Market for Impact

Summary

What do they do? Operation Access coordinates donated specialty medical care for uninsured adults in California. Volunteer clinicians and participating facilities provide surgery, procedures and diagnostic services, while staff help eligible patients navigate access. Its 2025 annual report describes 1,529 services across 29 counties. More

Why this approach interests us

Donated specialist care can treat painful or disabling conditions that uninsured people would otherwise struggle to address.
Volunteer clinicians and participating facilities supply a substantial complement to the organization’s coordination work.
The program covers several treatable needs, from cataracts and symptomatic surgery to diagnostic follow-up.

Our main reservations

The additional care donations would enable and the recipients’ alternative care are uncertain; average support costs are not purchasable slots.
Most clinical transfers, household payments and restored paid days are planning judgments rather than measured local effects.
Travel and lost pay can offset household gains, and county coverage does not identify the share of benefit reaching SF or the Bay Area.

What do you get for your dollar?

Our conditional estimate is $763K per DALY in the Bay Area and $57.3M for SF recipients. An illustrative $10,000 comparison supports 2.03 completed-service equivalents, or 1.50 course-household equivalents after an approximate repeat-service adjustment. These are modeled additional courses, not a confirmed donation offer; clinical gains are positive and signed household-resource effects are negative centrally. Inspect formulas, inputs and sources. Historical selected-program models.

bay area: $763K — Conditional cost per ten combined health and household-resource equivalents.
san francisco: $57.3M — Separate 8% residence prior; not an extra benefit added to the Bay total.
health only — bay: $7.4M — Household access costs make the combined comparison less favorable.

1. What do they do?

Operation Access coordinates donated specialty medical care for uninsured adults in California. Volunteer clinicians and participating facilities provide surgery, procedures and diagnostic services, while staff help eligible patients navigate access. Its 2025 annual report describes 1,529 services across 29 counties.

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. The model keeps the complete gift in the denominator and assigns native completed-service equivalents once across the clinical mix. It is not a referral model requiring another completion haircut, and it does not establish the impact of every organizational activity.

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

Donated specialist care can treat painful or disabling conditions that uninsured people would otherwise struggle to address.

Key reservations

The additional care donations would enable and the recipients’ alternative care are uncertain; average support costs are not purchasable slots.
Most clinical transfers, household payments and restored paid days are planning judgments rather than measured local effects.
Travel and lost pay can offset household gains, and county coverage does not identify the share of benefit reaching SF or the Bay Area.

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
Ordinary wages of additional survivors; unmeasured secondary activities and comprehensive external resource costs.

4. What do you get for your dollar?

Coordination supports donated care; lasting clinical benefit and household costs determine what it achieves.

GiveBetter sees plausible value in specialist care that relieves untreated symptoms or changes serious disease risks. We estimate $763K per DALY for Bay Area recipients under the current conditional assumptions. The $10,000 comparison models 2.03 completed services and 1.12 genuinely additional course-household equivalents after separating patients who would purchase the same care or receive equivalent free care. Cataract benefit is a first-year trial contrast with a transfer judgment, not an annual gain repeated indefinitely; symptom benefits fade as other patients obtain care, and colorectal mortality uses a finite ten-year comparison. Actual otherwise-paid bills can create buyer savings, whereas unmet patients are not credited with bills they would never have paid. Travel, medication changes and paid recovery/acquisition time are valued separately from clinical benefits.

DALY is our one-year comparison unit. QALY-based health gains and income-welfare equivalents retain their original assumptions; they are not measured clinical DALYs. These are uncertain estimates, not measured returns or verified donation offers.

How we calculate the estimate

Current conditional estimate: donor dollars ÷ (local clinical health years + signed local household-resource equivalents)
Per $10,000: Bay health 0.0136077 + resources -0.0005064 = 0.0131013; $763K per DALY.

