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Access","version":"oa-whole-gift-named-coverage-v2","foundation":{"organization":"Operation Access","slug":"operation-access","model_version":"oa-whole-gift-finite-portfolio-v1","recipient":{"legal_name":"Ambulatory Surgery Access Coalition dba Operation Access","ein":"94-3180356","giving_url":"https://www.operationaccess.org/donate"},"finance":{"year":2025,"total_accrual_expense":22876888,"donated_clinical_waived_charges":20530000,"other_donated_support":89922,"cash_like_expense":2256966,"annual_report_cash_expense":2256967,"budget2026_cash":1900000,"services":1529,"specialty_services":{"gi":575,"general":201,"gyne":168,"ortho":158,"head_neck":127,"urology":101,"derm":80,"vascular":58,"eye":45,"other":16},"note":"Cash-like accrual subtraction is not cash flow. Waived charges are not economic costs. Prospective allocation is not observed specialty cash spending."},"categories":["gi","general","gyne","ortho","head_neck","urology","derm","vascular","eye","other"],"central_inputs":{"gift_usd":10000,"funding_additionality":0.3,"max_additional_services":20,"discount":0.03,"bay_share":0.6,"sf_share":0.08,"independent_harm_q":0,"outside_support_per_service":60,"patient_time_per_service":100,"crc_treatment_cost_per_selected":1500,"gi_allocation":0.3760627861347286,"gi_cash_per_service":1479.0745585349903,"gi_clinical_resource_per_service":2500,"general_allocation":0.131458469587966,"general_cash_per_service":1479.0745585349903,"general_clinical_resource_per_service":5500,"gyne_allocation":0.10987573577501634,"gyne_cash_per_service":1479.0745585349903,"gyne_clinical_resource_per_service":4500,"ortho_allocation":0.10333551340745585,"ortho_cash_per_service":1479.0745585349903,"ortho_clinical_resource_per_service":5000,"head_neck_allocation":0.08306082406801832,"head_neck_cash_per_service":1479.0745585349903,"head_neck_clinical_resource_per_service":3500,"urology_allocation":0.06605624591236102,"urology_cash_per_service":1479.0745585349903,"urology_clinical_resource_per_service":4000,"derm_allocation":0.052321778940483975,"derm_cash_per_service":1479.0745585349903,"derm_clinical_resource_per_service":1800,"vascular_allocation":0.03793328973185088,"vascular_cash_per_service":1479.0745585349903,"vascular_clinical_resource_per_service":4500,"eye_allocation":0.029431000654022238,"eye_cash_per_service":1479.0745585349903,"eye_clinical_resource_per_service":2500,"other_allocation":0.010464355788096796,"other_cash_per_service":1479.0745585349903,"other_clinical_resource_per_service":3000,"eye_selected_fraction":0.65,"eye_services_per_person":1.3530973451327433,"eye_disjoint_fraction":1,"eye_treatment_success":1,"eye_utility_gain":0.04369288612091463,"eye_catchup_hazard":0,"eye_loss_hazard":0.03,"eye_mortality_hazard":0.02,"eye_horizon_years":1,"eye_delay_years":0.25,"eye_harm_q_per_person":0.002,"hernia_selected_fraction":0.45,"hernia_services_per_person":1.3530973451327433,"hernia_disjoint_fraction":1,"hernia_treatment_success":0.85,"hernia_utility_gain":0.04,"hernia_catchup_hazard":0.7,"hernia_loss_hazard":0.08,"hernia_mortality_hazard":0.02,"hernia_horizon_years":3,"hernia_delay_years":0.25,"hernia_harm_q_per_person":0.004,"crc_selected_fraction":0.5,"crc_services_per_person":1.3530973451327433,"crc_disjoint_fraction":1,"crc_treatment_linkage":0.7,"crc_annual_fatal_hazard_reduction":0.0006,"crc_baseline_total_mortality_hazard":0.025,"crc_catchup_hazard":0.5,"crc_latency_years":2,"crc_active_years":5,"crc_horizon_years":10,"crc_delay_years":0.25,"crc_surviving_utility":0.75,"crc_harm_q_per_person":0.001},"scenarios":[{"id":"central","overrides":{}},{"id":"favorable","overrides":{"funding_additionality":0.75,"eye_selected_fraction":0.9,"hernia_selected_fraction":0.7,"crc_selected_fraction":0.75,"eye_utility_gain":0.1,"hernia_utility_gain":0.1,"eye_catchup_hazard":0.2,"hernia_catchup_hazard":0.2,"crc_catchup_hazard":0.15,"crc_treatment_linkage":0.9,"crc_annual_fatal_hazard_reduction":0.001,"eye_horizon_years":5,"hernia_horizon_years":5,"crc_horizon_years":15}},{"id":"cautious","overrides":{"funding_additionality":0.1,"eye_selected_fraction":0.3,"hernia_selected_fraction":0.2,"crc_selected_fraction":0.2,"eye_utility_gain":0.01,"hernia_utility_gain":0.005,"crc_annual_fatal_hazard_reduction":0.0001,"eye_catchup_hazard":2,"hernia_catchup_hazard":2,"crc_catchup_hazard":2,"crc_treatment_linkage":0.3}},{"id":"funding_replacement","overrides":{"funding_additionality":0}},{"id":"capacity_zero","overrides":{"max_additional_services":0}},{"id":"limited_capacity","overrides":{"max_additional_services":5}},{"id":"fast_alternative_care","overrides":{"eye_catchup_hazard":4,"hernia_catchup_hazard":4,"crc_catchup_hazard":4}},{"id":"no_later_care","overrides":{"eye_catchup_hazard":0,"hernia_catchup_hazard":0,"crc_catchup_hazard":0}},{"id":"one_year_nonfatal_benefit","overrides":{"eye_horizon_years":1,"hernia_horizon_years":1}},{"id":"crc_no_treatment","overrides":{"crc_treatment_linkage":0}},{"id":"crc_association_does_not_transfer","overrides":{"crc_annual_fatal_hazard_reduction":0}},{"id":"minimally_symptomatic_hernia_null","overrides":{"hernia_utility_gain":0}},{"id":"all_health_null","overrides":{"eye_utility_gain":0,"hernia_utility_gain":0,"crc_annual_fatal_hazard_reduction":0,"eye_harm_q_per_person":0,"hernia_harm_q_per_person":0,"crc_harm_q_per_person":0}},{"id":"benefit_null_harms_retained","overrides":{"eye_utility_gain":0,"hernia_utility_gain":0,"crc_annual_fatal_hazard_reduction":0}},{"id":"signed_adverse_health","overrides":{"eye_utility_gain":-0.02,"hernia_utility_gain":-0.02,"crc_annual_fatal_hazard_reduction":-0.0003}},{"id":"independent_harm_zero_activity","overrides":{"funding_additionality":0,"independent_harm_q":1}},{"id":"repeat_services","overrides":{"eye_services_per_person":2,"hernia_services_per_person":2,"crc_services_per_person":2}},{"id":"lower_target_portfolio","overrides":{"gi_allocation":0.25,"general_allocation":0.08,"eye_allocation":0.01,"other_allocation":0.21}},{"id":"higher_target_portfolio","overrides":{"gi_allocation":0.42,"general_allocation":0.15,"eye_allocation":0.05,"other_allocation":0,"derm_allocation":0,"vascular_allocation":0.02}},{"id":"double_external_resources","overrides":{"gi_clinical_resource_per_service":5000,"general_clinical_resource_per_service":11000,"gyne_clinical_resource_per_service":9000,"ortho_clinical_resource_per_service":10000,"head_neck_clinical_resource_per_service":7000,"urology_clinical_resource_per_service":8000,"derm_clinical_resource_per_service":3600,"vascular_clinical_resource_per_service":9000,"eye_clinical_resource_per_service":5000,"other_clinical_resource_per_service":6000}},{"id":"local_zero","overrides":{"bay_share":0,"sf_share":0}},{"id":"higher_local_share","overrides":{"bay_share":0.8,"sf_share":0.15}},{"id":"no_selected_subsets","overrides":{"eye_selected_fraction":0,"hernia_selected_fraction":0,"crc_selected_fraction":0}}],"sources":[{"key":"audit","publisher":"Operation Access","title":"2025 audited financial statements","url":"https://www.operationaccess.org/s/2025-Audited-Financial-Statements.pdf","published":"Year ended December31,2025; auditMay20,2026","sourceType":"Primary audited whole-organization expense, waived-charge accounting, liquidity and restrictions; relevant PDF7–8,14–15 visually verified.","retrieved":"September9,2026"},{"key":"report","publisher":"Operation Access","title":"2025 annual report","url":"https://www.operationaccess.org/s/Operation-Access-Annual-Report-2025.pdf","published":"2025 reporting year","sourceType":"Primary specialty counts/chartPDF7, funding lossPDF2, wait/readinessPDF6, cash financePDF13. Counts are services, not unique people or measured health.","retrieved":"September9,2026"},{"key":"budget","publisher":"Operation Access","title":"2026 budget","url":"https://www.operationaccess.org/s/2026Budget-8pz4.pdf","published":"ApprovedDecember10,2025","sourceType":"Primary1.9million cash plan, not actual2026 unit cost or procedure target.","retrieved":"September9,2026"},{"key":"eligibility","publisher":"Operation Access","title":"Patient eligibility and procedures","url":"https://www.operationaccess.org/for-patients-para-pacientes","published":"Current undated","sourceType":"Uninsured and ineligible fullMedi-Cal/Medicare/CMSP; cataract and hernia procedures explicitly offered; not insurance.","retrieved":"September9,2026"},{"key":"giving","publisher":"Operation Access","title":"Donate","url":"https://www.operationaccess.org/donate","published":"Current undated","sourceType":"Official ordinary donation route and EIN94-3180356. Waived-dollar fundraising leverage is not QALY evidence.","retrieved":"September9,2026"},{"key":"fit","publisher":"California Colorectal Cancer Coalition","title":"OA facilitated donated colonoscopy","url":"https://www.cacoloncancer.org/operation-access-facilitated-access-to-donated-colonoscopies/","published":"Current undated","sourceType":"Primary referral mechanism; above-average risk/positive stool tests; not575verifiedFITcases.","retrieved":"September9,2026"},{"key":"cataract","publisher":"Sach et al.","title":"First-eye cataract randomized economic evaluation","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC2095519/","published":"2007","sourceType":"306women over70, expedited4weeks vsroutine12months; first-yearQALYdifference.056(.006,.108), integratedyear—not annualutilityorOAlocalestimate.","retrieved":"September9,2026"},{"key":"hernia","publisher":"Fitzgibbons et al.","title":"Watchful waiting versus repair","url":"https://pubmed.ncbi.nlm.nih.gov/16418463/","published":"2006","sourceType":"720minimallysymptomatic men;2-yearpain/physicalfunction differences notsignificant;23%watchfulwaiting crossed torepair. Strong warning against assuming allhernias benefit.","retrieved":"September9,2026"},{"key":"crc","publisher":"Zorzi et al.","title":"Mortality after positive FIT without program colonoscopy","url":"https://pubmed.ncbi.nlm.nih.gov/33789965/","published":"2021","sourceType":"Observational10-yearCRC mortality6.8vs16per1000. Not randomization, no directly imported hazardorQALY.","retrieved":"September9,2026"},{"key":"critique","publisher":"Methodological correspondence","title":"Immortal-time concern in positive-FIT mortality comparison","url":"https://pubmed.ncbi.nlm.nih.gov/37549982/","published":"2023","sourceType":"Primary methodological criticism; exposure timing/selection biases not assumed solved.","retrieved":"September9,2026"},{"key":"navigation","publisher":"PRECISE investigators","title":"Navigation after abnormal stool test trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13007779/","published":"2025","sourceType":"967analysis;55.1vs42.1%one-yearcompletion. Not multiplied into already-completed OAservice units.","retrieved":"September9,2026"},{"key":"coverage","publisher":"California DHCS","title":"Medi-Cal eligibility changes","url":"https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/","published":"2026","sourceType":"Public coverage remains baseline when available; no assertion alluninsured have no latercare.","retrieved":"September9,2026"}],"funding_room":{"verified_offer_usd":null,"additional_slots":null,"accepted_sf_restriction":null,"statement":"Largest-funder loss and layoffs documented, but maintainedgrowth/newdonors and16monthsoperatingcash do not measure marginalcapacity. Allnumericalcaps are priors."},"boundaries":["All ten cash allocations sum to one. Other services retain full costs with health unquantified; zero credit is not a finding they are ineffective. This partial-health whole-gift estimate is not an upper bound on cost-effectiveness.","Completed-service cost includes coordination, overhead and failed referrals. Selected clinical subset, service-to-person conversion, financial additionality and disjointness are separate assumptions; service count alone is never a health outcome.","Current uninsured/ineligible-Medi-Cal eligibility is not a never-care baseline. Later safety-net care, coverage changes, other donors, donated provider capacity and OA's existing navigation remain in the counterfactual.","CRC uses an explicitly judgmental mean-hazard survival approximation. Cohort mortality association and navigationRCT are not causal manufacturer-like coefficients; no .13 completion multiplier or legacy aggregate.05Q is reused.","One exclusive linked-person ledger CRC then eye then hernia. Repeats/second eyes and overlapping diagnoses retain costs but cannot earn duplicate whole-person health. No productivity, caregiver or other mortality gains are added.","Donated clinical resources, distinct nonclinical support, patient time and downstream cancer-care allowances are gross associated costs on all nominal services, including uncredited/replaced activity. They are not waived charges, net incremental resources, or exhaustive societal cost.","Both health comparisons start with the same people alive at care. Delay discounts only; horizons start at care, not gift. Harms are already gift-date PV and include repeat procedures within an episode; late-comparator harms are not subtracted.","Bay and SF are nested weak residence priors, not measured local return. US equals all-region direct health here; no international or indirect local spillovers are credited.","Historical selectedSF$600,000 donor/$1,012,000 expanded price remains a separate program comparison. It must not remain the ordinary-gift ranking input after this revision."],"input_provenance":{"gift_usd":{"central":"100000","scenario_range":"Scenario inputs 100000 to 100000; not a confidence interval","basis":"Reference ordinary unrestricted gift; every dollar retained, not an SF colonoscopy restriction."},"funding_additionality":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% judgment for extra maintained/expanded services after replacement funding and provider bottlenecks. Existing OA care is baseline. Not estimated from the deficit or reserves."},"max_additional_services":{"central":"100","scenario_range":"Scenario inputs 0 to 100; not a confidence interval","basis":"100 extra mixed-service cap is an assumption, not identified open appointments. Shared capacity reduces all specialty activity proportionately."},"discount":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"3% annual health discount; economic resource amounts are gross associated present-dollar allowances, not a discounted net-social ledger."},"bay_share":{"central":"0.6","scenario_range":"Scenario inputs 0 to 0.8; not a confidence interval","basis":"60% weak beneficiary-residence prior within Northern California/Central Valley reach. No published specialty-specific county shares verified."},"sf_share":{"central":"0.08","scenario_range":"Scenario inputs 0 to 0.15; not a confidence interval","basis":"8% weak SF beneficiary-residence prior nested within Bay, not office location or guaranteed restricted allocation."},"independent_harm_q":{"central":"0","scenario_range":"Scenario inputs 0 to 1; not a confidence interval","basis":"Gift-date PV health loss independent of clinical activity; central0, zero-activity adverse case1."},"outside_support_per_service":{"central":"60","scenario_range":"Scenario inputs 60 to 60; not a confidence interval","basis":"$60 distinct nonclinical donated support per nominal mixed service, rounded from89,922/1,529; not already cash-paid interpretation/travel."},"patient_time_per_service":{"central":"100","scenario_range":"Scenario inputs 100 to 100; not a confidence interval","basis":"$100 additional patient/caregiver time allowance per nominal service, not earnings benefits or OA-paid travel."},"crc_treatment_cost_per_selected":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"$1,500 expected downstream therapy/surveillance resource allowance per nominal selectedFIT service, beyond endoscopy resources; weak prior, not provider quote or complete treatment estimate."},"gi_allocation":{"central":"0.37","scenario_range":"Scenario inputs 0.25 to 0.42; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gi_cash_per_service":{"central":"1400","scenario_range":"Scenario inputs 1400 to 1400; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gi_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"general_allocation":{"central":"0.13","scenario_range":"Scenario inputs 0.08 to 0.15; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"general_cash_per_service":{"central":"1700","scenario_range":"Scenario inputs 1700 to 1700; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"general_clinical_resource_per_service":{"central":"5500","scenario_range":"Scenario inputs 5500 to 11000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"gyne_allocation":{"central":"0.11","scenario_range":"Scenario inputs 0.11 to 0.11; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gyne_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gyne_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"ortho_allocation":{"central":"0.1","scenario_range":"Scenario inputs 0.1 to 0.1; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"ortho_cash_per_service":{"central":"1600","scenario_range":"Scenario inputs 1600 to 1600; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"ortho_clinical_resource_per_service":{"central":"5000","scenario_range":"Scenario inputs 5000 to 10000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"head_neck_allocation":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"head_neck_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"head_neck_clinical_resource_per_service":{"central":"3500","scenario_range":"Scenario inputs 3500 to 7000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"urology_allocation":{"central":"0.07","scenario_range":"Scenario inputs 0.07 to 0.07; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"urology_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"urology_clinical_resource_per_service":{"central":"4000","scenario_range":"Scenario inputs 4000 to 8000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"derm_allocation":{"central":"0.05","scenario_range":"Scenario inputs 0 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"derm_cash_per_service":{"central":"1300","scenario_range":"Scenario inputs 1300 to 1300; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"derm_clinical_resource_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 3600; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"vascular_allocation":{"central":"0.04","scenario_range":"Scenario inputs 0.02 to 0.04; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"vascular_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"vascular_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_allocation":{"central":"0.03","scenario_range":"Scenario inputs 0.01 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"eye_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"eye_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"other_allocation":{"central":"0.02","scenario_range":"Scenario inputs 0 to 0.21; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"other_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"other_clinical_resource_per_service":{"central":"3000","scenario_range":"Scenario inputs 3000 to 6000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_selected_fraction":{"central":"0.65","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"65% of nominal ophthalmology services assumed selected first-eye function-limiting cataract pathway;45observedeye services also include other procedures."},"eye_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"eye_disjoint_fraction":{"central":"0.95","scenario_range":"Scenario inputs 0.95 to 0.95; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"eye_treatment_success":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"eye_utility_gain":{"central":"0.05","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".05 utility-point gain per successful person-year is a separate judgment. The RCT's.056 integrated first-yearQALY is a magnitude anchor only, not a rate multiplied by three years."},"eye_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"eye_loss_hazard":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"eye_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"eye_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"eye_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"eye_harm_q_per_person":{"central":"0.002","scenario_range":"Scenario inputs 0 to 0.002; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"hernia_selected_fraction":{"central":"0.45","scenario_range":"Scenario inputs 0 to 0.7; not a confidence interval","basis":"45% of nominal general-surgery services assumed selected symptomatic hernia episodes;201general services are not201hernias."},"hernia_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"hernia_disjoint_fraction":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"hernia_treatment_success":{"central":"0.85","scenario_range":"Scenario inputs 0.85 to 0.85; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"hernia_utility_gain":{"central":"0.04","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".04 utility-point gain per successful symptomatic-person-year is a judgment; minimallysymptomatic randomized evidence is essentially null. Selected pain-limiting hernia fraction and transport are unknown."},"hernia_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"hernia_loss_hazard":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"hernia_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"hernia_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"hernia_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"hernia_harm_q_per_person":{"central":"0.004","scenario_range":"Scenario inputs 0 to 0.004; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"crc_selected_fraction":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% of nominal GI services assumed abnormal-FIT follow-up;575GI services are not575positiveFIT patients."},"crc_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"crc_disjoint_fraction":{"central":"1","scenario_range":"Scenario inputs 1 to 1; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"crc_treatment_linkage":{"central":"0.7","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"70% judgment chance that necessary appropriate downstream management can deliver the modeled contrast. Diagnostic completion alone earns no full treatment gain."},"crc_annual_fatal_hazard_reduction":{"central":"0.0006","scenario_range":"Scenario inputs -0.0003 to 0.001; not a confidence interval","basis":".0006/year is a judgment if no later-care catchup, lasting five hazard-years after latency. It is not.0092/10 or an estimated causal attenuation of the cohort. Fiveyears×.0006=.003 cumulative hazard only as a scale check."},"crc_baseline_total_mortality_hazard":{"central":"0.025","scenario_range":"Scenario inputs 0.025 to 0.025; not a confidence interval","basis":".025/year all-cause hazard prior already includes CRC mortality. Only the modeled CRC component changes; no second mortality hazard added."},"crc_catchup_hazard":{"central":"0.5","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".5/year aggregate hazard-effect decay prior (two-year characteristic time) for eventual ordinary diagnostic/treatment care; mean-hazard approximation, not exact random individual care-time mixture."},"crc_latency_years":{"central":"2","scenario_range":"Scenario inputs 2 to 2; not a confidence interval","basis":"Two-year assumed lag from procedure to differential fatal risk. Not observed OA survival timing; existing alternative care can catch up during this lag."},"crc_active_years":{"central":"5","scenario_range":"Scenario inputs 5 to 5; not a confidence interval","basis":"Five years of possibly different fatal hazard after latency, not five avoided deaths or a life expectancy."},"crc_horizon_years":{"central":"10","scenario_range":"Scenario inputs 10 to 15; not a confidence interval","basis":"Ten-year finite survival observation from procedure; both arms return to common mortality after the hazard-effect window. No lifetime tail."},"crc_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"crc_surviving_utility":{"central":"0.75","scenario_range":"Scenario inputs 0.75 to 0.75; not a confidence interval","basis":".75 utility for extra surviving person-time; no extra cancer morbidity or household benefit."},"crc_harm_q_per_person":{"central":"0.001","scenario_range":"Scenario inputs 0 to 0.001; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."}},"historical_comparison":{"model_path":"/private/tmp/mfi-oa-model.json","model_version":"oa-abnormal-fit-completed-pathway-v1","donor_per_10q":600000,"resource_per_10q":1012000,"boundary":"Selected SF abnormal-FIT completed pathway only; not ordinary whole gift. Preserved unchanged, not directly interchangeable with portfolio estimate."}},"paths":[{"id":"gi_symptom_diagnosis","category":"gi","share":0.5,"name":"Non-FIT GI investigation → benign treatable dyspepsia/dysphagia management","utility_gain":0.03,"treatment_success":0.4,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Diagnostic procedure alone earns no cure; treatment linkage is a prior, alternative primary-care therapy remains baseline.","downstream_resource_per_nominal_service":200},{"id":"general_cyst","category":"general","share":0.225,"name":"Painful cyst/lipoma excision","utility_gain":0.025,"treatment_success":0.85,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA procedure explicitly listed; utility and symptom-limiting fraction are priors, not cosmetic benefit.","downstream_resource_per_nominal_service":0},{"id":"anorectal","category":"general","share":0.12,"name":"Symptomatic haemorrhoid/fissure treatment","utility_gain":0.05,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Historical minor anorectal mix only; assume persistent symptoms despite medical management.","downstream_resource_per_nominal_service":0},{"id":"gallstone","category":"general","share":0.065,"name":"Uncomplicated symptomatic gallstone surgery","utility_gain":0,"treatment_success":0.7,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"C-GALL control includes later surgery; nonsignificant small integrated QALY difference; conservative care may suffice.","downstream_resource_per_nominal_service":0},{"id":"breast_diagnostic","category":"general","share":0.14,"name":"Breast lesion diagnostic assessment and linked benign symptom treatment","utility_gain":0.01,"treatment_success":0.25,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No unverified cancer survival gain. Prior only for changed symptom management, not all negative tests.","downstream_resource_per_nominal_service":200},{"id":"aub","category":"gyne","share":0.65,"name":"Refractory abnormal uterine bleeding → definitive outpatient treatment","utility_gain":0.07,"treatment_success":0.8,"harm_q_per_person":0.015,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Ms trial supports surgery vs expanded medical care; no hysterectomy-vs-ablation transfer, fertility/recovery losses retained.","downstream_resource_per_nominal_service":0},{"id":"pelvic","category":"gyne","share":0.25,"name":"Symptomatic pelvic prolapse/incontinence treatment","utility_gain":0.07,"treatment_success":0.7,"harm_q_per_person":0.01,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Case-mix and utility priors, not confirmed OA frequency; pessary/conservative alternatives retained.","downstream_resource_per_nominal_service":0},{"id":"gyne_diagnostic","category":"gyne","share":0.1,"name":"Gynaecologic diagnostic workup → nonmalignant symptom management","utility_gain":0.02,"treatment_success":0.3,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Diagnosis without management has zero benefit through linkage; no automatic cancer cure.","downstream_resource_per_nominal_service":200},{"id":"cts","category":"ortho","share":0.35,"name":"Carpal tunnel decompression for symptomatic confirmed CTS","utility_gain":0.03,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Primary economic trial .04 at12months is nonsignificant point utility, not integrated QALY. .03 here is an independent transfer prior.","downstream_resource_per_nominal_service":0},{"id":"foot_tendon","category":"ortho","share":0.45,"name":"Painful foot deformity / tendon or trigger-finger intervention","utility_gain":0.06,"treatment_success":0.75,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Named mechanical function hypothesis; OA ortho/podiatry totals not diagnosis frequencies. Utilities are priors. Torkki hallux-valgus RCT11368700 supports the painful-bunion subset only; two-year catch-up12807332 rules out lifelong timing gain.","downstream_resource_per_nominal_service":0},{"id":"degenerative_knee","category":"ortho","share":0.2,"name":"Degenerative knee arthroscopy without acute mechanical indication","utility_gain":0,"treatment_success":0.8,"harm_q_per_person":0.006,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Null benefit central, not assume all orthopaedic surgery is useful; harm retained.","downstream_resource_per_nominal_service":0},{"id":"nasal","category":"head_neck","share":0.7,"name":"Septal nasal obstruction surgery versus nasal medical therapy","utility_gain":0.04,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"NAIROS validates symptom mechanism, not SNOT22-to-QALY conversion or universal ENT benefit.","downstream_resource_per_nominal_service":0},{"id":"ear","category":"head_neck","share":0.3,"name":"Conductive ear disease treatment","utility_gain":0.03,"treatment_success":0.7,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Clinical indication and utility priors; no all-ENT survival credit.","downstream_resource_per_nominal_service":200},{"id":"bph","category":"urology","share":0.45,"name":"Bothersome BPH/outlet obstruction treatment","utility_gain":0.06,"treatment_success":0.8,"harm_q_per_person":0.006,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"TURP vs watchful waiting trial supports symptom relief, not current OA frequency; modern medication baseline matters.","downstream_resource_per_nominal_service":0},{"id":"stone","category":"urology","share":0.35,"name":"Symptomatic urinary stone treatment","utility_gain":0.05,"treatment_success":0.75,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No prophylactic life-saving claim for asymptomatic stones; spontaneous passage and medical treatment in comparator.","downstream_resource_per_nominal_service":200},{"id":"scrotal","category":"urology","share":0.2,"name":"Symptomatic benign scrotal/hydrocele treatment","utility_gain":0.025,"treatment_success":0.75,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Indication and finite utility priors; no infertility or cancer mortality award.","downstream_resource_per_nominal_service":0},{"id":"derm_cyst","category":"derm","share":0.8,"name":"Symptomatic benign skin cyst/lesion treatment","utility_gain":0.02,"treatment_success":0.8,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA cyst/lipoma service; disjoint allocation from general surgery required.","downstream_resource_per_nominal_service":0},{"id":"skin_lesion","category":"derm","share":0.2,"name":"Localized skin lesion diagnosis and treatment","utility_gain":0.03,"treatment_success":0.6,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Symptom/functional relief only; no melanoma mortality extrapolation.","downstream_resource_per_nominal_service":200},{"id":"veins","category":"vascular","share":1,"name":"Symptomatic uncomplicated varicose vein treatment","utility_gain":0.04,"treatment_success":0.8,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"REACTIV randomized conservative comparator; integrated two-year .054Q not annual gain.","downstream_resource_per_nominal_service":0},{"id":"pterygium","category":"eye","share":0.35,"name":"Symptomatic pterygium treatment","utility_gain":0.025,"treatment_success":0.8,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA explicitly offered; first-eye cataract cohort excluded; finite symptom/vision utility prior.","downstream_resource_per_nominal_service":0},{"id":"other_assessment","category":"other","share":1,"name":"Specialty assessment without established diagnosis-changing intervention","utility_gain":0,"treatment_success":0,"harm_q_per_person":0.0005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Only2%wholegift allocation; centralzero benefit explicitly due absent disease/intervention evidence, not blanket residual zero for major specialties.","downstream_resource_per_nominal_service":0}],"scope":"Expected whole-organization health CONDITIONAL on explicit diagnostic case-mix priors. All2025 specialty categories covered in a service ledger; other assessment2% receives zero benefit plus burden. No generic residual QALY/$ or inverse allocation uplift.","scenarios":[{"id":"central","baseOverrides":{},"pathOverrides":{}},{"id":"new_pathways_null","baseOverrides":{},"allPaths":{"utility_gain":0},"pathOverrides":{}},{"id":"fast_later_care","baseOverrides":{"eye_catchup_hazard":4,"hernia_catchup_hazard":4,"crc_catchup_hazard":4},"allPaths":{"catchup_hazard":4},"pathOverrides":{}},{"id":"zero_activity","baseOverrides":{"funding_additionality":0},"pathOverrides":{}},{"id":"adverse_new_pathways","baseOverrides":{},"allPaths":{"utility_gain":-0.01},"pathOverrides":{}},{"id":"favorable_joint","baseOverrides":{"funding_additionality":0.8,"eye_utility_gain":0.1,"hernia_utility_gain":0.1,"eye_catchup_hazard":0.2,"hernia_catchup_hazard":0.2},"allPaths":{"catchup_hazard":0.2,"horizon_years":5},"pathOverrides":{}},{"id":"no_local","baseOverrides":{"sf_share":0,"bay_share":0},"pathOverrides":{}},{"id":"double_new_resources","baseOverrides":{"outside_support_per_service":120,"patient_time_per_service":200},"pathOverrides":{}},{"id":"one_year","baseOverrides":{"eye_horizon_years":1,"hernia_horizon_years":1},"allPaths":{"horizon_years":1},"pathOverrides":{}}],"note":"v1 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Waived-dollar fundraising leverage is not QALY evidence.","retrieved":"September9,2026"},{"key":"fit","publisher":"California Colorectal Cancer Coalition","title":"OA facilitated donated colonoscopy","url":"https://www.cacoloncancer.org/operation-access-facilitated-access-to-donated-colonoscopies/","published":"Current undated","sourceType":"Primary referral mechanism; above-average risk/positive stool tests; not575verifiedFITcases.","retrieved":"September9,2026"},{"key":"cataract","publisher":"Sach et al.","title":"First-eye cataract randomized economic evaluation","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC2095519/","published":"2007","sourceType":"306women over70, expedited4weeks vsroutine12months; first-yearQALYdifference.056(.006,.108), integratedyear—not annualutilityorOAlocalestimate.","retrieved":"September9,2026"},{"key":"hernia","publisher":"Fitzgibbons et al.","title":"Watchful waiting versus repair","url":"https://pubmed.ncbi.nlm.nih.gov/16418463/","published":"2006","sourceType":"720minimallysymptomatic men;2-yearpain/physicalfunction differences notsignificant;23%watchfulwaiting crossed torepair. Strong warning against assuming allhernias benefit.","retrieved":"September9,2026"},{"key":"crc","publisher":"Zorzi et al.","title":"Mortality after positive FIT without program colonoscopy","url":"https://pubmed.ncbi.nlm.nih.gov/33789965/","published":"2021","sourceType":"Observational10-yearCRC mortality6.8vs16per1000. Not randomization, no directly imported hazardorQALY.","retrieved":"September9,2026"},{"key":"critique","publisher":"Methodological correspondence","title":"Immortal-time concern in positive-FIT mortality comparison","url":"https://pubmed.ncbi.nlm.nih.gov/37549982/","published":"2023","sourceType":"Primary methodological criticism; exposure timing/selection biases not assumed solved.","retrieved":"September9,2026"},{"key":"navigation","publisher":"PRECISE investigators","title":"Navigation after abnormal stool test trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13007779/","published":"2025","sourceType":"967analysis;55.1vs42.1%one-yearcompletion. Not multiplied into already-completed OAservice units.","retrieved":"September9,2026"},{"key":"coverage","publisher":"California DHCS","title":"Medi-Cal eligibility changes","url":"https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/","published":"2026","sourceType":"Public coverage remains baseline when available; no assertion alluninsured have no latercare.","retrieved":"September9,2026"}],"funding_room":{"verified_offer_usd":null,"additional_slots":null,"accepted_sf_restriction":null,"statement":"Largest-funder loss and layoffs documented, but maintainedgrowth/newdonors and16monthsoperatingcash do not measure marginalcapacity. Allnumericalcaps are priors."