Center for Studying Health System Change

he Phoenix-Mesa metropolitan statistical area (MSA) covers nearly 38,000 square miles. It includes Maricopa County, with a population of 2.3 million, and Pinal County, which has a population of 126,000. Phoenix and its surrounding suburban areas, including Scottsdale, Sun City, Temple and Mesa, account for approximately 95 percent of the MSA’s population. Known locally as "the Valley," Phoenix is one of the fastest-growing metropolitan areas in the U.S.; its population is projected to increase by nearly 3 percent annually for the next 15 years. Low unemployment and the availability of large tracts of undeveloped land outside the city will contribute to that growth.

Despite Phoenix’s reputation as a retirement community, the proportion of residents over age 65 was only slightly above the U.S. average in 1995.² However, these data may not reflect the area’s "snowbirds," retirees who spend only the winter in Phoenix. The average per capita income and income distribution in Phoenix are similar to national averages, but a higher proportion of Phoenix residents are educated beyond high school. Hispanics account for 17 percent of Phoenix’s population, well above the national average.³ The gross mortality rate was slightly below the U.S. average in 1994, but the infant mortality rate was above the national average for white and non-white residents.⁴

THE HEALTH CARE MARKET

Phoenix has several distinct but overlapping health care markets. The central downtown region, east of Interstate 17 and north of Interstate 10, is home to the area’s largest tertiary hospitals, including Good Samaritan Regional Medical Center, St. Joseph’s Hospital and the Maricopa Medical Center. South Phoenix, directly below the central downtown area, has large concentrations of Hispanic residents and is served by Phoenix Memorial Hospital, Samaritan’s Maryvale facility and Columbia HealthWest. The north Phoenix market, above the downtown area, includes John C. Lincoln Hospital and the Baptist Health System.

The most affluent areas of the Valley include Scottsdale and Paradise Valley, located northeast of downtown and are served by the Scottsdale Memorial Health System. Sun City, in the northwest corner of Phoenix, has a sizable retirement community and is served by the two-hospital Sun Health Corporation. Mesa, Gilbert and Chandler are located east of I-17 and are among the Valley’s most rapidly growing areas. East Phoenix is served by several systems, including the Lutheran Healthcare Network, Desert Samaritan Medical Center, Mesa General Hospital and Chandler Hospital. Tempe, southeast of downtown, is home to Arizona State University and St. Luke’s Tempe Hospital.

The combination of rapid population growth, the absence of an allopathic medical school and a long history of managed health care has helped moderate health care capacity in Phoenix. The MSA has nearly 25 percent fewer hospital beds per 1,000 population than the U.S. average⁵ and about 2 percent fewer physicians per 1,000 than the average for cities with a population of more than 200,000.⁶ Nevertheless, the reach of Phoenix health care organizations extends beyond the MSA boundaries. Samaritan is a 50 percent owner of HealthPartners, an HMO with a statewide market, and the Mayo Clinic draws patients from the surrounding region.

LEADERSHIP AND DECISION MAKING

Respondents characterized the political culture at the state and local levels as anti-tax and anti-entitlement. The widespread perception is that the health care system is driven predominantly by individual decisions made by the market’s many private provider systems and health plans, and that the system works well for most people. Perhaps as a result, many respondents noted a lack of community concern about health care issues. The government’s role centers on financing and delivering care for the poor through the state’s AHCCCS program and the Maricopa County health care system.

There was no consensus among respondents concerning organizations they considered leaders on community health issues. The state legislature, the county Board of Supervisors and the county public health department all influence health care, but they are not perceived as focal points for community health improvement efforts. Respondents noted the influence of the Arizona Hospital Association and Medical Association in the state legislature. They also mentioned that the Flinn Foundation, which focuses 75 percent of its grant making on Arizona health care issues, provides important health-related information to the community. Other groups identified with specific health care issues include the Catholic Diocese, the Arizona Latin American Medical Association, the Children’s Action Coalition and the Area Agency on Aging. However, most respondents said health care advocacy at the grassroots level is limited. The lack of a strong community voice on health issues relevant to the Hispanic population was especially noteworthy.