An estimated 4,800 Kauaians do not have any medical insurance. If they are like other uninsured folks across the state — and the numbers are growing — they delay or avoid getting medical care when afflictions arise, often complicating medical
An estimated 4,800 Kauaians do not have any medical insurance. If they are like other uninsured folks across the state — and the numbers are growing — they delay or avoid getting medical care when afflictions arise, often complicating medical problems.
But before equating the island’s poorest residents with those not holding medical insurance cards, realize that the most economically disadvantaged Kauaians likely qualify for the QUEST program’s broad coverage and benefits, explained Dr. Fred Fortin, vice president of policy and planning with Hawai’i Medical Service Association (HMSA).
“Oftentimes, the very poor have the most insurance,” he said.
Still, the increase in the percentage of Hawai’i residents not holding medical insurance — from around 5 percent to 7 percent in 1998 (and 8 percent on Kaua’i) — has prompted the non-profit HMSA Foundation to fund a three-year, $300,000 program. Fortin says it has a “modest” goal of reducing the numbers of uninsured residents of Hawai’i.
“I think it’s a big problem. It’s a growing problem in Hawai’i,” he said. “What are we going to be doing? We need a statewide approach.
“We need an intelligent approach, that is, having information. We need to be sensitive to the local nuances of the problem with the uninsured, and we need to build a solution. And that’s a big challenge. That is a very big challenge. That’s what we’re trying to do here.” “It is a community problem, because the rise in the uninsured ultimately affects the cost and quality of healthcare for everyone,” said Cliff Cisco, HMSA senior vice president.
Data from the Hawai’i Uninsured Project’s late-November meeting on O’ahu shows Kaua’i leads the state in percentages of uninsured people in two diverse age categories: 15 to 17-year-olds (13 percent) and 55 to 64-year-olds (9 percent).
Kaua’i also has a high percentage of young adults (ages 18 to 24) who are uninsured, at 15 percent. Fortin says there are several reasons they may be uninsured, among them a feeling of invincibility that comes with being young and healthy.
Sometimes, he explained, people in this age group are getting out from under their parents’ medical coverage and may not be working full-time jobs, which by state law (with a few exceptions) are required to come equipped with medical insurance.
Fortin said people working several part-time jobs have the hardest time paying for medical care, in part because of the long hours and physical wear and tear of their work schedules. This so-called “worker middle class” is another group which might not have any or adequate medical insurance, so the focus can’t be on just the poorest people in the state, he explained.
The lone Kaua’i resident to attend the November conference was Neva Olsen, who is with the state Department of Health Kaua’i district health office. She was on a committee looking into ways of getting better data on numbers of uninsured folks in the state.
The data on the uninsured is from the 1998 Hawai’i Health Survey, a scientific telephone poll of 4,382 households representing 12,923 people.
Olsen said the data presented at the conference was “close,” but may not pinpoint exact numbers of uninsured people in the state.
As an example, data given to participants at the uninsured conference came from four sources of information, including U.S.
Census figures, interviews, surveys and hospitals and clinics across the state.
Some data, especially differences in percentages of uninsured residents between islands and among age groups polled, is perplexing for Fortin and others. But because of HMSA’s statewide research into other medical problems, he said, the different counties may have different programs to address the needs of the uninsured and underinsured.
Differences in unemployment rates among the counties and other factors play roles in the differences seen in the data presented at the November conference.
Olsen said numbers on underinsured residents may be getting into the figures for uninsured people, skewing that data.
On Kaua’i, she is using a federal grant to get more needed primary medical care (at clinics as opposed to hospitals) for the island’s uninsured and underinsured.
To get an idea of how such patients impact healthcare costs, Wilcox Health System (Wilcox Memorial Hospital and Kaua’i Medical Clinic) annually does $1 million in charity services and writes off another $3 million to bad debt (mostly people who receive services and don’t have insurance, enough insurance or the ability to pay the medical bills).
Nobody is turned away for inability to pay, said David Patton, Wilcox Health System’s chief executive officer.
While the goals of Hawai’i Uninsured Project are to get better data and “brainstorm” on statewide strategies to reduce the numbers of uninsured residents, it is not ready to approach the 2001 Legislature with its ideas, Fortin said.
“We have to really understand better the nature of the issues involved here before we do that,” he said. “This is a long-term problem. This is something that’s been with us for a while, and it goes up and down depending on economic activity.
“We tend to have less uninsured if we have a robust economy, just given the nature of the prepaid health care law. But we have to have safety mechanisms, safety nets in place, because it’s not just being insured, but what happens when you are not insured. You don’t go for early treatment, you don’t get the services you need, discontinuities in who provides care for you — all of those things are sort of correlated with not having insurance.” Staff Writer Paul C. Curtis can be reached at pcurtis@pulitzer.net or 245-3681 (ext. 224).
