California Health Care Foundation

Over the last 20 years, the Bay Area health care market has consolidated, leaving four dominant systems — Kaiser, Sutter Health, UCSF Health, and Stanford Health Care. At the same time, smaller systems, such as John Muir Health and El Camino Health, play key roles in geographic submarkets, making them attractive partners for the larger systems seeking to expand market share.

The Sacramento area — a region spanning El Dorado, Placer, Sacramento, and Yolo Counties — stands out among other inland California localities in boasting relatively high household incomes and a stable economy. Yet the region's hospital market continues to be dominated by four large health systems, a trend that likely contributes to the area’s high private health insurance premiums.

The San Diego health care market has long been dominated by four health systems: Kaiser Permanente, Sharp HealthCare, Scripps Health, and University of California San Diego Health. Despite significant gains in health coverage, access to care for people with lower incomes, especially for behavioral health services, remains a challenge.

The Los Angeles health care market juggles the needs of more than 10 million people. The vast county includes 88 cities, and the historically fragmented health care sector tends to serve distinct geographic areas where people live and work.

Federally Qualified Health Centers and Rural Health Clinics continue to expand across the region. They are also working with hospitals to improve care integration and access to specialty services for Medi-Cal patients.

Following the implementation of the Affordable Care Act, this region, comprising Riverside and San Bernardino Counties, has seen a decrease in people who are uninsured and an increase in people with Medi-Cal coverage. In turn, the number of Federally Qualified Health Centers has grown, and patient visits more than doubled in just a few years.

The rural North Coast California counties of Humboldt and Del Norte face multiple health and health care challenges, including high death rates from preventable causes and shortages of health care providers. The region is addressing these challenges through strong collaborative efforts.

This paper is one of two cross-site analyses drawn on insights from the seven publications in the 2020 Regional Market Report series. In the post-ACA period, FQHCs have added patients and clinic sites at a rapid pace, and many health centers have increased offerings of specialty services and of care for elderly patients. This paper examines the changing FQHC landscape, focusing on emerging trends and regional differences in FQHCs across the state.

This paper is the second of two cross-site analyses drawn on insights from the seven publications in the 2020 Regional Market Report series. It explores factors contributing to behavioral health access issues, including workforce shortages and the complexity of the Medi-Cal system for behavioral health services. It also highlights efforts to improve and integrate services to Medi-Cal enrollees.