Note: Figures in Table 8 of the report and of the Quick Reference Guide were corrected, and new versions of these documents were posted on December 16, 2020. 

The rural North Coast California counties of Humboldt and Del Norte face multiple health and health care challenges, including high death rates from stroke, accidents, suicide, and alcohol and drug use; severe shortages of health care professionals in primary care and behavioral health; and limited access to care in remote areas.

To work on solving these and other challenges, the region joins as a community, including in collaborations to keep clinicians in the area and to expand treatment for mental health and substance use disorder (SUD). Passage of the Affordable Care Act, particularly expansion of Medi-Cal, has helped expand access to care and stabilize health care providers’ finances as the share of people without health insurance declined markedly.

However, the cost of private health insurance is high and rising rapidly. Like other California communities and the nation as a whole, the region faces significant disruptions from the COVID-19 pandemic but avoided an initial surge in cases by quickly mobilizing to stem the virus’s spread.

Summary of Findings

Key factors affecting the local health care market include:

• A stagnant economy, high poverty rates, and the health consequences of long-term alcohol, tobacco, and drug use. After peaking as a logging center in the 1990s, the region has struggled to diversify economically. The all-cause death rate in Humboldt County is about one-third higher than statewide, and almost 60% of people get health coverage through Medi-Cal or Medicare, compared with 45% statewide.
• Erosion of independent physician practice. The retirement of a generation of local doctors, higher costs associated with running a practice, such as the expense of electronic health records, and increased complexity of billing and regulatory requirements have contributed to an exodus of independent physicians in private practice, who have largely disappeared from the region.
• A severe shortage of health care professionals, especially in primary care and behavioral health. Driven by the retirement of local doctors and difficulty recruiting physicians and other clinicians, the workforce shortage makes providing access to care in remote areas extremely challenging. The community has come together to create a wide-ranging plan to fill the gap, from creating a family residency program for new physicians to offering training opportunities for locals interested in health care careers.
• Leadership from a local nonprofit on data exchange to improve care and community health outcomes. Launched as an effort to connect health care providers in the area, the region’s health information exchange in recent years has moved to cross-sector data exchange with human services agencies in support of community health outcomes. The resulting community care coordination platform serves approximately 1,400 clients with complex needs across Humboldt County, linking hospitals and emergency departments with local social service and criminal justice agencies.
• Strong community collaboration — anchored by the region’s Medi-Cal health plan, largest Federally Qualified Health Center, and dominant hospital — to address provider shortages and expand access to mental health and SUD treatment. In response to ongoing shortages and recruitment challenges, the community has adopted a “grow your own” health workforce strategy that has broad engagement from the health sector, educational institutions, and local government. Similarly, the community has collaborated on multiple initiatives to improve access to mental health services and SUD treatment, especially in light of the opioid epidemic’s devastating impact on the area.

Since 2009, CHCF has published a series of regional market studies that examine the health care markets in specific regions across California. These studies highlight the range of economic, demographic, and health care delivery and financing conditions in California. They are published as part of the CHCF California Health Care Almanac, an online clearinghouse for key data and analyses examining California’s health care system.

About the Authors

Jill Yegian, PhD, is principal of Yegian Health Insights, and a Blue Sky Consulting Group affiliate; and Katrina Connolly, PhD, senior consultant of Blue Sky Consulting Group. Blue Sky Consulting Group helps government agencies, nonprofit organizations, foundations, and private-sector clients tackle complex policy issues with nonpartisan analytical tools and methods.