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Since 2010, Orange County has largely recovered from the economic downturn and remains a relatively well-educated community with high rates of private insurance coverage overall. Socioeconomic variation persists in this county, with the number of low-income residents growing and a large jump in the proportion of the population that gained Medi-Cal coverage under the Affordable Care Act (ACA).

Other key findings include:

• The region's major hospital systems are expanding ambulatory services and geographic reach.
• Orange County physicians are increasingly giving up independence to varying degrees and joining larger physician organizations or hospital-affiliated groups to gain shelter from mounting financial pressures and administrative burdens.
• Providers are collaborating on new payment arrangements, with some Orange County physician organizations and hospitals working toward assuming more risk for more patients, particularly the growing numbers in preferred-provider organizations (PPOs).
• The proportion of Orange County residents covered by Medi-Cal has jumped, with a greater proportional increase in Medi-Cal enrollment than other California regions studied.
• Safety-net provider capacity is tight; private providers are playing a significant role in serving the Medi-Cal expansion population.