Saturday, November 25, 2006


Kahuku Hospital closure comes even as nation experiences a hospital construction boom

A Wall Street Journal article raises alarms that hospitals in poorer areas are closing even as the nation experiences a boom in hospital construction. (WSJ requires a subscription, so read the article here or here).

What's the problem? The WSJ article begins:
A building boom under way in the U.S. hospital industry is sparking concern about economic and geographic disparities in health care.

Much of the construction is occurring in fast-growing suburbs, as hospitals target the most affluent, insured patients who can afford to pay for top care. At the same time, many urban hospitals - which often treat poorer people - are struggling financially, and scores have had to shut their doors.
The idea that North Shore patients will have to travel long distances through increasingly heavy traffic for acute or regular care should raise alarm bells. See also, Flirting with disaster - Kahuku Hospital should not close on this blog.

The deaths that result when someone cannot make it to a far-away hospital don't make the news, but they certainly occur. Going back a couple of years, those who depended on maternity services at St. Francis West were in a similar situation when the hospital announced that it would shut down those services. See St. Francis West maternity services will close: With West Oahu service ending, area women must go downtown to give birth. You know that many of those babies didn't make it, but their names don't appear in headlines.

The medical and hospital crisis in Hawaii is deepening, and will call for city and state to come up with solutions. But just as he did when the issue of homeless shelters came up earlier this year, Mayor Mufi Hannemann has not stepped forward to help find solutions, he is trying to pass the burden on to others. In a Pacific Business News article the mayor offered only that someone else should do it:
The city is not equipped to run [an emergency] medical facility," Hannemann said. "What's needed is for others to step forward with funding and other resources to get such a center established.
The reason hospitals in poorer or rural areas are closing is crystal clear--they are losing money and can't recoup it. A hospital can cure many ills, but not the continual spilling of red ink. Nor is it likely that a competent entity will come forward and take on that loss. It's not happening elsewhere, why should it happen here?

There needs to be a viable long-term solution to avoid a predictable crisis in healthcare in this state. Doctors are leaving, in part due to reduced reimbursements and in part (I have been told) due to inadequate facilities. Instead of running away from the problem, the mayor might instead do something useful, like convene a task force to identify the issues (diagnosis), determine what can be done (prognosis), and then get busy putting in place a solution (cure). In other words, what is needed is to apply the medical model to prevent the affliction facing the people of the City and County of Honolulu.

There is talk that Hannemann may have higher ambitions. In that case, he might look to his image. It was Mufi who kicked out over 200 people from Ala Moana Park with no plan in place for their shelter, leading many of them to camp out on his doorstep in protest. He then ignominiously arrested the protest leaders, still avoiding any proposal of his own for a solution to the problem he had caused. Transit plans and the transit tax are now controversial, with no solution from the mayor for another problem he has caused: proposing a transit system he knew could not be paid for within the limits he promised.

The one thing predictable about the 12.5% excise tax increase is that it will further increase the ranks of the homeless and produce even more demand on the medical infrastructure. And now, as the strain on hospitals is reaching the breaking point (see also Hospitals Struggle with High Costs), the mayor's expectation may be that a miracle will provide a solution to Oahu's hospital crisis. There has been talk that the Kulima Resort people can do something to alleviate the crisis. That would be welcome, of course (assuming the development goes ahead), but stopgap solutions are not the answer.

Of course, the solution will fall to the legislature and governor to discover. That's not inappropriate. It's just too bad that our mayor is not part of the team.


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