Market for Impact

Summary

What do they do? Clinic by the Bay is Volunteers in Medicine – San Francisco, EIN 26-2593712. It supplies free medical, dental, mental-health and food-pharmacy services. Dental access requires being an active medical patient; exams, cleaning and prevention are not completed pain treatment. Its current dental scope includes simple fillings/extractions but not root canals or tooth replacement. Counseling is short-term; psychiatry is monthly. The organization reports no government or insurance receipts, but public and other free-care alternatives remain relevant. The medical model now includes a selected hypertensive annual-care cohort and an explicit uncertain residual person-course model for the other health-bearing activities. More

Why this approach interests us

Sustained treatment of hypertension can reduce mortality; dental, mental and other medical care can bring symptom/function improvement sooner.

Our main reservations

Gift allocation and named service-mix priors are unobserved locally. Favorable15% supplies 82.6%of expectedQ; zero favorable weight raises expected SF donor price to$13,517,426.

What do you get for your dollar?

For a $100,000 ordinary gift, our subjective expected donor cost per 10 QALYs is $2,002,578 across all recipients, $2,002,578 in the Bay Area and $2,860,825 in SF. Expected gross associated resource prices are $3,967,448, $3,967,448 and $5,667,783 respectively. This averages signed health across explicitly weighted scenarios (70% central,15% favorable,10% cautious,5% no additional funding), not positive-only ratios. It adds selected hypertension care and uncertain residual morbidity to dental relief and counseling. The unweighted central SF donor scenario is $11,395,651. These are weak, judgment-heavy best estimates, not measured clinic impact or confidence bounds. Inspect formulas, assumptions and scenario weights.

subjective expected — sf: $2,860,825 — Whole gift divided by expected signed direct SF QALYs; weak scenario-weight priors.
expected gross resources — sf: $5,667,783 — Ratio of expected gross associated costs to expected health; not full net societal ICER.
central scenario — sf: $11,395,651 — Not equal to expectation; favorable tail materially affects mean.
funding room: Unknown — Capacity and displacement are explicit priors, not a priced additional-care offer.

1. What do they do?

Clinic by the Bay is Volunteers in Medicine – San Francisco, EIN 26-2593712. It supplies free medical, dental, mental-health and food-pharmacy services. Dental access requires being an active medical patient; exams, cleaning and prevention are not completed pain treatment. Its current dental scope includes simple fillings/extractions but not root canals or tooth replacement. Counseling is short-term; psychiatry is monthly. The organization reports no government or insurance receipts, but public and other free-care alternatives remain relevant. The medical model now includes a selected hypertensive annual-care cohort and an explicit uncertain residual person-course model for the other health-bearing activities.

Fund the full portfolio

Retain all $100K:20%dental,15%mental,55%medical,10%food/other, including allocated support. BP courses use30% of medical spending centrally. Remaining budget after selected dental/counseling/BP course shares enters the residual model; no second spending allocation is added.

Count distinct annual patient courses

One patient-period ledger assigns dental, counseling, BP then residual. Unique fractions explicitly remove overlap and repeats. These are priors; downstream effects must be reconciled before combining other organizations.

Model finite clinical effects and residual uncertainty

BP survival differs only during funded effective care after latency; equal hazards afterward to10year horizon. Six named residual service groups each have distinct course cost, target/response, signed utility and finite catchup/horizon: acute/rheumatology, non-BP medication care, completed referrals, other dental, other mental, and food support.

Scope of this review. Whole-gift expected direct-health model with four explicit branches. Residual aggregate priors are much weaker than trial-anchored BP evidence. Rare preventive tails and indirect effects remain unresolved rather than asserted absent; sensitivity must expose their possible materiality. SF nests within Bay, not an additive second population.

2. Monitoring and information sharing

Paired extraction respondents, 18 at 12 months

Primary prospective nonrandomized Swedish cohort. Extraction EQ5D mean .77 to .81 was nonsignificant (p=.297); the study lacks untreated access controls.

Our assessment. The .04 signed utility is a judgment, not a causal coefficient. Selected painful clinically indicated extraction only; no root-canal benefit transferred to an unavailable procedure.

197 patients randomized among three arms; 464 total includes preference and therapy-only allocation

Primary pragmatic randomized comparison with preference arms. Brief counseling/CBT improved depression symptoms at four months, but groups converged by twelve months. GP psychological referral was held for four months.

Our assessment. A direction and short-duration anchor, not a QALY estimate. Utility is an independent prior, with a one-year fade, local fidelity attenuation and extra alternative-care catchup. No trial fidelity is assumed from generic short-term counseling availability.

Entire legal recipient

Primary FY2025 IRS return, not audited accounts. Bundles service costs and confirms a broader medical home rather than a dental-only organization.

Our assessment. No specialty cash split or verified next-gift treatment plan. Annual report is linked but unreadable through available access; index counts are not used as a dated throughput denominator.

Eligible uninsured SF residents

Official local access-program disclosure. Healthy SF covers primary and mental-health care; routine dental is outside its covered service list.

Our assessment. Uninsured is not equivalent to no care. Funding replacement is separate from patient alternative-care catchup; eligibility, availability and waits still vary.

HDFP:10,940 hypertensive adults ages30–69, DBP≥90

Community-based randomized treatment-access trial. Systematic stepped care versus referral to community therapy: five-year all-cause mortality6.4% versus7.7%.

Our assessment. Current-care risk, modern gap, finite funded exposure/latency and relative implementation are explicit priors. Derived constant-hazard ratio is not an observed early effect. Trial assignment already incorporates adherence. No mortality double counting.

Six disjoint named service groups, not generic remaining visits

Explicit bounded health-state prior, not causal clinic evidence. Service-specific illness fractions, successful response, signed utility and catchup/horizon are separately exposed in99inputs. Clinical/referral completion and low food-related utility are not assumed uniform.

Our assessment. All numerical residual parameters remain weak priors; official menus support existence, not causal magnitude. No life-long disease-prevention award, generic starvation counterfactual or average visits×QALY. Measure mix and patient health, and retain null/adverse group stresses.

3. Qualitative assessment

Sustained treatment of hypertension can reduce mortality; dental, mental and other medical care can bring symptom/function improvement sooner.

