Market for Impact

Summary

What do they do? Recipient Ambulatory Surgery Access Coalition dba Operation Access, EIN94-3180356, coordinates donated outpatient specialty services for eligible uninsured people.2025reported1,529services across10specialties; these are not distinct patients or diagnosis-specific procedures. More

Why this approach interests us

Coordinated donated specialty treatment can relieve persistent bleeding, neuropathy, obstruction, pain and vision loss across multiple specialties.

Our main reservations

Current specialty totals are known but modern diagnosis frequencies are not. Historical mix, heterogeneous trial comparators, generic utility mapping and no-gift timing require explicit priors.

What do you get for your dollar?

For $100,000, central net health is 0.513674 QALYs nationally. Donor cost per10Q is $1,946,762 US, $3,244,603 Bay and $24,334,519 SF. These are conditional case-mix expectations, not measured OA outcomes. Inspect formulas, inputs and sources. Historical selected-program models.

full gift: $100,000 — All-function coordination cost retained across all10 specialty categories; no inverse allocation uplift.
expanded net health: 0.513674 QALYs — Old3pathways 0.064065; named additions 0.449609. Bay 0.308204 / SF 0.041094.
gross associated resources: $369,105 — All nominal service clinical/support/time resources retained, plus explicit further-treatment allowance; not waived charges or net societal costs.

1. What do they do?

Recipient Ambulatory Surgery Access Coalition dba Operation Access, EIN94-3180356, coordinates donated outpatient specialty services for eligible uninsured people.2025reported1,529services across10specialties; these are not distinct patients or diagnosis-specific procedures.

Allocate current specialty service equivalents

Use complete whole-gift cash and existing specialty costs; no repeated overhead or navigation multiplier.

Use a complete named case-mix ledger

Each specialty sums to100%across old and new pathways, with fractions explicitly assumed rather than observed.

Count finite earlier appropriate treatment

Symptom relief stops with comparator catch-up, recurrence, death or horizon. Diagnosis requires management; acute harm remains.

Scope of this review. Current specialties are verified, but naming a representative diagnosis does not establish actual OA procedure frequency. Expected organization health is conditional on the inspectable case-mix prior. Other assessment2%has explicitzero benefit plus burden.

2. Monitoring and information sharing

OA specialty services, not unique diagnosis cohorts

Current annual report plus historical descriptive study. Current10specialty totals anchor resource allocation; historical within-general-surgery mix informs weak priors only.

Our assessment. Postprocedure yes/no surveys are not utility scores; actual treated waits are not counterfactual waits avoided.

Confirmed CTS and refractory abnormal uterine bleeding

Randomized surgery vs conservative/medical care trials. CTS utility difference at12months was small/nonsignificant; AUB earlier benefit diminished as comparator patients received surgery.

Our assessment. No integrated-QALY misreading, no ablation-vs-hysterectomy comparison substituted for access.

Selected symptomatic patients with organ-specific comparators

TURP, septoplasty, veins, foot and other primary trials. Some procedures improve symptoms; C-GALL/degenerative-knee evidence cautions against generic surgical benefits.

Our assessment. Utility gains, success and diagnosis mix remain explicit priors. No one specialty's efficacy is assigned unchanged to another.

3. Qualitative assessment

Coordinated donated specialty treatment can relieve persistent bleeding, neuropathy, obstruction, pain and vision loss across multiple specialties.

Key reservations

Case-mix hypotheses cover all material specialties but current diagnosis crosswalk is missing.
Medical, splint, pessary and later-surgery alternatives prevent interpreting treatment as lifelong benefit versus no care.
New named pathways increase central health roughlyeightfold; v1three-subset headline was not a whole-organization expected return.
Some pathways have weak primary causal evidence and explicit utility priors; linked diagnostic benefit and severe cancer outcomes remain especially uncertain.

Benefits not included in our estimate

Unverified breast/skin/gynaecologic cancer-survival effects
Repeated full-person health for multiple services or specialties
Money/waived charges or work-productivity gains converted into QALYs
Lifetime symptom benefit after comparator care, recurrence or death
Unestablished benefit of the2%other-assessment category; burden retained

4. What do you get for your dollar?

Named-pathway coverage replaces the three-subset headline

Preserves original finite CRC, cataract and hernia components; adds21named clinical/assessment rows. No generic residual QALY-per-dollar parameter.

