Editor’s Note: This is the third part of a six-part series on the Healthy San Francisco program, which provides nearly universal health care for the city’s residents. Each part of the series will examine the program through the eyes of different people in the community, including a patient, a doctor who runs a clinic, two employers with different views of the program, and a hospital administrator. To see the entire series, go here.
By Richard C. Paddock
When the Healthy San Francisco program began three years ago, Dr. Kenneth Tai and his clinic on the edge of Chinatown were flooded with thousands of new patients. Many had serious health problems that had long been neglected.
Some patients had suffered debilitating strokes and were not receiving adequate care, said Dr. Tai, medical director of the North East Medical Services clinic. Others came in with pains they had ignored only to find they had cancer.
“We have quite a number of sick patients that have come through because of Healthy San Francisco,” he said. “A lot of patients with stroke and they can’t walk. Or cancer that was diagnosed because of Healthy San Francisco. They were not being cared for appropriately because of access issues.”
Today, more than a quarter of the clinic’s 40,000 patients are enrolled in San Francisco’s innovative health care program. Dr. Tai sees it as an important step in serving patients who had been unable to afford medical care.
“Healthy San Francisco is a great start toward a universal health care program,” he said. “Healthy San Francisco has enabled a lot of patients to sign up and not worry, ‘Will I be able to pay?’”
The North East Medical Services is a non-profit community clinic that began treating poor patients in Chinatown 38 years ago. It now has five locations.
NEMS, as it is known, was one of the first two Healthy San Francisco clinic sites. “It’s our mission to serve the underserved,” Dr. Tai said. “When Healthy San Francisco came along, that was the type of patient we were serving a lot of already.”
Dr. Tai, 35, became medical director a year ago and spends half his time as an administrator and half seeing patients. Most of the clinic doctors and staff are multilingual. Dr. Tai, who was born in Taiwan and grew up in Chicago, speaks Mandarin and Cantonese.
Of the 11,000 NEMS patients covered by Healthy San Francisco, about half are new to the clinic. The clinic receives a flat fee from the city for each patient and provides all primary care services, preventive care visits, urgent care, medications and lab work. Those with serious medical problems are referred to a hospital.
“Fiscally speaking, it is at best break even,” he said. “The reimbursement is definitely not high. We try to provide the best quality care without breaking the bank.”
In the early days, the clinic was overwhelmed with Healthy San Francisco patients eager to see a doctor. Many were so happy with the free service, they returned frequently. To reduce the crowds, NEMS began requiring a $5 co-payment for the poorest patients and $10 for those with higher income.
“Once patients get their universal access program, the demand is very great,” Dr. Tai said. “They all want to come and see a doctor.”
The clinic also has expanded rapidly. In the past year, it has hired a dozen new doctors. Using federal stimulus money, it added 10 exam rooms to its main clinic on Stockton Street.
With the city program, Dr. Tai sees a shift towards prevention, which experts hope will contribute to a healthier community and reduce medical care costs.
“It’s really going from a paradigm of taking care of the sick to a model that tries to prevent people from getting sick,” he said. “That’s where we are heading with Healthy San Francisco and where we are heading as a nation. We are very excited about that.”
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