Key reservations

The mean is sensitive to elicited favorable-scenario probability and residual priors; neither numerical precision nor a passing calculator makes those probabilities evidence.
Current BP mortality is a selected-patient prior. HDFP is old and compared systematic care with existing community referral, not no treatment. Modern public access may eliminate the local treatment gap.
Residual morbidity is a coarse weak-prior branch for remaining direct care, not a multiplier fitted to a ranking threshold. Undocumented rare-event prevention may still matter.
Four cohorts are disjoint by assumptions, not linked data. Patient overlap and combined utility effects need direct validation.
Annual courses include unsuccessful and nonresponsive activity costs. Funded duration is finite; one year of donations does not buy lifelong medication adherence.
All harmful utility, treatment burden and mortality effects must remain signed without charging the same adverse outcome twice.
Government-free clinic financing does not mean government-free patient alternatives. Net public costs and savings remain unknown.

Benefits not included in our estimate

Indirect/spillover health and lifetime earnings
Additional fatal MI/stroke credit beyond BP all-cause survival
Unspecified perpetual prevention benefit from visits or education attendance
Net public savings and exhaustive downstream costs

4. What do you get for your dollar?

$2,860,825 expected donor dollars per 10 direct SF QALYs

Central components: dental0.03478304880Q; counseling0.009869798320; BP0.01690422578; six residual groups together0.06380403741. BP uses HDFP assignment-level systematic-care versus community-referral evidence, not untreated all-visits effects. Six group-specific residual priors replace the generic uplift; service availability is sourced, but numeric illness mix and utility are explicitly weak judgments. Non-BP medical spending splits40%acute/rheumatology,40%other symptomatic chronic medication care and20%completed specialty pathways. Each cohort is counted once.

A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.

How we calculate the estimate

EXPECTED FULL-GIFT PRICE: Q=Q_dental+Q_counseling+Q_BP+Σ_g N_g[target_g×response_g×signed utility_g×discount(delay)×F(catchup_g+m+r,H_g)−harm]−independent harm; N_g is unique additional patient-courses from its partitioned whole-gift budget, capped jointly; E[Q]=Σscenario w_i×signed Q_i; donor price=10G/E[Q_SF], only if positive.
$2,860,825