},"boundaries":["All ten cash allocations sum to one. Other services retain full costs with health unquantified; zero credit is not a finding they are ineffective. This partial-health whole-gift estimate is not an upper bound on cost-effectiveness.","Completed-service cost includes coordination, overhead and failed referrals. Selected clinical subset, service-to-person conversion, financial additionality and disjointness are separate assumptions; service count alone is never a health outcome.","Current uninsured/ineligible-Medi-Cal eligibility is not a never-care baseline. Later safety-net care, coverage changes, other donors, donated provider capacity and OA's existing navigation remain in the counterfactual.","CRC uses an explicitly judgmental mean-hazard survival approximation. Cohort mortality association and navigationRCT are not causal manufacturer-like coefficients; no .13 completion multiplier or legacy aggregate.05Q is reused.","One exclusive linked-person ledger CRC then eye then hernia. Repeats/second eyes and overlapping diagnoses retain costs but cannot earn duplicate whole-person health. No productivity, caregiver or other mortality gains are added.","Donated clinical resources, distinct nonclinical support, patient time and downstream cancer-care allowances are gross associated costs on all nominal services, including uncredited/replaced activity. They are not waived charges, net incremental resources, or exhaustive societal cost.","Both health comparisons start with the same people alive at care. Delay discounts only; horizons start at care, not gift. Harms are already gift-date PV and include repeat procedures within an episode; late-comparator harms are not subtracted.","Bay and SF are nested weak residence priors, not measured local return. US equals all-region direct health here; no international or indirect local spillovers are credited.","Historical selectedSF$600,000 donor/$1,012,000 expanded price remains a separate program comparison. It must not remain the ordinary-gift ranking input after this revision."],"input_provenance":{"gift_usd":{"central":"100000","scenario_range":"Scenario inputs 100000 to 100000; not a confidence interval","basis":"Reference ordinary unrestricted gift; every dollar retained, not an SF colonoscopy restriction."},"funding_additionality":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% judgment for extra maintained/expanded services after replacement funding and provider bottlenecks. Existing OA care is baseline. Not estimated from the deficit or reserves."},"max_additional_services":{"central":"100","scenario_range":"Scenario inputs 0 to 100; not a confidence interval","basis":"100 extra mixed-service cap is an assumption, not identified open appointments. Shared capacity reduces all specialty activity proportionately."},"discount":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"3% annual health discount; economic resource amounts are gross associated present-dollar allowances, not a discounted net-social ledger."},"bay_share":{"central":"0.6","scenario_range":"Scenario inputs 0 to 0.8; not a confidence interval","basis":"60% weak beneficiary-residence prior within Northern California/Central Valley reach. No published specialty-specific county shares verified."},"sf_share":{"central":"0.08","scenario_range":"Scenario inputs 0 to 0.15; not a confidence interval","basis":"8% weak SF beneficiary-residence prior nested within Bay, not office location or guaranteed restricted allocation."},"independent_harm_q":{"central":"0","scenario_range":"Scenario inputs 0 to 1; not a confidence interval","basis":"Gift-date PV health loss independent of clinical activity; central0, zero-activity adverse case1."},"outside_support_per_service":{"central":"60","scenario_range":"Scenario inputs 60 to 60; not a confidence interval","basis":"$60 distinct nonclinical donated support per nominal mixed service, rounded from89,922/1,529; not already cash-paid interpretation/travel."},"patient_time_per_service":{"central":"100","scenario_range":"Scenario inputs 100 to 100; not a confidence interval","basis":"$100 additional patient/caregiver time allowance per nominal service, not earnings benefits or OA-paid travel."},"crc_treatment_cost_per_selected":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"$1,500 expected downstream therapy/surveillance resource allowance per nominal selectedFIT service, beyond endoscopy resources; weak prior, not provider quote or complete treatment estimate."},"gi_allocation":{"central":"0.37","scenario_range":"Scenario inputs 0.25 to 0.42; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gi_cash_per_service":{"central":"1400","scenario_range":"Scenario inputs 1400 to 1400; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gi_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"general_allocation":{"central":"0.13","scenario_range":"Scenario inputs 0.08 to 0.15; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"general_cash_per_service":{"central":"1700","scenario_range":"Scenario inputs 1700 to 1700; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"general_clinical_resource_per_service":{"central":"5500","scenario_range":"Scenario inputs 5500 to 11000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"gyne_allocation":{"central":"0.11","scenario_range":"Scenario inputs 0.11 to 0.11; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gyne_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gyne_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"ortho_allocation":{"central":"0.1","scenario_range":"Scenario inputs 0.1 to 0.1; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"ortho_cash_per_service":{"central":"1600","scenario_range":"Scenario inputs 1600 to 1600; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"ortho_clinical_resource_per_service":{"central":"5000","scenario_range":"Scenario inputs 5000 to 10000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"head_neck_allocation":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"head_neck_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"head_neck_clinical_resource_per_service":{"central":"3500","scenario_range":"Scenario inputs 3500 to 7000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"urology_allocation":{"central":"0.07","scenario_range":"Scenario inputs 0.07 to 0.07; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"urology_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"urology_clinical_resource_per_service":{"central":"4000","scenario_range":"Scenario inputs 4000 to 8000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"derm_allocation":{"central":"0.05","scenario_range":"Scenario inputs 0 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"derm_cash_per_service":{"central":"1300","scenario_range":"Scenario inputs 1300 to 1300; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"derm_clinical_resource_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 3600; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"vascular_allocation":{"central":"0.04","scenario_range":"Scenario inputs 0.02 to 0.04; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"vascular_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"vascular_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_allocation":{"central":"0.03","scenario_range":"Scenario inputs 0.01 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"eye_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"eye_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"other_allocation":{"central":"0.02","scenario_range":"Scenario inputs 0 to 0.21; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"other_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"other_clinical_resource_per_service":{"central":"3000","scenario_range":"Scenario inputs 3000 to 6000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_selected_fraction":{"central":"0.65","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"65% of nominal ophthalmology services assumed selected first-eye function-limiting cataract pathway;45observedeye services also include other procedures."},"eye_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"eye_disjoint_fraction":{"central":"0.95","scenario_range":"Scenario inputs 0.95 to 0.95; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"eye_treatment_success":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"eye_utility_gain":{"central":"0.05","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".05 utility-point gain per successful person-year is a separate judgment. The RCT's.056 integrated first-yearQALY is a magnitude anchor only, not a rate multiplied by three years."},"eye_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"eye_loss_hazard":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"eye_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"eye_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"eye_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"eye_harm_q_per_person":{"central":"0.002","scenario_range":"Scenario inputs 0 to 0.002; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"hernia_selected_fraction":{"central":"0.45","scenario_range":"Scenario inputs 0 to 0.7; not a confidence interval","basis":"45% of nominal general-surgery services assumed selected symptomatic hernia episodes;201general services are not201hernias."},"hernia_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"hernia_disjoint_fraction":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"hernia_treatment_success":{"central":"0.85","scenario_range":"Scenario inputs 0.85 to 0.85; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"hernia_utility_gain":{"central":"0.04","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".04 utility-point gain per successful symptomatic-person-year is a judgment; minimallysymptomatic randomized evidence is essentially null. Selected pain-limiting hernia fraction and transport are unknown."},"hernia_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"hernia_loss_hazard":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"hernia_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"hernia_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"hernia_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"hernia_harm_q_per_person":{"central":"0.004","scenario_range":"Scenario inputs 0 to 0.004; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"crc_selected_fraction":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% of nominal GI services assumed abnormal-FIT follow-up;575GI services are not575positiveFIT patients."},"crc_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"crc_disjoint_fraction":{"central":"1","scenario_range":"Scenario inputs 1 to 1; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"crc_treatment_linkage":{"central":"0.7","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"70% judgment chance that necessary appropriate downstream management can deliver the modeled contrast. Diagnostic completion alone earns no full treatment gain."},"crc_annual_fatal_hazard_reduction":{"central":"0.0006","scenario_range":"Scenario inputs -0.0003 to 0.001; not a confidence interval","basis":".0006/year is a judgment if no later-care catchup, lasting five hazard-years after latency. It is not.0092/10 or an estimated causal attenuation of the cohort. Fiveyears×.0006=.003 cumulative hazard only as a scale check."},"crc_baseline_total_mortality_hazard":{"central":"0.025","scenario_range":"Scenario inputs 0.025 to 0.025; not a confidence interval","basis":".025/year all-cause hazard prior already includes CRC mortality. Only the modeled CRC component changes; no second mortality hazard added."},"crc_catchup_hazard":{"central":"0.5","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".5/year aggregate hazard-effect decay prior (two-year characteristic time) for eventual ordinary diagnostic/treatment care; mean-hazard approximation, not exact random individual care-time mixture."},"crc_latency_years":{"central":"2","scenario_range":"Scenario inputs 2 to 2; not a confidence interval","basis":"Two-year assumed lag from procedure to differential fatal risk. Not observed OA survival timing; existing alternative care can catch up during this lag."},"crc_active_years":{"central":"5","scenario_range":"Scenario inputs 5 to 5; not a confidence interval","basis":"Five years of possibly different fatal hazard after latency, not five avoided deaths or a life expectancy."},"crc_horizon_years":{"central":"10","scenario_range":"Scenario inputs 10 to 15; not a confidence interval","basis":"Ten-year finite survival observation from procedure; both arms return to common mortality after the hazard-effect window. No lifetime tail."},"crc_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"crc_surviving_utility":{"central":"0.75","scenario_range":"Scenario inputs 0.75 to 0.75; not a confidence interval","basis":".75 utility for extra surviving person-time; no extra cancer morbidity or household benefit."},"crc_harm_q_per_person":{"central":"0.001","scenario_range":"Scenario inputs 0 to 0.001; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."}},"historical_comparison":{"model_path":"/private/tmp/mfi-oa-model.json","model_version":"oa-abnormal-fit-completed-pathway-v1","donor_per_10q":600000,"resource_per_10q":1012000,"boundary":"Selected SF abnormal-FIT completed pathway only; not ordinary whole gift. Preserved unchanged, not directly interchangeable with portfolio estimate."}},"paths":[{"id":"gi_symptom_diagnosis","category":"gi","share":0.5,"name":"Non-FIT GI investigation → benign treatable dyspepsia/dysphagia management","utility_gain":0.03,"treatment_success":0.4,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Diagnostic procedure alone earns no cure; treatment linkage is a prior, alternative primary-care therapy remains baseline.","downstream_resource_per_nominal_service":200},{"id":"general_cyst","category":"general","share":0.225,"name":"Painful cyst/lipoma excision","utility_gain":0.025,"treatment_success":0.85,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA procedure explicitly listed; utility and symptom-limiting fraction are priors, not cosmetic benefit.","downstream_resource_per_nominal_service":0},{"id":"anorectal","category":"general","share":0.12,"name":"Symptomatic haemorrhoid/fissure treatment","utility_gain":0.05,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Historical minor anorectal mix only; assume persistent symptoms despite medical management.","downstream_resource_per_nominal_service":0},{"id":"gallstone","category":"general","share":0.065,"name":"Uncomplicated symptomatic gallstone surgery","utility_gain":0,"treatment_success":0.7,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"C-GALL control includes later surgery; nonsignificant small integrated QALY difference; conservative care may suffice.","downstream_resource_per_nominal_service":0},{"id":"breast_diagnostic","category":"general","share":0.14,"name":"Breast lesion diagnostic assessment and linked benign symptom treatment","utility_gain":0.01,"treatment_success":0.25,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No unverified cancer survival gain. 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Access","version":"oa-whole-gift-named-coverage-v2","foundation":{"organization":"Operation Access","slug":"operation-access","model_version":"oa-whole-gift-finite-portfolio-v1","recipient":{"legal_name":"Ambulatory Surgery Access Coalition dba Operation Access","ein":"94-3180356","giving_url":"https://www.operationaccess.org/donate"},"finance":{"year":2025,"total_accrual_expense":22876888,"donated_clinical_waived_charges":20530000,"other_donated_support":89922,"cash_like_expense":2256966,"annual_report_cash_expense":2256967,"budget2026_cash":1900000,"services":1529,"specialty_services":{"gi":575,"general":201,"gyne":168,"ortho":158,"head_neck":127,"urology":101,"derm":80,"vascular":58,"eye":45,"other":16},"note":"Cash-like accrual subtraction is not cash flow. Waived charges are not economic costs. Prospective allocation is not observed specialty cash spending."},"categories":["gi","general","gyne","ortho","head_neck","urology","derm","vascular","eye","other"],"central_inputs":{"gift_usd":10000,"funding_additionality":0.1,"max_additional_services":20,"discount":0.03,"bay_share":0.6,"sf_share":0.08,"independent_harm_q":0,"outside_support_per_service":60,"patient_time_per_service":100,"crc_treatment_cost_per_selected":1500,"gi_allocation":0.3760627861347286,"gi_cash_per_service":1479.0745585349903,"gi_clinical_resource_per_service":2500,"general_allocation":0.131458469587966,"general_cash_per_service":1479.0745585349903,"general_clinical_resource_per_service":5500,"gyne_allocation":0.10987573577501634,"gyne_cash_per_service":1479.0745585349903,"gyne_clinical_resource_per_service":4500,"ortho_allocation":0.10333551340745585,"ortho_cash_per_service":1479.0745585349903,"ortho_clinical_resource_per_service":5000,"head_neck_allocation":0.08306082406801832,"head_neck_cash_per_service":1479.0745585349903,"head_neck_clinical_resource_per_service":3500,"urology_allocation":0.06605624591236102,"urology_cash_per_service":1479.0745585349903,"urology_clinical_resource_per_service":4000,"derm_allocation":0.052321778940483975,"derm_cash_per_service":1479.0745585349903,"derm_clinical_resource_per_service":1800,"vascular_allocation":0.03793328973185088,"vascular_cash_per_service":1479.0745585349903,"vascular_clinical_resource_per_service":4500,"eye_allocation":0.029431000654022238,"eye_cash_per_service":1479.0745585349903,"eye_clinical_resource_per_service":2500,"other_allocation":0.010464355788096796,"other_cash_per_service":1479.0745585349903,"other_clinical_resource_per_service":3000,"eye_selected_fraction":0.65,"eye_services_per_person":1.3530973451327433,"eye_disjoint_fraction":1,"eye_treatment_success":1,"eye_utility_gain":0.04369288612091463,"eye_catchup_hazard":0,"eye_loss_hazard":0.03,"eye_mortality_hazard":0.02,"eye_horizon_years":1,"eye_delay_years":0.25,"eye_harm_q_per_person":0.002,"hernia_selected_fraction":0.45,"hernia_services_per_person":1.3530973451327433,"hernia_disjoint_fraction":1,"hernia_treatment_success":0.85,"hernia_utility_gain":0.04,"hernia_catchup_hazard":0.7,"hernia_loss_hazard":0.08,"hernia_mortality_hazard":0.02,"hernia_horizon_years":3,"hernia_delay_years":0.25,"hernia_harm_q_per_person":0.004,"crc_selected_fraction":0.5,"crc_services_per_person":1.3530973451327433,"crc_disjoint_fraction":1,"crc_treatment_linkage":0.7,"crc_annual_fatal_hazard_reduction":0.0006,"crc_baseline_total_mortality_hazard":0.025,"crc_catchup_hazard":0.5,"crc_latency_years":2,"crc_active_years":5,"crc_horizon_years":10,"crc_delay_years":0.25,"crc_surviving_utility":0.75,"crc_harm_q_per_person":0.001},"scenarios":[{"id":"central","overrides":{}},{"id":"favorable","overrides":{"funding_additionality":0.75,"eye_selected_fraction":0.9,"hernia_selected_fraction":0.7,"crc_selected_fraction":0.75,"eye_utility_gain":0.1,"hernia_utility_gain":0.1,"eye_catchup_hazard":0.2,"hernia_catchup_hazard":0.2,"crc_catchup_hazard":0.15,"crc_treatment_linkage":0.9,"crc_annual_fatal_hazard_reduction":0.001,"eye_horizon_years":5,"hernia_horizon_years":5,"crc_horizon_years":15}},{"id":"cautious","overrides":{"funding_additionality":0.1,"eye_selected_fraction":0.3,"hernia_selected_fraction":0.2,"crc_selected_fraction":0.2,"eye_utility_gain":0.01,"hernia_utility_gain":0.005,"crc_annual_fatal_hazard_reduction":0.0001,"eye_catchup_hazard":2,"hernia_catchup_hazard":2,"crc_catchup_hazard":2,"crc_treatment_linkage":0.3}},{"id":"funding_replacement","overrides":{"funding_additionality":0}},{"id":"capacity_zero","overrides":{"max_additional_services":0}},{"id":"limited_capacity","overrides":{"max_additional_services":5}},{"id":"fast_alternative_care","overrides":{"eye_catchup_hazard":4,"hernia_catchup_hazard":4,"crc_catchup_hazard":4}},{"id":"no_later_care","overrides":{"eye_catchup_hazard":0,"hernia_catchup_hazard":0,"crc_catchup_hazard":0}},{"id":"one_year_nonfatal_benefit","overrides":{"eye_horizon_years":1,"hernia_horizon_years":1}},{"id":"crc_no_treatment","overrides":{"crc_treatment_linkage":0}},{"id":"crc_association_does_not_transfer","overrides":{"crc_annual_fatal_hazard_reduction":0}},{"id":"minimally_symptomatic_hernia_null","overrides":{"hernia_utility_gain":0}},{"id":"all_health_null","overrides":{"eye_utility_gain":0,"hernia_utility_gain":0,"crc_annual_fatal_hazard_reduction":0,"eye_harm_q_per_person":0,"hernia_harm_q_per_person":0,"crc_harm_q_per_person":0}},{"id":"benefit_null_harms_retained","overrides":{"eye_utility_gain":0,"hernia_utility_gain":0,"crc_annual_fatal_hazard_reduction":0}},{"id":"signed_adverse_health","overrides":{"eye_utility_gain":-0.02,"hernia_utility_gain":-0.02,"crc_annual_fatal_hazard_reduction":-0.0003}},{"id":"independent_harm_zero_activity","overrides":{"funding_additionality":0,"independent_harm_q":1}},{"id":"repeat_services","overrides":{"eye_services_per_person":2,"hernia_services_per_person":2,"crc_services_per_person":2}},{"id":"lower_target_portfolio","overrides":{"gi_allocation":0.25,"general_allocation":0.08,"eye_allocation":0.01,"other_allocation":0.21}},{"id":"higher_target_portfolio","overrides":{"gi_allocation":0.42,"general_allocation":0.15,"eye_allocation":0.05,"other_allocation":0,"derm_allocation":0,"vascular_allocation":0.02}},{"id":"double_external_resources","overrides":{"gi_clinical_resource_per_service":5000,"general_clinical_resource_per_service":11000,"gyne_clinical_resource_per_service":9000,"ortho_clinical_resource_per_service":10000,"head_neck_clinical_resource_per_service":7000,"urology_clinical_resource_per_service":8000,"derm_clinical_resource_per_service":3600,"vascular_clinical_resource_per_service":9000,"eye_clinical_resource_per_service":5000,"other_clinical_resource_per_service":6000}},{"id":"local_zero","overrides":{"bay_share":0,"sf_share":0}},{"id":"higher_local_share","overrides":{"bay_share":0.8,"sf_share":0.15}},{"id":"no_selected_subsets","overrides":{"eye_selected_fraction":0,"hernia_selected_fraction":0,"crc_selected_fraction":0}}],"sources":[{"key":"audit","publisher":"Operation Access","title":"2025 audited financial statements","url":"https://www.operationaccess.org/s/2025-Audited-Financial-Statements.pdf","published":"Year ended December31,2025; auditMay20,2026","sourceType":"Primary audited whole-organization expense, waived-charge accounting, liquidity and restrictions; relevant PDF7–8,14–15 visually verified.","retrieved":"September9,2026"},{"key":"report","publisher":"Operation Access","title":"2025 annual report","url":"https://www.operationaccess.org/s/Operation-Access-Annual-Report-2025.pdf","published":"2025 reporting year","sourceType":"Primary specialty counts/chartPDF7, funding lossPDF2, wait/readinessPDF6, cash financePDF13. Counts are services, not unique people or measured health.","retrieved":"September9,2026"},{"key":"budget","publisher":"Operation Access","title":"2026 budget","url":"https://www.operationaccess.org/s/2026Budget-8pz4.pdf","published":"ApprovedDecember10,2025","sourceType":"Primary1.9million cash plan, not actual2026 unit cost or procedure target.","retrieved":"September9,2026"},{"key":"eligibility","publisher":"Operation Access","title":"Patient eligibility and procedures","url":"https://www.operationaccess.org/for-patients-para-pacientes","published":"Current undated","sourceType":"Uninsured and ineligible fullMedi-Cal/Medicare/CMSP; cataract and hernia procedures explicitly offered; not insurance.","retrieved":"September9,2026"},{"key":"giving","publisher":"Operation Access","title":"Donate","url":"https://www.operationaccess.org/donate","published":"Current undated","sourceType":"Official ordinary donation route and EIN94-3180356. Waived-dollar fundraising leverage is not QALY evidence.","retrieved":"September9,2026"},{"key":"fit","publisher":"California Colorectal Cancer Coalition","title":"OA facilitated donated colonoscopy","url":"https://www.cacoloncancer.org/operation-access-facilitated-access-to-donated-colonoscopies/","published":"Current undated","sourceType":"Primary referral mechanism; above-average risk/positive stool tests; not575verifiedFITcases.","retrieved":"September9,2026"},{"key":"cataract","publisher":"Sach et al.","title":"First-eye cataract randomized economic evaluation","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC2095519/","published":"2007","sourceType":"306women over70, expedited4weeks vsroutine12months; first-yearQALYdifference.056(.006,.108), integratedyear—not annualutilityorOAlocalestimate.","retrieved":"September9,2026"},{"key":"hernia","publisher":"Fitzgibbons et al.","title":"Watchful waiting versus repair","url":"https://pubmed.ncbi.nlm.nih.gov/16418463/","published":"2006","sourceType":"720minimallysymptomatic men;2-yearpain/physicalfunction differences notsignificant;23%watchfulwaiting crossed torepair. Strong warning against assuming allhernias benefit.","retrieved":"September9,2026"},{"key":"crc","publisher":"Zorzi et al.","title":"Mortality after positive FIT without program colonoscopy","url":"https://pubmed.ncbi.nlm.nih.gov/33789965/","published":"2021","sourceType":"Observational10-yearCRC mortality6.8vs16per1000. Not randomization, no directly imported hazardorQALY.","retrieved":"September9,2026"},{"key":"critique","publisher":"Methodological correspondence","title":"Immortal-time concern in positive-FIT mortality comparison","url":"https://pubmed.ncbi.nlm.nih.gov/37549982/","published":"2023","sourceType":"Primary methodological criticism; exposure timing/selection biases not assumed solved.","retrieved":"September9,2026"},{"key":"navigation","publisher":"PRECISE investigators","title":"Navigation after abnormal stool test trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13007779/","published":"2025","sourceType":"967analysis;55.1vs42.1%one-yearcompletion. Not multiplied into already-completed OAservice units.","retrieved":"September9,2026"},{"key":"coverage","publisher":"California DHCS","title":"Medi-Cal eligibility changes","url":"https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/","published":"2026","sourceType":"Public coverage remains baseline when available; no assertion alluninsured have no latercare.","retrieved":"September9,2026"}],"funding_room":{"verified_offer_usd":null,"additional_slots":null,"accepted_sf_restriction":null,"statement":"Largest-funder loss and layoffs documented, but maintainedgrowth/newdonors and16monthsoperatingcash do not measure marginalcapacity. Allnumericalcaps are priors."},"boundaries":["All ten cash allocations sum to one. Other services retain full costs with health unquantified; zero credit is not a finding they are ineffective. This partial-health whole-gift estimate is not an upper bound on cost-effectiveness.","Completed-service cost includes coordination, overhead and failed referrals. Selected clinical subset, service-to-person conversion, financial additionality and disjointness are separate assumptions; service count alone is never a health outcome.","Current uninsured/ineligible-Medi-Cal eligibility is not a never-care baseline. Later safety-net care, coverage changes, other donors, donated provider capacity and OA's existing navigation remain in the counterfactual.","CRC uses an explicitly judgmental mean-hazard survival approximation. Cohort mortality association and navigationRCT are not causal manufacturer-like coefficients; no .13 completion multiplier or legacy aggregate.05Q is reused.","One exclusive linked-person ledger CRC then eye then hernia. Repeats/second eyes and overlapping diagnoses retain costs but cannot earn duplicate whole-person health. No productivity, caregiver or other mortality gains are added.","Donated clinical resources, distinct nonclinical support, patient time and downstream cancer-care allowances are gross associated costs on all nominal services, including uncredited/replaced activity. They are not waived charges, net incremental resources, or exhaustive societal cost.","Both health comparisons start with the same people alive at care. Delay discounts only; horizons start at care, not gift. Harms are already gift-date PV and include repeat procedures within an episode; late-comparator harms are not subtracted.","Bay and SF are nested weak residence priors, not measured local return. US equals all-region direct health here; no international or indirect local spillovers are credited.","Historical selectedSF$600,000 donor/$1,012,000 expanded price remains a separate program comparison. It must not remain the ordinary-gift ranking input after this revision."],"input_provenance":{"gift_usd":{"central":"100000","scenario_range":"Scenario inputs 100000 to 100000; not a confidence interval","basis":"Reference ordinary unrestricted gift; every dollar retained, not an SF colonoscopy restriction."},"funding_additionality":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% judgment for extra maintained/expanded services after replacement funding and provider bottlenecks. Existing OA care is baseline. Not estimated from the deficit or reserves."