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

Each new clinical row: People=whole gift×specialty allocation/cost×diagnostic share×common additional-activity factor÷services/episode×disjoint fraction. Q=people×[success/linkage×signed utility gain×delay discount×finite annuity(catch-up+recurrence+death+discount,H)−acute burden]. Sum all rows and original components; retain whole gift and all nominal clinical resources.
Central 0.5136735945144643 QALYs; same full gift priced against each geographic share.

Model inputs and assumptions

gift usd: 100000 (range: Existing bounded foundation model and v2 scenarios). Reference ordinary unrestricted gift; every dollar retained, not an SF colonoscopy restriction. Foundation source-qualified assumption.
funding additionality: 0.5 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
max additional services: 100 (range: Existing bounded foundation model and v2 scenarios). 100 extra mixed-service cap is an assumption, not identified open appointments. Shared capacity reduces all specialty activity proportionately. Foundation source-qualified assumption.
discount: 0.03 (range: Existing bounded foundation model and v2 scenarios). 3% annual health discount; economic resource amounts are gross associated present-dollar allowances, not a discounted net-social ledger. Foundation source-qualified assumption.
bay share: 0.6 (range: Existing bounded foundation model and v2 scenarios). 60% weak beneficiary-residence prior within Northern California/Central Valley reach. No published specialty-specific county shares verified. Foundation source-qualified assumption.
sf share: 0.08 (range: Existing bounded foundation model and v2 scenarios). 8% weak SF beneficiary-residence prior nested within Bay, not office location or guaranteed restricted allocation. Foundation source-qualified assumption.
independent harm q: 0 (range: Existing bounded foundation model and v2 scenarios). Gift-date PV health loss independent of clinical activity; central0. The preserved historical foundation tested a zero-activity adverse loss of1; this is not one of the nine v2 scenarios. Foundation source-qualified assumption.
outside support per service: 60 (range: Existing bounded foundation model and v2 scenarios). $60 distinct nonclinical donated support per nominal mixed service, rounded from89,922/1,529; not already cash-paid interpretation/travel. Foundation source-qualified assumption.
patient time per service: 100 (range: Existing bounded foundation model and v2 scenarios). $100 additional patient/caregiver time allowance per nominal service, not earnings benefits or OA-paid travel. Foundation source-qualified assumption.
crc treatment cost per selected: 1500 (range: Existing bounded foundation model and v2 scenarios). $1,500 expected downstream therapy/surveillance resource allowance per nominal selectedFIT service, beyond endoscopy resources; weak prior, not provider quote or complete treatment estimate. Foundation source-qualified assumption.
gi allocation: 0.37 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
gi cash per service: 1400 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
gi clinical resource per service: 2500 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
general allocation: 0.13 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
general cash per service: 1700 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
general clinical resource per service: 5500 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
gyne allocation: 0.11 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
gyne cash per service: 1500 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
gyne clinical resource per service: 4500 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
ortho allocation: 0.1 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
ortho cash per service: 1600 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
ortho clinical resource per service: 5000 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
head neck allocation: 0.08 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
head neck cash per service: 1500 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
head neck clinical resource per service: 3500 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
urology allocation: 0.07 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
urology cash per service: 1500 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
urology clinical resource per service: 4000 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
derm allocation: 0.05 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
derm cash per service: 1300 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
derm clinical resource per service: 1800 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
vascular allocation: 0.04 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