Model inputs and assumptions

gift usd: 100000 (range: 100000 / 1000000). Hypothetical ordinary unrestricted gift; not a quoted tranche. Analyst prior unless stated otherwise.
funding additionality: 0.5 (range: 0.5 / 0.75 / 0.25 / 0). Fraction expanding or preserving otherwise-lost care after replacement of existing donors; distinct from alternative care after treatment starts. Analyst prior unless stated otherwise.
dental allocation: 0.2 (range: 0.2 / 0.1 / 0.3). Fully loaded ordinary-gift share for all dental work, not just painful teeth; judgment from new two-day dental service within broader medical clinic. Analyst prior unless stated otherwise.
mental allocation: 0.15 (range: 0.15 / 0.05 / 0.25). Fully loaded ordinary-gift share for counseling and psychiatry; specialty spending not disclosed. Analyst prior unless stated otherwise.
medical allocation: 0.55 (range: 0.55 / 0.75 / 0.35). General medical, chronic care, prescriptions and referral support; health left unquantified. Analyst prior unless stated otherwise.
food other allocation: 0.1 (range: 0.1). Food pharmacy and remaining services; health left unquantified. All four shares sum to one. Analyst prior unless stated otherwise.
dental episode cost: 600 (range: 600 / 350 / 1000). Average fully loaded cost per nominal all-dental course, not only selected extraction. Target and non-target shares partition that activity; non-target budget feeds residual model without adding donor cost. Salary-oriented prior, not measured throughput. Analyst prior unless stated otherwise.
mental course cost: 1200 (range: 1200 / 700 / 2200). All-in mental-health course budget, independent prior: roughly eight funded/coordinated contacts at $150, including overhead and unsuccessful attempts; not clinic quote. Analyst prior unless stated otherwise.
dental target: 0.4 (range: 0.4 / 0.65 / 0.2). Share of dental courses with severe pain and clinically indicated simple extraction; no credit to cleanings/exams/fillings here. Analyst prior unless stated otherwise.
mental target: 0.6 (range: 0.6 / 0.8 / 0.3). Share of mental-health courses suitable for short-term counseling of depressive symptoms; exclude psychiatry-only and unsupported diagnoses. Analyst prior unless stated otherwise.
dental completion: 0.8 (range: 0.8 / 0.95 / 0.6). Completed definitive care conditional on initiated target course; no credit to emergency exam alone. Analyst prior unless stated otherwise.
mental completion: 0.7 (range: 0.7 / 0.9 / 0.5). Fraction reaching an adequate local counseling dose; full attempt costs retained. Analyst prior unless stated otherwise.
dental unique: 0.9 (range: 0.9 / 1). Unique patient-period fraction; repeat teeth and repeat episodes excluded from additional utility summation. Analyst prior unless stated otherwise.
mental disjoint: 0.8 (range: 0.8 / 0.95 / 0). Unique counseling patient-period fraction after excluding every dental-credited person and repeat courses; unknown linked-data prior. Analyst prior unless stated otherwise.
dental capacity: 30 (range: 30 / 0). Maximum additional completed unique target patients in gift cohort; unverified capacity prior. Analyst prior unless stated otherwise.
mental capacity: 20 (range: 20 / 0). Maximum additional completed disjoint counseling patients; unverified capacity prior. Analyst prior unless stated otherwise.
dental utility: 0.04 (range: 0.04 / 0.12 / 0.01 / 0 / -0.02). Signed relief utility prior, loosely oriented by nonsignificant Swedish extraction before/after EQ5D .77 to .81; not a causal estimate. Analyst prior unless stated otherwise.
dental resolution: 0.8 (range: 0.8 / 0.95). Successful pain resolution conditional on completed extraction, separate from course completion. Analyst prior unless stated otherwise.
dental catchup: 4 (range: 4 / 1 / 12 / 20 / 0). Annual no-gift alternative-treatment/spontaneous symptom-resolution hazard, conditional on successful early treatment; central mean .25 years before hard cap. Analyst prior unless stated otherwise.
dental horizon: 1 (range: 1 / 0.04). Hard maximum years of earlier relief after care begins, never lifetime. Analyst prior unless stated otherwise.
dental delay: 0.15 (range: 0.15 / 0). Years until care starts; cohorts conditioned alive at start, delay discounts only. Analyst prior unless stated otherwise.
dental harm: 0.0005 (range: 0.0005 / 0.0002 / 0.001 / 0). Gift-date PV incremental procedural/tooth-function QALY loss per additional completed unique patient; net of eventual alternative-care harm. Analyst prior unless stated otherwise.
mental utility: 0.03 (range: 0.03 / 0.07 / 0.005 / 0 / -0.02). Signed initial counseling utility advantage: independent prior, NOT Beck-score to EQ5D conversion. Analyst prior unless stated otherwise.
mental fidelity: 0.6 (range: 0.6 / 0.9 / 0.3 / 0). Local effect-size transfer prior among adequate-dose completers; no claim clinic replicates trained trial therapists. Analyst prior unless stated otherwise.
mental catchup: 1.5 (range: 1.5 / 0.5 / 4 / 10 / 0). Additional local alternative-care attenuation beyond imposed one-year fading; accounts for accessible public/free mental care. Analyst prior unless stated otherwise.
mental horizon: 1 (range: 1). Counseling utility fades linearly to zero by one year after start; no residual lifetime mental-health benefit. Analyst prior unless stated otherwise.
mental delay: 0.15 (range: 0.15 / 0). Care start delay, discounts only for an alive-at-start cohort. Analyst prior unless stated otherwise.
mental harm: 0.001 (range: 0.001 / 0.0002 / 0.002 / 0). Gift-date PV incremental burden/adverse effects per additional completed unique counseling patient; clinical deterioration already in signed utility excluded. Analyst prior unless stated otherwise.
mortality: 0.01 (range: 0.01 / 0). Annual competing all-cause hazard during finite benefit, not a mortality reduction claim. Analyst prior unless stated otherwise.
discount: 0.03 (range: 0.03 / 0). Continuous annual health discount rate. Analyst prior unless stated otherwise.
bay share: 1 (range: 1 / 0). Direct Bay Area fraction; intended clinic catchment; no measured marginal residency split. Analyst prior unless stated otherwise.
sf share: 0.7 (range: 0.7 / 0.3 / 0). Direct SF subset of Bay Area; weak prior from SF and San Mateo mission, not proof clinic location equals resident location. Analyst prior unless stated otherwise.
volunteer resource per donor: 0.6 (range: 0.6 / 2). Additional gross associated volunteer opportunity-cost allowance per donor dollar, not a clinic valuation or incremental net cost. Analyst prior unless stated otherwise.
external resource per donor: 0.15 (range: 0.15 / 1). Outside support for original dental/mental branches and common patient support only; BP/residual per-course allowances exclude these costs. Analyst prior unless stated otherwise.
independent harm q: 0 (range: 0 / 0.1). Gift-date PV QALY loss independent of expanded care; separate from per-patient harms. Analyst prior unless stated otherwise.
bp medical fraction: 0.3 (range: 0.3 / 0.4 / 0.15 / 0). General-medical budget fraction for HDFP-like hypertensive adults ages30–69/DBP≥90; unknown local case mix, not all visits. Explicit analyst prior.
bp course cost: 1500 (range: 1500 / 1000 / 2500). Fully loaded annual systematic-care cost: six contacts at$200 plus$300 drugs/labs; multiply by max(1,funded years), so longer care never costs only one year. Explicit analyst prior.
bp unique: 0.8 (range: 0.8). Unique annual patients after excluding dental/counseling patient-periods and repeats. Explicit analyst prior.
bp capacity: 30 (range: 30 / 0). Unverified additional unique annual-course capacity. Explicit analyst prior.
bp baseline hazard: 0.016 (range: 0.016). Current-care all-cause annual mortality prior near annualized HDFP referral arm, not untreated mortality. Explicit analyst prior.
bp relative hazard: 0.8254469933511347 (range: 0.8254469933511347 / 1 / 1.2). Constant-hazard approximation from HDFP5y risks6.4%stepped versus7.7%community referral; not observed first-year HR. Primary-trial-derived approximation.
