People without health insurance are less likely to get timely treatment, screening and preventive services and are more likely to use emergency services.  This often results in delay in care and is often associated with poorer outcomes and is often more expensive in the long-run.

 

Accurate measurement of the uninsured is difficult and it is generally agreed that most sources underestimate the problem.  According to the Behavioral Risk Factor Surveillance Survey, the percent of the population without health insurance in Hawaii County increased between 2004 to 2006 and decreased in 2007 (BRFSS, 2002-2007).

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According to the Hawaii Uninsured Project, a collaborative effort to analyze this statewide uninsured issue, 58% of the uninsured are actually employed.

Hawaii law requires employers to provide health insurance for employees who work more than 19.5 hours per week.  Many people work more than two jobs which are each less than 19.5 hours per week.  Part-time and self-employed workers are more likely to be uninsured: 18% and 15% respectively and may rely on emergency rooms for care (Hawaii Uninsured Report 2003).

According to research by Kawachi et al (1999), better access to primary care is correlated with better population health outcomes.

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Here we see that Hawaii County has a smaller ratio of total physicians to population (2.1%) compared to the State (3.0%).  Kawachi’s (1999) research refers to primary care physician ratios, which are not yet available.

Note:  The data on number of physicians reflects licensed physician rather than active physician and therefore underestimates the access to care problem (State of Hawaii, Department of Commerce and Consumer Affairs, April 2008).

Better data is needed on the number of active primary care physicians (Family Practice, Pediatrics, Internal Medicine and Obstetric and Gynecology) to help set better targets and track improvements.

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According to the Behavioral Risk Factor Surveillance Survey (2002-2007) Hawaii County has more people without a personal doctor than the State.  About one out of five people surveyed on the Big Island answered that they did not have one person they thought of as their personal doctor.

Improvement in this indicator is expected to lead to improvement in health outcomes.

• The How’s Your Health, North Hawaii on-line self-selected survey of 802(as of 02.15.08) adults in North Hawaii showed a slightly higher percentage, 30%, answered that they did not have a primary care physician. Similarly, 21% answered that they traveled out of North Hawaii for primary care.

This How’s Your Health, North Hawaii? survey of 802(as of 02.15.08) adults in North Hawaii revealed that 42% of those surveyed felt that the most important strategy to improve the health of the people in North Hawaii was to improve access to doctors and health insurance.

 "Which option do you believe is most important to improve the health of the people of North Hawaii?

Better access to:

42%   Doctors and health insurance

25%   Healthy, inexpensive take-out food

6%    Mental health counselors

12%   Alcohol and drug treatment program

15%   Academic help and support for youth

Source:  www.howsyourhealth.com, Feb. 2008

As the community looks at systems changes which can support prevention through lifestyle change, it is important to note that 25%, feel that better access to healthy, inexpensive take-out food would help improve the health of people in North Hawaii.

Federally Designated Medically Undeserved

Federal designation as a “medically underserved” area sets policies for receiving federal dollars to improve access.  According the Department of Health and Human Services, in 2007, the island of Hawaii was designated as a medically under served area and medically under served population.

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Attracting and retaining high quality health professionals is a challenge in North Hawaii and Hawaii County, because the cost of living is high, cost of private education is high, reimbursement from Medicare and Medicaid and private insurers is low.  At the same time, the demands for night and weekend call are high. Improving health status for North Hawaii and Hawaii County will require effectively addressing the complex issues behind physician and health professional recruitment and retention.

Partnerships between providers, employers, payers, insurers and government to improve access to primary care in Hawaii County are essential to improve health status.

Children without health insurance are five times more likely to use emergency rooms for regular care and four times more likely to delay seeking care. To find information or to help enroll children in health insurance, see www.coveringkids.com/news.