vascular cash per service: 1800 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
vascular clinical resource per service: 4500 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
eye allocation: 0.03 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
eye cash per service: 1800 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
eye clinical resource per service: 2500 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
other allocation: 0.02 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
other cash per service: 1500 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
other clinical resource per service: 3000 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
eye selected fraction: 0.65 (range: Existing bounded foundation model and v2 scenarios). 65% of nominal ophthalmology services assumed selected first-eye function-limiting cataract pathway;45observedeye services also include other procedures. Foundation source-qualified assumption.
eye services per person: 1.2 (range: Existing bounded foundation model and v2 scenarios). 1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained. Foundation source-qualified assumption.
eye disjoint fraction: 0.95 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
eye treatment success: 0.9 (range: Existing bounded foundation model and v2 scenarios). Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure. Foundation source-qualified assumption.
eye utility gain: 0.05 (range: Existing bounded foundation model and v2 scenarios). .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. Foundation source-qualified assumption.
eye catchup hazard: 0.7 (range: Existing bounded foundation model and v2 scenarios). .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. Foundation source-qualified assumption.
eye loss hazard: 0.03 (range: Existing bounded foundation model and v2 scenarios). Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality. Foundation source-qualified assumption.
eye mortality hazard: 0.02 (range: Existing bounded foundation model and v2 scenarios). All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway. Foundation source-qualified assumption.
eye horizon years: 3 (range: Existing bounded foundation model and v2 scenarios). At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit. Foundation source-qualified assumption.
eye delay years: 0.25 (range: Existing bounded foundation model and v2 scenarios). Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only. Foundation source-qualified assumption.
eye harm q per person: 0.002 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
hernia selected fraction: 0.45 (range: Existing bounded foundation model and v2 scenarios). 45% of nominal general-surgery services assumed selected symptomatic hernia episodes;201general services are not201hernias. Foundation source-qualified assumption.
hernia services per person: 1.2 (range: Existing bounded foundation model and v2 scenarios). 1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained. Foundation source-qualified assumption.
hernia disjoint fraction: 0.9 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
hernia treatment success: 0.85 (range: Existing bounded foundation model and v2 scenarios). Clinical success/transfer judgment, not observed OA success or the96%self-reported broadquality-of-life figure. Foundation source-qualified assumption.
hernia utility gain: 0.04 (range: Existing bounded foundation model and v2 scenarios). .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. Foundation source-qualified assumption.
hernia catchup hazard: 0.7 (range: Existing bounded foundation model and v2 scenarios). .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. Foundation source-qualified assumption.
hernia loss hazard: 0.08 (range: Existing bounded foundation model and v2 scenarios). Recurrence or loss-of-benefit hazard prior, separate from eventual comparator care and mortality. Foundation source-qualified assumption.
hernia mortality hazard: 0.02 (range: Existing bounded foundation model and v2 scenarios). All-cause competing mortality hazard prior during symptom gain. No mortality benefit claimed for this pathway. Foundation source-qualified assumption.
hernia horizon years: 3 (range: Existing bounded foundation model and v2 scenarios). At most three years of possible postprocedure symptom difference centrally; no permanence claim. Later care and recurrence shorten expected benefit. Foundation source-qualified assumption.
hernia delay years: 0.25 (range: Existing bounded foundation model and v2 scenarios). Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only. Foundation source-qualified assumption.
hernia harm q per person: 0.004 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
