In Fresno, the Road to Health Reform Is Bumpy

(Charles Nadeau/Flickr)

The greater Fresno area may be the most challenging region in California to implement the health care overhaul. Earlier this week a panel of experts gathered at Fresno State to review the issues and consider a path forward. Funding is always a problem, and Fresno is no exception. But in Fresno, collaboration seems to be an even bigger stumbling block.

Peter Cunningham, with the Center for Studying Health Systems Change, first outlined findings from a regional study. For starters, the region encompasses a huge geographic area: five counties (Fresno, Tulare, Kings, Madera and Mariposa) stretch across 16,000 square miles and comprise both urban and very remote rural areas.

In addition to this geographic challenge, the region also faces:

  • High poverty and high uninsurance rates — as well as a high number of undocumented residents — people who are excluded from the benefits of Affordable Care Act, but will still need health care
  • Severe, chronic physician shortages
  • Structural or bureaucratic barriers to reform, specifically a 30-year contract between one hospital and Fresno County to provide care for the poor
“There is no health care policy in Fresno County. We’re in a position of haphazardly approaching this.”

After Cunningham’s presentation, the discussion started off on a note everyone could agree on: more doctors are urgently needed. The region has 118 doctors per 100,000 people, about one-third below the state average of 174.


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