Cultivating Molokai’s Healthcare System

Opinion by Keith Izawa

Recent coverage in The Molokai Dispatch has touched on the importance of strategic health planning on the island (“Health Center Awaits Funding,” March 16, 2011).  Molokai is certainly a medically underserved area, but creating a high-performing health system is more complicated than “more is better.”  Unnecessary duplication of services poses serious risks.  Furthermore, healthcare workforce trends will pose particular challenges for Molokai.  Strategic service design and community-based workforce development will be critical for sustainable, high-quality healthcare services. 

Molokai’s population cannot support every service and product the island might desire at any given time, whether for auto repair, construction, or health care.  Likewise, for services that are available on-island, the population can only support a certain number of providers.  This makes strategic health planning absolutely essential in providing reliable services for patients, stable employment for healthcare professionals, and predictable revenue for healthcare organizations.

Healthcare expansion without planning takes the risk of creating excess supply. Patients will be spread more thinly as providers increase, making it increasingly difficult for any to stay afloat.  Such a scenario would pressure one or more of those providers to go out of business, increase competition for patients, or perform more services for their patients.  Rather than resulting in a free-market balance, these outcomes would actually destabilize healthcare on Molokai.  Planned expansion based on estimates of community need prevents this from occurring.

Building a great healthcare system for the island takes not only a careful service structure, but also the right people.  It has always been difficult to attract healthcare professionals to establish a career on Molokai. This makes the island especially vulnerable to the looming national nursing shortage and ongoing decline in the number of doctors entering primary care.  As current providers retire, relocate, or otherwise leave practice, how can Molokai fill those gaps?

One strategy is for Molokai to cultivate new generations of nurses, dentists, doctors, social workers, psychologists, and other health professionals from within.  Those who grow up on Molokai know the island and its people best, and are those most likely to want to return to work and live after completing their education.  We as a community must guide and support students and their families in first accessing healthcare education, then completing that training, and finally returning to Molokai to practice.

Most Molokai residents would probably agree that living on the island requires some compromise.  We give up some conveniences for priceless intangible benefits.  However, no Molokai resident should have to compromise on receiving high quality healthcare.  Effective service planning and workforce development are essential for reliable, capable, and sustainable healthcare on the Friendly Isle.

Keith Izawa is a Molokai High School graduate, licensed Clinical Social Worker, and Certified Substance Abuse Counselor.  He is pursuing concurrent Master of Business and Health Services Administration degrees at the University of Michigan.