crc selected fraction: 0.5 (range: Existing bounded foundation model and v2 scenarios). 50% of nominal GI services assumed abnormal-FIT follow-up;575GI services are not575positiveFIT patients. Foundation source-qualified assumption.
crc services per person: 1.2 (range: Existing bounded foundation model and v2 scenarios). 1.2 service-equivalents per unique selected patient-episode planning prior; avoids service=person. All associated service costs retained. Foundation source-qualified assumption.
crc disjoint fraction: 1 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
crc treatment linkage: 0.7 (range: Existing bounded foundation model and v2 scenarios). 70% judgment chance that necessary appropriate downstream management can deliver the modeled contrast. Diagnostic completion alone earns no full treatment gain. Foundation source-qualified assumption.
crc annual fatal hazard reduction: 0.0006 (range: Existing bounded foundation model and v2 scenarios). .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. Foundation source-qualified assumption.
crc baseline total mortality hazard: 0.025 (range: Existing bounded foundation model and v2 scenarios). .025/year all-cause hazard prior already includes CRC mortality. Only the modeled CRC component changes; no second mortality hazard added. Foundation source-qualified assumption.
crc catchup hazard: 0.5 (range: Existing bounded foundation model and v2 scenarios). .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. Foundation source-qualified assumption.
crc latency years: 2 (range: Existing bounded foundation model and v2 scenarios). Two-year assumed lag from procedure to differential fatal risk. Not observed OA survival timing; existing alternative care can catch up during this lag. Foundation source-qualified assumption.
crc active years: 5 (range: Existing bounded foundation model and v2 scenarios). Five years of possibly different fatal hazard after latency, not five avoided deaths or a life expectancy. Foundation source-qualified assumption.
crc horizon years: 10 (range: Existing bounded foundation model and v2 scenarios). Ten-year finite survival observation from procedure; both arms return to common mortality after the hazard-effect window. No lifetime tail. Foundation source-qualified assumption.
crc delay years: 0.25 (range: Existing bounded foundation model and v2 scenarios). Quarter-year procedure delay; cohort already conditioned alive at service start, so delay discounts only. Foundation source-qualified assumption.
crc surviving utility: 0.75 (range: Existing bounded foundation model and v2 scenarios). .75 utility for extra surviving person-time; no extra cancer morbidity or household benefit. Foundation source-qualified assumption.
crc harm q per person: 0.001 (range: Existing bounded foundation model and v2 scenarios). 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. Foundation source-qualified assumption.
Non-FIT GI investigation → benign treatable dyspepsia/dysphagia management: Share0.5; gain0.03; response/linkage0.4; harm0.001; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources200/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Diagnostic procedure alone earns no cure; treatment linkage is a prior, alternative primary-care therapy remains baseline. Explicit diagnostic mix and utility prior.
Painful cyst/lipoma excision: Share0.225; gain0.025; response/linkage0.85; harm0.002; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Current OA procedure explicitly listed; utility and symptom-limiting fraction are priors, not cosmetic benefit. Explicit diagnostic mix and utility prior.
Symptomatic haemorrhoid/fissure treatment: Share0.12; gain0.05; response/linkage0.8; harm0.004; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Historical minor anorectal mix only; assume persistent symptoms despite medical management. Explicit diagnostic mix and utility prior.
Uncomplicated symptomatic gallstone surgery: Share0.065; gain0.01; response/linkage0.7; harm0.005; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). C-GALL control includes later surgery; nonsignificant small integrated QALY difference; conservative care may suffice. Explicit diagnostic mix and utility prior.
Breast lesion diagnostic assessment and linked benign symptom treatment: Share0.14; gain0.01; response/linkage0.25; harm0.001; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources200/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). No unverified cancer survival gain. Prior only for changed symptom management, not all negative tests. Explicit diagnostic mix and utility prior.
Refractory abnormal uterine bleeding → definitive outpatient treatment: Share0.65; gain0.1; response/linkage0.8; harm0.015; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Ms trial supports surgery vs expanded medical care; no hysterectomy-vs-ablation transfer, fertility/recovery losses retained. Explicit diagnostic mix and utility prior.
