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February 19, 1997

California Public HospitalsThe Buck Has Stopped

JAMA. 1997;277(7):577-581. doi:10.1001/jama.1997.03540310075039

It is often said that California is the most trend-setting state in the nation; what happens first there is supposed to happen soon after in other places. There is ample evidence that this is the case with health care. California has been far ahead of the national curve in the restructuring of the health care system, penetration by managed care, and creative (to say the least) financing of public health services.

California also requires each county to ensure that health care is available to medically indigent legal residents. For decades, that commitment was expressed through county hospitals; in 1964, of 58 counties in the state, 49 had at least 1 public hospital, for a total of 66. Today, the number is 24 hospitals in 17 counties, and both numbers will likely drop further this year; facilities in Los Angeles, Merced, San Luis Obispo, and Stanislaus counties are facing potential closure