Perhaps it's time ALIPAC issues a new flyer with directions to San Francisco. San Francisco now offers ID cards ala New Haven to illegal aliens AND also offers taxpayer funded UNIVERSAL HEALTH CARE to illegal aliens. AAAAAAHHHHHH...it is great to be an illegal alien in America, especially if you live in San Francisco. What do you say activists? Spread the word so all illegal aliens are aware that SAN FRANCISCO WANTS YOU!!!


S.F. focuses on racial, cultural groups in pioneering health plan
Heather Knight, Chronicle Staff Writer
Sunday, November 18, 2007

San Francisco is the first city in the country to find the money and political will to attempt to provide universal health care for its residents, but leaders of the new plan say its success hinges on a notion rarely discussed in the health care debates raging at the state and national levels: cultural competency.

Rather than treating patients using just raw data such as blood pressure levels and cholesterol counts, medical professionals also are taking into account patients' race, gender, age, sexual orientation, native language and other demographics in marketing the plan and providing the best medical care once they enroll.

In a city of distinct neighborhoods often populated by particular racial or ethnic groups, thousands of immigrants speaking more than 100 languages and a significant population of gays and lesbians, those behind the new plan, dubbed Healthy San Francisco, believe it will succeed or fail largely on how well cultural competency is practiced.

"There's a reason we have a clinic in Chinatown and a separate clinic in the Mission and a separate clinic in the Bayview," said Dr. Mitch Katz, director of the city's public health department. "That's because we realize there are cultural differences in the ways people seek care. ... We try to get as specific as we can."

In San Francisco, that means anything from a special clinic for gay and lesbian youths who might find it off-putting to be surrounded by middle-aged gay and lesbian patients to hiring Asian actors to star in public service announcements about health care to run on Chinese-language television stations.

On a recent afternoon, Cantonese-speaking women undergoing chemotherapy as part of their cancer treatment gathered around a conference table at the Chinatown Public Health Center, one of two clinics in the neighborhood to serve as the testing ground for Healthy San Francisco beginning in July.

Lei-Chun Fung, a health educator at the clinic, helped lead a session in which stylists showed the women, bald and gaunt from the treatment, how to apply makeup and find the right wigs to feel attractive again. Myriad pamphlets on makeup application, all written in Chinese characters, sat on the table.

Jin Xuan Yu, a 43-year-old housekeeper who has battled lung cancer for two years, peered into a compact mirror and giggled as she applied pink blush to her cheeks.

"I feel a little bit more uplifted - in higher spirits," she said in Cantonese.

It's a big change from the commonly held views of cancer among Chinese immigrants, Fung said, noting many of them believe that cancer is contagious and means an automatic death sentence. Many Chinese immigrants have never had a mammogram or any other cancer check.

"For some people, they think screening will mean they have it. ... They don't want their friends to know - they don't want them to look at them differently," she said. "But with education, people comply with it. They trust authority, and they're good at following what the doctor says."

Fung said the clinic has strived for years to serve the Chinatown population in a culturally competent way - such as the staff nutritionist compiling a cookbook with healthy Chinese-inspired recipes and working with Chinese restaurants to get them to carry it.

Tak Jam Wong, a retired cook who lives in public housing in Chinatown, recently took a free acupuncture class at the clinic that is intended to help people quit smoking. Wong said he was up to 30 cigarettes a day and is now down to just a few.

"Acupuncture in Chinese medicine is a longtime tradition," Wong explained, adding he also learned Western information about lung cancer and emphysema. "I like that combination."

Acupuncture and cosmetics are not covered by Healthy San Francisco, but are available through free classes for patients at the Chinatown Public Health Center, which considers them important facets of care.

The notion of cultural competency has long been a part of the city's public health department, its neighborhood clinics and San Francisco General Hospital.

But as Healthy San Francisco aims to draw more people into the health care system as regular patients with a medical home - rather than just relying on emergency rooms in a crisis - the idea becomes all the more crucial, especially because so many of them are poor and hail from other countries.

The 82,000 San Francisco residents who are uninsured are a diverse group: 32 percent are white, 32 percent Asian, 26 percent Latino, 3 percent African American and 2 percent Native American. Sixty-three percent are believed to have an income below 300 percent of federal poverty, roughly $31,000 per year for one person.

Only 39 percent are thought to be U.S. citizens, while another 39 percent are undocumented immigrants and 22 percent are immigrants here legally. Healthy San Francisco does not take into account immigration status, pre-existing medical conditions or employment status in offering coverage.

Any uninsured adult living in the city who doesn't qualify for Medicare or Medi-Cal is eligible. Children and youths up to age 24 are already covered under a separate city program called Healthy Kids and Young Adults.

Healthy San Francisco isn't considered insurance because it doesn't follow people outside city limits. It is estimated to cost $200 million a year and is supposed to be paid for with public funds, participants' fees and employer contributions. The latter is being challenged in court.

So far, close to 5,000 people have enrolled in the program, all of them earning less than 100 percent of the federal poverty level. Participants are seen at 14 clinics run by the health department and eight private, nonprofit clinics.

In January, the program is scheduled to throw open its doors to every qualifying San Franciscan.

Participants must pay a quarterly premium assessed on a sliding scale to be part of the program, as well as co-payments.

Katz said a big advantage to Healthy San Francisco is that it isn't a traditional fee-for-service health insurance program in which the clinic or hospital gets paid by the insurance company only when the patient sees the doctor and not when they participate in other beneficial programs like health education classes or support groups.

Instead, once someone has paid their quarterly fee for Healthy San Francisco, they can participate in whatever is deemed best for them - be it classes to teach beauty techniques to Cantonese women undergoing chemotherapy or something else.

"The whole program is funded without the usual you go to the doctor and therefore your insurance provider sends your doctor $68," Katz explained. "Within the Healthy San Francisco model, we can draw more people into the system and make it clear if they need a specific cultural service, we're prepared to do it. We are assuming responsibility to meet the whole person's needs."

Private, nonprofit clinics are given a flat rate for each Healthy San Francisco patient who chooses them as their medical home. Staff at the public health department's clinics are salaried, and seeing Healthy San Francisco participants is a part of their regular job.

Katz said this is particularly important for poor people and immigrants who under the U.S. health care system are increasingly trying to avoid getting medical care in order to save money - and then winding up in the emergency room when they get very sick.

"People typically are putting whatever financial resources they have into their business or into their children, not spending it on themselves," Katz said. "In Healthy San Francisco, once you join there's no separate charge to get a mammogram or a pap smear. You've joined for three months and you can get all the services that are appropriate."

Dr. Albert Yu, who directs the Chinatown Public Health Center, said cultural competency is especially important when it comes to written materials - including marketing campaigns to promote Healthy San Francisco and instructions on how to follow doctor's orders.

Not only do they need to be written in a variety of languages, but they need to be written at a middle-school level or lower, even in English, so people who struggle with literacy can understand them, he said. Another challenging facet of cultural competency, he said, is finding enough staff.

"The entire health system from the front desk to the treating physicians have to have linguistic fluency as well as cultural competency," he said. "It's not easy to hire staff that are bilingual or trilingual. And then to allocate them throughout the system - that's always been a limiting factor."

All the effort will be worth it, though, if Healthy San Francisco lives up to its name, Yu and Katz said.

"Certainly the only way you can change the health of entire neighborhoods is to cover everyone," Katz said. "And Healthy San Francisco is the best shot at that."
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