Holy Hawaiian health care!

ARTICLE: In Hawaii's Health System, Lessons for Lawmakers, By GARDINER HARRIS, New York Times, October 16, 2009

The joy of having 50 simultaneous experiments going on: Hawaii has required all employers to make health care available to any 20-hours-or-more employee, and it's done it for 35 years.

The outcomes are impressive:

But perhaps the most intriguing lesson from Hawaii has to do with costs. This is a state where regular milk sells for $8 a gallon, gasoline costs $3.60 a gallon and the median price of a home in 2008 was $624,000 -- the second-highest in the nation. Despite this, Hawaii's health insurance premiums are nearly tied with North Dakota for the lowest in the country, and Medicare costs per beneficiary are the nation's lowest.

Hawaii residents live longer than people in the rest of the country, recent surveys have shown, and the state's health care system may be one reason. In one example, Hawaii has the nation's highest incidence of breast cancer but the lowest death rate from the disease.

Why is Hawaiian care so efficient? No one really knows.

Worth finding out, yes?

The encouraging part:

But the Hawaii experience suggests that overhauling health insurance before changing the way care is provided could work, eventually. With more people given access to care, hospital and insurance executives in Hawaii say they have been able to innovate efficiencies. For instance, the state's top three medical providers are adopting electronic medical records -- years ahead of most mainland counterparts.

The Hawaii Medical Service Association, the state's largest insurer and a Blue Cross Blue Shield member, recently offered the nation's only statewide system whereby anyone for a nominal fee can talk by phone or e-mail, day or night, to doctors of their choosing.

Kaiser Permanente Hawaii, which covers about 20 percent of the state's population, screens 85 percent of its female members ages 42 to 69 for breast cancer, among the highest screening rates in the country.

Most impressive: ERs are not overburdened as a result.

Comments

[historyguy99]

The most obvious thing is that they have no common border with a foreign country or other states. Hence very low level of trancient undocumented and homeless compared to continental U.S.

[TEJ]

Hawaii is a great place to experiment (small & isolated) but a poor place from which to generalize (culturally and racially much different from mainland). The averages can be misleading here, as health stats are skewed by many healthy, long-lived Japanese Issei and Nisei or by many obese chronically unhealthy Pacific Islanders. From inside the ambulance the ER at Queens Hospital (Honolulu) was pretty similar to the ER at Grady (Atlanta).

[Andrew in DC]

Adding to historyguy's comment - I would also wonder what their free-rider percentage is. Un/undereducated individuals who occupy menial (if any) jobs. Their presence in California, much of the South and many major metro areas also serves to drag down other indicators of general health - life expectancies, rates of infectious diseases and, significantly, rates of dietary-related illnesses.

I'd also speculate that the differences in the predominantly present ethnic cultures would also capture different genetic predispositions, and not being a doctor I've no idea how those would play out.

Finally, as for using Medicare benefits as a measure of the efficiency of the state's healthcare - given the costs to live in Hawaii, I don't see a lot of people on a fixed salary living out their final years there.

"This is a state where regular milk sells for $8 a gallon, gasoline costs $3.60 a gallon" ... yet no connection, anywhere in the article, between those costs and the fact that the health care burden levied against the employers is radically higher? "Here's your one-topping, large pizza sir, that'll be $30... and thanks for paying for my insurance"

[Larry]

I know this is anecdotal, but my mother-in-law had a horrible experience with Kaiser on the Big Island. Her primary care physician wouldn't refer her to a orthopedic surgeon for chronic stenoisis until my wife made a stink. Seemed like they just wanted to push pain pills until she died or was judged to old to survive the surgery. She did survive but suffered permanent nerve damage due to the delay that makes her less less steady on her feet.

[deichmans]

It has the tax base to cover the expenses. We declared residency in Hawai'i during my Science Advisor tour (expecting to live there three years; only stayed two); our State Income Tax for 1998 was nearly equal to our Federal Income Tax. Add in the beaucoup revenues received from a near-continuous tourist season, and it rivals France's 19%+ sales tax.

[Adam Theo]

Another anecdotal story from personal experience staying in Honolulu for 4 months: They have a large number of homeless out on the streets and on the beaches. Downtown at night had a homeless guy or gal on almost every street sleeping in a doorway. It's more than I'd seen in any major city I've stayed in: Atlanta, Boston, or DC.