Symptomatic pelvic prolapse/incontinence treatment: Share0.25; gain0.07; response/linkage0.7; harm0.01; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Case-mix and utility priors, not confirmed OA frequency; pessary/conservative alternatives retained. Explicit diagnostic mix and utility prior.
Gynaecologic diagnostic workup → nonmalignant symptom management: Share0.1; gain0.02; response/linkage0.3; harm0.002; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources200/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Diagnosis without management has zero benefit through linkage; no automatic cancer cure. Explicit diagnostic mix and utility prior.
Carpal tunnel decompression for symptomatic confirmed CTS: Share0.35; gain0.03; response/linkage0.8; harm0.004; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Primary economic trial .04 at12months is nonsignificant point utility, not integrated QALY. .03 here is an independent transfer prior. Explicit diagnostic mix and utility prior.
Painful foot deformity / tendon or trigger-finger intervention: Share0.45; gain0.06; response/linkage0.75; harm0.005; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). 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. Explicit diagnostic mix and utility prior.
Degenerative knee arthroscopy without acute mechanical indication: Share0.2; gain0; response/linkage0.8; harm0.006; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Null benefit central, not assume all orthopaedic surgery is useful; harm retained. Explicit diagnostic mix and utility prior.
Septal nasal obstruction surgery versus nasal medical therapy: Share0.7; gain0.04; response/linkage0.8; harm0.004; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). NAIROS validates symptom mechanism, not SNOT22-to-QALY conversion or universal ENT benefit. Explicit diagnostic mix and utility prior.
Conductive ear disease treatment: Share0.3; gain0.03; response/linkage0.7; harm0.003; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources200/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Clinical indication and utility priors; no all-ENT survival credit. Explicit diagnostic mix and utility prior.
Bothersome BPH/outlet obstruction treatment: Share0.45; gain0.06; response/linkage0.8; harm0.006; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). TURP vs watchful waiting trial supports symptom relief, not current OA frequency; modern medication baseline matters. Explicit diagnostic mix and utility prior.
Symptomatic urinary stone treatment: Share0.35; gain0.05; response/linkage0.75; harm0.005; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources200/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). No prophylactic life-saving claim for asymptomatic stones; spontaneous passage and medical treatment in comparator. Explicit diagnostic mix and utility prior.
Symptomatic benign scrotal/hydrocele treatment: Share0.2; gain0.025; response/linkage0.75; harm0.004; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Indication and finite utility priors; no infertility or cancer mortality award. Explicit diagnostic mix and utility prior.
Symptomatic benign skin cyst/lesion treatment: Share0.8; gain0.02; response/linkage0.8; harm0.002; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Current OA cyst/lipoma service; disjoint allocation from general surgery required. Explicit diagnostic mix and utility prior.
Localized skin lesion diagnosis and treatment: Share0.2; gain0.03; response/linkage0.6; harm0.003; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources200/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Symptom/functional relief only; no melanoma mortality extrapolation. Explicit diagnostic mix and utility prior.
Symptomatic uncomplicated varicose vein treatment: Share1; gain0.04; response/linkage0.8; harm0.003; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). REACTIV randomized conservative comparator; integrated two-year .054Q not annual gain. Explicit diagnostic mix and utility prior.
Symptomatic pterygium treatment: Share0.35; gain0.025; response/linkage0.8; harm0.003; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Current OA explicitly offered; first-eye cataract cohort excluded; finite symptom/vision utility prior. Explicit diagnostic mix and utility prior.
Specialty assessment without established diagnosis-changing intervention: Share1; gain0; response/linkage0; harm0.0005; services/person1.2; distinct0.85; catch-up0.7; loss0.1; death0.02; H3; delay0.25; extra resources0/nominal service (range: Signed gains−1..1, horizons0..30; scenarios expose null/adverse/fast-catch-up). Only2%wholegift allocation; centralzero benefit explicitly due absent disease/intervention evidence, not blanket residual zero for major specialties. Explicit diagnostic mix and utility prior.

