The State of Healthcare in California


The State of Healthcare in California

More nurses would help

By Elizabeth Hanink, RN, BSN, PHN
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We Need More Nurses — Tell your friends in Merced not to get sick.

Although the number of RN jobs per capita has increased by 22 since 2004, California’s ratio of nurses to total population still ranks well below the national average. According to the California Institute for Nursing and Health Care’s 2010 California Report Card, which assigned letter grades to 23 regions of the state based on the number of nurses per capita, more than half of California regions received a D or an F.

To earn an A grade, a region must have at least 1,257 nurse jobs per 100,000 persons. The nation as a whole scores a C, with a national average of 860 RN jobs per capita. California lags far behind, with only 644 nurses per 100,000 persons in 2010.

Report Card

The state’s highest mark went to the San Francisco-San Mateo-Redwood City region, which earned a C+ Here is how other California communities scored:

•  C: Redding.

•  C-: Chico-Paradise, Sacramento, San Diego-Carlsbad-San Marcos, San Luis Obispo-Paso Robles, Santa Ana-Anaheim-Irvine, Santa Rosa-Petaluma and Vallejo-Fairfield.

•  D: Los Angeles-Long Beach, Modesto, Oakland-Fremont-Hayward, Riverside-San Bernardino, Salinas, San Jose-Sunnyvale-Santa Clara, Santa Barbara-Santa Maria-Goleta, Santa Cruz-Watsonville, Stockton and Visalia-Tulare-Porterville.

•  F: Bakersfield, Fresno, Merced and Oxnard-Thousand Oaks-Ventura.

Nurse Ratios

Ratios ranged from a low of 195.5 RNs per capita in Merced to a high of 960 in San Francisco-San Mateo-Redwood City. Only the Redding and San Francisco areas were close to or exceeded the national average, with 960 and 857.7 RN jobs per 100,000 respectively. According to Deloras Jones, RN, MSN, CINHC executive director, “This study supports the need to maintain capacity in nursing schools as a high priority, since California lags behind most states in RN utilization. The report card is invaluable for regional planning efforts.”


Only half of us have employer-sponsored health coverage

California now has the largest uninsured population in the United States: 7.1 million Californians under 65 are without health insurance, a number has grown steadily over the past two decades.

Not a Work Perk

Today, only 52 percent of Californians have employer-sponsored insurance, compared to 67 percent in 1987. Public insurance covers some of those without employer-provided coverage, but a whopping 22 percent of Californians are still without health insurance of any kind.

According to the California HealthCare Foundation, nearly one in four California workers has no health insurance and the percentage of California businesses of all kinds that provide health coverage to their employees is lower than the national average. For example, 40 percent of California businesses with fewer than 10 employees offer no health coverage, compared to 36 percent of similarly sized businesses nationwide.

By the Numbers

While many of the uninsured are in lower income brackets, 9 percent of employees with incomes of $75,000 or more still lack health coverage. People of color are also less likely to have insurance: Nearly 60 percent of California’s uninsured population is Latino. Many of the uninsured are children. Even in households with a parent working full-time all year, 54 percent of California children remain without coverage. All of these numbers are expected to change dramatically as the Patient Protection and Affordable Care Act is implemented and transforms the way many people are insured.

For more health coverage statistics and analysis, see the California HealthCare Foundation website at


Not exactly surprising news

Healthcare access, quality and costs vary widely between different California communities and, not surprisingly, higher-income areas are more likely to have better care systems — at least, according to a national study conducted by the Commonwealth Fund. Researchers rated 306 “hospital referral regions” across the country based on health-related markers such as mortality rates from heart attacks. The data, gathered from 2008 to 2010, also includes the percentage of uninsured adults in each region.

How California Ranked

St. Paul, Minn., ranked highest in terms of quality of care. Among the lowest were Shreveport, La., and Jackson, Miss.
Ten California communities were included in the study. Their rankings were:

•  Santa Rosa: sixth
•  San Mateo County: ninth
•  San Francisco: 50th
•  Ventura: 93rd
•  Orange County: 142nd
•  San Diego: 150th
•  Palm Springs/Rancho Mirage: 187th
•  San Bernardino: 220th
•  Los Angeles: 25th
•  Bakersfield: 234th.

According the Los Angeles Times, which published the results of the study on March 14, the Los Angeles area ranked low because 31 percent of residents lack insurance and there is a shortage of preventive care services. However, Los Angeles was among the regions with the fewest unnecessary emergency department visits for Medicare recipients.

The study also found that Los Angeles, Ventura and Orange County all had below-average costs for patients with private insurance. The conclusion? Where you live does make a difference in the healthcare you receive. 

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