},"max_additional_services":{"central":"100","scenario_range":"Scenario inputs 0 to 100; not a confidence interval","basis":"100 extra mixed-service cap is an assumption, not identified open appointments. Shared capacity reduces all specialty activity proportionately."},"discount":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"3% annual health discount; economic resource amounts are gross associated present-dollar allowances, not a discounted net-social ledger."},"bay_share":{"central":"0.6","scenario_range":"Scenario inputs 0 to 0.8; not a confidence interval","basis":"60% weak beneficiary-residence prior within Northern California/Central Valley reach. No published specialty-specific county shares verified."},"sf_share":{"central":"0.08","scenario_range":"Scenario inputs 0 to 0.15; not a confidence interval","basis":"8% weak SF beneficiary-residence prior nested within Bay, not office location or guaranteed restricted allocation."},"independent_harm_q":{"central":"0","scenario_range":"Scenario inputs 0 to 1; not a confidence interval","basis":"Gift-date PV health loss independent of clinical activity; central0, zero-activity adverse case1."},"outside_support_per_service":{"central":"60","scenario_range":"Scenario inputs 60 to 60; not a confidence interval","basis":"$60 distinct nonclinical donated support per nominal mixed service, rounded from89,922/1,529; not already cash-paid interpretation/travel."},"patient_time_per_service":{"central":"100","scenario_range":"Scenario inputs 100 to 100; not a confidence interval","basis":"$100 additional patient/caregiver time allowance per nominal service, not earnings benefits or OA-paid travel."},"crc_treatment_cost_per_selected":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"$1,500 expected downstream therapy/surveillance resource allowance per nominal selectedFIT service, beyond endoscopy resources; weak prior, not provider quote or complete treatment estimate."},"gi_allocation":{"central":"0.37","scenario_range":"Scenario inputs 0.25 to 0.42; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gi_cash_per_service":{"central":"1400","scenario_range":"Scenario inputs 1400 to 1400; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gi_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"general_allocation":{"central":"0.13","scenario_range":"Scenario inputs 0.08 to 0.15; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"general_cash_per_service":{"central":"1700","scenario_range":"Scenario inputs 1700 to 1700; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"general_clinical_resource_per_service":{"central":"5500","scenario_range":"Scenario inputs 5500 to 11000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"gyne_allocation":{"central":"0.11","scenario_range":"Scenario inputs 0.11 to 0.11; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gyne_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gyne_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"ortho_allocation":{"central":"0.1","scenario_range":"Scenario inputs 0.1 to 0.1; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"ortho_cash_per_service":{"central":"1600","scenario_range":"Scenario inputs 1600 to 1600; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"ortho_clinical_resource_per_service":{"central":"5000","scenario_range":"Scenario inputs 5000 to 10000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"head_neck_allocation":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"head_neck_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"head_neck_clinical_resource_per_service":{"central":"3500","scenario_range":"Scenario inputs 3500 to 7000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"urology_allocation":{"central":"0.07","scenario_range":"Scenario inputs 0.07 to 0.07; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"urology_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"urology_clinical_resource_per_service":{"central":"4000","scenario_range":"Scenario inputs 4000 to 8000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"derm_allocation":{"central":"0.05","scenario_range":"Scenario inputs 0 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"derm_cash_per_service":{"central":"1300","scenario_range":"Scenario inputs 1300 to 1300; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"derm_clinical_resource_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 3600; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"vascular_allocation":{"central":"0.04","scenario_range":"Scenario inputs 0.02 to 0.04; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"vascular_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"vascular_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_allocation":{"central":"0.03","scenario_range":"Scenario inputs 0.01 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"eye_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"eye_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"other_allocation":{"central":"0.02","scenario_range":"Scenario inputs 0 to 0.21; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"other_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"other_clinical_resource_per_service":{"central":"3000","scenario_range":"Scenario inputs 3000 to 6000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_selected_fraction":{"central":"0.65","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"65% of nominal ophthalmology services assumed selected first-eye function-limiting cataract pathway;45observedeye services also include other procedures."},"eye_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"eye_disjoint_fraction":{"central":"0.95","scenario_range":"Scenario inputs 0.95 to 0.95; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"eye_treatment_success":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"eye_utility_gain":{"central":"0.05","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".05 utility-point gain per successful person-year is a separate judgment. The RCT's.056 integrated first-yearQALY is a magnitude anchor only, not a rate multiplied by three years."},"eye_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"eye_loss_hazard":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"eye_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"eye_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"eye_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"eye_harm_q_per_person":{"central":"0.002","scenario_range":"Scenario inputs 0 to 0.002; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"hernia_selected_fraction":{"central":"0.45","scenario_range":"Scenario inputs 0 to 0.7; not a confidence interval","basis":"45% of nominal general-surgery services assumed selected symptomatic hernia episodes;201general services are not201hernias."},"hernia_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"hernia_disjoint_fraction":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"hernia_treatment_success":{"central":"0.85","scenario_range":"Scenario inputs 0.85 to 0.85; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"hernia_utility_gain":{"central":"0.04","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".04 utility-point gain per successful symptomatic-person-year is a judgment; minimallysymptomatic randomized evidence is essentially null. Selected pain-limiting hernia fraction and transport are unknown."},"hernia_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"hernia_loss_hazard":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"hernia_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"hernia_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"hernia_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"hernia_harm_q_per_person":{"central":"0.004","scenario_range":"Scenario inputs 0 to 0.004; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"crc_selected_fraction":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% of nominal GI services assumed abnormal-FIT follow-up;575GI services are not575positiveFIT patients."},"crc_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"crc_disjoint_fraction":{"central":"1","scenario_range":"Scenario inputs 1 to 1; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"crc_treatment_linkage":{"central":"0.7","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"70% judgment chance that necessary appropriate downstream management can deliver the modeled contrast. Diagnostic completion alone earns no full treatment gain."},"crc_annual_fatal_hazard_reduction":{"central":"0.0006","scenario_range":"Scenario inputs -0.0003 to 0.001; not a confidence interval","basis":".0006/year is a judgment if no later-care catchup, lasting five hazard-years after latency. It is not.0092/10 or an estimated causal attenuation of the cohort. Fiveyears×.0006=.003 cumulative hazard only as a scale check."},"crc_baseline_total_mortality_hazard":{"central":"0.025","scenario_range":"Scenario inputs 0.025 to 0.025; not a confidence interval","basis":".025/year all-cause hazard prior already includes CRC mortality. Only the modeled CRC component changes; no second mortality hazard added."},"crc_catchup_hazard":{"central":"0.5","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".5/year aggregate hazard-effect decay prior (two-year characteristic time) for eventual ordinary diagnostic/treatment care; mean-hazard approximation, not exact random individual care-time mixture."},"crc_latency_years":{"central":"2","scenario_range":"Scenario inputs 2 to 2; not a confidence interval","basis":"Two-year assumed lag from procedure to differential fatal risk. Not observed OA survival timing; existing alternative care can catch up during this lag."},"crc_active_years":{"central":"5","scenario_range":"Scenario inputs 5 to 5; not a confidence interval","basis":"Five years of possibly different fatal hazard after latency, not five avoided deaths or a life expectancy."},"crc_horizon_years":{"central":"10","scenario_range":"Scenario inputs 10 to 15; not a confidence interval","basis":"Ten-year finite survival observation from procedure; both arms return to common mortality after the hazard-effect window. No lifetime tail."},"crc_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"crc_surviving_utility":{"central":"0.75","scenario_range":"Scenario inputs 0.75 to 0.75; not a confidence interval","basis":".75 utility for extra surviving person-time; no extra cancer morbidity or household benefit."},"crc_harm_q_per_person":{"central":"0.001","scenario_range":"Scenario inputs 0 to 0.001; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."}},"historical_comparison":{"model_path":"/private/tmp/mfi-oa-model.json","model_version":"oa-abnormal-fit-completed-pathway-v1","donor_per_10q":600000,"resource_per_10q":1012000,"boundary":"Selected SF abnormal-FIT completed pathway only; not ordinary whole gift. Preserved unchanged, not directly interchangeable with portfolio estimate."}},"paths":[{"id":"gi_symptom_diagnosis","category":"gi","share":0.5,"name":"Non-FIT GI investigation → benign treatable dyspepsia/dysphagia management","utility_gain":0.03,"treatment_success":0.4,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Diagnostic procedure alone earns no cure; treatment linkage is a prior, alternative primary-care therapy remains baseline.","downstream_resource_per_nominal_service":200},{"id":"general_cyst","category":"general","share":0.225,"name":"Painful cyst/lipoma excision","utility_gain":0.025,"treatment_success":0.85,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA procedure explicitly listed; utility and symptom-limiting fraction are priors, not cosmetic benefit.","downstream_resource_per_nominal_service":0},{"id":"anorectal","category":"general","share":0.12,"name":"Symptomatic haemorrhoid/fissure treatment","utility_gain":0.05,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Historical minor anorectal mix only; assume persistent symptoms despite medical management.","downstream_resource_per_nominal_service":0},{"id":"gallstone","category":"general","share":0.065,"name":"Uncomplicated symptomatic gallstone surgery","utility_gain":0,"treatment_success":0.7,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"C-GALL control includes later surgery; nonsignificant small integrated QALY difference; conservative care may suffice.","downstream_resource_per_nominal_service":0},{"id":"breast_diagnostic","category":"general","share":0.14,"name":"Breast lesion diagnostic assessment and linked benign symptom treatment","utility_gain":0.01,"treatment_success":0.25,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No unverified cancer survival gain. Prior only for changed symptom management, not all negative tests.","downstream_resource_per_nominal_service":200},{"id":"aub","category":"gyne","share":0.65,"name":"Refractory abnormal uterine bleeding → definitive outpatient treatment","utility_gain":0.07,"treatment_success":0.8,"harm_q_per_person":0.015,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Ms trial supports surgery vs expanded medical care; no hysterectomy-vs-ablation transfer, fertility/recovery losses retained.","downstream_resource_per_nominal_service":0},{"id":"pelvic","category":"gyne","share":0.25,"name":"Symptomatic pelvic prolapse/incontinence treatment","utility_gain":0.07,"treatment_success":0.7,"harm_q_per_person":0.01,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Case-mix and utility priors, not confirmed OA frequency; pessary/conservative alternatives retained.","downstream_resource_per_nominal_service":0},{"id":"gyne_diagnostic","category":"gyne","share":0.1,"name":"Gynaecologic diagnostic workup → nonmalignant symptom management","utility_gain":0.02,"treatment_success":0.3,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Diagnosis without management has zero benefit through linkage; no automatic cancer cure.","downstream_resource_per_nominal_service":200},{"id":"cts","category":"ortho","share":0.35,"name":"Carpal tunnel decompression for symptomatic confirmed CTS","utility_gain":0.03,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Primary economic trial .04 at12months is nonsignificant point utility, not integrated QALY. .03 here is an independent transfer prior.","downstream_resource_per_nominal_service":0},{"id":"foot_tendon","category":"ortho","share":0.45,"name":"Painful foot deformity / tendon or trigger-finger intervention","utility_gain":0.06,"treatment_success":0.75,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Named mechanical function hypothesis; OA ortho/podiatry totals not diagnosis frequencies. Utilities are priors. Torkki hallux-valgus RCT11368700 supports the painful-bunion subset only; two-year catch-up12807332 rules out lifelong timing gain.","downstream_resource_per_nominal_service":0},{"id":"degenerative_knee","category":"ortho","share":0.2,"name":"Degenerative knee arthroscopy without acute mechanical indication","utility_gain":0,"treatment_success":0.8,"harm_q_per_person":0.006,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Null benefit central, not assume all orthopaedic surgery is useful; harm retained.","downstream_resource_per_nominal_service":0},{"id":"nasal","category":"head_neck","share":0.7,"name":"Septal nasal obstruction surgery versus nasal medical therapy","utility_gain":0.04,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"NAIROS validates symptom mechanism, not SNOT22-to-QALY conversion or universal ENT benefit.","downstream_resource_per_nominal_service":0},{"id":"ear","category":"head_neck","share":0.3,"name":"Conductive ear disease treatment","utility_gain":0.03,"treatment_success":0.7,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Clinical indication and utility priors; no all-ENT survival credit.","downstream_resource_per_nominal_service":200},{"id":"bph","category":"urology","share":0.45,"name":"Bothersome BPH/outlet obstruction treatment","utility_gain":0.06,"treatment_success":0.8,"harm_q_per_person":0.006,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"TURP vs watchful waiting trial supports symptom relief, not current OA frequency; modern medication baseline matters.","downstream_resource_per_nominal_service":0},{"id":"stone","category":"urology","share":0.35,"name":"Symptomatic urinary stone treatment","utility_gain":0.05,"treatment_success":0.75,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No prophylactic life-saving claim for asymptomatic stones; spontaneous passage and medical treatment in comparator.","downstream_resource_per_nominal_service":200},{"id":"scrotal","category":"urology","share":0.2,"name":"Symptomatic benign scrotal/hydrocele treatment","utility_gain":0.025,"treatment_success":0.75,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Indication and finite utility priors; no infertility or cancer mortality award.","downstream_resource_per_nominal_service":0},{"id":"derm_cyst","category":"derm","share":0.8,"name":"Symptomatic benign skin cyst/lesion treatment","utility_gain":0.02,"treatment_success":0.8,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA cyst/lipoma service; disjoint allocation from general surgery required.","downstream_resource_per_nominal_service":0},{"id":"skin_lesion","category":"derm","share":0.2,"name":"Localized skin lesion diagnosis and treatment","utility_gain":0.03,"treatment_success":0.6,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Symptom/functional relief only; no melanoma mortality extrapolation.","downstream_resource_per_nominal_service":200},{"id":"veins","category":"vascular","share":1,"name":"Symptomatic uncomplicated varicose vein treatment","utility_gain":0.04,"treatment_success":0.8,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"REACTIV randomized conservative comparator; integrated two-year .054Q not annual gain.","downstream_resource_per_nominal_service":0},{"id":"pterygium","category":"eye","share":0.35,"name":"Symptomatic pterygium treatment","utility_gain":0.025,"treatment_success":0.8,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA explicitly offered; first-eye cataract cohort excluded; finite symptom/vision utility prior.","downstream_resource_per_nominal_service":0},{"id":"other_assessment","category":"other","share":1,"name":"Specialty assessment without established diagnosis-changing intervention","utility_gain":0,"treatment_success":0,"harm_q_per_person":0.0005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Only2%wholegift allocation; centralzero benefit explicitly due absent disease/intervention evidence, not blanket residual zero for major specialties.","downstream_resource_per_nominal_service":0}],"scope":"Expected whole-organization health CONDITIONAL on explicit diagnostic case-mix priors. All2025 specialty categories covered in a service ledger; other assessment2% receives zero benefit plus burden. No generic residual QALY/$ or inverse allocation 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Waived-dollar fundraising leverage is not QALY evidence.","retrieved":"September9,2026"},{"key":"fit","publisher":"California Colorectal Cancer Coalition","title":"OA facilitated donated colonoscopy","url":"https://www.cacoloncancer.org/operation-access-facilitated-access-to-donated-colonoscopies/","published":"Current undated","sourceType":"Primary referral mechanism; above-average risk/positive stool tests; not575verifiedFITcases.","retrieved":"September9,2026"},{"key":"cataract","publisher":"Sach et al.","title":"First-eye cataract randomized economic evaluation","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC2095519/","published":"2007","sourceType":"306women over70, expedited4weeks vsroutine12months; first-yearQALYdifference.056(.006,.108), integratedyear—not annualutilityorOAlocalestimate.","retrieved":"September9,2026"},{"key":"hernia","publisher":"Fitzgibbons et al.","title":"Watchful waiting versus repair","url":"https://pubmed.ncbi.nlm.nih.gov/16418463/","published":"2006","sourceType":"720minimallysymptomatic men;2-yearpain/physicalfunction differences notsignificant;23%watchfulwaiting crossed torepair. Strong warning against assuming allhernias benefit.","retrieved":"September9,2026"},{"key":"crc","publisher":"Zorzi et al.","title":"Mortality after positive FIT without program colonoscopy","url":"https://pubmed.ncbi.nlm.nih.gov/33789965/","published":"2021","sourceType":"Observational10-yearCRC mortality6.8vs16per1000. Not randomization, no directly imported hazardorQALY.","retrieved":"September9,2026"},{"key":"critique","publisher":"Methodological correspondence","title":"Immortal-time concern in positive-FIT mortality comparison","url":"https://pubmed.ncbi.nlm.nih.gov/37549982/","published":"2023","sourceType":"Primary methodological criticism; exposure timing/selection biases not assumed solved.","retrieved":"September9,2026"},{"key":"navigation","publisher":"PRECISE investigators","title":"Navigation after abnormal stool test trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13007779/","published":"2025","sourceType":"967analysis;55.1vs42.1%one-yearcompletion. Not multiplied into already-completed OAservice units.","retrieved":"September9,2026"},{"key":"coverage","publisher":"California DHCS","title":"Medi-Cal eligibility changes","url":"https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/","published":"2026","sourceType":"Public coverage remains baseline when available; no assertion alluninsured have no latercare.","retrieved":"September9,2026"}],"funding_room":{"verified_offer_usd":null,"additional_slots":null,"accepted_sf_restriction":null,"statement":"Largest-funder loss and layoffs documented, but maintainedgrowth/newdonors and16monthsoperatingcash do not measure marginalcapacity. Allnumericalcaps are priors."},"boundaries":["All ten cash allocations sum to one. Other services retain full costs with health unquantified; zero credit is not a finding they are ineffective. This partial-health whole-gift estimate is not an upper bound on cost-effectiveness.","Completed-service cost includes coordination, overhead and failed referrals. Selected clinical subset, service-to-person conversion, financial additionality and disjointness are separate assumptions; service count alone is never a health outcome.","Current uninsured/ineligible-Medi-Cal eligibility is not a never-care baseline. Later safety-net care, coverage changes, other donors, donated provider capacity and OA's existing navigation remain in the counterfactual.","CRC uses an explicitly judgmental mean-hazard survival approximation. Cohort mortality association and navigationRCT are not causal manufacturer-like coefficients; no .13 completion multiplier or legacy aggregate.05Q is reused.","One exclusive linked-person ledger CRC then eye then hernia. Repeats/second eyes and overlapping diagnoses retain costs but cannot earn duplicate whole-person health. No productivity, caregiver or other mortality gains are added.","Donated clinical resources, distinct nonclinical support, patient time and downstream cancer-care allowances are gross associated costs on all nominal services, including uncredited/replaced activity. They are not waived charges, net incremental resources, or exhaustive societal cost.","Both health comparisons start with the same people alive at care. Delay discounts only; horizons start at care, not gift. Harms are already gift-date PV and include repeat procedures within an episode; late-comparator harms are not subtracted.","Bay and SF are nested weak residence priors, not measured local return. US equals all-region direct health here; no international or indirect local spillovers are credited.","Historical selectedSF$600,000 donor/$1,012,000 expanded price remains a separate program comparison. It must not remain the ordinary-gift ranking input after this revision."],"input_provenance":{"gift_usd":{"central":"100000","scenario_range":"Scenario inputs 100000 to 100000; not a confidence interval","basis":"Reference ordinary unrestricted gift; every dollar retained, not an SF colonoscopy restriction."},"funding_additionality":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% judgment for extra maintained/expanded services after replacement funding and provider bottlenecks. Existing OA care is baseline. Not estimated from the deficit or reserves."},"max_additional_services":{"central":"100","scenario_range":"Scenario inputs 0 to 100; not a confidence interval","basis":"100 extra mixed-service cap is an assumption, not identified open appointments. Shared capacity reduces all specialty activity proportionately."},"discount":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"3% annual health discount; economic resource amounts are gross associated present-dollar allowances, not a discounted net-social ledger."},"bay_share":{"central":"0.6","scenario_range":"Scenario inputs 0 to 0.8; not a confidence interval","basis":"60% weak beneficiary-residence prior within Northern California/Central Valley reach. No published specialty-specific county shares verified."},"sf_share":{"central":"0.08","scenario_range":"Scenario inputs 0 to 0.15; not a confidence interval","basis":"8% weak SF beneficiary-residence prior nested within Bay, not office location or guaranteed restricted allocation."},"independent_harm_q":{"central":"0","scenario_range":"Scenario inputs 0 to 1; not a confidence interval","basis":"Gift-date PV health loss independent of clinical activity; central0, zero-activity adverse case1."},"outside_support_per_service":{"central":"60","scenario_range":"Scenario inputs 60 to 60; not a confidence interval","basis":"$60 distinct nonclinical donated support per nominal mixed service, rounded from89,922/1,529; not already cash-paid interpretation/travel."},"patient_time_per_service":{"central":"100","scenario_range":"Scenario inputs 100 to 100; not a confidence interval","basis":"$100 additional patient/caregiver time allowance per nominal service, not earnings benefits or OA-paid travel."},"crc_treatment_cost_per_selected":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"$1,500 expected downstream therapy/surveillance resource allowance per nominal selectedFIT service, beyond endoscopy resources; weak prior, not provider quote or complete treatment estimate."},"gi_allocation":{"central":"0.37","scenario_range":"Scenario inputs 0.25 to 0.42; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gi_cash_per_service":{"central":"1400","scenario_range":"Scenario inputs 1400 to 1400; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gi_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"general_allocation":{"central":"0.13","scenario_range":"Scenario inputs 0.08 to 0.15; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"general_cash_per_service":{"central":"1700","scenario_range":"Scenario inputs 1700 to 1700; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"general_clinical_resource_per_service":{"central":"5500","scenario_range":"Scenario inputs 5500 to 11000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"gyne_allocation":{"central":"0.11","scenario_range":"Scenario inputs 0.11 to 0.11; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gyne_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gyne_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"ortho_allocation":{"central":"0.1","scenario_range":"Scenario inputs 0.1 to 0.1; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"ortho_cash_per_service":{"central":"1600","scenario_range":"Scenario inputs 1600 to 1600; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"ortho_clinical_resource_per_service":{"central":"5000","scenario_range":"Scenario inputs 5000 to 10000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"head_neck_allocation":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"head_neck_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"head_neck_clinical_resource_per_service":{"central":"3500","scenario_range":"Scenario inputs 3500 to 7000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"urology_allocation":{"central":"0.07","scenario_range":"Scenario inputs 0.07 to 0.07; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"urology_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"urology_clinical_resource_per_service":{"central":"4000","scenario_range":"Scenario inputs 4000 to 8000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"derm_allocation":{"central":"0.05","scenario_range":"Scenario inputs 0 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"derm_cash_per_service":{"central":"1300","scenario_range":"Scenario inputs 1300 to 1300; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"derm_clinical_resource_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 3600; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"vascular_allocation":{"central":"0.04","scenario_range":"Scenario inputs 0.02 to 0.04; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"vascular_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"vascular_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_allocation":{"central":"0.03","scenario_range":"Scenario inputs 0.01 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"eye_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"eye_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"other_allocation":{"central":"0.02","scenario_range":"Scenario inputs 0 to 0.21; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"other_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"other_clinical_resource_per_service":{"central":"3000","scenario_range":"Scenario inputs 3000 to 6000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_selected_fraction":{"central":"0.65","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"65% of nominal ophthalmology services assumed selected first-eye function-limiting cataract pathway;45observedeye services also include other procedures."},"eye_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"eye_disjoint_fraction":{"central":"0.95","scenario_range":"Scenario inputs 0.95 to 0.95; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"eye_treatment_success":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"eye_utility_gain":{"central":"0.05","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".05 utility-point gain per successful person-year is a separate judgment. The RCT's.056 integrated first-yearQALY is a magnitude anchor only, not a rate multiplied by three years."},"eye_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"eye_loss_hazard":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"eye_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"eye_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"eye_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"eye_harm_q_per_person":{"central":"0.002","scenario_range":"Scenario inputs 0 to 0.002; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"hernia_selected_fraction":{"central":"0.45","scenario_range":"Scenario inputs 0 to 0.7; not a confidence interval","basis":"45% of nominal general-surgery services assumed selected symptomatic hernia episodes;201general services are not201hernias."},"hernia_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"hernia_disjoint_fraction":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"hernia_treatment_success":{"central":"0.85","scenario_range":"Scenario inputs 0.85 to 0.85; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"hernia_utility_gain":{"central":"0.04","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".04 utility-point gain per successful symptomatic-person-year is a judgment; minimallysymptomatic randomized evidence is essentially null. Selected pain-limiting hernia fraction and transport are unknown."},"hernia_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"hernia_loss_hazard":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"hernia_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"hernia_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"hernia_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"hernia_harm_q_per_person":{"central":"0.004","scenario_range":"Scenario inputs 0 to 0.004; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"crc_selected_fraction":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% of nominal GI services assumed abnormal-FIT follow-up;575GI services are not575positiveFIT patients."},"crc_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"crc_disjoint_fraction":{"central":"1","scenario_range":"Scenario inputs 1 to 1; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"crc_treatment_linkage":{"central":"0.7","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"70% judgment chance that necessary appropriate downstream management can deliver the modeled contrast. Diagnostic completion alone earns no full treatment gain."