Time to tackle Hawaii’s healthcare crisis

by Keli'i Akina, Ph.D., President / CEO, Grassroot Institute of Hawaii

People around the world view Hawaii as a paradise. And in a lot of ways, it is. But for many of us who live here, our islands have become a place where we simply cannot afford to get sick. 

The statewide physician shortage continues to worsen and is now estimated to be 833 full-time equivalent doctors. Our greatest need is in specialty care, especially on the neighbor islands — and particularly for children. In fact, virtually no pediatric specialists are reported to be employed outside of Honolulu.

Hawaii did join a nationwide medical compact last year that allows doctors to more easily get licensed to practice here, but the results so far have been minimal. More needs to be done — and I hope we see that happen during this year’s legislative session.

There are several significant healthcare bills still making their way through the Legislature. Perhaps the most important are those that would reform the state’s medical “certificate of need” regulations.

These rules require that healthcare providers get the state’s permission to adjust existing services or offer new ones, and that process can be expensive and time-consuming with no guarantee of success.

I hardly think a provider would be interested in opening a burn care center in Hawaii or offering substance abuse treatment if it didn’t think the community would benefit from those services, yet they still need government approval to do so. 

The bills being considered this year unfortunately would not totally repeal Hawaii’s CON laws. SB2289, however, would be a good start. It would at least allow exemptions for healthcare facilities and services that care for vulnerable populations or reduce patient costs. In particular, the bill lists neonatal intensive care centers, substance abuse treatment programs and licensed home care agencies.

Two other CON reform bills, SB3139 and HB2319, both propose exempting state Department of Health facilities from CON requirements and increasing the threshold for bed-change exemptions from 10% of existing licensed beds to 30%. Those changes alone would be less transformative, but still a step in the right direction.

Another way to improve healthcare access would be to pass HB2558, which would allow Hawaii residents to use telehealth services to receive care from out-of-state physicians. This would especially benefit patients in rural areas where specialty care is scarce to nonexistent.

Last but not least, lawmakers are considering bills that would allow Hawaii to join more interstate medical compacts to make it easier for providers to practice here. 

SB2080 would allow Hawaii to join the Psychology Interjurisdictional Compact, which would help improve access to mental health care in Hawaii. More than 40 states have already signed on.

And SB3105 would allow Hawaii to join the Physician Assistant Licensure Compact, which would certainly help alleviate the impact of our doctor shortage.

All of these reforms have been safely and successfully enacted in other states, so I see no reason we shouldn’t be adopting them here too. 

E hana kākou! (Lets work together!)