bp modern gap: 0.5 (range: 0.5 / 0.8 / 0.1 / 0). Remaining opportunity relative to historical referral comparator after modern public/free access, not fraction never treated. Explicit analyst prior.
bp delivery transfer: 0.75 (range: 0.75 / 1 / 0.3). Implementation relative to trial assignment effect; no second multiplication by absolute trial adherence. Explicit analyst prior.
bp active years: 1 (range: 1 / 5). Funded exposure; hazards equal comparator after this period. Explicit analyst prior.
bp latency: 0.25 (range: 0.25 / 0 / 0.75 / 1). Initial delay before any hazard effect within the funded exposure. Explicit analyst prior.
bp horizon: 10 (range: 10 / 3). Finite survival followup after care start; no permanent risk reduction. Explicit analyst prior.
bp delay: 0.15 (range: 0.15). Discount-only start delay, cohort alive at service start. Explicit analyst prior.
bp utility: 0.75 (range: 0.75). Utility among living high-risk cohort, independent prior. Explicit analyst prior.
bp harm: 0.0005 (range: 0.0005 / 0). Gift-date PV nonfatal incremental treatment harm; fatal effects already inside signed mortality contrast. Explicit analyst prior.
bp external per course: 300 (range: 300). Annual outside BP clinical/patient-time cost, multiplied by max(1,funded years); donor-paid and common original-branch support excluded. Explicit analyst prior.
residual unique: 0.65 (range: 0.65). Unique residual patient-periods after excluding all credited cohorts/repeats; full costs retained. Explicit analyst prior.
residual capacity: 100 (range: 100 / 0). Unknown additional unique annual-course capacity prior. Explicit analyst prior.
residual delay: 0.15 (range: 0.15). Discount-only delay; cohort alive at start. Explicit analyst prior.
residual harm: 0.0005 (range: 0.0005 / 0.001 / 0). Gift-date PV incremental harm outside signed utility, per additional unique course. Explicit analyst prior.
acute cost: 1000 (range: 1000 / 750 / 1500). Fully loaded nominal patient-course cost. 40% of non-BP medical budget; short symptomatic courses, mixed acute/rheumatology need; no automatic disease cure. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
acute target: 0.5 (range: 0.5 / 0.75 / 0.25). Share with completed/actionable burden-bearing care. 40% of non-BP medical budget; short symptomatic courses, mixed acute/rheumatology need; no automatic disease cure. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
acute utility: 0.06 (range: 0.06 / 0.09 / 0.015 / 0 / -0.02 / 0.12). Signed utility change conditional on response. 40% of non-BP medical budget; short symptomatic courses, mixed acute/rheumatology need; no automatic disease cure. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
acute response: 0.7 (range: 0.7 / 0.84 / 0.35). Meaningful symptom/function response. 40% of non-BP medical budget; short symptomatic courses, mixed acute/rheumatology need; no automatic disease cure. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
acute catchup: 4 (range: 4 / 2 / 8). Annual alternative-care/spontaneous catchup. 40% of non-BP medical budget; short symptomatic courses, mixed acute/rheumatology need; no automatic disease cure. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
acute horizon: 0.5 (range: 0.5 / 1). Hard post-care benefit horizon. 40% of non-BP medical budget; short symptomatic courses, mixed acute/rheumatology need; no automatic disease cure. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
acute external: 100 (range: 100). Outside clinical/patient-time cost beyond donor/volunteer/common support. 40% of non-BP medical budget; short symptomatic courses, mixed acute/rheumatology need; no automatic disease cure. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
chronic cost: 1500 (range: 1500 / 1125 / 2250). Fully loaded nominal patient-course cost. 40% of non-BP medical budget; sustained symptom control in selected chronic illness, not diabetes education→mortality or broad preventive event credit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
chronic target: 0.4 (range: 0.4 / 0.6000000000000001 / 0.2). Share with completed/actionable burden-bearing care. 40% of non-BP medical budget; sustained symptom control in selected chronic illness, not diabetes education→mortality or broad preventive event credit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
chronic utility: 0.03 (range: 0.03 / 0.045 / 0.0075 / 0 / -0.02 / 0.06). Signed utility change conditional on response. 40% of non-BP medical budget; sustained symptom control in selected chronic illness, not diabetes education→mortality or broad preventive event credit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
chronic response: 0.65 (range: 0.65 / 0.78 / 0.325). Meaningful symptom/function response. 40% of non-BP medical budget; sustained symptom control in selected chronic illness, not diabetes education→mortality or broad preventive event credit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
chronic catchup: 1.5 (range: 1.5 / 0.75 / 3). Annual alternative-care/spontaneous catchup. 40% of non-BP medical budget; sustained symptom control in selected chronic illness, not diabetes education→mortality or broad preventive event credit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
chronic horizon: 1 (range: 1 / 2). Hard post-care benefit horizon. 40% of non-BP medical budget; sustained symptom control in selected chronic illness, not diabetes education→mortality or broad preventive event credit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
chronic external: 300 (range: 300). Outside clinical/patient-time cost beyond donor/volunteer/common support. 40% of non-BP medical budget; sustained symptom control in selected chronic illness, not diabetes education→mortality or broad preventive event credit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
referral cost: 3000 (range: 3000 / 2250 / 4500). Fully loaded nominal patient-course cost. 20% of non-BP medical budget; target fraction requires completed actionable specialty care, not a referral alone. External actual treatment resources modeled separately. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
referral target: 0.3 (range: 0.3 / 0.44999999999999996 / 0.15). Share with completed/actionable burden-bearing care. 20% of non-BP medical budget; target fraction requires completed actionable specialty care, not a referral alone. External actual treatment resources modeled separately. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
referral utility: 0.1 (range: 0.1 / 0.15000000000000002 / 0.025 / 0 / -0.02 / 0.2). Signed utility change conditional on response. 20% of non-BP medical budget; target fraction requires completed actionable specialty care, not a referral alone. External actual treatment resources modeled separately. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
referral response: 0.7 (range: 0.7 / 0.84 / 0.35). Meaningful symptom/function response. 20% of non-BP medical budget; target fraction requires completed actionable specialty care, not a referral alone. External actual treatment resources modeled separately. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
referral catchup: 1 (range: 1 / 0.5 / 2). Annual alternative-care/spontaneous catchup. 20% of non-BP medical budget; target fraction requires completed actionable specialty care, not a referral alone. External actual treatment resources modeled separately. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
referral horizon: 2 (range: 2 / 3). Hard post-care benefit horizon. 20% of non-BP medical budget; target fraction requires completed actionable specialty care, not a referral alone. External actual treatment resources modeled separately. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
referral external: 3000 (range: 3000). Outside clinical/patient-time cost beyond donor/volunteer/common support. 20% of non-BP medical budget; target fraction requires completed actionable specialty care, not a referral alone. External actual treatment resources modeled separately. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/services Weak explicit service-specific prior.
