{"theory":{"version":"sf-city-theory-v1","reviewedAt":"2026-09-07","status":"working-theory-after-original-25","thesis":"The strongest search hypothesis is inexpensive, genuinely additional access to an effective service—not housing, or any organization category, in the abstract.","thresholdUsdPerTenQalys":100000,"requiredQalysPerDollar":0.0001,"assumptionBoundary":"The registry contains heterogeneous exploratory models, not 25 independent measurements or current marginal funding offers. A central scenario is not an expected value over quantified probabilities.","researchPriorities":[{"title":"Remove a small barrier to a large health benefit","claim":"Test whether navigation, supplies or timely access unlock care that already has clinical and public infrastructure.","support":"Medication access, earlier clinical care, glasses and naloxone illustrate the mechanism. Cheap donor cash may rely on substantial publicly funded or donated resources.","falsifier":"Existing services would reach the same people anyway, the missing resource is not money, or completed effective treatment does not increase."},{"title":"Target severe, avoidable harm rather than broad reach","claim":"A low-cost intervention has more scope when untreated risk or impairment is high.","support":"Fatal-risk and vision models are highly sensitive to recipient selection. Contacts and city-average risk do not identify the relevant subgroup.","falsifier":"The reachable marginal recipients have mild impairment, low untreated risk or good alternative coverage."},{"title":"Buy durable benefit without buying an expensive full bundle","claim":"Compare a marginal access increment with its own counterfactual, not an entire system's average budget.","support":"Short housing acceleration and crisis diversion yield only days or weeks of modeled health; lifetime mortality and credential models depend heavily on persistence assumptions.","falsifier":"Benefits fade quickly, completion is poor, recurrent events duplicate lifetime credit or the proposed cheap increment cannot operate independently."},{"title":"Treat housing as several mechanisms, not one finding","claim":"Preventing a cash shortfall, averting legal displacement, providing a long subsidy and readying a vacant room are different interventions.","support":"GLIDE, Compass and Hamilton share a VA simulation transfer. EDC, Larkin and THC use different health-time judgments and causal endpoints.","falsifier":"Comparable costs and health-state assumptions erase the apparent gap; a housing outcome does not improve health relative to the actual alternative."},{"title":"Investigate policy leverage, but earn every attribution link","claim":"A small policy grant could affect many people; large scale is a hypothesis to test after the two candidate cohorts.","support":"The policy phase will separately assess SPUR, GrowSF and HAC. No policy or election win is treated as a QALY.","falsifier":"The change would happen anyway, is not implemented, displaces another improvement or does not change health-relevant outcomes."}],"costLedger":[{"name":"Marginal donor cash","question":"What extra delivery does this dated gift buy after replacement financing?","boundary":"Do not infer it from a public contract ceiling, donation button or historical average."},{"name":"Total incremental resources","question":"What clinical care, public reimbursement, volunteer time, donated goods and infrastructure are also required?","boundary":"Low private cash cost does not make those resources free; record whether they can expand."},{"name":"Net payer or societal cost","question":"Which downstream costs change causally, and who captures the saving?","boundary":"Hospital savings are not automatically money returned to the donor or additional QALYs."}],"causalLedger":["Specify the recipient subgroup, program dose and realistic alternative.","Price incremental delivery and all complementary resources.","Estimate additional completed outcomes, excluding funding replacement and alternative access.","Translate those outcomes into person-level health utility or survival over an explicit horizon.","Account for overlap, repeated events, null/harm, and shared evidence before comparing or aggregating."],"nextOrder":["Ten mechanism-first research bets","Ten unconventional programs","SPUR, GrowSF and Housing Action Coalition","Final strongest-four selection and GiveWell-style visual rebuild"],"sources":[{"title":"VA temporary financial-assistance simulation","url":"https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825636","published":"2024-11-05","retrieved":"2026-09-07","role":"Shared housing model, not a local randomized health effect"},{"title":"Homelessness utility valuation","url":"https://pubmed.ncbi.nlm.nih.gov/34629422/","published":"2021","retrieved":"2026-09-07","role":"Standard-gamble valuation of a housing state; not measured within-person clinical improvement"}]},"registry":{"version":"sf-city-registry-v1","reviewedAt":"2026-09-07","denominator":"10 incremental QALYs","scope":"Original 25 exploratory models, not a recommendation ranking. 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