This Date in UCSF History: Prepayment for Healthcare

Sunday, September 26, 2021

Originally published on September 27, 1973. In February, within weeks of the announcement of severe federal cutbacks in grant monies and the ensuing threat of mass lay-offs of workers, the Hospital and Clinics administration instituted a new patient admissions policy for Moffitt Hospital.

In essence, the policy required that all prospective patients must pay or guarantee payment of 50% of their projected hospital bill before admission to the hospital.

This new policy marked a radical departure from the hospital’s traditional ability-to-pay policy, and severely threatened the accessibility of services to a large number of low- and middle-income patients who earned too much for MediCal but not enough to afford the costs of private health insurance.

While UCSF was bemoaning its financial hardships, however, it announced plans for further expansion of facilities on the Parnassus Heights campus — including a new wing for Moffitt Hospital and a large new dental building. Both were strongly opposed by the surrounding community.

The Health Care Coalition was formed initially in response to the new patient admissions policy however it was immediately obvious to the Coalition that all the problems and struggles surrounding UCSF were closely interrelated.

The Coalition is a group of workers, health science students, faculty, and community members who have been working together since February in the struggle to make the university more responsible and accessible to the people who work here, who live near the campus, and who receive health care here.

We have also been concerned with the crucial relationship between the kind of education UCSF gives its health students and the kind of care it delivers — or doesn’t deliver — to its patients. In the past, we have whole-heartedly supported the Dental School’s need for more space and better facilities, but we have joined with the community in insisting that these needs not be filled at the community’s expense.

To this end we went to Sacramento and testified before Assembly and Senate committees to urge that the new building not be funded. We suggested decentralization of services as one alternative.

The result of this concerted effort of the Coalition, working with the Haight-Ashbury/Inner Sunset communities, was that Assemblyman Willie Brown, Jr., acting with our input, was able to effect a compromise with the University regarding the proposed expansion.

The compromise not only significantly decreased the size of the new dental building, but also dealt with the larger issues of expansion by setting a size limit for the campus by severely limiting future University expansion’ on Mt. Sutro, and by providing for decentralization of the Dental School through construction of two off campus clinics.

The Coalition has also dealt, in conjunction with AFSCME, with the question of workers’ rights on the campus and the serious flaws in the Personnel Office’s attempts to deal with workers’ grievances.

The Coalition recently has been turning increasing attention to the New Clinics Building. The opening of this building, designed to house all ambulatory care facilities on the campus, brings to the fore questions about the kind of health care that UCSF provides.

Wouldn’t students and patients gain by more of an emphasis on primary care? Wouldn’t students and the community be benefited more by several smaller, dispersed community clinics, rather than the monolithic, highly centralized, “glass gazebo”?

These questions are very important; in the long run they are crucial. But of the utmost immediate importance is whether the introduction of private practice into the new building will hurt those who depend on the UC Outpatient Clinics for low-cost medical care.

What is going to be the relationship of private practice space to official clinics space in the new building? Are some, or all, or many of the clinics going to reorganize as private group practices? What will happen to clinic discounts if private group practices do replace clinics? What will be the relationship of students to the private croup practices?

The Health Care Coalition has been asking these questions for months. Public explanations by the University regarding any facet of operation in the new building have been slow in coming.