Ka Wai Ola - Office of Hawaiian Affairs, Volume 39, Number 1, 1 Ianuali 2022 — Native Hawaiian Access to Healthcare is a Symptom of a Statewide Problem [ARTICLE+ILLUSTRATION]

Native Hawaiian Access to Healthcare is a Symptom of a Statewide Problem

J LEO 'ELELE V ^ TRUSTEE MESSAGES "

Hawai'i residents often face barriers in accessing medieal care. For Native Hawaiians in particular, COVID19's impact served as yet another reminder that access to adequate healthcare is lacking for many of our people and is a consequence of a bigger problem. In December 2020, UH's Hawai'i Physician Workforce As-

Keli'i Akina, Ph.D. Trustee, At-large

nolulu-certificate-of-need-gen-eral-excise-tax-11638569759. I noted that Hawai'i has among the fewest hospital beds per capita of any state, and when Hawai'i residents visit the emergency room, wait times are I0th longest in the country. The reality is, if C0VID-19 had hit Hawai'i as hard as it did parts of the U.S. mainland, our hospitals would quickly have been overwhelmed. In addition to the shortage of

sessment Project reported that the statewide physician shortage remains between 710 and 1,008. For doctors starting their careers while saddled with student loan debt, it simply does not make sense to pay the high cost to live and work in Hawai'i, when other states have lower tax burdens that would allow them to pay their loans off faster. Consequences of the physician shortage include longer wait times for appointments and having to travel further away for specialists. For Native Hawaiians in rural and neighbor island regions, the problem is especially acute, often requiring travel to O'ahu or the mainland. Dr. Scott Grosskreutz, a Hilo-based physician, co-authored a study that attributed high breast cancer mortality rates in Native Hawaiian women to a laek of access. "Mueh of that research is related to the ability to access heahh care, to be referred for a mammogram, or - onee you're diagnosed - [the ability] to be treated in a timely manner if you're living on Moloka'i, or Maui, or Kaua'i or the Big Island compared to Honolulu, or if you're in Los Angeles or New York," said Dr. Grosskreutz. (Nieole Pasia, "Hawai'i is the 'most hostile heahh environment to practice in,' physician says," Nov. 30 2021, available online at https:// stateofreform.com/news/hawaii/202l/ll/ hawaii-is-the-most-hostile-health-envi-ronment-to-practice-in-physician-says/) Aside from the shortage of physicians, there is a shortage of facilities. Recently, I penned a commentary in the Wall Street Journal, entitled "Hawai'i Is No Paradise if You Need Medical Care" (Dec. 3, 2021, available online at https:// www.wsj.com/articles/hawaii-no-par-adise-medical-care-covid-hospitals-ho-

providers and facilities are Hawai'i's certificate of need (CON) laws. These laws require those proposing a new medical facility to prove there is a need for h, to a committee whieh includes their competitors. Hawai'i's CON laws are among the most restrictive in the nation, requiring a CON for everything ffom substance abuse shelters to expansions of existing medical facilities. The State Heahh Planning & Development Agency (SHPDA) administers Hawai'i's CON program. Since 2006, SHPDA has denied 24 CON petitions, including applications for three medical facilities that would have added 206 beds, increasing hospital capacity by 8%. These denied petitions also would have brought jobs. Hawai'i clearly faces a healthcare supply and accessibility problem that COVID-19 brought into sharper focus. Hawai'i lawmakers ean effect change, however, by relaxing CON regulations that exacerbate barriers to healthcare access. Hawai'i lawmakers must also get creative to attract physicians to practice here, perhaps by relaxing the tax burden on medical practices setting up shop in rural areas, or by offering student loan repayment assistance. Existing programs that support and encourage Native Hawaiians to enter the medical professions in Hawai'i, and especially on the neighbor islands, are worth expanding. Until we improve the availability of and access to medical resources in the state, Native Hawaiians will continue to face barriers to critical healthcare. ■