Need strains isle health clinics

STORY SUMMARY »

The demand on Hawaii's community health centers continues to grow, especially on the neighbor islands, where private health services are becoming more scarce as doctors leave the area or turn away Medicare and Medicaid patients.

The Molokai Community Health Center, for example, sees more than 3,000 patients a year, a big increase from when it opened in 2004.

While the demand for more centers and more services is high, finding money and property is a major hurdle to increasing the number of sites, officials say.

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Hawaii's 13 community health centers are seeing nearly 100,000 patients annually, and that is still only a fraction of those who need medical care, officials say.

"We're not reaching the population in need, on the neighbor islands particularly," said Beth Giesting, Hawaii Primary Care Association executive director.

Federal funds, rural patients The community health centers: »  Bring about $14 million into the state in federal funds yearly for health care for underserved and uninsured residents. » Save the state $153 million a year because of lower medical expenses for patients. (The average cost per patient is $848 per year.) » Directly contribute $77 million to the economy and employ 900 people yearly. » Indirectly contribute $149 million to the state and support more than 1,800 jobs annually. » Serve a significant number of HIV/AIDS patients and are the primary health care provider for homeless populations. » A 2005 patient profile showed 71 percent were below poverty, 32 percent were uninsured, 40 percent had Medicaid or QUEST coverage, 6,000 were homeless, 29 percent were native Hawaiians, 25 percent Caucasian, 19 percent Asian and 14 percent other Pacific Islanders. » Total funding for the centers in 2005 included $14 million in federal funds, $12.7 in state and local funds, $43.6 million in public and private insurance payments (largely MedQUEST) and $5.1 million from foundations and donations. Source: Hawaii Primary Care Association

Part of the reason is capacity, she said, with new centers on some islands in development stages.

The centers provide services at 50 sites on five islands, and more satellite sites are needed, Giesting said. However, finding money and property to rent or renovate is a major impediment to increasing center sites, she said.

The centers provide medical services to those who cannot afford medical care, but many patients pay something on a sliding scale, Giesting said.

Last year the centers cared for 29,562 of the state's 120,000 uninsured residents and 39,288 of the 200,000 islanders with MedQUEST health coverage. Other patients included 7,181 on Medicare and 22,404 with private insurance.

Community health centers make up Hawaii's largest health care safety net, providing health care many people might otherwise go without. But they are often overlooked, said Giesting, who did say that Community Health Center Week was observed last month.

More satellite community health centers are needed, she said, because private health services are drying up with doctors leaving the neighbor islands or turning away Medicare and Medicaid patients.

In some neighbor island areas, such as Hana, Maui, and Hamakua, on the Big Island, community health centers are the only places available for medical care, she said. The only island without a health center is Lanai, and the Primary Care Association is supporting development of one there, Giesting said.

On the Big Island, the Hamakua Health Center is getting patients from Hilo and Kau and surrounding areas, including people with health insurance who cannot get appointments at Hilo clinics, said Dr. Gina Williams, whose husband, Dr. Brian Williams, is medical director of the center. "We do see the whole Hamakua Coast."

Many Waimea patients also are going to Hamakua since a doctor there closed his practice, she said.

The Hamakua center, headed by Susan Hunt, recently took over the Kohala Family Center because two primary care doctors in the area retired, and a third doctor was having a hard time making it as a solo practitioner, Brian Williams said.

Each of the 13 centers is unique, but all serve federally designated underserved areas and populations that do not have access to health care for economic, cultural or geographic reasons.

They provide culturally appropriate services, including mental, dental and behavioral health care, prescription drugs, diagnostic services, case management, language and transportation assistance, and help with Medicaid, housing and cash assistance applications.

"They make communities livable," Giesting said. "If you lived in Hana and had diabetes, you would be concerned if you had to drive to Wailuku monthly."

She said community health centers are "a great model" for health care because they are stable, nonprofit organizations that provide quality services to people who most need help regardless of ability to pay. Hospitalizations and unnecessary use of emergency rooms are reduced because of the community centers, she said.

To maximize resources, the centers use a teamwork approach with doctors, nurse practitioners, physician assistants, nurse midwives, psychologists and social workers, Giesting said.

Medical and social work students, residents, interns and others in the health care field receive training at the centers. And the centers work with the Native Hawaiian Health Care Systems and other nonprofit health care groups to conduct outreach, health education and prevention programs, Giesting said.

Lack of space to accommodate growing health needs is a major problem at the centers.

The Molokai Community Health Center, for example, has jumped from 59 patients per year when it opened in March 2004 to more than 3,000, said Jina Lee, executive director.

It has an ideal site next to Molokai Drugs and partners with the pharmacy for a discount prescription program, but it needs a larger site or to rent additional space, she said.

The West Hawaii Community Health Center, which received its first federal funding in January 2006, also has experienced rapid growth in patients and services, said Executive Director Richard Taafe.

"We are covering North and South Kona and South Kohala -- an 80-mile stretch, the whole west side," he said. "The territory is larger than some islands."

He said the center's "ultimate vision" is to have a main site in Kona and satellite sites in South Kohala and South Kona.

TOMORROW: Community centers are serving more insured patients, which can actually hurt the facilities' funding.