California Site Studies

California is large and diverse, and health care is organized, delivered and financed differently across the state. To help inform policy makers, private decision makers, the public and the media about these regional differences, the California HealthCare Foundation (CHCF), as part of California Health Almanac project, has funded the Center for Studying Health System Change (HSC) to conduct in-depth studies of six California regions. The most recent round of site studies was conducted in 2011-12, while the first round was conducted in 2008.

The six regions reflect the range of economic, demographic, health delivery and financing conditions in California. They are the San Francisco Bay Area, Sacramento, Fresno, Los Angeles, Riverside/San Bernardino and San Diego.

The second round of site studies focuses on how the communities’ health care delivery systems have changed since 2008 and how they are preparing for national health reform, including the development of new payment arrangements between providers and health plans. To gather this information, researchers interviewed health care leaders, including representatives of hospitals, physician organizations, community health centers and clinics, health agencies, state and local trade associations, health plan executives, and other knowledgeable observers.

CHCF will publish regional market reports for each community and two cross-site analyses based on findings from the 2011-12 site studies.

2011-12 California Site Studies

From the project’s 2011-12 visits, CHCF has released six regional market reports.

• Los Angeles: Fragmented Health Care Market Shows Signs of Coalescing
• San Diego: Health Care Providers Expand Capacity as Competition Increases for Well-Insured Patients
• San Francisco Bay Area: Health Care Providers Shift Allegiances as Regional Networks Emerge
• Fresno: Health Providers Expand Capacity, but Health Reform Preparation Lags
• Sacramento: Health Providers Collaborate and Weather Economic Downturn
• Riverside/San Bernardino: Vast Region, Market Fragmentation Add to Access Woes

2008 California Site Studies

From the project’s 2008 visits, CHCF released six community reports in July 2009.

In December 2009, the Foundation released five analyses of cross-community trends in health care delivery and finance and analyze the implications of regional variations.

• Shifting Ground: Erosion of the Delegated Model in California
• California's Safety Net: The Role of Counties in Overseeing Care
• A Tighter Bond: California Hospitals Seek Stronger Ties with Physicians
• Managed Care in California: Cost Concerns Influence Product Design

On Feb. 25, 2010, an article titled "Unchecked Provider Clout in California Foreshadows Challenges to Health Reform," was published in the journal Health Affairs.