Riverside/San Bernardino: Sprawling Area, Economic Woes Create Access Challenges

Center for Studying Health System Change



The more than 4 million residents of Riverside/San Bernardino represent about 11 percent of the state’s total population. The area’s population has grown rapidly — 34% in the past decade, versus 14% for the state overall — as people moved to the area in search of lower housing costs, especially from neighboring Los Angeles County. The local population is ethnically diverse, with higher proportions of African Americans and Latinos than California as a whole, and roughly comparable levels of household income, poverty, and high school educational attainment.

The recession and housing market collapse have hit the region doubly hard. Many people have lost their homes; Riverside/San Bernardino ranks among the areas with the highest home foreclosure rates in the country. In part because many residents were employed in housing construction and development, the area’s unemployment rate of 11.8% in January 2009 was higher than the statewide rate of 10.6%. Likewise, local residents are more likely to be uninsured than the California average but slightly less likely to be covered by Medi-Cal or other public programs. Residents’ self-reported health status is about average for California.

The Riverside/San Bernardino area has a larger blue-collar workforce than the neighboring counties of Los Angeles, Orange, and San Diego. The largest employers are local governments, hospitals, and universities. A significant number of residents work in the agricultural sector, and many of these workers are reportedly undocumented immigrants. Labor unions are strong in the market’s public and hospital sectors.

Issues to Track

Riverside/San Bernardino encompasses an expansive geographic area, fragmenting the local health care system and creating access challenges for local residents. The recession has had a significant impact on the area, and the number of unemployed and uninsured residents is rising. Riverside/San Bernardino has a significant shortage of physicians, and recruiting physicians to the area is difficult. Health plans are struggling to maintain enrollment given the economic downturn, and employers are seeking relief from high health care costs through less costly coverage options and increased patient cost sharing. Political support for the safety net is strong, but the safety net is challenged to meet the growing demand for services. The following are among the key issues to track:

  • How will the recession affect the Riverside/San Bernardino health care system? Will the two county-owned hospitals continue to have financial stability in the face of the ongoing recession and public budget cuts? Will demand for Medi-Cal coverage continue to increase, and will the health care system be able to meet that demand?
  • Will physician shortages grow — particularly among those willing to serve low-income residents — and how successful will efforts be to address these shortages?
  • Will provider expansion strategies, such as those of Kaiser and Loma Linda, continue? How will this affect residents’ access to care and the outmigration of care to neighboring counties? What will be the response of other providers in the market?
  • How will health plans respond to declining membership? Will the prevalence of CDHPs increase in the face of economic pressures? Will employers continue to downsize health benefits or eliminate them altogether?

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.