Quality and cost of medical care vary widely among local areas Orange County and Ventura outpaced Los Angeles, San Bernardino and Bakersfield in a national score card looking at how area hospitals, doctors and insurance companies manage patient care and costs. The Commonwealth Fund, a New York foundation that studies the U.S. healthcare market, ranked 306 communities nationwide on key areas of health system performance, such as whether patients are getting timely preventive care and avoiding unnecessary hospital stays and whether healthcare is affordable. The report expands on previous research showing wide variations in the quality and cost of medical care across the country and within states. This marked the first time that the Commonwealth Fund drilled down into the differences among local areas. The report is based on broad areas called hospital referral regions that may cross city and county borders. Overall, more prosperous areas tend to fare better on a wide range of health measures. "Poverty does matter," said Cathy Schoen, coauthor of the report and a senior vice president at the Commonwealth Fund. Local communities with higher rates of poverty over 20% tend to lag behind more affluent communities, particularly for access and preventive treatments. "This report shows where you live in the country largely determines, better or worse, the kind of healthcare you will receive," said Karen Davis, Commonwealth Fund's president. Davis said she hopes policymakers and healthcare industry leaders will examine the best practices from high-performing areas and use them to improve patient care and slow down rising costs. In Southern California, Ventura led the way. It ranked No. 93 nationally, followed by Orange County (142), Palm Springs/Rancho Mirage (187), San Bernardino (220), Los Angeles (225) and Bakersfield (234). In Northern California, Santa Rosa (6) and San Mateo County (9) were among the top 10 nationally in this study. San Francisco (50) and San Diego (150) also ranked in the top half nationwide. Areas of the Upper Midwest and Northeast tended to score highest while many regions of the South fared poorly. Most of the data in the study were from 2008 to 2010. St. Paul, Minn., ranked first overall while Monroe, La., population 270,000, came in last. Los Angeles lagged behind other big metro areas, such as Philadelphia (91), Manhattan (121), Atlanta (166) and Detroit (189). It did outshine Dallas (264), Las Vegas (268) and New Orleans (276). Los Angeles trailed nationally because of its higher-than-average rate of uninsured residents at 31% and the shortage of basic preventive care available for many patients. Only 69% of adults in the Los Angeles area reported having a routine source of medical care, compared with the national median of 82%. But Los Angeles was among the best nationally in avoiding unnecessary emergency-room visits among Medicare beneficiaries, according to the report. The Commonwealth Fund gave Ventura and Orange County higher marks on consumer access to care and for holding down the rate of hospital admissions among Medicare patients, among other items. Los Angeles, Ventura and Orange County all reported below-average costs for patients with private health insurance.