How Healthy is Healthcare in Hawaii? - Extended Version
Leading doctors and other experts discuss major trends and problems in Hawaii healthcare
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Pressler: We were starting to run out of time. I have more questions I’d love to ask but we’re starting to run out of time. So, let me ask if payments to primary doctors were doubled, access would increase, hospitalizations would decrease, and millions of dollars would be saved. Why can’t doctors have control of their pay and their patients’ health instead of giving all of the resources to insurance and other companies? I think that was a statement but I think that many of you can address the issue about the focus on prevention and investing in patient-centered medical homes … Well, I think question has to do with improving payments to primary care and access to primary care.
Tsang: I think there’s an acknowledgment, at least nationally, from folks that primary care doctors need their payments and the reimbursement system needs to be realigned and redesigned. That’s why at least with Medicaid, the payments of primary care doctors are being increased through Medicare values.
Anderson: There’s a huge shortage of primary care physicians in Hawaii that we need to address and I’m sure in our next panel we’ll talk to some of those issues. But the really difficult part is getting physicians interested in working in many of the rural areas in Hawaii. This is from our perspective and we do need to find ways to compensate them.
Pressler: I think our second panel can address some of these questions. We each have one minute a piece to make closing comments if you wish before we pass this on to the next panel.
Anderson: I think maintaining our critical safety net service is extremely important, given the isolation of Hawaii and the challenges we have with the economy. We have to find ways to make the system work more efficiently. Now we see there are some opportunities there, but this is something we hope we can work with all of you on and I’m certainly welcome to any suggestions or comments you might have.
Andrews: After being in healthcare now for almost 30 years, it’s no wonder we’re so confusing as an industry — look at the complexity of our system. I’m looking forward to with the advancements of IT and as Dr. Tsang said with innovation that we are going to achieve greater efficiency. We’ll see better utilization of the dollars in the healthcare delivery system but we’re going to need the ideas and the forward-thinking types of environments that you all practice to come on board and help us out. Certainly within the connector, the philosophy that we have is we want to create opportunities to grow knowledge around health and around IT here in our own state.
Tsang: Hawaii could really serve as a model of excellence for the rest of the country. It is in some ways the gateway for Asia and as we look at all this new therapy in terms of genomics, bioengineering, and large molecular therapy in the pharmaceutical industry, I think there needs to be a consideration for the Asian-American/Pacific Islander native of Hawaii and segment of any clinical trial. So, I think there could be a whole new industry here in Hawaii in terms of biogenomics.
Giesting: I would like to remind everyone that the healthcare sector is very big, diverse, broad with lots of vested interests that might like to keep it the way it is, and while it is already taking up 17 percent of the GDP, it is slated to go higher and larger, much faster than inflation. We have just got to change it. Despite that it’s a very daunting job, I am really optimistic and that’s because there is an overwhelming number of people right here in this room and in our state who are allies in making sure that we can change the system for the better.
Pressler: Thank you. I’d like to thank our panelists for their participation and for those who had questions that were answered, glad to hear them and I’m going to pass on the ones I have written here to Josh because I think some of them pertained to the second panel so let’s hear it for our panel. Thank you.
Jay Fidell (ThinkTech Hawaii): How about a warm welcome for the moderator of our second panel, Senator Josh Green.
Senator Josh Green (Chair, Senate Health Committee): Aloha, everyone! I’m going to layout a few facts, large concepts, and then we’re going to dive right into our panelists.
So, does the healthcare system work in America? Well, it works for a lot of people. Let’s be candid about that. It does work for a lot of people. But we’re also talking about for whom it doesn’t work. It doesn’t work for the working poor very well. It doesn’t work for children that live below the poverty line. That’s two large groups. And it doesn’t work for a solid part of the middle class that has really serious health problems that are extremely costly and pushes them over the edge, so keep that in mind.
Another thing to keep in mind also because the group here is very focused on economics as well as the humanitarian issue is that in 2001, America spent $1.3 trillion on healthcare. In 2011, we spent twice that — $2.6 trillion — on healthcare. What does that tell you? It tells you that there is incredible expansion. It tells you there’s an incredible opportunity to get involved in solutions. It tells you that number could continue to grow and therefore, people should be very attentive from a business model standpoint, of helping to be a part of the solution because it’s a good place to have a career. In Hawaii, we’re 750 doctors short right now, a very large number.
Hawaii has about 3,000 practicing physicians. I’m one of them and I’m sitting in the Senate — so we have a very serious shortage. By 2020, we will be 1,500 physicians short, and that is a very big problem. I want you to keep that in mind when we talk about the scope of what the healthcare system will look like and what kind of solutions my panel might be recommending to deal with that. I would also toss out another number.
In 2020, 43 percent of the physicians in this state will be 65 years or older. That’s a very big problem when you think about the grind that goes on in healthcare and the taxing nature of delivering healthcare in a challenging system. When those people retire, the problem could get much larger. And I would tell you this, if we can’t deliver healthcare to people – primary healthcare – all the mandates in the world are not going to be worth anything.
So from my perspective, our solutions have to be focused at least on that provider base. What I would recommend is that we’re going to need a primary care renaissance. We’re going to need to drive the next generation of healthcare providers. I don’t just mean doctors. I mean nurse practitioners and all the rest toward primary care and I hope that some people will be able to address that today.
When we talk about giant expenditures in our country for anything, one thing that’s important to people is that they get their money’s worth when they spend it. I’m not particularly concerned — and this may sound a little leftwing or crazy — but I’m not particularly concerned about spending trillions of dollars in healthcare.
I’m concerned about spending it badly, or not spending it on what people actually need. Two percent of the population consumes 65 percent of our healthcare resources. That’s one study. It is certainly bad. But is it that bad? We could debate that for hours, but in no other business is that tolerated and in no other system will that be sustainable. So, that has to be addressed as well, but I’m willing to see large percentages of our domestic – our GDP and so on spent, because if people value the service, if it makes a difference in their life, if it creates good jobs and professions, then frankly, I think it’s good from a moral standpoint to get those people to healthcare.
If you told me today that my 4-year-old had leukemia, what percent of the dollars that I earn from my three jobs would I spend on that leukemia? If I could get her well, if I had a good oncologist, I might spend all of it. Think about that. Think about what healthcare means to people and what its actual value is, and then think about how we get that healthcare to the people who need it. On our panel today we have Jerris Hedges, Dean of the John Burns School of Medicine at UH; we have Hilton Raethel, a senior vice-president at HMSA; we have Dr. Nadine Tenn Salle, a practicing physician and President of the board of the Hawaii Independent Physicians Association; and we have Art Ushijima, the CEO of Queen’s Hospital.
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