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Access and Sustainability of Quality Health Care
In Hawaii, much like everywhere else, economic development and sustainability go hand-in-hand with quality healthcare. We depend on quality healthcare to nurture and protect our children, maintain a healthy workforce, and care for the aging. If the quality and safety of Hawaii’s healthcare is in question or at risk, the state won’t be able to care for its own citizens, much less attract and retain essential workers and professionals, new companies, or tourists. Yet, at this very time of considerable promise in economic expansion and opportunity, the state finds itself most vulnerable in its crucial healthcare sector. Reimbursement policies at the federal and state levels don’t cover essential costs. In Hawaii, there’s an annual shortfall of $30million for Medicare ($1,187 per average Medicare patient discharged), and a shortfall of $21 million for Medicaid ($2,405 per average Medicaid patient discharged). Hawaii Medicare payments per enrollee are the lowest in the nation and 30 percent below the national average. Even as hospitals around the state aggressively attack the costs of care they must absorb more than $90 million annually in bad debt or charity care losses, meet the upward compensation and benefit pressures to retain and hire skilled workers, and watch as much as 20 percent of the population with certain diseases leave the state for treatment elsewhere. Hawaii is the only state in the nation not receiving disproportionate share to hospitals (DSH) payments as a federal allotment by Congress. They have not received these payments since 1994. Fortunately, the Hawaii Department of Human Services took action to amend the current 1115 Waiver and began to receive DSH-like payments for safety net hospitals in September, 2005. The Department of Human Services (DHS) and the Department of Health (DOH) are committed to a multi-year process to increase Medicaid rates to levels that are sustainable for the State and equitable to the providers. However, the planning and implementation are far from complete and will require support from the Legislature, Administration, and constituents. An essential strategy to meet the demand and supply challenge is reinvestment in facilities and equipment. Here, the news is again sobering at best. Flat or negative financial margins prevent essential reinvestment. Hawaii is last in the nation in healthcare capital reinvestment. Another essential strategy is to increase recruitment and retention of vital healthcare personnel. BY 2012, the state is projected to need more than 9,000 additional healthcare practitioners, technicians, and healthcare support occupations. Yet today, there is a vacancy rate for registered nurses of 21 percent. Hawaii also lacks the capacity to educate and train the healthcare personnel we need now, much less in the future. Because of that, each year Hawaii spends millions of dollars on temporary healthcare workers from the mainland. To compound the problem, the state’s population is aging 2.5 times more rapidly than the rest of the nation. An aging population is projected to further increase the demand for healthcare services. The 2000 census showed that 17% of Hawaii’s population was 60 years of age or older. By 2020 the % of people over age 60 is projected to be 24%. Eight five per cent of people in Hawaii have indicated that they wish to receive long term care services in their own home. Investment in healthcare information technology for electronic health records, telehealth and measurement and tracking of quality measures are a must and will require millions of dollars in capital investment. Physician coverage in our emergency rooms and particularly in rural areas is also a growing problem. All of these issues are made worse by increasing malpractice liability costs. The measurement of quality outcomes, processes, and the overall patient experience, is also lacking due to liability issues and difficulty collecting and tracking data because of the lack of electronic recordkeeping and electronic interface between medical care systems. Models of health care that increase accountability of the consumer are becoming more popular amongst employers but these require access of the consumer to the information needed for informed decision making. Looking to consumers and employers to pay for rising healthcare costs is a dead end because insurance rates have continued to rise two to three times faster than inflation and wages. A more sustainable long term solution would be to reduce costs by improving operational efficiency of the healthcare system through improvement in processing and management of healthcare information and healthcare technology, curtailment of malpractice liability costs, and exploration of new models of care. Otherwise, we are in the midst of a healthcare financing dilemma that threatens not only the quality and delivery of healthcare services, but undermines the state’s progress in economic development. Footnotes:
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