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The article succinctly explains the history of Healthy San Francisco and how the program came to be developed. However, towards the end of the history section where changes in response to the Affordable Care Act (ACA) are discussed, the article does not effectively or explicitly elaborate on how the ACA impacted those insured by the San Francisco Health Access Plan. The article can also further elaborate on the lawsuit with the Golden Gate Restaurant Association, and how that legal battle contributed to the viability of the program. The section on the program's reception can also be expanded and could incorporate more information about the patients' experiences with this insurance program.

All of the information included in the article is relevant to the subject matter. The article maintains a neutral stance, and does not advocate for one position over another. The viewpoints represented in the article can be expanded to include information. Currently, the article includes viewpoints from city officials, the Golden Gate Restaurant Association, and patients. The article could become richer with perspectives from health policy experts, the Supreme Court, and physicians.

The links to citations do work, although the article heavily relies on news outlets instead of scholarly sources. The sources do support the claims made in the article, but some of the sources appear to be biased against conservative viewpoints. The article can be improved with more reliable sources, along with more scholarly references. It may be beneficial to add information about theories on universal healthcare, citing academic articles with diverse viewpoints. Furthermore, the first sentence of the Funding section is a direct quote from a source, so this can be changed to be paraphrased.

The article includes some information about changes to the Healthy San Francisco program since the passage of the ACA, but could further elaborate on the current state of the program and changes to its operation. The article has not been edited since 2010, the same year that the ACA was initially passed.

The Talk page of the article does not have any active conversations. The article is part of two WikiProjects -- WikiProject California and WikiProject Medicine. The article is rated as start-class in terms of quality in both projects. In WikiProject Medicine, the article's importance is rated as low-importance. The article's importance has yet to be rated within WikiProject California.

All of the information in the article is relevant to the topic, and the article comprehensively discusses the history of community health centers, how they are funded, who they serve, and what services they are able to provide. More information can be added about patients' experiences at CHCs and how CHCs fit into the United States healthcare safety net. The article is mostly maintains neutrality, and focuses on discussing the intent and design of CHCs. However, there are some judgments made about the people involved in the development of CHCs. The article includes viewpoints from the federal government and from patients, but could benefit from including physicians' perspectives -- both from physicians who work at CHCs and physicians who do not.

The citation links do work, and the article accurately reflects the information provided by the cited sources. The facts and data in the article come from reliable sources, which much of the article depending on reports from respected health research centers, including the Kaiser Family Foundation and the National Health Policy Forum. Not much information has been provided about how CHCs have been affected by the Affordable Care Act and past attempts at health care reform. While the article was last edited in June 2017, it has only been edited twice in its history, and thus could benefit from being updated.

The Talk page does not have any active conversations. The article is apart of the WikiProject United States and the WikiProject Hospitals. It is not rated for quality or importance within either of these WikiProjects.

