County project

County Project: San Francisco

County Project: San Francisco County Bri Weed Student ID: 011790439 HCA 300 Monday/Wednesday 5:00-9:00 California State University, Long Beach

County Project: San Francisco

2 Abstract

San Francisco is the only city in the State of California to be a city and a county. This dense county/large city, in California, is activists for Gay Rights, county-sponsored health care, environment and recycling programs. San Francisco is an eclectic group of individuals fighting for equal rights and health care prevention. This paper gives a general overview about the demographics that make up San Francisco County and the comparisons between it, other counties and the State of California. This paper will also examine the effects of HIV and AIDS in San Francisco County and what is being done to prevent and treat the residents affected. In the last section, there is a new and innovated solution on how control the HIV infected rates and raise awareness.

Key Terms: San Francisco population and statistic, HIV, San Francisco Health Access Program.

County Project: San Francisco

3

In the 2010 United States Census, the total population of San Francisco was 805,235, as compared to California’s population of 38,041,430 (State Census Bureau). The persons per square mile is 17,179.1, making it the densest city in California and ranked second in United States of America, only to New York City. This is almost seventy-two times California’s average density, per person, per square mile. The 15-64 year old group comprises 75.2% of the population, which are the contributing members to society. 11.2% of the population is under the age of 5 to 14 years old. The rest of the population (13.6%) are 65 years and older There are slightly more males (50.7%) than females (49.3%). During the 2010 Census, the majority of the population stated they were Caucasian American at 48.5% (State Census Bureau). Other nationalities included in census are Asian (33.3%), African American (6.1%), and a diverse group of American-Indian, Native Hawaiian, Latino, make up the rest.

San Francisco is an educated county with the percentage of high school graduates at 85% compared to California at 80.8%. The number of residents with a bachelor’s degree or higher is 51.4% while the California average is30.2%.

This would explain why the median household income is $72,947, which is ten

County Project: San Francisco

4

thousand dollars more than California’s average (Census Bureau 2010). On the other hand, the overall poverty rate for San Francisco County is 12.3%, while the children poverty rate is 12% (City-Data.com). The poorest residents are in the age group of 18-24 years old, making up more than half of the poverty group. As of January of 2013, the unemployment rate for San Francisco County was 6%, which has been lower each quarter (2013, May 29). The “Cost of Living Index” dated March 2012 was at 156.8.

Only 65,000 residents, which are 7.9% of San Francisco, are uninsured, which 59% are under the age of 40 (Healthcare Council). This means that 92.1% of San Franciscans are covered either by private insurance or the San Francisco Health Access Program (San Francisco Health Plan). SFHP is an affordable and comprehensive health care plan that covers low and moderateincome families. Their mission is to provide superior, affordable health care that emphasize prevention and promotes healthy living; they strive to improve the quality of life for the people of San Francisco and to support the providers who serve them (San Francisco Health Plan). Both federal and state government fund the programs provided by SFHP, which covers 55,000 residents, including 99.2% of the children residing in San Francisco.

The Medi-Cal managed care provides a safety net for low-income individuals and residents with disabilities. Managed care contracts for health

County Project: San Francisco

5

care services emphasize primary and preventive care, which in the long run have proven to be more cost effective. In the Rural Expansion Meeting Summary, Keith Parsley, presented three very different ideas of managed care: County Organized Health System, Geographic Managed Care and Two Plan Model. With the County Organized Health System (COHS), everyone is the in the same managed care plan which is created by the Count Board of Supervisors and run by the county. The Geographic Managed Care (GMC), uses the DHCS to contracts with commercial plans providing more choices for patients and competition between the different plans. San Francisco County is utilizing the two-plan system, including a local initiative and a commercial plan. The local initiative meets the community needs, while the commercial plan is a private insurance plan. The DHCS contracts with both of the plans (Medi-Cal Managed Care Program Fact Sheet-Managed Care Models).

