Here’s the response I received from the county HR Director to my question:
What has the county of San Diego done over the last 5-10 years to keep healthcare costs low?

The County of San Diego has done a number of things to keep health, dental and vision insurance rates low. The following is a sampling of things that have taken place:
- We have gone out to the market, as needed, via RFPs, to ensure that we get the best rates available.
- We self-funded the vision plan resulting in no rate increases since 1999.
- We self-funded one of our pharmacy plans which allows the County to directly receive the rebates from the pharmaceutical companies. This provides a savings of approximately $600K per year.
- We aggressively negotiate with healthcare vendors and keep constant track of the experience for the group. This way we make sure that any proposed rate increase makes sense and is not exaggerated. We also ensure that administrative costs are kept at a minimum.
- The County has a wellness program that includes free flu shots for the employees, partially covered by our vendors, which reduces expenditures caused by flu-related illnesses and increases productivity.
- We have reduced co-pays to $5 per wellness visit for children (Kaiser plan)
- We have adjusted and increased office co-pays and coverage to ensure reasonable rates.
- Through union negotiations, we have increased the employees’ share of the increasing cost of health insurance.
- Unlike many other public agencies, the County does not include retirees in its health plans.
I’m still waiting to hear back from the city.