Whole $100,000 in every geographic denominator

central: 0.51367359 national QALYs; $1,946,762 donor/10Q. us: Q=0.5136735945144643; donor=$1,946,762; gross resources=$7,185,600 per10Q; bay: Q=0.30820415670867857; donor=$3,244,603; gross resources=$11,976,000 per10Q; sf: Q=0.041093887561157144; donor=$24,334,519; gross resources=$89,819,997 per10Q
new_pathways_null: -0.00934436 national QALYs; unpriced donor/10Q. us: Q=-0.009344364422171401; donor=unpriced; gross resources=unpriced per10Q; bay: Q=-0.0056066186533028405; donor=unpriced; gross resources=unpriced per10Q; sf: Q=-0.0007475491537737121; donor=unpriced; gross resources=unpriced per10Q
fast_later_care: 0.04646966 national QALYs; $21,519,416 donor/10Q. us: Q=0.04646966310240659; donor=$21,519,416; gross resources=$79,429,301 per10Q; bay: Q=0.027881797861443954; donor=$35,865,693; gross resources=$132,382,168 per10Q; sf: Q=0.0037175730481925273; donor=$268,992,697; gross resources=$992,866,264 per10Q
zero_activity: 0.00000000 national QALYs; unpriced donor/10Q. us: Q=0; donor=unpriced; gross resources=unpriced per10Q; bay: Q=0; donor=unpriced; gross resources=unpriced per10Q; sf: Q=0; donor=unpriced; gross resources=unpriced per10Q
adverse_new_pathways: -0.12818108 national QALYs; unpriced donor/10Q. us: Q=-0.12818107721082567; donor=unpriced; gross resources=unpriced per10Q; bay: Q=-0.0769086463264954; donor=unpriced; gross resources=unpriced per10Q; sf: Q=-0.010254486176866053; donor=unpriced; gross resources=unpriced per10Q
favorable_joint: 2.15096914 national QALYs; $464,907 donor/10Q. us: Q=2.150969144084584; donor=$464,907; gross resources=$1,715,995 per10Q; bay: Q=1.2905814864507505; donor=$774,845; gross resources=$2,859,992 per10Q; sf: Q=0.17207753152676675; donor=$5,811,334; gross resources=$21,449,941 per10Q
no_local: 0.51367359 national QALYs; $1,946,762 donor/10Q. us: Q=0.5136735945144643; donor=$1,946,762; gross resources=$7,185,600 per10Q; bay: Q=0; donor=unpriced; gross resources=unpriced per10Q; sf: Q=0; donor=unpriced; gross resources=unpriced per10Q
double_new_resources: 0.51367359 national QALYs; $1,946,762 donor/10Q. us: Q=0.5136735945144643; donor=$1,946,762; gross resources=$7,393,443 per10Q; bay: Q=0.30820415670867857; donor=$3,244,603; gross resources=$12,322,406 per10Q; sf: Q=0.041093887561157144; donor=$24,334,519; gross resources=$92,418,041 per10Q
one_year: 0.28797828 national QALYs; $3,472,484 donor/10Q. us: Q=0.2879782775452944; donor=$3,472,484; gross resources=$12,817,123 per10Q; bay: Q=0.17278696652717665; donor=$5,787,474; gross resources=$21,361,871 per10Q; sf: Q=0.023038262203623556; donor=$43,406,052; gross resources=$160,214,031 per10Q

Uncertainty. Within-specialty diagnosis mix is not measured. This is a conditional expected whole-organization model, not a confidence interval or claim that all named procedures are currently supplied at these frequencies.

5. Funding and previous grants

No verified marginal procedure mix, distinct-patient wait comparison or complete treatment linkage. Even joint favorable national donor scenario is about$465k/10Q.

Current cash-like expense and all-service donated clinical resources are retained from the audited foundation. No additional slots or restricted offer is verified. New health does not add duplicate hospital costs; six follow-on diagnostic/treatment rows add$200per nominal service. Gross associated resources are not net induced costs, and no public reimbursement or waived-charge saving is subtracted.