dental other cost: 600 (range: 600 / 450 / 900). Fully loaded nominal patient-course cost. All nonselected dental budget; only a minority have responsive symptomatic disease. Cleanings/prevention not assigned lifelong benefit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental Weak explicit service-specific prior.
dental other target: 0.25 (range: 0.25 / 0.375 / 0.125). Share with completed/actionable burden-bearing care. All nonselected dental budget; only a minority have responsive symptomatic disease. Cleanings/prevention not assigned lifelong benefit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental Weak explicit service-specific prior.
dental other utility: 0.04 (range: 0.04 / 0.06 / 0.01 / 0 / -0.02 / 0.08). Signed utility change conditional on response. All nonselected dental budget; only a minority have responsive symptomatic disease. Cleanings/prevention not assigned lifelong benefit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental Weak explicit service-specific prior.
dental other response: 0.8 (range: 0.8 / 0.96 / 0.4). Meaningful symptom/function response. All nonselected dental budget; only a minority have responsive symptomatic disease. Cleanings/prevention not assigned lifelong benefit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental Weak explicit service-specific prior.
dental other catchup: 4 (range: 4 / 2 / 8). Annual alternative-care/spontaneous catchup. All nonselected dental budget; only a minority have responsive symptomatic disease. Cleanings/prevention not assigned lifelong benefit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental Weak explicit service-specific prior.
dental other horizon: 1 (range: 1 / 2). Hard post-care benefit horizon. All nonselected dental budget; only a minority have responsive symptomatic disease. Cleanings/prevention not assigned lifelong benefit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental Weak explicit service-specific prior.
dental other external: 150 (range: 150). Outside clinical/patient-time cost beyond donor/volunteer/common support. All nonselected dental budget; only a minority have responsive symptomatic disease. Cleanings/prevention not assigned lifelong benefit. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental Weak explicit service-specific prior.
mental other cost: 1000 (range: 1000 / 750 / 1500). Fully loaded nominal patient-course cost. All nonselected mental budget; symptomatic anxiety/other psychiatry supported monthly, not depressive counseling credited twice. No suicide mortality claim. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental-1 Weak explicit service-specific prior.
mental other target: 0.5 (range: 0.5 / 0.75 / 0.25). Share with completed/actionable burden-bearing care. All nonselected mental budget; symptomatic anxiety/other psychiatry supported monthly, not depressive counseling credited twice. No suicide mortality claim. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental-1 Weak explicit service-specific prior.
mental other utility: 0.04 (range: 0.04 / 0.06 / 0.01 / 0 / -0.02 / 0.08). Signed utility change conditional on response. All nonselected mental budget; symptomatic anxiety/other psychiatry supported monthly, not depressive counseling credited twice. No suicide mortality claim. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental-1 Weak explicit service-specific prior.
mental other response: 0.6 (range: 0.6 / 0.72 / 0.3). Meaningful symptom/function response. All nonselected mental budget; symptomatic anxiety/other psychiatry supported monthly, not depressive counseling credited twice. No suicide mortality claim. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental-1 Weak explicit service-specific prior.
mental other catchup: 2 (range: 2 / 1 / 4). Annual alternative-care/spontaneous catchup. All nonselected mental budget; symptomatic anxiety/other psychiatry supported monthly, not depressive counseling credited twice. No suicide mortality claim. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental-1 Weak explicit service-specific prior.
mental other horizon: 0.75 (range: 0.75 / 1.5). Hard post-care benefit horizon. All nonselected mental budget; symptomatic anxiety/other psychiatry supported monthly, not depressive counseling credited twice. No suicide mortality claim. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental-1 Weak explicit service-specific prior.
mental other external: 200 (range: 200). Outside clinical/patient-time cost beyond donor/volunteer/common support. All nonselected mental budget; symptomatic anxiety/other psychiatry supported monthly, not depressive counseling credited twice. No suicide mortality claim. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/dental-1 Weak explicit service-specific prior.
food cost: 800 (range: 800 / 600 / 1200). Fully loaded nominal patient-course cost. Food/other budget, financial strain plus metabolic conditions; food substitution and public CalFresh/EatSF support in baseline. Small transient morbidity prior, not starvation prevention. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/food-pharmacy Weak explicit service-specific prior.
food target: 0.4 (range: 0.4 / 0.6000000000000001 / 0.2). Share with completed/actionable burden-bearing care. Food/other budget, financial strain plus metabolic conditions; food substitution and public CalFresh/EatSF support in baseline. Small transient morbidity prior, not starvation prevention. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/food-pharmacy Weak explicit service-specific prior.
food utility: 0.01 (range: 0.01 / 0.015 / 0.0025 / 0 / -0.02 / 0.02). Signed utility change conditional on response. Food/other budget, financial strain plus metabolic conditions; food substitution and public CalFresh/EatSF support in baseline. Small transient morbidity prior, not starvation prevention. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/food-pharmacy Weak explicit service-specific prior.
food response: 0.4 (range: 0.4 / 0.48 / 0.2). Meaningful symptom/function response. Food/other budget, financial strain plus metabolic conditions; food substitution and public CalFresh/EatSF support in baseline. Small transient morbidity prior, not starvation prevention. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/food-pharmacy Weak explicit service-specific prior.
food catchup: 2 (range: 2 / 1 / 4). Annual alternative-care/spontaneous catchup. Food/other budget, financial strain plus metabolic conditions; food substitution and public CalFresh/EatSF support in baseline. Small transient morbidity prior, not starvation prevention. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/food-pharmacy Weak explicit service-specific prior.
food horizon: 1 (range: 1 / 2). Hard post-care benefit horizon. Food/other budget, financial strain plus metabolic conditions; food substitution and public CalFresh/EatSF support in baseline. Small transient morbidity prior, not starvation prevention. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/food-pharmacy Weak explicit service-specific prior.
food external: 250 (range: 250). Outside clinical/patient-time cost beyond donor/volunteer/common support. Food/other budget, financial strain plus metabolic conditions; food substitution and public CalFresh/EatSF support in baseline. Small transient morbidity prior, not starvation prevention. Source confirms service, not this numerical prior: https://www.clinicbythebay.org/food-pharmacy Weak explicit service-specific prior.
acute medical share: 0.4 (range: 0.4). Shares of non-BP medical budget sum to1. Symptom care and chronic medication support each40%, completed specialty-care branch20%; not observed clinic spending. Unobserved non-BP medical case-mix allocation prior.
chronic medical share: 0.4 (range: 0.4). Shares of non-BP medical budget sum to1. Symptom care and chronic medication support each40%, completed specialty-care branch20%; not observed clinic spending. Unobserved non-BP medical case-mix allocation prior.
referral medical share: 0.2 (range: 0.2). Shares of non-BP medical budget sum to1. Symptom care and chronic medication support each40%, completed specialty-care branch20%; not observed clinic spending. Unobserved non-BP medical case-mix allocation prior.

