Commentary
Hawai'i's health care industry may be at crucial crossroads
By Bob Dye
Kailua-based historian and writer
Hawai'i needs an economy supported by equal-sized but interrelated industries of education, health and leisure. Each of these environmentally friendly industries can help to expand and diversify agriculture, our natural industry.
Advertiser library photo • March 16, 2000
Health, our second-largest private industry, is caught up in a national transition. As a result, a Honolulu hospital may close and others may merge. So an urgent concern of the industry is finding a way to halt further erosion of governmental financial support in this time of dramatic change.
University of Hawai'i medical students, from left, Shanon Takaoka, Cedric Lorenzo and Christina Kealoha reacted happily to news of their residency assignments. Substantial investment in the medical school now could help reinvigorate the Islands' troubled health care sector for years to come.
"The government must put more dollars into the Medicaid and COBRA (Consolidated Omnibus Budget Reconciliation Act) programs," says Rich Meiers, president of the Healthcare Association of Hawai'i.
Because of the severe financial impact of the Sept. 11 attacks, Meiers will tell legislators in the coming special session: "As Hawai'i's unemployment rate rises, more people may enroll in the Medicaid program, or we may see Hawai'i's uninsured rate climb again. The health care industry certainly will see an increase in the already large amount of charity/uncompensated care."
Despite less government support, he points out, the industry is called upon to increase its support of the community's health care. Including bad debt and charity care, its contribution has grown from $83 million in 1998 to well over $110 million this year.
"The industry is in the weakest financial condition I've seen in the last 11 1/2 years," says Meiers. "With the increase in uninsured people during the last seven years, Hawai'i can no longer call itself the Health State. Nevertheless," he says, "the industry continues to provide quality care to Hawai'i citizens."
During the past several years, the health industry here has lost momentum, clear direction and political clout. Health care costs continue to spiral upward and may rise more than 10 percent this year.
State Sen. David Matsuura, chairman of the Health & Human Services Committee, sees the present situation as critical. He says a way to help reverse the downward financial spiral of the health industry is to expand the leadership and grantsmanship role of the University of Hawai'i's John A. Burns School of Medicine.
"It's sound economics for government to invest in medical research," says House Minority Leader Galen Fox. "We will get back more than we will put into it."
There is more than $30 billion available annually for biomedical research. The National Institute for Health (NIH) alone provides $20 billion in research money.
Last year, the UH medical school ranked 115th nationally by total dollars ($2.5 million) in grants from the NIH. By comparison, Johns Hopkins in Baltimore received $419.4 million; University of Pennsylvania, Philadelphia, was given $321.3 million; University of Washington, Seattle, was awarded $302.5 million; University of California, San Francisco, got $295.3 million.
Because Hawai'i was getting the dregs at the bottom of the money barrel, NIH awarded UH a $5.9 million grant to establish and operate a biomedical research infrastructure network. All of the institutions of higher education in Hawai'i are included. Hawai'i Pacific University, for example, will work with secondary schools to encourage students to pursue a career in biomedical research. A two-day NIH grant-writing seminar and workshop will be held at the East-West Center Nov. 7-8.
Under the leadership of Dr. Ed Cadman, dean of the school of medicine, the University of Hawai'i has proposed that a public-private partnership build a $300 million bioscience campus in Kaka'ako. Cadman says the new center can develop $50 million to $80 million each year in new research support.
"We need the private sector to be a part of this complex," says Cadman. "Leasable research space is incubator space. It is space entrepreneurs need to drive the biotech industry." He points out that there are "wonderful" tax incentives to encourage private bio/high-tech development. The 10-acre site has an adjacent 10- to 15-acre area available for expansion.
The focal point of the new campus will be "a research intensive" medical school employing 500 researchers. He estimates that 1,250 researchers will be employed in the private-sector laboratories. "Medical research is big business," Cadman observes.
The medical school will continue to forge research partnerships with Hawai'i hospitals. In addition, it now will provide management support for research grants to hospitals, if appropriate.
In addition to establishing a biomedical infrastructure, other relationships with the state's educational institutions are being developed. A small but happy example is the tutoring of Hawai'i Pacific University pre-med students by UH med school physicians. Two HPU graduates are enrolled in the UH medical school.
Reversing the "brain drain" is a high priority goal. "Talented medical students and researchers will not need to go to school on the Mainland to receive a world-class education with state-of-the-art facilities," Cadman says. And he hopes the new biomedical campus will lure back those Hawai'i folks who sought better professional opportunities on the Mainland.
Other institutions, too, respond to Hawai'i health care needs. Although there is a surplus of hospital beds in Hawai'i today, there is a shortage of nurses. To address that need, HPU has increased its 600-member nursing student body by 7 percent. The private university has the largest nurse training program in Hawai'i.
So there is hope.
"We must believe that we can become great!" is Cadman's motto. It's one that all of us in Hawai'i can adopt.
