Danger and opportunity in Hawaii’s health-care crisis

Hawaii's health-care crisis, with hospitals bursting past capacity, patients waiting five to six hours in emergency rooms and ambulances being re-routed for lack of hospital openings actually illuminates a much deeper crisis -- our culture's prevailing attitude of what constitutes effective healthcare.

The United States spends more than $2 trillion and more than 17 percent of its gross domestic product on health-care services, yet our citizens' health ranks 37th among developed nations. Other industrialized nations spend considerably less on health care, while offering services to all of their citizens with better outcomes.

As long as society expects that a sick or "broken" person goes to a physician or clinic to be passively "fixed," we will be faced with more doctor visits, more prescriptions, more hospitalizations, more procedures and more tests. As long as patients are viewed as a collection of "parts," each of which must be treated by a different specialist in a health-care system that is not conducive to optimal coordination and collaboration, we are unlikely to achieve cost-effective health care. Instead, we can expect annual health-care spending to continue to increase at two to five times the rate of inflation. We can expect General Motors and Ford to continue to lose market share to Toyota and Honda as health insurance costs rise. We can expect Medicare to become insolvent. We can expect half of all personal bankruptcies to continue to be due, at least in part, to medical expenses.

Conventional medicine has its roots in surgery and pharmacology, treating specific illnesses and symptoms. It sees emotional and environmental factors as secondary. But a growing body of evidence points to the success of integrative health-care models that combine both conventional medicine and the traditional healing arts, including the 570-patient Berman study from University of Maryland School of Medicine in 2004. Berman found that patients with osteoarthritis of the knee had a 40 percent decrease in pain and a 40 percent increase in function with acupuncture plus routine care.

Even a crisis management model of care can benefit from the perspective that optimal health care requires. One's care improves when both provider and patient focus on a healthy lifestyle with discrete short-term goals, such as limiting soda to a maximum of one can per day, together with long-term wellness goals such as keeping body weight under control. Hospitals and emergency rooms are obviously vital, but so are treatments that focus on whole-person wellness and preventive care. Physician Terry Shintani published a study in 2001 in the Honolulu Medical Journal showing that Hawaii residents, educated to eat a diet low in fat and high in the right carbohydrates, had improved weight, blood pressure and cholesterol.

Outpatient integrative health care can be an extremely effective adjunct or at times even an alternative to standard hospitalization. Consider chronic pain: Last year, the John A. Burns School of Medicine published a study in the Honolulu Medical Journal reviewing responses from 5,000 households in the Hawaii Health Survey. It found that 78 percent of people whose pain severely interferes with normal work use integrative services.

Is access to a bigger tool set in healthcare a luxury reserved only for the already healthy and wealthy? No. A well-coordinated, integrative health-care plan can actually cost less than a purely conventional medical approach. Even a single day of hospitalization saved is big money. One study, on acupuncture for migraine headaches in the British Medical Journal, demonstrated a 65 percent decrease in costs each year when combining health-care services and sick leave. As a result, the British National Health Service concluded that acupuncture should be considered as a viable treatment for patients with migraine.

Pain, obesity, diabetes and heart disease are all examples of very costly public health challenges that could benefit greatly from a patient-centered, integrative health-care focus in disease prevention and treatment. Health care that addresses not only immediate health concerns but also factors such as nutrition, employment conditions, physical activity, temperament and emotional health might, in its own way, help relieve our overburdened health-care system and obviate some of the need for new ambulances and more hospital beds.

Problems are best solved when those involved are receptive to the widest possible range of solutions. Dedication to partnership in health to bring together the best of modern medicine and traditional healing arts offers one solution to the current crises, one that will enable us to best serve not only those in need of care but the system in which we all work and live. If we do not seize this opportunity, we face only further danger to life, limb and wallet.