},"crc_annual_fatal_hazard_reduction":{"central":"0.0006","scenario_range":"Scenario inputs -0.0003 to 0.001; not a confidence interval","basis":".0006/year is a judgment if no later-care catchup, lasting five hazard-years after latency. It is not.0092/10 or an estimated causal attenuation of the cohort. Fiveyears×.0006=.003 cumulative hazard only as a scale check."},"crc_baseline_total_mortality_hazard":{"central":"0.025","scenario_range":"Scenario inputs 0.025 to 0.025; not a confidence interval","basis":".025/year all-cause hazard prior already includes CRC mortality. Only the modeled CRC component changes; no second mortality hazard added."},"crc_catchup_hazard":{"central":"0.5","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".5/year aggregate hazard-effect decay prior (two-year characteristic time) for eventual ordinary diagnostic/treatment care; mean-hazard approximation, not exact random individual care-time mixture."},"crc_latency_years":{"central":"2","scenario_range":"Scenario inputs 2 to 2; not a confidence interval","basis":"Two-year assumed lag from procedure to differential fatal risk. Not observed OA survival timing; existing alternative care can catch up during this lag."},"crc_active_years":{"central":"5","scenario_range":"Scenario inputs 5 to 5; not a confidence interval","basis":"Five years of possibly different fatal hazard after latency, not five avoided deaths or a life expectancy."},"crc_horizon_years":{"central":"10","scenario_range":"Scenario inputs 10 to 15; not a confidence interval","basis":"Ten-year finite survival observation from procedure; both arms return to common mortality after the hazard-effect window. No lifetime tail."},"crc_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"crc_surviving_utility":{"central":"0.75","scenario_range":"Scenario inputs 0.75 to 0.75; not a confidence interval","basis":".75 utility for extra surviving person-time; no extra cancer morbidity or household benefit."},"crc_harm_q_per_person":{"central":"0.001","scenario_range":"Scenario inputs 0 to 0.001; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."}},"historical_comparison":{"model_path":"/private/tmp/mfi-oa-model.json","model_version":"oa-abnormal-fit-completed-pathway-v1","donor_per_10q":600000,"resource_per_10q":1012000,"boundary":"Selected SF abnormal-FIT completed pathway only; not ordinary whole gift. Preserved unchanged, not directly interchangeable with portfolio estimate."}},"paths":[{"id":"gi_symptom_diagnosis","category":"gi","share":0.5,"name":"Non-FIT GI investigation → benign treatable dyspepsia/dysphagia management","utility_gain":0.03,"treatment_success":0.4,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Diagnostic procedure alone earns no cure; treatment linkage is a prior, alternative primary-care therapy remains baseline.","downstream_resource_per_nominal_service":200},{"id":"general_cyst","category":"general","share":0.225,"name":"Painful cyst/lipoma excision","utility_gain":0.025,"treatment_success":0.85,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA procedure explicitly listed; utility and symptom-limiting fraction are priors, not cosmetic benefit.","downstream_resource_per_nominal_service":0},{"id":"anorectal","category":"general","share":0.12,"name":"Symptomatic haemorrhoid/fissure treatment","utility_gain":0.05,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Historical minor anorectal mix only; assume persistent symptoms despite medical management.","downstream_resource_per_nominal_service":0},{"id":"gallstone","category":"general","share":0.065,"name":"Uncomplicated symptomatic gallstone surgery","utility_gain":0,"treatment_success":0.7,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"C-GALL control includes later surgery; nonsignificant small integrated QALY difference; conservative care may suffice.","downstream_resource_per_nominal_service":0},{"id":"breast_diagnostic","category":"general","share":0.14,"name":"Breast lesion diagnostic assessment and linked benign symptom treatment","utility_gain":0.01,"treatment_success":0.25,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No unverified cancer survival gain. 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Access","title":"2025 audited financial statements","url":"https://www.operationaccess.org/s/2025-Audited-Financial-Statements.pdf","published":"Year ended December31,2025; auditMay20,2026","sourceType":"Primary audited whole-organization expense, waived-charge accounting, liquidity and restrictions; relevant PDF7–8,14–15 visually verified.","retrieved":"September9,2026"},{"key":"report","publisher":"Operation Access","title":"2025 annual report","url":"https://www.operationaccess.org/s/Operation-Access-Annual-Report-2025.pdf","published":"2025 reporting year","sourceType":"Primary specialty counts/chartPDF7, funding lossPDF2, wait/readinessPDF6, cash financePDF13. Counts are services, not unique people or measured health.","retrieved":"September9,2026"},{"key":"budget","publisher":"Operation Access","title":"2026 budget","url":"https://www.operationaccess.org/s/2026Budget-8pz4.pdf","published":"ApprovedDecember10,2025","sourceType":"Primary1.9million cash plan, not actual2026 unit cost or procedure target.","retrieved":"September9,2026"},{"key":"eligibility","publisher":"Operation Access","title":"Patient eligibility and procedures","url":"https://www.operationaccess.org/for-patients-para-pacientes","published":"Current undated","sourceType":"Uninsured and ineligible fullMedi-Cal/Medicare/CMSP; cataract and hernia procedures explicitly offered; not insurance.","retrieved":"September9,2026"},{"key":"giving","publisher":"Operation Access","title":"Donate","url":"https://www.operationaccess.org/donate","published":"Current undated","sourceType":"Official ordinary donation route and EIN94-3180356. Waived-dollar fundraising leverage is not QALY evidence.","retrieved":"September9,2026"},{"key":"fit","publisher":"California Colorectal Cancer Coalition","title":"OA facilitated donated colonoscopy","url":"https://www.cacoloncancer.org/operation-access-facilitated-access-to-donated-colonoscopies/","published":"Current undated","sourceType":"Primary referral mechanism; above-average risk/positive stool tests; not575verifiedFITcases.","retrieved":"September9,2026"},{"key":"cataract","publisher":"Sach et al.","title":"First-eye cataract randomized economic evaluation","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC2095519/","published":"2007","sourceType":"306women over70, expedited4weeks vsroutine12months; first-yearQALYdifference.056(.006,.108), integratedyear—not annualutilityorOAlocalestimate.","retrieved":"September9,2026"},{"key":"hernia","publisher":"Fitzgibbons et al.","title":"Watchful waiting versus repair","url":"https://pubmed.ncbi.nlm.nih.gov/16418463/","published":"2006","sourceType":"720minimallysymptomatic men;2-yearpain/physicalfunction differences notsignificant;23%watchfulwaiting crossed torepair. Strong warning against assuming allhernias benefit.","retrieved":"September9,2026"},{"key":"crc","publisher":"Zorzi et al.","title":"Mortality after positive FIT without program colonoscopy","url":"https://pubmed.ncbi.nlm.nih.gov/33789965/","published":"2021","sourceType":"Observational10-yearCRC mortality6.8vs16per1000. Not randomization, no directly imported hazardorQALY.","retrieved":"September9,2026"},{"key":"critique","publisher":"Methodological correspondence","title":"Immortal-time concern in positive-FIT mortality comparison","url":"https://pubmed.ncbi.nlm.nih.gov/37549982/","published":"2023","sourceType":"Primary methodological criticism; exposure timing/selection biases not assumed solved.","retrieved":"September9,2026"},{"key":"navigation","publisher":"PRECISE investigators","title":"Navigation after abnormal stool test trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13007779/","published":"2025","sourceType":"967analysis;55.1vs42.1%one-yearcompletion. Not multiplied into already-completed OAservice units.","retrieved":"September9,2026"},{"key":"coverage","publisher":"California DHCS","title":"Medi-Cal eligibility changes","url":"https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/","published":"2026","sourceType":"Public coverage remains baseline when available; no assertion alluninsured have no latercare.","retrieved":"September9,2026"}],"funding_room":{"verified_offer_usd":null,"additional_slots":null,"accepted_sf_restriction":null,"statement":"Largest-funder loss and layoffs documented, but maintainedgrowth/newdonors and16monthsoperatingcash do not measure marginalcapacity. Allnumericalcaps are priors."},"boundaries":["All ten cash allocations sum to one. Other services retain full costs with health unquantified; zero credit is not a finding they are ineffective. This partial-health whole-gift estimate is not an upper bound on cost-effectiveness.","Completed-service cost includes coordination, overhead and failed referrals. Selected clinical subset, service-to-person conversion, financial additionality and disjointness are separate assumptions; service count alone is never a health outcome.","Current uninsured/ineligible-Medi-Cal eligibility is not a never-care baseline. Later safety-net care, coverage changes, other donors, donated provider capacity and OA's existing navigation remain in the counterfactual.","CRC uses an explicitly judgmental mean-hazard survival approximation. Cohort mortality association and navigationRCT are not causal manufacturer-like coefficients; no .13 completion multiplier or legacy aggregate.05Q is reused.","One exclusive linked-person ledger CRC then eye then hernia. Repeats/second eyes and overlapping diagnoses retain costs but cannot earn duplicate whole-person health. No productivity, caregiver or other mortality gains are added.","Donated clinical resources, distinct nonclinical support, patient time and downstream cancer-care allowances are gross associated costs on all nominal services, including uncredited/replaced activity. They are not waived charges, net incremental resources, or exhaustive societal cost.","Both health comparisons start with the same people alive at care. Delay discounts only; horizons start at care, not gift. Harms are already gift-date PV and include repeat procedures within an episode; late-comparator harms are not subtracted.","Bay and SF are nested weak residence priors, not measured local return. US equals all-region direct health here; no international or indirect local spillovers are credited.","Historical selectedSF$600,000 donor/$1,012,000 expanded price remains a separate program comparison. It must not remain the ordinary-gift ranking input after this revision."],"input_provenance":{"gift_usd":{"central":"100000","scenario_range":"Scenario inputs 100000 to 100000; not a confidence interval","basis":"Reference ordinary unrestricted gift; every dollar retained, not an SF colonoscopy restriction."},"funding_additionality":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% judgment for extra maintained/expanded services after replacement funding and provider bottlenecks. Existing OA care is baseline. Not estimated from the deficit or reserves."},"max_additional_services":{"central":"100","scenario_range":"Scenario inputs 0 to 100; not a confidence interval","basis":"100 extra mixed-service cap is an assumption, not identified open appointments. Shared capacity reduces all specialty activity proportionately."},"discount":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"3% annual health discount; economic resource amounts are gross associated present-dollar allowances, not a discounted net-social ledger."},"bay_share":{"central":"0.6","scenario_range":"Scenario inputs 0 to 0.8; not a confidence interval","basis":"60% weak beneficiary-residence prior within Northern California/Central Valley reach. No published specialty-specific county shares verified."},"sf_share":{"central":"0.08","scenario_range":"Scenario inputs 0 to 0.15; not a confidence interval","basis":"8% weak SF beneficiary-residence prior nested within Bay, not office location or guaranteed restricted allocation."},"independent_harm_q":{"central":"0","scenario_range":"Scenario inputs 0 to 1; not a confidence interval","basis":"Gift-date PV health loss independent of clinical activity; central0, zero-activity adverse case1."},"outside_support_per_service":{"central":"60","scenario_range":"Scenario inputs 60 to 60; not a confidence interval","basis":"$60 distinct nonclinical donated support per nominal mixed service, rounded from89,922/1,529; not already cash-paid interpretation/travel."},"patient_time_per_service":{"central":"100","scenario_range":"Scenario inputs 100 to 100; not a confidence interval","basis":"$100 additional patient/caregiver time allowance per nominal service, not earnings benefits or OA-paid travel."},"crc_treatment_cost_per_selected":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"$1,500 expected downstream therapy/surveillance resource allowance per nominal selectedFIT service, beyond endoscopy resources; weak prior, not provider quote or complete treatment estimate."},"gi_allocation":{"central":"0.37","scenario_range":"Scenario inputs 0.25 to 0.42; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gi_cash_per_service":{"central":"1400","scenario_range":"Scenario inputs 1400 to 1400; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gi_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"general_allocation":{"central":"0.13","scenario_range":"Scenario inputs 0.08 to 0.15; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"general_cash_per_service":{"central":"1700","scenario_range":"Scenario inputs 1700 to 1700; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"general_clinical_resource_per_service":{"central":"5500","scenario_range":"Scenario inputs 5500 to 11000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"gyne_allocation":{"central":"0.11","scenario_range":"Scenario inputs 0.11 to 0.11; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gyne_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gyne_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"ortho_allocation":{"central":"0.1","scenario_range":"Scenario inputs 0.1 to 0.1; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"ortho_cash_per_service":{"central":"1600","scenario_range":"Scenario inputs 1600 to 1600; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"ortho_clinical_resource_per_service":{"central":"5000","scenario_range":"Scenario inputs 5000 to 10000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"head_neck_allocation":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"head_neck_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"head_neck_clinical_resource_per_service":{"central":"3500","scenario_range":"Scenario inputs 3500 to 7000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"urology_allocation":{"central":"0.07","scenario_range":"Scenario inputs 0.07 to 0.07; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"urology_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"urology_clinical_resource_per_service":{"central":"4000","scenario_range":"Scenario inputs 4000 to 8000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"derm_allocation":{"central":"0.05","scenario_range":"Scenario inputs 0 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"derm_cash_per_service":{"central":"1300","scenario_range":"Scenario inputs 1300 to 1300; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"derm_clinical_resource_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 3600; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"vascular_allocation":{"central":"0.04","scenario_range":"Scenario inputs 0.02 to 0.04; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"vascular_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"vascular_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_allocation":{"central":"0.03","scenario_range":"Scenario inputs 0.01 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"eye_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"eye_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"other_allocation":{"central":"0.02","scenario_range":"Scenario inputs 0 to 0.21; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"other_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"other_clinical_resource_per_service":{"central":"3000","scenario_range":"Scenario inputs 3000 to 6000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_selected_fraction":{"central":"0.65","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"65% of nominal ophthalmology services assumed selected first-eye function-limiting cataract pathway;45observedeye services also include other procedures."},"eye_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"eye_disjoint_fraction":{"central":"0.95","scenario_range":"Scenario inputs 0.95 to 0.95; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"eye_treatment_success":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"eye_utility_gain":{"central":"0.05","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".05 utility-point gain per successful person-year is a separate judgment. The RCT's.056 integrated first-yearQALY is a magnitude anchor only, not a rate multiplied by three years."},"eye_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"eye_loss_hazard":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"eye_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"eye_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"eye_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"eye_harm_q_per_person":{"central":"0.002","scenario_range":"Scenario inputs 0 to 0.002; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"hernia_selected_fraction":{"central":"0.45","scenario_range":"Scenario inputs 0 to 0.7; not a confidence interval","basis":"45% of nominal general-surgery services assumed selected symptomatic hernia episodes;201general services are not201hernias."},"hernia_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"hernia_disjoint_fraction":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"hernia_treatment_success":{"central":"0.85","scenario_range":"Scenario inputs 0.85 to 0.85; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"hernia_utility_gain":{"central":"0.04","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".04 utility-point gain per successful symptomatic-person-year is a judgment; minimallysymptomatic randomized evidence is essentially null. Selected pain-limiting hernia fraction and transport are unknown."},"hernia_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"hernia_loss_hazard":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"hernia_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. 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No delayed no-gift procedure harm is subtracted, conservatively."},"crc_selected_fraction":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% of nominal GI services assumed abnormal-FIT follow-up;575GI services are not575positiveFIT patients."},"crc_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"crc_disjoint_fraction":{"central":"1","scenario_range":"Scenario inputs 1 to 1; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"crc_treatment_linkage":{"central":"0.7","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"70% judgment chance that necessary appropriate downstream management can deliver the modeled contrast. Diagnostic completion alone earns no full treatment gain."},"crc_annual_fatal_hazard_reduction":{"central":"0.0006","scenario_range":"Scenario inputs -0.0003 to 0.001; not a confidence interval","basis":".0006/year is a judgment if no later-care catchup, lasting five hazard-years after latency. It is not.0092/10 or an estimated causal attenuation of the cohort. Fiveyears×.0006=.003 cumulative hazard only as a scale check."},"crc_baseline_total_mortality_hazard":{"central":"0.025","scenario_range":"Scenario inputs 0.025 to 0.025; not a confidence interval","basis":".025/year all-cause hazard prior already includes CRC mortality. Only the modeled CRC component changes; no second mortality hazard added."},"crc_catchup_hazard":{"central":"0.5","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".5/year aggregate hazard-effect decay prior (two-year characteristic time) for eventual ordinary diagnostic/treatment care; mean-hazard approximation, not exact random individual care-time mixture."},"crc_latency_years":{"central":"2","scenario_range":"Scenario inputs 2 to 2; not a confidence interval","basis":"Two-year assumed lag from procedure to differential fatal risk. Not observed OA survival timing; existing alternative care can catch up during this lag."},"crc_active_years":{"central":"5","scenario_range":"Scenario inputs 5 to 5; not a confidence interval","basis":"Five years of possibly different fatal hazard after latency, not five avoided deaths or a life expectancy."},"crc_horizon_years":{"central":"10","scenario_range":"Scenario inputs 10 to 15; not a confidence interval","basis":"Ten-year finite survival observation from procedure; both arms return to common mortality after the hazard-effect window. No lifetime tail."},"crc_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"crc_surviving_utility":{"central":"0.75","scenario_range":"Scenario inputs 0.75 to 0.75; not a confidence interval","basis":".75 utility for extra surviving person-time; no extra cancer morbidity or household benefit."},"crc_harm_q_per_person":{"central":"0.001","scenario_range":"Scenario inputs 0 to 0.001; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."}},"historical_comparison":{"model_path":"/private/tmp/mfi-oa-model.json","model_version":"oa-abnormal-fit-completed-pathway-v1","donor_per_10q":600000,"resource_per_10q":1012000,"boundary":"Selected SF abnormal-FIT completed pathway only; not ordinary whole gift. Preserved unchanged, not directly interchangeable with portfolio estimate."}},"paths":[{"id":"gi_symptom_diagnosis","category":"gi","share":0.5,"name":"Non-FIT GI investigation → benign treatable dyspepsia/dysphagia management","utility_gain":0.03,"treatment_success":0.4,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Diagnostic procedure alone earns no cure; treatment linkage is a prior, alternative primary-care therapy remains baseline.","downstream_resource_per_nominal_service":200},{"id":"general_cyst","category":"general","share":0.225,"name":"Painful cyst/lipoma excision","utility_gain":0.025,"treatment_success":0.85,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA procedure explicitly listed; utility and symptom-limiting fraction are priors, not cosmetic benefit.","downstream_resource_per_nominal_service":0},{"id":"anorectal","category":"general","share":0.12,"name":"Symptomatic haemorrhoid/fissure treatment","utility_gain":0.05,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Historical minor anorectal mix only; assume persistent symptoms despite medical management.","downstream_resource_per_nominal_service":0},{"id":"gallstone","category":"general","share":0.065,"name":"Uncomplicated symptomatic gallstone surgery","utility_gain":0,"treatment_success":0.7,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"C-GALL control includes later surgery; nonsignificant small integrated QALY difference; conservative care may suffice.","downstream_resource_per_nominal_service":0},{"id":"breast_diagnostic","category":"general","share":0.14,"name":"Breast lesion diagnostic assessment and linked benign symptom treatment","utility_gain":0.01,"treatment_success":0.25,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No unverified cancer survival gain. 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Torkki hallux-valgus RCT11368700 supports the painful-bunion subset only; two-year catch-up12807332 rules out lifelong timing gain.","downstream_resource_per_nominal_service":0},{"id":"degenerative_knee","category":"ortho","share":0.2,"name":"Degenerative knee arthroscopy without acute mechanical indication","utility_gain":0,"treatment_success":0.8,"harm_q_per_person":0.006,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Null benefit central, not assume all orthopaedic surgery is useful; harm retained.","downstream_resource_per_nominal_service":0},{"id":"nasal","category":"head_neck","share":0.7,"name":"Septal nasal obstruction surgery versus nasal medical therapy","utility_gain":0.04,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"NAIROS validates symptom mechanism, not SNOT22-to-QALY conversion or universal ENT benefit.","downstream_resource_per_nominal_service":0},{"id":"ear","category":"head_neck","share":0.3,"name":"Conductive ear disease treatment","utility_gain":0.03,"treatment_success":0.7,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Clinical indication and utility priors; no all-ENT survival credit.","downstream_resource_per_nominal_service":200},{"id":"bph","category":"urology","share":0.45,"name":"Bothersome BPH/outlet obstruction treatment","utility_gain":0.06,"treatment_success":0.8,"harm_q_per_person":0.006,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"TURP vs watchful waiting trial supports symptom relief, not current OA frequency; modern medication baseline matters.","downstream_resource_per_nominal_service":0},{"id":"stone","category":"urology","share":0.35,"name":"Symptomatic urinary stone treatment","utility_gain":0.05,"treatment_success":0.75,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No prophylactic life-saving claim for asymptomatic stones; spontaneous passage and medical treatment in comparator.","downstream_resource_per_nominal_service":200},{"id":"scrotal","category":"urology","share":0.2,"name":"Symptomatic benign scrotal/hydrocele treatment","utility_gain":0.025,"treatment_success":0.75,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Indication and finite utility priors; no infertility or cancer mortality award.","downstream_resource_per_nominal_service":0},{"id":"derm_cyst","category":"derm","share":0.8,"name":"Symptomatic benign skin cyst/lesion treatment","utility_gain":0.02,"treatment_success":0.8,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA cyst/lipoma service; disjoint allocation from general surgery required.","downstream_resource_per_nominal_service":0},{"id":"skin_lesion","category":"derm","share":0.2,"name":"Localized skin lesion diagnosis and treatment","utility_gain":0.03,"treatment_success":0.6,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Symptom/functional relief only; no melanoma mortality extrapolation.","downstream_resource_per_nominal_service":200},{"id":"veins","category":"vascular","share":1,"name":"Symptomatic uncomplicated varicose vein treatment","utility_gain":0.04,"treatment_success":0.8,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"REACTIV randomized conservative comparator; integrated two-year .054Q not annual gain.","downstream_resource_per_nominal_service":0},{"id":"pterygium","category":"eye","share":0.35,"name":"Symptomatic pterygium treatment","utility_gain":0.025,"treatment_success":0.8,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA explicitly offered; first-eye cataract cohort excluded; finite symptom/vision utility prior.","downstream_resource_per_nominal_service":0},{"id":"other_assessment","category":"other","share":1,"name":"Specialty assessment without established diagnosis-changing intervention","utility_gain":0,"treatment_success":0,"harm_q_per_person":0.0005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Only2%wholegift allocation; centralzero benefit explicitly due absent disease/intervention evidence, not blanket residual zero for major specialties.","downstream_resource_per_nominal_service":0}],"scope":"Expected whole-organization health CONDITIONAL on explicit diagnostic case-mix priors. All2025 specialty categories covered in a service ledger; other assessment2% receives zero benefit plus burden. No generic residual QALY/$ or inverse allocation uplift.","scenarios":[{"id":"central","baseOverrides":{},"pathOverrides":{}},{"id":"new_pathways_null","baseOverrides":{},"allPaths":{"utility_gain":0},"pathOverrides":{}},{"id":"fast_later_care","baseOverrides":{"eye_catchup_hazard":4,"hernia_catchup_hazard":4,"crc_catchup_hazard":4},"allPaths":{"catchup_hazard":4},"pathOverrides":{}},{"id":"zero_activity","baseOverrides":{"funding_additionality":0},"pathOverrides":{}},{"id":"adverse_new_pathways","baseOverrides":{},"allPaths":{"utility_gain":-0.01},"pathOverrides":{}},{"id":"favorable_joint","baseOverrides":{"funding_additionality":0.8,"eye_utility_gain":0.1,"hernia_utility_gain":0.1,"eye_catchup_hazard":0.2,"hernia_catchup_hazard":0.2},"allPaths":{"catchup_hazard":0.2,"horizon_years":5},"pathOverrides":{}},{"id":"no_local","baseOverrides":{"sf_share":0,"bay_share":0},"pathOverrides":{}},{"id":"double_new_resources","baseOverrides":{"outside_support_per_service":120,"patient_time_per_service":200},"pathOverrides":{}},{"id":"one_year","baseOverrides":{"eye_horizon_years":1,"hernia_horizon_years":1},"allPaths":{"horizon_years":1},"pathOverrides":{}}],"note":"v1 selected-path estimate and source artifacts remain unchanged. v2 is an asset-only correction; external resources already cover all nominal services and are NOT added again.","new_sources":[{"key":"cts_econ","publisher":"Korthals-de Bos et al.","title":"Surgery versus splinting economic evaluation","url":"https://research.vu.nl/ws/files/2213413/195347.pdf","published":"2006","retrieved":"September 9, 2026 UTC","sourceType":"Primary economic RCT; 12-month utility point difference, not integrated QALYs"},{"key":"aub","publisher":"Kuppermann et al.","title":"Medicine or Surgery randomized trial","url":"https://pubmed.ncbi.nlm.nih.gov/15039411/","published":"2004","retrieved":"September 9, 2026 UTC","sourceType":"Primary hysterectomy vs expanded medical treatment; not ablation comparator"},{"key":"bph","publisher":"Wasson et al.","title":"TURP versus watchful waiting","url":"https://pubmed.ncbi.nlm.nih.gov/7527493/","published":"1995","retrieved":"September 9, 2026 UTC","sourceType":"Primary randomized clinical trial; contemporary medication baseline differs"},{"key":"nasal","publisher":"NAIROS investigators","title":"Septoplasty versus medical management","url":"https://pubmed.ncbi.nlm.nih.gov/38477237/","published":"2024","retrieved":"September 9, 2026 UTC","sourceType":"Primary trial and economic report; SNOT22 not utility"},{"key":"veins","publisher":"REACTIV investigators","title":"Varicose veins randomized clinical/economic trial","url":"https://pubmed.ncbi.nlm.nih.gov/16707070/","published":"2006","retrieved":"September 9, 2026 UTC","sourceType":"Primary integrated two-year QALY estimate, not annual utility"},{"key":"gallstone","publisher":"C-GALL investigators","title":"Conservative treatment versus cholecystectomy","url":"https://pubmed.ncbi.nlm.nih.gov/38943314/","published":"2024","retrieved":"September 9, 2026 UTC","sourceType":"Primary randomized report; small nonsignificant QALY difference"},{"key":"foot","publisher":"Torkki et al.","title":"Painful hallux valgus surgery versus orthosis/wait","url":"https://pubmed.ncbi.nlm.nih.gov/11368700/","published":"2001","retrieved":"September 9, 2026 UTC","sourceType":"Primary randomized trial; selected painful bunion patients"},{"key":"foot_catchup","publisher":"Torkki et al.","title":"Hallux valgus two-year randomized follow-up","url":"https://pubmed.ncbi.nlm.nih.gov/12807332/","published":"2003","retrieved":"September 9, 2026 UTC","sourceType":"Primary later-care catch-up; no persisting difference assumed"},{"key":"pelvic","publisher":"van der Vaart et al.","title":"Pessary versus surgery for prolapse","url":"https://pubmed.ncbi.nlm.nih.gov/36538310/","published":"2022","retrieved":"September 9, 2026 UTC","sourceType":"Primary randomized trial with substantial crossover; neither arm no care"},{"key":"knee","publisher":"Sihvonen et al.","title":"Degenerative meniscus surgery versus 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Access","title":"2025 audited financial statements","url":"https://www.operationaccess.org/s/2025-Audited-Financial-Statements.pdf","published":"Year ended December31,2025; auditMay20,2026","sourceType":"Primary audited whole-organization expense, waived-charge accounting, liquidity and restrictions; relevant PDF7–8,14–15 visually verified.","retrieved":"September9,2026"},{"key":"report","publisher":"Operation Access","title":"2025 annual report","url":"https://www.operationaccess.org/s/Operation-Access-Annual-Report-2025.pdf","published":"2025 reporting year","sourceType":"Primary specialty counts/chartPDF7, funding lossPDF2, wait/readinessPDF6, cash financePDF13. Counts are services, not unique people or measured health.","retrieved":"September9,2026"},{"key":"budget","publisher":"Operation Access","title":"2026 budget","url":"https://www.operationaccess.org/s/2026Budget-8pz4.pdf","published":"ApprovedDecember10,2025","sourceType":"Primary1.9million cash plan, not actual2026 unit cost or procedure target.","retrieved":"September9,2026"},{"key":"eligibility","publisher":"Operation Access","title":"Patient eligibility and procedures","url":"https://www.operationaccess.org/for-patients-para-pacientes","published":"Current undated","sourceType":"Uninsured and ineligible fullMedi-Cal/Medicare/CMSP; cataract and hernia procedures explicitly offered; not insurance.","retrieved":"September9,2026"},{"key":"giving","publisher":"Operation Access","title":"Donate","url":"https://www.operationaccess.org/donate","published":"Current undated","sourceType":"Official ordinary donation route and EIN94-3180356. Waived-dollar fundraising leverage is not QALY evidence.","retrieved":"September9,2026"},{"key":"fit","publisher":"California Colorectal Cancer Coalition","title":"OA facilitated donated colonoscopy","url":"https://www.cacoloncancer.org/operation-access-facilitated-access-to-donated-colonoscopies/","published":"Current undated","sourceType":"Primary referral mechanism; above-average risk/positive stool tests; not575verifiedFITcases.","retrieved":"September9,2026"},{"key":"cataract","publisher":"Sach et al.","title":"First-eye cataract randomized economic evaluation","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC2095519/","published":"2007","sourceType":"306women over70, expedited4weeks vsroutine12months; first-yearQALYdifference.056(.006,.108), integratedyear—not annualutilityorOAlocalestimate.","retrieved":"September9,2026"},{"key":"hernia","publisher":"Fitzgibbons et al.","title":"Watchful waiting versus repair","url":"https://pubmed.ncbi.nlm.nih.gov/16418463/","published":"2006","sourceType":"720minimallysymptomatic men;2-yearpain/physicalfunction differences notsignificant;23%watchfulwaiting crossed torepair. Strong warning against assuming allhernias benefit.","retrieved":"September9,2026"},{"key":"crc","publisher":"Zorzi et al.","title":"Mortality after positive FIT without program colonoscopy","url":"https://pubmed.ncbi.nlm.nih.gov/33789965/","published":"2021","sourceType":"Observational10-yearCRC mortality6.8vs16per1000. Not randomization, no directly imported hazardorQALY.","retrieved":"September9,2026"},{"key":"critique","publisher":"Methodological correspondence","title":"Immortal-time concern in positive-FIT mortality comparison","url":"https://pubmed.ncbi.nlm.nih.gov/37549982/","published":"2023","sourceType":"Primary methodological criticism; exposure timing/selection biases not assumed solved.","retrieved":"September9,2026"},{"key":"navigation","publisher":"PRECISE investigators","title":"Navigation after abnormal stool test trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13007779/","published":"2025","sourceType":"967analysis;55.1vs42.1%one-yearcompletion. Not multiplied into already-completed OAservice units.","retrieved":"September9,2026"},{"key":"coverage","publisher":"California DHCS","title":"Medi-Cal eligibility changes","url":"https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/","published":"2026","sourceType":"Public coverage remains baseline when available; no assertion alluninsured have no latercare.","retrieved":"September9,2026"}],"funding_room":{"verified_offer_usd":null,"additional_slots":null,"accepted_sf_restriction":null,"statement":"Largest-funder loss and layoffs documented, but maintainedgrowth/newdonors and16monthsoperatingcash do not measure marginalcapacity. Allnumericalcaps are priors."