Photo: Riverside University Health System

History of California's Public Health Care Systems

California’s public hospitals and health care systems predate California’s statehood itself.

In 1844, on the outskirts of Monterey, the hospital now known as Natividad Medical Center was established, under contract to the Mexican government.  In 1850, the year California became a state, San Francisco set up a temporary hospital to deal with a cholera outbreak, and would make the hospital permanent in 1857.  Over the next few decades, Los Angeles, Alameda, Santa Clara and San Joaquin would all open county hospitals.

By 1914 almost every county in the state ran a hospital as part of a state-mandated obligation for counties to “relieve and support” those with no other source of care. This responsibility was codified in 1933 through Section 17000 of the state’s Welfare and Institutions Code.  In 1964, there were 66 county hospitals in the state.

In the decades since, a majority of these hospitals have either closed or been turned into private hospitals. A few have remained public institutions by becoming University of California medical centers. Currently there are 21 public health care systems (PHS) in California.

Our Members' Mission

The essential safety net mission and mandate of California’s public health care systems remains to provide the highest possible quality health care to everyone, regardless of insurance status, ability to pay, or other circumstance.

California’s public health care systems are true systems of care, providing a comprehensive range of health care services, including primary care, outpatient specialty care, emergency and inpatient services, rehabilitative services, and in some instances, long-term care. They offer life-saving trauma, burn and disaster-response services, provided by expert medical staff.

These health care systems serve more than 2.85 million patients each year. They are the primary care provider for more than 500,000 Californians who gained Medi-Cal coverage through the expansion, and provide 10 million outpatients visits annually. They operate half of the state’s top-level trauma and burn centers, and train more than half of all new doctors in hospitals across the state.

California’s public health care systems operate in 15 counties where more than 80% of Californians live. Despite accounting for just 6% of the state’s hospitals, they provide 35% of hospital care to Medi-Cal beneficiaries and 40% of hospital care to the remaining uninsured in California.

To achieve and sustain this work, California’s public health care systems recognize they must be models of integrated care that are high value, high quality, patient-centered, efficient and equitable, with great patient experience and a demonstrated ability to improve health care and the health status of populations.

Learn More