‘Access to Care’ Data Shows Troubling Trends in Community Health

A statewide survey that involved nearly 3,300 residents this spring has revealed some troubling data.

Community First, together with health care, government and social services partners, released this week the results of the “Access to Care” research initiative. The survey and research are meant to help better understand local communities’ barriers in accessing the care they need to be healthy.

“I cannot afford to see a doctor or receive medical or surgical care. It’s strange how inconsequential we become to society as we age. I spent most of my life giving to my community only to find out I no longer matter,” a survey respondent wrote, according to a press release.

“I feel invisible, unheard and that no one cares about our family in the health care community,” another resident who responded to the survey wrote, according to the press release. “It’s never been like this before.”

The initiative began in summer 2021, with initial assessment of Hawaiʻi Island’s health care system, including informal meetings with policymakers and focus groups with health care leaders. In fall 2021, Access to Care conducted a pilot survey on the Big Island before expanding to a statewide research initiative in April of this year.

Some highlights from the survey’s findings include:

• Many people in Hawaiʻi are hurting. The COVID-19 pandemic has taken a toll on financial, physical and mental wellbeing.
• While a majority of those who responded, 55%, view island communities as healthy, much of the survey tells a different story. It is one of strife, hardship and need.
• Financial insecurity looms large with a majority of respondents, 52%, reporting making cuts to their food and grocery budgets for personal financial reasons. In addition, 36% said they cut back on medical care or medicine in the past year because they were short on money. And the pandemic made economic insecurity worse for 40% of the public, while only 8% say they have gotten ahead financially compared to before COVID-19.
• Mental (38%) and physical health (33%) are deteriorating among the public in the past two years. Similar numbers of medical providers who responded to the survey said their mental (38%) and physical (36%) health has declined.
• Nearly 3 in 10, or 28%, of respondents reported they and/or a family member are in need of counseling or coping skills.
• Nearly 6 in 10, or 58%, said they have experienced health care delays in the past year. One in five, or 21%, characterize the wait time issue as “significant.”
• Majorities of kamaʻaina who responded on every island think there are not enough doctors where they live. Providers surveyed concur.
• The number of providers contemplating reducing their hours (52%), leaving or retiring from medicine (53%) and/or moving to the mainland (49%), suggest Hawaiʻi has a recruitment and a retention problem.
• Psychiatry and mental health counseling are the two professional areas needed most, according to providers.

The Access to Care project will convene working groups to examine the findings and seek action and solutions. Briefings on the report findings are underway at all levels of state and local government, social services and health care sectors.

The public as well as health care experts in Hawaiʻi realize health care needs, approaches and stigma are different across cultures and require an increase in cultural competency and language access, especially to the Hawaiian, Pacific Islander and Filipino populations.

Those suffering the most from the current system, especially when it comes to delayed health care and access to specialists, are Medicaid/MED-QUEST patients.

The researchers found these multi-layered and broader community challenges complicate the ability to find solutions; Hawaiʻi has greater racial and ethnic diversity; therefore, there is a need for interpretation and translation services for residents with limited English proficiency. Hawaiʻi has the highest cost of living in the nation, which compounds a number of high needs in rural communities, where access to care is a challenge.

Many recognize the moment for positive change in health care delivery is now.

“We have opportunities for creating an abundance of positive change to improve health care quality and safety, raise employee engagement and increase patient satisfaction and care. Providers report a greater willingness to collaborate, communicate and coordinate in order to improve health care delivery for all,” a health care professional interviewed for the survey said, according to the press release.

Access to Care is a comprehensive health care assessment that combines data from resident surveys, input from health care and social service providers and feedback from policymakers into a snapshot to better understand the terrain of the health care landscape of Hawai‘i. Methodology included focus groups, an online public survey and in-community outreach in neighborhoods on each island.

To access the full report, click here.

Community First is a nonprofit that serves as a neutral forum for the community to come together and as a catalyst for solutions to improve health and lower medical costs on the Big Island. For more information about Community First, click here.