There are eleven different medical hospitals in San Francisco County, including Kaiser Permanente and San Francisco General Hospital (2013 MA/SNP Matching Plans). They are all considered general acute care. Each are funded three different ways, non-profit with religious affiliations, city/county supported, and as California University teaching hospitals. The most popular hospital in San Francisco County is San Francisco General Hospital; this is home to the level one-trauma center in the county (SFGHF-About San Francisco General Hospital

County Project: San Francisco

6

and Trauma Center). This hospital is owned by San Francisco County but operated by the Department of Public Health’s Community Health Network. All the hospitals in the city have a combined total of 1,876 total licensed medsurgical beds. This is a total of 2.34 beds per 1,000 residents in San Francisco County while California only has an average of 1.9 beds per 1,000 persons. The number of hospital beds ratio in San Francisco County is well above the state average because it has two medical universities in its boundaries.

In 2012, there were a total of 6,009 physicians in San Francisco County, as compared to the total number of 102,372 in the State of California (OSHPDHID-Facility Listings). This means 7.5 physicians per 1,000 persons in San Francisco County as compared to 2.0 physicians per 1,000 in California (RAND California Physician and Surgeon Statistics). Again, this can be attributed the two medical schools in the county.

In San Francisco County there are fifty-four clinics, eight of which are specialized for chronic dialysis and psychology. The majority of the fifty-four clinics are primary care, four are free clinics and forty-two are community clinics.

14% of the population is serviced by the community clinics and health centers.

The clinics serve 122,218 residences each year, with a total of 523,006 visits (San Francisco County Profile of Community Clinics and Health Centers).

County Project: San Francisco

7

As data shows San Francisco County, proves to be innovative when it comes to Public Health and Mental Services. The Department of Human Services serves the residents of San Francisco County by helping those who have suffered hardships, both economically and emotional. The county has become policy makers and regulators of the hospitals and community centers.

San Francisco has a Community Behavioral Health Services Organization, which allows every resident receiving Medi-Cal, eligible to see psychiatrists, psychologist, and therapists (San Francisco Health Plan). The indigent members of San Francisco County can go to any nonprofit clinic or health center and the County will reimburse for the services provided.

San Francisco County was compared and ranked with the rest of the counties in California on 26 different indicators. The different colors above show the ranking between the counties. Red indicates low scores while the green shows top rankings. Some key areas denoted are children who possess health insurance (#2), at 99% with an increase by 3%, in the year 2010 (2010 California County Scorecard: San Francisco County). Children who report excellent health status (#1) are in the middle, but this is now up 11%.

Number five, on the chart above, shows children who have asthma that did not

County Project: San Francisco

8

require an ER visit increased 18%, placing San Francisco County in the top category (2010 California County Scorecard: San Francisco County). In the trends box, the red arrow pointing down represents categories where the percentage was decreasing. The yellow bar symbolizing where the percentage changed little to none, while the green arrow stands for an improvement in that category.

In the county of San Francisco, there are 57 areas that have populations that are Medically Undeserved Areas (MUA). These are areas or populations having too few primary care providers, a high infant morality, high poverty, and a high elderly population. The HPSA or Health Professional Shortage Areas have an overall average score of 7.3 (Shortage Designation: Health Professional Shortage Areas and Medically Underserved Area/populations). The discipline of dental has 4 records, all having high scores of 10. Mental Health discipline displays a score of 8.5, while primary medical care has a low score of 4.2.

Out of the 57 California counties, San Francisco ranked 23rd according to the 2013 County Health Ranking in the California Health Outcome. Under Health Outcomes, counties are ranked in two categories: mortality and morbidity. San Francisco’s County mortality ranking is 17 due to premature deaths, which was a lower number than both the national benchmark and the State of California.

Morbidity had a lower ranking of 35; this was attributed to the counties poor or

County Project: San Francisco fair health exceeding the national average by 7%.

