OAKLAND, CA – California's sprawling size and the diversity of its regional healthcare systems result in care that is organized, delivered and financed differently throughout the state, according to the non-profit California HealthCare Foundation.

The CHCF has published six regional market reports providing what it says is a first-time analysis of six distinct California healthcare economies. The organization's goal is to better understand the market dynamics for each region studied (the San Francisco Bay area, Sacramento, Fresno, Los Angeles, Riverside/San Bernardino and San Diego).

"This project provides a detailed picture of each local healthcare system and identifies common themes and emerging issues that influence how Californians receive healthcare now and in the future," said Marian Mulkey, a CHCF senior program officer.

The reports are the result of a 15-month partnership with the Center for Studying Health System Change, based in Washington, D.C. HSC research teams conducted site visits and interviewed nearly 50 healthcare leaders in each region, including health plan, hospital and medical group representatives, major employers, benefit consultants, insurance brokers, community clinic administrators, consumer advocates and policymakers.

Topics covered in the reports include the supply and organization of hospitals, physicians, other providers, and the accessibility of services for low-income residents.

"The contrasts in how local health systems are organized and their responses to challenges, especially caring for uninsured people, are quite striking," said Debra A. Draper, the HSC senior fellow who coordinated the project.

For instance, Draper said, San Francisco Bay area physicians, pressured by low reimbursement and recruitment difficulties, are finding independent practice untenable and are moving into medical groups or affiliating with hospital systems. In Fresno, meanwhile, the physician workforce is aging and there aren't enough physicians to meet demand, hampering access to care for the low-income population.

The healthcare safety net in San Diego is also fragmented, according to the reports, and the county is widely perceived as having a weak commitment to healthcare for the low-income and uninsured. Draper said San Diego County operates the County Medical Services Program as part of its state-mandated responsibilities to provide indigent care, but restrictive eligibility requirements have held down enrollment.

The reports also address competition between hospitals in California’s diverse regional economies.

Sacramento is dominated by powerful hospital systems with significant bargaining leverage over health plans, one report notes. While the hospitals compete vigorously, the degree to which they also cooperate – in areas such as community benefits and research funding – contrasts sharply with other communities.

Hospitals in Riverside and San Bernardino are viewed as competitive, but some collaborate in an effort to keep patients from seeking their care in neighboring Los Angeles, Orange and San Diego Counties.

In Los Angeles hospitals, however, the gap is growing between the financially advantaged "haves" and the disadvantaged "have-nots." The "haves" serve a predominantly affluent and insured population and enjoy leverage with health plans, while the "have-nots" serve largely Medi-Cal and uninsured patients.