},"boundaries":["All ten cash allocations sum to one. Other services retain full costs with health unquantified; zero credit is not a finding they are ineffective. This partial-health whole-gift estimate is not an upper bound on cost-effectiveness.","Completed-service cost includes coordination, overhead and failed referrals. Selected clinical subset, service-to-person conversion, financial additionality and disjointness are separate assumptions; service count alone is never a health outcome.","Current uninsured/ineligible-Medi-Cal eligibility is not a never-care baseline. Later safety-net care, coverage changes, other donors, donated provider capacity and OA's existing navigation remain in the counterfactual.","CRC uses an explicitly judgmental mean-hazard survival approximation. Cohort mortality association and navigationRCT are not causal manufacturer-like coefficients; no .13 completion multiplier or legacy aggregate.05Q is reused.","One exclusive linked-person ledger CRC then eye then hernia. Repeats/second eyes and overlapping diagnoses retain costs but cannot earn duplicate whole-person health. No productivity, caregiver or other mortality gains are added.","Donated clinical resources, distinct nonclinical support, patient time and downstream cancer-care allowances are gross associated costs on all nominal services, including uncredited/replaced activity. They are not waived charges, net incremental resources, or exhaustive societal cost.","Both health comparisons start with the same people alive at care. Delay discounts only; horizons start at care, not gift. Harms are already gift-date PV and include repeat procedures within an episode; late-comparator harms are not subtracted.","Bay and SF are nested weak residence priors, not measured local return. US equals all-region direct health here; no international or indirect local spillovers are credited.","Historical selectedSF$600,000 donor/$1,012,000 expanded price remains a separate program comparison. It must not remain the ordinary-gift ranking input after this revision."],"input_provenance":{"gift_usd":{"central":"100000","scenario_range":"Scenario inputs 100000 to 100000; not a confidence interval","basis":"Reference ordinary unrestricted gift; every dollar retained, not an SF colonoscopy restriction."},"funding_additionality":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% judgment for extra maintained/expanded services after replacement funding and provider bottlenecks. Existing OA care is baseline. Not estimated from the deficit or reserves."},"max_additional_services":{"central":"100","scenario_range":"Scenario inputs 0 to 100; not a confidence interval","basis":"100 extra mixed-service cap is an assumption, not identified open appointments. Shared capacity reduces all specialty activity proportionately."},"discount":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"3% annual health discount; economic resource amounts are gross associated present-dollar allowances, not a discounted net-social ledger."},"bay_share":{"central":"0.6","scenario_range":"Scenario inputs 0 to 0.8; not a confidence interval","basis":"60% weak beneficiary-residence prior within Northern California/Central Valley reach. No published specialty-specific county shares verified."},"sf_share":{"central":"0.08","scenario_range":"Scenario inputs 0 to 0.15; not a confidence interval","basis":"8% weak SF beneficiary-residence prior nested within Bay, not office location or guaranteed restricted allocation."},"independent_harm_q":{"central":"0","scenario_range":"Scenario inputs 0 to 1; not a confidence interval","basis":"Gift-date PV health loss independent of clinical activity; central0, zero-activity adverse case1."},"outside_support_per_service":{"central":"60","scenario_range":"Scenario inputs 60 to 60; not a confidence interval","basis":"$60 distinct nonclinical donated support per nominal mixed service, rounded from89,922/1,529; not already cash-paid interpretation/travel."},"patient_time_per_service":{"central":"100","scenario_range":"Scenario inputs 100 to 100; not a confidence interval","basis":"$100 additional patient/caregiver time allowance per nominal service, not earnings benefits or OA-paid travel."},"crc_treatment_cost_per_selected":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"$1,500 expected downstream therapy/surveillance resource allowance per nominal selectedFIT service, beyond endoscopy resources; weak prior, not provider quote or complete treatment estimate."},"gi_allocation":{"central":"0.37","scenario_range":"Scenario inputs 0.25 to 0.42; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gi_cash_per_service":{"central":"1400","scenario_range":"Scenario inputs 1400 to 1400; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gi_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"general_allocation":{"central":"0.13","scenario_range":"Scenario inputs 0.08 to 0.15; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"general_cash_per_service":{"central":"1700","scenario_range":"Scenario inputs 1700 to 1700; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"general_clinical_resource_per_service":{"central":"5500","scenario_range":"Scenario inputs 5500 to 11000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"gyne_allocation":{"central":"0.11","scenario_range":"Scenario inputs 0.11 to 0.11; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gyne_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gyne_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"ortho_allocation":{"central":"0.1","scenario_range":"Scenario inputs 0.1 to 0.1; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"ortho_cash_per_service":{"central":"1600","scenario_range":"Scenario inputs 1600 to 1600; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"ortho_clinical_resource_per_service":{"central":"5000","scenario_range":"Scenario inputs 5000 to 10000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"head_neck_allocation":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"head_neck_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"head_neck_clinical_resource_per_service":{"central":"3500","scenario_range":"Scenario inputs 3500 to 7000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"urology_allocation":{"central":"0.07","scenario_range":"Scenario inputs 0.07 to 0.07; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"urology_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"urology_clinical_resource_per_service":{"central":"4000","scenario_range":"Scenario inputs 4000 to 8000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"derm_allocation":{"central":"0.05","scenario_range":"Scenario inputs 0 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"derm_cash_per_service":{"central":"1300","scenario_range":"Scenario inputs 1300 to 1300; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"derm_clinical_resource_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 3600; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"vascular_allocation":{"central":"0.04","scenario_range":"Scenario inputs 0.02 to 0.04; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"vascular_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"vascular_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_allocation":{"central":"0.03","scenario_range":"Scenario inputs 0.01 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"eye_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"eye_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"other_allocation":{"central":"0.02","scenario_range":"Scenario inputs 0 to 0.21; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"other_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"other_clinical_resource_per_service":{"central":"3000","scenario_range":"Scenario inputs 3000 to 6000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_selected_fraction":{"central":"0.65","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"65% of nominal ophthalmology services assumed selected first-eye function-limiting cataract pathway;45observedeye services also include other procedures."},"eye_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"eye_disjoint_fraction":{"central":"0.95","scenario_range":"Scenario inputs 0.95 to 0.95; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"eye_treatment_success":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"eye_utility_gain":{"central":"0.05","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".05 utility-point gain per successful person-year is a separate judgment. The RCT's.056 integrated first-yearQALY is a magnitude anchor only, not a rate multiplied by three years."},"eye_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"eye_loss_hazard":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"eye_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"eye_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"eye_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"eye_harm_q_per_person":{"central":"0.002","scenario_range":"Scenario inputs 0 to 0.002; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"hernia_selected_fraction":{"central":"0.45","scenario_range":"Scenario inputs 0 to 0.7; not a confidence interval","basis":"45% of nominal general-surgery services assumed selected symptomatic hernia episodes;201general services are not201hernias."},"hernia_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"hernia_disjoint_fraction":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"hernia_treatment_success":{"central":"0.85","scenario_range":"Scenario inputs 0.85 to 0.85; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"hernia_utility_gain":{"central":"0.04","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".04 utility-point gain per successful symptomatic-person-year is a judgment; minimallysymptomatic randomized evidence is essentially null. Selected pain-limiting hernia fraction and transport are unknown."},"hernia_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"hernia_loss_hazard":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"hernia_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. 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No delayed no-gift procedure harm is subtracted, conservatively."},"crc_selected_fraction":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% of nominal GI services assumed abnormal-FIT follow-up;575GI services are not575positiveFIT patients."},"crc_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"crc_disjoint_fraction":{"central":"1","scenario_range":"Scenario inputs 1 to 1; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. 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Only the modeled CRC component changes; no second mortality hazard added."},"crc_catchup_hazard":{"central":"0.5","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".5/year aggregate hazard-effect decay prior (two-year characteristic time) for eventual ordinary diagnostic/treatment care; mean-hazard approximation, not exact random individual care-time mixture."},"crc_latency_years":{"central":"2","scenario_range":"Scenario inputs 2 to 2; not a confidence interval","basis":"Two-year assumed lag from procedure to differential fatal risk. Not observed OA survival timing; existing alternative care can catch up during this lag."},"crc_active_years":{"central":"5","scenario_range":"Scenario inputs 5 to 5; not a confidence interval","basis":"Five years of possibly different fatal hazard after latency, not five avoided deaths or a life expectancy."},"crc_horizon_years":{"central":"10","scenario_range":"Scenario inputs 10 to 15; not a confidence interval","basis":"Ten-year finite survival observation from procedure; both arms return to common mortality after the hazard-effect window. 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No delayed no-gift procedure harm is subtracted, conservatively."}},"historical_comparison":{"model_path":"/private/tmp/mfi-oa-model.json","model_version":"oa-abnormal-fit-completed-pathway-v1","donor_per_10q":600000,"resource_per_10q":1012000,"boundary":"Selected SF abnormal-FIT completed pathway only; not ordinary whole gift. 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no infertility or cancer mortality award.","downstream_resource_per_nominal_service":0},{"id":"derm_cyst","category":"derm","share":0.8,"name":"Symptomatic benign skin cyst/lesion treatment","utility_gain":0.02,"treatment_success":0.8,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA cyst/lipoma service; disjoint allocation from general surgery required.","downstream_resource_per_nominal_service":0},{"id":"skin_lesion","category":"derm","share":0.2,"name":"Localized skin lesion diagnosis and treatment","utility_gain":0.03,"treatment_success":0.6,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Symptom/functional relief only; no melanoma mortality extrapolation.","downstream_resource_per_nominal_service":200},{"id":"veins","category":"vascular","share":1,"name":"Symptomatic uncomplicated varicose vein treatment","utility_gain":0.04,"treatment_success":0.8,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"REACTIV randomized conservative comparator; integrated two-year .054Q not annual gain.","downstream_resource_per_nominal_service":0},{"id":"pterygium","category":"eye","share":0.35,"name":"Symptomatic pterygium treatment","utility_gain":0.025,"treatment_success":0.8,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA explicitly offered; first-eye cataract cohort excluded; finite symptom/vision utility prior.","downstream_resource_per_nominal_service":0},{"id":"other_assessment","category":"other","share":1,"name":"Specialty assessment without established diagnosis-changing intervention","utility_gain":0,"treatment_success":0,"harm_q_per_person":0.0005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Only2%wholegift allocation; centralzero benefit explicitly due absent disease/intervention evidence, not blanket residual zero for major specialties.","downstream_resource_per_nominal_service":0}],"scope":"Expected whole-organization health CONDITIONAL on explicit diagnostic case-mix priors. All2025 specialty categories covered in a service ledger; other assessment2% receives zero benefit plus burden. No generic residual QALY/$ or inverse allocation uplift.","scenarios":[{"id":"central","baseOverrides":{},"pathOverrides":{}},{"id":"new_pathways_null","baseOverrides":{},"allPaths":{"utility_gain":0},"pathOverrides":{}},{"id":"fast_later_care","baseOverrides":{"eye_catchup_hazard":4,"hernia_catchup_hazard":4,"crc_catchup_hazard":4},"allPaths":{"catchup_hazard":4},"pathOverrides":{}},{"id":"zero_activity","baseOverrides":{"funding_additionality":0},"pathOverrides":{}},{"id":"adverse_new_pathways","baseOverrides":{},"allPaths":{"utility_gain":-0.01},"pathOverrides":{}},{"id":"favorable_joint","baseOverrides":{"funding_additionality":0.8,"eye_utility_gain":0.1,"hernia_utility_gain":0.1,"eye_catchup_hazard":0.2,"hernia_catchup_hazard":0.2},"allPaths":{"catchup_hazard":0.2,"horizon_years":5},"pathOverrides":{}},{"id":"no_local","baseOverrides":{"sf_share":0,"bay_share":0},"pathOverrides":{}},{"id":"double_new_resources","baseOverrides":{"outside_support_per_service":120,"patient_time_per_service":200},"pathOverrides":{}},{"id":"one_year","baseOverrides":{"eye_horizon_years":1,"hernia_horizon_years":1},"allPaths":{"horizon_years":1},"pathOverrides":{}}],"note":"v1 selected-path estimate and source artifacts remain unchanged. v2 is an asset-only correction; external resources already cover all nominal services and are NOT added again.","new_sources":[{"key":"cts_econ","publisher":"Korthals-de Bos et al.","title":"Surgery versus splinting economic evaluation","url":"https://research.vu.nl/ws/files/2213413/195347.pdf","published":"2006","retrieved":"September 9, 2026 UTC","sourceType":"Primary economic RCT; 12-month utility point difference, not integrated QALYs"},{"key":"aub","publisher":"Kuppermann et al.","title":"Medicine or Surgery randomized trial","url":"https://pubmed.ncbi.nlm.nih.gov/15039411/","published":"2004","retrieved":"September 9, 2026 UTC","sourceType":"Primary hysterectomy vs expanded medical treatment; not ablation comparator"},{"key":"bph","publisher":"Wasson et al.","title":"TURP versus watchful waiting","url":"https://pubmed.ncbi.nlm.nih.gov/7527493/","published":"1995","retrieved":"September 9, 2026 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spending."},"categories":["gi","general","gyne","ortho","head_neck","urology","derm","vascular","eye","other"],"central_inputs":{"gift_usd":10000,"funding_additionality":0.3,"max_additional_services":20,"discount":0.03,"bay_share":0.6,"sf_share":0.08,"independent_harm_q":0,"outside_support_per_service":60,"patient_time_per_service":100,"crc_treatment_cost_per_selected":1500,"gi_allocation":0.3760627861347286,"gi_cash_per_service":1479.0745585349903,"gi_clinical_resource_per_service":2500,"general_allocation":0.131458469587966,"general_cash_per_service":1479.0745585349903,"general_clinical_resource_per_service":5500,"gyne_allocation":0.10987573577501634,"gyne_cash_per_service":1479.0745585349903,"gyne_clinical_resource_per_service":4500,"ortho_allocation":0.10333551340745585,"ortho_cash_per_service":1479.0745585349903,"ortho_clinical_resource_per_service":5000,"head_neck_allocation":0.08306082406801832,"head_neck_cash_per_service":1479.0745585349903,"head_neck_clinical_resource_per_service":3500,"urology_allocation":0.06605624591236102,"urology_cash_per_service":1479.0745585349903,"urology_clinical_resource_per_service":4000,"derm_allocation":0.052321778940483975,"derm_cash_per_service":1479.0745585349903,"derm_clinical_resource_per_service":1800,"vascular_allocation":0.03793328973185088,"vascular_cash_per_service":1479.0745585349903,"vascular_clinical_resource_per_service":4500,"eye_allocation":0.029431000654022238,"eye_cash_per_service":1479.0745585349903,"eye_clinical_resource_per_service":2500,"other_allocation":0.010464355788096796,"other_cash_per_service":1479.0745585349903,"other_clinical_resource_per_service":3000,"eye_selected_fraction":0.65,"eye_services_per_person":1.3530973451327433,"eye_disjoint_fraction":1,"eye_treatment_success":1,"eye_utility_gain":0.04369288612091463,"eye_catchup_hazard":0,"eye_loss_hazard":0.03,"eye_mortality_hazard":0.02,"eye_horizon_years":1,"eye_delay_years":0.25,"eye_harm_q_per_person":0.002,"hernia_selected_fraction":0.45,"hernia_services_per_person":1.3530973451327433,"hernia_disjoint_fraction":1,"hernia_treatment_success":0.85,"hernia_utility_gain":0.04,"hernia_catchup_hazard":0.7,"hernia_loss_hazard":0.08,"hernia_mortality_hazard":0.02,"hernia_horizon_years":3,"hernia_delay_years":0.25,"hernia_harm_q_per_person":0.004,"crc_selected_fraction":0.5,"crc_services_per_person":1.3530973451327433,"crc_disjoint_fraction":1,"crc_treatment_linkage":0.7,"crc_annual_fatal_hazard_reduction":0.0006,"crc_baseline_total_mortality_hazard":0.025,"crc_catchup_hazard":0.5,"crc_latency_years":2,"crc_active_years":5,"crc_horizon_years":10,"crc_delay_years":0.25,"crc_surviving_utility":0.75,"crc_harm_q_per_person":0.001},"scenarios":[{"id":"central","overrides":{}},{"id":"favorable","overrides":{"funding_additionality":0.75,"eye_selected_fraction":0.9,"hernia_selected_fraction":0.7,"crc_selected_fraction":0.75,"eye_utility_gain":0.1,"hernia_utility_gain":0.1,"eye_catchup_hazard":0.2,"hernia_catchup_hazard":0.2,"crc_catchup_hazard":0.15,"crc_treatment_linkage":0.9,"crc_annual_fatal_hazard_reduction":0.001,"eye_horizon_years":5,"hernia_horizon_years":5,"crc_horizon_years":15}},{"id":"cautious","overrides":{"funding_additionality":0.1,"eye_selected_fraction":0.3,"hernia_selected_fraction":0.2,"crc_selected_fraction":0.2,"eye_utility_gain":0.01,"hernia_utility_gain":0.005,"crc_annual_fatal_hazard_reduction":0.0001,"eye_catchup_hazard":2,"hernia_catchup_hazard":2,"crc_catchup_hazard":2,"crc_treatment_linkage":0.3}},{"id":"funding_replacement","overrides":{"funding_additionality":0}},{"id":"capacity_zero","overrides":{"max_additional_services":0}},{"id":"limited_capacity","overrides":{"max_additional_services":5}},{"id":"fast_alternative_care","overrides":{"eye_catchup_hazard":4,"hernia_catchup_hazard":4,"crc_catchup_hazard":4}},{"id":"no_later_care","overrides":{"eye_catchup_hazard":0,"hernia_catchup_hazard":0,"crc_catchup_hazard":0}},{"id":"one_year_nonfatal_benefit","overrides":{"eye_horizon_years":1,"hernia_horizon_years":1}},{"id":"crc_no_treatment","overrides":{"crc_treatment_linkage":0}},{"id":"crc_association_does_not_transfer","overrides":{"crc_annual_fatal_hazard_reduction":0}},{"id":"minimally_symptomatic_hernia_null","overrides":{"hernia_utility_gain":0}},{"id":"all_health_null","overrides":{"eye_utility_gain":0,"hernia_utility_gain":0,"crc_annual_fatal_hazard_reduction":0,"eye_harm_q_per_person":0,"hernia_harm_q_per_person":0,"crc_harm_q_per_person":0}},{"id":"benefit_null_harms_retained","overrides":{"eye_utility_gain":0,"hernia_utility_gain":0,"crc_annual_fatal_hazard_reduction":0}},{"id":"signed_adverse_health","overrides":{"eye_utility_gain":-0.02,"hernia_utility_gain":-0.02,"crc_annual_fatal_hazard_reduction":-0.0003}},{"id":"independent_harm_zero_activity","overrides":{"funding_additionality":0,"independent_harm_q":1}},{"id":"repeat_services","overrides":{"eye_services_per_person":2,"hernia_services_per_person":2,"crc_services_per_person":2}},{"id":"lower_target_portfolio","overrides":{"gi_allocation":0.25,"general_allocation":0.08,"eye_allocation":0.01,"other_allocation":0.21}},{"id":"higher_target_portfolio","overrides":{"gi_allocation":0.42,"general_allocation":0.15,"eye_allocation":0.05,"other_allocation":0,"derm_allocation":0,"vascular_allocation":0.02}},{"id":"double_external_resources","overrides":{"gi_clinical_resource_per_service":5000,"general_clinical_resource_per_service":11000,"gyne_clinical_resource_per_service":9000,"ortho_clinical_resource_per_service":10000,"head_neck_clinical_resource_per_service":7000,"urology_clinical_resource_per_service":8000,"derm_clinical_resource_per_service":3600,"vascular_clinical_resource_per_service":9000,"eye_clinical_resource_per_service":5000,"other_clinical_resource_per_service":6000}},{"id":"local_zero","overrides":{"bay_share":0,"sf_share":0}},{"id":"higher_local_share","overrides":{"bay_share":0.8,"sf_share":0.15}},{"id":"no_selected_subsets","overrides":{"eye_selected_fraction":0,"hernia_selected_fraction":0,"crc_selected_fraction":0}}],"sources":[{"key":"audit","publisher":"Operation Access","title":"2025 audited financial statements","url":"https://www.operationaccess.org/s/2025-Audited-Financial-Statements.pdf","published":"Year ended December31,2025; auditMay20,2026","sourceType":"Primary audited whole-organization expense, waived-charge accounting, liquidity and restrictions; relevant PDF7–8,14–15 visually verified.","retrieved":"September9,2026"},{"key":"report","publisher":"Operation Access","title":"2025 annual report","url":"https://www.operationaccess.org/s/Operation-Access-Annual-Report-2025.pdf","published":"2025 reporting year","sourceType":"Primary specialty counts/chartPDF7, funding lossPDF2, wait/readinessPDF6, cash financePDF13. Counts are services, not unique people or measured health.","retrieved":"September9,2026"},{"key":"budget","publisher":"Operation Access","title":"2026 budget","url":"https://www.operationaccess.org/s/2026Budget-8pz4.pdf","published":"ApprovedDecember10,2025","sourceType":"Primary1.9million cash plan, not actual2026 unit cost or procedure target.","retrieved":"September9,2026"},{"key":"eligibility","publisher":"Operation Access","title":"Patient eligibility and procedures","url":"https://www.operationaccess.org/for-patients-para-pacientes","published":"Current undated","sourceType":"Uninsured and ineligible fullMedi-Cal/Medicare/CMSP; cataract and hernia procedures explicitly offered; not insurance.","retrieved":"September9,2026"},{"key":"giving","publisher":"Operation Access","title":"Donate","url":"https://www.operationaccess.org/donate","published":"Current undated","sourceType":"Official ordinary donation route and EIN94-3180356. Waived-dollar fundraising leverage is not QALY evidence.","retrieved":"September9,2026"},{"key":"fit","publisher":"California Colorectal Cancer Coalition","title":"OA facilitated donated colonoscopy","url":"https://www.cacoloncancer.org/operation-access-facilitated-access-to-donated-colonoscopies/","published":"Current undated","sourceType":"Primary referral mechanism; above-average risk/positive stool tests; not575verifiedFITcases.","retrieved":"September9,2026"},{"key":"cataract","publisher":"Sach et al.","title":"First-eye cataract randomized economic evaluation","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC2095519/","published":"2007","sourceType":"306women over70, expedited4weeks vsroutine12months; first-yearQALYdifference.056(.006,.108), integratedyear—not annualutilityorOAlocalestimate.","retrieved":"September9,2026"},{"key":"hernia","publisher":"Fitzgibbons et al.","title":"Watchful waiting versus repair","url":"https://pubmed.ncbi.nlm.nih.gov/16418463/","published":"2006","sourceType":"720minimallysymptomatic men;2-yearpain/physicalfunction differences notsignificant;23%watchfulwaiting crossed torepair. Strong warning against assuming allhernias benefit.","retrieved":"September9,2026"},{"key":"crc","publisher":"Zorzi et al.","title":"Mortality after positive FIT without program colonoscopy","url":"https://pubmed.ncbi.nlm.nih.gov/33789965/","published":"2021","sourceType":"Observational10-yearCRC mortality6.8vs16per1000. Not randomization, no directly imported hazardorQALY.","retrieved":"September9,2026"},{"key":"critique","publisher":"Methodological correspondence","title":"Immortal-time concern in positive-FIT mortality comparison","url":"https://pubmed.ncbi.nlm.nih.gov/37549982/","published":"2023","sourceType":"Primary methodological criticism; exposure timing/selection biases not assumed solved.","retrieved":"September9,2026"},{"key":"navigation","publisher":"PRECISE investigators","title":"Navigation after abnormal stool test trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13007779/","published":"2025","sourceType":"967analysis;55.1vs42.1%one-yearcompletion. Not multiplied into already-completed OAservice units.","retrieved":"September9,2026"},{"key":"coverage","publisher":"California DHCS","title":"Medi-Cal eligibility changes","url":"https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/","published":"2026","sourceType":"Public coverage remains baseline when available; no assertion alluninsured have no latercare.","retrieved":"September9,2026"}],"funding_room":{"verified_offer_usd":null,"additional_slots":null,"accepted_sf_restriction":null,"statement":"Largest-funder loss and layoffs documented, but maintainedgrowth/newdonors and16monthsoperatingcash do not measure marginalcapacity. Allnumericalcaps are priors."},"boundaries":["All ten cash allocations sum to one. Other services retain full costs with health unquantified; zero credit is not a finding they are ineffective. This partial-health whole-gift estimate is not an upper bound on cost-effectiveness.","Completed-service cost includes coordination, overhead and failed referrals. Selected clinical subset, service-to-person conversion, financial additionality and disjointness are separate assumptions; service count alone is never a health outcome.","Current uninsured/ineligible-Medi-Cal eligibility is not a never-care baseline. Later safety-net care, coverage changes, other donors, donated provider capacity and OA's existing navigation remain in the counterfactual.","CRC uses an explicitly judgmental mean-hazard survival approximation. Cohort mortality association and navigationRCT are not causal manufacturer-like coefficients; no .13 completion multiplier or legacy aggregate.05Q is reused.","One exclusive linked-person ledger CRC then eye then hernia. Repeats/second eyes and overlapping diagnoses retain costs but cannot earn duplicate whole-person health. No productivity, caregiver or other mortality gains are added.","Donated clinical resources, distinct nonclinical support, patient time and downstream cancer-care allowances are gross associated costs on all nominal services, including uncredited/replaced activity. They are not waived charges, net incremental resources, or exhaustive societal cost.","Both health comparisons start with the same people alive at care. Delay discounts only; horizons start at care, not gift. Harms are already gift-date PV and include repeat procedures within an episode; late-comparator harms are not subtracted.","Bay and SF are nested weak residence priors, not measured local return. US equals all-region direct health here; no international or indirect local spillovers are credited.","Historical selectedSF$600,000 donor/$1,012,000 expanded price remains a separate program comparison. It must not remain the ordinary-gift ranking input after this revision."],"input_provenance":{"gift_usd":{"central":"100000","scenario_range":"Scenario inputs 100000 to 100000; not a confidence interval","basis":"Reference ordinary unrestricted gift; every dollar retained, not an SF colonoscopy restriction."},"funding_additionality":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% judgment for extra maintained/expanded services after replacement funding and provider bottlenecks. Existing OA care is baseline. Not estimated from the deficit or reserves."