SAN FRANCISCO — American cities--almost all of which are or will be caught up in the human and economic devastation of AIDS--are being urged to look here for a lesson in how comparatively inexpensive compassion can do better than high-tech, big-bucks medicine.
The San Francisco approach, a major national foundation argues, may save public health departments, hospitals and other health centers across the country from the economic calamity imposed by treating victims of AIDS--acquired immune deficiency syndrome.
The people who run the first-of-its-kind AIDS unit at San Francisco General Hospital say that there is a larger message in this, too--one that may eventually alter some of the basic U.S. philosophy of medical economics, which seems to say that the most expensive type of treatment is always the best.
The economic lesson to be exported from San Francisco is this, according to the Robert Wood Johnson Foundation, which on Thursday announced in Washington that it is putting up $17.5 million in grants to 10 cities to develop their own financially sound AIDS treatment programs:
Nationwide, according to the federal government's Centers for Disease Control in Atlanta, the first 10,000 cases of AIDS have cost $1.4 billion in medical care costs, alone--an average of $140,000 each. But in San Francisco, the cost has been held to $29,000 per case through greater use of non-hospital facilities and an altered perception of AIDS here that has made it possible to develop a humane community response to its victims instead of simply locking them away to die in intensive care units, with ventilator tubes in their throats.
A California Department of Health Services analysis of AIDS costs in the state made somewhat different computations for San Francisco's costs-per-case, finding the total costs for the final 18 months of AIDS victims' lives to be from $52,000 to $74,000 here and between $70,000 and $109,000 in Los Angeles County. The statewide cost-per-case was between $65,000 and $110,000, the state agency found.
San Francisco combines a special inpatient AIDS unit at San Francisco General with a network of 20 different organizations that work together to plan treatment programs for AIDS victims that emphasize out-of-hospital services ranging from hospice care to house cleaning.
With 1,800 AIDS cases reported so far, San Francisco has the second-highest total in the country--after New York, which has reported 5,224 cases. Los Angeles, with 1,384, will probably pass San Francisco this year in the total number, AIDS experts here say. Statewide, California had tallied 3,793 cases as of the end of January.
But the cost differences between the rest of the state and country and San Francisco are pronounced, no matter how the calculations are made. Dr. Philip Lee, director of UC San Francisco's Institute for Health Policy Studies, said local health officials have been able to prevent AIDS from bankrupting the local health system because "they responded to it as if it was a disease, with people who deserved treatment, instead of (as if) the victims were just a stigmatized population."
It is that message that Lee, who is also president of the San Francisco Health Commission, and Dr. Mervyn Silverman, former San Francisco director of health, went to Washington to deliver Thursday at a news conference sponsored by the Robert Wood Johnson Foundation. Lee will serve as chairman of the foundation's national advisory committee for the new program to help cities find ways to control the cost of treating AIDS and Silverman will be project director.
In an interview here earlier this week, Lee said he thinks the growing panic over just the financial implications of the AIDS epidemic--as well as the syndrome's spread to almost every state and city of any size in the country--has finally made the time ripe for major changes in the way AIDS victims are treated.
"When San Francisco put its first money into AIDS, there were fewer than 50 patients," Lee said, noting that the epidemic here traces to as early as 1983. "Nationally now, I think there is more interest and willingness to learn (from what San Francisco has done) because of the increased numbers (across the country). One of the important things (in the struggle to change the perception of AIDS and its victims) is to dispel the myths about the high costs of this problem."
"There . . . is a unique opportunity here to do something that has proven difficult to achieve in American health care--create improved and expanded health services that actually cost less," noted Drew Altman, vice president of the foundation that is providing the money for the new national program.
'Best Possible Response'