100% of children and adults have health insurance and a  "medical home."

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• Uninsured (Chart).
• Ratio of primary care physicians per population (Chart).
• Proportion of population without a primary care physician or “medical home” (Chart).

• Potentially avoidable hospital admissions per 10,000 population.

• Admissions per 10,000 population for ambulatory sensitive conditions.

• Annual number enrolled in State Children Health Insurance Program.
• Infant mortality rate per age-adjusted 100,000 population (Chart).
• Stroke death rate per age-adjusted 100,000 population (Chart).
• All Causes death rate per age-adjusted 100,000 population (Chart).

• Increasing percent of population without health insurance, in North Hawaii, Hawaii County, State and the nation (Chart).
• Large portion of population do not have a primary care provider or “medical home.”
• Increasing emergency room visits for ambulatory sensitive conditions, and hospital admissions for “potentially avoidable” conditions.
• Many physicians in North Hawaii, Hawaii County, and state leaving practices.
• Recruitment and retention of high quality health care providers and allied professionals limited by:
• Reimbursement from Medicare, Medicaid and private insurance, which is about 30% to 50% lower than mainland reimbursement.
• Cost of living, especially housing, in Hawaii is at least 50% higher than the mainland
• Public education in Hawaii is ranked as 6th worst in the country in total taxable resources spent on public education (www.nea.org).
• Cost of private education is high.
Health status data shows higher all causes death rates (Chart) and higher stroke (Chart) and infant death rates in Hawaii County (Chart).
• Research shows that overall death rates are highly correlated with lack of access to primary care (Kawachi, 1999).
• Perception that some local physicians may oppose recruitment of new physicians.
• Recent efforts to develop x-ray technician training and new pharmacy school started in Hilo.  Plans for branch of JABSOM in Hilo.
• Currently fragmented efforts to address current and future workforce shortages.

Local:  

Hamakua Health Center, Catholic Charities Mobile Care Van, Employers, Hawaii Island Hospital - Kona and Hawaii Island Hospital - Hilo.

County:             

Hawaii Island Rural Health Association, Department of Health - District Health Office, UH Hilo-School of Nursing, Hawaii Area Health Education Center (AHEC), and the Hilo Bay Clinic.

State:                

State Health Planning and Development Agency (SHPDA), AHEC, Health Care Association of Hawaii (HAH), Hawaii Medical Association (HMA), Primary Care Association, Department of Health-State Office of Rural Health, Department of Health-Primary Care Needs Assessment, Hawaii State Rural Health Association, Hawaii Uninsured Project-Hawaii Covering Kids, Hawaii Health Systems Corporation, UH: John A. Burns School of Medicine and School of Nursing, Health Insurers (Medicare, Medicaid, HMSA, Kaiser, Tricare, Summerlin), Hawaii Business Coalition on Heath, AARP and Hawaii Tourism Authority.

National:

American College of Physicians (ACP), Center for Medicare and Medicaid (CMS), National Rural Health Association, Robert Wood Johnson Foundation (The Access Project), Association for Community Health Improvement (ACHI), Rural Policy Research Institute, and Health Resources and Services Administration (HRSA)-Community Access, and Communities Joined in Action.

Academic:        

Dartmouth Center for Clinical Evaluative Sciences, University of California, San Francisco Health Professional Development, and UH JABSOM - Department of Public Health.

• See WHO Alma Ata Declaration.
• See National Rural Health Association Issue Paper:  Recruitment and Retention of a Quality Health Workforce in Rural Areas.
• Develop new model for health services delivery with more physician extenders, more telemedicine capacity and stronger focus on risk assessment, risk reduction and prevention.  See Reforming Primary Care: A Comprehensive Strategy from the American College of Physicians http://nhop.org/documents/ReformingPrimaryCare_001.pdf.
• Promote and support local students entering health professions through partnerships with local schools and Area Health Education Centers and hospital auxiliaries.
• Increase access through Federally Qualified Heath Centers.

• Expansion of federally qualified Health Center to West Hawaii.
• Hamakua Health Center expanded service in North Kohala.
• Area Health Education Centers.
• State Health Planning and Development Agency collecting health workforce data.

Increase Awareness:

• Increase awareness of consequences of workforce shortages, shared responsibility and what’s worked elsewhere.
Increase awareness of objective health workforce data.
• Increase awareness of access to care through Federally Qualified Health Centers.
• Continue to publicize phone numbers to access health insurance for children and adults.

Increase Organizational Links:

• Increase links with organizations working on this issue.  Find lead organization to convene a work group, engage stakeholders and drive further analysis, goal setting and improvement.

Obtain Additional Data:

• Quantify the relative reimbursement and cost of living by state and counties.
• Collaborate with SHPDA, DOH, AHEC, and JABSOM to improve data to track access to primary care physicians, including percent uninsured, primary care ratio and proportion without “medical home.” Develop an ongoing annual update process.
• Collaborate with SHPDA, HHIC, AHEC, DOH, HMA, (HAH), Primary Care Association, insurers, and others to develop Hawaii Health Workforce and Primary Care Needs Report, which identifies the need for and barriers to recruitment and retention as well as short and long term strategies to improve.

Inventory and Build on Existing Resources:

• Inventory existing assets and resources and/or organizations working on health workforce development and their specific targets and programs.

Develop Effective Programs:

• Collaborate with Federal Qualified Health Centers to increase capacity to provide access to high quality health care and publicize availability.

Develop Effective Practices:

• Investigate alliance with national locum tenens companies to address immediate crisis in specialist access.            
Investigate partnership with emergency preparedness resources to fund expansion of primary care base.
• Collaborate with Hawaii Tourism Authority to assess impact on visitors of inadequate access.
• Collaborate with stakeholders to find models and resources for recruitment and retention of primary care physicians, primary care practitioners, and ancillary health providers.
• Identify model reimbursement policies which increase access.
• Collaborate with Hawaii Public Health Association to focus its annual conference on improving Access to Primary care.

Promote Effective Policies:

• Work with insurers to develop a pilot project which addresses reimbursement barriers.

Identify and Address Barriers:

• Work with stakeholders to develop annual quantification of relative cost of living index in Hawaii State and Hawaii County.
• Support improvements in public education.
• Support policies which increase access to affordable housing.

Improve Health Systems:

• See recommendations under What Works - Best Practices from the American College of Physicians.
• Continue to publicize phone numbers to access health insurance for children and adults.
• Collaborate with Federal Qualified Health Center to increase capacity to provide access to high quality health care and publicize availability.