VOLUNTEER LOW-RISK OUTPATIENT SURGERY FOR UNINSURED PATIENTS IN SAN-FRANCISCO - THE AMBULATORY SURGERY ACCESS COALITION

Objective: To provide uncompensated elective low-risk outpatient surge ry for uninsured patients through a coalition of volunteer physicians, nurses, and hospitals. Design: Description of the process of establis hing the Ambulatory Surgery Access Coalition (ASAC), the political and administrative obstacles encountered, and the clinical results of tre atment of the first 25 patients in the pilot project. Setting: The ASA C includes the Kaiser Foundation Hospital, San Francisco, Calif, the U niversity of California, San Francisco, the San Francisco General Hosp ital (SFGH), the San Francisco Department of Public Health, the San Fr ancisco Consortium of Community Clinics, the Northern California Chapt er of the American College of Surgeons, and the San Francisco Medical Society. A pilot program of uncompensated outpatient surgery was perfo rmed at the Kaiser Foundation Hospital. Patients: Twenty-nine patients were referred to the ASAC between January 1 and November 1, 1994. Twe nty-six patients were judged to be candidates for surgery, and 25 pati ents met the criteria for the ASAC program. One patient was referred t o SFGH for treatment because of a perceived increased risk for hospita lization after surgery. Results: Twenty-one patients underwent hernior rhaphy; three, excision of large inclusion cysts; and one, anal fistul otomy. Seventeen procedures were done under local anesthesia, seven un der general anesthesia, and one under spinal anesthesia. None of the p atients required hospital admission. No wound infections occurred. Con clusion: The ASAC successfully provided uncompensated low-risk outpati ent surgery to 25 low-income uninsured patients in San Francisco. The coalition hopes, first, to include other San Francisco hospitals and s urgical specialties, and second, to serve as a model for other communi ties throughout the country.