How Healthy is Healthcare in Hawaii?
Leading doctors and other experts discuss major trends and problems in Hawaii healthcare
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Pressler: Who are the 8 percent uninsured?
Giesting: Some are unemployed and can’t afford COBRA, or their working spouse can’t afford dependent-care coverage. Some have part-time jobs or are self-employed, homeless people or immigrants who are not working. Providing affordable insurance products for them is going to be a big boom (economically).
Pressler: 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?
Tsang: I think there’s an acknowledgment, at least nationally, that primary-care doctors need their payments, and the reimbursement system needs to be redesigned. That’s why, at least with Medicaid, the payments of primary-care doctors are being increased to Medicare values.
- Sen. Josh Green, chair of the Senate Committee on Health and a physician
- Dr. Jerris Hedges, dean of the John A. Burns School of Medicine at UH;
- Hilton Raethel, senior VP at HMSA;
- Dr. Nadine Tenn Salle, a practicing physician and president of the board of the Hawaii Independent Physicians Association; and
- Dr. Art Ushijima, CEO of the Queen's Health Systems.
Green: The healthcare system in America works for a lot of people, but doesn’t work for the working poor very well or for children who live below the poverty line. Those are two large groups. And it doesn’t work for a solid part of the middle class that has serious health problems that are extremely costly and push them over the edge.
In 2001, America spent $1.3 trillion on healthcare. In 2011, we spent twice that, $2.6 trillion. That tells you that there was incredible expansion. It also tells you there’s an incredible opportunity for solutions.
When we talk about giant expenditures for anything, people want to get their money’s worth. This may sound a little crazy, but I’m not particularly concerned about spending trillions of dollars in healthcare, but I am 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. In no other business is that tolerated. That has to be addressed.
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 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.
Hedges: We have a shortage of providers here in Hawaii and nationally. In 2025, it’s anticipated that there’ll be 120,000 fewer providers than what the demographics in the U.S. will require. So we cannot simply pull from other states to meet Hawaii’s needs.
But we can create a more efficient model of training. I would like to outline a concept proposed by Daniel Hunt, executive director for the accrediting body for medical schools in the U.S. He proposed a Doctor of Clinical Practice degree, to be done in conjunction with current medical schools – essentially a streamlined path to becoming licensed, so instead of the four years of medical-school training, there will be three years.
The three years would be based on the clinical knowledge set that we now provide but would be focused more on application and less on the basic science elements. The anticipation is that the in-hospital subsequent training would be more attenuated and would focus on what one needs to do for continuity of care. The bottom line is that students would complete their training and become ready for a license in four years total, rather than the four years in medical school plus the three or four additional years in residency training. This is something we can do in Hawaii.
Another great benefit is that such trainees would only be licensed in Hawaii and we wouldn’t lose physician trainees to other parts of the nation.
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