Studies show California concerned with care costs, physician shortages
A number of regional healthcare trends in California have been identified in new market studies of Sacramento and Riverside/San Bernardino conducted by the Center for Studying Health System Change (HSC) in Washington, D.C., and funded by the California HealthCare Foundation (CHCF).
The studies, which are based on interviews with local healthcare leaders in 2011 and 2012, assess how the financing and delivery of healthcare are changing statewide and provide a snapshot of the healthcare market in each region. Among the most common trends in the two regions studied so far are increased pressure on hospitals to contain costs, growing concerns about physician shortages and strained safety nets.
[See also: Calif. budget crisis pressures providers]
A previous round of California site studies was also conducted in 2008. In the coming months, CHCF will also publish regional market studies of the San Francisco Bay area, Fresno, Los Angeles and San Diego. The reports are published as part of the CHCF California Health Care Almanac, an online clearinghouse for key data and analysis examining California's medical system.
Specifically in Sacramento, hospitals and physicians dealt with the economic downturn fairly well, due in part to the fact that residents have slightly higher education and income levels and a higher proportion of private health insurance than other regions. However, according to the report, there were a number of concerns.
Some of the regions major concerns include an inadequate supply of physicians, particularly primary care physicians, and the reported deteriorating payer mixes because of declining commercial coverage; an uptick in public coverage, smaller commercial payment rate increases; and rising rates of uninsured patients. The report also mentioned an increased pressure on outpatient capacity at safety net providers.
“With the economic downturn driving up the proportion of uninsured people, the fragmented safety net’s outpatient capacity is insufficient to keep pace with demand, in spite of considerable growth in community health centers," said the report.
[See also: California could serve as model for physician payment reform]
Riverside/San Bernardino, on the other hand, has been hard hit by the slow economic recovery and a significant loss of employee-sponsored coverage. According to the report, access to care continues to be a problem for patients with low incomes or those living in remote areas due to the fact that many of the region’s hospitals, physicians and private community health centers are mostly contained in its two largest cities, rather than its rural areas.
There are also growing concerns in the Riverside/San Bernardino region about physician supply. The per capita physician supply in the region is low compared with other California markets, and some observers reported that demand for physicians continues to outpace supply, according to the report.
Much like Sacramento, there are also increased pressures on safety nets in the Riverside/San Bernardino region. “County-run safety net organizations face capacity and financial pressures to care for growing numbers of Medi-Cal and uninsured patients," said the report.
"I think a lot of the concerns outlined in these reports are statewide concerns as well to varying degrees. Certainly, providers in other parts of the country would have similar concerns like the pressures to retain costs and the deteriorating payer mixes with the recession and people losing Medicaid," said Laurie Felland, senior researcher and director of qualitative research at the HSC. "Some issues are a little more pressing to California, like the pressure to redesign facilities for earthquake preparation and Kaiser Permanente's strong presence in the state."
Both the Sacramento and the Riverside/San Bernardino studies mention that Kaiser Permanente's presence has expanded with other providers, including hospitals and physicians. The regions view the growth of the integrated delivery system as their biggest threat to cost containment due to the decrease in market competition.
[See also: California Blue Shield to raise some individual policy rate by 59 percent]