9 San Francisco County ranked

number 8 out of 57 for Health Factors which encompasses four different categories: health behaviors, clinic care, social and economic factors and physical environment. Under health behaviors, sexually transmitted infections scored 571, which is six times the national average of 92. While the STIs display a high rating, physical inactivity and adult obesity and smoking all score well below national and state levels, giving San Francisco a ranking of 7 out of 57.

Another category of Health Factor is clinical care, which looked at uninsured, screening and primary care, ranking San Francisco County as 5th. Social and economic factors take into consideration the education, crime and poverty rates giving San Francisco County a ranking of 15 out of 57. The last category under health categories, ranked San Francisco County’s physical environment at 25/57. This section looked at food, drinking water and recreational facilities presented with its highest ranking at second place.

The Food and Nutrition Insecurities data are based upon the research from California Food Policy Advocates. In 2008, there were 89,423 residents living in poverty, 15,848 were children (2010 San Francisco County Nutrition and Food insecurity Profile). In San Francisco County, the Food Stamp Program is one of the highest expenditures, shelling out more than 114 million dollars to feed 30,752 residents. Out of all the counties, San Francisco ranks 36 out of

County Project: San Francisco

10

57. Another Food and Nutrition Assistance Program San Francisco participates in, is the National School Lunch Program. This program feeds 16,821 students and spent about six million dollars in 2008. San Francisco County ranked number one, in the percentage of children who are the least overweight for their age. The percentage of overweight or obese San Francisco adults is 42.9%, ranking them 3rd overall, since the percentage for California is 57.1% (2010 California Nutrition and Food Insecurity Profile).

The Human Immunodeficiency Virus (HIV) was once named the “gay cancer.” Then it became known as “GRID,” Gay Related Immune Deficiency. In 2010, there was 15,861 San Franciscans living with HIV. HIV is contracted through blood either by intercourse or intravenous drug injections.

Men having

sex with other men caused ¾ of the San Francisco HIV cases (SFHIV.ORG). One of the problems with being HIV positive is the symptoms can stay dormant for years. This means a person can be a carrier for the virus without even knowing it. The symptoms, if any, can be flu-like symptoms, fever, headaches, and skin rashes. There are many places where a San Francisco resident can be tested.

However, volunteering to be tested can be traumatic for a patient, especially if the results come back positive. San Francisco County has done a lot of advanced research to help with prevention and to eventually find a cure for HIV. San Francisco Aids Foundation is one of the leading advocates for HIV

County Project: San Francisco

11

prevention. The HIV Health Service is a section of the San Francisco Department of Public Health, which finances and monitors the health care system for residences living with HIV (DPH).

The non-profit foundations and

government agencies have teamed up to sponsor testing and prevention for HIV. “People respond to incentives, Principle #4 in Economics.� An innovativenew plan would be to provide incentives for residences to get HIV tested. The first step is to make a Public Service Announcements (PSA) using film, music and sports celebrities to get the publics attention. This should be a media blitz on television, in movie theaters, on radio broadcast, in magazines and on billboards. These PSA would remind residents that they may be carriers and to get tested at any number of free treatment centers. They would also contain an incentive of a complementary dinner and/or movie tickets, which would be sponsored by donations and state or community government. This would be a great way to get the entire community and visitors to get involved with the campaign and raise HIV awareness.

County Project: San Francisco

12 References

2010 California County Scorecard: San Francisco County. (n.d.). Children Now. Retrieved June 10, 2013, from http://www.childrennow.org/subsites/publications/invest/scorecard10/s corecard10_sanfrancisco.htm 2010 California Nutrition and Food Insecurity Profile. (n.d.). California Food

Policy Advocates. Retrieved June 9, 2013, from http://cfpa.net/GeneralNutrition/CFPAPublications/CountyProfiles/2010 /CountyProfile-Statewide-2010.pdf 2010 San Francisco County Nutrition and Food Insecurity Profile. (n.d.).