• Pauly, Mark V., and José A. Pagán. "Spillovers and vulnerability: the case of community uninsurance." Health Affairs 26.5 (2007): 1304-1314, http://content.healthaffairs.org/content/26/5/1304.short.
  • This source indicates how safety net health systems and their service provision for the uninsured may affect the quality of service not only to the uninsured, but the already insured as well. This paper discusses how "pecuniary spillovers," in terms of cost-shifting, and "non-pecuniary spillovers," in terms of lower quality of care for the entire community, should motivate the insured to fight for greater insurance rates for the uninsured.
  • Healthy San Francisco covers San Franciscans who have no other form of insurance. Thus, this paper highlights crucial points to consider when discussing Healthy San Francisco, not only in terms of how it is financed, but how the program can improve health outcomes and quality of care throughout the city. This source can be used to indicate the importance and necessity of programs like Healthy San Francisco, along with possible incentives to create the program. I used this source in the "Results and Reception" section to indicate how the program has had benefits even for those who are not enrolled.
• Sack, Kevin. “San Francisco to Offer Care for Uninsured Adults.” The New York Times, The New York Times, 13 Sept. 2007, www.nytimes.com/2007/09/14/us/14health.html?mcubz=3.
  • This article outlines the premise and financing of Healthy San Francisco and outlines some of the challenges it faced and questions it needed to answer as it began developing.
  • The article is from 2007, so it provides a nice look back at what the issues were at that time (including whether or not the program would attract the middle-class), in addition to serving as a springboard for analyzing progress since. The piece also describes why this program is so uniquely San Franciscan, allowing the opportunity to delve into why this program may not be generalizable across the United States. Lastly, this NYT article includes a case study of a participating client, creating useful insight on how the patient experience of the uninsured has been affected by the program. I used this article in the introduction and in the Results section.
• Varney, Sarah. “San Francisco's Universal Health Care Model.” NPR, NPR, 15 Sept. 2009, www.npr.org/templates/story/story.php?storyId=112839236.
  • The article includes another example of patient experience, along with information about the employer mandate -- including Golden Gate Restaurant Association lawsuit and how the mandate has affected employment in San Francisco.
  • This will be useful information to the Wikipedia article in terms of the popularity of the program from various stakeholder perspectives: patients, physicians, city government, and private businesses.
• “Golden Gate Restaurant Association v. City and County of San Francisco: 546 F.3d 639 (9th Cir. 2008).” Berkeley Law, 11 Apr. 2015, https://www.law.berkeley.edu/golden-gate-restaurant-association-v-city-and-county-of-san-francisco-546-f-3d-639-9th-cir/.
  • This page discusses the court decision regarding the Golden Gate Restaurant Association lawsuit along with analysis about the decision.
  • The analysis presented in this page is all useful information to add to a section on how the program became constitutionally viable.
• “Golden Gate Restaurant Association v. City and County of San Francisco.” 9 Mar. 2009, http://cdn.ca9.uscourts.gov/datastore/opinions/2009/03/09/0717370o.pdf.
  • This is the official court decision on the lawsuit, which provides insight as to why the program was allowed to be created, and why it was deemed constitutional.
  • This lawsuit is an important part of the program's history, so it will be useful to add to the history section.
• Katz, Mitchell H., and Tangerine M. Brigham. "Transforming a traditional safety net into a coordinated care system: lessons from healthy San Francisco." Health Affairs 30.2 (2011): 237-245, http://content.healthaffairs.org/content/30/2/237.short.
  • An article written by the SF health director and the Healthy San Francisco program director reflecting on the successes of the program, and how other safety net health care systems can improve by learning from this model. The paper provides critical information about the SF health system before and after the program was implemented, along with information about how the program was financed.
  • This paper can be used to beef up both the history and reception sections of the article. The fact that the authors of this paper were directly involved in the creation of Healthy San Francisco can be of extreme value, but it will be important to consider their biases, particularly in describing the reception and impact of the program. I used this article to proofread the Wikipedia page and ended up citing this article multiple times and in many sections when writing my contributions.
• Locke, Laura A. “San Francisco's Latest Innovation: Universal Health Care.” Time, Time Inc., 23 June 2006, http://content.time.com/time/nation/article/0,8599,1207599,00.html.
  • This article provided some insight into the political issues surrounding Healthy San Francisco, falling into the framework of healthcare as a right vs. commodity.
  • I used this article to develop the intro and "History" section.
• “Survey of Healthy San Francisco Participants.” The Henry J. Kaiser Family Foundation, 1 Aug. 2009, https://www.kff.org/uninsured/poll-finding/survey-of-healthy-san-francisco-participants/.
  • This article provides a summary of the results of a survey regarding the effectiveness of Healthy San Francisco. The results showed that patients were overwhelmingly satisfied with the program.
  • I used this article to develop the "Results and Reception" section.
• Sankin, Aaron. Healthy San Francisco, The City's Universal Health Care Plan, Finalist For Harvard Prize. The Huffington Post, 29 Nov. 2011, https://www.huffingtonpost.com/2011/11/29/healthy-san-francisco-the_n_1119167.html.
  • This article provided some context into the services Healthy San Francisco can and cannot provide.
  • I incorporated this information into the introduction.