},"max_additional_services":{"central":"100","scenario_range":"Scenario inputs 0 to 100; not a confidence interval","basis":"100 extra mixed-service cap is an assumption, not identified open appointments. Shared capacity reduces all specialty activity proportionately."},"discount":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"3% annual health discount; economic resource amounts are gross associated present-dollar allowances, not a discounted net-social ledger."},"bay_share":{"central":"0.6","scenario_range":"Scenario inputs 0 to 0.8; not a confidence interval","basis":"60% weak beneficiary-residence prior within Northern California/Central Valley reach. No published specialty-specific county shares verified."},"sf_share":{"central":"0.08","scenario_range":"Scenario inputs 0 to 0.15; not a confidence interval","basis":"8% weak SF beneficiary-residence prior nested within Bay, not office location or guaranteed restricted allocation."},"independent_harm_q":{"central":"0","scenario_range":"Scenario inputs 0 to 1; not a confidence interval","basis":"Gift-date PV health loss independent of clinical activity; central0, zero-activity adverse case1."},"outside_support_per_service":{"central":"60","scenario_range":"Scenario inputs 60 to 60; not a confidence interval","basis":"$60 distinct nonclinical donated support per nominal mixed service, rounded from89,922/1,529; not already cash-paid interpretation/travel."},"patient_time_per_service":{"central":"100","scenario_range":"Scenario inputs 100 to 100; not a confidence interval","basis":"$100 additional patient/caregiver time allowance per nominal service, not earnings benefits or OA-paid travel."},"crc_treatment_cost_per_selected":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"$1,500 expected downstream therapy/surveillance resource allowance per nominal selectedFIT service, beyond endoscopy resources; weak prior, not provider quote or complete treatment estimate."},"gi_allocation":{"central":"0.37","scenario_range":"Scenario inputs 0.25 to 0.42; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gi_cash_per_service":{"central":"1400","scenario_range":"Scenario inputs 1400 to 1400; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gi_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"general_allocation":{"central":"0.13","scenario_range":"Scenario inputs 0.08 to 0.15; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"general_cash_per_service":{"central":"1700","scenario_range":"Scenario inputs 1700 to 1700; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"general_clinical_resource_per_service":{"central":"5500","scenario_range":"Scenario inputs 5500 to 11000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"gyne_allocation":{"central":"0.11","scenario_range":"Scenario inputs 0.11 to 0.11; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gyne_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gyne_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"ortho_allocation":{"central":"0.1","scenario_range":"Scenario inputs 0.1 to 0.1; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"ortho_cash_per_service":{"central":"1600","scenario_range":"Scenario inputs 1600 to 1600; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"ortho_clinical_resource_per_service":{"central":"5000","scenario_range":"Scenario inputs 5000 to 10000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"head_neck_allocation":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"head_neck_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"head_neck_clinical_resource_per_service":{"central":"3500","scenario_range":"Scenario inputs 3500 to 7000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"urology_allocation":{"central":"0.07","scenario_range":"Scenario inputs 0.07 to 0.07; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"urology_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"urology_clinical_resource_per_service":{"central":"4000","scenario_range":"Scenario inputs 4000 to 8000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"derm_allocation":{"central":"0.05","scenario_range":"Scenario inputs 0 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"derm_cash_per_service":{"central":"1300","scenario_range":"Scenario inputs 1300 to 1300; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"derm_clinical_resource_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 3600; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"vascular_allocation":{"central":"0.04","scenario_range":"Scenario inputs 0.02 to 0.04; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"vascular_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"vascular_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_allocation":{"central":"0.03","scenario_range":"Scenario inputs 0.01 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"eye_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"eye_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"other_allocation":{"central":"0.02","scenario_range":"Scenario inputs 0 to 0.21; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"other_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"other_clinical_resource_per_service":{"central":"3000","scenario_range":"Scenario inputs 3000 to 6000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_selected_fraction":{"central":"0.65","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"65% of nominal ophthalmology services assumed selected first-eye function-limiting cataract pathway;45observedeye services also include other procedures."},"eye_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"eye_disjoint_fraction":{"central":"0.95","scenario_range":"Scenario inputs 0.95 to 0.95; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"eye_treatment_success":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"eye_utility_gain":{"central":"0.05","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".05 utility-point gain per successful person-year is a separate judgment. The RCT's.056 integrated first-yearQALY is a magnitude anchor only, not a rate multiplied by three years."},"eye_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"eye_loss_hazard":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"eye_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"eye_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"eye_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"eye_harm_q_per_person":{"central":"0.002","scenario_range":"Scenario inputs 0 to 0.002; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"hernia_selected_fraction":{"central":"0.45","scenario_range":"Scenario inputs 0 to 0.7; not a confidence interval","basis":"45% of nominal general-surgery services assumed selected symptomatic hernia episodes;201general services are not201hernias."},"hernia_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"hernia_disjoint_fraction":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"hernia_treatment_success":{"central":"0.85","scenario_range":"Scenario inputs 0.85 to 0.85; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"hernia_utility_gain":{"central":"0.04","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".04 utility-point gain per successful symptomatic-person-year is a judgment; minimallysymptomatic randomized evidence is essentially null. Selected pain-limiting hernia fraction and transport are unknown."},"hernia_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"hernia_loss_hazard":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"hernia_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. 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No delayed no-gift procedure harm is subtracted, conservatively."},"crc_selected_fraction":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% of nominal GI services assumed abnormal-FIT follow-up;575GI services are not575positiveFIT patients."},"crc_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"crc_disjoint_fraction":{"central":"1","scenario_range":"Scenario inputs 1 to 1; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"crc_treatment_linkage":{"central":"0.7","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"70% judgment chance that necessary appropriate downstream management can deliver the modeled contrast. Diagnostic completion alone earns no full treatment gain."},"crc_annual_fatal_hazard_reduction":{"central":"0.0006","scenario_range":"Scenario inputs -0.0003 to 0.001; not a confidence interval","basis":".0006/year is a judgment if no later-care catchup, lasting five hazard-years after latency. It is not.0092/10 or an estimated causal attenuation of the cohort. Fiveyears×.0006=.003 cumulative hazard only as a scale check."},"crc_baseline_total_mortality_hazard":{"central":"0.025","scenario_range":"Scenario inputs 0.025 to 0.025; not a confidence interval","basis":".025/year all-cause hazard prior already includes CRC mortality. Only the modeled CRC component changes; no second mortality hazard added."},"crc_catchup_hazard":{"central":"0.5","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".5/year aggregate hazard-effect decay prior (two-year characteristic time) for eventual ordinary diagnostic/treatment care; mean-hazard approximation, not exact random individual care-time mixture."},"crc_latency_years":{"central":"2","scenario_range":"Scenario inputs 2 to 2; not a confidence interval","basis":"Two-year assumed lag from procedure to differential fatal risk. Not observed OA survival timing; existing alternative care can catch up during this lag."},"crc_active_years":{"central":"5","scenario_range":"Scenario inputs 5 to 5; not a confidence interval","basis":"Five years of possibly different fatal hazard after latency, not five avoided deaths or a life expectancy."},"crc_horizon_years":{"central":"10","scenario_range":"Scenario inputs 10 to 15; not a confidence interval","basis":"Ten-year finite survival observation from procedure; both arms return to common mortality after the hazard-effect window. No lifetime tail."},"crc_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"crc_surviving_utility":{"central":"0.75","scenario_range":"Scenario inputs 0.75 to 0.75; not a confidence interval","basis":".75 utility for extra surviving person-time; no extra cancer morbidity or household benefit."},"crc_harm_q_per_person":{"central":"0.001","scenario_range":"Scenario inputs 0 to 0.001; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."}},"historical_comparison":{"model_path":"/private/tmp/mfi-oa-model.json","model_version":"oa-abnormal-fit-completed-pathway-v1","donor_per_10q":600000,"resource_per_10q":1012000,"boundary":"Selected SF abnormal-FIT completed pathway only; not ordinary whole gift. Preserved unchanged, not directly interchangeable with portfolio estimate."}},"paths":[{"id":"gi_symptom_diagnosis","category":"gi","share":0.5,"name":"Non-FIT GI investigation → benign treatable dyspepsia/dysphagia management","utility_gain":0.03,"treatment_success":0.4,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Diagnostic procedure alone earns no cure; treatment linkage is a prior, alternative primary-care therapy remains baseline.","downstream_resource_per_nominal_service":200},{"id":"general_cyst","category":"general","share":0.225,"name":"Painful cyst/lipoma excision","utility_gain":0.025,"treatment_success":0.85,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA procedure explicitly listed; utility and symptom-limiting fraction are priors, not cosmetic benefit.","downstream_resource_per_nominal_service":0},{"id":"anorectal","category":"general","share":0.12,"name":"Symptomatic haemorrhoid/fissure treatment","utility_gain":0.05,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Historical minor anorectal mix only; assume persistent symptoms despite medical management.","downstream_resource_per_nominal_service":0},{"id":"gallstone","category":"general","share":0.065,"name":"Uncomplicated symptomatic gallstone surgery","utility_gain":0,"treatment_success":0.7,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"C-GALL control includes later surgery; nonsignificant small integrated QALY difference; conservative care may suffice.","downstream_resource_per_nominal_service":0},{"id":"breast_diagnostic","category":"general","share":0.14,"name":"Breast lesion diagnostic assessment and linked benign symptom treatment","utility_gain":0.01,"treatment_success":0.25,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No unverified cancer survival gain. 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Torkki hallux-valgus RCT11368700 supports the painful-bunion subset only; two-year catch-up12807332 rules out lifelong timing gain.","downstream_resource_per_nominal_service":0},{"id":"degenerative_knee","category":"ortho","share":0.2,"name":"Degenerative knee arthroscopy without acute mechanical indication","utility_gain":0,"treatment_success":0.8,"harm_q_per_person":0.006,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Null benefit central, not assume all orthopaedic surgery is useful; harm retained.","downstream_resource_per_nominal_service":0},{"id":"nasal","category":"head_neck","share":0.7,"name":"Septal nasal obstruction surgery versus nasal medical therapy","utility_gain":0.04,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"NAIROS validates symptom mechanism, not SNOT22-to-QALY conversion or universal ENT benefit.","downstream_resource_per_nominal_service":0},{"id":"ear","category":"head_neck","share":0.3,"name":"Conductive ear disease treatment","utility_gain":0.03,"treatment_success":0.7,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Clinical indication and utility priors; no all-ENT survival credit.","downstream_resource_per_nominal_service":200},{"id":"bph","category":"urology","share":0.45,"name":"Bothersome BPH/outlet obstruction treatment","utility_gain":0.06,"treatment_success":0.8,"harm_q_per_person":0.006,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"TURP vs watchful waiting trial supports symptom relief, not current OA frequency; modern medication baseline matters.","downstream_resource_per_nominal_service":0},{"id":"stone","category":"urology","share":0.35,"name":"Symptomatic urinary stone treatment","utility_gain":0.05,"treatment_success":0.75,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No prophylactic life-saving claim for asymptomatic stones; spontaneous passage and medical treatment in comparator.","downstream_resource_per_nominal_service":200},{"id":"scrotal","category":"urology","share":0.2,"name":"Symptomatic benign scrotal/hydrocele treatment","utility_gain":0.025,"treatment_success":0.75,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Indication and finite utility priors; no infertility or cancer mortality award.","downstream_resource_per_nominal_service":0},{"id":"derm_cyst","category":"derm","share":0.8,"name":"Symptomatic benign skin cyst/lesion treatment","utility_gain":0.02,"treatment_success":0.8,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA cyst/lipoma service; disjoint allocation from general surgery required.","downstream_resource_per_nominal_service":0},{"id":"skin_lesion","category":"derm","share":0.2,"name":"Localized skin lesion diagnosis and treatment","utility_gain":0.03,"treatment_success":0.6,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Symptom/functional relief only; no melanoma mortality extrapolation.","downstream_resource_per_nominal_service":200},{"id":"veins","category":"vascular","share":1,"name":"Symptomatic uncomplicated varicose vein treatment","utility_gain":0.04,"treatment_success":0.8,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"REACTIV randomized conservative comparator; integrated two-year .054Q not annual gain.","downstream_resource_per_nominal_service":0},{"id":"pterygium","category":"eye","share":0.35,"name":"Symptomatic pterygium treatment","utility_gain":0.025,"treatment_success":0.8,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA explicitly offered; first-eye cataract cohort excluded; finite symptom/vision utility prior.","downstream_resource_per_nominal_service":0},{"id":"other_assessment","category":"other","share":1,"name":"Specialty assessment without established diagnosis-changing intervention","utility_gain":0,"treatment_success":0,"harm_q_per_person":0.0005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Only2%wholegift allocation; centralzero benefit explicitly due absent disease/intervention evidence, not blanket residual zero for major specialties.","downstream_resource_per_nominal_service":0}],"scope":"Expected whole-organization health CONDITIONAL on explicit diagnostic case-mix priors. All2025 specialty categories covered in a service ledger; other assessment2% receives zero benefit plus burden. No generic residual QALY/$ or inverse allocation uplift.","scenarios":[{"id":"central","baseOverrides":{},"pathOverrides":{}},{"id":"new_pathways_null","baseOverrides":{},"allPaths":{"utility_gain":0},"pathOverrides":{}},{"id":"fast_later_care","baseOverrides":{"eye_catchup_hazard":4,"hernia_catchup_hazard":4,"crc_catchup_hazard":4},"allPaths":{"catchup_hazard":4},"pathOverrides":{}},{"id":"zero_activity","baseOverrides":{"funding_additionality":0},"pathOverrides":{}},{"id":"adverse_new_pathways","baseOverrides":{},"allPaths":{"utility_gain":-0.01},"pathOverrides":{}},{"id":"favorable_joint","baseOverrides":{"funding_additionality":0.8,"eye_utility_gain":0.1,"hernia_utility_gain":0.1,"eye_catchup_hazard":0.2,"hernia_catchup_hazard":0.2},"allPaths":{"catchup_hazard":0.2,"horizon_years":5},"pathOverrides":{}},{"id":"no_local","baseOverrides":{"sf_share":0,"bay_share":0},"pathOverrides":{}},{"id":"double_new_resources","baseOverrides":{"outside_support_per_service":120,"patient_time_per_service":200},"pathOverrides":{}},{"id":"one_year","baseOverrides":{"eye_horizon_years":1,"hernia_horizon_years":1},"allPaths":{"horizon_years":1},"pathOverrides":{}}],"note":"v1 selected-path estimate and source artifacts remain unchanged. v2 is an asset-only correction; external resources already cover all nominal services and are NOT added again.","new_sources":[{"key":"cts_econ","publisher":"Korthals-de Bos et al.","title":"Surgery versus splinting economic evaluation","url":"https://research.vu.nl/ws/files/2213413/195347.pdf","published":"2006","retrieved":"September 9, 2026 UTC","sourceType":"Primary economic RCT; 12-month utility point difference, not integrated QALYs"},{"key":"aub","publisher":"Kuppermann et al.","title":"Medicine or Surgery randomized trial","url":"https://pubmed.ncbi.nlm.nih.gov/15039411/","published":"2004","retrieved":"September 9, 2026 UTC","sourceType":"Primary hysterectomy vs expanded medical treatment; not ablation comparator"},{"key":"bph","publisher":"Wasson et al.","title":"TURP versus watchful waiting","url":"https://pubmed.ncbi.nlm.nih.gov/7527493/","published":"1995","retrieved":"September 9, 2026 UTC","sourceType":"Primary randomized clinical trial; contemporary medication baseline differs"},{"key":"nasal","publisher":"NAIROS investigators","title":"Septoplasty versus medical management","url":"https://pubmed.ncbi.nlm.nih.gov/38477237/","published":"2024","retrieved":"September 9, 2026 UTC","sourceType":"Primary trial and economic report; SNOT22 not utility"},{"key":"veins","publisher":"REACTIV investigators","title":"Varicose veins randomized clinical/economic trial","url":"https://pubmed.ncbi.nlm.nih.gov/16707070/","published":"2006","retrieved":"September 9, 2026 UTC","sourceType":"Primary integrated two-year QALY estimate, not annual utility"},{"key":"gallstone","publisher":"C-GALL investigators","title":"Conservative treatment versus cholecystectomy","url":"https://pubmed.ncbi.nlm.nih.gov/38943314/","published":"2024","retrieved":"September 9, 2026 UTC","sourceType":"Primary randomized report; small nonsignificant QALY difference"},{"key":"foot","publisher":"Torkki et al.","title":"Painful hallux valgus surgery versus orthosis/wait","url":"https://pubmed.ncbi.nlm.nih.gov/11368700/","published":"2001","retrieved":"September 9, 2026 UTC","sourceType":"Primary randomized trial; selected painful bunion patients"},{"key":"foot_catchup","publisher":"Torkki et al.","title":"Hallux valgus two-year randomized follow-up","url":"https://pubmed.ncbi.nlm.nih.gov/12807332/","published":"2003","retrieved":"September 9, 2026 UTC","sourceType":"Primary later-care catch-up; no persisting difference assumed"},{"key":"pelvic","publisher":"van der Vaart et al.","title":"Pessary versus surgery for prolapse","url":"https://pubmed.ncbi.nlm.nih.gov/36538310/","published":"2022","retrieved":"September 9, 2026 UTC","sourceType":"Primary randomized trial with substantial crossover; neither arm no care"},{"key":"knee","publisher":"Sihvonen et al.","title":"Degenerative meniscus surgery versus 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Access","version":"oa-whole-gift-named-coverage-v2","foundation":{"organization":"Operation Access","slug":"operation-access","model_version":"oa-whole-gift-finite-portfolio-v1","recipient":{"legal_name":"Ambulatory Surgery Access Coalition dba Operation Access","ein":"94-3180356","giving_url":"https://www.operationaccess.org/donate"},"finance":{"year":2025,"total_accrual_expense":22876888,"donated_clinical_waived_charges":20530000,"other_donated_support":89922,"cash_like_expense":2256966,"annual_report_cash_expense":2256967,"budget2026_cash":1900000,"services":1529,"specialty_services":{"gi":575,"general":201,"gyne":168,"ortho":158,"head_neck":127,"urology":101,"derm":80,"vascular":58,"eye":45,"other":16},"note":"Cash-like accrual subtraction is not cash flow. Waived charges are not economic costs. Prospective allocation is not observed specialty cash spending."},"categories":["gi","general","gyne","ortho","head_neck","urology","derm","vascular","eye","other"],"central_inputs":{"gift_usd":10000,"funding_additionality":0.3,"max_additional_services":20,"discount":0.03,"bay_share":0.6,"sf_share":0.08,"independent_harm_q":0,"outside_support_per_service":60,"patient_time_per_service":100,"crc_treatment_cost_per_selected":1500,"gi_allocation":0.3760627861347286,"gi_cash_per_service":1479.0745585349903,"gi_clinical_resource_per_service":2500,"general_allocation":0.131458469587966,"general_cash_per_service":1479.0745585349903,"general_clinical_resource_per_service":5500,"gyne_allocation":0.10987573577501634,"gyne_cash_per_service":1479.0745585349903,"gyne_clinical_resource_per_service":4500,"ortho_allocation":0.10333551340745585,"ortho_cash_per_service":1479.0745585349903,"ortho_clinical_resource_per_service":5000,"head_neck_allocation":0.08306082406801832,"head_neck_cash_per_service":1479.0745585349903,"head_neck_clinical_resource_per_service":3500,"urology_allocation":0.06605624591236102,"urology_cash_per_service":1479.0745585349903,"urology_clinical_resource_per_service":4000,"derm_allocation":0.052321778940483975,"derm_cash_per_service":1479.0745585349903,"derm_clinical_resource_per_service":1800,"vascular_allocation":0.03793328973185088,"vascular_cash_per_service":1479.0745585349903,"vascular_clinical_resource_per_service":4500,"eye_allocation":0.029431000654022238,"eye_cash_per_service":1479.0745585349903,"eye_clinical_resource_per_service":2500,"other_allocation":0.010464355788096796,"other_cash_per_service":1479.0745585349903,"other_clinical_resource_per_service":3000,"eye_selected_fraction":0.65,"eye_services_per_person":1.3530973451327433,"eye_disjoint_fraction":1,"eye_treatment_success":1,"eye_utility_gain":0.04369288612091463,"eye_catchup_hazard":0,"eye_loss_hazard":0.03,"eye_mortality_hazard":0.02,"eye_horizon_years":1,"eye_delay_years":0.25,"eye_harm_q_per_person":0.002,"hernia_selected_fraction":0.45,"hernia_services_per_person":1.3530973451327433,"hernia_disjoint_fraction":1,"hernia_treatment_success":0.85,"hernia_utility_gain":0.04,"hernia_catchup_hazard":0.7,"hernia_loss_hazard":0.08,"hernia_mortality_hazard":0.02,"hernia_horizon_years":3,"hernia_delay_years":0.25,"hernia_harm_q_per_person":0.004,"crc_selected_fraction":0.5,"crc_services_per_person":1.3530973451327433,"crc_disjoint_fraction":1,"crc_treatment_linkage":0.7,"crc_annual_fatal_hazard_reduction":0.0006,"crc_baseline_total_mortality_hazard":0.025,"crc_catchup_hazard":0.5,"crc_latency_years":2,"crc_active_years":5,"crc_horizon_years":10,"crc_delay_years":0.25,"crc_surviving_utility":0.75,"crc_harm_q_per_person":0.001},"scenarios":[{"id":"central","overrides":{}},{"id":"favorable","overrides":{"funding_additionality":0.75,"eye_selected_fraction":0.9,"hernia_selected_fraction":0.7,"crc_selected_fraction":0.75,"eye_utility_gain":0.1,"hernia_utility_gain":0.1,"eye_catchup_hazard":0.2,"hernia_catchup_hazard":0.2,"crc_catchup_hazard":0.15,"crc_treatment_linkage":0.9,"crc_annual_fatal_hazard_reduction":0.001,"eye_horizon_years":5,"hernia_horizon_years":5,"crc_horizon_years":15}},{"id":"cautious","overrides":{"funding_additionality":0.1,"eye_selected_fraction":0.3,"hernia_selected_fraction":0.2,"crc_selected_fraction":0.2,"eye_utility_gain":0.01,"hernia_utility_gain":0.005,"crc_annual_fatal_hazard_reduction":0.0001,"eye_catchup_hazard":2,"hernia_catchup_hazard":2,"crc_catchup_hazard":2,"crc_treatment_linkage":0.3}},{"id":"funding_replacement","overrides":{"funding_additionality":0}},{"id":"capacity_zero","overrides":{"max_additional_services":0}},{"id":"limited_capacity","overrides":{"max_additional_services":5}},{"id":"fast_alternative_care","overrides":{"eye_catchup_hazard":4,"hernia_catchup_hazard":4,"crc_catchup_hazard":4}},{"id":"no_later_care","overrides":{"eye_catchup_hazard":0,"hernia_catchup_hazard":0,"crc_catchup_hazard":0}},{"id":"one_year_nonfatal_benefit","overrides":{"eye_horizon_years":1,"hernia_horizon_years":1}},{"id":"crc_no_treatment","overrides":{"crc_treatment_linkage":0}},{"id":"crc_association_does_not_transfer","overrides":{"crc_annual_fatal_hazard_reduction":0}},{"id":"minimally_symptomatic_hernia_null","overrides":{"hernia_utility_gain":0}},{"id":"all_health_null","overrides":{"eye_utility_gain":0,"hernia_utility_gain":0,"crc_annual_fatal_hazard_reduction":0,"eye_harm_q_per_person":0,"hernia_harm_q_per_person":0,"crc_harm_q_per_person":0}},{"id":"benefit_null_harms_retained","overrides":{"eye_utility_gain":0,"hernia_utility_gain":0,"crc_annual_fatal_hazard_reduction":0}},{"id":"signed_adverse_health","overrides":{"eye_utility_gain":-0.02,"hernia_utility_gain":-0.02,"crc_annual_fatal_hazard_reduction":-0.0003}},{"id":"independent_harm_zero_activity","overrides":{"funding_additionality":0,"independent_harm_q":1}},{"id":"repeat_services","overrides":{"eye_services_per_person":2,"hernia_services_per_person":2,"crc_services_per_person":2}},{"id":"lower_target_portfolio","overrides":{"gi_allocation":0.25,"general_allocation":0.08,"eye_allocation":0.01,"other_allocation":0.21}},{"id":"higher_target_portfolio","overrides":{"gi_allocation":0.42,"general_allocation":0.15,"eye_allocation":0.05,"other_allocation":0,"derm_allocation":0,"vascular_allocation":0.02}},{"id":"double_external_resources","overrides":{"gi_clinical_resource_per_service":5000,"general_clinical_resource_per_service":11000,"gyne_clinical_resource_per_service":9000,"ortho_clinical_resource_per_service":10000,"head_neck_clinical_resource_per_service":7000,"urology_clinical_resource_per_service":8000,"derm_clinical_resource_per_service":3600,"vascular_clinical_resource_per_service":9000,"eye_clinical_resource_per_service":5000,"other_clinical_resource_per_service":6000}},{"id":"local_zero","overrides":{"bay_share":0,"sf_share":0}},{"id":"higher_local_share","overrides":{"bay_share":0.8,"sf_share":0.15}},{"id":"no_selected_subsets","overrides":{"eye_selected_fraction":0,"hernia_selected_fraction":0,"crc_selected_fraction":0}}],"sources":[{"key":"audit","publisher":"Operation Access","title":"2025 audited financial statements","url":"https://www.operationaccess.org/s/2025-Audited-Financial-Statements.pdf","published":"Year ended December31,2025; auditMay20,2026","sourceType":"Primary audited whole-organization expense, waived-charge accounting, liquidity and restrictions; relevant PDF7–8,14–15 visually verified.","retrieved":"September9,2026"},{"key":"report","publisher":"Operation Access","title":"2025 annual report","url":"https://www.operationaccess.org/s/Operation-Access-Annual-Report-2025.pdf","published":"2025 reporting year","sourceType":"Primary specialty counts/chartPDF7, funding lossPDF2, wait/readinessPDF6, cash financePDF13. Counts are services, not unique people or measured health.","retrieved":"September9,2026"},{"key":"budget","publisher":"Operation Access","title":"2026 budget","url":"https://www.operationaccess.org/s/2026Budget-8pz4.pdf","published":"ApprovedDecember10,2025","sourceType":"Primary1.9million cash plan, not actual2026 unit cost or procedure target.","retrieved":"September9,2026"},{"key":"eligibility","publisher":"Operation Access","title":"Patient eligibility and procedures","url":"https://www.operationaccess.org/for-patients-para-pacientes","published":"Current undated","sourceType":"Uninsured and ineligible fullMedi-Cal/Medicare/CMSP; cataract and hernia procedures explicitly offered; not insurance.","retrieved":"September9,2026"},{"key":"giving","publisher":"Operation Access","title":"Donate","url":"https://www.operationaccess.org/donate","published":"Current undated","sourceType":"Official ordinary donation route and EIN94-3180356. Waived-dollar fundraising leverage is not QALY evidence.","retrieved":"September9,2026"},{"key":"fit","publisher":"California Colorectal Cancer Coalition","title":"OA facilitated donated colonoscopy","url":"https://www.cacoloncancer.org/operation-access-facilitated-access-to-donated-colonoscopies/","published":"Current undated","sourceType":"Primary referral mechanism; above-average risk/positive stool tests; not575verifiedFITcases.","retrieved":"September9,2026"},{"key":"cataract","publisher":"Sach et al.","title":"First-eye cataract randomized economic evaluation","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC2095519/","published":"2007","sourceType":"306women over70, expedited4weeks vsroutine12months; first-yearQALYdifference.056(.006,.108), integratedyear—not annualutilityorOAlocalestimate.","retrieved":"September9,2026"},{"key":"hernia","publisher":"Fitzgibbons et al.","title":"Watchful waiting versus repair","url":"https://pubmed.ncbi.nlm.nih.gov/16418463/","published":"2006","sourceType":"720minimallysymptomatic men;2-yearpain/physicalfunction differences notsignificant;23%watchfulwaiting crossed torepair. Strong warning against assuming allhernias benefit.","retrieved":"September9,2026"},{"key":"crc","publisher":"Zorzi et al.","title":"Mortality after positive FIT without program colonoscopy","url":"https://pubmed.ncbi.nlm.nih.gov/33789965/","published":"2021","sourceType":"Observational10-yearCRC mortality6.8vs16per1000. Not randomization, no directly imported hazardorQALY.","retrieved":"September9,2026"},{"key":"critique","publisher":"Methodological correspondence","title":"Immortal-time concern in positive-FIT mortality comparison","url":"https://pubmed.ncbi.nlm.nih.gov/37549982/","published":"2023","sourceType":"Primary methodological criticism; exposure timing/selection biases not assumed solved.","retrieved":"September9,2026"},{"key":"navigation","publisher":"PRECISE investigators","title":"Navigation after abnormal stool test trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13007779/","published":"2025","sourceType":"967analysis;55.1vs42.1%one-yearcompletion. Not multiplied into already-completed OAservice units.","retrieved":"September9,2026"},{"key":"coverage","publisher":"California DHCS","title":"Medi-Cal eligibility changes","url":"https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/","published":"2026","sourceType":"Public coverage remains baseline when available; no assertion alluninsured have no latercare.","retrieved":"September9,2026"}],"funding_room":{"verified_offer_usd":null,"additional_slots":null,"accepted_sf_restriction":null,"statement":"Largest-funder loss and layoffs documented, but maintainedgrowth/newdonors and16monthsoperatingcash do not measure marginalcapacity. Allnumericalcaps are priors."