Faith-based hospitals are playing an increasingly dominant role in California’s healthcare system, now controlling the majority of acute care hospital beds in over a quarter of the state’s counties. Their rapid expansion over the past decade has significant implications for access to care, as many restrict services like abortion, contraception, sterilization, and gender-affirming procedures. These restrictions vary by hospital system, but collectively limit comprehensive reproductive and sexual healthcare options for millions of Californians.
| Procedure or Service | Catholic Facilities (ERDs) | Dignity Health | Adventist Health |
|---|---|---|---|
| Contraception | No | Varies | Yes |
| Assisted reproductive technology | No | No | Yes |
| Elective sterilization | No | Varies | Yes |
| Elective abortion | No | No | No |
| Abortion to treat miscarriage | Varies | Unclear | Varies |
| Abortion in cases of incest or rape | No | Unclear | Varies |
| Referral to abortion service | No | Unclear | Varies |
| Gender-affirming hormone therapy | No | Varies | Varies |
| Gender-affirming surgery | No | Varies | No |
Faith-Based hospitals dominate care in over a quarter of California counties.
To better understand the presence of faith-based hospitals in California, we calculated the percentage of religiously affiliated acute, short-term care hospital beds (market share) by county. We found that five counties have exclusively faith-based acute, short-term care hospitals and that faith-based hospitals have a majority market share in 17 out of 58 counties.
Faith-Based hospitals in California are rapidly expanding their reach.
The number of faith-based hospitals in the top 25 counties (with >25% market share) has grown tenfold from 2011–2021 when compared to the previous decade, rising from 3% to 28% of the hospitals in these counties.
This increased presence is largely due to mergers and acquisitions by faith-based hospital systems that operate via a positive-feedback loop: expanding hospital systems increase their buying power through these acquisitions, which facilitates future acquisitions.
While faith-based hospitals can provide important community services and may reflect the values of a portion of Californians, patients should be able to make informed decisions about which hospitals they visit.
While faith-based hospitals can provide important community services and may reflect the values of a portion of Californians, patients should be able to make informed decisions about which hospitals they visit.