Paradise costly for health workers
By Karin Stanton
Associated Press
KAILUA-KONA » West Hawaii bid goodbye to more than a dozen primary-care physicians and specialists during the last couple of years, prompting many to declare a health care crisis.
With few other choices, many residents have been either going without health care or turning to Kona Community Hospital, which has long operated at or above capacity.
"I've lived here for 24 years, including working at the hospital for 15 years. I have good insurance, and I still can't get in to see my doctor sometimes," said Bruce Makarewicz, president of the board of directors at West Hawaii Community Health Center.
Instead, Makarewicz uses the health center in downtown Kona. One of nine in the state, the West Hawaii Community Health Center has been open for two years and sees anyone who needs help.
More than 5,000 patients had been seen last year through the end of November. Of those, 30 percent were uninsured, and 61 percent were well below the poverty threshold, said Jo-An Boland, the center's chief financial officer.
"That's our mission statement: Anyone who walks through the doors, regardless of income or insurance," Makarewicz said. "We'll treat you for the day, but we are here for the long haul."
Health centers are partially funded by federal and state grants and private donations, with slightly more than half coming from patient and insurance reimbursements.
State Rep. Josh Green (D, Keauhou-Honokohau) said he pushed to dedicate tobacco settlement funds to community health centers. Over the next few years, an annual allocation of $15 million will be available to support the state's community health centers and trauma care facilities.
The West Hawaii Community Health Center is more than doubling its size this year, adding four exam rooms and at least one doctor. In addition, the center will offer behavior guidance and dental care within a year.
Currently, it has three exam rooms and one full-time physician, plus support staff.
"From a dollars-and-cents issue, for a doctor to do business, he has all the business overhead -- office, staff, insurance," Makarewicz said. "The clinic can take the business side of it, and doctors and nurses can just come in and practice medicine."
The option of a health center relieves pressure on the hospital's emergency room.
Kona Community Hospital has seen an increase in the number of patients since doctors became scarce, and an outpatient clinic for less urgent cases is in the early planning stages.
"A lot of communities where health centers have started have ended up being the preferred place, not the ER," Makarewicz said. "Not that it's a competition, but that does take the edge off the ER."
Health centers now number more than 1,000 across the country, including three on the Big Island and six others on other islands.
"The shining star is in Waianae," Makarewicz said. "They have a 24-hour emergency room."
In addition to providing an alternative to hospitals, the centers also can serve as primary care providers.
Most common injuries, illnesses and complaints can be cared for at a health center for an average of $30, but if left untreated could result in an emergency room visit, which averages more than $1,000, said Green, chairman of the House Health Committee and an emergency room doctor.
"The health care centers are a wonderful addition, but they are not filling the gap entirely," he said.
Typically, Green said, a community needs one physician per 2,000 to 3,000 residents. Hawaii has about 2,000 practicing physicians, which would be ample for the state's nearly 1.3 million residents except for that most of the doctors are concentrated in Honolulu.
Green said he will call for better insurance reimbursements, malpractice reform and incentives to attract more physicians at the upcoming state Legislature session. He said the state must make Hawaii attractive to physicians through incentives such as tax breaks.
"When you think about the combination of arriving in Hawaii with student loan debts of $150,000 and then finding housing at $500,000," he said, "it's just too much."