California Food Policy Advocates. Retrieved June 8, 2103, from http://cfpa.net/GeneralNutrition/CFPAPublications/CountyProfiles/2010 /CountyProfile-SanFrancisco-2010.pdf 2013 MA/SNP Matching Plans. (n.d.). California Department of Heath Care

Services. Retrieved June 9, 2013, from http://www.dhcs.ca.gov/provgovpart/Documents/2013_MMCD_MASNP _MTCH_PLANS.pdf (2013, May 29). Unemployment Rates for Metropolitan Areas. U.S. Bureau of

Labor Statistics. Retrieved June 10, 2013, from http://www.bls.gov/web/metro/laummtrk.htm

County Project: San Francisco

13

A Healthier San Francisco | SPUR. (n.d.). SPUR Ideas and Actions for a Better

City. Retrieved June 8, 2013, from http://www.spur.org/publications/library/article/healthier_san_francisco Census Bureau 2010. (n.d.). Profile of General Demographic Characteristics.

Geographic Area: San Francisco County. Retrieved June 7, 2103, from www.dof.ca.gov/research/demographic/state_census_data_center/cens us_2010/documents/DP2010-San_Francisco_County.pdf City-data.com. (n.d.). San Francisco, California (CA) poverty rate data information about poor and low income residents living in this city. Stats

about all US cities - real estate, relocation info, crime, house prices, cost of living, races, home value estimator, recent sales, income, photos, schools, maps, weather, neighborhoods, and more. Retrieved June 7, 2013, from http://www.city-data.com/poverty/poverty-San-FranciscoCalifornia.html Healthcare Council. (2006, June 23). San Francisco Health Access Program: Serving Uninsured Adults. Final Report to Mayor Gavin Newsom. Retrieved June 7, 2013, from http://laborcenter.berkeley.edu/healthpolicy/uhc_report.pdf Medi-Cal Managed Care Program Fact Sheet-Managed Care Models. (n.d.).

Department of Health Care Service . Retrieved June 23, 2013, from

County Project: San Francisco

14

www.dhcs.ca.gov/provgovpart/Documents/MMCDModelFactSheet.pdf OSHPD - HID - Facility Listings. (2013, February 14). Office of Statewide Health

Planning and Development. Retrieved June 10, 2013, from http://www.oshpd.ca.gov/HID/Products/Listings.html#PC RAND California Physician and Surgeon Statistics. (n.d.). RAND California:

Comprehensive California and U.S. statistics on economics, demographics, education, health, environment, community and government finance..

Retrieved June 8, 2013, from http://ca.rand.org/stats/health/physicians.html San Francisco County Profile of Community Clinics and Health Center. (n.d.).

California Primary Care Association. Retrieved June 8, 2013, from http://www.cpca.org/cpca/assets/File/Data-Reports/2010Profiles/2011-05-24-SanFrancisco-County-Profile.pdf San Francisco Health Plan. (n.d.). San Francisco Health Plan: . San Francisco

Health Plan: . Retrieved June 10, 2013, from http://www.sfhp.org/ SFGHF - About San Francisco General Hospital & Trauma Center. San Francisco

General Hospital Foundation. Retrieved June 8, 2013, from http://sfghfoundation.net/about_sfgh.html SFHIV.ORG | City and County of San Francisco Department of Public Health HIV Prevention Section. (2013, December 13). SFHIV.ORG | City and County

County Project: San Francisco

15

of San Francisco Department of Public Health HIV Prevention Section.

Retrieved June 10, 2013, from http://www.sfhiv.org/ Shortage Designation: Health Professional Shortage Areas and Medically Underserved Areas/Populations . (n.d.). U.S. Department of Health and

Human Services, Health Resources and Services Administration. Retrieved June 9, 2013, from www.hrsa.gov/shortage/ States Census Bureau. (2013, June 6). San Francisco County QuickFacts from the US Census Bureau. State and County QuickFacts. Retrieved June 10, 2013, from http://quickfacts.census.gov/qfd/states/06/06075.html Tools

| UCLA Center for Health Policy Research. (n.d.).

Tools

for Health Policy Research. Retrieved June 10, 2013, from http://ask.chis.ucla.edu/main/default.asp

| UCLA Center