What is the current situation regarding healthcare in Hawaii?

In general, Hawaii has ranked fairly high for healthcare over the past few decades. In fact, an article published by WebMD (via CBS News) on June 13, 2007 revealed that Hawaii is currently the best state for healthcare – it scored two to three times higher than the lowest ranked states. The poll, taken by the Commonwealth Fund, was based on many factors, including access, quality, cost, insurance, preventive care, potentially avoidable hospital visits, and premature death. Hawaii's top ranking is probably due to its increasing number of insured adults. "In general, states that did well in the overall rankings had the lowest rates of uninsured in the nation," Cathy Schoen, the Commonwealth Fund's senior vice president, said. Hawaii was the first state to make it mandatory for employers to provide health insurance. This, along with our relatively low unemployment rate (2.6% in July), means that Hawaii has a fairly high number of employed, insured people. In fact, a related Star Bulletin article regarding the Commonwealth Fund poll stated that nearly 90% of Hawaii’s working adults are now insured. Furthermore, the rate of uninsured children was cut from 10% in 2000 to 5% in 2005. As long as Hawaii's number of insured residents remains steady or continues to increase, Hawaii may maintain its leading rank in healthcare.

Another aspect of Hawaii's healthcare that stands out is its accessibility (Hawaii ranked first in this category). This can be largely attributed to the state's prepaid health care act. Furthermore, a report from the National Center for Health Statistics (NCHS) showed that from 1994 to 2003, Medicaid took action to increase the number of healthcare recipients in Hawaii, resulting in a jump from 41,000 to 209,000. Also in the last decade, the percentage of the population registered in Health Maintenance Organizations (HMOs) has grown to 37.5% (final estimate made in 2005), which is higher than ever before. These accounts illustrate how Hawaii is taking steps towards making healthcare more accessible. Another strong point for Hawaii is its inpatient care. For example, Hawaii ranked fourth for avoidable hospital use and costs, eighth for healthy lives, and eighteenth for quality of care. It also has the lowest rate of breast cancer deaths and came in sixth for lowest in colorectal cancer deaths.

But Hawaii is not without its faults. As the Commonwealth Fund study showed, even for the highest ranked states, the performance fell "far short of optimal standards" in key areas. There are some noticeable categories in which Hawaii lacks strength. Our state was 49th for surgical patients receiving appropriately timed antibiotics, 47th for heart-failure patients given written discharge instructions, 44th for hospitalized care of patients with myocardial infarction, congestive heart failure and pneumonia, and 41st for the percentage of 50+ adults receiving recommended preventive treatment “We fell down in the area of patient education and hospital discharge planning and we need to look at a better job of screening and preventive care for adults over age 50,” said Loretta Fuddy, the state Health Department deputy director for administration. We should focus much of our efforts on improving and fixing these issues if we want to improve healthcare for the state.

Another issue Hawaii has been challenged with is having a large number of waitlisted patients. We have one of the lowest ratios of beds per population in the country (approximately 1.9 beds per 1,000 people in 2005). This allows for little flexibility, which causes dilemmas during heavy situations such as the flu season. This problem greatly affects the elderly, as they make up the majority of waitlisted patients. Currently, the Healthcare Association of Hawaii is trying to ease this problem. Another issue is the decreasing number of local doctors. An article from The Honolulu Advertiser sites that there has been a 29% drop in the number of orthopedic surgeons and a 9% drop in the number of obstetricians in the past few years, and these percentages are expected to increase. This is mainly due to doctors quitting and retiring because of the high cost of malpractice insurance and the risk of being sued.

(above: Tripler Army Medical Center). Hawaii also faces financial issues with its hospitals. As programs such as Medicare and Medicaid have made themselves more available to Hawaii’s residents, the quality of healthcare has seemed to drop. Between 1995 and 2006, the number of hospitalizations for Medicare and Medicaid patients increased by 35% and 56%, while private payers decreased by 18%. By 2006, private insurance represented 30% of the annual discharges and Medicare and Medicaid represented 49%. Currently, Medicare and Medicaid patients comprise half of all hospitalized patients in the state. And with government payers paying considerably less than the cost of providing care, this has most likely contributed to why Hawaii’s hospitals struggle financially. In fact, hospitals were paid 7% below costs in 2006. This was found to be especially true for Molokai and East Hawaii, where many people are covered by Medicare, Medicaid/Quest. On the other hand, patients on Lanai, Maui, and North Hawaii are generally better off, since many of them have private insurance. Yet, even though Medicare and Medicaid contribute the most to hospitalization charges, more of the population is covered by private health insurance. Thus, Medicare and Medicaid patients prove to be disproportionally demanding on Hawaii’s taxpayer money and healthcare system.

Below is a graph based on national figures. As it shows, Medicare and Medicaid (government run medical insurance programs) are predicted to exhaust more of our resources in future years. Although these are crucial programs, they are quite expensive. If recent trends continue, Medicare and Medicaid will account for approximately 30% of our nation's government spending by 2020, and 36% by 2040. This reflects locally as well.


While many of Hawai'i's healthcare issues seem difficult to fix, there are some possible means of action. We could reduce Medicare expenses in the hope that it would allow those with a real need to receive adequate care. We could also allocate more money to preventative care. Approximately 12% of hospitalizations in 2005 were preventable through immunization, common education, or improved outpatient care. If we invest in these areas, we may end up saving money overall.

Sources:
http://www.hhic.org/ (specifically "past articles")
http://www.healthtrends.org/
http://starbulletin.com/2007/06/13/news/story01.html
http://www.cbsnews.com/stories/2007/06/13/health/webmd/main2923760.shtml
http://the.honoluluadvertiser.com/article/2005/May/09/ln/ln03p.html
http://www.bls.gov/news.release/laus.nr0.htm
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
Tripler image: http://en.wikipedia.org/wiki/Tripler_Army_Medical_Center
Graph image: http://www.citizenshealthcare.gov/healthreport/images/figure5.jpg