Volunteer low-risk outpatient surgery for uninsured patients in San Francisco. The Ambulatory Surgery Access Coalition
W. P. Schecter, D. Grey, J. Burik, C. Caldwell, D. Elder, P. Neumann and P. Hofmann
Department of Surgery, University of California, San Francisco, USA.
OBJECTIVE: To provide uncompensated elective low-risk outpatient surgery
for uninsured patients through a coalition of volunteer physicians, nurses,
and hospitals. DESIGN: Description of the process of establishing the
Ambulatory Surgery Access Coalition (ASAC), the political and
administrative obstacles encountered, and the clinical results of treatment
of the first 25 patients in the pilot project. SETTING: The ASAC includes
the Kaiser Foundation Hospital, San Francisco, Calif, the University of
California, San Francisco, the San Francisco General Hospital (SFGH), the
San Francisco Department of Public Health, the San Francisco Consortium of
Community Clinics, the Northern California Chapter of the American College
of Surgeons, and the San Francisco Medical Society. A pilot program of
uncompensated outpatient surgery was performed at the Kaiser Foundation
Hospital. PATIENTS: Twenty-nine patients were referred to the ASAC between
January 1 and November 1, 1994. Twenty-six patients were judged to be
candidates for surgery, and 25 patients met the criteria for the ASAC
program. One patient was referred to SFGH for treatment because of a
perceived increased risk for hospitalization after surgery. RESULTS:
Twenty-one patients underwent herniorrhaphy; three, excision of large
inclusion cysts; and one, anal fistulotomy. Seventeen procedures were done
under local anesthesia, seven under general anesthesia, and one under
spinal anesthesia. None of the patients required hospital admission. No
wound infections occurred. CONCLUSION: The ASAC successfully provided
uncompensated low-risk outpatient surgery to 25 low-income uninsured
patients in San Francisco. The coalition hopes, first, to include other San
Francisco hospitals and surgical specialties, and second, to serve as a
model for other communities throughout the country.
