Healthcare in California

This article summarizes healthcare in California.

California State Department of Health Care Services[edit]

The California Department of Health manages state government projects in California.

Health insurance[edit]

As of 2018, most of the insured in California were in plans regulated by the California Department of Managed Health Care (DMHC) with about 60% regulated by either DMHC or the California Department of Insurance (CDI).[1] This dual regulation arose due for historical reasons, and when the DMHC was created in 2000,[2] the California legislature requested a report[2] on merging the health insurer responsibilities with the CDI.[3] Dual regulation has also raised questions around the applicability of premium tax to the DHMC-regulated entities, which have historically not paid premium taxes while CDI-regulated entities have.[4] Value-based pay for performance managed care plans where providers take on risk have arisen, and in 2019 the DHMC announced plans to regulate these "risk-bearing entities".[5]

Medi-Cal[edit]

As of 2018, about one-third of California was covered by Medi-Cal, which is California's Medicaid program. It is administered by the California Department of Health Care Services, which operates it in accordance with California's Medicaid State Plan and Title XIX of the Social Security Act.[6]

Private markets[edit]

As of 2015, about 14.1 million people were insured privately, including in self-funded plans; 1.3 million were in plans regulated by the CDI and 12.7 million were in plans regulated by the DHMC.[7] Kaiser Permanente had about 50% of the market, followed by Blue Shield of California, Anthem Blue Cross, and Health Net (a subsidiary of Centene).[7]

L.A. Care was among the top six in 2015, and the largest county-based insurer.[7] As of 2017, UnitedHealthcare was sixth-largest.[8]

Marketplace[edit]

The health insurance marketplace for California is Covered California.

Kaiser Permanente and Blue Shield of California had about two-thirds of the market share as of 2018.[9] In 2017 Anthem stopped selling on the exchange.[10]

California Hospitals[edit]

California has hospitals serving every part of the state.

Healthcare by region[edit]

Los Angeles[edit]

Los Angeles offers all available health care services. Notable health systems or hospitals in the region include Los Angeles County Department of Health Services, Kaiser Permanente, UCLA Health, Cedars-Sinai, Verity Health, Providence Health, UCI Medical Center, and Keck Hospital of USC.

San Francisco Bay Area[edit]

San Francisco offers all available health care services. Large health systems in Northern California include Sutter Health, Kaiser Permanente, UCSF Health, Dignity Health, and Stanford Medical.[11]

In 2018, a lawsuit was filed against Sutter Health for alleged antitrust.[12]

References[edit]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447696/

https://www.kff.org/health-reform/fact-sheet/the-california-health-care-landscape/

  1. ^ "Issue Brief: Estimates of Sources of Health Insurance in California for 2019" (PDF). California Health Benefits Review Program.
  2. ^ a b "Making Sense of Managed Care Regulation in California" (PDF). California HealthCare Foundation. 2001.
  3. ^ Kelso, J. Clark (2001). "Regulatory Jurisdiction Over Health Insurance Products: The Department of Managed Health Care & The Department of Insurance" (PDF). Archived (PDF) from the original on 2015-09-09. Retrieved 2019-10-12.
  4. ^ "New California Court of Appeal Decision May Impose Premium Taxes on California Health Plans". C&M Health Law. 2015-10-12. Retrieved 2019-11-29.
  5. ^ Oppenheim, Charles B.; Gross | 16-May-2019, Stephanie. "Changes Ahead for California's Managed Care Regulatory Scheme". www.health-law.com. Retrieved 2019-11-29.
  6. ^ "California's Medicaid State Plan (Title XIX)". California Department of Health Care Services.
  7. ^ a b c "The Private Insurance Market in California, 2015". California Health Care Foundation. Retrieved 2019-06-13.
  8. ^ "2019 Edition — California Health Insurers". California Health Care Foundation. Retrieved 2019-10-14.
  9. ^ "Evolving Market Share Of Health Plans In Covered California -". IMK. 2018-10-09. Retrieved 2019-06-13.
  10. ^ Bartolone, Pauline; Gorman, Anna; News, Chad Terhune Kaiser Health. "Anthem's retreat leaves Californians with fewer choices, more worries". The Sacramento Bee. ISSN 0890-5738. Retrieved 2019-06-13.
  11. ^ "Hospital consolidation in California linked to higher health prices - SFChronicle.com". www.sfchronicle.com. 2018-09-05. Retrieved 2019-05-17.
  12. ^ "Suit against Sutter spawns fight with Bay Area hospitals over trade secrets - SFChronicle.com". www.sfchronicle.com. 2018-10-15. Retrieved 2019-05-18.

External links[edit]