Hypothetical $100,000 unrestricted gift; no verified marginal offer

Central: $11,395,651 per10SF QALYs. all: Q 0.1253611103, donor $7,976,956, gross resource $15,789,985; bay: Q 0.1253611103, donor $7,976,956, gross resource $15,789,985; sf: Q 0.08775277722, donor $11,395,651, gross resource $22,557,121; gross associated resource budget $197,945.
Favorable: $519,510 per10SF QALYs. all: Q 2.749846199, donor $363,657, gross resource $738,150; bay: Q 2.749846199, donor $363,657, gross resource $738,150; sf: Q 1.924892340, donor $519,510, gross resource $1,054,501; gross associated resource budget $202,980.
Cautious: No finite positive ratio per10SF QALYs. all: Q -0.008732534295, donor No finite positive ratio, gross resource No finite positive ratio; bay: Q -0.008732534295, donor No finite positive ratio, gross resource No finite positive ratio; sf: Q -0.006112774007, donor No finite positive ratio, gross resource No finite positive ratio; gross associated resource budget $192,113.
No additional funding: No finite positive ratio per10SF QALYs. all: Q 0.000000000, donor No finite positive ratio, gross resource No finite positive ratio; bay: Q 0.000000000, donor No finite positive ratio, gross resource No finite positive ratio; sf: Q 0.000000000, donor No finite positive ratio, gross resource No finite positive ratio; gross associated resource budget $197,945.
No gift capacity: No finite positive ratio per10SF QALYs. all: Q 0.000000000, donor No finite positive ratio, gross resource No finite positive ratio; bay: Q 0.000000000, donor No finite positive ratio, gross resource No finite positive ratio; sf: Q 0.000000000, donor No finite positive ratio, gross resource No finite positive ratio; gross associated resource budget $197,945.
Zero net effect: No finite positive ratio per10SF QALYs. all: Q 0.000000000, donor No finite positive ratio, gross resource No finite positive ratio; bay: Q 0.000000000, donor No finite positive ratio, gross resource No finite positive ratio; sf: Q 0.000000000, donor No finite positive ratio, gross resource No finite positive ratio; gross associated resource budget $197,945.
Harm only: No finite positive ratio per10SF QALYs. all: Q -0.01754416667, donor No finite positive ratio, gross resource No finite positive ratio; bay: Q -0.01754416667, donor No finite positive ratio, gross resource No finite positive ratio; sf: Q -0.01228091667, donor No finite positive ratio, gross resource No finite positive ratio; gross associated resource budget $197,945.
Signed adverse utility: No finite positive ratio per10SF QALYs. all: Q -0.1015070905, donor No finite positive ratio, gross resource No finite positive ratio; bay: Q -0.1015070905, donor No finite positive ratio, gross resource No finite positive ratio; sf: Q -0.07105496338, donor No finite positive ratio, gross resource No finite positive ratio; gross associated resource budget $197,945.
Independent harm despite replacement: No finite positive ratio per10SF QALYs. all: Q -0.1000000000, donor No finite positive ratio, gross resource No finite positive ratio; bay: Q -0.1000000000, donor No finite positive ratio, gross resource No finite positive ratio; sf: Q -0.07000000000, donor No finite positive ratio, gross resource No finite positive ratio; gross associated resource budget $197,945.
Counseling benefit removed: $12,369,514 per10SF QALYs. all: Q 0.1154913120, donor $8,658,660, gross resource $17,139,384; bay: Q 0.1154913120, donor $8,658,660, gross resource $17,139,384; sf: Q 0.08084391839, donor $12,369,514, gross resource $24,484,835; gross associated resource budget $197,945.
Dental benefit removed: $15,771,716 per10SF QALYs. all: Q 0.09057806151, donor $11,040,201, gross resource $21,853,526; bay: Q 0.09057806151, donor $11,040,201, gross resource $21,853,526; sf: Q 0.06340464306, donor $15,771,716, gross resource $31,219,323; gross associated resource budget $197,945.
All counseling patients overlap: $12,369,514 per10SF QALYs. all: Q 0.1154913120, donor $8,658,660, gross resource $17,139,384; bay: Q 0.1154913120, donor $8,658,660, gross resource $17,139,384; sf: Q 0.08084391839, donor $12,369,514, gross resource $24,484,835; gross associated resource budget $197,945.
Lower target portfolio: $12,509,853 per10SF QALYs. all: Q 0.1141957015, donor $8,756,897, gross resource $17,629,823; bay: Q 0.1141957015, donor $8,756,897, gross resource $17,629,823; sf: Q 0.07993699108, donor $12,509,853, gross resource $25,185,461; gross associated resource budget $201,325.
Higher target portfolio: $10,463,692 per10SF QALYs. all: Q 0.1365265191, donor $7,324,584, gross resource $14,251,077; bay: Q 0.1365265191, donor $7,324,584, gross resource $14,251,077; sf: Q 0.09556856336, donor $10,463,692, gross resource $20,358,682; gross associated resource budget $194,565.
Fast usual-care catchup: $16,380,209 per10SF QALYs. all: Q 0.08721326229, donor $11,466,146, gross resource $22,696,663; bay: Q 0.08721326229, donor $11,466,146, gross resource $22,696,663; sf: Q 0.06104928361, donor $16,380,209, gross resource $32,423,804; gross associated resource budget $197,945.
No local counseling transfer: $12,598,597 per10SF QALYs. all: Q 0.1133913120, donor $8,819,018, gross resource $17,456,805; bay: Q 0.1133913120, donor $8,819,018, gross resource $17,456,805; sf: Q 0.07937391839, donor $12,598,597, gross resource $24,938,293; gross associated resource budget $197,945.
