Why is California Health Care So Expensive?

The important factors that underlie the pricing problem in California health care include high levels of consolidation of the healthcare industry, limited price oversight, and a high degree of administrative complexity. The state is fighting the high prices charged by doctors and hospitals, and if you don't have insurance because it seemed too expensive the last time you looked for it, it's time to look for it again. A new federal law could make it much cheaper to buy your own insurance if you don't get coverage through an employer or a government insurance program, such as Medicare or Medicaid. The California Health Care Quality and Affordability Act (OHCA) will examine the role of health personnel and assist health care entities with strategies to implement cost-reduction strategies that do not exacerbate existing staff shortages and that promote the stability of health personnel.

Because California is such a large and diverse state, a unique approach to growing per capita costs provides opportunities to adapt metrics to the state's variety of markets and could expose struggling healthcare entities, such as rural or safety net providers, to unintended consequences. The provisions of the OHCA are multifaceted, high-profile and ambitious. That flexibility also applies if you change one Covered California plan to another, but with more restrictions, so check with your health plan before making any changes. These materials are part of the CHCF California Health Almanac, an online exchange center with key data and analysis that describe the state's healthcare landscape.

California's approach to containing health care costs is based on the model that Massachusetts implemented more than a decade ago. The OHCA will publish an annual report together with a public meeting on trends in health care spending and underlying factors, along with policy recommendations to contain costs and maintain or improve the quality and equity of the health system. The application will begin with technical assistance to healthcare entities that do not meet cost targets and could progressively increase to include testimonies at public meetings, performance improvement plans, and the evaluation of financial penalties that could increase over time. This data represents personal health care expenses, which exclude public health activities, administration and investment.

Deputy Director of Communications Alex Stack said that making healthcare more affordable and accessible was a “top priority” for the administration. A health care affordability advisory committee, comprised of stakeholders and appointed by the Board, will provide information on a wide range of topics, including cost objectives. For years, consumer advocates and some legislators have been struggling to curb rising health care costs. This data will be supplemented by additional sources, such as detailed data on claims and encounters from the emerging healthcare payments database.

California Healthline is a service of the California Health Foundation produced by KFF Health News, an editorially independent program of the Kaiser Family Foundation. State spending on health and human services, which includes Medi-Cal, the health program for people with low incomes, represents nearly a third of the state budget. Consumer advocates and health economists say the office has the authority to make health care more affordable, but some of its power was undermined during negotiations.

Buddy Netterville
Buddy Netterville

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