The Business of Health Care

Two opinions on a plan for health care on Molokai emerged last week: residents want a patient-centric, easy-to-navigate system with choices, while providers are concerned about finding funding to keep their services available.

“I would like it if our current health care providers would stop squabbling,” said Jeannine Rossa, a Molokai resident, via the Dispatch’s Facebook page. “We need them all. We like them all. We want them all.”

The Department of Health (DOH) facilitated a second meeting on Molokai to develop a comprehensive health care plan for the island last Wednesday at Kalanianaole Hall. Facilitator Joe Lapilio broke the crowd of about 100 into four groups and asked them to discuss three questions: What would quality health care on Molokai look like? And, if successful, what changes would we see among providers, and amongst residents?

Resident vs. Provider
Health providers outnumbered community members at the meeting, and residents took the opportunity to ask for choice in their “wish list” of health care on Molokai such as configurable remote patient monitoring.

“With all these providers, there’s not enough,” said resident Debbie Davis. “We need more specialists as well as primary care on this island. We have one doctor accepting little ones… there’s not enough pediatricians.”

According to an inventory list gathered by the Molokai Community Health Center (MCHC) last year, MCHC is the only health organization on-island with a full-time pediatrician.

Resident Loretta Sherwood-Labrador joined in the discussion via the Dispatch’s Facebook page. She said she saw the need for an additional urgent care center.

“I have had to go to the ER for minor emergencies because the doctor’s offices are too full to take walk-ins,” she said. “This is $100 copay for me and my family. This also makes me question whether or not I can afford the copay, which puts my own health in jeopardy.”

Finding the Funding
Money was the main issue for many of the providers at the meeting – they agreed that providing care, especially accounting for those under- or uninsured takes money. However, providers were split on how to handle a fair distribution of funding.

Dino Fontes, head of nursing at Molokai General Hospital (MGH), suggested that funding be based on the services an organization provides – how it responds to patient needs rather than a system of competition.

Alternatively, Kristie Caparida, clinical manager at Molokai Dialysis Facility, said she didn’t understand why competition and duplication was a problem in the first place, using Molokai’s multiple restaurants as an example.

Janice Kalanihuia, president of MGH, said it may be better for each organization to present their own plans to each other, before approaching the public.

“I think what we’re trying to change is absolutely necessary,” she said. “[But] I’m not sure this is the proper venue,” adding that she is looking out for “what is best for health care on Molokai in the long term.”

Next Step
Lapilio said the DOH plans to hold at least one more meeting before evaluating how the process is coming along.

The next meeting – June 29 at the Mitchell Pauole Center at 6 p.m. – will discuss the ‘how’ of the plan, the specifics of implementation. Lapilio added that DOH Director Loretta Fuddy will be in attendance at the next meeting.