Short dental advantage: $15,225,777 per10SF QALYs. all: Q 0.09382584896, donor $10,658,044, gross resource $21,097,065; bay: Q 0.09382584896, donor $10,658,044, gross resource $21,097,065; sf: Q 0.06567809427, donor $15,225,777, gross resource $30,138,664; gross associated resource budget $197,945.
Low SF share: $26,589,852 per10SF QALYs. all: Q 0.1253611103, donor $7,976,956, gross resource $15,789,985; bay: Q 0.1253611103, donor $7,976,956, gross resource $15,789,985; sf: Q 0.03760833309, donor $26,589,852, gross resource $52,633,282; gross associated resource budget $197,945.
No SF beneficiaries: No finite positive ratio per10SF QALYs. all: Q 0.1253611103, donor $7,976,956, gross resource $15,789,985; bay: Q 0.1253611103, donor $7,976,956, gross resource $15,789,985; sf: Q 0.000000000, donor No finite positive ratio, gross resource No finite positive ratio; gross associated resource budget $197,945.
No Bay beneficiaries: No finite positive ratio per10SF QALYs. all: Q 0.1253611103, donor $7,976,956, gross resource $15,789,985; bay: Q 0.000000000, donor No finite positive ratio, gross resource No finite positive ratio; sf: Q 0.000000000, donor No finite positive ratio, gross resource No finite positive ratio; gross associated resource budget $197,945.
Larger gift capped: $19,818,308 per10SF QALYs. all: Q 0.7208342058, donor $13,872,816, gross resource $27,460,545; bay: Q 0.7208342058, donor $13,872,816, gross resource $27,460,545; sf: Q 0.5045839441, donor $19,818,308, gross resource $39,229,350; gross associated resource budget $1,979,450.
High gross resources: $11,395,651 per10SF QALYs. all: Q 0.1253611103, donor $7,976,956, gross resource $33,738,134; bay: Q 0.1253611103, donor $7,976,956, gross resource $33,738,134; sf: Q 0.08775277722, donor $11,395,651, gross resource $48,197,335; gross associated resource budget $422,945.
Zero dental and counseling discount/hazards: $5,639,511 per10SF QALYs. all: Q 0.2533147470, donor $3,947,658, gross resource $7,814,192; bay: Q 0.2533147470, donor $3,947,658, gross resource $7,814,192; sf: Q 0.1773203229, donor $5,639,511, gross resource $11,163,131; gross associated resource budget $197,945.
Immediate care: $11,375,534 per10SF QALYs. all: Q 0.1255827965, donor $7,962,874, gross resource $15,762,111; bay: Q 0.1255827965, donor $7,962,874, gross resource $15,762,111; sf: Q 0.08790795758, donor $11,375,534, gross resource $22,517,302; gross associated resource budget $197,945.
BP null despite medical activity: $13,444,507 per10SF QALYs. all: Q 0.1062568845, donor $9,411,155, gross resource $18,628,911; bay: Q 0.1062568845, donor $9,411,155, gross resource $18,628,911; sf: Q 0.07437981917, donor $13,444,507, gross resource $26,612,729; gross associated resource budget $197,945.
BP full usual-care replacement: $13,444,507 per10SF QALYs. all: Q 0.1062568845, donor $9,411,155, gross resource $18,628,911; bay: Q 0.1062568845, donor $9,411,155, gross resource $18,628,911; sf: Q 0.07437981917, donor $13,444,507, gross resource $26,612,729; gross associated resource budget $197,945.
BP no latency: $10,809,855 per10SF QALYs. all: Q 0.1321545470, donor $7,566,898, gross resource $14,978,297; bay: Q 0.1321545470, donor $7,566,898, gross resource $14,978,297; sf: Q 0.09250818292, donor $10,809,855, gross resource $21,397,567; gross associated resource budget $197,945.
BP no active effect window: $13,444,507 per10SF QALYs. all: Q 0.1062568845, donor $9,411,155, gross resource $18,628,911; bay: Q 0.1062568845, donor $9,411,155, gross resource $18,628,911; sf: Q 0.07437981917, donor $13,444,507, gross resource $26,612,729; gross associated resource budget $197,945.
BP five-year funded course: $11,310,994 per10SF QALYs. all: Q 0.1262993722, donor $7,917,696, gross resource $15,672,683; bay: Q 0.1262993722, donor $7,917,696, gross resource $15,672,683; sf: Q 0.08840956054, donor $11,310,994, gross resource $22,389,547; gross associated resource budget $197,945.
BP short survival followup: $12,766,175 per10SF QALYs. all: Q 0.1119028589, donor $8,936,322, gross resource $17,689,003; bay: Q 0.1119028589, donor $8,936,322, gross resource $17,689,003; sf: Q 0.07833200125, donor $12,766,175, gross resource $25,270,004; gross associated resource budget $197,945.
Residual null: $23,207,267 per10SF QALYs. all: Q 0.06155707290, donor $16,245,087, gross resource $32,156,337; bay: Q 0.06155707290, donor $16,245,087, gross resource $32,156,337; sf: Q 0.04308995103, donor $23,207,267, gross resource $45,937,625; gross associated resource budget $197,945.
Residual signed harm: $94,031,067 per10SF QALYs. all: Q 0.01519254729, donor $65,821,747, gross resource $130,290,857; bay: Q 0.01519254729, donor $65,821,747, gross resource $130,290,857; sf: Q 0.01063478310, donor $94,031,067, gross resource $186,129,795; gross associated resource budget $197,945.
Residual wider prior: $6,511,852 per10SF QALYs. all: Q 0.2193801945, donor $4,558,297, gross resource $9,022,920; bay: Q 0.2193801945, donor $4,558,297, gross resource $9,022,920; sf: Q 0.1535661362, donor $6,511,852, gross resource $12,889,886; gross associated resource budget $197,945.
No new pathways diagnostic: $31,992,841 per10SF QALYs. all: Q 0.04465284712, donor $22,394,989, gross resource $44,773,181; bay: Q 0.04465284712, donor $22,394,989, gross resource $44,773,181; sf: Q 0.03125699298, donor $31,992,841, gross resource $63,961,687; gross associated resource budget $199,925.

