EDITORIAL
Medical care problem needs total approach
The monumental task of controlling skyrocketing medical costs is a bit like pushing spilled mercury around a polished table: No matter where one pushes, the problem simply emerges in another spot.
One example: A story Monday talked about Kahuku Hospital's struggle to survive. A $1 million grant from the state will help, but the hospital continues to be squeezed by rising malpractice insurance premiums and declining reimbursements from insurance companies.
To underscore that point, an earlier story outlined Hawai'i's dangerous decline in the number of doctors choosing high-risk practices such as orthopedic and obstetrics. The issues there again are declining reimbursement schedules and rising insurance premiums coupled with overwork.
The result: Growing numbers of people in this state are faced with reduced, or no, medical services, putting us steps away from a public health crisis.
Unfortunately, there are no quick-and-easy solutions to this problem.
Efforts to cap payments made by insurance companies have driven many doctors out of practice or out of state.
Tort reform measures seeking to hold back lawsuits and levels of monetary awards have met with some success, but have also left some legitimate plaintiffs without adequate legal recourse.
It's likely that policy-makers will go on much as they have to date, tinkering with the rules governing lawyers, insurance companies and medical providers in an endless search for the "right" balance.
Real solutions will mean some sacrifices.
A good start would be re-examining reimbursement levels. Costs must be contained, but not to the point where it makes it impossible for practitioners to stay in business.
And insurance premiums need to be controlled. In part, this can happen through thoughtful, measured "tort reform" legislation such as that proposed by the state this past legislative session. The law would have capped sometimes outrageous "pain and suffering" awards that drive up the cost of all insurance. But it would have allowed generous payments to go forward for actual medical costs and economic damages.
The state also must do a better job of regulating and monitoring insurance company rates and practices. That is an achingly complex task.
But there is precedent. California, for instance, combined tort reform with stiff insurance company regulation in a way that produced measurable improvement in controlling the cost of malpractice insurance.
Finally, the medical community will have to become more aggressive in self-monitoring. It also will have to become more proactive with litigious or service-demanding patients who willfully use up precious resources and services.
Rising medical costs and a shortage of physicians cannot be dealt with by putting the squeeze on just one aspect of the problem— there is no silver bullet solution.
What will work best is a universal approach where all stakeholders are willing to compromise. Short of that, we'll find ourselves mired in a healthcare crisis that could cost us more than dollars.
