Healthcare in Hawaii has come a long way since the beginning of the twentieth century. During its history, it has improved the insurance and medical situation of its citizens, but at the same time it has placed a burden on practicing physicians.
The health of native Hawaiians is of special concern to the scholar of Hawaii’s healthcare, because their immune systems are less capable of coping with most diseases than the whites. When European illnesses were first introduced with Captain Cook in 1778, the Hawaiians lacked the antibodies to combat the diseases. “In 2002, Hawaiians (had) some of the worst health statistics in Hawaii for morbid obesity, substance abuse, depression and other mental illnesses, diabetes, respiratory illnesses, heart disease, cancer mortality” (nativehawaiianhealth.net) Due to the fact that native Hawaiians are generally less wealthy than the state’s average person, they need financial aid to pay insurance premiums. Several organizations throughout the islands, such as Oahu’s “Ke Ola Mano,” have represented and advanced the native Hawaiian healthcare agenda.
Emergency medical services are of paramount importance to local healthcare. The Honolulu Department of emergency services was established in 1908, and chartered its own ambulance service in 1916. When the system first began, ambulance drivers were required to have “a chauffeur's license, high school education or equivalency, American Red Cross First Aid Course, and no felony record.” Over the years, required training in CPR and other modern EMT (Emergency medical technician) functions were also tagged onto the job description. By 1977, we had a federally recognized Emergency medical services program that was considered an example for the rest of the nation. “The 911 system” became statewide with the Big Island’s cooperation in 1996.
Nursing statistics over the past six years has shown a general decrease in the number of nurses working in Hawaii. Measures should be taken to rectify this situation, as hospitals cannot be run without nurses.
Health insurance in Hawaii has generally been considered a success. In 1932, Hawaii’s legislature was already debating the topic of mandatory health insurance. By that time, the pineapple and sugar plantations had already given their employees a form of employment based medical insurance. By 1961, state employees were given a choice between Kaiser, HMSA, and Aethna life plans. In 1974, Hawaii enacted mandatory “employment-based health insurance,” or the (HPHCA: Hawaii prepaid healthcare act.) Nationally, this was the first act to push mandatory minimum healthcare standards for workers. In a 1978 report, the act was deemed successful by the Martin Segal Company. Due to several acts following this ground-breakingly controversial act (like the state health insurance program, passed in 1989), health insurance is potentially available to every Hawaii resident. Although we do not have a perfect insurance system, it is a model by national standards.
Our model health insurance system does take its toll on the livelihoods of doctors. Specialist doctors feel that high liability surgeries are more trouble than they are worth, citing high malpractice litigation. Doctors have argued that Hawaii’s high malpractice law should be reformed to make a career in medicine profitable. Insurance companies sue doctors, who aren’t covered by the state, to cut down their own costs of patient coverage. As far as doctors being properly paid by insurance companies, since most of Hawaii’s residents are covered by HMSA, doctors have little choice but to accept their decreasing reimbursements. Specialists are leaving Hawaii for states where they will make a substantially larger income for their work.
Sources:
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=14593658&dopt=AbstractPlus
http://starbulletin.com/2006/05/16/news/story04.html
http://72.14.253.104/search?q=cache:6czOicnwZlwJ:govinfo.library.unt.edu/ota/Ota_1/DATA/1993/9327.PDF+govinfo.library.unt.edu/ota/Ota_1/DATA/1993/9327.PDF&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a
http://www.co.honolulu.hi.us/esd/ems/emshist2.htm
http://www.nativehawaiianhealth.net/history.cfm
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