},"boundaries":["All ten cash allocations sum to one. Other services retain full costs with health unquantified; zero credit is not a finding they are ineffective. This partial-health whole-gift estimate is not an upper bound on cost-effectiveness.","Completed-service cost includes coordination, overhead and failed referrals. Selected clinical subset, service-to-person conversion, financial additionality and disjointness are separate assumptions; service count alone is never a health outcome.","Current uninsured/ineligible-Medi-Cal eligibility is not a never-care baseline. Later safety-net care, coverage changes, other donors, donated provider capacity and OA's existing navigation remain in the counterfactual.","CRC uses an explicitly judgmental mean-hazard survival approximation. Cohort mortality association and navigationRCT are not causal manufacturer-like coefficients; no .13 completion multiplier or legacy aggregate.05Q is reused.","One exclusive linked-person ledger CRC then eye then hernia. Repeats/second eyes and overlapping diagnoses retain costs but cannot earn duplicate whole-person health. No productivity, caregiver or other mortality gains are added.","Donated clinical resources, distinct nonclinical support, patient time and downstream cancer-care allowances are gross associated costs on all nominal services, including uncredited/replaced activity. They are not waived charges, net incremental resources, or exhaustive societal cost.","Both health comparisons start with the same people alive at care. Delay discounts only; horizons start at care, not gift. Harms are already gift-date PV and include repeat procedures within an episode; late-comparator harms are not subtracted.","Bay and SF are nested weak residence priors, not measured local return. US equals all-region direct health here; no international or indirect local spillovers are credited.","Historical selectedSF$600,000 donor/$1,012,000 expanded price remains a separate program comparison. It must not remain the ordinary-gift ranking input after this revision."],"input_provenance":{"gift_usd":{"central":"100000","scenario_range":"Scenario inputs 100000 to 100000; not a confidence interval","basis":"Reference ordinary unrestricted gift; every dollar retained, not an SF colonoscopy restriction."},"funding_additionality":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% judgment for extra maintained/expanded services after replacement funding and provider bottlenecks. Existing OA care is baseline. Not estimated from the deficit or reserves."},"max_additional_services":{"central":"100","scenario_range":"Scenario inputs 0 to 100; not a confidence interval","basis":"100 extra mixed-service cap is an assumption, not identified open appointments. Shared capacity reduces all specialty activity proportionately."},"discount":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"3% annual health discount; economic resource amounts are gross associated present-dollar allowances, not a discounted net-social ledger."},"bay_share":{"central":"0.6","scenario_range":"Scenario inputs 0 to 0.8; not a confidence interval","basis":"60% weak beneficiary-residence prior within Northern California/Central Valley reach. No published specialty-specific county shares verified."},"sf_share":{"central":"0.08","scenario_range":"Scenario inputs 0 to 0.15; not a confidence interval","basis":"8% weak SF beneficiary-residence prior nested within Bay, not office location or guaranteed restricted allocation."},"independent_harm_q":{"central":"0","scenario_range":"Scenario inputs 0 to 1; not a confidence interval","basis":"Gift-date PV health loss independent of clinical activity; central0, zero-activity adverse case1."},"outside_support_per_service":{"central":"60","scenario_range":"Scenario inputs 60 to 60; not a confidence interval","basis":"$60 distinct nonclinical donated support per nominal mixed service, rounded from89,922/1,529; not already cash-paid interpretation/travel."},"patient_time_per_service":{"central":"100","scenario_range":"Scenario inputs 100 to 100; not a confidence interval","basis":"$100 additional patient/caregiver time allowance per nominal service, not earnings benefits or OA-paid travel."},"crc_treatment_cost_per_selected":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"$1,500 expected downstream therapy/surveillance resource allowance per nominal selectedFIT service, beyond endoscopy resources; weak prior, not provider quote or complete treatment estimate."},"gi_allocation":{"central":"0.37","scenario_range":"Scenario inputs 0.25 to 0.42; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gi_cash_per_service":{"central":"1400","scenario_range":"Scenario inputs 1400 to 1400; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gi_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"general_allocation":{"central":"0.13","scenario_range":"Scenario inputs 0.08 to 0.15; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"general_cash_per_service":{"central":"1700","scenario_range":"Scenario inputs 1700 to 1700; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"general_clinical_resource_per_service":{"central":"5500","scenario_range":"Scenario inputs 5500 to 11000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"gyne_allocation":{"central":"0.11","scenario_range":"Scenario inputs 0.11 to 0.11; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gyne_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gyne_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"ortho_allocation":{"central":"0.1","scenario_range":"Scenario inputs 0.1 to 0.1; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"ortho_cash_per_service":{"central":"1600","scenario_range":"Scenario inputs 1600 to 1600; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"ortho_clinical_resource_per_service":{"central":"5000","scenario_range":"Scenario inputs 5000 to 10000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"head_neck_allocation":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"head_neck_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"head_neck_clinical_resource_per_service":{"central":"3500","scenario_range":"Scenario inputs 3500 to 7000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"urology_allocation":{"central":"0.07","scenario_range":"Scenario inputs 0.07 to 0.07; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"urology_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"urology_clinical_resource_per_service":{"central":"4000","scenario_range":"Scenario inputs 4000 to 8000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"derm_allocation":{"central":"0.05","scenario_range":"Scenario inputs 0 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"derm_cash_per_service":{"central":"1300","scenario_range":"Scenario inputs 1300 to 1300; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"derm_clinical_resource_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 3600; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"vascular_allocation":{"central":"0.04","scenario_range":"Scenario inputs 0.02 to 0.04; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"vascular_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"vascular_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_allocation":{"central":"0.03","scenario_range":"Scenario inputs 0.01 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"eye_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"eye_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"other_allocation":{"central":"0.02","scenario_range":"Scenario inputs 0 to 0.21; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"other_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"other_clinical_resource_per_service":{"central":"3000","scenario_range":"Scenario inputs 3000 to 6000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_selected_fraction":{"central":"0.65","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"65% of nominal ophthalmology services assumed selected first-eye function-limiting cataract pathway;45observedeye services also include other procedures."},"eye_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"eye_disjoint_fraction":{"central":"0.95","scenario_range":"Scenario inputs 0.95 to 0.95; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"eye_treatment_success":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"eye_utility_gain":{"central":"0.05","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".05 utility-point gain per successful person-year is a separate judgment. The RCT's.056 integrated first-yearQALY is a magnitude anchor only, not a rate multiplied by three years."},"eye_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"eye_loss_hazard":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"eye_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"eye_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"eye_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"eye_harm_q_per_person":{"central":"0.002","scenario_range":"Scenario inputs 0 to 0.002; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"hernia_selected_fraction":{"central":"0.45","scenario_range":"Scenario inputs 0 to 0.7; not a confidence interval","basis":"45% of nominal general-surgery services assumed selected symptomatic hernia episodes;201general services are not201hernias."},"hernia_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"hernia_disjoint_fraction":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"hernia_treatment_success":{"central":"0.85","scenario_range":"Scenario inputs 0.85 to 0.85; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"hernia_utility_gain":{"central":"0.04","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".04 utility-point gain per successful symptomatic-person-year is a judgment; minimallysymptomatic randomized evidence is essentially null. Selected pain-limiting hernia fraction and transport are unknown."},"hernia_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"hernia_loss_hazard":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"hernia_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"hernia_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"hernia_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"hernia_harm_q_per_person":{"central":"0.004","scenario_range":"Scenario inputs 0 to 0.004; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"crc_selected_fraction":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% of nominal GI services assumed abnormal-FIT follow-up;575GI services are not575positiveFIT patients."},"crc_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"crc_disjoint_fraction":{"central":"1","scenario_range":"Scenario inputs 1 to 1; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"crc_treatment_linkage":{"central":"0.7","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"70% judgment chance that necessary appropriate downstream management can deliver the modeled contrast. Diagnostic completion alone earns no full treatment gain."},"crc_annual_fatal_hazard_reduction":{"central":"0.0006","scenario_range":"Scenario inputs -0.0003 to 0.001; not a confidence interval","basis":".0006/year is a judgment if no later-care catchup, lasting five hazard-years after latency. It is not.0092/10 or an estimated causal attenuation of the cohort. Fiveyears×.0006=.003 cumulative hazard only as a scale check."},"crc_baseline_total_mortality_hazard":{"central":"0.025","scenario_range":"Scenario inputs 0.025 to 0.025; not a confidence interval","basis":".025/year all-cause hazard prior already includes CRC mortality. Only the modeled CRC component changes; no second mortality hazard added."},"crc_catchup_hazard":{"central":"0.5","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".5/year aggregate hazard-effect decay prior (two-year characteristic time) for eventual ordinary diagnostic/treatment care; mean-hazard approximation, not exact random individual care-time mixture."},"crc_latency_years":{"central":"2","scenario_range":"Scenario inputs 2 to 2; not a confidence interval","basis":"Two-year assumed lag from procedure to differential fatal risk. Not observed OA survival timing; existing alternative care can catch up during this lag."},"crc_active_years":{"central":"5","scenario_range":"Scenario inputs 5 to 5; not a confidence interval","basis":"Five years of possibly different fatal hazard after latency, not five avoided deaths or a life expectancy."},"crc_horizon_years":{"central":"10","scenario_range":"Scenario inputs 10 to 15; not a confidence interval","basis":"Ten-year finite survival observation from procedure; both arms return to common mortality after the hazard-effect window. No lifetime tail."},"crc_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"crc_surviving_utility":{"central":"0.75","scenario_range":"Scenario inputs 0.75 to 0.75; not a confidence interval","basis":".75 utility for extra surviving person-time; no extra cancer morbidity or household benefit."},"crc_harm_q_per_person":{"central":"0.001","scenario_range":"Scenario inputs 0 to 0.001; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."}},"historical_comparison":{"model_path":"/private/tmp/mfi-oa-model.json","model_version":"oa-abnormal-fit-completed-pathway-v1","donor_per_10q":600000,"resource_per_10q":1012000,"boundary":"Selected SF abnormal-FIT completed pathway only; not ordinary whole gift. Preserved unchanged, not directly interchangeable with portfolio estimate."}},"paths":[{"id":"gi_symptom_diagnosis","category":"gi","share":0.5,"name":"Non-FIT GI investigation → benign treatable dyspepsia/dysphagia management","utility_gain":0.03,"treatment_success":0.4,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Diagnostic procedure alone earns no cure; treatment linkage is a prior, alternative primary-care therapy remains baseline.","downstream_resource_per_nominal_service":200},{"id":"general_cyst","category":"general","share":0.225,"name":"Painful cyst/lipoma excision","utility_gain":0.025,"treatment_success":0.85,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA procedure explicitly listed; utility and symptom-limiting fraction are priors, not cosmetic benefit.","downstream_resource_per_nominal_service":0},{"id":"anorectal","category":"general","share":0.12,"name":"Symptomatic haemorrhoid/fissure treatment","utility_gain":0.05,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Historical minor anorectal mix only; assume persistent symptoms despite medical management.","downstream_resource_per_nominal_service":0},{"id":"gallstone","category":"general","share":0.065,"name":"Uncomplicated symptomatic gallstone surgery","utility_gain":0,"treatment_success":0.7,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"C-GALL control includes later surgery; nonsignificant small integrated QALY difference; conservative care may suffice.","downstream_resource_per_nominal_service":0},{"id":"breast_diagnostic","category":"general","share":0.14,"name":"Breast lesion diagnostic assessment and linked benign symptom treatment","utility_gain":0.01,"treatment_success":0.25,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No unverified cancer survival gain. Prior only for changed symptom management, not all negative tests.","downstream_resource_per_nominal_service":200},{"id":"aub","category":"gyne","share":0.65,"name":"Refractory abnormal uterine bleeding → definitive outpatient treatment","utility_gain":0.07,"treatment_success":0.8,"harm_q_per_person":0.015,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Ms trial supports surgery vs expanded medical care; no hysterectomy-vs-ablation transfer, fertility/recovery losses retained.","downstream_resource_per_nominal_service":0},{"id":"pelvic","category":"gyne","share":0.25,"name":"Symptomatic pelvic prolapse/incontinence treatment","utility_gain":0.07,"treatment_success":0.7,"harm_q_per_person":0.01,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Case-mix and utility priors, not confirmed OA frequency; pessary/conservative alternatives retained.","downstream_resource_per_nominal_service":0},{"id":"gyne_diagnostic","category":"gyne","share":0.1,"name":"Gynaecologic diagnostic workup → nonmalignant symptom management","utility_gain":0.02,"treatment_success":0.3,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Diagnosis without management has zero benefit through linkage; no automatic cancer cure.","downstream_resource_per_nominal_service":200},{"id":"cts","category":"ortho","share":0.35,"name":"Carpal tunnel decompression for symptomatic confirmed CTS","utility_gain":0.03,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Primary economic trial .04 at12months is nonsignificant point utility, not integrated QALY. .03 here is an independent transfer prior.","downstream_resource_per_nominal_service":0},{"id":"foot_tendon","category":"ortho","share":0.45,"name":"Painful foot deformity / tendon or trigger-finger intervention","utility_gain":0.06,"treatment_success":0.75,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Named mechanical function hypothesis; OA ortho/podiatry totals not diagnosis frequencies. Utilities are priors. Torkki hallux-valgus RCT11368700 supports the painful-bunion subset only; two-year catch-up12807332 rules out lifelong timing gain.","downstream_resource_per_nominal_service":0},{"id":"degenerative_knee","category":"ortho","share":0.2,"name":"Degenerative knee arthroscopy without acute mechanical indication","utility_gain":0,"treatment_success":0.8,"harm_q_per_person":0.006,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Null benefit central, not assume all orthopaedic surgery is useful; harm retained.","downstream_resource_per_nominal_service":0},{"id":"nasal","category":"head_neck","share":0.7,"name":"Septal nasal obstruction surgery versus nasal medical therapy","utility_gain":0.04,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"NAIROS validates symptom mechanism, not SNOT22-to-QALY conversion or universal ENT benefit.","downstream_resource_per_nominal_service":0},{"id":"ear","category":"head_neck","share":0.3,"name":"Conductive ear disease treatment","utility_gain":0.03,"treatment_success":0.7,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Clinical indication and utility priors; no all-ENT survival credit.","downstream_resource_per_nominal_service":200},{"id":"bph","category":"urology","share":0.45,"name":"Bothersome BPH/outlet obstruction treatment","utility_gain":0.06,"treatment_success":0.8,"harm_q_per_person":0.006,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"TURP vs watchful waiting trial supports symptom relief, not current OA frequency; modern medication baseline matters.","downstream_resource_per_nominal_service":0},{"id":"stone","category":"urology","share":0.35,"name":"Symptomatic urinary stone treatment","utility_gain":0.05,"treatment_success":0.75,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No prophylactic life-saving claim for asymptomatic stones; spontaneous passage and medical treatment in comparator.","downstream_resource_per_nominal_service":200},{"id":"scrotal","category":"urology","share":0.2,"name":"Symptomatic benign scrotal/hydrocele treatment","utility_gain":0.025,"treatment_success":0.75,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Indication and finite utility priors; no infertility or cancer mortality award.","downstream_resource_per_nominal_service":0},{"id":"derm_cyst","category":"derm","share":0.8,"name":"Symptomatic benign skin cyst/lesion treatment","utility_gain":0.02,"treatment_success":0.8,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA cyst/lipoma service; disjoint allocation from general surgery required.","downstream_resource_per_nominal_service":0},{"id":"skin_lesion","category":"derm","share":0.2,"name":"Localized skin lesion diagnosis and treatment","utility_gain":0.03,"treatment_success":0.6,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Symptom/functional relief only; no melanoma mortality extrapolation.","downstream_resource_per_nominal_service":200},{"id":"veins","category":"vascular","share":1,"name":"Symptomatic uncomplicated varicose vein treatment","utility_gain":0.04,"treatment_success":0.8,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"REACTIV randomized conservative comparator; integrated two-year .054Q not annual gain.","downstream_resource_per_nominal_service":0},{"id":"pterygium","category":"eye","share":0.35,"name":"Symptomatic pterygium treatment","utility_gain":0.025,"treatment_success":0.8,"harm_q_per_person":0.003,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA explicitly offered; first-eye cataract cohort excluded; finite symptom/vision utility prior.","downstream_resource_per_nominal_service":0},{"id":"other_assessment","category":"other","share":1,"name":"Specialty assessment without established diagnosis-changing intervention","utility_gain":0,"treatment_success":0,"harm_q_per_person":0.0005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Only2%wholegift allocation; centralzero benefit explicitly due absent disease/intervention evidence, not blanket residual zero for major specialties.","downstream_resource_per_nominal_service":0}],"scope":"Expected whole-organization health CONDITIONAL on explicit diagnostic case-mix priors. All2025 specialty categories covered in a service ledger; other assessment2% receives zero benefit plus burden. No generic residual QALY/$ or inverse allocation uplift.","scenarios":[{"id":"central","baseOverrides":{},"pathOverrides":{}},{"id":"new_pathways_null","baseOverrides":{},"allPaths":{"utility_gain":0},"pathOverrides":{}},{"id":"fast_later_care","baseOverrides":{"eye_catchup_hazard":4,"hernia_catchup_hazard":4,"crc_catchup_hazard":4},"allPaths":{"catchup_hazard":4},"pathOverrides":{}},{"id":"zero_activity","baseOverrides":{"funding_additionality":0},"pathOverrides":{}},{"id":"adverse_new_pathways","baseOverrides":{},"allPaths":{"utility_gain":-0.01},"pathOverrides":{}},{"id":"favorable_joint","baseOverrides":{"funding_additionality":0.8,"eye_utility_gain":0.1,"hernia_utility_gain":0.1,"eye_catchup_hazard":0.2,"hernia_catchup_hazard":0.2},"allPaths":{"catchup_hazard":0.2,"horizon_years":5},"pathOverrides":{}},{"id":"no_local","baseOverrides":{"sf_share":0,"bay_share":0},"pathOverrides":{}},{"id":"double_new_resources","baseOverrides":{"outside_support_per_service":120,"patient_time_per_service":200},"pathOverrides":{}},{"id":"one_year","baseOverrides":{"eye_horizon_years":1,"hernia_horizon_years":1},"allPaths":{"horizon_years":1},"pathOverrides":{}}],"note":"v1 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Strong warning against assuming allhernias benefit.","retrieved":"September9,2026"},{"key":"crc","publisher":"Zorzi et al.","title":"Mortality after positive FIT without program colonoscopy","url":"https://pubmed.ncbi.nlm.nih.gov/33789965/","published":"2021","sourceType":"Observational10-yearCRC mortality6.8vs16per1000. Not randomization, no directly imported hazardorQALY.","retrieved":"September9,2026"},{"key":"critique","publisher":"Methodological correspondence","title":"Immortal-time concern in positive-FIT mortality comparison","url":"https://pubmed.ncbi.nlm.nih.gov/37549982/","published":"2023","sourceType":"Primary methodological criticism; exposure timing/selection biases not assumed solved.","retrieved":"September9,2026"},{"key":"navigation","publisher":"PRECISE investigators","title":"Navigation after abnormal stool test trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13007779/","published":"2025","sourceType":"967analysis;55.1vs42.1%one-yearcompletion. 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No productivity, caregiver or other mortality gains are added.","Donated clinical resources, distinct nonclinical support, patient time and downstream cancer-care allowances are gross associated costs on all nominal services, including uncredited/replaced activity. They are not waived charges, net incremental resources, or exhaustive societal cost.","Both health comparisons start with the same people alive at care. Delay discounts only; horizons start at care, not gift. Harms are already gift-date PV and include repeat procedures within an episode; late-comparator harms are not subtracted.","Bay and SF are nested weak residence priors, not measured local return. US equals all-region direct health here; no international or indirect local spillovers are credited.","Historical selectedSF$600,000 donor/$1,012,000 expanded price remains a separate program comparison. It must not remain the ordinary-gift ranking input after this revision."],"input_provenance":{"gift_usd":{"central":"100000","scenario_range":"Scenario inputs 100000 to 100000; not a confidence interval","basis":"Reference ordinary unrestricted gift; every dollar retained, not an SF colonoscopy restriction."},"funding_additionality":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% judgment for extra maintained/expanded services after replacement funding and provider bottlenecks. Existing OA care is baseline. Not estimated from the deficit or reserves."},"max_additional_services":{"central":"100","scenario_range":"Scenario inputs 0 to 100; not a confidence interval","basis":"100 extra mixed-service cap is an assumption, not identified open appointments. Shared capacity reduces all specialty activity proportionately."},"discount":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"3% annual health discount; economic resource amounts are gross associated present-dollar allowances, not a discounted net-social ledger."},"bay_share":{"central":"0.6","scenario_range":"Scenario inputs 0 to 0.8; not a confidence interval","basis":"60% weak beneficiary-residence prior within Northern California/Central Valley reach. No published specialty-specific county shares verified."},"sf_share":{"central":"0.08","scenario_range":"Scenario inputs 0 to 0.15; not a confidence interval","basis":"8% weak SF beneficiary-residence prior nested within Bay, not office location or guaranteed restricted allocation."},"independent_harm_q":{"central":"0","scenario_range":"Scenario inputs 0 to 1; not a confidence interval","basis":"Gift-date PV health loss independent of clinical activity; central0, zero-activity adverse case1."},"outside_support_per_service":{"central":"60","scenario_range":"Scenario inputs 60 to 60; not a confidence interval","basis":"$60 distinct nonclinical donated support per nominal mixed service, rounded from89,922/1,529; not already cash-paid interpretation/travel."},"patient_time_per_service":{"central":"100","scenario_range":"Scenario inputs 100 to 100; not a confidence interval","basis":"$100 additional patient/caregiver time allowance per nominal service, not earnings benefits or OA-paid travel."},"crc_treatment_cost_per_selected":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"$1,500 expected downstream therapy/surveillance resource allowance per nominal selectedFIT service, beyond endoscopy resources; weak prior, not provider quote or complete treatment estimate."},"gi_allocation":{"central":"0.37","scenario_range":"Scenario inputs 0.25 to 0.42; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gi_cash_per_service":{"central":"1400","scenario_range":"Scenario inputs 1400 to 1400; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gi_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"general_allocation":{"central":"0.13","scenario_range":"Scenario inputs 0.08 to 0.15; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"general_cash_per_service":{"central":"1700","scenario_range":"Scenario inputs 1700 to 1700; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"general_clinical_resource_per_service":{"central":"5500","scenario_range":"Scenario inputs 5500 to 11000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"gyne_allocation":{"central":"0.11","scenario_range":"Scenario inputs 0.11 to 0.11; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gyne_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gyne_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"ortho_allocation":{"central":"0.1","scenario_range":"Scenario inputs 0.1 to 0.1; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"ortho_cash_per_service":{"central":"1600","scenario_range":"Scenario inputs 1600 to 1600; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"ortho_clinical_resource_per_service":{"central":"5000","scenario_range":"Scenario inputs 5000 to 10000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"head_neck_allocation":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"head_neck_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"head_neck_clinical_resource_per_service":{"central":"3500","scenario_range":"Scenario inputs 3500 to 7000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"urology_allocation":{"central":"0.07","scenario_range":"Scenario inputs 0.07 to 0.07; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"urology_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"urology_clinical_resource_per_service":{"central":"4000","scenario_range":"Scenario inputs 4000 to 8000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"derm_allocation":{"central":"0.05","scenario_range":"Scenario inputs 0 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"derm_cash_per_service":{"central":"1300","scenario_range":"Scenario inputs 1300 to 1300; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"derm_clinical_resource_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 3600; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"vascular_allocation":{"central":"0.04","scenario_range":"Scenario inputs 0.02 to 0.04; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"vascular_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"vascular_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_allocation":{"central":"0.03","scenario_range":"Scenario inputs 0.01 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"eye_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"eye_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"other_allocation":{"central":"0.02","scenario_range":"Scenario inputs 0 to 0.21; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"other_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"other_clinical_resource_per_service":{"central":"3000","scenario_range":"Scenario inputs 3000 to 6000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_selected_fraction":{"central":"0.65","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"65% of nominal ophthalmology services assumed selected first-eye function-limiting cataract pathway;45observedeye services also include other procedures."},"eye_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"eye_disjoint_fraction":{"central":"0.95","scenario_range":"Scenario inputs 0.95 to 0.95; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"eye_treatment_success":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"eye_utility_gain":{"central":"0.05","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".05 utility-point gain per successful person-year is a separate judgment. The RCT's.056 integrated first-yearQALY is a magnitude anchor only, not a rate multiplied by three years."},"eye_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"eye_loss_hazard":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"eye_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"eye_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"eye_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"eye_harm_q_per_person":{"central":"0.002","scenario_range":"Scenario inputs 0 to 0.002; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"hernia_selected_fraction":{"central":"0.45","scenario_range":"Scenario inputs 0 to 0.7; not a confidence interval","basis":"45% of nominal general-surgery services assumed selected symptomatic hernia episodes;201general services are not201hernias."},"hernia_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"hernia_disjoint_fraction":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"hernia_treatment_success":{"central":"0.85","scenario_range":"Scenario inputs 0.85 to 0.85; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"hernia_utility_gain":{"central":"0.04","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".04 utility-point gain per successful symptomatic-person-year is a judgment; minimallysymptomatic randomized evidence is essentially null. Selected pain-limiting hernia fraction and transport are unknown."},"hernia_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"hernia_loss_hazard":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"hernia_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"hernia_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"hernia_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"hernia_harm_q_per_person":{"central":"0.004","scenario_range":"Scenario inputs 0 to 0.004; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"crc_selected_fraction":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% of nominal GI services assumed abnormal-FIT follow-up;575GI services are not575positiveFIT patients."},"crc_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"crc_disjoint_fraction":{"central":"1","scenario_range":"Scenario inputs 1 to 1; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"crc_treatment_linkage":{"central":"0.7","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"70% judgment chance that necessary appropriate downstream management can deliver the modeled contrast. Diagnostic completion alone earns no full treatment gain."