Standing in line under flickering florescent lights, patients of various ages and cultures wait around, trying to get any information they can. "We're on lunch, don't ya see the sign?" a woman walking by in scrubs hisses as her co-worker smiles towards the crowd. One man groans in pain and leans against the wall for support while his right hand grips a plastic bag with a box of golf balls. His right foot is wrapped with a makeshift bandage.

"It's been a long time since I've seen you," says a nurse to a woman who joins the crowd. "I like your new hairstyle." The nurses take their spots behind the counter and their afternoon begins. The patients wait in line to see the nurse. Once they reach the front, she tells them they must wait in a different line before returning to the one they are now in, which is growing larger by the minute. When they register, they hand over a gold card that is swiped to bring up their information. The card provides information about health care providers, if any, and health history within the walls of General Hospital. The patients then return to the first line. Some bicker over where they were in line before they had to go register.

After the patients check-in with the nurses, a doctor sees them in a confusing order and the worst case patient is taken in first. They also try to follow the order of check-in. If you are not too badly hurt and registered somewhere toward the middle of the line, you may spend hours in the cold, noisy waiting room. Long lines and waiting for hours is not the solution for everyone using Healthy San Francisco. It is usually for those with emergencies who cannot get an appointment at their medical home. "Your medical home is the place (in most cases a clinic) where you will go for your basic medical care. Your medical home is the first place you should call when you need care. General Hospital is the main medical home and treatment center for program participants and serves over 80,000 patients a day," says The Healthy SF Medical Home Directory.

Many people first joining Healthy San Francisco have not been able to see doctors at their medical homes because the clinics are booked for months. This is due to the growing number of participants in the program, currently 54,036.
"There needs to be something to expedite the initial step of getting seen by a doctor. Lots of people don't think about health care until they need it and with this program you can't necessarily get care right away," said Charlie Pravel, a program participant. Pravel recently needed medical attention and found himself without insurance. The people at San Francisco General Hospital (SFGH) helped him figure out how to enroll in Healthy SF. Pravel had to set up a home location once he was enrolled. He needed to see a doctor while waiting a month for his visit.

There are an estimated sixty to seventy thousand people without health insurance living in San Francisco. Healthy SF is the city's solution for the thousands of uninsured residents. It allows program participants to get medical care ahead as well as when they need it. Participants pay a quarterly fee, depending on their income and expenses, and some may pay co-pays for emergency visits and prescriptions.

In order to enroll in the program, you must make less than $54,150 a year. Other requirements include being a San Francisco resident, uninsured for ninety days or more, between the ages of eighteen and sixty-four, and ineligible for Medi-Cal or any other similar public insurance programs. To check your status you can visit their website at Healthysf.org.


Pravel had to return to SFGH and spent hours being sent from clinic to clinic throughout the hospital. The hospital is under construction with makeshift desks and partitions lining the halls. Many patients wait in long lines only to find out they must go downstairs and pay first then return to the line they were in. There is a general consensus among them that things would be much easier if there were signs around saying 'pay first' or 'register before seeing a nurse."

There is a co-pay for Healthy SF participants choosing to seek emergency medical attention in the hospital rather than at their medical home. The amount of co-pay depends on your status as a member of the program.


"The first thing you do when you enroll is choose your home clinic, they explain emergency care options, review your income and assets, and assess what price bracket you're going to be in, and then you're out of there," Pravel says. The program aims at having extensive preventative care and each participant is required to pick a medical home and a doctor at that location. This enables the doctor to work with the patient in order to make lifestyle decisions that will positively affect the patient's health. They hope this will lower the amount of participants needing emergency service.


Reaching out to your home clinic is a different story. Pravel explains of calling during "what must have been their lunch hour." He continually got an answering machine and when he pressed the option to speak to an emergency nurse, it rang a few times then disconnected. He left a few voicemails, but never got a call back.

The program's customer service department is just as busy as the clinics. "Because the Healthy San Francisco Director has been deluged with so many students, journalists and researchers asking basically the same questions, we have endeavored to put as much as possible on the website," says Eileen Shields, the San Francisco Department of Health's Public Information Officer.


Recently Kaiser released survey results regarding participant satisfaction with Healthy San Francisco. Ninety-two percent of program participants say they enrolled in Healthy San Francisco because they could not afford health insurance or health care services. Fifty-seven percent of participants said their health needs are being met very well.

Marc, 55, is a long-time vendor at local events. He has lived in San Francisco for most of his life and has been enrolled in Healthy SF since the program first began. He regularly sees his doctor for check-ups. He believes the biggest problem of the program is the extra sales tax and fees that are placed on all San Francisco residents, regardless of whether they need care or not.

The Health Care Security Ordinance (HCSO), passed in 2008, employers are required "to spend a minimum amount of money each quarter on their Covered Employees' health care," according to the San Francisco Government's website. That means if a business has twenty or more employees they must pay either $1.31 or $1.96, every penny counting towards health care for each employee. If the business has over a hundred employees, they must pay the larger amount. One option of the ordinance is to pay a medical reimbursement fund for Healthy SF. This allows employees to be covered at a minimal amount, at least partially funded for by their employer.

On Healthy SF's website there is a section for employers that says, "The City option allows you to deposit money with the City on behalf of your employees that will be used to fund health care for your employees. Your employees will be given either Healthy San Francisco or a Medical Reimbursement Account, based on the information you provide."

Pravel works for a company with less than twenty employees. He is now healthy and has no need to see a doctor. However, he rests easier at night knowing that he can receive cheap medical care when necessary, even if he must wait in long lines.