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Maui County residents cited costs of care and lack of physicians as two of the biggest obstacles preventing access to care on their home islands, where patients are frequently forced to travel off island to seek treatment, according to a survey of patients and health care providers across the state.
The "Access to Care" report, released Tuesday by the nonprofit Community First along with health care, government and social services partners, surveyed 3,287 Hawaii residents and 324 health care providers from April 1 through May 9. A total of 339 interviews were done in Maui County.
Residents were asked about their financial situation, current physical and mental health, access to care and physicians and use of telehealth services.
Maui County residents were more likely to have had to cut back on food and groceries because they were short on money (59 percent in Maui County compared to 52 percent statewide), but were less likely to report their personal finances are worse since the pandemic (32 percent in Maui County, 40 percent statewide).
They were also more likely to report being in poorer physical health (40 percent worse in Maui County, compared to 33 percent statewide), and in poorer mental health (50 percent in Maui County said their health had gotten worse compared to 38 percent statewide).
While Maui County residents were also more likely to have used telehealth during the pandemic (70 percent compared to 64 percent statewide), they were less inclined to continue using it post-pandemic (57 percent said they don't plan to compared to 49 percent statewide), reporting more concerns with telehealth, "quality of care" chief among them.
Seventy percent of Maui County respondents believe "lack of physicians" is one of the two biggest obstacles preventing access to care, just behind costs of care (75 percent).
For residents living on Lanai, Molokai and Maui, these two concerns are most painfully obvious when they're forced to get on a plane or boat to seek specialists or treatment. About 70 percent of the care that Molokai and Lanai residents receive requires a trip off island, according to the report.
"Lanai is woefully lacking in access to health care," one respondent wrote. "There are too many areas to name ... but just a couple: It's terrible that pregnant women cannot stay on the island to give birth. We have to go to Maui or Oahu to even get a basic mammogram. It's expensive to fly there and takes an entire day away from our small business."
One Molokai resident worried they would be forced to leave their lifelong home over lack of access to some basic health monitoring tests.
"Please help improve the Island of Molokai's access to health care," the respondent said.
Maui residents also raised concerns about the need to fly off island for treatment.
"Maui is very limited on specialists," one respondent said. "General physicians cross boundaries into specialties without proper training, which can result in low quality care."
Statewide, the survey found issues with timely health care, with 58 percent saying they have experienced health care delays in the past year. Nearly half of providers, or 48 percent, confirmed this, saying that the wait time to see any type of specialist on island or off is more than a month and can be longer than two.
Roughly half of responding providers also said they were contemplating reducing their hours, leaving or retiring from medicine and/or moving to the Mainland, "suggesting Hawaii has a recruitment and retention problem."
Providers and community members agree that doctor shortages drive delays, the report said. When asked if there were enough physicians on their respective islands, 61 percent of residents said no. On Neighbor Islands, the number was unsurprisingly higher -- 82 percent on Hawaii island, 80 percent on Kauai, 76 percent on Molokai, 74 percent on Lanai and 69 percent on Maui. Most Oahu residents, however, (54 percent) also believe there is a provider shortage.
"How do we as a community deal with all the pukas in our system?" one Maui County resident asked. "We lack mental health professionals in addition to medical specialists, so patients wait longer and get more sick. The state of our medical system of care has to 'compete' with that of education, housing and the economy as priority for our community. It seems that we are lacking a systematic way to build capacity."
The report noted some solutions, including building a workforce of homegrown talent. Obstacles like high cost of living and lack of housing could be tackled through incentives like good pay, tax incentives, loan assistance and/or housing. Interest in the health care field could be generated early on through high school dual credit health care programs, free or reduced tuition, increased salaries across the health care spectrum and outreach to underrepresented groups and recent local graduates.
Growing more local health care workers would also address the need for providers who understand Hawaii's culturally and linguistically diverse community.
In a survey of a focus group that included mostly providers, proposals also included changing and expanding community health to include better access to multilingual and culturally relevant programs; addressing staffing shortages, starting with urgent needs in mental health care; dismantling physical barriers to access through ways such as offering additional or different clinic hours; improving understanding of and access to telehealth care; building a more equitable system that recognizes the sometimes unmet needs of Medicaid/MED-QUEST patients; and looking into policy changes regarding better reimbursement rates, general excise tax reforms and tax breaks.
To view the full report, visit www.accesstocarehawaii.org.
* Colleen Uechi can be reached at cuechi@mauinews.com.