• Lewin, Marion E., and Raymond J. Baxter. "America’s health care safety net: revisiting the 2000 IOM report." Health Affairs 26.5 (2007): 1490-1494, http://content.healthaffairs.org/content/26/5/1490.short.
  • This article discusses the financial viability of safety net health care systems, looking back at a report from 2000 six years later. Main topics discussed are the impact of managed care Medicaid and the rise of competition in the healthcare market. The article also examines how current reforms will impact health care for the most vulnerable, focusing on the perspective of a safety net provider -- in other words, providers at hospitals and clinics that primarily serve the low-income and uninsured. One interesting piece of this report was how changes in financial structuring have impacted these hospitals and clinics. At first, there was great uncertainty about whether or not it would be financially feasible to continue serving the uninsured. Yet, with secured government funding, the conversation has now shifted to how to provide sufficient quality of care in the face of competition from other providers and the advent of new technologies.
  • Community health centers serve primarily low-income and uninsured communities, making them a part of the healthcare safety net and the direct target of many policy changes and reforms. This article gave me insight about Medicaid's shift to managed care, and I was able to incorporate this information into the "Financing" section of the article. I also learned more about the juggling priorities that must be considered when making healthcare reforms -- such as finding a balance between expanding of coverage to more people, and providing the same quality of care to an increasing pool of people.
• O'malley, Ann S., and Jeanne Mandelblatt. "Delivery of preventive services for low-income persons over age 50: a comparison of community health clinics to private doctors' offices." Journal of community health 28.3 (2003): 185-197, https://link.springer.com/article/10.1023%2FA%3A1022956223774?LI=true.
  • This study compares the delivery of preventative services at community health centers to that of private doctors' offices, finding that CHCs and private providers provide preventive services at similar rates, with CHCs performing higher than private providers in terms of immunization rates, but lower in terms of diet and exercise counseling.
  • I used this article in a subsection of "Quality of Care" entitled "Preventive Services." This article falls into the concept of health equity, as it indicates that CHC patients still receive quality services, despite their low-income backgrounds.
• Chin, Marshall H., et al. "Quality of diabetes care in community health centers." American Journal of Public Health 90.3 (2000): 431, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446172/.
  • This is another study assessing quality of care in community health centers -- this time in terms of adherence to treatment plans for managing diabetes. This study found that CHCs exhibited low performance in terms of quality measures and did not meet ADA standards of adherence to treatment plans.
  • Patient adherence is a key consideration in assessing the effectiveness of CHCs in meeting the health and medical needs of uninsured and low-income patients. I added information from this study to the "Chronic Disease Management" subsection. This article also was interesting to think about in the context of social determinants of health.
• Forrest, Christopher B., and Ellen-Marie Whelan. "Primary care safety-net delivery sites in the United States: a comparison of community health centers, hospital outpatient departments, and physicians' offices." Jama 284.16 (2000): 2077-2083, http://jamanetwork.com/journals/jama/fullarticle/193204.
  • This study researches the effectiveness of our current health care safety net model, and how it can be expanded to better suit the needs of the most vulnerable. The report found that expanding CHCs across the US could be an effective way to make primary care accessible, in addition to having more private physicians who are open to accepting low-income patients.
  • It will be vital to the Wikipedia article to understand and assess where CHCs fit into this system. While I did not explicitly include this in the article, it was an interesting read that shed light on how the safety net is constructed and what gaps remain.
• Beal, Anne, and Susan Hernandez. "Patient reports of the quality of care in community health centers: the importance of having a regular provider." Journal of Health Care for the Poor and Underserved 21.2 (2010): 591-605, https://muse.jhu.edu/article/380412.
  • This is another study looking at quality of care in CHCs, now through the lens of sources and frequency of care. This report found that CHC patients do not often have a consistent provider, but if they use CHCs as their main source of care, they generally receive high-quality care. This again fits into the framework of health equity and health disparities, as well as social determinants of health. As indicated in this article, many CHC patients have high-quality care available to them, but often are not able to access it due to other social factors, such as lack of transportation.
  • Looking at quality of care in CHCs through a variety of measures will enrich the Wikipedia article with numerous perspectives, allowing for a more comprehensive analysis on how effective CHCs are in meeting their patients' needs. I used this article to add a subsection of "Quality of Care."
• “Community Health Centers Past, Present, and Future: Building on 50 Years of Success.” www.nachc.org/wp-content/uploads/2016/12/NACHC_50th-Report.pdf.
  • Written by the National Association of Community Health Centers, this report provides insight into the history of CHCs, along with nationwide data on how CHCs have impacted access to care, health outcomes of care, and costs of care. This report provides a brief overview how CHCs have shifted over time in terms of funding, yet have remained steadfast in their commitment to providing care to communities most in need. The report also provides some insight into what kinds of services are offered at these clinics.
  • This report can be usefully utilized to enhance the history section of the article, as well as the reception section with information about how CHCs have accessed access to care while creating monetary savings. I also used this report to develop the "Services" section and a paragraph about shifts in terminology.
• Taylor, Jessamyn. "Fundamentals of community health centers." (2004). http://www.ww.nhpf.org/library/background-papers/BP_CHC_08-31-04.pdf.
  • This is a comprehensive report that gives an in-depth account of community health centers, including its history, its services, its finances and its providers. It focuses on how CHCs fit into the health care safety net, and explores what that term means.
  • I have used this source in many of my additions, mostly as a way to double-check and in some cases, to cite directly from. I have gleaned information about CHC history and services from this report.

