Healthy San Francisco) and concentrated among Hispanic/Latinx and Black patients and people experiencing homelessness.
The San Francisco Department of Public Health presented a combined 2018–2019 charity-care report to the Health Commission on April 6 that found increases in the number of patients receiving charity care for the first time since implementation of the Affordable Care Act.
Presenter Max Gara said the number of charity-care patients rose by about 51% over the two-year span covered by the report. Expenditures tied to charity care rose approximately 37% and Medi-Cal reimbursement shortfalls increased roughly 23% in the period, according to the presentation. Gara said those trends were driven primarily by traditional charity-care patients rather than participants in the city’s Healthy San Francisco access program.
For the first time, hospitals provided additional demographic data for traditional charity-care patients: the report shows that recipients are disproportionately Hispanic/Latinx and Black/African American compared with the city population and that about 15% of patients were homeless or had unknown addresses. Gara noted that Zuckerberg San Francisco General remains the largest provider of charity care in the city, accounting for roughly 59% of expenditures and about 61% of patients served.
Hospital representatives and commissioners discussed possible drivers for the increases, including expanded hospital service volumes, rising health-care prices (presenter cited a ~7% increase), longer inpatient stays due to placement difficulties, and a February 2019 policy change at ZSFG that ended certain patient balance billing and expanded eligibility for discounts.
Commissioners asked about access to and readability of charity-care application forms and about verifying that patients receive clear notifications about the availability of charity care. Presenter Gara said hospitals had been engaged in drafting the report and that DPH conducts periodic on-site (or, due to the pandemic, electronic) compliance reviews of notification requirements.
The commission accepted the report and thanked hospital partners for providing the new demographic data, which commissioners said will help target equity efforts.
