Ensuring the Health of Our Communities 

    Hilo Medical Center is faced with a $25 million operating shortfall for this fiscal year and ways to address this deficit are being explored.  In the meantime, all departments are implementing cost saving methods.  Acute care beds at Hilo Medical Center are being occupied by long-term care patients, which limit the reimbursement per patient day for these rooms.  According to a Healthcare Association of Hawai‘i Waitlist Task Force report, Hawai‘i ranks 48th in the nation with its low ratio of long-term care beds per population, averaging 23 beds per 1,000 people, compared with the national average of 47.

    There is also a shortage of primary care physicians on our island.  In Hilo, the two newest physicians to open practices are now full and people looking for a primary care doctor are being placed on a wait list.  Because of this, those without primary care physicians seek medical care only when ill and do not receive the benefits of preventive care.  In addition, individuals in these unfortunate circumstances are relegated to substituting emergency rooms or urgent care settings as their primary care venue.  Preventive, educational services are not reimbursed by health insurance that would prevent major medical problems in the future such as diabetes, cardiac and vascular conditions.  The continuum of care, which can serve to keep medical costs affordable, is stretched and solutions must be implemented before quality of care is significantly affected.

    Act 277 approved the appropriation of $1.5 million for the 2008 fiscal year and $2.5 million for the 2009 fiscal year to supplement major grants obtained through the Center for Medicare and Medicaid Services and HMSA.  While the statewide rural training program aims to ease the Big Island’s doctor shortage, the initial $1.5 million for 2008 has not yet been released by Governor Lingle’s office.

    I also supported a measure that became law without the Governor's signature on July, 9 2008 to create the Hawai'i Health Corps Program Working Group that will present a plan to establish the Hawai'i Health Corps Program that will provide financial incentives in the form of tax credits, stipends and student loan repayments to address these healthcare challenges.  One part of the program would reimburse up to $20,000 per year for the education and training expenses for no more than 5 years for 20 doctors or dentists a year who choose to practice in underserved areas for a period of 5 years.  Another aspect creates a pilot project similar to DBEDT's Enterprise Zones in which physicians and dentists will be granted  various tax and other benefits for agreeing to work for 7 consecutive years in areas designated "medically underserved or where a health professional shortage exists."

    In addition, we worked to secure funding for the University of Hawai‘i at Hilo and Hawai‘i Community College to increase their faculty so more students could be admitted into their nursing programs.  Within 2 years, the number of nursing students graduating from Hawai‘i Community College and UH Hilo should see an increase of at least 33 percent.  Funding that we helped to obtain for the Quentin Burdick program allowed the University of Hawai‘i at Manoa to continue the goal of their program to encourage students to consider working in rural communities upon graduation. 

    Participants in this program include students from the School of Medicine, Nursing, Speech/ Audiology and Pathology, Social Work, Public Health, Psychology and Education.   In the near future we also hope to secure funding to complete the Cardiac Care Center at Hilo Medical Center to meet the growing need of our underserved communities as documented in the 2006 Goodman Study. 

    Providing more long-term care beds means freeing up acute care beds currently occupied by long-term care patients and as a fiscal benefit, increases the revenues earned by HHSC due to the higher reimbursement rates for acute care beds than for long-term care beds and ensuring access to quality care for the general public. Our efforts to help secure funding for Hale Ho‘ola Hamakua to add 28 additional beds is part of a comprehensive strategy that we have been working on to address some of the structural problems with HHSC while meeting the obligation we have to the elderly and their families in our community and it is our intention to bring such efforts to East Hawai‘i.

    We also need to use financial incentives like tuition reimbursement and fund the residency program to bring and retain more physicians to Hawai'i County.  These steps would allow us to move past short-term stopgap measures and lay the groundwork for across the board strengthening of our system.  An effective care continuum would allow for more emphasis to be placed on preventive medicine and put ourselves in a position to better derive the associated health and cost savings benefits.  Solving our health care crisis will be difficult, but it is not insurmountable if we work together to develop a more sustainable system now and for the future.

•    Continuing the efforts to attract and retain physicians, nurses and other essential health care professions

•    Securing continued investment in our island’s health care infrastructure and expanding the long-term care capacity

•    Maintaining the long term perspective of increasing emphasis on preventive medicine and to put ourselves in a position to better derive the associated health and cost savings benefits