Model inputs and assumptions

Completed-service support cost: $1479 (range: Three-year mean-cost stress). Latest Form 990 expenses $2,261,505 divided by 1,529 annual services; coordination/support proxy, not a marginal slot quote or full outside economic cost. Average-cost proxy.
Gift response and capacity: 30% response; cap 20 completed-service equivalents (range: 10%–50% response; null capacity). No current marginal ledger identifies extra care per donation. The software gift domain is not verified funding room. Judgment.
Care recipients would otherwise obtain: 5% purchased; 20% equivalent free; 75% unmet (range: All-purchased/free tests). Purchased/free clinical effects and matching harms cancel. Later-care catchup applies to initially unmet care, not the already-free group again. Judgment.
Clinical effect transfer: Cataract first-year .056 × .75; AUB utility .07 (range: Faster catchup; adverse AUB; inherited utilities). The trial contrasts do not establish local utilities. Uncomplicated gallstone utility is zero centrally but procedural harms remain; CRC uses a finite survival difference. Evidence plus judgment.
Actual household resources: $30,000 baseline; $500 buyer payment; $60 successful medication saving; $25 travel/service (range: Zero/greater savings and additional medicine costs). Actual net disposable resources, not waived hospital charges or shadow-valued time. Known currency and unavailable response-linked effects remain separate. Judgment.
Common-alive paid days: 50% workers; $100 net/day; 1 lost day; 5 recovered cyst days (range: Adverse/greater recovery; zero workers). The worker story supports a possible channel, not a causal coefficient. No baseline wages of additional survivors are added. Judgment.
Recipient residence: Bay 60%; SF 8% (range: Bay 40%–80%; SF 4%–12%). County service reach is not measured patient residence. Attribution occurs once for health and resources. Judgment.

Assumption tests, not confidence limits

central: $763K Bay. Change the named assumption only; inspect the calculator for native and signed components.
lowFunding: $2.3M Bay. Change the named assumption only; inspect the calculator for native and signed components.
threeYearCostOnly: $855K Bay. Change the named assumption only; inspect the calculator for native and signed components.
allPurchased: $1.5M Bay. Change the named assumption only; inspect the calculator for native and signed components.
allFree: No finite positive price Bay. Change the named assumption only; inspect the calculator for native and signed components.
payLoss: $769K Bay. Change the named assumption only; inspect the calculator for native and signed components.
fastCatchup: $16.7M Bay. Change the named assumption only; inspect the calculator for native and signed components.
responseUnknown: No finite positive price Bay. Unavailable response does not become observed zero; independent known travel, buyer payments and lost-pay dollars remain inspectable.

Uncertainty. These are unweighted planning scenarios, not a locally identified posterior. The current model independently reconstructs clinical and household effects rather than adding income inside a fixed inherited total.

Health and income effects

Household resources use the Coefficient Giving welfare crosswalk: 0.5 times the logarithmic change in annual disposable resources, multiplied by people and discounted exposure. Income-welfare equivalents are not measured clinical QALYs. First-year flows use common-alive midpoint survival and resource-only delay/discount controls.

The model splits buyer/free/unmet households, workers/nonworkers and relevant treatment-success/failure groups before logarithmic conversion. Medication savings and successful cyst work share the same response state. Employment and response are assumed independent population incidences; this is not evidence that they actually are independent.

Travel, buyer savings, medication changes, lost pay and recovered pay update the same household baseline sequentially. Buyer savings retain full weight because matching buyer clinical gains already cancel. Other positive medicine/recovery welfare retains 50% for possible overlap, while every negative burden is fully debited. Raw dollars are shown separately and are not discounted by welfare overlap.

Unknown clinical utility, response, cash, pay, reach and locality are separate controls. Unavailable success-dependent savings or recovery do not become zero; known independent dollar routes remain visible even where an unknown preceding baseline prevents complete welfare valuation. With all positive retention removed, known negative losses still persist.

Historical estimate — retained for comparison

The previous unweighted clinical center was $324K Bay/$2.4M SF per DALY. The revised comparison changes the service support normalizer, alternative-care cohorts, finite clinical transfers and signed household resources. It does not preserve the old total by subtracting income from health. All nine original full scenario outputs remain unchanged in the historical calculator and API.

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 0.51 QALYs; same full gift priced against each geographic share.

