Wp. Schecter et al., VOLUNTEER LOW-RISK OUTPATIENT SURGERY FOR UNINSURED PATIENTS IN SAN-FRANCISCO - THE AMBULATORY SURGERY ACCESS COALITION, Archives of surgery, 130(7), 1995, pp. 778-780
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.