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

2025 audited financial statements. Operation Access. Primary audited whole-organization expense, waived-charge accounting, liquidity and restrictions; relevant PDF7–8,14–15 visually verified.. Published: Year ended December31,2025; auditMay20,2026; retrieved: September9,2026.
2025 annual report. Operation Access. Primary specialty counts/chartPDF7, funding lossPDF2, wait/readinessPDF6, cash financePDF13. Counts are services, not unique people or measured health.. Published: 2025 reporting year; retrieved: September9,2026.
2026 budget. Operation Access. Primary1.9million cash plan, not actual2026 unit cost or procedure target.. Published: ApprovedDecember10,2025; retrieved: September9,2026.
Patient eligibility and procedures. Operation Access. Uninsured and ineligible fullMedi-Cal/Medicare/CMSP; cataract and hernia procedures explicitly offered; not insurance.. Published: Current undated; retrieved: September9,2026.
Donate. Operation Access. Official ordinary donation route and EIN94-3180356. Waived-dollar fundraising leverage is not QALY evidence.. Published: Current undated; retrieved: September9,2026.
OA facilitated donated colonoscopy. California Colorectal Cancer Coalition. Primary referral mechanism; above-average risk/positive stool tests; not575verifiedFITcases.. Published: Current undated; retrieved: September9,2026.
First-eye cataract randomized economic evaluation. Sach et al.. 306women over70, expedited4weeks vsroutine12months; first-yearQALYdifference.056(.006,.108), integratedyear—not annualutilityorOAlocalestimate.. Published: 2007; retrieved: September9,2026.
Watchful waiting versus repair. Fitzgibbons et al.. 720minimallysymptomatic men;2-yearpain/physicalfunction differences notsignificant;23%watchfulwaiting crossed torepair. Strong warning against assuming allhernias benefit.. Published: 2006; retrieved: September9,2026.
Mortality after positive FIT without program colonoscopy. Zorzi et al.. Observational10-yearCRC mortality6.8vs16per1000. Not randomization, no directly imported hazardorQALY.. Published: 2021; retrieved: September9,2026.
Immortal-time concern in positive-FIT mortality comparison. Methodological correspondence. Primary methodological criticism; exposure timing/selection biases not assumed solved.. Published: 2023; retrieved: September9,2026.
Navigation after abnormal stool test trial. PRECISE investigators. 967analysis;55.1vs42.1%one-yearcompletion. Not multiplied into already-completed OAservice units.. Published: 2025; retrieved: September9,2026.
Medi-Cal eligibility changes. California DHCS. Public coverage remains baseline when available; no assertion alluninsured have no latercare.. Published: 2026; retrieved: September9,2026.
Surgery versus splinting economic evaluation. Korthals-de Bos et al.. Primary economic RCT; 12-month utility point difference, not integrated QALYs. Published: 2006; retrieved: September 9, 2026 UTC.
Medicine or Surgery randomized trial. Kuppermann et al.. Primary hysterectomy vs expanded medical treatment; not ablation comparator. Published: 2004; retrieved: September 9, 2026 UTC.
TURP versus watchful waiting. Wasson et al.. Primary randomized clinical trial; contemporary medication baseline differs. Published: 1995; retrieved: September 9, 2026 UTC.
Septoplasty versus medical management. NAIROS investigators. Primary trial and economic report; SNOT22 not utility. Published: 2024; retrieved: September 9, 2026 UTC.
Varicose veins randomized clinical/economic trial. REACTIV investigators. Primary integrated two-year QALY estimate, not annual utility. Published: 2006; retrieved: September 9, 2026 UTC.
Conservative treatment versus cholecystectomy. C-GALL investigators. Primary randomized report; small nonsignificant QALY difference. Published: 2024; retrieved: September 9, 2026 UTC.
Painful hallux valgus surgery versus orthosis/wait. Torkki et al.. Primary randomized trial; selected painful bunion patients. Published: 2001; retrieved: September 9, 2026 UTC.
Hallux valgus two-year randomized follow-up. Torkki et al.. Primary later-care catch-up; no persisting difference assumed. Published: 2003; retrieved: September 9, 2026 UTC.
Pessary versus surgery for prolapse. van der Vaart et al.. Primary randomized trial with substantial crossover; neither arm no care. Published: 2022; retrieved: September 9, 2026 UTC.
Degenerative meniscus surgery versus sham. Sihvonen et al.. Primary sham-controlled trial; central benefit null for this assumed subset. Published: 2013; retrieved: September 9, 2026 UTC.
Historical OA services1994–2008. Matula et al.. Primary descriptive study; root visually verified diagnosis table, no current frequencies or QALY outcome. Published: 2009; retrieved: September 9, 2026 UTC.
Actual refractory uterine bleeding and donated hysterectomy pathway. Operation Access / treating partner Sutter Health. Primary provider account; activity evidence only, not diagnosis frequency or mean causal outcome. Published: 2023; retrieved: September 9, 2026 UTC.

Annual expenses: years and sources

Average annual expenses (three consecutive fiscal years): $2,532,800. Organization size is separate from the modeled cost-effectiveness of a donation.

Ambulatory Surgery Access Coalition dba Operation Access

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

Calendar years ended December 31. Reported organization expenses do not add the fundraising valuation of donated specialist services.