California's sprawling size and the diversity of its regional healthcare systems result in care that is organized, delivered and financed differently throughout the state, according to new research by the non-profit California HealthCare Foundation.
The CHCF published six regional market reports this week, providing what they say is a first-time, in-depth analysis of six distinct healthcare economies. The organization's goal is to better understand the market dynamics for each region studied (the San Francisco Bay Area, Sacramento, Fresno, Los Angeles, Riverside/San Bernardino and San Diego).
Topics covered in the reports include the supply and organization of hospitals, physicians and other providers and the accessibility of services for low-income residents.
"This project provides a detailed picture of each local healthcare system and identifies common themes and emerging issues that influence how Californians receive healthcare now and in the future," said Marian Mulkey, a CHCF senior program officer.
The reports are the result of a 15-month partnership with the Center for Studying Health System Change, based in Washington, D.C. HSC research teams conducted site visits and interviewed nearly 50 healthcare leaders in each region, including health plan, hospital and medical group representatives, major employers, benefit consultants, insurance brokers, community clinic administrators, consumer advocates and state and local policymakers.
"The contrasts in how local health systems are organized and their responses to challenges, especially caring for uninsured people, are quite striking," said Debra A. Draper, the HSC senior fellow who coordinated the project.
The regional market reports are published as part of the CHCF California Health Care Almanac, an online clearinghouse for key data and analysis examining California's medical system.
The regional findings include:
San Francisco Bay Area
Pressured by low reimbursement and recruitment difficulties, Bay Area physicians are finding independent practice untenable and are moving into medical groups or affiliating with hospital systems.
Sacramento
Sacramento is dominated by powerful hospital systems with significant bargaining leverage over health plans. While they compete vigorously, the degree to which they also cooperate – in areas such as community benefits and research funding – contrasts sharply with many other communities.
Fresno
Fresno's physician workforce is aging and there aren't enough physicians to meet demand. Access to care for the low-income population is hampered by the shortages of healthcare professionals – nurses and dentists are also in short supply.
Los Angeles
Among the Los Angeles market's hospitals, the gap is growing between the financially advantaged "haves" and the disadvantaged "have-nots." The "haves" serve a predominantly affluent and insured population and enjoy leverage with health plans, while the "have-nots" serve largely Medi-Cal and uninsured patients.
Riverside/San Bernardino
The Riverside/San Bernardino region encompasses a vast geographic area, creating significant healthcare access challenges for residents. Hospitals in Riverside and San Bernardino are viewed as competitive, but some collaborate in an effort to keep patients from seeking their care in neighboring Los Angeles, Orange and San Diego counties.
San Diego
San Diego's safety net is fragmented, and the county is widely perceived as having a weak commitment to healthcare for the low-income and uninsured. San Diego County operates the County Medical Services Program as part of its state-mandated responsibilities to provide indigent care, but restrictive eligibility requirements have held down enrollment.