A report surveying access to health care in Hawaii offers a sobering picture and troubling trends for the state.
The COVID-19 pandemic has taken a toll on many Hawaii residents and their financial, physical and mental well-being, with nearly a third reporting that they or a family member are in need of counseling or coping skills.
A majority of those surveyed, 52%, reported having to make cuts to their food and grocery budgets, while 36% said they cut back on medical care due to financial challenges.
Nearly 6 in 10, 58%, reported experiencing delays when attempting to access health care over the past year, with many saying that they could not get appointments with doctors.
Seeing a specialist can be even more challenging, with a wait time that can last more than a month or two.
Community First, a nonprofit based in Hilo, released the “Access to Care” report Tuesday — a snapshot based on online survey results from nearly 3,300 Hawaii residents, along with input from more than 300 health care providers statewide in April and May.
Individual and small-group interviews were also conducted in March, April and May among health care professionals and social service agencies.
“There really is a tale of two Hawaiis,” said Lisa Grove, CEO of Grove Insight, which managed and analyzed the data. “There are those that are doing well but also a whole lot of folks not doing as well.”
Those who are college-educated and not struggling financially, including some kupuna, are among those more likely to rate Hawaii a healthy community. Those who live on Oahu, particularly Honolulu, where the most extensive medical resources are concentrated, have more access to health care.
Those in rural Hawaii or on a neighbor island — especially Lanai and Molokai — have a much more difficult time accessing health care and oftentimes have to travel to receive care, which is arduous and expensive.
Pacific Islanders and Native Hawaiians are struggling more, as are those with only a high school diploma, Medicaid/Med-Quest patients and those who speak limited English.
These same patients also tend to struggle with internet availability or the technological know-how to access telehealth care.
But some patients on Oahu also said they had to drive across the island to get access to health care or a specialist. One person in Kahaluu said they had to go to Hawaii Kai to find a primary care physician taking new patients.
“What we found was really a huge divergence based on socioeconomic status, racial ethnicity and then what island you live on,” said Grove.
The pandemic has contributed to poorer physical and mental health overall, according to the survey, with 38% reporting worsening mental health and 33% reporting deterioration of physical health over the past two years.
The pandemic also made economic insecurity worse for 40% of residents surveyed. Surprisingly, those ages 35 to 44, the prime of adulthood, are struggling financially and reporting a need for mental health counseling.
Among comments community members used to describe the current state of health care in Hawaii: heartbreaking, kind of hopeless, frightening, a succession of obstacles — even “a death sentence.”
The most common complaints were the inability to get appointments — or even people to answer the phone — due to physician shortages. Others are being told to go to urgent care instead of seeing their primary care physicians.
Others said they felt rushed at their in-person or telehealth appointments, or that there were layers of red tape to get those initial appointments or referrals. There were also complaints of delays in testing and diagnoses, and rising costs, even among those who are well insured.
On the health care provider side, there are challenges with recruitment and retention, which contributes to the ongoing doctor shortage.
Most medical providers say affordable housing remains one of the biggest barriers in recruiting new doctors, along with the high cost of living in Hawaii. Providers also cited low reimbursement rates from Med-Quest, Medicare and commercial insurers as obstacles to recruitment and retention.
More than half of providers, 52%, are contemplating reducing their hours; 53% are considering leaving medicine; and 49% are considering moving to the mainland.
There is also a shortage of psychiatry and behavioral health specialists in the state at a time of great need, particularly those specializing in younger people and teens, the report noted.
More than three-quarters, or 78%, of providers say mental health and counseling is the most needed medical specialty.
“The stories of anguish resulting from mental illness and lack of mental health care in Hawaii are devastating,” the report said. “A number of respondents chose to tell stories of suicide.”
Health care access problems could soon reach a crisis, the report noted, due to greater patient need and fewer doctors on the horizon.
The next step, according to Community First, is to convene working groups to seek action and find solutions.
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Access to Care highlights
>> A majority, 52%, reported making cuts to their food and grocery budgets for financial reasons. More than a third, 36%, say they cut back on medical care or medicine in the past year because they were short on money.
>> Nearly 6 in 10, 58%, say they have experienced health care delays in the past year.
>> Nearly 3 in 10, 28%, reported that they and/or a family member are in need of counseling or coping skills.
>> More than half, 53%, of health care providers are contemplating leaving or retiring from medicine; 52% are considering reducing patient hours; 49% are considering moving to the mainland.
Source: Access to Care
