Native Hawaiian Access to Healthcare is a Symptom of a Statewide Problem

by OHA Trustee Keli‘i Akina, PhD, Ka Wai Ola, January 1, 2022

Hawaiʻi residents often face barriers in accessing medical care. For Native Hawaiians in particular, COVID-19’s impact served as yet another reminder that access to adequate healthcare is lacking for many of our people and is a consequence of a bigger problem.

In December, 2020, UH’s Hawaiʻi Physician Workforce Assessment Project reported that the statewide physician shortage remains between 710 and 1,008. For doctors starting their careers while saddled with student loan debt, it simply does not make sense to pay the high cost to live and work in Hawaiʻi, when other states have lower tax burdens that would allow them to pay their loans off faster.

Consequences of the physician shortage include longer wait times for appointments and having to travel further away for specialists. For Native Hawaiians in rural and neighbor island regions, the problem is especially acute, often requiring travel to Oʻahu or the mainland.

Dr. Scott Grosskreutz, a Hilo-based physician, co-authored a study that attributed high breast cancer mortality rates in Native Hawaiian women to a lack of access. “Much of that research is related to the ability to access health care, to be referred for a mammogram, or – once you’re diagnosed – [the ability] to be treated in a timely manner if you’re living on Molokaʻi, or Maui, or Kauaʻi or the Big Island compared to Honolulu, or if you’re in Los Angeles or New York,” said Dr. Grosskreutz. (Nicole Pasia, “Hawaiʻi is the ʻmost hostile health environment to practice in,’ physician says”, Nov. 30, 2021)

Aside from the shortage of physicians, there is a shortage of facilities. Recently, I penned a commentary in the Wall Street Journal, entitled “Hawaiʻi Is No Paradise if You Need Medical Care” (Dec. 3, 2021). I noted that Hawaiʻi has among the fewest hospital beds per capita of any state, and when Hawaiʻi residents visit the emergency room, wait times are 10th longest in the country.

The reality is, if COVID-19 had hit Hawaiʻi as hard as it did parts of the U.S. mainland, our hospitals would quickly have been overwhelmed.

In addition to the shortage of providers and facilities are Hawaiʻi’s certificate of need (CON) laws. These laws require those proposing a new medical facility to prove there is a need for it, to a committee which includes their competitors. Hawaiʻi’s CON laws are among the most restrictive in the nation, requiring a CON for everything from substance abuse shelters to expansions of existing medical facilities.

The State Health Planning & Development Agency (SHPDA) administers Hawaiʻi’s CON program. Since 2006, SHPDA has denied 24 CON petitions, including applications for three medical facilities that would have added 206 beds, increasing hospital capacity by 8%.

These denied petitions also would have brought jobs.

Hawaiʻi clearly faces a healthcare supply and accessibility problem that COVID-19 brought into sharper focus. Hawaiʻi lawmakers can effect change, however, by relaxing CON regulations that exacerbate barriers to healthcare access.

Hawaiʻi lawmakers must also get creative to attract physicians to practice here, perhaps by relaxing the tax burden on medical practices setting up shop in rural areas, or by offering student loan repayment assistance. Existing programs that support and encourage Native Hawaiians to enter the medical professions in Hawaiʻi, and especially on the neighbor islands, are worth expanding.

Until we improve the availability of and access to medical resources in the state, Native Hawaiians will continue to face barriers to critical healthcare.