Key Ideas

• Health care safety net
• Medical and health care for the uninsured
• The government's role in providing health care

The program's stated objective is to bring universal health care to the city,^[1][2] and the program website states that insurance "is always a better choice."^[3] Healthy San Francisco represents the first time a local government has attempted to provide health insurance for all of its constituents.^[4]

With implementation of the Patient Protection and Affordable Care Act starting in 2010 and the setting up of health exchanges in 2013, half of the 60,000 patients enrolled in 2013 are eligible for Medi-Cal because of the expansion of that program by the Affordable Health Care Act.^[5] Another 10,000 or so people are likely to get health insurance through the Covered California health exchange that was created as part of the Affordable Health Care Act.^[5] The remaining patients are likely to be undocumented immigrants and people who live in the city for less than 5 years, so are not eligible for Covered California, and people who make too much money for Medi-Cal but not enough to afford health insurance.^[5] The 2010 Affordable Care Act also removed categorical eligibility for Medicaid.^[6] As a result, many who previously did not qualify for Medicaid and instead relied on Healthy San Francisco could enroll in Medi-Cal.^[6]

San Francisco residents who have benefitted from Healthy San Francisco have noted how the program has made them less wary of accessing health care, as previously many of the beneficiaries of Healthy San Francisco did not see a provider regularly due to cost.^[4]

Much of Healthy San Francisco's positive reception stems from the city's uniquely structured health care safety-net network, consisting of a conglomerate of both public and private hospitals, clinics, and health centers.^[7] This collaborative system allows for greater communication between providers and enables patients to access facilities that are equipped to offer the type of care they need, whether that be primary, specialty, or urgent care.^[7]

Key Ideas:

• Quality of Care at CHCs
  • Various measures of quality: health outcomes, patient experience
• Cost of Care at CHCs

Patients who use community health centers as a regular source of care are likely to have a positive patient experience and receive high-quality preventative services.^[8] However, community health center patients are less likely to seek medical care consistently, as many of these patients tend to be from vulnerable populations in terms of socioeconomic background and insurance status.^[8]

Quality of care at CHCs can be assessed through many measurements and indices, including the availability of preventative services, treatment and management of chronic diseases, other health outcomes, cost effectiveness, and patient satisfaction.^{[8][9][10][11]} According to several studies, the quality of care at community health centers is comparable to the quality of care provided by private physicians.^{[8][9][10][11]} Nevertheless, community health centers face numerous challenges in light of the population they face. As CHCs primarily serve the low-income and uninsured, many of their patients do not regularly see a primary care physician, which can lead to poorer health outcomes.^[8]

• Restructured introductory paragraph
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• Rearranged sentences and citations from throughout article to fit into ACA subsection
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• Restructured 1st introductory paragraph
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• Changed Patients section to Patient Demographics section
• Rearranged sentences and citations from throughout article to create Services section
• Added information to 2 sentences in Services section
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• Created Quality of Care section
• Created 4 subsections within Quality of Care section
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• Added 5 sentences to Financing section