Layoffs increase pressure on community health centers
| • | How to contact health centers |
By Alice Keesing
Advertiser Health Writer
The state's community health centers offer a safety net for the homeless, the uninsured and the needy. But with the number of uninsured on the rise, particularly since Sept. 11, those who manage the centers are worried how they will juggle already stretched resources to help everyone.
Cory Lum • The Honolulu Advertiser
"Every day I hear the awful stories of someone affected by 9-11," said Carmen Olivier, nurse midwife at the Waimanalo center. "They've lost their jobs, so they don't have insurance but they don't qualify for QUEST because they have assets. So they fall in the gap where they're too rich and too poor at the same time."
Officials such as Dr. Deane Hatakeyama of the Waimanalo Health Center are wondering whether already slim budgets can be stretched further to meet a rise in demand.
State subsidies have not matched the growth in demand, and the health centers are in the frustrating situation of knowing they may not be able to help some of the very people they were created to serve, said Beth Giesting, executive director of the Hawai'i Primary Care Association, the umbrella organization for the centers.
Without more support, the association is warning of cutbacks, longer waits for appointments, and a lack of care for some of the most vulnerable, such as the homeless.
In the long term, that could drive more people to emergency rooms in hospitals, which already are struggling to cover costs for the state's uninsured.
"Our role in the continuum of care really is to be the finger in the dike," said the Rev. Frank Chong, executive director of the Waikiki Health Center. "Once we take the finger out of the dike that creates a cascade of problems."
The community health centers' mission is to help those the mainstream system cannot or does not want to serve: people with no insurance, those who have difficulty accessing Western medicine because of language or cultural barriers, people living in remote areas and the homeless. They help about 72,000 people a year — about 6 percent of the population.
Like other health centers, the Waimanalo center plays an important role in the Windward community. It is working to reduce the health and economic costs of diabetes, cardiovascular disease and cancer. It works with pregnant women and new mothers to foster infant health. Its "Da Backdoor Clinic" offers confidential family planning for teens.
Executive director Kawahine Kamakea-Ohelo said it's always a struggle to pay for everything and, like other centers, Waimanalo is seeing more people who have no health insurance.
Between 1997 and 2001, the number of uninsured served by the health centers increased 60 percent. The Sept. 11 attacks made the situation worse.
While the demand for the centers has been growing, the state subsidy went from $1.5 million to just $1.8 million.
"Although the health centers have done pretty well getting additional federal dollars, state funding really has fallen far behind compared to the need," Giesting said.
Giesting believes legislators are concerned but unwilling to make any promises.
"Everybody is going to have to figure out how to balance the state dollars, and we are concerned that the health centers really can't wait any longer," she said. "We have been waiting over the past nine years as the number of people who are uninsured has kept growing."
Without more money, health centers will have to look at who they can help, Chong said. "It's going to make it much more difficult, we're already stretched to the limit, we're already cutting back on programs because we don't have any money."
The center has no money to run its North Shore drop-in clinic past April, he said. That clinic helps many patients with chronic diseases such as diabetes. Without primary and preventive care, those patients could be at increased risk of complications such as amputation, blindness or heart disease.
Possibilities such as these alarm people like Giesting.
"I'm sure that the hospitals and emergency rooms are cringing also because as people neglect their primary care and preventative services, they are much more likely to finally report to a doctor or an emergency room with a much more serious case of whatever they've got," she said. "That is a time bomb we are very concerned about."
How to contact health centers
For more information or contacts for the community health centers, call Ask Aloha United Way (275-2000 on O'ahu, or toll free (877) 275-6569 on Neighbor Islands), or the health center nearest you.
Big Island
Bay Clinic Hilo: 969-1427
Pahoa Family Health Center: 965-9711
Ka'u Family Health Center: 929-7311
Hamakua Health Center, Honoka'a: 775-7206
Maui
Community Clinic of Maui, Kahului/Wailuku: 971-7772 (In Lahaina, call this number)
Hana Community Health Center: 248-8294
O'ahu
Kalihi-Palama Health Center: 848-1438
Kokua Kalihi Valley: 848-0976
Wai'anae Coast Comprehensive Health Center: call 696-7081 for locations
Waikiki Health Center: 922-4787
Waimanalo Health Center: 259-7948
Kaua'i
Kaua'i Community Health Center: 338-1855
Reach Alice Keesing at akeesing@honoluluadvertiser.com or 525-8014.