Uncertainty. Weights are subjective elicited priors, not empirical frequencies. Central is not automatically the expectation. Preserve null/harm scenarios; never average ratios after dropping negative outcomes. Generic computational bounds are not credible intervals. A total impact claim beyond these direct-health mechanisms remains unwarranted.

Subjective expectation-weight sensitivity

Favorable15% supplies 82.6%of meanQ. Subjective elicitation, not empirical frequencies: documented ongoing care and waiting demand put most mass on some added but partly replacing activity; central70% represents existing-provider alternatives and mixed clinical need. Favorable15% is a correlated high-need/volunteer-capacity state (severe case mix makes more targets and longer waits, available volunteer capacity lowers course cash cost), not independent success of every optimistic parameter. Cautious10% represents largely low-burden/already-served patients and weak effective delivery; structural null5% reserves complete displacement/no additional activity despite existing operation. These exact probabilities are judgment calls with no calibrated reference class; broad0–30% favorable-weight stress is required, and85%of meanhealth can come from15%tail. They are not evidence of specific funding room.

MEAN HEALTH BEFORE PRICE: E[Q] = Σ w_i Q_i, including negative and zero outcomes; price=10×gift/E[Q_SF]
$2,860,825

QALY conversion assumptions

Central: 0.7 (range: 0.85 / 0.8 / 0.55). Subjective elicitation, not empirical frequencies: documented ongoing care and waiting demand put most mass on some added but partly replacing activity; central70% represents existing-provider alternatives and mixed clinical need. Favorable15% is a correlated high-need/volunteer-capacity state (severe case mix makes more targets and longer waits, available volunteer capacity lowers course cash cost), not independent success of every optimistic parameter. Cautious10% represents largely low-burden/already-served patients and weak effective delivery; structural null5% reserves complete displacement/no additional activity despite existing operation. These exact probabilities are judgment calls with no calibrated reference class; broad0–30% favorable-weight stress is required, and85%of meanhealth can come from15%tail. They are not evidence of specific funding room. Subjective joint-scenario probability.
Favorable: 0.15 (range: 0 / 0.05 / 0.3). Subjective elicitation, not empirical frequencies: documented ongoing care and waiting demand put most mass on some added but partly replacing activity; central70% represents existing-provider alternatives and mixed clinical need. Favorable15% is a correlated high-need/volunteer-capacity state (severe case mix makes more targets and longer waits, available volunteer capacity lowers course cash cost), not independent success of every optimistic parameter. Cautious10% represents largely low-burden/already-served patients and weak effective delivery; structural null5% reserves complete displacement/no additional activity despite existing operation. These exact probabilities are judgment calls with no calibrated reference class; broad0–30% favorable-weight stress is required, and85%of meanhealth can come from15%tail. They are not evidence of specific funding room. Subjective joint-scenario probability.
Cautious: 0.1 (range: 0.1 / 0.1 / 0.1). Subjective elicitation, not empirical frequencies: documented ongoing care and waiting demand put most mass on some added but partly replacing activity; central70% represents existing-provider alternatives and mixed clinical need. Favorable15% is a correlated high-need/volunteer-capacity state (severe case mix makes more targets and longer waits, available volunteer capacity lowers course cash cost), not independent success of every optimistic parameter. Cautious10% represents largely low-burden/already-served patients and weak effective delivery; structural null5% reserves complete displacement/no additional activity despite existing operation. These exact probabilities are judgment calls with no calibrated reference class; broad0–30% favorable-weight stress is required, and85%of meanhealth can come from15%tail. They are not evidence of specific funding room. Subjective joint-scenario probability.
No additional funding: 0.05 (range: 0.05 / 0.05 / 0.05). Subjective elicitation, not empirical frequencies: documented ongoing care and waiting demand put most mass on some added but partly replacing activity; central70% represents existing-provider alternatives and mixed clinical need. Favorable15% is a correlated high-need/volunteer-capacity state (severe case mix makes more targets and longer waits, available volunteer capacity lowers course cash cost), not independent success of every optimistic parameter. Cautious10% represents largely low-burden/already-served patients and weak effective delivery; structural null5% reserves complete displacement/no additional activity despite existing operation. These exact probabilities are judgment calls with no calibrated reference class; broad0–30% favorable-weight stress is required, and85%of meanhealth can come from15%tail. They are not evidence of specific funding room. Subjective joint-scenario probability.

No favorable tail: $13,517,426 donor per10SFQ. Weights central/favorable/cautious/null 0.85/0/0.1/0.05; expected SF Q 0.07397858323; gross resource $26,678,239.
Five percent favorable: $6,030,070 donor per10SFQ. Weights central/favorable/cautious/null 0.8/0.05/0.1/0.05; expected SF Q 0.1658355614; gross resource $11,916,237.
Thirty percent favorable: $1,599,692 donor per10SFQ. Weights central/favorable/cautious/null 0.55/0.3/0.1/0.05; expected SF Q 0.6251204519; gross resource $3,181,344.

No positive-only filtering or average of ratios. Use as elicited expected value, not statistically estimated expectation; rare omitted consequences remain uncertain.

5. Funding and previous grants

Validate ordinary-gift service capacity, patient mix and current-care contrast; measure utilities and linked unique outcomes. Use expectation-weight and residual-null sensitivities before treating the ranking as robust.

FY2025 unaudited primary return has$1,183,897 PartIX expense including$291,013 depreciation plus$38,265 event directcost netted from revenue: combined$1,222,162. These are not a marginal quote or cashflow. Program$872,675,management$173,535,fundraising$137,687 do not disclose specialties. Whole$100K gift remains. BP donor/external annual costs scale with max(1,fundedyears). Residual course/external priors differ by group: acute$1,000/$100,chronic$1,500/$300,referral$3,000/$3,000,otherdental$600/$150,othermental$1,000/$200,food$800/$250. Outside categories exclude donor,volunteer and original-branch/common costs. Full gross associated cost is not a net societal ICER or exhaustive public-cost ledger; funds/food transfers are not automatically resource additions.

This review does not establish a verified marginal funding offer or a complete history of grants.

Donate

Opens the organization’s giving page. A general donation may not fund the specific activity modeled here; confirm allocation with the recipient.

6. Sources

Medical services. Clinic by the Bay. Primary service disclosure. Published: Undated; retrieved: 2026-09-09 UTC.
Dental services. Clinic by the Bay. Primary service and patient-selection disclosure. Published: Undated; retrieved: 2026-09-09 UTC.
Mental health services. Clinic by the Bay. Primary short-term counseling/psychiatry disclosure. Published: Undated; retrieved: 2026-09-09 UTC.
Patient eligibility. Clinic by the Bay. Primary uninsured eligibility. Published: Undated; retrieved: 2026-09-09 UTC.
Dental director recruitment. Clinic by the Bay. Local salary anchor, not funded capacity. Published: Undated; retrieved: 2026-09-09 UTC.
FY2025 Form 990. Volunteers in Medicine - San Francisco / IRS. Primary unaudited return. Published: Year ended 30 June 2025; retrieved: 2026-09-09 UTC.
FY2025 Schedule M. Volunteers in Medicine - San Francisco / IRS. Primary noncash contribution disclosure. Published: Year ended 30 June 2025; retrieved: 2026-09-09 UTC.
Annual reports index. Clinic by the Bay. Primary index only; linked Canva contents unavailable. Published: Undated; links 2025 report; retrieved: 2026-09-09 UTC.
Cost-effectiveness of root canal treatment compared with tooth extraction. Wigsten et al.. Primary nonrandomized Swedish cohort. Published: 2023; retrieved: 2026-09-09 UTC.
Brief psychological therapies versus usual GP care. King, Ward et al.. Primary randomized trial report. Published: 2000; retrieved: 2026-09-09 UTC.
Covered medical services. Healthy San Francisco. Primary local public alternative-care baseline. Published: Undated; retrieved: 2026-09-09 UTC.
Five-year findings: stepped care versus community referral. HDFP Cooperative Group. Primary randomized assignment mortality evidence. Published: 1979; retrieved: 2026-09-09 UTC.
HDFP study record. NHLBI. Primary study design. Published: Study1970s; retrieved: 2026-09-09 UTC.
Oregon Experiment: Medicaid and clinical outcomes. Baicker et al.. Randomized access counterweight: generic care is not assured BP control. Published: 2013; retrieved: 2026-09-09 UTC.
Food pharmacy and CalFresh/EatSF support. Clinic by the Bay. Primary service disclosure; no direct QALY effect measured. Published: Undated; retrieved: 2026-09-09 UTC.

Annual expenses: years and sources

Average annual expenses (three consecutive fiscal years): $1,336,186. Organization size is separate from the modeled cost-effectiveness of a donation.

Volunteers in Medicine - San Francisco dba Clinic by the Bay

Form 990 reported whole-entity expenses; includes program, administration and fundraising costs, but excludes costs netted against revenue.

Fiscal years ended June 30. Current-year total expenses verified in each original return.