},"crc_annual_fatal_hazard_reduction":{"central":"0.0006","scenario_range":"Scenario inputs -0.0003 to 0.001; not a confidence interval","basis":".0006/year is a judgment if no later-care catchup, lasting five hazard-years after latency. It is not.0092/10 or an estimated causal attenuation of the cohort. Fiveyears×.0006=.003 cumulative hazard only as a scale check."},"crc_baseline_total_mortality_hazard":{"central":"0.025","scenario_range":"Scenario inputs 0.025 to 0.025; not a confidence interval","basis":".025/year all-cause hazard prior already includes CRC mortality. Only the modeled CRC component changes; no second mortality hazard added."},"crc_catchup_hazard":{"central":"0.5","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".5/year aggregate hazard-effect decay prior (two-year characteristic time) for eventual ordinary diagnostic/treatment care; mean-hazard approximation, not exact random individual care-time mixture."},"crc_latency_years":{"central":"2","scenario_range":"Scenario inputs 2 to 2; not a confidence interval","basis":"Two-year assumed lag from procedure to differential fatal risk. Not observed OA survival timing; existing alternative care can catch up during this lag."},"crc_active_years":{"central":"5","scenario_range":"Scenario inputs 5 to 5; not a confidence interval","basis":"Five years of possibly different fatal hazard after latency, not five avoided deaths or a life expectancy."},"crc_horizon_years":{"central":"10","scenario_range":"Scenario inputs 10 to 15; not a confidence interval","basis":"Ten-year finite survival observation from procedure; both arms return to common mortality after the hazard-effect window. No lifetime tail."},"crc_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"crc_surviving_utility":{"central":"0.75","scenario_range":"Scenario inputs 0.75 to 0.75; not a confidence interval","basis":".75 utility for extra surviving person-time; no extra cancer morbidity or household benefit."},"crc_harm_q_per_person":{"central":"0.001","scenario_range":"Scenario inputs 0 to 0.001; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."}},"historical_comparison":{"model_path":"/private/tmp/mfi-oa-model.json","model_version":"oa-abnormal-fit-completed-pathway-v1","donor_per_10q":600000,"resource_per_10q":1012000,"boundary":"Selected SF abnormal-FIT completed pathway only; not ordinary whole gift. Preserved unchanged, not directly interchangeable with portfolio estimate."}},"paths":[{"id":"gi_symptom_diagnosis","category":"gi","share":0.5,"name":"Non-FIT GI investigation → benign treatable dyspepsia/dysphagia management","utility_gain":0.03,"treatment_success":0.4,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Diagnostic procedure alone earns no cure; treatment linkage is a prior, alternative primary-care therapy remains baseline.","downstream_resource_per_nominal_service":200},{"id":"general_cyst","category":"general","share":0.225,"name":"Painful cyst/lipoma excision","utility_gain":0.025,"treatment_success":0.85,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Current OA procedure explicitly listed; utility and symptom-limiting fraction are priors, not cosmetic benefit.","downstream_resource_per_nominal_service":0},{"id":"anorectal","category":"general","share":0.12,"name":"Symptomatic haemorrhoid/fissure treatment","utility_gain":0.05,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Historical minor anorectal mix only; assume persistent symptoms despite medical management.","downstream_resource_per_nominal_service":0},{"id":"gallstone","category":"general","share":0.065,"name":"Uncomplicated symptomatic gallstone surgery","utility_gain":0,"treatment_success":0.7,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"C-GALL control includes later surgery; nonsignificant small integrated QALY difference; conservative care may suffice.","downstream_resource_per_nominal_service":0},{"id":"breast_diagnostic","category":"general","share":0.14,"name":"Breast lesion diagnostic assessment and linked benign symptom treatment","utility_gain":0.01,"treatment_success":0.25,"harm_q_per_person":0.001,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"No unverified cancer survival gain. Prior only for changed symptom management, not all negative tests.","downstream_resource_per_nominal_service":200},{"id":"aub","category":"gyne","share":0.65,"name":"Refractory abnormal uterine bleeding → definitive outpatient treatment","utility_gain":0.07,"treatment_success":0.8,"harm_q_per_person":0.015,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Ms trial supports surgery vs expanded medical care; no hysterectomy-vs-ablation transfer, fertility/recovery losses retained.","downstream_resource_per_nominal_service":0},{"id":"pelvic","category":"gyne","share":0.25,"name":"Symptomatic pelvic prolapse/incontinence treatment","utility_gain":0.07,"treatment_success":0.7,"harm_q_per_person":0.01,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Case-mix and utility priors, not confirmed OA frequency; pessary/conservative alternatives retained.","downstream_resource_per_nominal_service":0},{"id":"gyne_diagnostic","category":"gyne","share":0.1,"name":"Gynaecologic diagnostic workup → nonmalignant symptom management","utility_gain":0.02,"treatment_success":0.3,"harm_q_per_person":0.002,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Diagnosis without management has zero benefit through linkage; no automatic cancer cure.","downstream_resource_per_nominal_service":200},{"id":"cts","category":"ortho","share":0.35,"name":"Carpal tunnel decompression for symptomatic confirmed CTS","utility_gain":0.03,"treatment_success":0.8,"harm_q_per_person":0.004,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Primary economic trial .04 at12months is nonsignificant point utility, not integrated QALY. .03 here is an independent transfer prior.","downstream_resource_per_nominal_service":0},{"id":"foot_tendon","category":"ortho","share":0.45,"name":"Painful foot deformity / tendon or trigger-finger intervention","utility_gain":0.06,"treatment_success":0.75,"harm_q_per_person":0.005,"services_per_person":1.3530973451327433,"disjoint_fraction":1,"catchup_hazard":0.7,"loss_hazard":0.1,"mortality_hazard":0.02,"horizon_years":3,"delay_years":0.25,"basis":"Named mechanical function hypothesis; OA ortho/podiatry totals not diagnosis frequencies. Utilities are priors. 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Access","version":"oa-whole-gift-named-coverage-v2","foundation":{"organization":"Operation Access","slug":"operation-access","model_version":"oa-whole-gift-finite-portfolio-v1","recipient":{"legal_name":"Ambulatory Surgery Access Coalition dba Operation Access","ein":"94-3180356","giving_url":"https://www.operationaccess.org/donate"},"finance":{"year":2025,"total_accrual_expense":22876888,"donated_clinical_waived_charges":20530000,"other_donated_support":89922,"cash_like_expense":2256966,"annual_report_cash_expense":2256967,"budget2026_cash":1900000,"services":1529,"specialty_services":{"gi":575,"general":201,"gyne":168,"ortho":158,"head_neck":127,"urology":101,"derm":80,"vascular":58,"eye":45,"other":16},"note":"Cash-like accrual subtraction is not cash flow. Waived charges are not economic costs. Prospective allocation is not observed specialty cash spending."},"categories":["gi","general","gyne","ortho","head_neck","urology","derm","vascular","eye","other"],"central_inputs":{"gift_usd":10000,"funding_additionality":0.3,"max_additional_services":20,"discount":0.03,"bay_share":0.6,"sf_share":0.08,"independent_harm_q":0,"outside_support_per_service":60,"patient_time_per_service":100,"crc_treatment_cost_per_selected":1500,"gi_allocation":0.3760627861347286,"gi_cash_per_service":1479.0745585349903,"gi_clinical_resource_per_service":2500,"general_allocation":0.131458469587966,"general_cash_per_service":1479.0745585349903,"general_clinical_resource_per_service":5500,"gyne_allocation":0.10987573577501634,"gyne_cash_per_service":1479.0745585349903,"gyne_clinical_resource_per_service":4500,"ortho_allocation":0.10333551340745585,"ortho_cash_per_service":1479.0745585349903,"ortho_clinical_resource_per_service":5000,"head_neck_allocation":0.08306082406801832,"head_neck_cash_per_service":1479.0745585349903,"head_neck_clinical_resource_per_service":3500,"urology_allocation":0.06605624591236102,"urology_cash_per_service":1479.0745585349903,"urology_clinical_resource_per_service":4000,"derm_allocation":0.052321778940483975,"derm_cash_per_service":1479.0745585349903,"derm_clinical_resource_per_service":1800,"vascular_allocation":0.03793328973185088,"vascular_cash_per_service":1479.0745585349903,"vascular_clinical_resource_per_service":4500,"eye_allocation":0.029431000654022238,"eye_cash_per_service":1479.0745585349903,"eye_clinical_resource_per_service":2500,"other_allocation":0.010464355788096796,"other_cash_per_service":1479.0745585349903,"other_clinical_resource_per_service":3000,"eye_selected_fraction":0.65,"eye_services_per_person":1.3530973451327433,"eye_disjoint_fraction":1,"eye_treatment_success":1,"eye_utility_gain":0.04369288612091463,"eye_catchup_hazard":0,"eye_loss_hazard":0.03,"eye_mortality_hazard":0.02,"eye_horizon_years":1,"eye_delay_years":0.25,"eye_harm_q_per_person":0.002,"hernia_selected_fraction":0.45,"hernia_services_per_person":1.3530973451327433,"hernia_disjoint_fraction":1,"hernia_treatment_success":0.85,"hernia_utility_gain":0.04,"hernia_catchup_hazard":0.7,"hernia_loss_hazard":0.08,"hernia_mortality_hazard":0.02,"hernia_horizon_years":3,"hernia_delay_years":0.25,"hernia_harm_q_per_person":0.004,"crc_selected_fraction":0.5,"crc_services_per_person":1.3530973451327433,"crc_disjoint_fraction":1,"crc_treatment_linkage":0.7,"crc_annual_fatal_hazard_reduction":0.0006,"crc_baseline_total_mortality_hazard":0.025,"crc_catchup_hazard":0.5,"crc_latency_years":2,"crc_active_years":5,"crc_horizon_years":10,"crc_delay_years":0.25,"crc_surviving_utility":0.75,"crc_harm_q_per_person":0.001},"scenarios":[{"id":"central","overrides":{}},{"id":"favorable","overrides":{"funding_additionality":0.75,"eye_selected_fraction":0.9,"hernia_selected_fraction":0.7,"crc_selected_fraction":0.75,"eye_utility_gain":0.1,"hernia_utility_gain":0.1,"eye_catchup_hazard":0.2,"hernia_catchup_hazard":0.2,"crc_catchup_hazard":0.15,"crc_treatment_linkage":0.9,"crc_annual_fatal_hazard_reduction":0.001,"eye_horizon_years":5,"hernia_horizon_years":5,"crc_horizon_years":15}},{"id":"cautious","overrides":{"funding_additionality":0.1,"eye_selected_fraction":0.3,"hernia_selected_fraction":0.2,"crc_selected_fraction":0.2,"eye_utility_gain":0.01,"hernia_utility_gain":0.005,"crc_annual_fatal_hazard_reduction":0.0001,"eye_catchup_hazard":2,"hernia_catchup_hazard":2,"crc_catchup_hazard":2,"crc_treatment_linkage":0.3}},{"id":"funding_replacement","overrides":{"funding_additionality":0}},{"id":"capacity_zero","overrides":{"max_additional_services":0}},{"id":"limited_capacity","overrides":{"max_additional_services":5}},{"id":"fast_alternative_care","overrides":{"eye_catchup_hazard":4,"hernia_catchup_hazard":4,"crc_catchup_hazard":4}},{"id":"no_later_care","overrides":{"eye_catchup_hazard":0,"hernia_catchup_hazard":0,"crc_catchup_hazard":0}},{"id":"one_year_nonfatal_benefit","overrides":{"eye_horizon_years":1,"hernia_horizon_years":1}},{"id":"crc_no_treatment","overrides":{"crc_treatment_linkage":0}},{"id":"crc_association_does_not_transfer","overrides":{"crc_annual_fatal_hazard_reduction":0}},{"id":"minimally_symptomatic_hernia_null","overrides":{"hernia_utility_gain":0}},{"id":"all_health_null","overrides":{"eye_utility_gain":0,"hernia_utility_gain":0,"crc_annual_fatal_hazard_reduction":0,"eye_harm_q_per_person":0,"hernia_harm_q_per_person":0,"crc_harm_q_per_person":0}},{"id":"benefit_null_harms_retained","overrides":{"eye_utility_gain":0,"hernia_utility_gain":0,"crc_annual_fatal_hazard_reduction":0}},{"id":"signed_adverse_health","overrides":{"eye_utility_gain":-0.02,"hernia_utility_gain":-0.02,"crc_annual_fatal_hazard_reduction":-0.0003}},{"id":"independent_harm_zero_activity","overrides":{"funding_additionality":0,"independent_harm_q":1}},{"id":"repeat_services","overrides":{"eye_services_per_person":2,"hernia_services_per_person":2,"crc_services_per_person":2}},{"id":"lower_target_portfolio","overrides":{"gi_allocation":0.25,"general_allocation":0.08,"eye_allocation":0.01,"other_allocation":0.21}},{"id":"higher_target_portfolio","overrides":{"gi_allocation":0.42,"general_allocation":0.15,"eye_allocation":0.05,"other_allocation":0,"derm_allocation":0,"vascular_allocation":0.02}},{"id":"double_external_resources","overrides":{"gi_clinical_resource_per_service":5000,"general_clinical_resource_per_service":11000,"gyne_clinical_resource_per_service":9000,"ortho_clinical_resource_per_service":10000,"head_neck_clinical_resource_per_service":7000,"urology_clinical_resource_per_service":8000,"derm_clinical_resource_per_service":3600,"vascular_clinical_resource_per_service":9000,"eye_clinical_resource_per_service":5000,"other_clinical_resource_per_service":6000}},{"id":"local_zero","overrides":{"bay_share":0,"sf_share":0}},{"id":"higher_local_share","overrides":{"bay_share":0.8,"sf_share":0.15}},{"id":"no_selected_subsets","overrides":{"eye_selected_fraction":0,"hernia_selected_fraction":0,"crc_selected_fraction":0}}],"sources":[{"key":"audit","publisher":"Operation Access","title":"2025 audited financial statements","url":"https://www.operationaccess.org/s/2025-Audited-Financial-Statements.pdf","published":"Year ended December31,2025; auditMay20,2026","sourceType":"Primary audited whole-organization expense, waived-charge accounting, liquidity and restrictions; relevant PDF7–8,14–15 visually verified.","retrieved":"September9,2026"},{"key":"report","publisher":"Operation Access","title":"2025 annual report","url":"https://www.operationaccess.org/s/Operation-Access-Annual-Report-2025.pdf","published":"2025 reporting year","sourceType":"Primary specialty counts/chartPDF7, funding lossPDF2, wait/readinessPDF6, cash financePDF13. Counts are services, not unique people or measured health.","retrieved":"September9,2026"},{"key":"budget","publisher":"Operation Access","title":"2026 budget","url":"https://www.operationaccess.org/s/2026Budget-8pz4.pdf","published":"ApprovedDecember10,2025","sourceType":"Primary1.9million cash plan, not actual2026 unit cost or procedure target.","retrieved":"September9,2026"},{"key":"eligibility","publisher":"Operation Access","title":"Patient eligibility and procedures","url":"https://www.operationaccess.org/for-patients-para-pacientes","published":"Current undated","sourceType":"Uninsured and ineligible fullMedi-Cal/Medicare/CMSP; cataract and hernia procedures explicitly offered; not insurance.","retrieved":"September9,2026"},{"key":"giving","publisher":"Operation Access","title":"Donate","url":"https://www.operationaccess.org/donate","published":"Current undated","sourceType":"Official ordinary donation route and EIN94-3180356. Waived-dollar fundraising leverage is not QALY evidence.","retrieved":"September9,2026"},{"key":"fit","publisher":"California Colorectal Cancer Coalition","title":"OA facilitated donated colonoscopy","url":"https://www.cacoloncancer.org/operation-access-facilitated-access-to-donated-colonoscopies/","published":"Current undated","sourceType":"Primary referral mechanism; above-average risk/positive stool tests; not575verifiedFITcases.","retrieved":"September9,2026"},{"key":"cataract","publisher":"Sach et al.","title":"First-eye cataract randomized economic evaluation","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC2095519/","published":"2007","sourceType":"306women over70, expedited4weeks vsroutine12months; first-yearQALYdifference.056(.006,.108), integratedyear—not annualutilityorOAlocalestimate.","retrieved":"September9,2026"},{"key":"hernia","publisher":"Fitzgibbons et al.","title":"Watchful waiting versus repair","url":"https://pubmed.ncbi.nlm.nih.gov/16418463/","published":"2006","sourceType":"720minimallysymptomatic men;2-yearpain/physicalfunction differences notsignificant;23%watchfulwaiting crossed torepair. Strong warning against assuming allhernias benefit.","retrieved":"September9,2026"},{"key":"crc","publisher":"Zorzi et al.","title":"Mortality after positive FIT without program colonoscopy","url":"https://pubmed.ncbi.nlm.nih.gov/33789965/","published":"2021","sourceType":"Observational10-yearCRC mortality6.8vs16per1000. Not randomization, no directly imported hazardorQALY.","retrieved":"September9,2026"},{"key":"critique","publisher":"Methodological correspondence","title":"Immortal-time concern in positive-FIT mortality comparison","url":"https://pubmed.ncbi.nlm.nih.gov/37549982/","published":"2023","sourceType":"Primary methodological criticism; exposure timing/selection biases not assumed solved.","retrieved":"September9,2026"},{"key":"navigation","publisher":"PRECISE investigators","title":"Navigation after abnormal stool test trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13007779/","published":"2025","sourceType":"967analysis;55.1vs42.1%one-yearcompletion. Not multiplied into already-completed OAservice units.","retrieved":"September9,2026"},{"key":"coverage","publisher":"California DHCS","title":"Medi-Cal eligibility changes","url":"https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/","published":"2026","sourceType":"Public coverage remains baseline when available; no assertion alluninsured have no latercare.","retrieved":"September9,2026"}],"funding_room":{"verified_offer_usd":null,"additional_slots":null,"accepted_sf_restriction":null,"statement":"Largest-funder loss and layoffs documented, but maintainedgrowth/newdonors and16monthsoperatingcash do not measure marginalcapacity. Allnumericalcaps are priors."},"boundaries":["All ten cash allocations sum to one. Other services retain full costs with health unquantified; zero credit is not a finding they are ineffective. This partial-health whole-gift estimate is not an upper bound on cost-effectiveness.","Completed-service cost includes coordination, overhead and failed referrals. Selected clinical subset, service-to-person conversion, financial additionality and disjointness are separate assumptions; service count alone is never a health outcome.","Current uninsured/ineligible-Medi-Cal eligibility is not a never-care baseline. Later safety-net care, coverage changes, other donors, donated provider capacity and OA's existing navigation remain in the counterfactual.","CRC uses an explicitly judgmental mean-hazard survival approximation. Cohort mortality association and navigationRCT are not causal manufacturer-like coefficients; no .13 completion multiplier or legacy aggregate.05Q is reused.","One exclusive linked-person ledger CRC then eye then hernia. Repeats/second eyes and overlapping diagnoses retain costs but cannot earn duplicate whole-person health. No productivity, caregiver or other mortality gains are added.","Donated clinical resources, distinct nonclinical support, patient time and downstream cancer-care allowances are gross associated costs on all nominal services, including uncredited/replaced activity. They are not waived charges, net incremental resources, or exhaustive societal cost.","Both health comparisons start with the same people alive at care. Delay discounts only; horizons start at care, not gift. Harms are already gift-date PV and include repeat procedures within an episode; late-comparator harms are not subtracted.","Bay and SF are nested weak residence priors, not measured local return. US equals all-region direct health here; no international or indirect local spillovers are credited.","Historical selectedSF$600,000 donor/$1,012,000 expanded price remains a separate program comparison. It must not remain the ordinary-gift ranking input after this revision."],"input_provenance":{"gift_usd":{"central":"100000","scenario_range":"Scenario inputs 100000 to 100000; not a confidence interval","basis":"Reference ordinary unrestricted gift; every dollar retained, not an SF colonoscopy restriction."},"funding_additionality":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% judgment for extra maintained/expanded services after replacement funding and provider bottlenecks. Existing OA care is baseline. Not estimated from the deficit or reserves."},"max_additional_services":{"central":"100","scenario_range":"Scenario inputs 0 to 100; not a confidence interval","basis":"100 extra mixed-service cap is an assumption, not identified open appointments. Shared capacity reduces all specialty activity proportionately."},"discount":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"3% annual health discount; economic resource amounts are gross associated present-dollar allowances, not a discounted net-social ledger."},"bay_share":{"central":"0.6","scenario_range":"Scenario inputs 0 to 0.8; not a confidence interval","basis":"60% weak beneficiary-residence prior within Northern California/Central Valley reach. No published specialty-specific county shares verified."},"sf_share":{"central":"0.08","scenario_range":"Scenario inputs 0 to 0.15; not a confidence interval","basis":"8% weak SF beneficiary-residence prior nested within Bay, not office location or guaranteed restricted allocation."},"independent_harm_q":{"central":"0","scenario_range":"Scenario inputs 0 to 1; not a confidence interval","basis":"Gift-date PV health loss independent of clinical activity; central0, zero-activity adverse case1."},"outside_support_per_service":{"central":"60","scenario_range":"Scenario inputs 60 to 60; not a confidence interval","basis":"$60 distinct nonclinical donated support per nominal mixed service, rounded from89,922/1,529; not already cash-paid interpretation/travel."},"patient_time_per_service":{"central":"100","scenario_range":"Scenario inputs 100 to 100; not a confidence interval","basis":"$100 additional patient/caregiver time allowance per nominal service, not earnings benefits or OA-paid travel."},"crc_treatment_cost_per_selected":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"$1,500 expected downstream therapy/surveillance resource allowance per nominal selectedFIT service, beyond endoscopy resources; weak prior, not provider quote or complete treatment estimate."},"gi_allocation":{"central":"0.37","scenario_range":"Scenario inputs 0.25 to 0.42; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gi_cash_per_service":{"central":"1400","scenario_range":"Scenario inputs 1400 to 1400; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gi_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"general_allocation":{"central":"0.13","scenario_range":"Scenario inputs 0.08 to 0.15; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"general_cash_per_service":{"central":"1700","scenario_range":"Scenario inputs 1700 to 1700; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"general_clinical_resource_per_service":{"central":"5500","scenario_range":"Scenario inputs 5500 to 11000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"gyne_allocation":{"central":"0.11","scenario_range":"Scenario inputs 0.11 to 0.11; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"gyne_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"gyne_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"ortho_allocation":{"central":"0.1","scenario_range":"Scenario inputs 0.1 to 0.1; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"ortho_cash_per_service":{"central":"1600","scenario_range":"Scenario inputs 1600 to 1600; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"ortho_clinical_resource_per_service":{"central":"5000","scenario_range":"Scenario inputs 5000 to 10000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"head_neck_allocation":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"head_neck_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"head_neck_clinical_resource_per_service":{"central":"3500","scenario_range":"Scenario inputs 3500 to 7000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"urology_allocation":{"central":"0.07","scenario_range":"Scenario inputs 0.07 to 0.07; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"urology_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"urology_clinical_resource_per_service":{"central":"4000","scenario_range":"Scenario inputs 4000 to 8000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"derm_allocation":{"central":"0.05","scenario_range":"Scenario inputs 0 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"derm_cash_per_service":{"central":"1300","scenario_range":"Scenario inputs 1300 to 1300; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"derm_clinical_resource_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 3600; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"vascular_allocation":{"central":"0.04","scenario_range":"Scenario inputs 0.02 to 0.04; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"vascular_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"vascular_clinical_resource_per_service":{"central":"4500","scenario_range":"Scenario inputs 4500 to 9000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_allocation":{"central":"0.03","scenario_range":"Scenario inputs 0.01 to 0.05; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"eye_cash_per_service":{"central":"1800","scenario_range":"Scenario inputs 1800 to 1800; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"eye_clinical_resource_per_service":{"central":"2500","scenario_range":"Scenario inputs 2500 to 5000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"other_allocation":{"central":"0.02","scenario_range":"Scenario inputs 0 to 0.21; not a confidence interval","basis":"Prospective all-function cash allocation prior, loosely anchored to mixed2025 specialty service shares; specialty cash spending not observed. Ten categories sum to1; management/fundraising are allocated once across all categories."},"other_cash_per_service":{"central":"1500","scenario_range":"Scenario inputs 1500 to 1500; not a confidence interval","basis":"All-function cash allocation per completed specialty service-equivalent, including failed-referral work. Judgment around audited$1,476 mixed-service average, not a specialist-specific quote. No added13pp navigation multiplier."},"other_clinical_resource_per_service":{"central":"3000","scenario_range":"Scenario inputs 3000 to 6000; not a confidence interval","basis":"Distinct donated clinician/facility/anesthesia/pathology resource prior per nominal service; not waived charges, no patient fee or public payment subtracted. Includes repeat services through the nominal-service denominator."},"eye_selected_fraction":{"central":"0.65","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"65% of nominal ophthalmology services assumed selected first-eye function-limiting cataract pathway;45observedeye services also include other procedures."},"eye_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"eye_disjoint_fraction":{"central":"0.95","scenario_range":"Scenario inputs 0.95 to 0.95; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"eye_treatment_success":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"eye_utility_gain":{"central":"0.05","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".05 utility-point gain per successful person-year is a separate judgment. The RCT's.056 integrated first-yearQALY is a magnitude anchor only, not a rate multiplied by three years."},"eye_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"eye_loss_hazard":{"central":"0.03","scenario_range":"Scenario inputs 0.03 to 0.03; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"eye_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"eye_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"eye_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"eye_harm_q_per_person":{"central":"0.002","scenario_range":"Scenario inputs 0 to 0.002; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"hernia_selected_fraction":{"central":"0.45","scenario_range":"Scenario inputs 0 to 0.7; not a confidence interval","basis":"45% of nominal general-surgery services assumed selected symptomatic hernia episodes;201general services are not201hernias."},"hernia_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"hernia_disjoint_fraction":{"central":"0.9","scenario_range":"Scenario inputs 0.9 to 0.9; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"hernia_treatment_success":{"central":"0.85","scenario_range":"Scenario inputs 0.85 to 0.85; not a confidence interval","basis":"Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure."},"hernia_utility_gain":{"central":"0.04","scenario_range":"Scenario inputs -0.02 to 0.1; not a confidence interval","basis":".04 utility-point gain per successful symptomatic-person-year is a judgment; minimallysymptomatic randomized evidence is essentially null. Selected pain-limiting hernia fraction and transport are unknown."},"hernia_catchup_hazard":{"central":"0.7","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".7/year rate prior for later public/safety-net/self-funded care catching up; discounts finite earlier-care health even when no new gift finances the initial procedure."},"hernia_loss_hazard":{"central":"0.08","scenario_range":"Scenario inputs 0.08 to 0.08; not a confidence interval","basis":"Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality."},"hernia_mortality_hazard":{"central":"0.02","scenario_range":"Scenario inputs 0.02 to 0.02; not a confidence interval","basis":"All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway."},"hernia_horizon_years":{"central":"3","scenario_range":"Scenario inputs 1 to 5; not a confidence interval","basis":"At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit."},"hernia_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only."},"hernia_harm_q_per_person":{"central":"0.004","scenario_range":"Scenario inputs 0 to 0.004; not a confidence interval","basis":"Extra procedure/recovery/complication burden per unique episode in gift-date PVQALYs; includes all repeat procedures in that episode. Independent of treatment success. No delayed no-gift procedure harm is subtracted, conservatively."},"crc_selected_fraction":{"central":"0.5","scenario_range":"Scenario inputs 0 to 0.75; not a confidence interval","basis":"50% of nominal GI services assumed abnormal-FIT follow-up;575GI services are not575positiveFIT patients."},"crc_services_per_person":{"central":"1.2","scenario_range":"Scenario inputs 1.2 to 2; not a confidence interval","basis":"1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained."},"crc_disjoint_fraction":{"central":"1","scenario_range":"Scenario inputs 1 to 1; not a confidence interval","basis":"Exclusive patient ledger order CRC→cataract→hernia, fractions1/.95/.90. Prior allowance for people already credited; no second eye, repeat operation or second pathway full-person health award."},"crc_treatment_linkage":{"central":"0.7","scenario_range":"Scenario inputs 0 to 0.9; not a confidence interval","basis":"70% judgment chance that necessary appropriate downstream management can deliver the modeled contrast. Diagnostic completion alone earns no full treatment gain."},"crc_annual_fatal_hazard_reduction":{"central":"0.0006","scenario_range":"Scenario inputs -0.0003 to 0.001; not a confidence interval","basis":".0006/year is a judgment if no later-care catchup, lasting five hazard-years after latency. It is not.0092/10 or an estimated causal attenuation of the cohort. Fiveyears×.0006=.003 cumulative hazard only as a scale check."},"crc_baseline_total_mortality_hazard":{"central":"0.025","scenario_range":"Scenario inputs 0.025 to 0.025; not a confidence interval","basis":".025/year all-cause hazard prior already includes CRC mortality. Only the modeled CRC component changes; no second mortality hazard added."},"crc_catchup_hazard":{"central":"0.5","scenario_range":"Scenario inputs 0 to 4; not a confidence interval","basis":".5/year aggregate hazard-effect decay prior (two-year characteristic time) for eventual ordinary diagnostic/treatment care; mean-hazard approximation, not exact random individual care-time mixture."},"crc_latency_years":{"central":"2","scenario_range":"Scenario inputs 2 to 2; not a confidence interval","basis":"Two-year assumed lag from procedure to differential fatal risk. Not observed OA survival timing; existing alternative care can catch up during this lag."},"crc_active_years":{"central":"5","scenario_range":"Scenario inputs 5 to 5; not a confidence interval","basis":"Five years of possibly different fatal hazard after latency, not five avoided deaths or a life expectancy."},"crc_horizon_years":{"central":"10","scenario_range":"Scenario inputs 10 to 15; not a confidence interval","basis":"Ten-year finite survival observation from procedure; both arms return to common mortality after the hazard-effect window. No lifetime tail."},"crc_delay_years":{"central":"0.25","scenario_range":"Scenario inputs 0.25 to 0.25; not a confidence interval","basis":"Quarter-year procedure delay; cohort already conditioned alive at service start, so d