Hospitals in crisis — right now
By Chuck Sted
After some hopeful give and take between Gov. Lingle and the Legislature on the need for medical malpractice reform, it is tremendously disappointing to see this much-needed measure succumb to the virus of politics as usual.
The Advertiser's April 26 editorial was right on the mark in pointing out that to deal with the "growing shortage of physicians willing to go into 'high risk' fields" — including some as basic to the general health and welfare as obstetrics and gynecology — the issue of malpractice reform needs to be thoroughly aired, not bottled up in committee.
Everyone knows that healthcare is in need of emergency care, so it is hard to understand how our elected leaders find it so difficult to put politics and special interests aside and take badly needed action.
The failure to move forward on medical malpractice reform is only one symptom of the serious condition that afflicts the quality of health-care in Hawai'i. Lest anyone believe that solving the issue of physician flight is all we need to do to ensure our hospitals deliver quality care to all our citizens, let's take a reality check.
The big picture is that quality healthcare is at risk in Hawai'i, not tomorrow but today. Our hospitals are losing massive amounts of money year after year. This financial hemorrhage has less to do with doctor flight and more to do with other issues the governor and the Legislature can do something about if the voters demand action in place of endless studies and delays.
Voters need to understand three fundamentals that mean the difference between quality healthcare and unacceptable healthcare in our state.
First, our hospitals are locked into a cycle of losing money year after year. Since 2000, Hawai'i's hospitals have lost more than $200 million. This means that hospitals cannot reinvest in the next-generation medical technology that is key to providing our people — our keiki, our kupuna, our husbands and wives, brothers and sisters — with the quality healthcare we have taken for granted until now. We cannot continue to upgrade facilities to accommodate new specialties and a growing population. We cannot serve as we wish as a place where our own young people can be educated here at home and remain here to enter the crucial medical workforce.
These chronic years of losing money have forced Hawai'i's hospitals into making choices that threaten to compromise quality healthcare for our youngest, our oldest and our most vulnerable. This situation is not a potential; it is the reality our hospitals face today. It is the reality facing all of us and those we love.
Second, it is wishful thinking to believe that cost-cutting will solve all our problems. We all want and deserve quality healthcare, yet thanks to the speed of advances in medical technology and to a growing population of the elderly, the unit cost of care will continue to rise throughout our lifetimes. This is a trend we cannot escape. Even if hospitals become super efficient, if they retain their traditional commitment to each and every patient, the cost of quality healthcare will keep growing.
The third fundamental — fortunately — is that we can break this cycle of hospitals perpetually losing money if government, citizens, the medical profession and labor come together to insist on action instead of hand-wringing and finger-pointing. Here are several steps to help break the cycle that has put us in the crisis we face.
In addition to concrete action on medical malpractice reform, public officials must move rapidly on a statewide trauma-system plan. Hawai'i has a trauma center rather than a trauma system. Yet the state government would have us believe we are prepared to handle all manner of disasters, natural and man-made. Voters need to know we are not prepared even to handle all the ordinary medical traumas people face from day to day, especially on most Neighbor Islands.
Voters need to press legislators to support resolutions SCR 77 and SCR 71, or measures like them next year. The former will continue to provide support for essential children's health programs, and the latter will study the long-term-care needs of our increasingly aging citizens. A study is important, but voters need to press elected officials on why there is constant growth in condominiums and timeshares but virtual stagnation in long-term-care facilities.
Meanwhile, every day in hospitals across Hawai'i there are hundreds of long-term-care patients occupying acute-care beds because there are not enough rehabilitation or long-term-care beds to be found.
Voters need to tell their elected officials that hospitals should be reimbursed at least for the costs of the services they provide the poor and uninsured, so that hospitals can continue to provide top medical care in crucial yet unprofitable specialties like pediatrics. And voters should write our congressional delegation and ask them to get Congress to reinstate federal "DSH" (Disproportionate Share to Hospitals) dollars for Hawai'i. This one change alone would bring nearly $80 million in additional federal reimbursement to Hawai'i's hospitals.
There are many practical prescriptions for addressing the crisis facing our hospitals and the quality of healthcare in Hawai'i. It is time for citizens to raise their voices and demand action in one of the most fundamental responsibilities of government — the health and welfare of the people.