QALY conversion 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.

central: 0.51367359 national QALYs; $195K donor per DALY. us: Q=0.5136735945144643; donor=$1,946,762; gross resources=$719K per DALY; bay: Q=0.30820415670867857; donor=$3,244,603; gross resources=$1.2M per DALY; sf: Q=0.041093887561157144; donor=$24,334,519; gross resources=$9.0M per DALY
new_pathways_null: -0.00934436 national QALYs; unpriced donor per DALY. us: Q=-0.009344364422171401; donor=unpriced; gross resources=unpriced per DALY; bay: Q=-0.0056066186533028405; donor=unpriced; gross resources=unpriced per DALY; sf: Q=-0.0007475491537737121; donor=unpriced; gross resources=unpriced per DALY
fast_later_care: 0.04646966 national QALYs; $2.2M donor per DALY. us: Q=0.04646966310240659; donor=$21,519,416; gross resources=$7.9M per DALY; bay: Q=0.027881797861443954; donor=$35,865,693; gross resources=$13.2M per DALY; sf: Q=0.0037175730481925273; donor=$268,992,697; gross resources=$99.3M per DALY
zero_activity: 0.00000000 national QALYs; unpriced donor per DALY. us: Q=0; donor=unpriced; gross resources=unpriced per DALY; bay: Q=0; donor=unpriced; gross resources=unpriced per DALY; sf: Q=0; donor=unpriced; gross resources=unpriced per DALY
adverse_new_pathways: -0.12818108 national QALYs; unpriced donor per DALY. us: Q=-0.12818107721082567; donor=unpriced; gross resources=unpriced per DALY; bay: Q=-0.0769086463264954; donor=unpriced; gross resources=unpriced per DALY; sf: Q=-0.010254486176866053; donor=unpriced; gross resources=unpriced per DALY
favorable_joint: 2.15096914 national QALYs; $46K donor per DALY. us: Q=2.150969144084584; donor=$464,907; gross resources=$172K per DALY; bay: Q=1.2905814864507505; donor=$774,845; gross resources=$286K per DALY; sf: Q=0.17207753152676675; donor=$5,811,334; gross resources=$2.1M per DALY
no_local: 0.51367359 national QALYs; $195K donor per DALY. us: Q=0.5136735945144643; donor=$1,946,762; gross resources=$719K per DALY; bay: Q=0; donor=unpriced; gross resources=unpriced per DALY; sf: Q=0; donor=unpriced; gross resources=unpriced per DALY
double_new_resources: 0.51367359 national QALYs; $195K donor per DALY. us: Q=0.5136735945144643; donor=$1,946,762; gross resources=$739K per DALY; bay: Q=0.30820415670867857; donor=$3,244,603; gross resources=$1.2M per DALY; sf: Q=0.041093887561157144; donor=$24,334,519; gross resources=$9.2M per DALY
one_year: 0.28797828 national QALYs; $347K donor per DALY. us: Q=0.2879782775452944; donor=$3,472,484; gross resources=$1.3M per DALY; bay: Q=0.17278696652717665; donor=$5,787,474; gross resources=$2.1M per DALY; sf: Q=0.023038262203623556; donor=$43,406,052; gross resources=$16.0M per DALY

Historical and current prices are distinct planning quantities, not confidence intervals or validated funding offers.

5. Funding and previous grants

Confirm current fully loaded costs, additional service capacity, unique recipients and alternative care. Current operations and financial returns establish the organization, not the marginal productivity of a donation.

The 2025 annual report describes loss of the largest funder, layoffs and subsequent stabilization at a smaller budget. Audited gross spending and waived specialist charges differ from reported Form 990 costs and actual household savings. Comprehensive opportunity costs, marginal capacity and additional portfolio benefits remain unknown.

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.
2023 original Form 990. Operation Access / IRS. Original expense denominator; selected physical pages 1, 9 and 10 reviewed. Published: 2023; retrieved: 2026-10-03.
2024 original Form 990. Operation Access / IRS. Original expense denominator; selected physical pages 1, 9 and 10 reviewed. Published: 2024; retrieved: 2026-10-03.
2025 original Form 990. Operation Access / IRS. Original expense denominator; selected physical pages 1, 9 and 10 reviewed. Published: 2025; retrieved: 2026-10-03.
Cost-effectiveness and health/income comparison. Coefficient Giving. Welfare crosswalk, not local effect evidence. Published: Framework; retrieved: Previously reviewed framework.

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.