A survey of Hawaii primary health care providers reveals struggles to stay in business following changes to compensation by the state’s largest insurer.

More than 80% of providers surveyed believe the Hawaii Medical Service Association payment system is putting physicians out of business, Hawaii Public Radio reported.

The study was conducted by health policy organization Aimed Alliance, based in Washington, D.C., and funded by the Atherton Family Foundation in Honolulu.

“The big concerns are that the pay was too low and they felt this disincentivized them to practice medicine and that it was contributing to provider shortages that were already occurring in Hawaii,” Aimed Alliance counsel Stacey Worthy said.

The study surveyed 60 primary care providers in the association’s payment transformation program and found a majority believed the program caused an increase in administrative tasks, resulting in longer hours and higher staffing costs.

“We found that it was causing financial stress on primary care providers and it is also increasing administrative costs, which trickle down the health-care system,” Worthy said.

Doctors have traditionally been reimbursed for serv­ices under a “fee-for-service” model in which physicians provide services such as annual check-ups and the insurer then pays the doctor.

Under the Hawaii Medical Service Association’s compensation program launched five years ago, the insurer pre-pays primary care doctors with capped amounts per patient.