Healthcare reform with a safety net: lessons from San Francisco.

Public hospital safety net systems face constant financial constraints, hindering their ability to provide adequate healthcare services. Many healthcare reform proposals would further weaken these systems by redirecting current safety net resources toward private insurance. Despite or perhaps because of this challenging environment, many successes in improving care for poor and vulnerable populations have been pioneered in safety net systems. San Francisco, California, is implementing several innovative programs to strengthen the financial viability of its healthcare safety net while also attempting to improve the access to and the quality of healthcare services.