Let’s seize the chance to have better health for all

A fresh window of opportunity is open for the health of residents and visitors in Hawaii. Although much remains to be done, the greatest challenges faced by health care reform, Obama­care, are now behind us. The aim of improved access to quality care combined with cost containment is within reach.

In its second year the Hawaii Health Connector is working more smoothly than at the outset. The health provider community is for the first time in many years regaining its confidence, focus and direction. Insurance and hospital leadership have demonstrated a genuine commitment to patient engagement in disease prevention. At the same time, the fundamentals of both the U.S. and Hawaii economies appear to be on a reasonably solid footing.

Among the top health priorities facing the new administration is the need to forge a durable solution to the chronically mounting financial burdens of the Hawaii Health Systems Corp. Important decisions must be made regarding the potential for public-private partnerships. If the private sector does take a stake, the better choice is to facilitate a level playing field among proven local organizations that understand the unique needs of each island community. Still, all considered will need to make sacrifices for a better future.

Continuing efforts must be made to more skillfully support the local homeless population while discouraging those who have no possibility of earning a living from flying to Hawaii without a viable plan. The long-term solution will not be found by simply adding to the list of places where homeless are prohibited from camping, sitting or lying. Rather, Hawaii must augment strategies that support the family unit and strengthen the ohana. To do so we must better organize services that care for residents with behavioral and mental health problems together with those troubled by alcohol and substance abuse. Sadly, the number of homeless with dual diagnoses of behavioral and substance abuse problems is extremely high.

Taking measures to better support the family unit while improving access to behavioral health services including autism and working to combat prescription drug abuse and narcotic diversion will go a long way toward mitigating inefficient and inappropriate use of hospital emergency departments and hospital readmissions. Hawaii also needs an expertly structured pilot dispensary for medical marijuana so that those who hold approved certificates given by registered physicians are not forced to make illegal purchases. Such headway will reduce the cost of health care in Hawaii that will, in turn, further improve access to quality health care. Doing so will enable both law enforcement and the criminal justice system to more readily focus on violent crime and other pressing matters of public safety.

The primary strategy to improve health in Hawaii should not be additional funding. In most cases, existing resources are reasonably adequate but can be used more wisely. Notable exceptions are the John A. Burns School of Medicine and the Cancer Center.

The good news is that Hawaii is already far ahead of the rest of the nation owing to the Prepaid Healthcare Act of 1974, which requires employers to provide health insurance to staff who work at least 20 hours per week for four weeks. The people of Hawaii also benefit from the unique QUEST program, a legacy of former Department of Health Director Dr. Jack Lewin and others, which combines federal and state dollars to insure those who still have the potential to rejoin the workforce. These two elements have already afforded access to a greater percentage of the population than in the rest of country. In fact, to a large degree, Obama­care is really about the mainland trying to catch up to Hawaii.

The ability to move the state of health care in Hawaii further ahead also depends on team-based, interdisciplinary collaboration to manage obesity and diabetes and the many chronic diseases that can be prevented or improved by lifestyle changes. Physicians are highly trained to exercise clinical judgment and to perform procedures, but many other health professions are better suited to provide not only health education, but also supportive coaching so that those who are ready can meet their health goals.

Getting health and wellness right will build Hawaii’s brand and strengthen our tourism industry. It will also bring more visitors who respect the host culture and our precious but fragile aina. There is accelerating demand, especially from China, for health and wellness tourism. The flight of capital from Asia in search of a safe haven for health care, investment, education and the rule of law, if carefully facilitated, will make a positive contribution to Hawaii in the coming years. The millions of tourists who visit Hawaii each year and who contribute so much to the economy also dictate the importance of dynamic strategies to prevent the spread of infectious disease epidemics and to ensure environmental safety.

The incoming administration has unprecedented potential to preserve, protect and further improve our precious island home. During the current term, Hoku­leʻa’s worldwide voyage will continue to bring Hawaii into the global spotlight. The current juncture is blessed with a most auspicious set of conditions conducive to positive change for the health of Hawaii together with an opportunity to share these gains on the international stage.