The San Francisco Bay Area has a stable, highly educated, relatively affluent, and ethnically diverse population. Although the economy is stronger than in other areas of California and the unemployment rate is lower than the state average, the cost of living is relatively high, including the cost of medical care.

To provide more perspective on the unique challenges facing San Francisco and other large health care markets in California, CHCF asked the Center for Studying Health System Change to produce a regional market study in six areas: Fresno, Los Angeles, Riverside/San Bernardino, Sacramento, San Diego, and the San Francisco Bay Area. These reports are published as part of CHCF's California Health Care Almanac.

Key findings of the San Francisco report include:

• Kaiser Permanente and Sutter Health are the dominant hospital systems in the Bay Area.
• Due to low reimbursements and rising practice costs, physicians are finding it difficult to practice independently and are moving into medical groups or affiliating with hospital systems through foundation models.
• Kaiser and Anthem Blue Cross are the largest health plans in the market, followed by Health Net and Blue Shield of California.
• San Francisco General Hospital and Alameda County Medical Center are the major safety-net hospitals, and a mix of county-run facilities and community health centers provide primary care to the uninsured.

The complete issue brief and an executive summary are available through Document Downloads. An addendum to the brief is included under Related CHCF Pages.