California continues to rank among the top 10 states for Public Health and Injury Prevention and has improved in three of the other four categories. However, this large and diverse state suffers from poor overall Access to Emergency Care, with an inadequate supply of medical facilities and low rates of health insurance coverage.
California is a national leader in Public Health and Injury Prevention. It has extremely low rates of adult smoking (13.7%) and obesity (23.8%). California's infant mortality rate (4.7 per 1,000 live births) is among the lowest in the nation, and the infant mortality disparity ratio is better than average. California has implemented strong child safety seat and seat belt legislation, primary enforcement of distracted driving laws, and requires motorcycle helmet use for all riders. These state policies, in concert with the provision of outstanding trauma care in a large state where 97.7% of the population lives within 60 minutes of a Level I or II trauma center, contribute to a low overall rate of traffic fatalities (5.3 per 100,000 people).
California continues to support a favorable Medical Liability Environment and has been rewarded with lower-than-average medical liability insurance premiums, which will help recruit physicians to the state and improve Access to Emergency Care. The state encourages physician apologies by preventing them from being admitted as evidence in a trial. California has enacted a $250,000 cap on non-economic damages in medical liability cases, which helps to control health care costs by keeping medical liability insurance premiums affordable.
California has also improved in Disaster Preparedness since the 2009 Report Card. It is one of only 11 states that has a state budget line item for Disaster Preparedness funding specific to health care surge. In 2011, it conducted more than nine emergency drills per hospital involving hospital personnel, equipment, or facilities. California has been accredited by the Emergency Management Accreditation Program.
California continues to struggle with provider and facility shortages in Access to Emergency Care. Overcrowding and lack of access to needed medical facilities are critical problems for the state. California has the lowest number of emergency departments (ED) per capita (6.7 per 1 million people) and lacks adequate numbers of staffed inpatient beds (223.8 per 100,000 people) and psychiatric care beds (18.3 per 100,000 people). The state also has extremely low rates of orthopedists and hand surgeon specialists (8.5 per 100,000 people) and registered nurses (664.0 per 100,000 people), and has a shortage of physicians accepting Medicare fee-for-service patients. All these factors contribute to high ED wait times, which average 334 minutes (or 5.6 hours) from ED arrival to ED departure for admitted patients.
Financial barriers to care persist in California, impeding access to care. The state has one of the highest rates of adults with no health insurance (22.7%) and a high rate of children with no health insurance (10.8%). It also has moderately high rates of underinsurance for adults (8.2%) and children (18.9%).
While California has regionalized much of its emergency medical services (EMS), there are some key aspects of the Quality and Patient Safety Environment that the state could support, including funding for quality improvement of the EMS system and the development of state field triage protocols. California lacks a statewide trauma registry and a uniform system for providing pre-arrival instructions.
California must work to address a number of issues in Access to Emergency Care, including a gap in medical facilities, financial barriers to care, and long wait times in the emergency department. It should invest in ensuring that its citizens can afford doctor visits. Without a concentrated effort to increase the health care workforce and support adequate facilities, the problem of overcrowding will worsen.
Despite its improved Disaster Preparedness grade, California should consider developing additional statewide systems and procedures to ensure that all citizens are protected in the event of a disaster. California does not have a statewide patient tracking system or a real-time or near realtime syndromic surveillance system. While this kind of surveillance system has been installed in some counties, the state could work to ensure that all counties have access to this technology.
California could also improve its overall emergency care system by enhancing its Medical Liability Environment, including pretrial screening panels or case certification, which would help discourage frivolous lawsuits. Additional liability protection for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA) would help ensure fairness regarding the liability burden placed on emergency care providers and help encourage specialists to be on call for high-risk patients.